Trauma Informed Care for Persons Who Are NeuroAtypical Counselor Continuing Education

Foreign. I'd like to welcome everybody to today's presentation on trauma informed care for persons who are neuro atypical. I AM your host, Dr. Donnelly Snipes. In this presentation we're going to define neuroatypical. Explore how people who are neuroatypical may experience the world differently. Reflect on experiences that are not traumatic to people who are neurotypical, which may be traumatic to those who are neuro atypical. Will hypothesize about how common parenting and business practices might be traumatic and overwhelming to people who are neuro atypical. We'll explore adverse childhood experiences in individuals who are neuro atypical. And then we will wrap it up by talking about trauma informed approaches in order to help ensure that people who are neuro atypical feel safe and we prevent revictimization. The focus in this presentation is on people who are neuro atypical who also cannot communicate their needs and preferences. Many people who are neuro atypical can communicate very well what their needs and preferences are. Thank you. And they can tell you stop doing that because that is not, you know, pleasant in some way. But what we're really talking about here is those individuals like infants and toddlers who may be pre verbal or people who are older than that who may be non verbal or for some reason unable to articulate that something is painful or scary because they may go into overdrive and start stimming or have some other reaction. So we really, you know, I really want to emphasize that people who are neuro atypical do experience world differently. And a lot of what we're going to be talking about is how those people may have experienced trauma as very, very young children by very well meaning parents who just had no idea that they were neuro atypical. Neuroatypical is a newer term that's used to describe individuals of, who have developmental, in like developmental intellectual and cognitive disabilities that are not typical. I should have the word not in there. People who are neuro atypical differ from the general culture. People's experiences and things may vary culture to culture. So you know, we try to avoid, in behavioral health and I think in physical health the term quote normal. But what we want to look at is in general, according to the general population, are they responding the same way as other people in their culture, in their, in their population? But a lot of times when we say neuroatypical, people automatically think autism spectrum. And yes, that is a diagnosis in which a some one in which someone may be neuro atypical. But people who have schizophrenia, who have fetal alcohol spectrum disorders, who have ADHD and OCD have all been identified as having some similar or very overlapping neuro atypical issues that they deal with on a regular basis and they may have been dealing with since infancy. And just kind of a side note, we'll talk about schizophrenia a little bit in the presentation, but a lot of people don't have a, don't get a diagnosis of schizophrenia until their mid to late 20s or later. That doesn't mean that they didn't have some neuro atypical issues leading up to that that just were never noticed or diagnosed. Definitely once they have developed symptoms of a psychotic disorder. The, the research has shown that there are some very different neuro neurological functioning. I would also encourage you to consider, and I couldn't find research on it, but I couldn't find research against it either. I, I would encourage you to consider that personality disorders may also represent a behavioral adaptation of individuals who are neuro atypical. But we're not able to communicate that. We know that to be diagnosed as a personality disorder it has to be a long standing behavior, typically with symptoms present in childhood. And it has to be present across multiple situations pervasive throughout their life. And that would fit for neuro atypicality. And as we go through, you may understand that and I want you to think about, you know, how could schizoid behaviors which overlap a lot with autism spectrum disorder behaviors in terms of lack of interest in socializing with others? And there, there's a lot of overlap there, they're not the same, but there's overlap. Or even borderline personality disorder. How could those behaviors have evolved as a result of experiencing repeated trauma as an infant or young child and just not being able to protect oneself or communicate that. So you know, something to think about. When we talk about trauma, what we want to talk about is in, in part is a lack of a sense of safety. When people are traumatized, they feel or experience trauma, they have a lack of personal power and they have a sense of a loss of safety. So let's think about when we have someone who is neuro atypical and we're going to focus mainly on sensory abnormalities in this presentation. But when we have a person who has sensory abnormalities, how does that make the average day potentially traumatic for that person? Physically, the person may experience heightened pain as opposed to what someone else experiences. You have a lot of conditions, for example, where people may touch may be painful to them or even having the water from the shower head hit them or the air from the air vent touch their ross, their naked skin can be excruciatingly painful. On the other end of the spectrum, those people who are hyper responsive to pain may be more vulnerable to injury because they don't know that they're hurting themselves. Or they may, I don't know, you know, if any of you pick at your nails or you know, have some sort of fidgety behavior, you do. But some people who have fidgety behaviors, especially those who have exceptionally high pain tolerance, if you want to think about it that way, may actually pick at their own skin or, or scratch themselves and not realize they're causing themselves injury. Sensory overload is also, and I have this under physical because it can be painful and scary to someone who everything seems 10 times as loud or just overwhelming. It feels like they're in a, a coliseum, for example, and it's just really loud bombarding sounds that can be really scary. Especially, you know, well, for anybody. But think about it from the perspective of an infant or, or a toddler who hasn't had a lot of experiences, who knows good and well that they are really still very vulnerable. They can't articulate that. But children know that they are dependent on their caregivers to keep them safe. And if the child is experiencing something way more intensely than their parents perceive them to be experiencing it, parent, the parents may not be stepping in to shield or protect them, which can make them feel vulnerable on the other end. You know, we have hyper and hypo responsivity on all of these things. And the world can be very underwhelming to some children or to some people. And that underwhelming causes a lot of just like overwhelming triggers that HPA axis to go into overdrive and to fight or flee. Underwhelming can trigger or fail to trigger the excitatory neurochemicals that would prompt exploration and motivation to interact with others and, and other things. So we want to understand kind of what's going on with this person. Now remember when people are chronically exposed to trauma, stressors, pain, threats, whatever, whatever it looks like to that person, it, it results in a dysfunction in that threat response system in that HPA axis, which can ultimately lead to a whole cascade of other mental health and physical health issues. And we've gone, gone over the impact of hpa, a disregulation on mood and health in other videos on the YouTube channel. So I'm not going to go deep into that right now. But we do need to remember that once that dysregulation happens and the person starts to experience the world in terms of the flat or the furious, you know, they're. They. They're intolerant or resistant or they're resistant to glutamate and cortisol and everything until it's a big deal, until it's a crisis. So they're flat. And then when they are triggered, they have an exaggerated response. And I don't mean exaggerated in a negative way. I mean exaggerated in a heightened response compared to others in that similar situation. So it's important to recognize that if people are repeatedly traumatized as infants, as toddlers, then they are in that framework of the flat and the furious. They're in that framework of experiencing, regularly experiencing emotional dysregulation from childhood. And a lot of times that puts them in a situation in which they're in invalidating environments. People are telling them, oh, you're overreacting. They're. They're not helping them get the tools. They're not understanding why the person is having a more prominent response to the stimuli than they would expect. So there are a lot of things that start going on which, if you read Linehan's, you know, prefaces to the books on dialectical behavior therapy and borderline personality disorder. She talks about invalidating environments in childhood contributing to the development of BPD symptoms. So which is why I propose that there may be a case for sensory abnormalities in people who eventually go on to develop personality disorders. And we just need to look at, you know, what do the. What do these behaviors mean? How can they be protective of this person? Or how did they develop anyhow, affectively and cognitively? People who have sensory abnormalities because of this regular exposure to fear, to trauma, to pain, or underwhelming. Under stimulation, there may be a lot of emotional lability. You know, they have that emotional dysregulation. When we see that in young children, a lot of times that's identified as problem behavior or tantrums or oppositional. So we really want to explore what does that behavior mean for that person, for that child? Affectively and cognitively, the person may have difficulty processing stimuli in order to learn from it. Sensory abnormalities mean they may l literally see things differently. They may not be able to process what they hear into something useful and meaningful or what they read into something useful and meaningful. Now, a lot of people, one or the other works, they can either read and process or hear and process. But some people are not able to Process information from both channels. Just important to recognize, especially as youth start going into kindergarten and school, we do want to recognize that they may not have something like dyslexia. They may not have hearing disorders in terms of they can't hear, but they may have neurological differences that prevent them from being able to take what they hear and turn it into something meaningful, to understand it, to process verbal language in the same way or at the same rate or even at all as other classmates. So we do want to recognize that because this difficulty processing stimuli can lead to school failure, frequent discipline, and both of those things often lead to a sense of powerless and low self esteem, increases stress, increases glutamate levels, which, remember I said I wasn't going to go over the HPA axis, but we're still going to touch on it a little. When that HPA axis is activated, especially if it's chronically activated, keeps glutamate levels in the brain too high. Now you've got this young, especially in young people, you've got this young developing brain which is like a, a clay pot that has not yet been put in the kiln. It's still very malleable and it's really easy to poke holes in it and to break it. The same sort of thing is going on with the child's brain. It's still very malleable. And when it's exposed to these increased glutamate levels, the glutamate is even more neurotoxic to that developing brain than it would be if the brain had finished developing, if the pot had already been put in the kiln. It's a lot more resistant to insults than it is before it's fired, which ultimately leads to a decrease in white and gray matter and a decrease in prefrontal, in the prefrontal cortex and later on in executive functioning. So it, it is a problem. It creates not only behavioral issues, but actual changes in the structure of the brain. Impaired development of healthy adaptive behaviors can also develop, which can lead to increased emotional ability and frustration in the person who's trying to say stop doing that. It hurts, for example. So they may not be able to develop those healthy adaptive behaviors if they can't articulate what's going on or if they're regularly invalidated interpersonally. Well, if when you're around people it causes you more pain, it's overwhelming in some way now, it may not be like physical pain like you think of getting a shot. It may be just completely overwhelming and being bombarded and you're Just like, oh my gosh, I can't take that kind of input. Then people, you know, children early on may learn that, hey, if I withdraw, it's not as overwhelming if I don't go play in the middle of the playground with all of the screaming children. If I sit over here on a bench, it's a lot less distressful for me. So the child may start avoiding activities and social interactions. For some children, even something as seemingly benign as direct eye contact can seem, can feel very overwhelming to them. And this can also lead to seemingly disruptive or defiant behavior. When the child refuses to go to bed, you know, maybe the parent thinks, well, you know, it's just a stage. But the child is trying to communicate. The bed sheets, whatever you're using to launder the bed sheets is overwhelming me. And you know, it makes me gag. Well, a two year old can't find those words or the, the sheets that I'm sleeping on, they hurt, they hurt my skin because being touched. Same thing with children who, you know, refuse to take a bath. Sometimes they are so sensitive to temperature differences or even the like. I mentioned the shower head earlier that they may not want to bathe. Not because they don't want to bathe or they're trying to be oppositional, but because it hurts. I don't know if you've ever taken a shower somewhere where they had like super high water pressure and the shower head, it almost felt like pins and needles, you know, bombarding you when it was on, you know, a certain setting. And that can be really uncomfortable. So we want to explore with the person or with the child, you know, what is it about the bath that you don't like? My son, when he was little, used to have this thing with his ears and he didn't even have ear infections a lot. But something about water going to into his ears completely freaked him out. And so whenever it came time to washing his, washing his hair as a baby, it was always, you know, a challenge because he would grab onto his ears and just shriek, the ears, the ears, the ears. So, you know, obviously we learned very early or very quickly to give him earplugs and allow him to put his hands over his ears when we were trying to rinse his hair. And that, you know, was one way to adapt to that. Never exactly figured out what it was about getting his hair washed that freaked him out so bad, but it was something to do with his ears. So, you know, we just kind of adapted as best as we could. Over stimulation is common in people with who Are neuroatypical. And one of the categories. That's not the word I'm looking for. One of the reasons for overstimulation is something called sensory gating abnormalities. And it's exactly what it sounds like. Gating. In people who are neurotypical, we have sort of gatekeepers that filter out stimuli. They say, that's not important. That's not important. That's not important. We'll let that one through. People who are neuro atypical may not have a. The ability to filter out stimuli, so they call that sensory gating abnormalities. This is some. One of the characteristics of ADHD that one of my classmates in college taught us about. She was giving a presentation, and she was up there talking, and she had, you know, gotten some people in. In class to help her out. We didn't understand this at the time, but she's up there giving her presentation, and somebody starts taking their pencil and tapping it really loudly on the desk. And then two other people over in the corner start talking to themselves, talking to each other, and, you know, whispering, but whispering loudly. And then somebody else starts flicking the lights on and off. That was our clue that this was actually a demonstration of something. Then all of those things were going on. It was a cacophony of stimulus input. And we were all just like, we're trying to focus on what you're saying, and it's hard to do that with all this going on. And she's. She was like, okay, you know, stop. That's what it's like for me every day because I can't filter out what's important to pay attention to. So the police car going by gets just as much attention as the professor in the front of the room. Not because I want to, but because my brain can't wait appropriately which stimuli are important and which stimuli are not. Which, you know, that was such a poignant experience for all of us. But that sensory gating is common in ocd, in people with schizophrenia, in people with autism spectrum disorders, and people with adhd, among others. So we do want to start considering this as a contributor to people's behaviors. If they are having difficulty filtering, if they're having difficulty paying attention, remembering things, are they being oppositional and defiant? You know, my heart really says 99 of the time. That's no, 99 of the time. There's another reason, but I like to give the benefit of the doubt. People with sensory gating difficulties and ptsd. Now, they found that people with PTSD also develop sensory gating difficulties, which Is evidenced by hyper vigilance. But people with sensory gating difficulties and PTSD demonstrate exaggerated responses to stimuli and reduced habituation. And this was specifically, for example, in terms of the startle response in this, in this particular study. So think about that. When you've got an infant or a young child, what is one of the things that they're born with a startle response. You see a child startle and then they generally start to cry hysterically because they've been frightened. Children who have sensory gating difficulties likely have the similar issue where when things happen, they have a, you know, that flat to furious. They have that dysregulated response to stimuli, but instead of getting used to it, they don't habituate. We have dogs in our house and we have wood floors and when the dogs decide to bark, it is very, very loud. So it can be very quiet in our house. And I'll be reading a book or doing something and just kind of relaxed and all of a sudden our dogs, for no apparent reason go ate bananas. And you know, I kind of jump out of my skin a little bit. But imagine if that happened every single time, you know, now you. Over, over time I've gotten used to, gotten used to the dogs kind of doing that. So I don't hardly notice it anymore. I've habituated to it. But people with sensory gating abnormalities don't habituate. They don't ever recognize that as, oh, okay, that's normal. So every time they hear it, they're having that startle response as if they've heard it for the first time. Basically. Sensory processing disorder, or sensory integration issues as they're sometimes called, is different than sensory processing sensitivity. And neither of these is in the DSM or the icd, but you can look online. There's a lot of that's been written about sensory processing and sensory integration issues especially. Well, I'll get there in a minute. Sensory processing disorder has more to do with sensory integration, Being able to take information in and use it effectively to understand what it means. Sensory processing sensitivity tends to refer to sensitivities, either hyper responsiveness or hyporesponsiveness to certain stimuli. Either way, it's going to cause differences in, in neurological functioning and differences in experiencing the world for people, whichever type they have. Now, being neuroatypical or having characteristics of neuro atypicality is not unique to autism spectrum disorders or to schizophrenia. But I found some of this information on schizophrenia fascinating. So you're going to get to sit through it. Schizophrenia impairs people's ability to process sensory stimuli because they're unable to properly filter both visual and tactile information at the input stage, which leads to distortion. So they get visual input, they see something and you know, they touch something, but that those messages don't go together. So if you see a hot stove and you touch a hot stove and it feels hot, then your brain's going to go, hey, that's hot. We need to stay away from it. People with schizophrenia have difficulty taking in multi sensory information and processing it. Think about mindfulness exercises for a second. When we ask people to focus on mindfulness, one of the most common activities is the 5, 4, 3, 2, 1. What are five things that you see, four things that you hear, three things that you smell, you see where we're going. But that requires people to be able to take in data from all of their senses and sort of create this three dimensional picture, which may not be possible for some people. This 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. Okay, so just kind of think about challenges in visual processing, challenges in seeing things. You have 2020 vision, but the information that's coming into your brain once it hits that optic nerve kind of gets all jumbled up. So the information, if they took an eye test, they would likely test, you know, they could possibly test just fine, visually speaking. But you know, it's. Once the information gets into their brain, it gets all jumbled, which can be really challenging Integrating visually, integrating what you're seeing. Backward masking is something that is also very interesting. And in, in terms of senses, Backward masking can work for any of our senses, but in this example, it's in terms of visual. 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. So that's a lot of words with stimulus in it. Basically you see something that is, that is awful and it's immediately replaced with something that's pleasant. You know, you see something as a child, you may have seen, you know, an animal that got hit by on the road or something just, you know, really awful. And your parent or caregiver may have said, you know, don't look at it, look at this instead. Well, that's basically what they're referring to is backward masking. It's turning your attention to something that is not unpleasant, so you don't. So that memory, that brief encounter with that Negative stimulus is not turned into a enduring memory. Think about as similar tactilely when you get a shot, for example, you get a shot that's unpleasant. But a lot of times the nurse or your caregiver or you, whomever, after you get a shot rubs it really, really fast. You know, partly that's bombarding the nerves, but that also makes, it makes the tactile sense kind of go away. The bad memory of that kind of go away, you know, and you can think about lots of different experiences where something unpleasant was immediately followed by something that was pleasant and prevented you from, prevented you from solidifying the unpleasant memory. Backward masking auditorily. You're right. Jennifer can refer to playing a record or playing something auditory backward to see if there are hidden messages and things. But it's also used in this other, in this other sense to basically hide or, or mask unpleasant experiences. But people who have disrupted sensory processing may not be able to benefit from that. So the unpleasant experiences get as much weight as the pleasant experiences. So the world starts to again seem more dangerous, feel more dangerous. Several lines of evidence support the notion that psychotic symptoms are associated with lower activation thresholds. So people tend to be hyper responsive to stimuli, which is known to be associated with tactile auditory and visual hallucinations. So they found that people with schizophrenia tend to be hypersensitive to certain stimuli. And it may be tactile, it may be visual, it may be auditory, it may be smells, olfactory. But we do want to recognize that a lot of times stimulation of those that hypersensitivity can trigger hallucinations in people. Abnormal perception arises from abnormal sensory predictions. Well, that makes sense. If we predict something is going to be hot and we put our hand on it, we kind of expect it to be hot, but, and, and perhaps due to abnormally strong predictions in combination with noisy bottom up sensory signaling. Now I'm going to go back to the hyperactivity and the hallucinations and the delusions. And you're right. There is an association between developing psychotic symptoms, hallucinations and delusions, and increased levels of dopamine. However, they haven't found an exact causation. You can have sensory processing differences and excessively high levels of dopamine at the same time. They are still learning, they're still trying to figure out exactly what quote causes those hallucinations. So you're right. People who are experiencing psychotic symptoms often do have excessively high levels of dopamine. So abnormal perception arises from abnormal sensory predictions. When we expect something to be hot and it's not. We may still perceive it as hot, perhaps due to abnormally strong predictions in combination with a noisy bottom up sensory signal. So the people with sensory abnormalities may be so hyper responsive and have such problem with sensory gating that they're getting so much information that coming in it's noisy. You know, they're getting so much input that it's hard to filter out and actually perceive what's actually going on because they're being bombarded with so much stuff. And this always reminds me of when I used to volunteer in my kids preschool classroom and there would be 15 little people running around and excited and noisy and it was, wow, it was a lot of input trying to keep track of so many children all at once. I have a lot of respect for parents with multiple children and, and teachers. Perceptual processing in people with schizophrenia had different impairment in their capacity to recognize fragmented OB objects. And this may include people or things that look differently. Think about how scary that is. There's an anecdote. Oh, I need to pick up the pace here. So one quick antidote and then I will move on. When I was, oh golly, about five, four, something like that, my daddy had always had a mustache for as long as I'd been alive. And he shaved it off one day and you know, came out of the bathroom, totally didn't recognize him. I evidently wouldn't go near him for like two weeks. I was terrified. So, but, and you know, I don't have sensory processing issues. I'm pretty sure I'm pretty neurotypical. So imagine how scary it must be for people who are neuro atypical when something like that happens. They have a loved one that they're living with that all of a sudden changes the color of their hair. Think about if they have difficulty recognizing fragmented objects. That can mean, you know, the child may not recognize the caregiver. If the caregiver is all bundled up, you know, they've got a hat on and they've got a scarf on and maybe sunglasses and the child can't recognize the person. It could be, you know, as minimal changes, you know, like shaving off a mustache or wearing a mask. Think about for someone with sensory processing issues how different and how scary it must look when everybody, what they're used to seeing is not what they're seeing anymore. People are basically fragmented when you cut off their nose and mouth from being able to be seen. Negative symptoms of schizophrenia may be caused by underactive sensory processing in people who are neuro atypical they may experience neglect, intentional neglect, you know, from a caregiver who just. I can't deal, I just don't know how to deal with you. I'm going to put you in your crib because, because I don't know why you're screaming and I can't deal with it. Um, so you can kind of put that in the intentional neglect or unintentional neglect in which the caregiver's trying to meet the child's needs, but they're not because they don't understand what the problem is. And I'm not saying this is malicious neglect, but when the child is not able to get their needs met, that is the definition of neglect. And so we'll put that under unintentional abuse. Again, you have a child who is defiant, oppositional, won't take a bath, won't go to bed, screams a lot. The if the parent, if the caregiver doesn't understand what's going on, they may lose their temper, they may become verbally or physically abusive. So you know, people who are neuro atypical may experience more abuse because their caregivers don't understand why they're reacting the way they are. An unintentional abuse would fall under the category, for example, of putting them in a bath that is for them too hot. You know, the caregiver is going, you know, that's barely warm and the kids just screaming bloody murder because it hurts so bad, because they perceive it as very hot. And that's obviously unintentional. The caregiver is not understanding what's going on. Mood or substance disorders in the household can occur when a child or someone living in the household is neuro atypical as a result of the diagnosed or undiagnosed special needs of the child. It can create a lot of anxiety, anger, depression and in the caregivers either because they feel guilty or they feel ashamed because they've got a special needs child or because they don't understand why the child is not behaving the way they expect and it causes a lot of frustration and helplessness, etc. There's also the possibility the mood or substance disorders were pre existing. Interpersonal violence in the household again could be as the result of the diagnosed special needs of the child. Where parents become aggressive, blaming each other, there can be, you know, a lot of more verbal interpersonal violence probably than physical but undiagnosed special needs of the child could also create challenges between caregivers which may result in more interpersonal violence. Among them, an abandonment or divorce can also result in in families and maybe at a greater risk in families with people. Children who are neuro atypical because the parents or the caregivers may argue about taking care of the child and the children may hear this and then the one parent disappears and the child personalizes and says they were fighting about something that I did and then ex caregiver went away. Must be my fault. Children are really egocentric. So a lot of times children do take it personally, especially if they perceive that in some way they are at the crux of some of the dysfunction in the house. So going back over aces really quick. Adverse childhood experiences People who are neuro atypical are at higher risk of being experiencing adverse childhood experiences including neglect, abuse, being in a household where there's mood or substance use disorders or interpersonal violence or, or experiencing abandonment by one or even both caregivers. So let's talk trauma informed care. The four Rs of the trauma informed approach. And you can find this on the SAMSA website. But you want to realize the widespread impact of trauma and the potential paths for recovery. How you know, just understanding that neuroatypical and these sensory gating abnormalities occur in people other than or in addition to people with autism spectrum disorder. We need to consider the prevalence of this in the community. And I believe one of the studies I read said 3 to 5% of children have some level of sensory processing issues. So that's, you know, one out of every 20 children. So probably one out of one child in every classroom and how that impacts the child both physically, emotionally, cognitively, interpersonally. We want to recognize the signs and symptoms of trauma in the person, in their families, in staff who work with the child, you know, teachers who work with a child who is has neuro atypical issues, especially if they don't realize it may feel frustrated and overwhelmed and helpless. So we do want to recognize that it's not just the identified patient or their immediate family. That diagnosis can have impacts on everyone that that person the identified patient interacts with. We want to respond by fully integrating knowledge about trauma into policies, procedures, practices and seek to actively resist re traumatization. Four key principles of a trauma informed approach. Now SAMSA has six and I've kind of diluted them down into four Safety. We need to remember that behavior is communication. And if we've got someone who is acting in a way that we don't understand or we don't like, we need to explore what is that behavior saying. Why are they doing that? Are they protecting themselves? Is it rewarding in some way? We need to help people who have experienced trauma or who are experiencing trauma develop a sense of safety. Even think of Maslow's hierarchy. That's that, you know, the bottom rung is getting those basic needs met and being safe. Safety is actually two for Maslow, but first two are kind of smushed together. Validation. We need people who to experience validation. Other people saying, you know what, I may not be experiencing it the same way, but I believe that you're experiencing that as hot or painful or overwhelming support in, you know, figuring out how to deal with the situation and get safe and empowerment to take those steps needed to get safe. Safe. Over 10,000 people come to Better Help every day looking for a counselor. Better Help makes it easy for you to move your practice online and focus on what you love most, helping others. Better Help's easy to use platform, takes care of referrals and billing and provides a secured platform to communicate with your clients. Join more than 18,000 therapists at better Help helping to improve people's mental health and lives. Think of ways that a well meaning caregiver or teacher might inadvertently cause trauma to an infant or a person who cannot communicate their experience. And I've given a lot of those examples. Think of ways your organizational environment, policies and procedures might inadvertently cause trauma to an infant. You know, people come in with their kid in tow and you have loud music blaring or something, I don't know. But to an infant or person who cannot experience, who cannot communicate effectively their experience. Think of behaviors which a person who is neuro atypical might exhibit which may be seen as resistant or defiant as opposed to what they really are in that they're protective, you know, the person is trying to stay safe in the only way they know how. How do these behaviors impact your relationship with them or how do these behaviors impact their relationship with the outside world? How do these behaviors impact their self esteem and how do the their relationships or lack thereof impact their self esteem? So those are all questions that you can just kind of ponder. Those are pretty big meta concepts there. So talking about startle and persistence, remember I said that a lot of people who have gating difficulties won't habituate. So we do want to explore the physical environment to try to make it free of startle triggers. And when we talk about the environment, if you're working with a family, then exploring the house, the home situation and the school situation where the child spends the most time and figuring out, you know, what is a startle trigger? In our house, when somebody's getting ready to make a sudden noise, they call out ahead of time and they say loud noise. Like when my daughter's getting ready to use the blender, just so it lets us know. So we have, you know, we can brace ourselves ahead of time and turn up the TV if needed. But there are ways that you can prevent or hedge against startling, startling people, infants and otherwise. Now, obviously with infants, you have to take different steps because saying loud noise is going to mean nothing to the infant. But evaluating the environment and trying to help identify the sensory sensitivities the person may have and, and eliminate as or minimize as many of those as possible to make it so it's a relaxing environment for that person. Explore the environment for persistent tactile sensations, sounds, sights or smells that can be noxious to the person. And there's a variety of things for some people, you know, I was talking about material earlier, and there can be certain materials that are very painful or itchy or unpleasant to wear. If you've ever worn a actual wool sweater, you know, that certain wool sweater will that wool sweaters can be very, very itchy. And that can be exhausting throughout the day if you're constantly scratching at yourself. But that's obviously, you know, pales in comparison to someone who is hypersensitive to touch, where that might feel like somebody is cutting them. With RA constantly throughout the day, explore your organizational procedures, which may overwhelm and you know, a lot of us are clinicians, but we also want to look at the child's organizations where the child spends time, like at school. If the child is hypersensitive to noise or has auditory integration issues, noisy activities like recess may be really overwhelming to that child. Obviously we're not going to call off recess, but how can we help that child so they feel safe during recess so they don't feel assaulted by the excessive level of noise? Same thing with touch, you know, in picking up a child, moving a child, having children hold hands as they cross the street or something maybe noxious to certain children. So we do want to go through the day with the child and identify issues that might be more prevalent for them or more problematic for them in as many different situations as possible and figure out ways to mitigate that. So, so they we can mitigate or minimize the number of times throughout the day that they're exposed to stressors, especially painful or noxious stressors in terms of touch. Sensory integration issues or neuro atypicality may result in high or low pain tolerance or sensitivity. Self injuring, picking or tapping. Dislike of physical contact, including certain clothing items. Clothing texture or tightness can be problematic for certain children. Some want it really tight because that helps them feel safe. Some of them can't stand to have clothes on and they're going to regularly run around and strip their clothes off. And you may, you know, sometimes that causes problems for parents because they don't understand why it's going on. We want to explore that and it could be certain materials and not others. Food texture maybe another issue and that's an issue for a lot of children, which is, you know, something that a lot of occupational therapists work with. But certain food textures may be unpleasant to children. I guess I've got it on there twice. My son to this day, he's 20 years old and he will not drink soda. He cannot take the bubbly texture in his mouth. It just weirds him out. For me, oysters. Can't do raw oysters. It's just something about. Or raw eggs. Something about the texture doesn't work for me. Well, take that, which, you know, all of us have our own unique preferences, but take that and intensify it. If we're talking about people who may be neuro ATYP may experience it 10 times as strongly as you do. Talked about the shower head, water, you know, the temperature or bath temperature even depending on the person. If they are hyposensitive, they may get in a bath that's too hot and accidentally, accidentally burn themselves. Likewise, somebody who's hypersensitive may react at as if something is way too hot when it's, you know, lukewarm. So we do want to articulate, try to help people articulate. What is it about this situation that is causing you distress? Air vents. Having air vents blow directly on people is, you know, can be annoying anyway. But it can also be a constant stimulation of the, the hairs on the skin which can be disruptive for people. Upholstery. If you've ever peeled yourself off of leather upholstery in the summer when you're wearing shorts or something, you know how, you know, it has a certain feeling to it. And that can be, that's one example of how upholstery, for example, can be unpleasant for people. Easy modification with that one is you, you know, if you know you're going to be around somewhere where there's leather and you can't stand to touch that kind of texture, bring a towel or some kind of blanket with you that you can sit on but it's important to figure out, you know, what is it that's bothering you. And a lack of fidget items can lead to more self injury, accidental self injury. And this isn't self injurious behavior, like non suicidal type stuff. This isn't designed to gain control. This is mindless fidgeting that may result in picking. You know, I know people who bite their fingernails all the way down to where they bleed and oh, that looks so painful. But giving people fidget items if they need them in order to prevent them from harming themselves. Taste is one that can be another issue for certain people. They may have strong aversions to certain categories of taste. Sweet, sour, salty, bitter and savory. Now bitter and savory, I've never been good at really picking out. But the definition of bitter can be something that tastes toxic or something that cuts sweetness, quote unquote, like parsley, kale, arugula or brussels sprouts. So I'm not really sure. I still don't know how to explain bitter or savory. But savory is like mushrooms, tomatoes and most cheeses, especially Parmesan, evidently. But if children are having food aversions, we may want to explore with the family whether it's a particular taste category that is aversive to them or if it's a texture. Sounds and sounds and light all come in, in have wavelengths. You know, light wavelengths, sound wavelengths. For some people, they have difficulty processing auditory information, so you may need to slow down and write it down so they can read it. They may have difficulty with multiple, what I call multiple sound concordance. If you're in a noisy area like a restaurant or a classroom and there's other stuff going on, they may have difficulty filtering out those other sounds. So providing them headphones to, so they can focus on what they're, you know, reading can be helpful. Or having quiet zones. Some people are more sensitive to high pitched notes. Some people are more sensitive to low pitch notes. For example. Again, headphones and quiet zones can be helpful here. And where do we encounter these things? Music, Obviously some people prefer a lot of bass. Other people, that bass makes their head feel like it's going to explode. Some people like a lot of treble. Other people, it makes their eardrums feel like they're going to explode. So being sensitive to the tone of, of music that that may be potentially problematic to people, but recognizing that even television shows and movies that have the soundtracks that go with them, there can be sounds that are problematic for some people, especially the Ones that are sensitive to the higher sounds. The wind whistling or birds chirping can be painful. Or dishes clanking as you're doing them in the kitchen or putting them away from the dishwasher. Ballasts and fluorescent lights have that awful hum, especially the old ballasts. Or when they're getting ready to go out, that can be a problem. Decibel level, you know, that's another one we want to consider. How loud is too loud for you and, and some people, you know, for me, I don't think there is such a thing as too loud. But for, for other people there, there definitely is. And then particular types of sounds like chewing, writing with a lead pencil G that makes my skin crawl. Writing on a chalkboard or the squeaking of markers on a whiteboard, or even the sound of the click, click, click from typing can be overwhelming to some people's senses. So we do want to pay attention and help them figure out modifications. Auditory delay or auditory processing disorder in children in children with FASDs, autism and autism spectrum disorders may prove to be a useful neural marker of information processing difficulties. As I said, 3 to 5% of children have auditory processing disorders. They may talk louder than necessary, have trouble remembering a list or sequence of words or directions, have poor ability to memorize information that they learned by listening, like from lecture. They may interpret things too literally or have difficulty in noisy environments. We do want to look at what's going on and see if there's something like this going on with children to and figure out how to adapt their learning environment site in terms of wavelength, frequency and amplifier amplitude. Sometimes light can be too bright, so we want to consider sunglasses lamps instead of overhead lights or lamps if you need to illuminate it more. Ditch the fluorescence whenever possible. The flickering and the intensity of those can be difficult. Lumens is the intensity of the light, how bright it is that may need to be adjusted. Temperature is how yellow or how bright blue the light is. Some people can do fine with soft white. Some people can do fine with daylight. You know, working to figure out what works for people. And flickering ballasts that are getting ready to go out can flicker, they can cause headaches, they can cause seizures in people with seizure disorder. They can also be very overwhelming to people with sensory and neuro integration issues. Dappled shade is another one that we don't talk about too much. But especially when you're driving, for example, and you're going in and out and the light is just flickering in and out as you drive through trees. That is Akin to flickering. And it can be overwhelming and cause some people nausea, hypersensitivity and sometimes even seizures. And people who are super sensitive. Colors. Neon colors versus pastel colors. You want to consider the intensity. One modification could be to have one wall in the classroom, for example, that is white, you know, no posters, no nothing. Or black. Whatever color you want, but just a solid neutral color that the person can look at if they're feeling overwhelmed. We talked about fragmenting already. Direct eye contact can be overwhelming. We also need to work with the person to figure out if we need to eliminate visual stimulation or even add it. Sometimes people may need additional stimulation, like they enjoy looking at a fan as it spins around. Smell. We want to talk again about intensity of the smell. Some people can do fine with a mild smell. Some people none. No smell at all. Interventions provide a room on a different AC or with windows that can be opened in order to handle noxious smells. Even at home, like cooking, aromas can be overwhelming. Have a fragrance free area in the home. In the workplace, allow people to bring personal fans so they can, you know, blow away the smell if they're going to a hotel or somewhere. Bring your own linens. If detergents bother you. Laundering clean with fragrance free substances. Consider masking it with alternate smells that you don't find offensive. And you know, if other all else fails. Consider video conferencing if you just can't go into a particular building or area because of the smell. Sensory processing differences can cause infants, children and adults to experience repeated distress. Unaware caregivers and professionals may not understand the communication and persistent 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 in the person. Trauma informed care for people who are neuro atypical means developing an understanding of their neurological differences and working with them to create a safe environment that is also validative, validating, supportive and empowering. In answer to your question, Patricia, yes, there is a higher percentage of youth with neuro atypical issues than in the past as evidenced by the sharp increase in the diagnoses of autism spectrum disorders and ADHD and the hypothesized increase in fetal alcohol spectrum disorders. So yes, I would.