Introduction

Childhood is the developmental stage during which the foundation for an individual’s identity, personality, and self-regulation skills is established (Montroy et al., 2016). Adverse Childhood Experiences (ACEs) are potentially traumatic events that can profoundly shape development, both physiologically and psychologically (Centers for Disease Control and Prevention, 2024). The majority of the existing literature surrounding childhood trauma has focused on the negative health effects of traditionally defined ACEs, which include family relationships and household factors (Merrick et al., 2019). However, another fundamental setting informs childhood development through learning methods, peer interactions, and relationships with adult figures: school. In the United States, children spend an average of 1000 hours each year, which equates to approximately 1/6th of their waking hours, in school environments (ED100, 2009). The undeniable role of schools in child development prompts the question: Do punitive school discipline measures act as ACE-like exposures, contributing to chronic conditions and long-term public health consequences?

When educational spaces overuse punitive disciplinary measures that seek to limit behaviors of concern through restrictive or exclusionary interventions, they can exacerbate students’ short-term risk for both physical harm and mental health consequences in relatively intuitive ways (Restorative Resources, n.d.; Duarte et al., 2022; American Psychological Association, 2021; Krause et al., 2024). Viewing punitive discipline through a public health lens reveals that these students are also more vulnerable to high-risk behaviors and long-term adverse health outcomes (Tariq & Gupta, 2023). Much like ACEs demonstrate a dose-response relationship towards a harmful health trajectory, the cascade of negative effects that even a single act of punitive discipline can initiate underscores the need to consider other approaches to behavior management (Merrick et al., 2025). The literature contains evidence of established links to mental health problems and high-risk behaviors, reinforcing the necessity of seeking effective, evidence-based alternatives to punitive and exclusionary disciplinary measures. 

Punitive practices target vulnerable students

Punitive disciplinary practices, including suspension, expulsion, corporal punishment, seclusion, and restraint, are commonly used in K-12 public schools in the United States. These measures are often justified as a means of maintaining order and obedience in a classroom; however, this should be weighed against the reality that every child has a unique background, set of abilities, and needs. Vulnerable populations are the most affected by these intense interventions. Exposure to trauma among students who experience school discipline is a relatively underexplored area of research (Sanders et al., 2023). However, what is better known is that students with two or more adverse childhood experiences are more likely to repeat a year of school, compared to their counterparts without any adverse experiences (Feldman Hertz, 2020). A qualitative longitudinal research project explains the causative relationship between trauma in young people’s lives and experiencing exclusion at school (King, 2016). In other words, those who were already undergoing trauma experienced the compounding effects of punitive discipline, which can also be traumatic (Sanders et al., 2023). 

Initiatives have been taken in many states to reduce the use of punitive discipline over the past decade (Leung-Gagné et al., 2022). In some cases, the level of discipline has increased since the COVID-19 pandemic, as seen in school districts in California and Kentucky (Flores & Losen, 2023; Povich, 2023). This suggests that increased punitive measures remain a common school-level response to behaviors of concern, despite their limited efficacy and the harmful cycles of academic and social burdens that such actions perpetuate (Lewis et al., 2014; Morris & Perry, 2016). A report from the World Health Organization on the social determinants of health reinforces that “the nurturant qualities of the environments where children grow up, live, and learn matter the most for their development” (Partnership & Health, 2007). This emphasizes how every space—school, community, and one’s home alike—shapes every child. One cannot categorically separate the home as a space to nurture a child and the school as a solely academic environment, because in reality, the effects are intertwined. Punitive discipline can add to trauma by misinterpreting behavior, isolating and retraumatizing children. These interventions are also disproportionately used on students with disabilities, students of color, and students who have experienced trauma, which raises concerns about inequity and discrimination (Whear et al., 2013; Morris & Perry, 2016; Ablon, 2020; Nowicki, 2018). 

Children who experience instability in their household or familial relationships may be more likely to have altered neurobiological development due to chronic activation of their physiological stress response system at a young age, when their brains are still developing (Cross et al., 2019). If this state of alertness persists throughout an individual’s childhood, it can lead to overactivation of the stress system (Downey & Crummy, 2021). In a school environment, overactivation may result in traits such as negative thinking, hypervigilance, and challenges with executive function (Miller, 2025). Unfortunately, these symptoms can all be, and often are, conflated with Attention Deficit Hyperactivity Disorder (ADHD), which leaves the potential underlying trauma unaddressed (Jimenez et al., 2017). That is why trauma-informed care is so vital. In many classrooms, students greatly outnumber adults and are expected to exhibit behavior norms to make the classroom manageable. Yet, this vision of complete compliance is simply not achievable, particularly for students who may be unable, not unwilling, to meet those expectations due to their neurobiological state. In these inevitable situations, punitive discipline should not be relied upon. While all children are susceptible to the harms of punitive and exclusionary discipline, those with prior trauma are particularly at risk.

Types of punitive discipline

Exclusionary discipline refers to policies that temporarily or permanently remove students from their typical educational environment, including timeout, seclusion, isolation, suspension, or expulsion. A suspensable offense may be for an infraction as minor as the use of profanity, and over the course of a K-12 school career, a third of US students experience suspension (Lacoe & Steinberg, 2018; Rosenbaum, 2018). A disciplinary response can lead to negative academic consequences in both the short and long term, as students are required to miss classes and make up learning opportunities, which has been linked to higher dropout rates (Jackson, 2018; Christle et al., 2007). Both dropping out of high school and experiencing exclusionary discipline are independently and consistently linked to a higher likelihood of future involvement with the criminal justice system (Aronowitz et al., 2020; Hemez et al., 2019; Boudreau, 2019;  Mittleman, 2018). Even if the punishment is only a brief absence from classes, with no immediate educational effects, a suspension may be enough to label a child as a problem child or delinquent (Thomas, 2025; Bernburg & Krohn, 2003). There are serious social implications to the stigmatizing labels associated with punitive discipline, which can make it difficult for students to network or socialize with their peers, affecting school connectedness. Research from the American Academy of Pediatrics identified school connectedness, or the extent to which students feel that adults and their peers at school care about their success, as a protective factor for reducing emotional distress, substance abuse, and the odds of suicidal ideation in adulthood (Steiner et al., 2019; CDC, 2024). Beyond the short-term consequences that feeling supported at school can have for a student’s opportunities and well-being, the long-term trends reveal associations with better health. On the other hand, recent research has indicated that the mental health effects of students who experience exclusionary discipline are linked to depression, self-confidence issues, and lower engagement with school (Luster, 2018). At a school-age, an individual’s future decisions and outcomes are not yet concrete, but if a child is struggling and met with harsh, isolating discipline, that can secure such outcomes in a self-fulfilling prophecy (Fei & Abdullah, 2023).

Corporal or physical punishment, despite lacking any evidence-based benefits, remains prevalent in schools across the globe (Anderson, 2024; World Health Organization, 2021). Nearly 70,000 children in the U.S. experienced corporal punishment in the 2017-2018 school year (Civil Rights Data Collection, n.d.). The Office for Civil Rights (OCR) defines corporal punishment in schools as the deliberate use of physical force with the intention of causing a child to experience pain to address misbehavior or discipline the student (Texas Classroom Teachers Association, 2025). This can include practices such as hitting, paddling, slapping, spanking, or other physical force used as a means of discipline (Texas Classroom Teachers Association, 2025). The definition specifically notes that corporal punishment is intended to inflict physical pain, distinguishing it from other forms of physical intervention. According to the World Health Organization, corporal punishment can negatively affect children’s physical and mental health, as well as contribute to problems in behavior over time (World Health Organization, 2021). Children with disabilities are disproportionately affected by corporal punishment at the individual level. At the same time, poverty, racism, and class-based discrimination increase the risk of experiencing corporal punishment at the community level (World Health Organization, 2021). These discriminatory patterns emphasize not only the ineffectiveness of the practice but also the inequitable ways through which it is applied as a strategy for disciplining children. 

The Department of Justice defines seclusion as the involuntary confinement of a student alone in any room or area where the student is not free—or believes they are not free—to leave (Civil Rights Division | What Is Seclusion?, 2022). Seclusion can occur even if an unlocked door is physically blocked or if staff prevent exit verbally or through other means. This definition distinguishes seclusion from behavioral time-out methods, which are not considered seclusion if the student is monitored and allowed to leave freely. The Office for Civil Rights (OCR) defines physical restraint in schools as a personal restriction that immobilizes or reduces a student’s ability to move their torso, arms, legs, or head freely (PBIS.org | Restraint/Seclusion, n.d.). This definition excludes temporary touching or holding, known as physical escort, which is only used to induce a student to walk to a safe location and does not continue once the secure area is reached. Physical restraint specifically refers to actions by school staff to restrict movement in order to control behavior and maintain safety.

According to the U.S. Department of Education, these practices should not be used “except when there is a threat of imminent danger of serious physical harm to the student or others” (U.S. Department of Education, 2022). The Individuals with Disabilities Education Act (IDEA) defines serious physical harm (often referred to as serious bodily injury) as bodily injury that involves one or more of the following: “a substantial risk of death, extreme physical pain, protracted and obvious disfigurement, or protracted loss or impairment of the function of a bodily member, organ, or mental faculty” (U.S. Department of Education, n.d.). This definition aligns with the federal criminal code definition cited in IDEA regulations (34 CFR 300.530(g)(3) and 18 U.S.C. § 1365(h)(3)) and guides special education disciplinary decisions, such as the removal of a student to an interim alternative educational setting for up to 45 days if they inflict such injury on another person at school (34 CFR § 300.530 – Authority of School Personnel., n.d.). Unfortunately, evidence suggests that these practices are used much more frequently in situations not supported by the guidelines (Ryan et al., 2007). The 2020–21 Civil Rights Data Collection (CRDC) reveals the number of students reported to be secluded or restrained in U.S. public schools, which was 52,800 (U.S. Department of Education, 2023). However, as acknowledged in the report, this was during the coronavirus pandemic, which altered educational conditions. A few years prior, the federal data from 2017-18 measured 101,990 cases of seclusion and restraint (U.S. Department of Education, 2020). Even before the introduction of virtual learning, this number is expected to be a vast underrepresentation due to the process of schools’ self-reporting seclusion and restraint events to the federal government, and the subsequent underreporting (U.S. Government Accountability Office, 2019). 

For instance, one situation from 2019 involved a second grader in Wake County who was secluded in a small room and repeatedly hurt himself to the extent that blood was visibly scattered on the floor and walls (Clasen-Kelly, 2024). This damaging and severe event did not reach the U.S. Department of Education, as this school district reported zero cases of seclusion and restraint for that year. This serious lapse in reporting emphasizes the need for school districts to have accountability and transparency in self-reported data. The use of seclusion and restraints has already been banned in multiple states and school districts as a result of investigations by the Department of Justice and journalists (U.S. Department of Education, 2025; Civil Rights Division, 2022).

Mental Health Impacts

In a study using a stratified random sample of roughly 20,000 adolescents in grades 7 through 12, across 132 schools, researchers found empirical evidence that youth who were suspended and expelled demonstrated greater depressive symptoms in adulthood compared to youth who did not experience any exclusionary discipline (Angton et al., 2024). Based on these findings, the researchers concluded that adverse school-related mechanisms are early life stressors with the potential to contribute to mental health outcomes throughout one’s future (Angton et al., 2024). They also called upon future researchers to include adverse school experiences when evaluating the relationship between ACEs and mental health patterns (Angton et al., 2024). 

The impacts and predictive patterns of punitive discipline are immense. For example, evidence indicates that students who experience out-of-school suspension and expulsion have up to 10 times greater likelihood of ultimately dropping out of high school than those who do not experience exclusionary discipline (King, 2016; American Academy of Pediatrics Council on School Health, 2013). Not completing high school not only reduces offers for employment and opportunities for social mobility, but also directly impacts the risk of poor mental health. Barriers to seeking mental health care may include a lack of mental health literacy, stigma, financial limitations, and a lack of social support (Gulliver et al., 2010; Rickwood et al., 2005). Understanding limited access to care is significant, as untreated conditions, such as depression or anxiety, are closely linked to self-harm (Singhal et al., 2014). In an investigation using data from the 2010 National Survey on Drug Use and Health, high school dropouts were two times more likely to report attempting suicide than their high school graduate counterparts, highlighting how educational factors and insufficient support intersect to increase mental health risk (Maynard et al., 2014).

High-Risk Behaviors

Beyond punitive discipline having links to academic, social, and mental health consequences, it is also associated with high-risk behaviors, such as substance abuse, alcoholism, and sexual risk behavior (Olajide et al., 2022). These actions are all shown to increase the likelihood of illness, injury, or premature death. Matters of risky health behaviors and punitive discipline are intertwined and indicate reciprocity, even at the school environment level. For instance, a study examining correlations between a school’s average substance use and risk factors found that smoking, binge drinking, and cannabis use being just a single standard deviation higher were associated with 16%, 18%, and 21% higher subsequent prevalence of total discipline, respectively (Prins et al., 2021). Additionally, higher violence/harassment was associated with 5% higher total discipline (Prins et al., 2021). In this study, the actions defined as discipline were both exclusionary and police-involved events. 

The issue is cyclic, as research indicates that young people who smoke and drink alcohol from an early age are more likely to be excluded from school, but it is unclear how the behaviors contribute to each other (King, 2016). At an individual level, substance abuse and punitive discipline also have a reciprocal relationship where experiencing one increases a student’s risk for the other. Data from the National Longitudinal Study of Adolescent to Adult Health reveal that students reporting substance use had 2.07 times greater odds of reporting subsequent school discipline, and students exposed to school discipline had 1.59 times greater odds of reporting subsequent substance use (Prins et al., 2023). 

Engaging in sexual risk behaviors is regarded as a significant threat to individual health (Bozzini et al., 2020). One study, using data from the National Longitudinal Study of Adolescent and Adult Health, explored whether suspension predicts a positive test for chlamydia, gonorrhea, or trichomoniasis in a urine sample (Rosenbaum, 2020). The researchers found that suspended youth had 2.87 times the odds of testing positive for trichomoniasis 5 years later compared to matched non-suspended youth, indicating that suspension is positively associated with Sexually Transmitted Infection (STI) risk (Rosenbaum, 2020). 

Educational attainment is one of the strongest protective factors against engaging in high-risk behaviors (Viinikainen et al., 2022). If a student experiencing difficulty is not meeting behavioral expectations and this is misinterpreted as intentional disruption, this student may be met with punitive and exclusionary discipline. This can make educational attainment increasingly difficult for this student to achieve, as the individual now faces added obstacles. 

Overview of ACEs

The original ACEs study, conducted from 1995 to 1997, provided groundbreaking revelations in terms of the frequency and health impacts of childhood trauma in three categories of childhood abuse (psychological, physical, or sexual) and four categories of exposure to household dysfunction (exposure to substance abuse, mental illness, domestic abuse, or criminal behavior in the household) (Centers for Disease Control and Prevention, 2021a; Felitti et al., 1998). Through categorical childhood traumas in the ACEs study, a correlation was established between trauma and risks of chronic disease, mental illness, and high-risk behaviors in adulthood (Merrick et al., 2019). For example, adverse childhood experiences were significantly associated with depression, smoking, heavy drinking, lower educational attainment, lack of health insurance, and unemployment, similar to the negative health and social patterns that can be seen with adverse school experiences, such as punitive discipline (Merrick et al., 2019). 

In the decades following the results of the ACEs study, a substantial amount of research was done to better understand childhood trauma and its long-term associations with health. This led to tools such as the ACE-THL questionnaire, adapted in Finland, looking at both adverse childhood experiences as well as protective experiences (Hietamäki et al., 2023). The protective factors involved relationships and self-worth, reflected through questions such as: “I had an adult who I could talk to about my own matters” and “I was appreciated and considered important at home” (Hietamäki et al., 2023). Another route of ACE expansion includes peer victimization, bullying, isolation from peers, and violent community environments (Finkelhor et al., 2015). Through this perspective, punitive and exclusionary discipline (involving isolation, potential violence, and often leading to peer victimization) can be understood as fitting within the broader ACE framework that is proven to disrupt safety, belonging, and healthy development. There have also been international scales to this measure, reported by the World Health Organization as the ACE International Questionnaire, or ACE-IQ, which is intended for global distribution to inform interventions that limit ACEs (World Health Organization, 2020). The development and advancement of these tools in numerous studies has led to a more nuanced understanding of how environments and trauma correlate to various health outcomes. One qualitative longitudinal research project found a causative relationship between traumas in young people’s lives and experiencing exclusion at school (King, 2016). 

Self-Concept and Worldview 

Framing discipline practices as potential ACEs is important to understanding the direct links between school environments and long-term health risks and inequities. A 2011-2012 study by Johns Hopkins School of Public Health found that in a cohort of 95,677 children, almost half reported exposure to traumatic childhood experiences (Bethell et al., 2014). The impacts of a child’s experiences or trauma at home can have a direct effect on behavior or emotional regulation at school. Notably, out of children affected, resilience, or “staying calm and in control when faced with a challenge,” as defined in their survey, was a trait associated with reducing the negative impact of adverse childhood experiences (Bethell et al., 2014). For example, in terms of school engagement, higher rates were found among children with adverse childhood experiences who demonstrated resilience than those who did not (Johns Hopkins Bloomberg School of Public Health, 2014). For children to develop resilience, they should be allowed to work on personal growth and emotional regulation (Marshall, 2021). Responding to children with immediate punishment and implicit labels prioritizes compliance over development, and this undermines opportunities to grow and learn.

Children with higher numbers of ACEs are more likely to experience school disengagement and are disproportionately subjected to punitive discipline (McDoniel & Bierman, 2022; Pierce et al., 2021). Exclusionary disciplinary responses not only tend to contribute to a student’s challenges but can also make educational environments more hostile and isolating to navigate. An excerpt from The Boy Who Was Raised as a Dog, by child psychiatrist Dr. Bruce Perry, highlights the importance of nurturing a child’s potential: “Our genetic gifts will only manifest themselves if we get the proper types of developmental experience, appropriately timed.” (Perry, 2017, p. 130). Even brief or seemingly inconsequential disciplinary measures can be damaging enough to create a shift in a child’s worldview (Mifsud & Sammut, 2023). A worldview is something that develops gradually over time, through observation, experience, and relationships. It is the lens through which we perceive things, and a subconscious framework that guides our actions and decisions. When students are subject to traumatic experiences, their innate worldview and self-concept may be affected as they explore questions like: What kind of person am I? What am I capable of? Where do I belong? (Liao et al., 2025; Niu et al., 2025). This concept of a child’s worldview is discussed extensively by Dr. Bruce Perry and Oprah Winfrey in their book What Happened to You? The central tenet of this book is reframing how we address behavior from focusing on what is wrong with the child to what they have been through. This perspective can lead to growth and behavior change, rather than inadvertently reinforcing a child’s negative self-concept. 

Public Health Concern

From a public health perspective, punitive and exclusionary discipline are preventable adverse experiences with potential harmful health consequences, and should be avoided as much as possible (Mental Health America, 2025). In many instances, suppressing a child’s behavior or placing them in isolation is used as a quick solution to minimize classroom disruption. However, this approach may exacerbate existing challenges or further inhibit the child’s well-being. According to the 2017-2018 report from the U.S. Department of Education, students with disabilities served under the Individuals with Disabilities Education Act (IDEA) made up only 13% of total students, but 77% of those physically restrained and 71% of those secluded (U.S. Department of Education, 2020; National Disability Rights Network, 2012). These practices were also disproportionately used on students of color (U.S. Department of Education, 2020). No matter the intensity of the situation that led to the intervention, seclusion and restraint events in school can lead to anxiety and stress (Harkin, 2014). These practices are neither proven to decrease disruptive behaviors nor to improve students’ emotional well-being (Mental Health America, 2025). On the contrary, they can decrease trust and feelings of safety between a student and an educator. The prefrontal cortex, the brain’s center for higher-order thinking, logic, and learning, is less connected and less functional when someone is feeling unsafe and unseen (Brosschot et al., 2018). Thus, it is surprising that physically restraining and secluding children—which has the potential of serious physical harm—is permitted and actively occurring in K-12 classrooms across the country (National Disability Rights Network, 2012; Harkin, 2014). The U.S. Department of Education has made claims of concern regarding how these practices are maintained, but policy change is needed at a federal level, beyond suggestions and requests (The Council of Parent Attorneys and Advocates, Inc., 2021; U.S. Department of Education, 2025b).

Conclusion 

Results from the original ACEs study shaped the significance of childhood events in relation to adult health behaviors and outcomes. This sparked decades of public health initiatives and research aimed at better understanding and preventing childhood trauma (Choi, 2018; National Governors Association, 2021). Yet, it is not the home environment that distinguishes the impact of childhood trauma, but the sensitive age of children (Grauduszus et al., 2024). Reducing the impact of early childhood trauma requires conditions in school that foster safety, security, and equity. Punitive and exclusionary discipline can serve as ACE-like exposures due to the evidence indicating parallels of deleterious effects. From academic struggles to health-risk behaviors and mental health concerns, punitive discipline functions as a dangerous tool that is overused and disproportionately applied to Black and Brown students, as well as students with disabilities. The importance of understanding punitive discipline in schools as a public health issue, in the same way ACEs have been understood through research, is that associations with health outcomes are preventable and significant. More can be done to reduce the use of punitive discipline in schools, as numerous evidence-based alternatives are available and in practice (Ablon, 2020). One important gap in the literature is the need to understand how exposure to punitive or exclusionary discipline in childhood is associated with the development of chronic physical conditions in adulthood, beyond mental health and behavioral risks. A longitudinal cohort study may be beneficial in understanding these health trajectories. Moreover, future research should examine the specific psychological and physical impacts of punitive and exclusionary practices (Stephens, 2025). Punitive and exclusionary disciplinary measures must be recognized as an ACE-like exposure to fully protect children from the harmful effects of school-based trauma. 

Acknowledgments 

I would like to thank the Alliance Against Seclusion and Restraint’s Founder and CEO, Guy Stephens, and Project Manager Courtney Litzinger, for their invaluable feedback and guidance throughout the development of this literature review.

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