ELSA – not for neurodivergents

I had never heard of ELSA, other than of Frozen fame, until recently.

For those who don’t know this acronym, ELSA in a UK state primary school contact stands for “Emotional Literacy Support Assistant”, and is a programme developed by an educational psychologist, designed to be delivered by teaching assistants, to offer emotional, mental health and social communication support to children in schools.

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It sounds like a wonderful idea, and something every school should have. However, I have come across a number of cases of children being triggered by ELSA sessions – put into extreme fight/flight (trashing classrooms or violence against others) or freeze (anxiety school-based avoidance).

Schools are bemused – after all, this is a programme designed by an educational psychologist, so how can it be the cause of these issues?

I asked this question to a forum for trauma-aware professionals (except, what I had failed to appreciate is that the only trauma they have studied in detail is ACES – Adverse Childhood Experiences), as well as to a forum for SEND parents.

ELSA training apparently includes a few hours on ACE awareness. However, just because a child doesn’t have obvious ACEs in their history, it doesn’t mean they are not living with trauma.

A colleague of mine, and former ELSA, says:

So many times after a referral for ELSA, we said “This isn’t an ELSA child”. I was lucky enough to be left to my own devices so I could use my initiative and experience, but if that is all you have in your toolbox, it is a worry that they TAs are doing more harm than good.

Tracey, Neuroplasticity practitioner and former ELSA

One of the components of ELSA is “building resilience”. To a neurodivergent person, “building resilience” means being made to fit into a neurotypical world… and being made to fit into a neurotypical world is trauma-inducing. This makes me want to draw a comparison between ABA therapy (Applied Behaviour Analysis) and ELSA. ABA is also about “building resilience”, and getting autistic people to blend in.

An experienced SEND parent and Doctor, who also happens to be autistic herself, hence has a heartfelt and much-valued insight, gave the following very clear and insightful reply to my question about why we might see children triggered by ELSA sessions:

In EHCPs, for example, “x struggles with peer groups and needs support to understand how to make friends.” This sounds harmless enough, until you unpick what that’s saying… the word “struggle” automatically places the person at fault in this “struggle” on x – on the Autistic child. They are the ones that struggle to engage with peer groups, not the other way around, and so they need to be taught to change this. And the fact they “struggle” means they are the ones that need to change, adapt, understand how to mask and be more accepted by those peers – they’re the ones who don’t understand. Autistic kids thus get the message that they are not enough, they are the ones that have to change, and that it’s their fault that social stuff is difficult. Of course, if someone who truly understood neurodiversity wrote the EHCP, it would say something like “x finds neurotypical peers’ way of looking at the world difficult. However, they interact well with other neurodivergent children. They need support to understand why neurotypicals operate the way they do, and how to handle that, and support to foster their neurodivergent friendships.”

It would be wonderful if there were a form of ELSA for “neurotypical” children (and adults) to better understand neurodivergent people – but without drawing a distinction. We would never expect someone who uses a wheelchair to build their own ramp or place blame on them because they use a wheelchair. We would recognise that as a socieity, we adapt and put in reasonable adjustments and create equity. It’s not OK to effectively ask a neurodivergent child to build their own ramp whilst everyone else stands by and watches.

Dr Justine Reilly

Personally, I suspect that ELSA is wholly unsuitable for those with developmental trauma, or trauma as a result of being forced to mask/fit in. Some of the activities would be perceived as a threat and could cause a child to either hide/refuse to go to sessions or even to school, or potentially to get violent/act out/vocalise frustrations in less than desirable language for a primary-aged child.

What seems to be missing from ELSA training is the emphasis on co-regulation during sessions, even if some ELSAs probably do this automatically anyway.

What would be a more appropriate approach for the children that ELSA is not appropriate for? Well, anything reinforcing “safety” and incorporating co-regulation with the TA.

The Safe and Sound Protocol is a far gentler approach for those who might be triggered by ELSA sessions, but is unfortunately only available privately – and MOST of the time, it’s completely inappropriate, in my opinion, to offer SSP in a school setting. The beauty of SSP is that there are no demands to “open up”. There is no expectation to put trauma into words, or to force someone to verbalise anything at all. The only expectation is to ensure safety for the subject of SSP. The Safe and Sound Protocol does not attempt to make a neurodivergent person fit into a neurotypical world, but instead helps a person deal with the cumulative trauma from constantly being expected to fit in. The “progress” people see is NOT because a person is trying to fit in, but is a physiological reaction, due to the autonomic nervous system firing better and not feeling under constant threat.

The bottom line is that ELSA, although not considered to be a “therapy” relies on neurotypical connections to the prefrontal cortex, which are not efficient in a child with developmental trauma/neurodiversity. These children need fully trauma-informed interventions. Although ELSA may be extremely helpful for some children, while ELSAs are probably well-meaning individuals, they cannot be expected to understand polyvagal theory in depth.

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