Trauma has become a contentious issue in schools. The lack of a clear definition of what constitutes trauma, a lack of clarity about how to diagnose and support young people with trauma, and the complex intersection between trauma, special educational needs and disabilities, and mental health have all contributed to a fractious and often polarised debate about how schools should approach it.

So what does “trauma” actually mean? And what should teachers know about it in order to best look after the young people in their care?

We spoke to David Trickey, co-director of the UK Trauma Council and a consultant clinical psychologist who specialises in working with traumatised young people and their families, to explore these questions.

Tes: What is the technical definition of “trauma”?

David Trickey: It’s difficult because there are different definitions that people use.

The DSM-5 (the American Psychiatric Association’s classification of mental disorders), defines it as exposure to actual or threatened serious harm, death or sexual violence, which is a very high bar.

The World Health Organisation has a different set of criteria, describing it as exposure to an event or events that are extremely threatening or horrific. It’s a more subjective approach, which I like because it asks us what sense the child made of that event.

We also have “complex trauma”, which we normally think of as something that is repeated or chronic, and interpersonal, which means that another person is responsible for causing it.

Could you explain how post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (C-PTSD) may present?

With PTSD, we normally see three different types of problems.

One is intrusive thoughts, where memories of the event intrude into the present. In school, that may show up when a student is, for instance, participating in a play containing elements relating to the event, and re-experiences the feelings they had at the time.

There is also avoidance, for example not wanting to talk about the event or avoiding triggers related to it, whatever they may be.

Then there’s hyperarousal, where people get stuck on a higher level of anxiety, so they might be always on the lookout (hypervigilant) or seem jumpy.

Complex PTSD is those three difficulties, plus difficulties with relationships, difficulties managing emotions and difficulties with how those affected see themselves. It might be that they don’t trust other people because of what’s happened to them, so they’re not going to engage with others; they might lose their temper easily; they might see themselves as a failure or useless.

Then there are the reactions that aren’t covered by PTSD, such as somatic problems - where they suddenly start to get headaches or tummy aches - or regression, where they suddenly start becoming clingy or don’t want to sleep alone at night.

How common are PTSD and C-PTSD?

Different studies give different estimates, but we often use the figure of about a quarter to a third of the children who experience potentially traumatic events will go on to develop full-blown, enduring post-traumatic stress disorder. Professor Richard Meiser-Stedman, a trauma expert, suggests it’s about one child in every class.

People will often say that traumatised children can’t concentrate in the classroom, but actually some are very good at concentrating, just not on what we want them to. They’re looking over their shoulder because someone just made a noise, they’re concentrating on what’s happening in the playground and the corridor because they’ve learned that their environment is unsafe, and their brain has become very good at spotting threats.

But not every child who experiences a potentially traumatic event will go on to develop PTSD?

Exactly. There are different trajectories. Some children will experience those events and sail through them pretty unaffected. Some will seem to do OK, but later on, something will trigger things and they’ll get worse. And many will start off being really distressed and have difficulties, but they’ll recover.

We can sometimes wrongly pathologise distress. If you’ve just witnessed someone being badly beaten up in the street, that is going to be upsetting for most people.

But many of those people - even though they’re initially distressed and upset and having difficulties - will fully recover from that, while some, regardless of the aftercare, will end up needing therapy. So an important question is how do we create an environment where they are most likely to recover?

Do we know what the different processes are for those who become traumatised and those who don’t?

We often think about three things that dictate whether something is going to be a problem: memory, meaning and maintenance.

Memories of traumatic events tend to be very different from normal event memories; they can be volatile and people don’t have control over them. They tend to be stored as sensory information - sights, sounds, smells, tastes and touches - rather than as a narrative.

If something bad happens in front of me - say, someone getting hit by a train on my commute - that’s awful and I would probably come home and talk about it. That’s my way of taking the sensory information from that moment and creating a narrative. It changes the type of memory it is; it becomes stored differently in my brain. I’ve got more control over it.

The “meaning” bit is exploring what thoughts and behaviours result from that event. Does it mean I should never go on the tube again? Does it mean every train in the world is dangerous? How does it colour the way that I see myself, the world and others? I might not go on a train for the next couple of weeks, but then I’ll have to get to work and I hate the bus, so I’ll end up going back on the train.

However, some people, particularly those who develop PTSD, have an overestimation of risk based on that past event. So they might see themselves as more vulnerable or useless, or view other people as violent or the world as dangerous. Whatever it is, they have this “meaning-making” causing a problem. And for some, they get stuck.

The “maintenance” bit is that the difficulty is maintained by avoidance. If they’re not thinking about the event, they don’t get to change their memory and they don’t get to rebalance the meaning.

How does diagnosis happen and what role should schools play in identifying affected pupils?

School staff are well placed to provide that environment for recovery, but they are also well placed to notice any changes and whether a young person’s difficulties and distress are lasting or reducing. If their difficulties don’t seem to be getting better in the weeks following a traumatic event, it would be worth considering if there is some additional support available for them.

The school educational psychologist would be a good place to start and, increasingly, schools have access to mental health professionals either through Mental Health in Schools teams or counselling services. But it might also be worth contacting the local NHS Child and Adolescent Mental Health Services.

You’ve highlighted the power of existing relationships in healing - that seems important for teachers in terms of the difference they can make?

Absolutely. There are so many therapeutic opportunities in schools because the teachers already have trusting relationships with the children. But when it comes to trauma, teachers can feel that they don’t know what to do, so they’d better get a specialist in - they are sometimes worried about making it worse.

I’m a big fan of educational psychologists. In an ideal world, if your educational psychologist already knows the school, and has a relationship with the teachers and the Sendco and other people, they are well placed to support the school to respond.

But it’s really important that any external person, like an ed psych or clinical psychologist, doesn’t arrive and say, “Step aside, I’ll fix this for you,” but instead says, “You’ve got this, you know these kids really, really well. You know your culture, your community, your school, your children, your teachers, and you can help them.”

We try to equip the school to be able to help the families and children. Being able to draw on external support, but not having them come in and undermine the school is important.

So what could those useful conversations look like between a teacher and pupil they suspect has experienced trauma and is experiencing PTSD?

If a teacher sits a child down and makes them talk about the trauma whether they like it or not, they could make it worse.

But if a child says, “Miss, I need to talk, I’ve got this stuff on my mind, and this happened and that happened...”, and the teacher just listens, that is therapeutic. They don’t have to be therapists, but just call on those basic skills of being empathic and allowing people to tell their stories. They don’t have to fix it, but helping the child to be able to tolerate telling their story, for example, is one way that they can be incredibly therapeutic.

So I would say don’t make them talk about it, but if they do start talking about it, don’t close them down. And, where you can, provide opportunities to talk about it and see if they’ve got any questions.

One of the problems following traumatic events is people think they shouldn’t mention it. So they don’t talk to the child about it, and then the child doesn’t get the chance to ask the questions they have in their minds - they have to try to make sense of it alone. And if they don’t have all the information, it’s very easy to fill in the gaps in a way that might be worse than the reality.

I worked with one child who refused to go home after the 9/11 attacks in New York. She lived in a block of flats near Heathrow Airport, and no one told her or explained to her why those planes flew into the World Trade Center on that day. Planes just became terrifying after seeing that image on the TV so many times. So it’s important to allow them the opportunity to think things through, and give them enough information to answer their questions.

More generally, what does the research say about how to create an environment for recovery in schools?

The research evidence around the immediate response to potentially traumatic events is pretty poor, because in the immediate aftermath of any potentially traumatic event, it’s difficult to do research.

So we don’t have a lot of high-quality evidence, but we do know a lot about trauma, how it works and what makes it less bad. So a group of authors looked at the evidence and came up with five principles for schools to use after critical incidents.

The first principle is about being safe. How do you help children feel safe despite what’s just happened to them? How can we help to rebalance their view of the world as somewhere that’s safe enough?

The second principle is about calm. Often, following trauma, people end up on a higher level of arousal, and that outlasts the actual threat itself - they can’t sleep, they can’t concentrate and so on. How do we help children to calm and regulate their emotions and level of arousal? Teachers do that all day, every day, and sometimes they don’t even know that’s what they’re doing.

The next one is about connection. How do you help people to feel connected and supported? That might be through family or friends, or with their class. It might be with their teacher.

Rather than having a stranger like me turn up and try to help, they already have a relationship with their teacher, or with the lunchtime supervisor or with the person who’s running the office. These are the people who are already familiar and connected to them, so let’s make sure we’re leveraging the therapeutic potential of those existing relationships.

The fourth principle is about feeling in control. Potentially traumatic events can make people feel they have no control. But there are things they do have some control over. We might adjust the timetable, for example. Do you want to do maths or do you want to do geography? What are we going to do if a pupil is killed? What are we going to do about their chair? Rather than the teacher making the decision, let’s think together with the other kids.

The last one is about hopefulness. How do you weave in a bit of hope?

I think that’s the most difficult one, because you don’t want to trample over the past. You don’t want to say, “Don’t worry about what happened before, just look at tomorrow.”

But you don‘t want them just preoccupied with the past. You want them to think: “OK, how are we going to get through this together? Where are we looking to head in the next year or the next week or tomorrow? What are we going to do for tomorrow?”

So you help young people to think positively about the future.