Pooky Ponders – Big Questions with Brilliant People

What can the rest of the world learn from the Scottish approach to ACEs? | Laura McConnell

September 09, 2020 Dr Pooky Knightsmith Season 3 Episode 3
Pooky Ponders – Big Questions with Brilliant People
What can the rest of the world learn from the Scottish approach to ACEs? | Laura McConnell
Show Notes Transcript

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.

Laura is a teacher who has worked for over a decade in Scottish mainstream primary schools, most recently in a Support for Learning capacity. As an adult, Laura was diagnosed as Autistic and ADHD. She is passionate about inclusion in education and advocates for the voices of Neurodivergent and disabled individuals to be heard when planning services that affect them. 

In January 2018, Laura founded the Edinburgh ACEs Hub. This was part of the wider Scottish grassroots movement towards recognising the effects of Adverse Childhood Experiences and trauma on the health outcomes in Scottish society. The group promotes partnership work, collaboration and the voice of those affected by ACEs and trauma to build capacity across education, healthcare and criminal justice.

Twitter: https://twitter.com/LauraFMcConnell & https://twitter.com/AcesEdinburgh
Website: https://lauramcconnell.com & https://acesedinburgh.com

 

Laura McConnell: welcome to Peaky 

Pooky Knightsmith: ponders, the podcast where I explore big questions with brilliant people. I'm 

Laura McConnell: picky, Nate Smith. And I'm your host today's question is what can the rest of the world learn from the Scottish approach to ACEs? 

Pooky Knightsmith: And I'm in conversation with Laura McConnell. 

Laura McConnell: My name is Walter McConnell.  skill teacher rater.

I knew there's over 60 advocate and disability campaigner. Um, I am also sick. I have ADHD and PTSD along with a lot of the other. Associated conditions that come with it being a noodle divergent person. Um, I recently joined the new, the development group of disability ed UK, which is linked to women's aid beam, ed LGBT ed, and our aim is to support disabled teachers and their employment in the Yuki 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 ed and braces hub, but just part of a network of localized ACEs across Scotland, um, and different local authorities that then grew off the needs for more conversation, I've owned their adverse childhood experiences study, and I had the opportunity to work with.

Professionals from multiple fields and lots of different areas. Um, and be part of that ASIS 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 a little bit what we've been doing in Scotland. Wow. 

Pooky Knightsmith: That was a really brilliant and succinct introduction.

I love it. So, first of all, what are 

Laura McConnell: ACEs? Can you explain. So ACEs, um, ECE as if our adverse childhood experiences and it was born off a study that was Katie do in America in 19 men to eight. So. Um, it's, it's quite a long time ago, but obviously it does take a little bit of a team for research to come through and for research to be listened to, and for it to be, um, cha cha sort of challenge championed and different areas.

And, um, really the ether study came about because, um, two doctors, Robert anda and Vince Felitti. Who were working separately at America on different topics. Robert under was interested in this sort of psychological reasons behind people's behaviors. And particularly the reason why people smoke by smoking was linked to depression.

And Vince Felicie was an obesity doctor in San Diego and they were both working separately. And Vince Felitti started to notice that has, um, population is brought in, has to BCC clinic Cobra, all college graduates in the U S. So they were educated people and they also had, and there were middle class Americans who had some money behind them just simply couldn't lose weight.

So I needed an quite reason why these people who would understand that. The messages of old of you eat less exercise more. Um, and they also had the access to exercise and good diet. She thinks 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 has documentary made by James Redford, um, that he, 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 as a medical school, a bit more about that, but he was so shocked by his books. A lot of has, you know, a network and colleagues and was put in touch with Robert under and they came together to, um, to study.

In 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 had read the study to be able to identify with the patients and see and see, Oh, well, I recognize those patients in my clinic and not try and say, Oh, well, you know, that's, uh, A problem for other populations.

That's a problem for people who are loving and enter 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 study.

And once the asks, all of them as these 17,000 plus people are a lot of questions and my boat, their past a bit, their childhood experiences about the experiences and the family home, they found out there was quite a significant amount of their city, um, and in their homes and the chores were. I have many, the 10, most common of the adverse experiences.

And that's quite an important thing to see it. They didn't choose the only 10. Um, adverse childhood experiences, they chose just as a sample, as you do the 10 most common, which became the 10th ACEs that you meet here at all right, covered, 80 years old abuse and neglect and family and family circumstance.

And the also track them to their meds, the outcomes of these patients and the link them to heart disease, to cancer. To diabetes, but also then to addictions, to mental health conditions and also some other SU M sort of society issues such as teenage pregnancy, joblessness, homelessness, and feeling 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, and the news will hear about eight atoms causing cancer. And then some study has linked that the more that you consume a certain item, the more that you will be, the more likely you are to have cancer.

And therefore we will be less likely to consume that item. Whereas they were finding the ad, their city and childhood trauma were actually causing nearly every single one of society's issues. And I, and there was, and there was really no sort of campaign in place to actually reduce this as a public health issue.

So that's where the study came from. It has trickled through and different places. For many years, Washington state in the USC certainly did a lot of work and then scope London in 2017 had an ISA lead exclusion, um, which has really benefited from in the last three years. 

Pooky Knightsmith: So tell me about ACEs and Scotland and how you came to set up the hub.

So Scotland are taking quite a well, a really proactive approach to, to ACEs and using it as a, as a way of informing public health decisions. 

Laura McConnell: Yeah. Tell us, well, I mean, it's. So squat Scotland has been known as a set amount of Europe. Scotland has had many, many problems. Um, you know, in our society for years, I grew up in an area called beers day and which is just on the border of Glasgow.

And it's. Quite important in our, as part of our, uh, sociological phenomenon called the Glasgow effect. And the Glasgow effect is basically, um, the low life expectancy and poor health outcomes or residents in Glasgow that just cannot be explained in comparison to similar communities and the rest of the UK and the new tip.

And I think actually the official. Um, title the glass effect is that the excess mortality in the wastes of Scotland blood school, after controlling for deactivation and bought that they basically found is that poverty alone didn't actually seem to account for the, the, the, the spasticity in glass schools in glass was death rate.

And. Even the wealthiest 10% in Glasgow had a lower life expectancy than the competitors and other places in the UK. Um, sort of, for example, Blas scores, life expectancy for them for a man is 71, but one in four men in gloves correlate with today before their 54th birthday in Liverpool, the age of 76 and London, the age is ITI.

And the Gaza strip in Palestine, they just 70, 30. So when you put those kind of comparative figures and especially to kind of, to shock you about that, then it does hit home, especially for someone who's been from Glasgow and bear's den as a, as a more affluent area. Let's just say the glass school G and Eastern Barton shirt.

The age, the life expectancy for Amman and bear's den is 82, but within one male in John chapel, which has, and it really is within one male. The age, the life expectancy is Lord by 12 years to 70. So. Th these, these sort of issues has always interested me. And they had always been a phenomenon in Scotland.

Had always been something of interest would be. We knew that we had public health issues. We knew that in, as I say in Glasgow, we had this in Glasgow effects. We've had issues historically with violence, with 16 ism, with drug drug abuse. And I think that there has almost been a. I create a powder keg of issues that people want to solve.

And rather than waiting on the government solving or waiting on people from above solving it, definitely groups to see them 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 urinate 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 in the East. Now that isn't perfect, which we'll we'll probably get to, but it has provided a conversation that has allowed people to see the value in hosting or society links up.

And how the work of different sectors in our society. So that kind of started the backgrounds behind everything and the load, all of th th the movement to sort of move to take place. And what 

Pooky Knightsmith: was your aim when you set up the ACEs hope? 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, what do we do about that? 

Laura McConnell: Well, there was a lovely lady called Tina Haney. Um, very sadly passed away in February. This year. Tina Hanley was our former police officer of the M uh, as part of the violence reduction unit. Um, she was a kinship Kedar.

She was a truly amazing women and Sienna, Henry M started a Facebook Fordham along with another lady, Becky and just a speech and language that at this called the ISA Scotland Fordham. And. Um, as Facebook groups and do these start to get all at that team, there was R M  along with M Sunzi Dake, who is a developmental psychologist that are two 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 nonprofessional backgrounds, people who are just. But just had lived experience or of adversity and had lived experiences of trauma, started to join together and it was. The Seder that wouldn't be guilty if we all had local groups to speak to and mill HUD's local people to talk to and talk about the different services and charities and flips going on an urban area, because just like in England than dislike in other places in the UK, there are lots of different groups doing really, really good work, but we're doing always.

Eat about each other. We're not always linked. So I put my hands up, I suppose, and said, well, I'll start the Edinburgh. And we started this group and really our aim was to have our multi-sector multi-disciplinary conversation and come together to learn what each we're doing from B that criminal justice.

Education social care, health care, 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 own expedience and work together. But also learn more from each other and then try to build capacity and for 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 her terrible things, where, and I'm an old, 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, and all that, all of the other grips that formed.

That the same. We don't all do the same things. We, we. And different local authorities. We all went over to and we, and, and kind of responded our 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 I either through us or they would hear through the Scotland Fordham, where they would hear through different groups about this conversation.

And it's opened up much more. A sculpt Scotland. Wade acknowledgement of that is a lot of trauma in our society. There's a lot of adversity in our society. Who can we mitigate against this? Also at the same time, a lot of us who have this trauma who have these adverse experiences. Are real key and we have survived and we are resilient people and it may have taken us a while to get there, but we've got, we've got them and we may need support, but it's not just having these adverse expediences as a child does not necessarily mean that you are.

Destined for it doesn't mean that you're destined for some negative outcome. I think that it's very important to remember that the study really was a medical study. They wanted to know who these adverse expediences would affect your legally, who dove 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 sh and then hopefully influence the fact that they wouldn't get these sort of medical issues when they're older. That's excellent. But it doesn't mean that in terms of our expediences all, um, you know, what advancement in society that, that those are short. So that was also an important part of our conversation as well.

And then to spread that with the thesis. And that's one of the 

things 

Pooky Knightsmith: that I've seen a lot of is this move towards kind of screening and scoring, um, using ACEs. And I'd love to hear a little bit about your, your thoughts on that, whether that's a good idea, bad idea. What are the pros and 

Laura McConnell: cons? I am a very, very bad idea, quite frankly.

Um, I, I, I can't, I can't, I can't be any more delicate about it than that at the beginning when, um, the East, the East studies kind of the, this, the, this Easter's explosion happened in Scotland. People were watching resilience, they rewatch it. They were going to different events and heating things and things, and they thought this is the right thing to do because that's what the, who in the film or Sean is 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. I am. And she's no, the, um, she she's no, the top doctor from California, she is even seen giving any CIS study to a patient and a patient's mother.

And the mother fills in the doc, 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 skills 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 were given the guidance from above to show that this wasn't a good idea, but I know that has dead East score children. And it took till our own October, 2018. So about a year and a half for it to be Philly and quick publicly delays that this is not what. What, when, what should be done for a lot of reasons?

Partly as a, as a teacher, we have, um, child planning meetings here. They're not quite the same as the ambitions that you have in England for the CHPs, but there are similar vein. They're part of the, what we call the Garfish, getting a refurbished shelter, we'll assess. And I can know family really, really well.

And I can no children. I can mother parents outside of school. But I can never know what goes on in our household and it's not my place to presume or judge what goes on in our household. So for M for me, I am, or Amy school staff to East score children. There's quite a lot of questionable ethics there.

Firstly. They do. Um, do you engage the parents with it and do the parents know why that you're scoring them? Do they know that it's actually not, not linked to education and that they know that it's really linked to medical outcomes, which I don't need to know as a teacher, their original ACEs study. Well it's 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 week? The are we doing it so that if a child has, you know, food or Maurices an educational report in everyone 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, the were able to access therapy. They were maybe shielded from some of the affects of the adversity. And then one to two. Not have as many of the they be doing, they may be doing 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 East and Doobie teak 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 her and then say, well, you have less ceases to wispy. We're not going to support you less. So it really isn't an appropriate educational tool, but at the same time, I, I, I can see why some schools and some, maybe school leaders did think that it was the thing to do because.

You want to develop an education or Philip initiatives, you go stand in service, stay in a skill and you get five initiatives, new initiatives thrown at you. And it's just a constant safe call versus something used to do. And ethers and understanding at their C is really, really important. So. I think in the, in the lack of ego, cadence from above where they were given proper information to see, this is what you should to do as a school.

And this is what you shouldn't do. Some M skills under C I and other services, but with education to jump and I think peak first and East score children, but yeah. As far as I knew, I would, I mean, I would go to conferences and sometimes stand and the ones too, and hear people talking about escorting children and get palpitations, but that hasn't happened for awhile.

And I think that there has been such a big online now that there's been more local authority and 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? The eaters is that if you are a school, if you're a service starting at ACEs journey, you don't need to be escorting your, that your, you don't need to be escorting the users, the children, you just need to have an acknowledgement that there will be people in your service that have their city in their life and you can't quantify it.

And you also can't quantify how they've experienced that adversity either. Well, just to be aware of that and be aware of that's who you, you would be trauma informed and, um, and, and flinch therapists. And is 

Pooky Knightsmith: that scoring that profiling useful in any way? Oh, the sense. So for example, um, 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?

Laura McConnell: Well, without being from a public health background. And if anybody from that back then were to disagree with me, I would absolutely accept that. But I would think so. Yes. Um, the ISA study itself give an impression of this one particular community and whale. As I said, at the beginning, it wasn't a particularly balanced community, but that sits there study at the team in the context of where they were in America.

Because they wanted that they wanted to be believed by all communities. Not in Batalla says that doctors in her community who she may be views Hunter point, which was a predominantly black community. They already knew this. It was just that they didn't quite have the scientific data, whereas doctors.

Sarah, mostly upper middle class white patients that are medical would have thought, well, this isn't a problem for those. Where does the ether study managed to show that actually that it trans ASIS transcend, you know, socioeconomic status and Reese. So I think that. And Tara, if you, as a public health approach, then it would certainly be useful because actually one of the, the, um, the statistics and resilience is that there's $3 trillion a year spent on the us healthcare system, but only 5% is spent on preventative medicine.

No, I don't know what our competitive figures in NHS Scotland work and Patterson  England. Well, I would imagine from my new inform, 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 part.

And partly because it's. Sometimes it's cheaper to give a medication or something's cheaper for them to not use per empathetic approaches. So that's why I think that having that, that as a study, having our ACEs score from a public health perspective would be very useful data. Because it also helped you plan your future health services.

If you know that that are a certain amount of people in your population of photo Maurices and you knew that food or moody says to too, you're twice as likely to have heart disease, then you're going to be able to date Exeter, future planning for you for the health services. I know that wheels have done a study.

And, um, so w we also have been quite proactive with the wheelchair NHS, and, um, we have done a study and they're the figures that the hearts were roughly similar to what came out of the USC. And I know that the, the race of the Yuki will probably eventually. Catch up as well, but where most in places be the small, smaller places I've had  studies in the health sector, then it has had similar figures.

So we kind of know what to expect. All the in Scotland's given her history, her history, like I said, the glass effect, and we know that that's, that's been our video long studied sociological phenomenon. I think we may expect certain figures to be slightly worse. So. What is a more 

Pooky Knightsmith: healthy part. So what, what have you been doing as a result of the learning that you've done around ACEs?

What have you changed in your setting? 

Laura McConnell: I think it's really a bit of school culture. So the culture of nurtured school, the culture of understanding and not, and not having a lot of. Oh, no, not placing a lot of judgment on children based on their behavior and understanding more where behave behaviors come from.

There's a head teacher from faith for name is Jennifer Lawson. 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 language of connection is essentially getting rid of words, like meltdown. Kicking off violent, challenging behavior being tricky and just seeing the child was distressed.

And by seeing, by removing all of those words, there is a phenomenal pepper in that and framing the way that the adult thinks about how the child is behaving, because ultimately challenging behavior, which is kind of the umbrella term for that. It's not challenging for the child, but when the person who is challenged by the heat that he viewed 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 behavior, traditionally, that would almost be in conflict with the teacher and the teacher, but then have to. Claim the child don't bait by somehow doing something to fix the situation.

That's sort of become quite combative. Where does, 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 lesson says, if you walked into skill staff room, one of your colleagues was picking up the chairs and throwing them at her and that in and smashing things and screaming and swearing.

You wouldn't be telling them off and telling them to go to the office, you would be shocked and you would be worried for them and you would be asking them what's happened to them and hope can you help them? And why did we do that with children? And I know from my years in working in skills, I was a behavior support teacher in a mainstream school for whale.

I've been support for learning rule for whale. And I have worked with lots of children who have been distressed in school. I've 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 realized is that we need to. Understands where they understand them. We, we earlier understand when they're starting to get buy in distressed, who we can fit, who we can modify own behavior. Paul Dex has an excellent book called when the adults change, everything changes. And I think every teacher in Scotland has read that.

But again, if they haven't, then they've probably got it in ready to be. And it talks a lot about, you know, Addressing the primary behaviors and not the secondary behavior saw the child has done something and then they go on and they maybe start to swear. Traditionally, we would then continue on a cycle of address and we'll know you're sweating at me and instills with pain of got rid of that.

And it's really relationship centered. And, um, behavior policies, um, in most local authorities in Scotland, there are no called relationship policies and or one, at least a cluster of schools that call them their Teddy bear policies. Um, um, until talking about kind of attachment releases, um, and policies.

So it's really been a different approach and skills. Not that it's quite perfect everywhere. Um, at all, but we're certainly getting there and trying to make sure that we recognize that children have children's somethings have really tough home lives. And we may never ever know that they have quite tough home lives, but we have to see, 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 D. That is the end of the D and B and give it 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 a rule in education, obviously, that additional things where if we know. That children have specific needs then using our, using the funding to maybe access services for them.

And then plea fair to Pyjama athletic and music therapy and counseling, different outdoor learning except CS, and also interventions and school. But just as a general approach. Whether you, whether you know, a child to have an ECE or not, it's treating everybody with that same approach in that you treat children as they come.

And instead of, you know, seeing what's wrong with you, you know, what's happened to you. If they're distressed, Where 

Pooky Knightsmith: we see, um, children faces that may or may not be disclosed. Then often there may be a family there where parents carers may also have experienced similar things. Is that 

Laura McConnell: relevant in this context?

Oh, a hundred percent. 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 I'm your child is eligible for free school meals and combust free school meals. Or you live in the, the one, the bottom one and 2% tail of the Scottish index of multiple deprivation.

Then the school gets what's called pupil equity funding, pay funding. And also there are some skills which are called a 10 minute challenge skills, which get additional money to close the poverty release or the attainment gap, and a lot of skills in what I've worked in until Amgen there and others have employed family workers.

Who are from, maybe they're not education specialists that come from community, or they come from community education, backgrounds, youth work, and the work with the family too. Um, because a lot of parents have really bad experiences of skill. I've had lots of generations of families have really bad experience in terms of school and that, and the think of skill.

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 it. Yeah, it can, that they do want to engage. And family workers can really bridge that gap, but family workers can also help support with teaching them to be in mental health appointments or helping them access benefits and votes.

I know that there was our. There was a doctor.  actually in an area called park kid and Glasgow, which is in the East end of Glasgow. And one of the most deprived areas and the youth key and be a benefits advisor in their surgery. And I think that benefits advise it in a year helped. Um, the, the patients get over 200,000 pounds worth of massive benefits and leave the doctor's surgery phones that their appointments drops because their patients were.

Am less stressed. Their patients had more access to funding. So, um, there's there's skills that will run family sessions. They will, in the, I know that there was one recently in Panorama, a school in Glasgow that had, um, care family counseling. And things as well. So some of that, that money that education has 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 them and supporting them in the way that they need to.

But not necessarily from education staff, from. People who are specialized in family work and who therefore are much less intimidating. So that is very important and dental and being a partner with the parents is very important. When one issue with ease is actually can sometimes be this as BT, parent critical and very mother physical.

I feel when you look at the 10 ACEs, when you aim other ACEs and. And you think of all that child's got five ISAs that tells us six pieces and we need to improve. We need to improve in that. There's often a lot of judgment about who 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 is, um, the mother as the caregiver, that's not universal. And I know that from having spoken in a number of, in panels to math, 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.

Um, you know, I was a victim of domestic violence and I've all these things are things that parents can't control. So I think work also having that nonjudgmental attitudes and not. And not giving parents a hard team for the Xs that their children may expedience because when parents have really good support networks that own them, then they're better able to be really supportive of their child as well.

And then we know that that mitigates against them eases and builds better resilience in children. So certainly intergenerational it's really important. And I know that lots of schools have used their funding in that week, which is, I'm not sure how. Pupil premium, you know, policy as, and how they can use that.

But it's certainly something that has been proven to be very beneficial here. I think 

Pooky Knightsmith: having spoken to lots of schools during COVID locked down, and then I've spoken to many schools where actually those relationships with, with families have improved up necessity, where schools have been fulfilling, basic functions around providing families with, with food or access to various sort of services and support.

And that. Um, actually, there's been, it's been very, very positive in, in, in many cases. And I hope that that will be the beginning of something rather than a temporary, a temporary thing. Um, one thing I was 

Laura McConnell: pretty keen to talk to you about Laura was, um, 

Pooky Knightsmith: the relationship between, um, 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 

Laura McConnell: to us a little bit about them. Yeah. So one of the, I suppose, the disadvantages really, or the ACEs explosion in Scotland has been a better of a misunderstanding around the relationship between trauma and ADHD and B that's based in a comment that. Nadine Burke Harris, Mason, and her felon also made a Ted talk where she said that children were coming to her clinic, um, to be assessed for ADHD.

And she found that it wasn't EDD 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 see that em, ADHD is actually misdiagnosed trauma. And there, uh, and that has, that has been something that has, um, exploded in a way that has been very, very unhelpful to families, um, and has also affected, um, access to services.

It has affected children's ability to be able to. Get referrals to comes for ADHD because unfortunately, age some education staff M 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 had been told about who really was traumatized, but had the, but they were diagnosed with ADHD.

I'd have a couple of poems, but. Still too much, still too many times that that's happened. And I think that. Well, we do it. What we don't realize as the actually M the relationship to undiagnosed ADHD is actually quite linked to the circumstances that can cause ACEs. So those adults, I was diagnosed as an adult and with ADHD, myself, adults who are undiagnosed with EDC are more likely to have mental health issues are more likely to have.

Uh, eating disorders in the past are, are more likely to Hubbard school failure have substance abuse issues, or they're certainly more likely to be imprisoned. In fact, the population of the youth key sits around about three to 5% prevalence for ADHD, but in prisons that's 25%. And in fact, in young offenders, it's 40%.

So. I love that mate it's to do with impulse impulsive behavior. I suppose it obviously there's a lot more to it than that. Impulsive behaviors does play a part in that. And adults who have undiagnosed ADHD are more likely to have had multiple sexual partners to have had field relationships, to have. Um, and to be homeless.

And when you look at a lot of the factors that can then cause ACEs, adults who have undiagnosed ADHD, um, obviously not all of us, but adults have M who have undiagnosed. EDC are more likely to have a lot of the factors hurting them that can then. Not only caused traumatic experiences for themselves, but also affect the children adversely.

And I think that. Rather than dismissing the F 19 bursitis as a pediatrician, she's not unused scientist or a psychologist. She works in pediatrics. And she, what she was observing was that people were covered. A referral was made to hold in our clinic for certain behaviors. And she was as a doctor using her professional judgment in determining that that was not the case.

And that's what our doctors do. That's what our chills, adolescent mental health services do. That's where our adult mental health services to be able to teach 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.

Um, it can take many, many years because the ethics comms wants to have demonstrated that there has been supports put in place to the family to ensure that. The the, the, the, maybe the child's behavior meet, help, that'd be help somebody. And then after this has gone on for prolonged periods of time, at that point, are they willing to acknowledge ADHD?

There's quite strict and CDs, diagnostic Caitlin's here and are professionals and comms are professionals. And know what they're doing. But that does, that does seem to have been lost in translation a bit. And unfortunately I know from a lot of grips that I work with, a lot of parents will go along to skills 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 recognized with hyper hyper activeness, although, um, being, uh, by hype and acts of war, people think of as somebody running it own their own bouncing off of walls, claiming things, but that doesn't actually describe in HyperFlex embassy in ADHD, very accurately hope that hyperactivity can include lots of things, talking a lot and overactive being

But. People have a very specific idea of for ADHD is many people are very shocked that I have ADHD when I tell them that I do. And. When, when, um, because there's a, I suppose as well, a lack of training and adequate training and our teacher education system, parents and families are going to skill th about the meat go to their GP and the GP will say, well, I need to insulate the skills.

You need to make it a federal for school. And then teachers who are not trained to recognize ADHD in any way, shape or form are now reading articles or reading. Online except fussy. Um, or having that shared with them, seeing, well, actually not ADHD is misdiagnosed trauma and observing, observing that the child doesn't run around the room and burns off the walls and seeing the actually you 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 am half on as a BD, she is untreated. I am, I do take medication, but there's an. And even the ADC community, we see it's poles on skills that you need.

You can't just take medication. You also have to have strategies in order to help they aren't magic pills that make your life better. They just give you the ability to help make your life better. If you're missing all of those skills and also missing maybe a medication to be able to access that, then you're more likely to end up in situations.

Which will then cause it, which will then as a CD's of events, cause trauma to occur, which can then have impacts on children and have the cyclical adverse childhood experiences affect. So one thing I think, I suppose as well, if we were to learn from the Scottish approach to ACEs is to not stay out of our Erlyn I suppose, an education.

And to know that we are teachers and we are. And own expertise lays 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 comment and the compliment and what we do.

And the, and their input was really volatile. And rather than us. Stepping out of early and imposing our judgment. We need to trust in those other expertise. Those are the experts and know that they're doing their job properly. What are the things 

Pooky Knightsmith: we can all be doing to find support? Because it feels like if I'm understanding correctly that maybe there's not.

Um, 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 experienced Stacy's or who might have ins general issues, intergenerational issues here, but might also support the next child too often.

There are some universal approaches on there that that will help. Or most wonderful 

Laura McConnell: children, but also help 

Pooky Knightsmith: everyone. I mean, what, what do you think we need to be doing that you talked before about relationships and, and, and re approaching behavior, 

Laura McConnell: but what else would you think we should do? It's really bit a cultural policy and a skill and relationships and behaviors are certainly very much a part of that, but also there's a lot of M punishment.

Policies, um, a solution, um, exclusion policies, um, children, especially with uniforms and children coming to school and then being penalized because of  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 may not have all been there because maybe their parent is unable. To, 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, and it needs our support and the child then comes into school, having tried their best and maybe slightly leaked.

And the first thing that happens to them is that they're pulled off and the, and the something negative happens. And then. Maybe they're told off because of the uniform. And then there could be children's setting in a classroom and the are fidgeting or they're talking and they're saying out, and they're sent a solution.

It's just. The these sort of negative interactions with children and can really, really diminish their relationship with skills. And, um, I'm probably going to miss court for a very badly, and I do apologize for this because their court was really great. But Suzanne Siddique said there was a, uh, a conference.

We had an agent by the push to bail or learning festival. And one of Suzanne's headaches, opening comments was that was that children in the second place that children. Come to for arcane this, this school, unless they don't get it there. And I think I have missed school to there, but the point is that if a child is living in their family and vitamins, and they're not necessarily getting keenness 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 Milt welcoming them and making them feel part of our community, then. But then what is the point of that then they're not going to achieve, they're not going to team. 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 skill, respecting children. As well as respecting children as human beings and not speaking to them in a controlling manner. And, um, also just acknowledging them. There are many, many quiet children and teachers who would listen, but identify with this, that when you get to the end of the school year and you're writing their school reports, you think.

I have not got as much to see about this child as everyone else, because they're quite quiet and you'd realize I should have interacted with them more. I should have gone and spoken to them more. And there are so many children that can come into this 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 see her loss to them and make them feel welcome is really, really bent that there's really beneficial. Um,  um, talks in her Ted talk and in all of the different talks, she gives to different organizations about their experiences that she had in school and her teachers really.

Benefits attorney 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 ADHD and autism, but wasn't diagnosed. I, I got, and I had gone to a lot of trouble in school, had a lot of the finishes and skill, and my parents were forever being called skill to be told so bad.

I was, and I remembered in my third year of secondary school, which I think your name setting outside the office. Once again with my parents and say, being told her terrible human being I wasn't dying. 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 it, 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 out their Louis.

And Mitch and letting them know that, that, you know, somebody out there likes them, somebody is thinking of them and that even tiny gestures like that is really important. For example, my skill, 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 see something nice to them.

And see, and maybe make a nice comment and say, well, you know, next team, you know that this wouldn't happen. And like you've done VT veil in the past and things will be ugly and, and I'll chase talk them about something else. Cause I want them to feel that there's someone in the school at that point that doesn't think that they are the most heritable person in the world because that's maybe how they feel about themself.

And if they feel about themselves like that at home, And then they're feeling a bit themselves like that in school, then that's a 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 still culture just costs and see.

And, um, so of having a joined up approach and examining some of the policies that you have in school and thinking, does the board actually purpose does the serve? I think that that's why pulled X'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 pulled next is a barrier for these days.

Am, but I've worked in two schools that have been pulled in and. That weird and it doesn't cost us anything to do it. It's just, it meant that we looked at some things and then implemented and then tweak them for setting and continued on. And the children prepare at the children prepare 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. Sure. What 

Pooky Knightsmith: would you like to leave in with? I always think it's important to close with, with something you'd like to leave in 

Laura McConnell: people's minds. I think. It's really important to leave your, your judgment of someone at the door to leave your judgment over their tune at the door, not to turn 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 something to being accused of being aggressive. But when I have heard the same conversation, I haven't actually heard any aggression. They've just tried to assert themselves, but it's maybe not come across in a, in the same way that a professional with a cert themselves. And I think that the best way to approach everyone be the, a child in your school or an adult in your school or patients that you're interacting with us to listen to the content of what they're seeing and not get overly concerned with the way they're seeing it.

And rather than thinking what's wrong with you think, well, what's happened to you that has. But th that, that has caused this and hope can I help? And as this person distressed, rather than thinking this person as being challenging to me and when I'm trying to win this interaction, but just taking that step back and nobody's perfect.

Even the most, even the cane does people have their moments where they probably don't listen as well as the kids, but also being able to then. Acknowledge that and say we didn't walk. 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's really, or some older app is really, it's just a bit 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 we that you them. Th th the way that you can influence that culture. Jennifer Nelson just started calling children's behavior distress.

You didn't tell any of her stuff right from today, we're going to stop the stop. Seeing challenging behavior. We're seeing distress. She just started calling it the stress and staff caught on. So what she was doing, and then she's done talks about it. And I don't think in the last two years, I've ha I've ever heard a teacher say in front of me that the child will had challenging behavior.

It's just, it's, it's influenced the culture in lots of places in Scotland to see distress sort of smaller acts. And you're demonstrating your own behavior. You don't practice can really have a big ripple effect. .