* Last year, 168 infants (four, five and six-year-olds) were expelled from their schools

* According to the Office for National Statistics, 10 per cent of children have a mental health disorder. The national children’s mental health charity Young Minds believes up to 40 per cent of young people in inner cities have emotional and behavioural problems

* In the United States, between 2 and 2.5 per cent of school age children are prescribed medication, mainly Ritalin, for hyperactivity. In Britain, it’s 1 per cent

* About 10,000 pupils are this year registered solely in the UK’s 365 pupil referral units - up from 5,000 in 1996

Permanent exclusions are once again on the rise. Last year, they rose by 9.8 per cent overall, although the rise in the number of pupils permanently excluded from primary schools was higher at 17 per cent. And 168 infants (four, five and six-year-olds) were expelled from their schools. Charles Clarke, the new Education Secretary, says poor behaviour is at the top of his schools agenda. It exacerbates problems with teacher retention and recruitment, and being thrown out of mainstream schooling dramatically increases the likelihood of a child being drawn into drugs and crime. The Government is favouring early intervention and a multi-agency focus on pupils with problems, as well as schemes to improve teachers’ behaviour management - while accepting that some children have such profound behavioural difficulties that provision outside mainstream is the only option.

What happened in the past?

Between the two Education Acts of 1944 and 1981, children with behavioural problems were labelled as “maladjusted” and dealt with according to a medical model - specialists believed that given the right treatment they could be made “better”. Provision was through child guidance clinics, and recommendations by psychiatrists and educational psychologists placed children in special schools, many of which developed a therapeutic rather than an educational emphasis. In 1947, there were four residential schools and one day school; by 1980, this had risen to 120 residential and 90 day schools. But the 1981 Act changed the emphasis to inclusion, based on an increased awareness of the links between low attainment and maladjustment. The classroom rather than the clinic became the focus for intervention.

Inclusion meant that many tutorial off-site units and classes for disruptive pupils, some offering therapeutic provision, others concentrating on routine remedial reading and arithmetic, closed in the 1990s. But with the exclusion rate rising exponentially during the first half of the decade, and with a few hours of home tuition patently inadequate for many excluded pupils, pupil referral units (PRUs) came into being in 1997 under a “revolving door” policy. They offered a national curriculum entitlement but with an emphasis on behaviour modification and with the specific intention of returning pupils to mainstream education.

Has there been a growth in the number of children with EBD?

Emotional and behavioural difficulties has become a catch-all phrase for children with poor behaviour and tends to encompass the spectrum of naughtiness and defiance, on the one hand, to specific mental disorders on the other. According to the Office for National Statistics, 10 per cent of children have a mental health disorder - a deep-seated, long-term condition encompassing anxiety, depression, attention deficit hyperactivity disorder (ADHD), or obsessive compulsive disorder, including half who have some kind of conduct disorder.

The new special educational needs code of practice has modified the term EBD to emotional, social and behavioural development. The national children’s mental health charity Young Minds says this is significant because development implies contributory factors, such as poor early family attachment, domestic violence and family break-up - all of which cause children to feel angry, sad, lonely or not heard.

Research by the psychiatrist and paediatrician Professor Michael Rutter shows that mental health problems in the young have increased significantly in the past 50 years in western Europe; Young Minds believes that in inner-city areas where there is poverty and street violence, up to 40 per cent of young people now present emotional and behavioural problems to a greater or lesser extent.

What about ADHD?

The Scottish-born physician Alexander Crichton published an account of “morbid inattentiveness” in 1798, not dissimilar to the ADHD diagnosis formulated by the American Psychiatric Association in 1994. It describes symptoms of inattention, impulsiveness and hyperactivity that significantly interfere with education or work, family and peer relations. In 1970, Michael Rutter and his colleagues surveyed all school-age children on the Isle of Wight and found less than 1 per cent with hyperactivity. Research in the late 1990s of children in east London by Professor Eric Taylor at the Maudsley Hospital, and Dr Geoff Thorley, a clinical psychologist in Leicester, found 3 to 5 per cent of school-age children affected.

According to Paul Cooper, professor of education at Leicester University and director of the Centre for Innovation in Raising Educational Achievement, there is an unhelpful polarisation of views about ADHD as a set of problems induced by biological factors on the one hand, and environment and experience on the other. There are no clinical tests for the condition, he says, because while there is strong evidence of a biological aspect, social and psychological factors play an important part.

In the United States, between 2 and 2.5 per cent of school-age children are prescribed medication, mainly Ritalin, for hyperactivity. In Britain, it is 1 per cent. Professor Cooper says a multi-disciplinary approach and the use of positive, non-medical interventions as the first priority is the best way forward.

Are there other behavioural disorders teachers should know about?

Behavioural problems are linked to a wide range of factors including bereavement, eating disorders, unresolved trauma, depression, autism (according to the National Autistic Society, 21 per cent of children along the autistic spectrum have been excluded from school as sensory overload often leads to extreme temper tantrums), language disorders, physical or sexual abuse, dyspraxia - an impairment of organisational skills causing a child to be clumsy and incapable of organising his or her own work, scotopic sensitivity syndrome - specific difficulty in reading print or Tourette’s syndrome - facial tics, spitting, uncontrolled swearing.

What relationship should schools have with educational psychologists? Is this service effective?

Many schools say they are in desperate need of regular, preventive work with children by an educational psychologist who can also offer teachers on-the-spot training and advice to deal with problems as they arise. In the early post-war days, educational psychologists worked directly with children with a range of support such as counselling, psychotherapy and hypnotherapy.

Brian Harrison-Jennings, general secretary of the Association of Educational Psychologists, says EPs are no more than firefighters in the current climate. They are wholly embroiled in identification and diagnoses as the gatekeepers of special needs statements. Moreover, shortages (between 60 and 70 per cent of local education authorities cannot fill posts) mean those in post cannot keep pace with the rising referral rate. Helen Nicholls, manager of the Phoenix Centre, a learning support unit at St Matthew’s RC high school in Manchester, says her school is supported by the service for only five days a year. “It’s like putting sticking plaster on a gaping wound, it’s about reacting to crises rather than prevention”.

What are the current options for dealing with children with behavioural problems outside the mainstream?

Provision varies enormously but options include learning or behaviour support units (technically on-site and part of mainstream provision), an alternative curriculum for those at risk of exclusion through FE colleges and work experience, home tuition, pupil referral units, EBD special schools and secure units. (An Ofsted report released last week says that nearly half of EBD schools have “significant” curriculum weaknesses, and that few have a record of reintegrating pupils back into the mainstream, although nearly half have a significant impact on behaviour).

As part of the Government’s newly announced Behaviour Improvement Programme (BIP), schools with high proportions of pupils at risk of developing behavioural problems and disaffection can access the services of Bests - behaviour and education support teams that include education, social work and health professionals. Their purpose is to provide early intervention, therapeutic input and ongoing support for individual children and families, as well as supporting schools and PRUs in developing whole-school behaviour strategies and training staff in promoting emotional well-being.

Child and Adolescent Mental Health Services (CAMHS) - multi-agency teams that include play therapists, clinical psychologists, child psychotherapists, psychiatrists, educational psychologists - can also be called upon through referrals to a GP. But although this service can be effective, there are long waiting lists - 18 months in many health authorities - and parents who don’t keep appointments are crossed off the list. A 1999 Audit Commission report said 10 per cent of CAMHs could not offer appointments for non-urgent cases and 33 per cent could not respond effectively to young people in crisis.

Are on-site learning support units effective?

The Government aims to make learning support units available in half of the nation’s secondary schools. LSUs are small, separate units taking six to 10 children, mostly from the schools in which they are based, with a high staff-student ratio. They aim to keep pupils in school who are at risk of exclusion, providing them with short-term teaching and support programmes to tackle poor behaviour and with the aim of reintegration into mainstream schooling as quickly as possible. Some units take in pupils from several schools. Provision is varied, some operating as little more than sin bins or holding operations for the disaffected. But some LSUs are pioneering. The Phoenix at St Matthew’s in Manchester caters for no more than 10 pupils from Years 7 to 11, some full-time, some mornings only, some coming in simply to register. No pupil stays for longer than two terms.

Although the Phoenix focus is on developing social skills, relationships and pupils managing their own behaviour, it is staffed by mainstream teachers across the curriculum and is integral to whole-school provision. There is a clear admissions policy, as well as a step-by-step re-integration into mainstream. Classroom teachers who make referrals are involved in the whole process.

The Zacchaeus Centre in Birmingham is an LSU shared by a cluster of 10 Catholic schools. It was established in an inner-city crypt in 1995 as an exclusion prevention strategy and has a high staffing ratio - three secondary teachers, one primary teacher and one teacher working out in primary schools to raise self-esteem among Year 3 pupils. At any one time, it takes no more than one child from each school for no more than two weeks, using the curriculum as a tool to teach behaviour. “Essentially, we teach social and emotional literacy in do-able, manageable steps,” says its head, Moira Healey.

How effective are PRUs? What is their relationship with schools?

The number of pupils registered solely in the UK’s 365 pupil referral units has grown from 5,000 in 1996 to 10,000 in 2002. Although the units were set up to spearhead reintegration, in reality it has proved difficult to readmit a significant number of permanently excluded pupils with severe and complex needs, and many have developed long-term provision.

The Department for Education and Skills now intends that PRUs also provide full-time education for expelled pupils. Some cater specifically for primary pupils, others key stages 3 or 4. Some might cater only for pregnant schoolgirls, young mothers or school refusers. Ofsted says many are effective, although attendance - rarely above 90 per cent - remains a concern. Ofsted also acknowledges that some PRUs are housed in seriously inadequate accommodation with implications for “health, safety and hygiene”.

John Visser, an EBD lecturer at Birmingham University, says one PRU he visited was housed in an old factory on an industrial estate with only two windows, one in the staffroom. Poor quality accommodation, he says, only reinforces low self-esteem among pupils.

But there are notable successes, among them the pupil referral units in York, which have significantly reduced the number of permanent exclusions in the city - from 40 in 1997-98 to 13 in 2001-2. One offers short-stay provision for key stage 3 pupils in danger of permanent exclusion from mainstream, the other, the Pupil Support Centre, offers full-time education for those permanently excluded as well as longer term key stage 3 support. Chris Nicholson, the centre’s headteacher, says last year 26 pupils achieved an average of three GCSE A-Cs in maths, science, English literature and language, art and design and technology. But an emphasis on achieving quality relationships “permeates every aspect of our work”. He says: “We genuinely believe here that behaviour can change, and tackle that challenge with enthusiasm.”

What does the future hold for pupils with behavioural problems?

The Government has earmarked pound;66 million for a range of projects - a pitifully inadequate sum, according to behaviour guru Bill Rogers. Certainly, if it is to succeed, the Government will have to face up to chronic shortages and inadequate funding in the many support services that schools need to call on. Frances Toynbee, headteacher of the PRU in Scarborough, North Yorkshire, reflects the views of many when she says:

“Children who have failed at school need Rolls-Royce treatment, they need bespoke education.”

Many schools accept that training in behaviour management and handling disaffection has to be a central part of professional development. Above all, says Joan Pritchard, chair of the Association for Workers with Children with EBD, again reflecting the view of many fellow professionals, there needs to be consolidation. “No sooner does one thing get off the ground than the Government brings out new initiatives.”