Children traumatised by abuse and neglect often get inappropriate treatment because they are misdiagnosed as having ADHD or bipolar disorder, says an American expert.
Pupils who have grown up in threatening environments tend to have all the indicators of fear, even when there is no external threat, says Bruce Perry, of the Child Trauma Academy in Texas.
This affects their physical health, making them more likely to develop heart disease, asthma and diabetes. There is also an impact on the brain that means children are more likely to be inattentive, have trouble sleeping and problems learning.
"It might look like attention deficit if you did not know they had had trauma, or bipolar if there was a behavioural element," said Dr Perry, who recently visited Scotland to share his knowledge. "One problem in the mental-health sector is that it is relatively young in understanding and addressing trauma-related problems - it's an emerging field."
Dr Perry has counselled traumatised children from the Waco siege in Texas, the Oklahoma City bombing and the Columbine school shootings. He has spent the past 10 years developing innovative clinical practices and programmes by working with maltreated and traumatised children.
Medication and talking therapy will not work, he said. First, abuse must be stopped, the child made to feel safe, then less conventional treatments embarked upon.
"The part of the brain that is impacted by trauma is not a part of the brain easily influenced or changed by talking," he said. "It is very responsive to pattern-repetitive and rhythmic-sensory experiences such as therapeutic massage, music and movement. Yoga is also more effective for trauma children than more conventional interventions."
The treatment of traumatised children is compounded by our systems, which are not set up to help them heal or develop: today's children are being raised in a "relationally impoverished environment", Dr Perry said. Ideally, every child should have four significant adults guiding their development, he says, but for about seven hours every day in school there is one "developmentally mature individual" - a teacher - to 25 or even 30 pupils.
"For 99.9 per cent of their time on this planet, human beings have lived in a very relationally-enriched environment," he said. But today children are not getting enough "healthy nurturing adult attention". Even in a therapeutic setting, there will usually be five children to one care-giver.
"We are not creating a relationally-healthy environment in which maltreated children can heal," Dr Perry said.
The ideal environment would be "heterogeneous", clustering children of different ages together alongside a number of healthy adults. "We can't have four teachers to every child," he said. "But we can create a classroom where high school kids and elementary school kids work together, and where parents and people from the corporate sector volunteer to become mentors."