 Welcome to Pookie Ponders, the podcast where I explore big questions with brilliant people. I'm Pookie Nightsmith and I'm your host. Today's question is, what can the rest of the world learn from the Scottish approach to aces? And I'm in conversation with Laura McConnell. So my name is Laura McConnell and I'm a primary school teacher, I'm a writer and neurodiversity advocate and disability campaigner. I am autistic, I have ADHD and PTSD along with a lot of the other associated conditions that come with being a neurodivergent person. I recently joined the development group of Disability Ed UK which is linked to Women's Ed, BAME Ed, LGBT Ed and our aim is to support disabled teachers in their employment in the UK and also champion the rights of disabled teachers. But the reason I'm here speaking to you today is that back in January 2018 I founded the Edinburgh Aces Hub which is part of a network of localised aces groups across Scotland in different local authorities that grew out of the need for more conversation around the adverse childhood experiences study and I've had the opportunity to work with professionals from multiple fields in lots of different areas and be part of that aces conversation that we've been having here and it's really benefited my own practice and I hope that it will benefit other people's practice to hear more about what we've been doing in Scotland. Wow, that was a really brilliant and succinct introduction, I love it. So first of all, what are aces? Can you explain? So ACEs, ACE is for Adverse Childhood Experiences and it was born of a study that was carried out in America in 1998. So it's quite a long time ago but obviously it does take a little bit of a time for research to come through and for research to be listened to and for it to be championed in different areas and really the ACEs study came about because two doctors, Robert and Vince Folletti, who were working separately in America on different topics, Robert and I was interested in the psychological reasons behind people's behaviours and particularly the reason why smoking was linked to depression and Vince Folletti was an obesity doctor in San Diego and they were both working separately and Vince Folletti started to notice that his population is in his obesity clinic who were all college graduates in the US. So they were educated people and they were middle class Americans who had some money behind them, just simply couldn't lose weight. So and they couldn't quite reason why these people who would understand the messages of old of you eat less, you exercise more and they also had the access to exercise and good dietary things just couldn't lose weight and he routinely started asking them questions about their childhood sexual experiences and found out that 55% of his patients actually had been sexually abused as a child and he says in the film Resilience which is a documentary made by James Redsford that he thought why wouldn't I have been told this in medical school if this was something that was a thing I would have been told this in medical school I would know about that but he was so shocked by he spoke to a lot of his you know network and colleagues and was put in touch with Robert and they came together to study a larger population which it was 17,000 plus adults who were mostly middle class mostly white college graduates in the US and from their point of view the reason that that was important was that they wanted the rest of the doctors who would read this study to be able to identify with the patients and say and say oh well I recognize those patients in my clinic and not try and say oh well you know that's a problem for other populations that's a problem for people who are living in inner cities that's a problem for people who are of a different race or people who are living in poverty so well the study is maybe not in terms of race and in terms of social socioeconomic outcomes very balanced there was a specific reason that for them that was a good group to study and once they asked all of them these 17,000 plus people a lot of questions about their past about their childhood experiences about the experiences in the family home they found out there was quite a significant amount of adversity in their homes and they chose what were of many the 10 most common of the adverse experiences and that's quite an important thing to say they didn't choose the only 10 adverse childhood experiences they chose just as a sample as you do the 10 most common which became the 10 aces that you may hear of which covered areas of abuse and neglect and family and family circumstance and they also track them to the medical outcomes of these patients and they link them to heart disease to cancer to diabetes but also then to addictions to mental health conditions and also some other sort of society issues such as teenage pregnancy joblessness homelessness and found that the further the more aces you had particularly if you had four or more aces then you were more likely to how to suffer from a lot of these different conditions which we consider as public health issues so in that respect it was quite a big deal to think that we sometimes in the news will hear about items causing cancer and some study has linked the more that you consume a certain item the more that you will the more likely you are to have cancer and therefore we will be less likely to consume that item whereas they were finding that adversity and childhood trauma were actually causing nearly every single one of society's issues and and there was and there was really no sort of campaign in place to actually reduce this as a public health issue so that that's where the study came from and it's it has trickled through in different places for many years Washington state in the USA certainly did a lot of work and then Scotland in 2017 had an ace away explosion which has really benefited from in the last three years so tell me about aces and Scotland and how you came to set up the hub so Scotland are taking quite a what a really proactive approach to aces and using it as a way of informing public health decisions yeah tell us well I mean so Scotland has been known as the sick man of Europe Scotland has had many many problems you know in our society for years I grew up in an area called Bearsden which is just on the border of Glasgow and it's quite important in a as part of a sociological phenomenon called the Glasgow effect and the Glasgow effect is basically the low life expectancy and poor health outcomes of residents in Glasgow that just cannot be explained in comparisons to similar communities in the rest of the UK and in Europe and I think actually the the official title of the Glasgow effect is that the excess mortality in the west of Scotland Glasgow after controlling for deprivation and what that they basically found is that poverty alone didn't actually seem to account for the disparity in Glasgow's in Glasgow's death rate and even the wealthiest 10% in Glasgow had a lower life expectancy than the comparative groups in other places in the UK so for example Glasgow's life expectancy for a man is 71 but one in four men in Glasgow are likely to die before their 54th birthday whereas in Liverpool the age is 76 in London the age is 80 in the Gaza Strip in Palestine the age is 73 so when you put those kind of comparative figures and you know especially like to kind of to shock you about that then it does hit home especially for someone who's in from Glasgow and Bearsden is a bit as a more affluent area it sits just outside the Glasgow boundary in eastern Burtonshire and the age the life expectancy for a man in Bearsden is 82 but within one mile in Drum Chapel which and it really is within one mile the age the life expectancy is lowered by 12 years to 70 so these these sort of issues had always interested me and they had always been a phenomenon in Scotland they had always been something of interest we we knew that we had in public health issues we knew that in as I say in Glasgow we had this in Glasgow effect we've had issues historically with violence with sectarianism with drug with drug abuse and I think that there has almost been a a powder keg of issues that people wanted to solve and rather than waiting on the government solving or waiting on people from above solving it different groups decided to do it themselves and along the way while they were doing it themselves and working really well in their sector over time sectors then started to unite a bit more and started to learn more about what each other was doing and then when the ACEs information came in it has been used as a catalyst to start a conversation and an accessible conversation to many people and the ACEs narrative isn't perfect which we will probably get to but it has provided a conversation that has allowed people to see the value and how our society links up and how the work of different sectors in our society link up so that kind of started the backgrounds behind everything and allowed all of the movement to sort of move to take place and what was your aim when you set up the ACEs hub because you know that that study that research that's really interesting but basically it's telling us things are bleak if you've had these experiences that these leads to poor outcomes but what do we do about that? Well there was a lovely lady called Tina Henry who very sadly passed away in February this year. Tina Henry was a former police officer of the as part of the violence reduction unit. She was a kinship carer she was a truly amazing woman and Tina Henry started a Facebook forum along with another lazy Vicky Mulholland to suspension language therapist called the ACEs Scotland forum and as Facebook groups do they start to grow. At that time there was a, they did a two, Tina Henry along with Zanzi Dyke who is a developmental psychologist did a tour of Scotland with the film resilience and more and more people started to join and as more and more people from different backgrounds from different professional backgrounds but also from non-professional backgrounds people who were just, just had lived experience of adversity and had lived experiences of trauma started to join together and it was decided that wouldn't it be great if we all had local groups to speak to and we all had local people to talk to and talk about the different services and charities and groups going on in our area because just like in England and just like in other places in the UK there are lots of different groups doing really really good work but we don't always hear about each other we're not always linked so I put my hand up a suppose and said well I'll start the Edinburgh group and we started this group and really our aim was to have a multi-sector multi-disciplinary conversation and come together to learn what each group were doing from be that criminal justice, education, social care, healthcare, the third sector but also to have people with lived experience involved and to come together through networking meetings through special speaker events through online materials and resources and try to combine our experience and work together but also learn more from each other and then try to build capacity and what in our own services and what we were doing and I was particularly keen that it wouldn't be a room full of people that would just come and talk about how terrible things were and this is really bad and just have a conversation I really wanted there to be what will we do moving forward what action points will there be and I know that all of the other groups that formed did the same we didn't all do the same things we in different local authorities we all went our own way and kind of responded organically to the needs in the area but we shared that as well as a national network and as that was shared more people would hear either through us or they would hear through the ASIS Scotland forum or they would hear through different groups about this conversation and it's opened up much more of a Scotland wide acknowledgement of there is a lot of trauma in our society there's a lot of adversity in our society how can we mitigate against this but also at the same time a lot of us who have this trauma who have these adverse experiences are okay and we have survived and we are resilient people and it might have taken us a while to get there but we've got we've got them we might need support but it's not just having these adverse experiences as a child does not necessarily mean that you are destined for doesn't mean that you're destined for a negative outcome I think that it's very important to remember that the study really was a medical study they wanted to know how these adverse experiences would affect your likelihood of heart disease and cancers and diabetes and that's really important because if we can stop adversity and trauma when children are young and then and then hopefully influence the fact that they won't get these sort of medical issues when they're older that's excellent but it doesn't mean that in terms of our experiences of you know advancement in society that those are stopped so that was also an important part of our conversation as well and to spread that with the ACEs help and that's one of the things that I've seen a lot of is this move towards kind of screening and scoring using ACEs and I'd love to hear a little bit about your thoughts on that whether that's a good idea a bad idea what are the pros and cons I am a very very bad idea quite frankly and I can't be any more delicate about it than that at the beginning when the ACE the ACEs studied kind of this this ACE's explosion happened in Scotland people were watching resilience they were watching they were going to different events and hearing things and think and they thought this is the right thing to do because that's what the doctors in the film are shown as doing and if we are able to do that then somehow we put in some interventions and then that will help things and I think it was lost somewhere in translation that it was a medical study and in fact Dr Nadine Burke Harris who is in the film and she's now the she's now the top doctor in California she is even seen giving an ACE study out to a patient and a patient's mother and the mother fills it in but Nadine Burke Harris doesn't even need to know which ACEs are on she just she's just looking for the score because as a pediatrician as a doctor she then wants to be able to give advice and to monitor the medical outcomes but that was somewhere lost in translation and unfortunately I do know that schools here and some services decided that they decided in good faith because everybody that works in the public sector ultimately really wants to do the right thing and they really want to help the people that they work with and possibly weren't given the guidance from above to show that this wasn't a good idea but I know that places did ACE score children and it took till around about October 2018 so about a year and a half for it to be fully and quite publicly realized that this is not what should be done for a lot of reasons partly as a teacher we have child planning meetings here they're not quite the same as the meetings that you have in England for the EHPs but they're of a similar vein they're part of the what we call the GURFIC getting it right for every child process and I can know a family really really well and I can know children really well I can know their parents outside of school but I can never know what goes on in a household and it's not my place to presume or judge what goes on in a household so for for me or any school staff to ACE score children there's quite a lot of questionable ethics there firstly do you engage the parents with it and do the parents know why that you are I am ACE scoring them but do they know that it's actually not linked to education and do they know that it's really linked to medical outcomes which I don't need to know as a teacher the original ACEs study was for adults and it was a reflective tool for adults it was never for children and it was never designed to be done to someone it was a reflective tool so therefore it doesn't translate into education either and also why why are we why are we doing this we are we doing it so that if a child has you know four or more ACEs in education are we going to put in an intervention there can be children who have five ACEs and it turns out that they have a really supportive family structure they were able to access therapy they were maybe shielded from some of the effects of the adversity and then and they go on to not have as many of the they may don't they maybe don't have any trauma associated with those and then there can be a child who has one ACE and who is absolutely traumatized and nobody knows that they have that one ACE and do we take the child that has four because we've quantified that and say we need to give them support or do we take the child who has one who and then say well you have less ACEs so we we're not going to support you less so it really isn't an appropriate educational tool but at the same time I can see why some schools and some maybe school leaders did think that it was the thing to do because you want to do well in education we're full of initiatives you go to an in-service day in a school and you get five initiative new initiatives thrown at you and it's just a constant cycle of this is something new to do and ACEs and understanding adversity is really really important so I think in the in the lack of a guidance from above where they were given proper information to say this is what you should do as a school and this is what you shouldn't do some in schools and to say and other services but with education did jump in I think feet first and did ACE score children but as far as I know I would I mean I would go to conferences and sometimes stand in the lunch queue and hear people talking about ACE scoring children and palpitations but that hasn't happened for a while and I think that there has been such a big online narrative there's been more local authority and a sharing of that that's not an appropriate thing to do and we've learned from that so I think that in terms of what can the world learn from the Scottish approach to ACEs is is that if you are a school if you're a service starting your ACEs journey you don't need to be ACE scoring you're you don't need to be scoring the users the children you just need to have an acknowledgement that there will be people in your service that have adversity in their life and you can't quantify it and you also can't quantify how they've experienced that adversity either but just to be aware of that and be aware of that's how you you would be trauma informed and and and then flinch your service and is that scoring that profiling useful in any other sense so for example you know would it be helpful for an area if you're looking at it from a kind of public health perspective to have a bit of an understanding that within this given area that we have a higher prevalence of some ACEs than others for example does that help to inform our thinking or not really? Well without being from a public health background and if anybody from that background were to disagree with me I would absolutely accept that but I would think so yes the ACEs study itself gave an impression of this one particular community and while as I said at the beginning it wasn't a particularly balanced community but that suited their study at the time in the context of where they were in America because they wanted that they wanted to be believed by all communities. Nadine Burke Harris says that doctors in her community who she made a Bayviews Hunter point which was a predominantly black community she they already knew this it was just that they didn't quite have the scientific data whereas doctors served mostly upper middle class white patients in America would have thought well this isn't a problem for us whereas the ACEs study managed to show that actually that ACEs transcend you know socioeconomic status and race so I think that if you as a public health approach then it would certainly be useful because actually one of the the the statistics and resilience is that there's three trillion dollars a year spent on the US healthcare system but only five percent is spent on preventative medicine. Now I don't know what our comparative figure is in NHS Scotland what our comparative figure is in in NHS England but I would imagine from my knowing from my own personal experiences and knowing from just the different groups that I'm involved with that the NHS does spend less on the preventative approaches the therapeutic approaches partly because it's sometimes it's cheaper to then give out medication that's sometimes cheaper for them to not use therapeutic approaches so that's why I think that having that that as a study having a ACE score from a public health perspective would be very useful data because it would also help you plan your future health services if you know that there are a certain amount of people in your population that have four or more ACEs and you know that four or more ACEs is isn't into your twice as likely to have heart disease then you're going to be able to direct your future planning for you for the health services. I know that Wales have done a study and so Wales have been quite proactive with the Welsh NHS and they have done a study and there the figures that they had were roughly similar to what came out of the USA and I know that the the rest of the UK will probably eventually catch up as well but where most in places be the small smaller places that have had ACEs studies in the health sector then it has had similar figures so we kind of know what to expect although in Scotland given our history like I said the Glasgow effect and we know that that's that's been a very long studied sociological phenomenon I think we may expect our figures to be slightly worse so what is a more helpful part so what have you been doing as a result of the learning that you've done around ACEs what have you changed in your setting? I think it's really about school culture so the culture of nurtured in school the culture of understanding and not having a lot of not placing a lot of judgment on children based on their behaviour and understanding more where behaviours come from there's a head teacher from Fife her name is Jennifer Nussan and she for again for a long time even before the ACEs conversation happened was talking about what she calls the language of connection and the language of connection is essentially getting rid of words like meltdown kicking off violent challenging behaviour being tricky and just saying the child was distressed and by saying by removing all of those words there is a phenomenal power in that in framing the way that the adult thinks about how the child is behaving because ultimately challenging behaviour which is the kind of the umbrella term for it it's not challenging for the child but only person who is challenged by the behaviour as the adult and when you are challenged by something then you want to win and you want to you want to be the victor in the situation and when children would display challenging behaviour traditionally it would almost be in conflict with the teacher and the teacher would then have to climb the child down by somehow doing something to to fix the situation so it would become quite combative whereas if you look at that as distress the first thing that you think of is what's happened to you not what's wrong with you but what's what's happened to you and Jennifer Nussan says if you walked into a school staff room and one of your colleagues was picking up the chairs and throwing them around the room and smashing things and screaming and swearing you wouldn't be telling them off and telling them to go to the office the first you would be shocked and you would be worried for them and you would be asking them what's happened to them and and how can you help them and why don't we do that with children and I know from my years working in schools I was a behaviour support teacher in a mainstream school for a while I've been a support for learning role for a while and I have worked with lots of children who have been distressed in school I have worked with lots of children who have thrown chairs but I have never yet met a child that has thrown a chair who wasn't upset about something and unfortunately they got to the point where they had to throw a chair because they were so upset and what we have realised is that we need to understand them way way earlier understand when they're starting to get distressed how we can how we can modify our own behaviour. Paul Dix has an excellent book called When the Adults Change Everything Changes and I think every teacher in Scotland has read that book and if they haven't then they've probably got it ready to read and it talks a lot about you know addressing the primary behaviours and not the secondary behaviours so the child has done something and then they go on and they maybe start to swear traditionally we would then continue on in a cycle of addressing well now you're swearing at me and in schools we've kind of got rid of that and it's really relationship-centred and behaviour policies in most local authorities in Scotland they're now called relationship policies I know of one at least a cluster of schools that call them their teddy bear policies and talking about kind of attachment-related policies so it's really been a different approach in schools not that it's quite perfect everywhere at all but we're certainly getting there and trying to make sure that we recognise that children have children sometimes have really tough home lives and we might never ever know that they have quite tough home lives but we have to see the child as they come into school and treat them with respect and have a relationship with them and treat them well and at the end of the day that is the end of the day and give each the child the next morning and let them know that they're welcome and they're part of the school community and I think that's our role in education obviously there are additional things where if we know that children have specific needs then using the funding to maybe access their services for them and play therapy, drama therapy, music therapy, counselling, different outdoor learning activities and also interventions in school but just as a general approach whether you know a child to have an ace or not it's treating everybody with that same approach in that you treat children as they come and instead of you know saying what's wrong with you you know what's happened to you if they're distressed. Where we see children with aces that may or may not be disclosed then often there may be a family there where parents carers may also have experience of similar things is that relevant in this context? 100% and one of the really good things that lots of schools are doing is using what's called it's called pupil equity fund which is similar to pupil premium so if your child is eligible for free school meals income based free school meals or you live in the one the bottom one and two percentile of the Scottish index of multiple deprivation then the school gets what's called pupil equity funding PEF funding and also there are some schools which are called attainment challenge schools which get additional money to close the poverty related attainment gap and a lot of schools in what one that I've worked in until in June there and others have employed family workers who are from maybe you they're not education specialists they come from community work they come from community education background youth work and they work with the family to because a lot of parents have really bad experiences of school in fact lots of generations of families have really bad experiences of school and that and they think of school and when the teacher calls them as they're going to get into trouble and they're going to come to school and they're going to get told off for something their child has done and it can they don't want to engage and family workers can really bridge that gap but family workers can also help support with taking them to mental health appointments or helping them access benefits and in fact I know that there was a there was a doctor's surgery actually in an area called Parkhead in Glasgow which is a in the east end of Glasgow and one of the most deprived areas in the UK and they put a benefits advisor in their surgery and I think that benefits advisor in a year helped the patients get over £200,000 worth of missed benefits and the doctor's surgery found that their appointments dropped because their patients were less stressed their patients had more access to funding so there's there's schools that will run family sessions they will I know that there was one recently in Panorama a school in Glasgow that had family counselling and things as well so some of that money that education is used is not necessarily used just specifically on the children and their experience in school but the intergenerational work and supporting their families and support and them but and supporting them but in the way that they need to but not necessarily from education staff from people who are specialised in family work and who therefore are much less intimidating so that is very important and parental and being a partner with the parents is very important one issue with ACE is actually can sometimes be that it's very parent critical and very mother critical I feel when you look at the 10 ACEs when you look at other ACEs and there's and you think of oh that child's got five ACEs that child has six ACEs and we need to improve we need to improve on that there's often a lot of judgment about how that child then got to to there and that's because of the circumstances that have gone on in their home and more often than not it is the mother is the caregiver although that's not universal and I know that from having spoken in a number of panels to after the film resilience parents have been quite on edge thinking this is just another judgment and as I am being told that my child has all of these experiences because of things I can't help because I've because I have a mental illness because my partner has gone to jail because I was my partner and you know I was a victim of domestic violence and a lot of these things are things that parents can't control so I think work also having that non-judgmental attitude and not and not giving parents a hard time for the ACEs that their children might experience because when parents have really good support networks around them then they are a better able to be really supportive of their child as well and then we know that that mitigates against the ACEs and builds better resilience in children so certainly intergenerational it's really important and I know that lots of schools here have used their funding in that way which is I'm not sure how pupil premium you know policy is and how they can use that but it's certainly something that has been proven to be very beneficial here. I don't see having spoken to lots of schools during COVID lockdown and then I've spoken to many schools where actually those relationships with families have improved out of necessity where schools have been fulfilling basic functions around you know providing families with with food or access to various sort of services and support and that actually there's been it's been very very positive in many cases and I hope that that'll be the beginning of something rather than a temporary a temporary thing. One thing I was really keen to talk to you about Laura was the relationship between sort of ADHD and autism and then sort of trauma and PTSD slash ACEs because that was something that you said was an area of sort of specific interest for you so I wondered if you could talk to us a little bit about that. Yeah so one of the I suppose the disadvantages really of the ACEs explosion in Scotland has been a bit of a misunderstanding around the relationship between trauma and ADHD and it's based around a comment that Nadine Burke Harris made in her film and also made in a TED talk where she said that children were coming to her clinic and to be assessed for ADHD and she found that it wasn't ADHD that they had it was trauma and for some reason that has been translated in Scotland by many people and it's no exaggeration to say that this is by many people to say that ADHD is actually misdiagnosed trauma and there and that has that has been something that has exploded in a way that has been very very unhelpful to families and has also affected access to services it has affected children's ability to be able to get referrals to CAMHS for ADHD because unfortunately some education staff now have a very false impression that ADHD doesn't exist and if I had a if I had a penny for every time that someone told me a story about a child that they knew or had been told about who really was traumatised by ADHD but they were diagnosed with ADHD I'd have a couple of pounds but it's still too many times that that's happened and I think that what we don't realize is actually the relationship between undiagnosed ADHD is actually quite linked to the circumstances that can cause ACEs so those adults if I was diagnosed as an adult with ADHD myself adults who are undiagnosed with ADHD are more likely to have mental health issues are more likely to have had eating disorders in the past are more likely to have a school failure and have substance abuse issues are certainly more likely to be imprisoned in fact the population of the UK sits at around about three to five percent prevalence for ADHD but in prisons it's 25 percent and in fact in young offenders it's 30 percent so a lot of that might be to do with impulsive behaviour I suppose obviously there's a lot more to it than that but impulsive behaviour I suppose does play a part in that adults who have undiagnosed ADHD are more likely to have had multiple sexual partners to have had failed relationships to have to be homeless and when you look at a lot of the factors that can then cause ACEs adults who have undiagnosed ADHD obviously not all of us but adults who have a who have undiagnosed ADHD are more likely to have a lot of the factors hitting them that can then not only cause traumatic experiences for themselves but also affect their children adversely and I think that rather than dismissing because Nadine Burke Harris is a pediatrician she's not a new scientist or a psychiatrist she works in in pediatrics and what she was observing was that people were a referral was made to her in her clinic for certain behaviours and she was as a doctor using her professional judgement and determining that that was not the case and that's what our doctors do that's what our children's adolescent mental health services do that's what our adult mental health services do they will take children and I know from experience working with many children if there is even the slightest hint of trauma in the child's background then they will not get a diagnosis of ADHD for many years even if they have it it can take many many years because the if it's CAMHS wants to have demonstrated that there has been supports put in place to the family to ensure that that that there may be the child's behaviour might help be helped sorry and then after this has gone on for a prolonged period of time at that point are they willing to acknowledge ADHD there's quite strict and serious diagnostic guidelines here and our professionals in CAMHS are professionals and know what they're doing but that's does that does seem to have been lost in translation a bit and unfortunately I know from a lot of groups that I work with a lot of parent groups parents will go along to schools and ADHD I'm sure this is the case across the United Kingdom is still seen as something that bad boys do it's still recognised with hyper hyperactiveness although I'm being by hyperactive what people think of as somebody running around a room bouncing off of walls claiming things but that doesn't actually describe hyperactivity and ADHD very accurately hyperactivity can include lots of things talking a lot overactive brain activity but people have a very specific idea of what ADHD is and many people are very shocked that I have ADHD when I tell them that I do and because there's I suppose as well a lack of training and adequate training in our teaching in our education system parents and families are going to school they might go to their GP and the GP will say well I need to interact with school you need to make it a federal through school and then teachers who are not trained to recognise ADHD in any way shape or form are now reading articles or reading online activity or having that shared with them saying well actually no ADHD is misdiagnosed trauma and observing observing that the child doesn't run around the room and bounce off the walls and saying no actually they don't have that and therefore it's causing children to miss referrals and miss access to services and I know from my own experience that as you get older and as you then have as ADHD is untreated I do take medication but there's in the ADC community we say it's pills and skills that you need you can't just take medication you also have to have strategies in order to help the aren't magic pills that make your life better they just give you the ability to help make your life better if you are missing all of those skills and also missing maybe medication to be able to access that then you are more likely to end up in situations which will then cause which will then as a series of events cause trauma to occur which can then have an impact on children and have this cyclical adverse childhood experiences effect so one thing I think is suppose as well if we were to learn from the Scottish approach to ACEs is to not step out of our lane I suppose in education and to know that we are teachers and we are and our expertise lies in the curriculum and pedagogy and working with children but we need to listen to our speech and language therapists and occupational therapists and CAMs and our educational psychologists and all of the other experts who come in and they complement what we do and they and their input is really valid and rather than us stepping out of our lane and imposing our judgement we need to trust in those other experts and know that they're doing their job properly. What are the things I think we can all be doing to kind of support because it feels like if I'm understanding correctly that maybe there's not the need here to be thinking about every individual child and what's their race score and so on and so forth but there might be general approaches that we can take that might you know support a child who has experience ACEs or who might have into general issues into generational issues here but might also support the next child too often there are some universal approaches aren't there that that will help our most wonderful children but also help everyone I mean what do you think we need to be doing there you talked before about relationships and and re-approaching behaviour but what else would you think we should be doing? I think it is really about a cultural policy in a school and relationships and behaviours are certainly very much a part of that but also there's a lot of punishment policies and isolation booths and exclusion policies and children with uniforms and children coming to school and then being penalised because they've not got the correct item of uniform on but those children might have had to get out of bed themselves that morning and find their uniform which might not have been washed from a laundry basket and it might not have all been there because maybe their parent is unable to be able to wash that for them and be able to keep that up for them and that's not a judgment of the parent that's a parent that needs our support and the child then comes into school having tried their best and maybe is slightly late and the first thing that happens to them is that they're told off and they happen something negative happens and then maybe they're told off because of their uniform and then there could be children sitting in a classroom and they are fidgeting or they're talking and they're sent out and they're sent to isolation booths it's just these sort of negative sort of interactions with children can really really diminish their relationship with schools and I'm probably going to miss quote her very badly and I do apologise for this because her quote was really great but Suzanne Zidike said there was a conference we had in Eddon by the Portobello Learning Festival and one of Suzanne Zidike's opening comments was that was that children, the second place that children come to for kindness is school unless they don't get it there and I think I've misquoted her but the point is that if a child is living in their family environment and they're not necessarily getting kindness and support for whatever reason that they come to school to get that and if we as a school are not providing that for every child and not welcoming them and making them feel part of our community then what then what is the point of that then they're not going to achieve they're not going to attain they're not going to achieve the exam results that we want to their education isn't going to be improved if they don't want to be in the building so I think that that it's changing our culture of school respecting children as respecting children as human beings and not speaking to them in a controlling manner and also just acknowledging them there are many many quiet children and teachers who would listen would identify with this that when you get to the end of the school year and you're writing their school reports you think I've not got as much to say about this child about as everyone else because they're quite quiet and you realize I should have interacted with them more I should have gone and spoken to them more and there's so many children that can come into into school and blend in and maybe not be spoken to for an entire day but what if they're not getting spoken to at home as well and just to acknowledge children and to say hello to them and make them feel welcome is really really bent it is really beneficial um jazz amp of our um talks and her kid talking and all of the different talks she gives to different organizations about the experiences that she had in school and how teachers really benefited her by just by making her feel human I actually my favorite ever teacher was a teacher that never ever taught me um probably because of the ADHD and um autism but wasn't diagnosed I got into a lot of trouble in school I had a lot of different issues in school and my parents were forever being called to school to be told how bad I was and I remember in my third year of secondary school which I think it's like year eight, year nine sitting outside the office once again with my parents inside being told how terrible a human being I wasn't crying and the deputy head of the school walked past and stood and spoke to me for a while and asked sort of why I was crying and I kind of explain oh I'm so terrible and things and he said well I don't think that you're that bad and and made me feel very human and made me feel like I wasn't the worst person in the world when at that time I felt I was the worst person in the world and it's even just little things like that by acknowledging children when they are feeling at their lowest and make it and letting them know that that you know somebody out there likes them somebody's thinking of them and that even tiny gestures like that is really important for example in my school when I'm walking through the corridor if I see someone who's very upset maybe because they've done something that they shouldn't have done and they're and they're upset and angry I'll still stop and talk to them and say something nice to them and say and maybe make a nice comment and say oh well you know next time you know that this won't happen and like you've done very well in the past and things will be great and I'll try to talk to them about something else because I want them to feel that there's someone in the school at that point that doesn't think that they are the most terrible person in the world because that's maybe how they feel about themselves and if they feel about themselves like that at home and then they're feeling about themselves like that in school then that's really significant for their ongoing mental health so I think that it's just our culture and it doesn't cost lots of money to to change your school culture it just costs consistency and sort of having a joined up approach and examining some of the policies that you have in school and thinking does what actually purpose does this serve I think that that's why Paul Dix's book was really popular and influential in Scotland because a lot of the things that are in his book and I've worked in two schools now that have been Paul Dix he's a verb these days but I've worked in two schools that have been Paul Dix and the way and it didn't cost us anything to do it's just it meant that we looked at some things and then implemented them then tweaked them to our setting and continued on and the children prefer it the children prefer being treated as as human beings so it does have a good effect and it doesn't cost a lot of money to be able to change your school culture what thought would you like to leave people with I always think it's important to close with with something you'd like to leave people's minds I think it's really important to leave your your judgment of someone at the door to leave your judgment of their tone at the door not not to tone police them where people often express themselves in a certain way because they are upset and because they are and they're trying to communicate to you in the best way possible parents are some I've heard sometimes being accused of being aggressive but when I have heard the same conversation I haven't actually heard any aggression they have just tried to assert themselves but it's maybe not come across in a in the same way that a professional would assert themselves and I think that the best way to approach everyone really a child in your school or an adult in your school or a parent that you're interacting with is to listen to the content of what they're saying and not get overly concerned with the way they're saying it and rather than thinking what's wrong with you think well what's happened to you that has caused this and how can I help and is this person distressed rather than thinking this person is being challenging to me and wants to put up a barrier and trying to win this interaction but take just taking that step back and nobody's perfect even the most even the kindest people have their moments where they probably don't listen as well as they could but also being able to then acknowledge that and say well do you know what I think that I probably didn't handle that well and generally trying to have a more joined up way of working with families so that we understand their children better and it's just it is really to some or some all of that because really it's just about changing the culture that you work in but changing the way that you are in that culture and trying to influence other people by demonstrating the way that you the way that you can influence that culture. Jennifer Nussin just started calling children's behaviour distress she didn't tell any of her staff right from today we're going to stop saying challenging behaviour we're saying distress she just started calling it distress and staff caught on to what she was doing and then she's done talks about it and I don't think in the last two years I've ever heard a teacher say in front of me that oh the child we've had challenging behaviour it's just that it's it's influenced the culture in lots of places in Scotland to say distress so for small acts and you're demonstrating your own behaviour your own practice can really have a big ripple effect.