Study highlights negative consequences of exclusionary discipline

Suspending or expelling a student is one of the most severe punishments a school can impose on a student – and it can have lifelong, devastating consequences. In an updated policy statement, the American Academy of Pediatrics recommends a trauma-informed approach to supporting students and reducing the need for exclusionary discipline. 

The policy statement, "School Suspension and Expulsion," published online Oct. 1 during the AAP 2024 National Conference & Exhibition, marks the first update to AAP guidance since March 2013. The policy statement, written by the Council on School Health, will be published in the October 2024 Pediatrics. 

Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics. 

According to the policy, exclusionary practices were first used for more severe behavior like bringing weapons to school. These practices ramped up following zero-tolerance policies put in place in the wake of the federal "War on Drugs" campaign and other federal policing policies.

Data examined while formulating the policy statement showed that from 1973 to 2006, the percentage of students disciplined with suspension or expulsion increased from 3.7% to 6.9% of total student enrollment.

"There is little evidence that zero-tolerance school exclusion policies make schools safer or deter misbehavior, but they do create significant harms for the individual child's mental and physical health," said policy author Susanna K. Jain, MD, FAAP.

Schools are responsible for providing a safe learning environment for all students but it's difficult for students to learn if they aren't in the classroom."

Susanna K. Jain, FAAP

Twenty years of research has shown that suspensions and expulsions don't necessarily lead to altered behavior, considering 28% of students suspended in the 2020-2021 school year were suspended more than once.

In that same school year, there were about 12 times more school shootings with casualties than in the 2000-2001 school year.

A related AAP policy statement, "Early childhood expulsion: Policy guides pediatricians to assist teachers, programs in discouraging harmful practice," published in Oct. 2023 extends the concern to early childhood education and other childcare environments, saying expulsions from these kinds of settings can lead to higher dropout rates, poor academic performance and higher incarceration rates.

Students who are part of marginalized communities, including students with disabilities and LGBTQ+ students, are shown to be disproportionately impacted by exclusionary school discipline policies. 

"We know from research that Black children and adolescents are among those students most severely affected by expulsion and suspension," Dr. Jain said. "When students are not in school, they are more likely to use recreational drugs, engage in fights, and carry a weapon, with potential for increased contact with the juvenile justice system. The school-to-prison pipeline places these children at increased risk of a cycle of incarceration."

The AAP recommends an examination of these disparities as part of collaborative efforts among students, families, pediatric health care providers, educators and those involved in juvenile criminal justice reform to create alternatives to exclusionary discipline practices.

The AAP recommends:

• Pediatricians advocate for increased access to mental health services for all students and support legislation aimed at ensuring children who are suspended or expelled receive education through remote learning or other means
• School-aged children get screened for chronic absenteeism and developmental delays that can make school more difficult
• Schools collect and analyze internal data on exclusionary discipline practices to identify areas of improvement 

Pediatricians and school administration should continue to inform themselves on disparities in school exclusionary practices, particularly for students in the Black and Native communities.

"A multidisciplinary and trauma-informed approach is crucial when working to keep children both safe and educated," said co-author Nathaniel Beers, MD, FAAP. "School administration should take steps to examine what policies are in place and adapt them to better serve students who have experienced trauma."