Trauma, Neurodivergence, and The AutPlay® Therapy Framework

It is typically understood that autistic and other neurodivergent children are more susceptible to victimization, experience traumatic effects differently than other children, and may perceive daily common events as traumatic due to their varied perceptions and sensitivity to stimuli (Guest & Ohrt, 2018). Although we know that neurodivergent children experience trauma, it is not fully understood how traumatic stress impacts neurodivergent individuals, and there is limited research on treatment of trauma symptoms in this population. When working on trauma with an autistic or other neurodivergent child, it is important to stay flexible and to adapt to the child’s individual needs and learning styles.

Autistic and/or other neurodivergent children may present with a combination of adverse life events and psychiatric comorbidities. Neurologically, neurodivergent children may process differently than neurotypical children. Processing style, cognitive awareness, receptive language ability, communication style, alexithymia, sensory differences, and executive functioning ability may look very different from working with a neurotypical or neuronormative. These factors must be taken into consideration when attempting to address trauma issues, especially when using trauma models that have been normed on the neurotypical population such as TF-CBT and EMDR.

Guest and Ohrt (2018) found that in a sample of 69 students diagnosed with autism, 26% had a history of trauma. Further, Im (2016) found that in a larger sample of 156 students with autism, 18.5% had a history of physical abuse that had led to trauma and 16.6% had been sexually abused leading to trauma. Those who are autistic have higher rates of inappropriate interactions with others, which leaves them more susceptible to becoming victims of traumatic events (Guest & Ohrt, 2018).  Fuld (2018) determined that adverse childhood experiences (ACEs) directly lead to stress and trauma, and those who are diagnosed with autism and/or attention deficit hyperactivity disorder (ADHD) have a “significantly higher probability” (than those who are not autistic) of experiencing one or more ACEs in their childhood.

Adverse Childhood Experiences (ACEs) and Neurodivergence

The ACE study is an ongoing research study that explores the relationship between childhood trauma experience and long-term medical health and social consequences.
Research findings suggest that autistic children encounter more ACEs than non-autistic children, and that this difference is especially pronounced in lower income families. As observed in the general population, autistic children who experience an increased number of ACEs are at elevated risk for comorbid psychiatric and medical health problems. Autistic children with an elevated number of ACEs also experience a delay in diagnosis and treatment initiation (Kerns et al. 2017).

Autistic children are bullied by peers at a rate 3-4 times that of non-disabled peers with negative impacts on academic functioning and mental health symptoms, including increased risk for suicidality. ACEs are reported more frequently by families of autistic children, particularly experiences of parental divorce and income insufficiency. As observed in the general population, autistic children who experience an increased number of ACEs are at elevated risk for comorbid psychiatric and medical health problems. Autistic children with an elevated number of ACEs also experience a delay in diagnosis and treatment initiation (Hoover & Kaufman, 2018).

Unique characteristics of co-occurring adverse experiences also exist with ADHD reports. Children with ADHD are reported to have higher rates of each ACE type compared to children without ADHD. As ACE scores increase, the reported risk of also having ADHD increases. ADHD severity increases as ACE scores increase. Socioeconomic hardship and having a caregiver with a mental illness significantly increase the odds of a child having moderate to severe ADHD (Brown, 2022).

Ableism, Non-Affirming Systems, and Trauma

The social elements related to neurodivergences may predispose neurodivergent children to stressful and traumatic situations. For example, difficulty with social navigation could lead to increased peer rejection, bullying, and social anxiety. Experiences known to be distressing for autistic children such as unexpected schedule changes, the prevention or discouragement of repetitive or preferred behaviors, and sensory challenges, could be perceived as traumatic particularly when such distress occurs on a consistent basis, adding to the potential for comorbidity. These core symptoms would make daily social situations and new or unexpected experiences highly stressful for many neurodivergent children. It is possible that consistent rumination on stressful or traumatic experiences could lead to co-occurring symptoms of depression, anxiety, suicidality, and post traumatic stress disorder (PTSD) if a significant traumatic event has taken place.

Research indicates that autistic children show an increase in anxiety chemicals (cortisol particularly) in responses to stressors triggering more quickly and intensely than in neurotypical individuals (Spratt, et al., 2011). An autistic child may have a stronger reaction to a trauma event than a neurotypical child would. Neurodivergent people experience their environments in heightened ways. Their social experiences are perceived through a lens unique to them. They are more likely to notice traumas and experience them more deeply on a biological level.  Regulating stress reactions can be more difficult for neurodivergent individuals. Neurodivergence as a trauma response means trying to navigate a world that is inherently rejecting of the way you think, process, learn, and experience and being forced to participate in a neurotypical climate that has been deemed right, correct, typical, and accepted as the way. Being told you are wrong, lacking, odd, something is wrong with you, not good enough, and “worked on” to fit into a system that is not how your system operates can create a trauma response.

The neurodivergent trauma cycle created by Amy Peters (Peters, 2024) illustrates how neurodivergent
individuals trying to navigate and live day to day in societies and systems that are not valuing their differences can lead to trauma responses. This becomes essential considerations when working with neurodivergent individuals in mental health care. Focus must be placed not only assessing for traumatic events but also trauma created from daily ableist and not affirming people and system exposure.

AutPlay Therapy Approach to Trauma Work with Neurodivergent Children

AutPlay Therapy is a neurodiversity affirming framework within child and play therapy theories and approaches. When working with autistic and other neurodivergent children who are affected by trauma, a three-step progression is considered. The three-step process is further outlined in the book – The AutPlay therapy handbook: Integrative family play therapy with neurodivergent children and in the home study training Autism and Trauma: AutPlay Therapy and Beyond. https://courses.jentaylorplaytherapy.com/courses/autplay-trauma

A brief explanation of the AutPlay framework three step process is offered below. These steps should be thought of as preliminary trauma work. The steps help establish the foundation needed to begin a more formal trauma protocol. Further the steps are designed to help professionals better understand the spectrum of presentation of the child and how that may impact the theory or approach administered.

Step 1) Relationship and Safety – Neurodivergent children who have experienced trauma must begin with building relationship with the therapist – feeling safe and familiar with the therapist and the clinical office and environment is essential for trauma issues to be addressed. Therapeutic relationship should be the primary focal point of beginning play therapy with strategic implementation of processes that help the child feel familiar and safe with the therapist and their surroundings.

Suggestions for this step include nondirective therapeutic relationship such as getting to know the child better, understanding their spectrum of presentation and building relationship. Providing child centered play therapy skills can help build relationship. Methods such as tracking, reflecting, being present, attuned, and not leading the session or play can facilitate the therapeutic relationship.

Creating familiarity by having the child see, hear, and be with the therapist and exploring the environment (take the child on a tour of the clinic). For neurodivergent children, familiarity equals feeling safe and secure. Additionally, creating a social story about going to therapy that can be read to the child prior to them attending their first session.

Conduct a sensory screening before the child’s first appointment. Give parents a screening tool to complete to better understand if the child has any sensory issues that could be triggered by your office environment. This provides an opportunity to better understand the child’s spectrum of presentation and modify anything needed prior to the child’s first appointment.

Step 2) Regulation – Neurodivergent children and adolescents may need help with regulating their system before a formal trauma protocol can begin. This is often implemented in three phases: Co-Facilitation (cognitive instruction) – teaching and providing information about emotions, sensations, what are feelings, and what is regulation. Co-Regulation – modeling, supporting, and assisting children with moving through a series of regulation processes and interventions and understanding regulation sensation. Self-Regulation – an obtained state where the child can recognize their need for regulation and understand how to access and implement tools on their own to regulate their system.

Suggestions for this step include gaining information from the caregivers and the child about what helps them regulate. It could be a process that another person assists with (co-regulation), or it could be an activity or item. The professional can also explore with the child various play interventions designed to help with regulation. This could be body movement, art and other expressive techniques, sensory items and activities, traditional relaxation (deep breathing), gaming, constructive play, nature, etc.

Step 3) Emotion Recognition and Expression – Neurodivergent children may not understand or recognize emotions in a traditional sense (alexithymia) and may have a challenging time expressing emotions when dysregulated and in ways that others accurately interpret. Trauma work will require helping neurodivergent children recognize, express, and manage emotions in ways that their system understands. This may require creating a process (a type of feeling language) that both the professional and the child understand – something that works for the child and the professional can understand what the child is communicating.

Suggestions for this step include using visuals and electronic resources to help children identify emotions. This could be a feelings chart or cards or an app on a tablet. Additionally, the professional could implement various feeling focused play interventions and assess the process for the child – are they able to identify feelings? Can they talk about them? Do they seem to struggle with the activity? It will be important when entering into a formal trauma protocol to have an understanding of how the child identifies and expresses feelings.

It is possible that any established trauma protocol could be effective for a neurodivergent child, but steps should be taken to ensure the above processes have been established before implementing any trauma protocol with autistic and other neurodivergent children. Additionally, professionals working with neurodivergent children should be comfortable with and prepared to adjust a protocol as needed to best fit the neurotype of the child. Professionals should not attempt to use child or play therapy to address trauma issues in autistic children without having a thorough understanding of trauma, a thorough knowledge of the neurodiversity paradigm (neurodiversity affirming constructs), and have been adequately trained in child and play therapy protocols that focus on trauma work.

Autism and Trauma Research and Resources:

Barrows, P. (2002). Becoming verbal: Autism, trauma, and playfulness. Journal of Child Psychotherapy. 28(1), 53-72.

Brown, N. M. (2022). Childhood trauma and ADHD: A complete overview & clinical guidance. Additude. Retrieved from https://www.additudemag.com/adhd-and-trauma-overview-signs-symptoms/.

Cox, R. (2016). The life recovery method: Autism treatment from a trauma perspective. Robert Cox Publisher.

Earl, R. K., Peterson, J. L., Wallace, A. S., Fox, E., Ma, R., Pepper, M., & Haidar, G. (2017). Trauma and autism spectrum disorder: A resource guide. Retrieved from https://depts.washington.edu/hcsats/PDF/TF-%20CBT/pages/1%20Therapist%20Resources/Bernier-Lab-UW-Trauma-and-ASD-Reference-Guide-2017.pdf

Fogler, J. M. & Phelps, R. A. (2018). Trauma, autism, and neurodevelopmental disorders: Integrating research, practice, and policy. Cham, Switzerland: Springer

Fuld, S. (2018). Autism spectrum disorder: The impact of stressful and traumatic life events and implications for clinical practice. Clinical Social Work Journal. 46(3), 210-219.

Gates, G. (2019). Trauma, stigma, and autism: Developing resilience and loosening the grip of shame. Philadelphia, PA: Jessica Kingsley Publishers.

Grant, R. J. (2023) The AutPlay therapy handbook: Integrative family play therapy with neurodivergent children. Routledge.

Grant, R. J., & Wethers, R. (2024). Trauma-informed considerations with neurodivergent children and adolescents. In J. Stone, R. J. Grant, & C. Mellenthin (Eds). Trauma impacts: The repercussions of individual and collective trauma, 111 – 125.

Guest, J. D. & Ohrt, J. H. (2018). Utilizing child centered play therapy with children diagnosed with autism spectrum disorder and enduring trauma: A case example. International Journal of Play Therapy, 27(3), 157-165.

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. 

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.

Hoover, D. W., & Kaufman, J. (2018). Adverse childhood experiences in children with autism spectrum disorder. Current opinion in psychiatry, 31(2), 128–132. https://doi.org/10.1097/YCO.0000000000000390

Hoover, D. W. (2015). The effects of psychological trauma on children with autism spectrum disorders: A research review. Review Journal of Autism and Developmental Disorders, 2(3), 287-299.

Im. (2016). Trauma as a contributor to violence in autism spectrum disorder. Journal of Academic American Psychiatric Law.

Kalisch, L. A., Lawrence, K. A., Howard, K., Basu, S., Gargaro, B., Kypriano, K., … & Ure, A. (2025). Recommendations provided to families of neurodivergent children with histories of interpersonal trauma across two clinical assessment services within a major metropolitan children’s hospital in Melbourne, Australia. Journal of Child & Adolescent Trauma, 1-14.

Kerns, C. M., Newschaffer, C. J., & Berkowitz, S. J. (2015). Traumatic childhood events and autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(11), 3475-3486. 

Kerns, C. M., Newschaffer, C. J., Berkowitz, S., & Lee, B. K. (2017). Brief report: Examining the association of autism and adverse childhood experiences in the national survey of children’s health: The important role of income and co-occurring mental health conditions. Journal of autism and developmental disorders, 47(7), 2275–2281. https://doi.org/10.1007/s10803-017-3111-7

Peters, A. (N.D. 2024). Neurodivergence and trauma. https://newgladecounselling.co.uk/2024/05/13/neurodivergence-and-trauma/

Quinton, A. M., Ali, D., Danese, A., Happe, F., & Rumball, F. (2024). The assessment and treatment of post-traumatic stress disorder in autistic people: a systematic review. Review Journal of Autism and Developmental Disorders, 1-35.

Reuben, K. E., Stanzione, C. M., & Singleton, J. L. (2021). Interpersonal trauma and posttraumatic stress in autistic adults. Autism in adulthood, 3(3), 247-256.

Stack, A. & Lucyshyn, J. (2019). Autism spectrum disorder and the experience of traumatic events: Review of the current literature to inform modifications to a treatment model for children with autism. Journal of Autism & Developmental Disorders. 49(4), 1613-1625.