Inclusive Healing: Trauma Support for Neurodivergent and Youth with Disabilities

Written By The CornerHouse Mental Health Team

There has been a great deal of research and discussion in recent decades about the impact of trauma on children and the ways in which support can be provided to children who have experienced trauma. However, many of the studies and resources currently available do not fully consider the extent to which neurodivergent children and children with disabilities both experience trauma differently from developmentally typical children and often require different types and levels of support following trauma.[1]

How do the experiences of neurodivergent and children with disabilities who experience abuse and neglect differ from those of developmentally typical children?

As Brooke Thomas-Skaf writes: “...The individual experiences of children with disabilities cannot be separated from the operation of ableism and disableism. Ableism and disableism are systems of oppression and marginalization that create the environment in which violence toward children with disabilities occurs – a fact (that is) largely neglected” (2020). Ableism and disableism, like racism, xenophobia, and sexism, are real and present forces that impact the lives and experiences of neurodivergent children and children with disabilities and can intersect with, compound, and even cause experiences of abuse. We know that neurodivergent and disabled children are more likely than their peers to experience abuse, neglect, and other forms of interpersonal trauma (Hoover, 2020). Now we must also acknowledge that the way that the way that trauma is experienced and the ways in which systems and adults respond to this trauma may also likely be impacted by the neurodivergence and/or disability of the child who has been impacted, whether intentional or not.

Neurodivergent and children with disabilities may be especially likely to experience the following symptoms following interpersonal trauma:

Symptoms of Post-Traumatic Stress Disorder, including reexperiencing-type symptoms such as flashbacks, avoidance-type symptoms such as attempting not to think about or acknowledge the experience of trauma, arousal- and reactivity-type symptoms such as outbursts of anger and frustration, and cognition- and mood-type symptoms such as depressed mood or frequent negative thoughts about themself (Mehtar & Mukaddes, 2011; Hoover, 2015; Stough, Ducy, & Kang, 2017)
Suicidal ideation and behaviors, which may be more difficult (functionally and/or emotionally) for children with some diagnoses to communicate (Hoover, 2015)
Self-injurious behaviors (Wigham, Hatton, & Taylor, 2011)
Underreporting of symptoms, including suicidality, both in conversation and formal measures and screenings (Hoover, 2015)
Decreases in “adaptive behaviors”, particularly in initial months following trauma, particularly in the areas of communication, socialization, and daily living skills: This may be more pronounced in some children who are neurodivergent or have a disability and may take longer to return to baseline, with some studies suggesting over a year (Stough, Ducy, & Kang, 2017; Hoover, 2015)

Of course, neurodivergent and children with disabilities are also likely to experience all of the other symptoms that we typically see in children who have experienced trauma, as well. The aforementioned symptoms, however, have been found in the limited body of research available to potentially occur in this population with increased frequency.

How can we better serve and support neurodivergent and children with disabilities who experience abuse and neglect in an appropriate and affirmative way?

After finding out about an experience of abuse or neglect, some adults may attempt to talk to children about the trauma they’ve experienced in the ways that they are most comfortable communicating: Verbally, using indirect and/or metaphorical language, with high levels of eye contact and directly oriented body language, etc. Consider other ways of communicating that may be more appropriate and comfortable for the child that you are communicating with:

Offer paper and writing implements to write or draw responses
Be prepared to engage with an interpreter for children who may feel more comfortable communicating through American Sign Language than through spoken language (This applies not only to deaf and hard-of-hearing children, but also to children with other disabilities who may find ASL to be an easier method of communication)
Ensure that children who use adaptive technology to communicate
Provide ways for children to create a physical sense of safety and comfort for themselves while discussing a frightening topic (i.e. letting them face away from you while you talk, helping them make a “blanket fort” between two chairs to give them their own contained space, orient your own body language slightly away from the child and reduce eye contact if it appears to make the child uncomfortable).
Use simple, developmentally appropriate language when engaging with children and determine what language is developmentally appropriate based on the way the child typically communicates, with the understanding that adjustments may still need to be made during conversation as children’s communication styles can be impacted and interrupted by trauma
For mental health professionals and others performing assessments, try not to rely too heavily on standardized assessment tools, techniques, and measures, especially if their results don’t appear to correlate with what the child and/or family are reporting

Due to the potential increase in likelihood of suicidal ideation and self-harm, along with that of underreporting symptoms, safety planning may be an appropriate intervention even when risk is not immediately reported. Safety plans may even be introduced using a different name, such as a “Self-Care Plan”, when risk has not been indicated in order to reduce the stigma that children and family members may feel attached to the original term. When safety planning, remember to focus on interventions and tools that the child and family members will be able and willing to use in times of need. If a child is highly uncomfortable speaking, for instance, advising them to call a hotline is likely not appropriate, and a text-based service would likely be a much better fit.

Remember that behavior is communication. As is true for all children, and adults for that matter, behavior is one of many tools that neurodivergent and children with disabilities may use to communicate that they are feeling distressed, uncomfortable, highly activated, etc. When a child reacts to certain stimuli, however benign they may seem, with a notable change in behavior, pay attention to that and work to understand what this child is communicating through their behavior. Work to accommodate and affirm the needs that the child is expressing, rather than attempting to talk them into being okay with the situation, even if the behavior feels disruptive and/or the situation at hand seems harmless to you and others.

Validate and affirm children as much as possible, both in direct relation to their experiences and reactions to trauma, and in their day-to-day lives. When a child feels seen, held, and accepted for who they are and what they need, they will have the best possible chance at healing from their experiences of trauma. Even when we don’t completely understand, we can always validate, affirm, and offer acceptance.

[1] Note: For the purposes of this paper, I will discuss neurodivergent children and children with disabilities as one population. While there are of course many differences in both the experiences and needs of children and adults with various types of neurodivergence and/or disability, the research cited in this paper largely discusses core forms of neurodivergence (i.e. ADHD, Autism, etc.) under the larger umbrella of disability.

References

Hoover, D. W. (2015). The effects of psychological trauma on children with autism spectrum disorders: A research review. Review Journal of Autism and Developmental Disorders, 2(3), 287-299. https://doi.org/10.1007/s40489-015-0052-y

Hoover, D. W. (2020). Trauma in Children with Neurodevelopmental Disorders: Autism, Intellectual Disability, and Attention-Deficit/Hyperactivity Disorder. In Childhood Trauma in Mental Disorders: A Comprehensive Approach (pp. 367-383). Springer International Publishing. https://doi.org/10.1007/978-3-030-49414-8_17

Mehtar, M., & Mukaddes, N. M. (2011). Posttraumatic stress disorder in individuals with diagnosis of autistic spectrum disorders. Research in Autism Spectrum Disorders, 5(1), 539–546. https://doi.org/10.1016/j.rasd.2010.06.020

Stough, L. M., Ducy, E. M., & Kang, D. (2017). Addressing the Needs of Children With Disabilities Experiencing Disaster or Terrorism. Current psychiatry reports, 19(4), 24. https://doi.org/10.1007/s11920-017-0776-8

Thomas-Skaf, B. A., & Jenney, A. (2020). Bringing Social Justice Into Focus: “Trauma-Informed” Work With Children With Disabilities. Child Care in Practice, 27(4), 316–332. https://doi.org/10.1080/13575279.2020.1765146

Wigham, S., Hatton, C., & Taylor, J. L. (2011). The effects of traumatizing life events on people with intellectual disabilities: A systematic review. Journal of Mental Health Research in Intellectual Disabilities, 4(1), 19–39. https://doi.org/10.1080/19315864.2010.534576

Related Resources

Inclusive Healing: Trauma Support for Neurodivergent and Youth with Disabilities