POPARD Podcast with Lynn Savoie, District Behaviour Specialist, SD 36
Lynn Savoie has a M.A. in Counselling Psychology and currently works for Surrey School District as a District Behavior Specialist. Prior to working for Surrey, she was a POPARD consultant and a clinician for Child and Youth Mental Health. Lynn has spent the last twenty years working with neurodiverse students in public education, residential care, mental health clinics and non-profits, providing direct service, assessment and treatment and consultation. She is certified to administer the CCI (which is a developmentally sensitive, trauma-focused intervention planning tool for children and youth), a registered facilitator for PEERS ( Program for the Education and Enrichment of Relational Skills), Connect Parent, Low Arousal Training and a trained counsellor in Trauma Informed CBT, DBT and Play therapy.
Episode 1: Definition and Diagnosis of Trauma
This episode provides a definition of trauma and complex trauma and explains what an ACE (Adverse Childhood Events) score is and the impact of ACEs on adult health outcomes. This episode also introduces the listener to the toxic stress response.
May 2023 3 min 42 sec
General Books on Trauma
Burke-Harris, N (2018). The deepest well: Healing the long-term effects of childhood adversity. Haughton Mifflen Harquort.
Geddes, C. (2022). Children and Complex Trauma: A Roadmap for Healing and Freisen Press.
Levine, Peter A. (1997). Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. Berkeley, Calif., North Atlantic Books.
Levine P., & Kline, M. (2006). Trauma through a child’s eyes: Awakening the ordinary miracle of healing. North Atlantic Books.
Nakazawa, D.J. (2015). Childhood disrupted: How your biography becomes your biology, and how you can heal. Atria Books.
Perry, B. D., & Szalavitz, M. (2006). The boy who was raised as a dog and other stories from a child psychiatrist’s notebook: What traumatized children can teach us about loss, love, and healing. Basic Books.
Perry, B.D & Winfrey, O. (2021). What happened to you? Conversations on trauma, resilience, and healing. Flatiron Books.
Van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
Siegel, D. J. & Payne Bryson, T. (Eds) (2003). Healing Trauma: Attachment, Mind, Body, And Brain.W. Norton and Company.
Wolynn, M. (2017). It didn’t start with you: How inherited family trauma shapes who we are and how to end the cycle. Penguin Books.
Episode 2: The Impact of Complex Trauma on a Child
This episode describes typical brain development and a healthy attachment relationship between an infant and their caregiver, and contrasts that to an infant who has experienced complex trauma and disrupted attachments. The impact of the toxic stress response on an infant’s limbic system and brain development is discussed.
May 2023 4 min 31 sec
Websites about Complex Trauma & Attachment
Complex Trauma Resources
This website was created by Dr. Chuck Geddes and his team at Complex Trauma Resources. It provides a very comprehensive hub of information on complex trauma for parents, educators, and other professionals. There are many free articles and videos to watch as well as the opportunity to sign up for a free membership to access a wide variety of videos on assessment, treatment, and school plans for students with complex trauma.
ChildTrauma Academy
This website was created by Dr. Bruce Perry who is a clinician, researcher, and teacher for over thirty years. His clinical research and practice focus on examining the long-term effects of trauma in children, adolescents, and adults and has been instrumental in describing how traumatic events in childhood change the biology of the brain. This website a library with a number of free and helpful articles and papers about trauma and child development.
NeuroSequential Network
This is a website created by a number of trauma specialists and clinicians led by Dr. Bruce Perry and focuses on his Neurosequential model. The neurosequential model it is a way to organize a child’s history and current functioning. The goal of this approach is to structure assessment of a child, the articulation of the primary problems, identification of key strengths and the application of interventions (educational, enrichment and therapeutic) in a way that will help family, educators, therapists, and related professionals best meet the needs of the child. This website offers comprehensive online training as well as options to book an in-person presentation on Dr. Perry’s neurosequential model.
Neufeld Institute
The website was created by Dr. Gordon Neufeld who is a clinician and researcher in the field of child development and attachment. The website offers free written resources and online courses for a small fee for parents, teachers, and other professionals. The content is offered in multiple languages and covers a wide range of content based on Dr. Neufeld’s attachment-based developmental approach. Course topics range from general workshops (e.g. Helping children grow up) to more specific topics (e.g., making sense of anxiety).
Mindinsight Institute
This website is created by the mindsight institute lead by Dr. Dan Segal. It offers lots of courses on trauma, attachment and neurobiology. There is a very comprehensive list of online courses available on topics ranging from general child development to the effect of toxic stress on a child’s developing brain. The majority of the courses are taught by Dr. Segal, and they offer a wide variety of course formats, duration, and prices.
Episode 3: The Impact of Trauma on Child-Teen Behaviour and How it Manifests in a School Environment
This episode describes the most common trauma responses, and how these responses impact behavioral symptoms we see in children who have experienced complex trauma. The specific behaviors related to each type of trauma responses is described.
May 2023 4 min 16 sec
Books about Trauma for Children & Youth
Haines, S & Standings, S. (2015 ). Trauma is really strange. Singing Dragon
Herman, S. ( 2015). Help your dragon cope with trauma. A Cute Children Story to Help Kids Understand and Overcome Traumatic Events. Digital Golden Solutions.
Karst, P. (2001). The invisible string. DeVorss.
Redford, A, (2015). The boy who built the wall around himself. Jessica Kingsley Publishers.
Steele, W. (1999). Trauma is like no other experience: a short booklet for teens. Starr Commonwealth.
Westcott, A., Hui, C. (2017). Bomji and Spotty’s frightening adventure: A story about how to recover from a scary experience. Jessica Kingsley Publishers.
Westcott, A., Hui, C. (2017). How little coyote found his secret strengths: A story about how to get through hard times. Jessica Kingsley Publishers.
Westcott, A., Hui, C. (2017). How sprinkle the pig escaped the river of tears: A story about being apart from a love one. Jessica Kingsley Publishers.
Episode 4: Trauma Informed Schools
An overview of the main principles embraced by trauma informed schools is presented. The PEACE acronym is used as a framework (Predictability, Emotional education, Attuned relationships, Calm people and spaces and empowerment). Many practical strategies are discussed that can be implemented in both classroom and school environments.
May 2023 10 min 32 sec
Trauma-Informed Books for School Professionals
The books in this section describe how schools can embrace a trauma-informed practice at all levels of the environment (class, school, district) and for all children. They provide a description of the specific impact complex trauma has on student’s emotions and behaviors in the school building and offer lots of strategies and interventions for teaching professionals to use. Many also discuss the general principles and perspective that school staff members need to understand and implement within their practice to provide trauma -informed support.
Alexander, Jen. (2019). Building trauma sensitive schools. Brookes Publishing.
Sorrels, B. (2015). Reaching and teaching children exposed to trauma. Gryphon House.
Jennings, P. A. (2019). The trauma sensitive classroom: Building resilience with compassionate teachers. W. Norton and company.
Rossen, E., & Hull, R. ( Eds.) (2013). Supporting and educating traumatized students: A guide for school-based professionals. Oxford.
Sporleder, J., & Forbes, H.T. ( 2016).The trauma-informed school: A step-by-step implementation guide for administrators and school personnel. Beyond Consequences Institute.
Episode 5: Autism and Trauma – The differences and Similaries between these Diagnoses
This episode begins by clarifying the differences and similarities between ASD and TSRD (Trauma and Stressor Related Disorders) in terms of their behavioral presentation. Further discussion outlines the differences in creating a school-based behavior plan for a child with ASD as opposed to a child with TSRD. Therapeutic options for children with ASD are compared to therapy options for children with TSRD.
May 2023 9 min 02 sec
What type of therapy is available for my child/teen with complex trauma?
There are a variety of different therapy options for children and teens who have experienced complex trauma. The type, duration and counsellor will depend on several variables including the child’s current age and at what age they experienced the trauma (as this impacts the type of damage that has been done to their brain), and their cognitive and communication abilities. An additional pragmatic consideration is the availability and type of therapy in the area. One of the most important things to remember is that everyone needs to feel safe and comfortable talking to the therapist and asking questions. Client-therapist match is one of the most important variables related to positive outcomes in any therapeutic process and this relational aspect, beyond the technique used by the therapist, cannot be overlooked. Don’t be afraid to switch to a different therapist if the first one isn’t a good fit for your family.
Trauma-Focused Cognitive Behavioural Therapy (TF-CBT)
This is the most common type of therapy offered to children and teens withcomplex trauma. In TF-CBT the therapist uses a combination of techniques. They usually begin with a focus on relaxation training and then proceed to some form of trauma narrative (discussion of the traumatic experience and examination and reprocessing of thoughts, feelings and behaviours associated with the experience) or in vivo exposure (a cognitive form of systematic desensitization). This would involve the client talking about the trauma or visualizing it in a safe place, using relaxation and other coping strategies. TF-CBT would also include some key features of CBT like cognitive coping and re-framing strategies (training their brain to think differently about the trauma). This type of therapy is flexible enough to be adapted to a wide age group (3 to 18). It does require the client to have at least low average level cognitive and language processing abilities including both receptive and expressive communication abilities. In addition, they must be able to retrieve and express some memory of the traumatic experiences (Pollio & Deblinger 2017). Parents and caregivers are key partners in the therapeutic process.
Further Reading:
Pollio, E. & Deblinger, E. (2017). Trauma-focused cognitive behavioural therapy for young children: clinical considerations, European Journal of Psychotraumatology, 8:sup7, DOI: 10.1080/20008198.2018.1433929
Cognitive Processing Therapy (CPT)
This therapy is frequently used with adults with PTSD but has recently been adapted for use with teens with good outcomes (Lavoie, Murphy & Resik, 2021). It involves teaching the teen to evaluate their cognitions using Socratic questioning and a series of progressive cognitive coping skills. The aim of this therapy is to help the client challenge and change unhelpful thoughts that they are maintaining about the negative event. This therapy can be done without the parent or caregiver and can be faster and more effective for a motivated client. Consistent with all forms of cognitive therapies, at least low average cognitive and communication abilities are required for the client to understand, participate and benefit from this form of therapy.
Further Reading:
LoSavioe T., Murphy, R.A., and Resick, P., (2021). Treatment outcomes for adolescents versus adults receiving cognitive processing therapy for posttraumatic stress disorder during community training. Journal of Traumatic Stress, 0, p 1-7.
Resick, P. A, Stirman, S. W., and LoSavioe, S. T. (2023). Getting Unstuck from PTSD: Using cognitive processing therapy to guide your recovery. Guildford Publications.
Eye Movement Desensitization and Re-processing Therapy (EMDR)
This therapy involves the therapist asking the client to hold a specific aspect of the traumatic event in their mind, while focusing on the movement of the therapist’s hands. The therapist’s hands will be moving back and forth or sometimes engaging in rhythmic tapping and the client will follow their hand movements with their eyes. The aim is to help the person’s brain release and /or re-process the traumatic memory through rapid eye movements. For some people, EMDR may yield results faster than other forms of therapy, such as talk therapy. EMDR can also be combined with other types of therapy. It does require the client to have at least low average level cognitive and language processing abilities including both receptive and expressive communication abilities.
Trauma Institute & Child Trauma Institute. (2015). Eye movement desensitization & reprocessing. Retrieved from https://www.ticti.org/treatment/emdr-therapy/.
Beckly-Forest, A. and Monaco, A. (2016). EMDR and the art of psychotherapy with children: Infants to adolescents Second Edition. Springer Publishing.
Somatic Therapy
Somatic therapy is an umbrella term for therapies that center on the mind-body connection. Somatic therapy focuses on how the emotions related to trauma can physically build up and impact the body. Somatic therapy uses techniques that focus on the physical body like developing body awareness, self and emotional regulation strategies, sensorimotor integration, physical movement, and grounding techniques to help a traumatized individual’s body recover from physical and mental health symptoms. There are a wide variety of somatic therapies that are used to treat children and teens with complex trauma.
Further Reading:
Kuhfuß M, Maldei T, Hetmanek A, Baumann N. (2021) Somatic experiencing – effectiveness and key factors of a body-oriented trauma therapy: a scoping literature review. European Journal of Psychotraumatology. 12;12(1), 1-17.
Finn, H., Warner, E., Price, M., & Spinazzola, J. (2018). The boy who was hit in the face: The role of somatic regulation and trauma processing in treatment of preverbal complex trauma. Journal of Child & Adolescent Trauma.11(3), 277-288.
Warner, E. Finn, H., Westcott, A., & Cook, A. (2020). Transforming trauma in children and adolescents: An embodied approach to somatic regulation, trauma processing and attachment building. North Atlantic Books.
Parent-Child Interaction Therapy (PCIT)
This is a play-based therapy which promotes positive parent-child relationships and teaches parents effective behavioral management strategies. In PCIT there are two main components to the therapy. The first component involves the therapist facilitating a child -directed interaction with the parent to help build positive play skills and a positive parent-child connection. The second component called parent-directed interaction, involves the therapist helping the parent establish clear boundaries and give effective and direct instructions. This helps the parent practice setting appropriate limits with their child with feedback and guidance from the therapist.
Further Reading:
Bodiford McNeil, C and Hembree-Kigin , T. ( 2011) Parent-Child Interaction Therapy. Springer.
Play Therapy
In play therapy, the therapist provides a room full of different types of toys and encourages the child to explore their thoughts and emotions through play. At first the play is non-directive as the child learns to relax, explore the available toys, and build a relationship with the therapist. After the child develops a sense of trust with the therapist and seems relaxed during the therapy sessions, the therapist creates a more directed type of play designed to elicit specific emotions and thoughts related to the trauma they have experienced.
Further Reading:
The Association for Play Therapy Board of Directors. (2020). Why Play Therapy is appropriate for children with symptoms of PTSD”. April.
Creative Therapy
Creative therapies can help boost mental health and support healing from trauma. They can take many forms, including dance, drama, music, writing, and creative art. The premise behind this type of therapy is that a person can use forms of communication other than talking to express their emotions, develop self awareness, and cope with stress. Through exploring their creativity people can look for or be aided to identify themes and conflicts that may be affecting their thoughts emotions and behavior. Creative therapies may be particularly appealing and appropriate to use with children and teens who struggle to express themselves via verbal language.
Further Reading:
Malchiodi, Cathy. (2008). Creative Interventions with Traumatized Children. Guilford Press.
Kagen, Richard. (2017) Real Life Heroes Life Storybook. 3rd Edition. Routledge.
Episode 6: Autism and TSRD – Children who have a Co-Morbid Diagnosis
The episode talks about children with ASD who also have been exposed to trauma and may have symptoms of TSRD. Although there is not a lot of research in this area, some preliminary findings around the vulnerability of children with ASD to trauma is presented as well as ongoing research in this area.
May 2023 5 min 13 sec
Annotated Bibliography
Autism and Trauma
Empirical investigations of trauma and post-traumatic stress disorder (PTSD) in individuals with autism spectrum disorder (ASD) in their infancy. Some research indicates that individuals with ASD are at increased risk for exposure to potentially traumatic events but the type and impact is still being investigated. Research on the treatment of Trauma and Stress Related Disorders in people with ASD is even more limited and tends to focus on the adult population. The following articles represent some of the current studies related to children with ASD who also have experienced traumatic events. There is critical need for additional and more comprehensive research in this area.
References:
Berg KL., Cheng-Shi, S., Kruti, A. Stolback, B.C., Msall, M.E. (2016). Disparities in adversity among children with autism spectrum disorder: a population-based study. Developmental Medicine & Child Neurology, 58,1124–1131.
This therapy is frequently used with adults with PTSD but has recently been adapted for use with teens with good outcomes (Lavoie, Murphy & Resik, 2021). It involves teaching the teen to evaluate their cognitions using Socratic questioning and a series of progressive cognitive coping skills. The aim of this therapy is to help the client challenge and change unhelpful thoughts that they are maintaining about the negative event. This therapy can be done without the parent or caregiver and can be faster and more effective for a motivated client. Consistent with all forms of cognitive therapies, at least low average cognitive and communication abilities are required for the client to understand, participate and benefit from this form of therapy.
Berg KL., Cheng-Shi, S., Kruti, A. Stolback, B.C., Msall, M.E. (2016). Disparities in adversity among children with autism spectrum disorder: a population-based study. Developmental Medicine & Child Neurology, 58,1124–1131.
The purpose of this study was to identify and compare the prevalence of + among families of children with and without ASD, using a population-based sample. Children with ASD reported a significantly higher level of exposure to neighborhood violence, parental divorce, traumatic loss, poverty, mental illness and substance abuse in the family. These situational indicators of stress and trauma experienced by the family are called adverse childhood experiences (ACE). The data was taken from the National Survey of Child Health and analyzed to estimate prevalence of ACEs among families of children with and without ASD, age 3 to 17 (Overall sample size was 1 165 34, of which 1611 were children with ASD). The child’s ASD status was obtained from parent report; ACEs were assessed with the modified Adverse Childhood Experiences Scale. Bivariate and multinomial logistic regression analyses were utilized to investigate the relationship between ACEs and childhood ASD status. ASD status among children was significantly and independently associated with higher probability of reporting one to three ACEs. The number of ACES is linearly corelated with adverse health outcomes, the more ACES a person experiences the higher the chance of poor adult health outcomes. The authors concluded that children with ASD may experience a greater number of family and neighborhood adversities, potentially compromising their chances for optimal physical and behavioral health.
Bitsika V., Sharpley C. F. (2014). Understanding, experiences, and reactions to bullying experiences in boys with an autism spectrum disorder. Journal of Developmental and Physical Disabilities, 26, 747–761.
In this study forty-eight high-functioning boys with an ASD, and their mothers, completed an online questionnaire about various aspects of bullying. The boys demonstrated an understanding of the behaviour that constitutes bullying that was consistent with the wider literature, enhancing the validity of their responses about their experiences. These boys reported ineffective coping strategies for bullying, and many reported significant physical and emotional negative reactions. Many boys found that telling adults made their bullying experiences worse, and most kept their bullying experiences to themselves until they reached home, then adopting a range of negative (tantrums) and positive (staying alone to calm down) coping behaviours. Unfortunately, over half of these boys sought to absent themselves from school as their preferred method for coping with their bullying experiences. These findings have major implications for interventions within schools to reduce bullying of children with ASD.
Haruvi-Lamdan N., Horesh D., Golan O. (2018). PTSD and autism spectrum disorder: Co-morbidity, gaps in research and potential shared mechanisms. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 290–299.
In this article the authors explored several pathways that may link trauma and autism. First, they suggest that autism spectrum disorder (ASD) may serve as a vulnerability marker for posttraumatic stress disorder (PTSD), by increasing the risk for exposure to traumatic events. Second, they suggest that PTSD, once it has appeared, may exacerbate certain ASD symptoms, for example, through maladaptive coping strategies and reduced help-seeking. Third, they suggest that there may be shared underlying mechanisms for PTSD and ASD, including neurological abnormalities associated with both disorders, as well as cognitive and behavioral mechanisms, such as increased rumination, cognitive rigidity, avoidance, anger, and aggression. In addition, the unique characteristics of ASD may determine which events are experienced as particularly traumatic (e.g., social insults and degradation, sensory overstimulation, abrupt changes in known routines) and affect both the manifestation and severity of posttraumatic sequelae among diagnosed individuals. The authors conclude that there is a pressing need for more PTSD-ASD research, focusing not only on the prevalence of traumatic stress in individuals with autism, but also on their potentially unique perception of traumatic events, particularly from the social sphere.
Fogler J.A. & Phelps R.A. (Eds.) Trauma, autism, and neurodevelopmental disorders: Integrating research, practice, and policy. Springer.
This book examined the diagnostic overlap and frequent confusion between autism spectrum disorders and other developmental disorders and trauma and stress related disorders (TSRDs). These conditions are similar in that both conditions have pervasive effects on the brain and development, and both may result in the child exhibiting challenging behaviour. The differences in etiology,progression and specific presentation, however, are distinct and significant in terms of treatment and school and home interventions. Each chapter is written by different authors, and they cover presentation, diagnosis, interventions (both school and therapeutic), important new research findings in both areas, and research and assessment suggestions for children with co-morbid conditions.
Fuld, J. (2018). Autism Spectrum Disorder: The Impact of Stressful and Traumatic Life Events and Implications for Clinical Practice. Clinical Social Work Journal. 46,210–219
The purpose of this paper was to review research on traumatic and stressful life events as they impact mental health in individuals with ASD. As social workers and other clinical professionals typically focus behavioural interventions with people with ASD to address the symptoms related to their primary struggles with social skills and communication, they may be ignoring the presence and impact of stress and trauma. The research reviewed in this paper suggests the need for a shift in the way social work practitioners conceptualize and approach work with this population, such that the presence and impact of stress and trauma is considered as part of the assessment and treatment planning process. In the conclusion, future directions for research are outlined including how to better understand the risk and resilience factors associated with the impact of stress and trauma on mental health in people with ASD and the need to develop effective assessment strategies and trauma-focused clinical interventions to improve their mental health.
Hoover, D.W., & Kaufman, J. (2018). Adverse childhood experiences in children with autism spectrum disorder. Current Opinion in Psychiatry 31(2), 128-132.
This paper reviewed recent studies examining the rates of bullying, adverse childhood experiences (ACEs), and reports of maltreatment among children with ASD. They summarized key research findings on this topic. Their main conclusions are that children with ASD are bullied at a rate of three to four times more than neurotypical children, that children with ASD are also at enhanced risk for other ACES (especially divorce and poverty) and that the more ACES they had, the later in life they were diagnosed with ASD. There was no evidence to indicate that children with ASD are more likely to be abused or neglected by their parents. They concluded that there is a need for additional research in this area to determine appropriate assessment and interventions with children with ASD and TSRD.
Hoover D.W., & Romero, E.M.G. (2019). The Interactive Trauma Scale: A web-based measure for children with autism. Journal of Autism and Developmental Disorders, 49(4),1686-1692.
This study examined the feasibility, acceptability, and psychometric characteristics of a web-based touchscreen app prototype designed to assess self-reported trauma exposure and symptoms in children with autism spectrum disorder (ASD). The prototype was piloted with twenty clinically referred children previously diagnosed with ASD and having various known trauma exposures. User satisfaction and reported ease of use was high. The measure was sensitive to reports of teasing and bullying, endorsed by 75% and 70% of participants, respectively. Validity was assessed via comparisons with the UCLA Posttraumatic Stress Disorder Reaction Index and analysis of participants’ trauma exposures and symptoms. Clinical implications are discussed including issues of trauma screening, diagnosis, and treatment planning for traumatized youth with ASD.
Kerns, C.M, Newschaffer, C.J., & Berkowitz, S.J (2015). Traumatic Childhood Events and Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 45, 3475-3486.
This paper explored the idea that children with Autism Spectrum disorder may be more likely to both encounter traumatic events and develop traumatic sequelae, while also acknowledging that this topic has been understudied. The authors considered the rationale for examining traumatic events and related symptomology in individuals with ASD and reviewed the limited research in this area. A conceptual framework for considering the interplay between ASD, early trauma and trauma symptoms is presented as well as recommendation for future research in this area.
Maïano, C., Normand, C.L., Salvas, M., Moullec, G., Aimé, A. (2016) Prevalence of school bullying among youth with autism spectrum disorders: A systematic review and meta-analysis. Autism Research. 9(6):601–615.
The purpose of this meta-analysis was to: (a) assess the proportion of school-aged youth with ASD involved in school bullying as perpetrators, victims or both; (b) examine whether the observed prevalence estimates vary when different sources of heterogeneity related to the participants’ characteristics and to the assessment methods are considered; and (c) compare the risk of school bullying between youth with ASD and their typically developing (TD) peers. A systematic literature search was performed, and seventeen studies met the inclusion criteria. The resulting pooled prevalence estimate for general school bullying perpetration, victimization and both was 10%, 44%, and 16%, respectively. Pooled prevalence was also estimated for physical, verbal, and relational school victimization and was 33%, 50%, and 31%, respectively. Moreover, subgroup analyses showed significant variations in the pooled prevalence by geographic location, school setting, information source, type of measures, assessment time frame, and bullying frequency criterion. Finally, school-aged youth with ASD were found to be at greater risk of school victimization in general, as well as verbal bullying, than their typically developing peers.
Peterson, J., Earl, R.K, Fox, E., Ma, R., Haidar, H., Pepper, M., Berliner, H., Arianne S., Wallace R., & Bernier, R. B. (2019). Trauma and Autism Spectrum Disorder: Review, Proposed Treatment Adaptations and Future Directions. Journal of Child & Adolescent Trauma. 12,529–54
This paper provided a review of the literature related to ASD and Trauma. It included recommendations for adapting current evidenced-based, trauma-specific interventions, specifically trauma-focused cognitive behavioral therapy (TF-CBT), for individuals with ASD based on well-established and evidence-based practices for working with this population. Future directions are discussed, including the development of instruments measuring trauma reactions in ASD, empirical investigations of modified trauma interventions for children with ASD to evaluate effectiveness, and collaboration between professionals specializing in ASD and trauma/PTSD to advance research and facilitate effective intervention.
Roberts AL, Koenen KC, Lyall K, Robinson EB, Weisskopf MG. (2015). Association of autistic traits in adulthood with childhood abuse, interpersonal victimization, and posttraumatic stress. Child Abuse & Neglect. 45, 135–142. doi: 10.1016/j.chiabu.2015.04.010.
This paper examined retrospectively reported prevalence of childhood abuse, trauma victimization and PTSD symptoms by autistic traits among adult women in a population-based longitudinal cohort using the Nurses’ Health Study II (N=1,077). Autistic traits were measured by the 65-item Social Responsiveness Scale. Women in the highest versus lowest quintile of autistic traits were more likely to have been sexually abused (40.1% versus 26.7%), physically/emotionally abused (23.9% versus 14.3%), mugged (17.1% versus 10.1%), pressured into sexual contact (25.4% versus 15.6%) and have high PTSD symptoms (10.7% versus 4.5%). Childhood abuse exposure partly accounted for elevated risk of PTSD in women with autistic traits.
What is Complex Trauma?
Complex trauma is when a person is exposed to multiple traumatic events, ongoingly, and continually. The traumatic events are invasive and interpersonal, and the person feels like they are going to die or be seriously physically or psychologically injured. Some examples are frequent physical or sexual abuse, ongoing exposure to domestic violence, or continuous bullying.
What is the difference between a Trauma and Stressor Related Disorder and Post Traumatic Stress Disorder?
Trauma and Stressor related disorders is a new global category in the Diagnostic and Statistical Manual for disorders related to exposure to trauma. Some of the mental health disorders listed under this category include PTSD, Acute Stress Disorder and Reactive Attachment Disorder. The various disorders listed under this global category may differ in specifics, like time of onset, duration of symptoms or presentation of symptoms.
How do I know my child is having mental health symptoms related to trauma?
If your child has been exposed to a traumatic event (or a series of them) and you notice they are exhibiting some or all the following symptoms, they may be suffering from a trauma and stressor related disorder:
Nightmares or night terrors
Extremely stressed or dysregulated most of the time.
Hypervigilant (alert to stressors in the environment)
Persistent intrusive thoughts or flashbacks of the traumatic experience
Physical symptoms like chronic stomach aches or headaches
Quick to react to stress with a fight (aggression), flight (bolting or running away) or freeze (withdrawing or seeming to be in a daze) reaction.
What can I ask the school to do to support my child if they have been diagnosed with a trauma and stressor related disorder?
For children suffering from a TSRD, it is important that their school team initially focus on making them feel safe and connected to the adults at school. There are a variety of excellent resources for school professional that describe how to create a trauma informed school with accompanying classroom and school strategies to support your child. Please see this website for a list of books about trauma informed schools and the further information section.
Is my child more susceptible to symptoms from trauma because they also have Autism?
Although there is still not very much research on TSRD in Children with Autism, the available studies indicate that it is highly likely that children with ASD are more vulnerable to the effects of trauma. This may be due to certain aspects of their ASD diagnosis like cognitive rigidity, difficulty with unpredictable events or sensory sensitivities which could make them more sensitive to the stress caused by trauma. This could also be related to the fact that a child with ASD has less access to protective factors like a supportive peer group or the ability to effectively communicate about traumatic events to helpful adults.
How can I get therapy for my child or teen if I think they are experiencing symptoms from trauma?
In most communities there is Child and Youth Mental Health Clinic that provides therapy for children and youth who are struggling with Trauma and Stressor Related Disorders. When you call or visit this clinic describe the trauma your child has been exposed to and the symptoms they are exhibiting, and they will help connect you to a therapist or another supportive agency.
What type of therapy is available?
This will vary depending on the community you live in. Most mental health teams will offer some form of Trauma-focused CBT or Parent-Child Interaction Therapy. There will also be private clinics that may offer EMDR (Eye Movement Desensitization and Re-processing Therapy) or different types of somatic therapies. Please see the list and descriptions of different types of therapies listed on this website.
If my child has ASD, can they also be diagnosed with a Trauma and Stressor related disorder?
Yes, but you will have to make sure you specifically describe the trauma they have been exposed to and differentiate the symptoms of TSRD from his or her symptoms of Autism for the diagnostician. It would also be helpful to ask if there is anyone available who is familiar with Autism and has experience working with children with ASD to do the assessment. Please see the For Further information section on this website to access an excellent guide for therapists working with children who have both ASD and TSRD.
Are there any good books that I can read to my child that might help them understand their feelings related to trauma, and why they are still feeling scared?
Yes, there are some excellent books written for children who have been exposed to traumatic events. Many have a fun and engaging story for children in addition to a tips list for the adults that are helping the child. There are also a few that would be great to read to a whole class to increase general awareness about trauma and the impact if can have. Please see a list of books for children and teens on this website.