Diagnostic Pathway for Suspected School-Based Trauma (Including Possible CPTSD)

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This page is part of the School Issues section.

Diagnostic Pathway for Suspected School-Based Trauma (Including Possible CPTSD)

This currently a page in developent due to much missunderstanding or research on of cPTSD disability discrimination trauma

1. Overview

Children—especially autistic or ADHD children—may develop trauma symptoms in response to repeated distress, punishment, exclusion, or unsafe experiences in school. Many of these children are labelled with “EBSA” (Emotionally Based School Avoidance), a term which is not a clinical diagnosis and often masks underlying trauma.

This page provides a clear, step-by-step pathway for:

  • recognising trauma symptoms,
  • understanding when CPTSD should be considered,
  • accessing the correct type of assessment,
  • avoiding the common dead-ends (especially EP-only involvement),
  • ensuring the child receives appropriate clinical input.

2. Why a Diagnostic Pathway Is Needed

Trauma in school settings is frequently missed because:

  • Educational Psychologists (EPs) cannot diagnose CPTSD or PTSD,
  • CAMHS often reject referrals unless risk is acute,
  • schools prefer non-clinical labels like “EBSA”,
  • autistic and ADHD children present trauma differently,
  • distress is mistaken for behaviour.

A structured pathway helps ensure children access proper mental health evaluation.

3. Key Indicators of School-Based Trauma

A. Psychological and Emotional Signs

  • Persistent anxiety linked to school
  • Sudden fear or panic at the idea of attending
  • Nightmares or sleep disruption
  • Hypervigilance (on edge, easily startled)
  • Emotional shutdowns or meltdowns
  • Withdrawal from activities or friends

B. Behavioural Signs

  • School avoidance or inability to enter school buildings
  • Freeze/fawn responses during conflict
  • Clinginess or unusual separation anxiety
  • Loss of skills or regression
  • Refusal perceived as fear-based rather than oppositional

C. Physical and Somatic Signs

  • Stomach aches, headaches, nausea
  • Fatigue or exhaustion
  • Increased sensory defensiveness

D. Academic and Functional Signs

  • Sudden decline in performance
  • Inability to complete work due to fear/distress
  • Avoidance of specific rooms, teachers, or routines

Any cluster of these signs may indicate trauma.

4. When CPTSD Should Be Considered

CPTSD is most likely when the child has experienced:

  • repeated exclusions or punishments,
  • isolation or seclusion rooms,
  • bullying that was not addressed,
  • unpredictable disciplinary responses,
  • sensory overload without support,
  • chronic fear of teachers or peers,
  • humiliation or shaming practices,
  • long-term lack of safety.

CPTSD requires prolonged, inescapable threat, which is an accurate description of many children’s school experience.

5. Who Can Diagnose Trauma or CPTSD?

Professionals who CAN diagnose:

  • Child and adolescent psychiatrists
  • Clinical psychologists trained in trauma
  • Specialist trauma therapists (with recognised diagnostic authority)

Professionals who CANNOT diagnose:

  • Educational psychologists (EPs)
  • Teachers or SENCOs
  • Attendance officers
  • Local authority behaviour teams
  • School nurses

EPs may recognise risk factors but cannot make a formal diagnosis.

6. Referral Routes

Step 1: GP Consultation

Parents request a trauma-focused mental health assessment, explaining:

  • the link between school experiences and current symptoms,
  • behavioural changes since specific incidents,
  • any exclusions, punishments, or distressing school events.

Step 2: Referral to CAMHS or Community Mental Health Services

The GP can refer for:

  • PTSD/CPTSD assessment,
  • anxiety disorder assessment,
  • depression or stress-related disorder assessment.

Step 3: If CAMHS Declines

Parents can seek:

  • private clinical psychology trauma assessment,
  • independent psychiatric opinion,
  • specialist autistic/ADHD trauma-informed clinicians.

A CAMHS refusal does not mean trauma is absent.

7. Assessment Components

A proper trauma assessment should include:

  • clinical interview with the child (using adapted methods if autistic/ADHD),
  • developmental and functional history,
  • parental interviews,
  • review of school records (sanctions, exclusions, behaviour logs),
  • sensory and communication needs analysis,
  • analysis of triggers and avoidance patterns,
  • evaluation of threat-based responses.

If school refusal follows repeated traumatic experiences, this supports a trauma formulation.

8. What Schools and EPs Should and Should Not Do

Schools should:

  • provide a chronology of distress triggers,
  • supply behaviour and exclusion records,
  • document support attempts,
  • share safeguarding notes (where appropriate).

Schools should NOT:

  • diagnose EBSA,
  • claim the child "won’t engage",
  • use attendance enforcement,
  • push a child into traumatising situations,
  • insist the issue is parental.

EPs should:

  • identify trauma indicators,
  • advise on environmental adjustments,
  • refer concerns to clinical services.

EPs should NOT:

  • dismiss trauma as "EBSA",
  • imply trauma diagnosis is outside child’s presentation,
  • apply behaviourist models to fear-based avoidance.

9. Barriers and Pitfalls to Avoid

Common pitfalls:

  • school insisting on EP-only assessment,
  • LA suggesting “EBSA” without clinical review,
  • attendance officers escalating parental blame,
  • schools framing trauma as “non-compliance”,
  • CAMHS rejecting referral due to school pressure.

Parents should insist on clinical assessment, not behavioural interpretation.

10. Outcomes of a Trauma-Informed Assessment

A correct assessment may result in:

  • diagnosis of CPTSD or PTSD,
  • recognition of anxiety disorders,
  • trauma-informed support plans,
  • changes in placement,
  • adjustments to reduce sensory and emotional triggers,
  • recommendations for EMDR, CBT-T, or stabilisation therapy.

These outcomes are legally significant for:

  • safeguarding,
  • EHCP evidence,
  • Equality Act claims,
  • personal injury claims.

11. Next Steps / Future Additions

Possible expansions:

  • template letters to GPs and CAMHS,
  • trauma symptom checklist,
  • example clinical referral wording,
  • flowcharts for parents and professionals,
  • guidance for traumatised autistic/ADHD assessments.

Let me know what you’d like added next.


Disclaimer: These pages are for general information only and does not constitute legal advice. For individual guidance, contact for children SENDIASS, IPSEA, otherwise Advisory, Conciliation and Arbitration Service(ACAS) or the Equality Advisory and Support Service (EASS). See the full Legal and Support Disclaimer for details.

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