Children traumatised by abuse and neglect often receive inappropriate treatment because they are misdiagnosed as suffering from attention deficit hyperactivity or bipolar disorders, says a US expert.
Children who have grown up in chaotic or threatening environments often show signs of fear even when there is no external threat, according to Bruce Perry of the Child Trauma Academy in Texas.
This affects their physical health, making them more likely to suffer from heart disease, asthma and diabetes. But there is also an impact on the brain, which makes such children more likely to be inattentive, to have trouble sleeping and problems learning.
"It might look like attention deficit if you didn't know they had had trauma, or bipolar if there was a behavioural element," said Dr Perry, who recently visited Scotland to share his knowledge with a range of professionals, including teachers.
"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," he said.
Dr Perry has counselled children traumatised by the Waco siege in Texas in 1993, the Oklahoma City bombing in 1995 and the Columbine school shootings in 1999. He has spent the past 10 years developing innovative clinical programmes with traumatised children.
Medication and talking therapy will not work, he said: "The part of the brain that is impacted by trauma is not . easily influenced or changed by talking. 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."
Misdiagnosis is further compounded by failure to establish support systems to help youngsters heal or develop, Dr Perry believes.
Today's children are being raised in a "relationally impoverished environment", he argues. Ideally, every child should have four significant adults guiding their development, he said, but for around seven hours every day in school there is just one "developmentally mature individual" - a teacher of 25 to 30 pupils.
"For 99.9 per cent of their time on this planet, human beings have lived in a very relationally enriched environment," said Dr Perry.
But now, he said, children are not receiving enough "healthy nurturing adult attention". Even in a therapeutic setting, there will usually be five children to one care-giver.
Lorraine Petersen, chief executive of the National Association for Special Educational Needs, said that misdiagnosis was also a concern for British schools, and that teachers would benefit from better training.
"It's easy to label a child as having a behavioural problem instead of looking at the underlying reasons behind it," she said. "A child may manifest behaviour when they start secondary school that suggests they have ADHD or autism, but this can actually stem from the fact they have speech or language problems."