The Value of Trauma-Informed Care in the Treatment of People with Autism
What constitutes a traumatic event for someone diagnosed with autism spectrum disorder? And does post-traumatic behavior manifest in ways similar to the symptoms of a typical person? As researchers begin to make inroads toward those answers, an emerging form of treatment called trauma-informed care might render their findings less significant. That’s because those using it are finding value in applying it regardless of whether there’s a documented history of traumatic events or not.
“In the field of behavioral health, everyone has experienced varying degrees of trauma. Not just those with disabilities. Everyone. So it stands to reason that trauma-informed care should be the approach for everyone,” says Hillary Sawyer, MHA, MPA, the Donor Relationship Manager at Potential, a nonprofit in Newtown, Pennsylvania, that works with people of all ages who have autism and other developmental disabilities to improve their communication, behavior, and social skills, among other basic needs. Sawyer has worked extensively with juveniles and adults who have experienced traumatic events, including abuse, sexual assault, and violence.
What constitutes a traumatic event for an autistic person is likely to be a far more extensive list than it is for a typical person. Arriving at a diagnosis, a confusing, frustrating process for some families that can unfold over years, should itself be considered a traumatic event, says Karen Yosmanovich, M.Ed., BCBA, LBS, the Clinical Manager at Potential. Even for those who reach a diagnosis quickly, she says, it can feel “overly clinical.”
The term trauma has traditionally been used to describe emotionally painful experiences or situations that overwhelm a person’s ability to cope. Recently, there’s also been a growing awareness of subtler forms, such as discrimination, that, when they’re experienced chronically, have a cumulative impact that can be just as life altering.
“We often use the analogy of an iceberg: There’s a lot more underwater than meets the eye,” Sawyer says. “And unless you try to see all of it, you’re never going to understand and you’re never truly going to be in a position to help.”
“One of the duties of applied behavioral analysis is focusing on why the behavior is happening, rather than what it looks like,” Yosmanovich says. “I’m not concerned with what it looks like. If I looked at only that, there would never be any long-term progress because you would correct the reaction, but then the topography changes and they simply pick up a new reaction.”
What is trauma-informed care?
Trauma-informed care shifts the foundation of the relationship between a healthcare provider and a patient, or a behavior analyst and a client. The provider or analyst recognizes that the only effective course of treatment is one that takes the complete picture of someone into account, not just their diagnosis.
“It’s the ability to meet people where they are at any given time,” Sawyer says, while simultaneously appreciating how past and current situations can influence someone’s behavior.
To that end, Potential employs the Child and Adolescent Needs and Strengths, or CANS, an open domain assessment tool. It’s designed to accurately represent the shared vision of the treatment/service provider and a child or adolescent’s family. As such, it’s based on a communication perspective, rather than the psychometric theories that influence most measurement development.
The CANS collects information on a child’s or adolescent’s needs and strengths. Strengths are things in which the child has an interest or ability. Needs are areas where the child requires help or clinical intervention. The provider or analyst gets to the know the child and their family through a transparent assessment process that’s been shown to facilitate engagement by building trust. While defining the needs is critical, the strengths identified in the assessment become the basis for the treatment or service plan.
At its core, a trauma-informed approach to care is compassionate, empathetic, and understanding. More specifically, it seeks to:
- Realize the full scope of the trauma and map out paths for recovery;
- Recognize the signs and symptoms of trauma in those who have experienced it first– or secondhand; and
- Actively avoid re-traumatization.
For a person impacted by trauma, autistic or not, any number of things directly and indirectly related to the experience can trigger the body’s “fight-or-flight” response, where adrenaline begins coursing through the bloodstream, the heart beats faster, and breathing speeds up. These changes can happen so quickly that people aren’t aware of them.
As a result, “trauma-informed care can also be a very individualized way of working with someone because two people may respond completely differently to the same approach or even the person administering the treatment,” Yosmanovich says. “Communication is not a strong suit with people on the spectrum, so they’re not likely to volunteer what’s bothering them.”
Acting out is very often, for someone who’s experienced trauma, a reaction to feeling a loss of control, Sawyer says. To counter that behavior, Potential promotes decision-making from the beginning of its clients’ enrollment.
“It’s a collaborative, skill-based approach where we want to teach you how to cooperate and empower you to advocate for your needs,” Yosmanovich says. “That may sound straightforward, but it’s not always an easy path. It can take years for some. However, those are always worthwhile goals to strive toward.”
What are its benefits?
Trauma-impacted people generally have difficulty maintaining healthy, open relationships with a healthcare or service provider in the traditional arrangement. Trauma-informed care offers an opportunity to engage more fully in their treatment and develop a trusting relationship with their provider, which, where people with autism are specifically concerned, can enhance their progress and improve their long-term abilities.
But, for trauma-informed care to be its most effective, it needs to be adopted at both the clinical and organizational levels. Sawyer and Yosmanovich stress that its power resides less within a single focused practice than a broad organizational culture change, where knowledge about trauma is integrated into policies, procedures, and practices. By enabling it to become a part of all aspects of day-to-day operations, it ensures that every interaction, even those with non-clinical staff, will help trauma-impacted people feel safe, physically and emotionally.
Minor as those moments might seem, their cumulative effect can be corrosive to a trauma-impacted person. But the opposite also holds: A safe physical, social, and emotional environment will nurture trust and confidence, inspiring, in turn, a new capacity to heal and grow.