Professor Amanda Kirby, CEO of Do-IT Solutions., Campaigner for Neurodiversity, Medic, Knowledge Translator, researcher

Originally published as part of The Neurodiversity 101 LinkedIn Newsletter.

Neurodiversity 101: Navigating the Intersection of Trauma and Neurodiversity

In the realm of paediatrics and neurodevelopmental medicine, understanding the intricate relationship between trauma and neurodiversity is paramount.

In this blog, I will delve into the multifaceted intersection of trauma and neurodiversity, examining the evidence, and advocating for a more holistic approach to care.

Unravelling Neurodiversity: Celebrating Differences

Neurodiversity encompasses the different ways we think, act, communicate, move and process information.The neurodiversity paradigm celebrates the unique strengths and perspectives of individuals with diverse neurological profiles

Associated with the concept of neurodivergence are the broad spectrum of neurodevelopmental variations, including Autism Spectrum Conditions, ADHD, Dyslexia, Developmental coordination disorder, Dyscalculia, Developmental Language Disorder and beyond.

Rather than viewing differences as deficits or disorders, each neurodivergent individual brings a valuable perspective to the table, contributing to the rich tapestry of human experience. We need to accept challenges for many are present and it is not all wonderful stuff!

The reality is that who gains a clinical diagnosis or not are often dependent on the varying pathways children traverse through and may be impacted by inequity and inaccessible pathways in gaining support.

Adverse Childhood Experiences (ACEs) stressful events occurring in childhood including:

  • domestic violence
  • parental abandonment through separation or divorce
  • a parent with a mental health condition
  • being the victim of abuse (physical, sexual and/or emotional)
  • being the victim of neglect (physical and emotional)
  • a member of the household being in prison
  • growing up in a household in which there are adults experiencing alcohol and drug use problems.

Understanding Trauma: Impact on Neurodevelopment

Trauma, whether acute or chronic, can have profound implications for neurodevelopment. A traumatic event is a frightening, dangerous, or violent event that poses bodily or psychological harm or is a threat to a student’s life or a loved one. Students in education (and others in other settings such as workplaces, justice settings) may or may not experience a situation as traumatic. The manifestation of trauma may differ based on cultural perspectives

The neurobiological effects of trauma on the developing brain are well-documented, with alterations in brain structure and function observed in individuals who have experienced adversity.

Developmental trauma, in particular, can disrupt key processes such as emotional regulation, attachment formation, and executive functioning, further complicating the presentation of neurodivergent traits.

The Interplay of trauma and neurodiversity: Unravelling Complexity

Navigating the intersection of trauma and neurodiversity requires a nuanced understanding of the complex interplay between these two phenomena. Neurodivergent individuals may be at increased vulnerability to trauma due to factors such as sensory sensitivities, social difficulties, and communication challenges.

Conversely,trauma symptoms can overlap with or exacerbate existing neurodivergent traits, posing diagnostic and therapeutic challenges.

Minnis and colleagues have shown the cumulative impact of adversity + neurodiversity. (Their paper is called: Double jeopardy: implications of neurodevelopmental conditions and adverse childhood experiences for child health). They showed that maltreated children were nearly 10x as likely as their non-maltreated peers to have symptoms of neurodevelopmental conditions in 3 or more of the 4 symptom clusters investigated—yet maltreatment did not cause this increased neurodevelopmental load (Dinkler L et al (2017) Maltreatment-associated neurodevelopmental disorders: a co-twin control analysis. J Child Psychol Psychiatry 58(6):691).

Children ( nor adults) never live a sterile life and we are all impacted on how others treat them.Bullying is defined as repeated and chronic negative actions directed at a student or group of students, characterised by a power imbalance between the aggressor and the victim.

School bullying is described as a sort of violence that harms others and occurs when a student or a group of students use their strength to harm other individuals or other groups while at school or participating in various activities.

Neurodivergent children are more likely to have been bullied e.g., greater risk with ADHD. Piek and colleagues showed the relationship with peer vicitimisation and lowered self worth in children with DCD/Dyspraxia. Interestingly, the impact of peer victimisation had a greater impact on girls compared with boys especially verbal victimisation.

Moving around means you can get called something else..

When children are out of ‘traditional educational systems’ they often get seen as ‘ behavioural problems… we provide names such as SEMH, SEBD, BESD.. rather that see all ‘behaviour’ is a means of communicating one way or another.

Children in care, along with those excluded from school have a higher rate of Neurodivergent traits but may not be diagnosed. Challenges often have behaviours seen attributed to these social experiences rather than considering ADHD, DLD and traumatic brain injury could be present and also in the mix.

The more systems they traverse the less likely we are to notice they have ND traits and gain an assessment for them. We tend to look one way or another and not bring the parts together.

An ACE survey with adults in Wales found that compared to people with no ACEs, those with 4 or more ACEs are more likely to

  • have been in prison
  • develop heart disease
  • frequently visit the GP
  • develop type 2 diabetes
  • have committed violence in the last 12 months
  • have health-harming behaviours (high-risk drinking, smoking, drug use).

When we face tough times, our bodies kick into gear, responding with changes like increased heart rate and stress hormone release. This is our way of coping with stress, but sometimes, our responses can become a bit too intense or not strong enough.

Researchers believe that how we react to stress might be influenced by our past experiences, especially when it comes to childhood adversity like abuse or neglect.

The ‘Adaptive Calibration Model’ suggests that our bodies adjust to these tough situations, preparing us to handle future stress. This can lead to positive outcomes, like developing hidden talents. However, if these adjustments become overwhelmed, it could lead to serious health issues later in life, such as heart disease or mental illness.

Sadly, child maltreatment, adversity and other forms of violence are all too common, with over half of the world’s children experiencing some form of violent victimisation. Despite this, not everyone ends up becoming mentally unwell.

Our bodies have a built-in stress response system, controlled by the autonomic nervous system. It determines how our heart rate and blood pressure react during stressful situations. Patterns in these responses can vary among individuals. Some people may have an exaggerated response to stress, while others may have a more suppressed one.

Factors like temperament play a role in how we respond to stress. For instance, individuals with neurodevelopmental conditions like ADHD or ASD may have unique challenges in coping with stress due to their impulsivity or sensory sensitivities. These challenges can lead to difficulties in managing everyday tasks, like forgetting homework or feeling overwhelmed by certain noises, sounds or textures.

Protective factors, like providing adjustments (or avoidance) for specific sensory sensitivities, can help mitigate stress and promote positive development in children with some neurodevelopmental conditions. By understanding how stress impacts each of us and recognising individual differences, we can better support children’s emotional well-being and resilience.

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"A person is, among all else, a material thing, easily torn and not easily mended.”― Ian McEwan,

Evidence-Based approaches: Integrating trauma-informed care

Incorporating trauma-informed principles into neurodiversity support services is essential for providing holistic and effective care. It is not an either/or approach.

Trauma-informed care emphasises safety, trustworthiness, choice, collaboration, and empowerment, aligning closely with the values of the neurodiversity paradigm.

Read through the work from team at WRAP who delivers an amazing service to so many.

They describe the aims of restorative approaches: “To build, maintain and repair relationships. To be restorative means believing that decisions are best made and conflicts best resolved by those most directly affected by them.”

From theory to practice and back again…

All professionals working with children can create environments that promote healing and increase resilience for neurodivergent individuals, and being aware of those who have been or are impacted by trauma.

Screening and assessment tools should consider the unique needs and experiences of neurodivergent individuals. This includes identify trauma exposure and associated symptoms ( including traumatic brain injury)>

Interventions should be tailored to address both neurodivergent traits AND trauma-related difficulties, drawing upon evidence-based strategies from BOTH fields.

References and resources:

1)Children Act 1989. Section 20 and 21 and Part IV.

2)Department for Education (2020) Children looked after in England (including adoption), year ending 31 March 2020. National Statistics: London, UK.

3)Russell G et al. (2014) Prevalence of parent-reported ASD and ADHD in the UK: findings from the Millennium Cohort Study. Journal of Autism & Developmental Disorders. 44, 31-40.

4)Ford T et al. (2003) The British child and adolescent mental health survey 1999: The prevalence of DSM-IV disorders. Journal of the American Academy of Child & Adolescent Psychiatry. 42, 1203-1211.

5)Green H et al. (2005) Mental health of children and young people in Great Britain 2004: Summary Report. Office for National Statistics: Newport, UK.

6)Holden SE et al. (2013) The prevalence and incidence, resource use and financial costs of treating people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). Child & Adolescent Psychiatry & Mental Health. 7, 1-13.

7)McCarthy S et al. (2012) The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care. BMB Pediatrics. 12, 78.

8)Ford T et al. (2007) Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households. British Journal of Psychiatry. 190, 319-325.

9)Meltzer H et al. (2003) The mental health of young people looked after by local authorities in England. Office for National Statistics: Newport, UK.

10)Meltzer H et al. (2004) The mental health of young people looked after by local authorities in Scotland. Office for National Statistics: Newport, UK.

11)Meltzer H et al. (2004) The mental health of young people looked after by local authorities in Wales. Office for National Statistics: Newport, UK.

12)Dimigen G et al. (1999) Psychiatric disorder among children at time of entering local authority care: questionnaire survey. British Medical Journal. 319, 675.

13)DeJong M et al. (2016) Children after adoption: Exploring their psychological needs. Clinical Child Psychology & Psychiatry. 21, 536-550.

14)Moore J & Fombonne E (1999) Psychopathology in adopted and non-adopted children: A clinical sample. American Journal of Orthopsychiatry. 69, 403-409.

15)Stanley N et al. (2005) The mental health of looked after children: Matching response to need. Health & Social Care in the Community. 13, 239-248.

16)McCann JB et al. (1996) Prevalence of psychiatric disorders in young people in the care system. British Medical Journal. 313, 1529-1530.

17)Goodman R et al. (2004) Using the Strengths and Difficulties Questionnaire (SDQ) multi-informant algorithm to screen looked-after children for psychiatric disorders. European Child & Adolescent Psychiatry Supplement. 13, 4-11.

18)Blower A et al. (2004) Mental health of ‘Looked after’ children: A needs assessment. Clinical Child Psychology & Psychiatry. 9, 117-129.

19)Baird G et al. (2006) Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet. 368, 210-215.

20)Baron-Cohen S et al. (2009) Prevalence of autism-spectrum conditions: UK school-based population study. British Journal of Psychiatry. 194, 500-509.

21)Brugha T et al. (2011) Epidemiology of autism spectrum disorders in adults in the community in England. Archives of General Psychiatry. 68, 459-466.

22)Latif AHA & Williams WR (2007) Diagnostic trends in autistic spectrum disorders in the South Wales valleys. Autism. 11, 479-487.

23)Dillenburger K et al. (2015) The millennium child with autism: early childhood trajectories for health, education and economic wellbeing. Developmental Neurorehabilitation. 18, 37-46.

24)Taggart L et al. (2007) Young people with learning disabilities living in state care: Their emotional, behavioural and mental health status. Child Care Practice. 13, 401-416.

25)Lingam R et al. (2009) Prevalence of developmental coordination disorder using the DSM-IV at 7 years of age: a UK population-based study. Pediatrics. 123, e693-e700.

26)Mather M (1999) Adoption: a forgotten paediatric speciality. Archives of Disease in Childhood. 81, 492-495.

27)Lindsay G & Strand S (2016) Children with language impairment: prevalence, associated difficulties, and ethnic disproportionality in an English population. Frontiers in Education. 1, 2.

28)Stevenson J & Richman N (1976) The prevalence of language delay in a population of three-year-old children and its association with general retardation. Developmental Medicine & Child Neurology. 18, 431-441.

29)McCool S & Stevens IC (2011) Identifying speech, language and communication needs among children and young people in residential care. International Journal of Language & Communication Disorders. 46, 665-674.

30)Lewis C et al. (1994) The prevalence of specific arithmetic difficulties and specific reading difficulties in 9- to 10-year-old boys and girls. Journal of Child Psychology & Psychiatry. 35, 283-292.

31)Rutter M et al. (1976) Isle of Wight studies, 1964-1974. Psychological Medicine. 6, 313-332.

32)Yule W et al. (1974) Over- and under-achievement in reading: distribution in the general population. British Journal of Educational Psychology. 44, 1-12.

33)Rees P (2013) The mental health, emotional literacy, cognitive ability, literacy attainment and ‘resilience’ of ‘looked after children’: A multidimensional, multiple-rater population based study. British Journal of Clinical Psychology. 52, 183-198.

34)Roeleveld N & Zielhuis GA (1997) The prevalence of mental retardation: a critical review of recent literature. Developmental Medicine & Child Neurology. 39, 125-132.

35)Simonoff E et al. (2006) The Croydon assessment of learning study: prevalence and educational identification of mild mental retardation. Journal of Child Psychology & Psychiatry Allied Disciplines. 47, 828-839.

36)Department for Education (2017) Special educational needs in England: January 2017. Department for Education: London, UK.

37)Scharf JM et al. (2012) Prevalence of Tourette Syndrome and chronic tics in the population-based Avon longitudinal study of parents and children cohort. Journal of the American Academy of Child & Adolescent Psychiatry. 51, 192-201.

38)Hornsey H et al. (2001) The prevalence of Tourette Syndrome in 13-14-year-olds in mainstream schools. Journal of Child Psychology & Psychiatry. 42, 1035-1039.

39)Mason A et al. (1998) The prevalence of Tourette Syndrome in a mainstream school population. Developmental Medicine & Child Neurology. 40, 292-296.

Blog Author

I am Amanda Kirby, CEO of Do-IT Solutions a tech-for-good company that delivers thought provoking consultancy and neuroinclusive guidance and training. We have developed cutting edge web-based screening tools that have helped 10s of 1000s of people. We strive to deliver person-centered solutions relating to neurodiversity and wellbeing.

I am a mixed bag of experiences and skills, an odd ball… and have 25+ years of working in the field of neurodiversity.

I am a medical doctor, Professor, and have a Ph.D. in the field of neurodiversity; parent and grandparent to neurodivergent wonderful kids and am neurodivergent myself.

Theo Smith and I wrote the UK award-winning book Neurodiversity at Work Drive Innovation, Performance, and Productivity with a Neurodiverse Workforce. My 10th book came out called Neurodiversity and Education in March this year. Excitingly, Theo and I have another book coming out next year!

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