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Trauma Informed Care for Persons Who Are NeuroAtypical

~ Define Neuro-Atypical
~ Explore how they may experience the world differently
~ Reflect on experiences not traumatic to people who are neurotypical may be traumatic to those who are neuroatypical
~ Hypothesize about how common parenting practices might be traumatic and overwhelming to the infant/toddler who is neuro-atypical
~ ACEs in individuals who are neuroatypical
~ TIC for people who are neuroatypical

Define Neuro-Atypical
~ “Neurotypical” is a newer term that’s used to describe individuals of typical developmental, intellectual, and cognitive abilities.
~ People who are neuroatypical differ from the general culture in those areas. Examples:
~ Schizophrenia or Schizoaffective Disorder
~ Autism Spectrum Disorders
~ Fetal Alcohol Spectrum Disorders
~ Schizoid and Borderline Personality Disorders?

Sensory Abnormalities Impact on Safety
~ Physical
~ Pain or vulnerability to injury
~ Sensory overload: World may be painful, scary or underwhelming
~ Sleep disruption
~ Affective/Cognitive
~ Emotional lability
~ Difficulty processing stimuli to produce learning experiences (i.e. difficulty processing spoken information due to receptive or attentional deficits) School failure, frequent discipline, low self esteem (Chronic stress and increased glutamate levels)
~ Impaired development of healthy adaptive behaviors (especially for individuals unable to articulate or receive validation for their experiences)

Sensory Abnormalities Impact on Safety
~ Relational
~ Avoidance of activities and social interactions including primary attachment
~ Seemingly disruptive or defiant behavior

Overstimulation Causes
~ Sensory gating abnormalities or the inability to filter out irrelevant stimuli
~ People with sensory gating difficulties and PTSD demonstrate exaggerated responses to stimuli and reduced habituation. (startle response)
~ Sensory Processing Disorder (sensory integration) vs. Sensory Processing Sensitivity (neither is in the DSM or ICD)
~ Hyper-responsiveness
~ Hyporesponsiveness

~ Schizophrenia impairs people’s ability to process sensory stimuli because they are unable to properly filter both visual and touch information at the input stage, which leads to distortion
~ Disrupted visual processing may result in a decrease of contrast sensitivity, sensory processing, orientation discrimination, visual integration, trajectory and spatial localization, backward masking and motion tracking
~ In cognitive psychology, backward masking involves presenting one stimulus (a “masking stimulus”) immediately after a brief “target” stimulus resulting in a failure to consciously perceive the first stimulus (visual, tactile, auditory) How can this be adaptive?

~ Several lines of evidence support the notion that psychotic symptoms are associated with lower activation thresholds which is known to be associated with tactile, auditory and visual hallucinations.
~ Abnormal perception arises from abnormal sensory predictions; perhaps due to abnormally strong predictions in combination with a noisy bottom-up sensory signal
~ Perceptual processing in people with schizophrenia had significant impairment in their capacity to recognize fragmented objects. (What about people or things that look differently?)
~ Negative symptoms of schizophrenia may be caused by under-active sensory processing

ACEs in Individuals Who Are Neuro-Atypical
~ Neglect (Intentional and unintentional)
~ Abuse (Intentional and unintentional)
~ Mood or substance use disorders in household
~ As a result of the diagnosed or undiagnosed special needs of the child
~ Pre-existing
~ Interpersonal violence in the household
~ As a result of the diagnosed or undiagnosed special needs of the child
~ Pre-existing
~ Abandonment/Divorce
~ Arguing about taking care of the child
~ Personalization by child

TIC for People Who Are NeuroAtypical
~ The 4 Rs of the Trauma-Informed approach:
• Realizes the widespread impact of trauma and understands potential paths for recovery;
• Recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system;
• Responds by fully integrating knowledge about trauma into policies, procedures, and practices; and
• Seeks to actively resist re-traumatization. (SAMHSA, 2020)

TIC for People Who Are NeuroAtypical
~ 4 key principles of a Trauma-Informed Approach:
• Safety (behavior is communication)
• Validation
• Support
• Empowerment

~ Think of ways that a well-meaning caregiver or teacher might inadvertently cause trauma to an infant or person who cannot communicate their experience?
~ Think of ways your organizational environment, policies and procedures might inadvertently cause trauma to an infant or person who cannot communicate their experience?
~ Think of behaviors which a person who is neuroatypical might exhibit which may be seen as resistant or defiant as opposed to protective. How does that impact the relationships? Self-Esteem?

Safety: Startle and Persistence
~ Create a physical environment free of “startle” triggers
~ Explore the environment for persistent tactile sensations sounds, sights or smells that can be noxious to the person
~ Explore organizational procedures which may overwhelm (Preschool: Noisy activities, touch)

Safety: Touch
~ Touch/Tactile
~ Clothing texture or tightness (including swaddling/weighted blankets)
~ Food texture
~ Shower head water (temp or touch)
~ Air vents
~ Food textures (soda, oysters)
~ Upholstery
~ Lack of fidget items

Safety: Taste
~ Taste
~ Sweet: Fruit, sugar, honey, maple syrup, caramelized onions, sweet potatoes, squash, basil and balsamic vinegar.
~ Sour. Vinegars, citrus and tart fruits, pickled vegetables and cultured dairy products.
~ Salty counterbalances bitterness and enhances sweetness.
~ Bitter. Send a warning that something is toxic, a “good” bitterness can cut the sweetness like parsley, kale, arugula, and Brussels sprouts,
~ Savory (Umami) was identified by scientists in 1908. Mushrooms, tomatoes and most cheeses, especially Parmesan.
Safety: Sounds (Wavelength, Frequency, Amplitude)
~ Rate (slow down, write it)
~ Multiple sound concordance (headphones, quiet zones)
~ Treble/High Pitch or Bass/Low Pitch (headphones, quiet zones)
~ Music
~ TV/Movies with music or background sounds
~ Birds chirping/Wind whistling
~ Dishes
~ Ballasts in fluorescent lights
~ Decibel level
~ Particular types of sounds (chewing, writing with a lead pencil, chalkboard, whiteboard markers, typing)

Safety: Sounds (Wavelength, Frequency, Amplitude)
~ Auditory delay or Auditory Processing Disorder, in children with FASDs, Autism Spectrum Disorders, may prove to be a useful neural marker of information processing difficulties (3-5% of children)
~ Problems with learning and day-to-day tasks:
• Talk louder or softer than necessary
• Have trouble remembering a list or sequence or often need words or sentences repeated
• Have poor ability to memorize information learned by listening
• Interpret words too literally
• Have difficulty receiving in noisy environments


Safety: Sight (Wavelength, Frequency, Amplitude)
~ Light (sunglasses, lamps, ditch fluorescents)
~ Intensity (lumens)
~ Temperature (i.e. 2500 – 6000 Kelvin)
~ Flickering (ballasts, dappled shade)
~ Color: Color, Richness (neon vs. pastel) (White wall)
~ Fragmenting (not recognizing something that looks different, or they can only see a part (hair in a towel, partially obscured by a cabinet, masks, pencil partially sticking out of a cup)
~ Direct eye contact
~ Eliminate (or add) visual stimulation
Safety: Smell (more variable intra-person)
~ Intensity
~ Type: sweet/flowery/fruity, musky/earthy, spicy, citrusy
~ Interventions
~ Provide a room on a different A/C or with windows to handle cooking aromas (cabbage, beans, coffee)…
~ Have a fragrance free area
~ Personal fans
~ Bring your own linens etc. to hotels
~ Launder and clean with fragrance free substances
~ Mask it with alternate smells
~ Video conference (i.e. when office is being painted)

~ Sensory processing differences can cause infants, children and adults to experience repeated distress
~ Unaware caregivers, professionals may not understand the communication and persist in exposing the person to the noxious stimulus or may view the person’s behavior as defiant.
~ Both situations lead to a sense of unsafeness and helplessness
~ TIC for people who are neuroatypical means developing an understanding of their neurological differences and working with them to create an environment that is safe, validating, supportive and empowering.