5 Trauma-Informed Tips for Speech Therapists

Speech therapists often work with children who have experienced trauma in their lives. In fact, studies show that disabled students are more likely to experience trauma, including violence and neglect, than students without disabilities. In addition, certain disabilities can impact an individual's ability to self-regulate (e.g., ADHD, anxiety, autism) and trauma has been found to exacerbate these difficulties.

It is also becoming more and more clear, both in the scientific literature as well as through anecdotal evidence from autistic adults, that some of the methods we have been trained to use may themselves be traumatizing. For example, Applied Behavior Analysis (ABA) has been linked to post-traumatic stress symptoms (PTSS) in autistic individuals. While speech therapy is not in itself ABA, speech therapists often use some of the same strategies ABA therapists use, including positive reinforcement, negative reinforcement, and prompting, including full physical prompts (i.e., hand-over-hand assistance).

For these reasons, we absolutely need to approach our speech therapy sessions with a trauma-informed or trauma-sensitive perspective. This means recognizing the potential impact of trauma on a child's development and behavior, creating a safe and supportive environment that allows for healing and growth, and establishing practices that prevent the child from experiencing more trauma.

Here are 5 trauma-informed tips for your speech therapy sessions.

1. Create a safe and predictable environment: Children who have experienced trauma often feel anxious or overwhelmed in new or unpredictable situations. Children will feel safer with us when we establish a clear routine, we tell them or show them what they can expect, and when there are clear expectations for everyone involved in the therapy. It can also help to provide a cozy and comfortable space with familiar objects, such as stuffed animals or a weighted blanket, to give the child a sense of security and comfort.

2. Focus on building a positive relationship using play-based approaches: Building a positive and supportive relationship with the child is key to creating a safe and trusting environment. This involves being attuned to the child's needs and interests and responding with empathy and understanding. Play-based therapy can help children process difficult experiences and emotions as well as help them develop communication skills. You can incorporate play into speech therapy sessions by using games, toys, art materials, and activities that are fun and interesting for the child.

3. Be attuned to the child's needs and boundaries: Children who have experienced trauma may have difficulty regulating their emotions and may have sensitivities to certain triggers or stimuli. It's important to be attuned to the child's non-spoken cues and to respect their boundaries. You can create opportunities for the child to express their needs and preferences, such as by providing a menu of activities to choose from or using visual supports to facilitate communication.

4. Provide unconditional acceptance: Children who have experienced trauma may have low self-esteem and may struggle with feelings of shame or guilt. To promote positive self-image and confidence, it's important to focus on the child's strengths and provide them with unconditional acceptance. A child who feels accepted is more likely to be willing to try and learn new things.

5. Promote autonomy: Prioritize a child's control over their own body and communication. Do this by asking for consent before engaging in any physical touch and by explaining the purpose and benefit of such touch. Provide choices and give them control over the pace and activities of therapy. Avoid withholding items or experiences that provide comfort or enjoyment to the child.
 Accept any and all communication attempts and honor the child’s needs and desires.

By implementing these trauma-sensitive practices, you can create a safe and supportive environment in which your clients learn, grow, and heal.

REFERENCES

Jones, L., Bellis, M. A., Wood, S., Hughes, K., McCoy, E., Eckley, L., et al. (2012). “Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies.” The Lancet, 380(9845), 899–907.

Kupferstein, H. (2018), "Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis." Advances in Autism, 4(1), 19-29.

Saxe, G. N., Ellis, B. H., Fogler, J., Hansen, S., & Sorkin, B. (2005). “Comprehensive care for traumatized children: An open trial examines treatment using trauma systems therapy.” Psychiatric Annals, 35(5), 443–448.