By Rachel Sempija
As a local authority social worker in a children’s therapeutic team, I would estimate that a query about autism comes up in my work about three times a week. The frequency of the ‘autism question’ is not that surprising given the similarities in how children who have experienced trauma and those with an autistic spectrum disorder may present and it has had an impact on how we work with our young people
Trauma and attachment.
One of the criteria for accessing our service is that young people have experienced trauma and/or have attachment difficulties. Half of the team are employed by the local authority and half by the NHS but the idea that disruption to early relationships can have wide-ranging and cumulative developmental effects joins our practice together.
We are based in looked-after children’s services which means that many of the adults caring for the children are not related to them by birth. This sometimes makes reflection about a child’s early experiences feel less ‘blaming’ (i.e. they are not associated with the reasons the child is looked after) and easier to accept.
But supporting a child therapeutically day-to-day is challenging, and popular approaches to child rearing can sometimes be unhelpful for traumatised children. ‘Typical’ parenting advice includes sanctioning, which can be unbearably shaming for young people who, because of abuse or neglect, may believe they are worthless and unlovable.
At Community Care Live, you can attend an expert training session on putting attachment theory into practice and its role in supporting a safe, nurturing environment for children.
Recovery and treatment.
It can be challenging for carers to take on board that recovery from trauma happens at the child’s pace. A permanent foster carer I have been visiting for a few months consistently tells me that another week has passed and the young person they care for is still hoarding food.
Every week, I suggest that the core beliefs of a child who has not been reliably provided with food are more likely to shift with reassurance that food is available rather than bolting up the food cupboard.
We are hardwired to survive and the strategies we adopt to keep us safe stick around even when trauma stops. This may be what’s happening when seemingly out-of-context behaviours appear to point to other explanations such as autism.
Autism spectrum disorders are often defined behaviourally – for example, individuals may have different combinations of impaired social communication, difficulties with coping with change or empathising. However these behaviours overlap with other diagnoses and ‘formulations’ – a term used to describe the assessment of past and present factors that contribute to an individual’s presentation. I use formulation to explore hypotheses about what children may have learnt about how worthy and how safe they are as well as underlying differences such as autism.
One of the first things I say in care team meetings is diagnosis is no magic wand. There are no pots of financial support waiting once a label is confirmed. It is closely followed by saying that ‘autism-friendly’ strategies don’t hurt anyone and can be implemented even without the label.
Ideas such as using visual prompts to aid communication can be useful to young people in heightened post-traumatic states of anxiety, for example.
Or using simple, factual language to gently remind young people about what they have done, what they are doing and what is happening next. This can reduce anxiety and ground young people who are managing a lot of wobbly feelings about fundamental things such as who will look after them even if they ‘know’ that this is now secure.
Honouring the strategies young people have adopted to help themselves feel safe is often useful (although harm minimisation may be needed). However, if a young person is opting out of activities, then this may be communicating rising anxiety levels or a struggle to contain their muddled feelings.
‘Wondering’ with them if they are feeling sad or angry can provide a script for children to express themselves, whilst giving them the message that their feelings are accepted.
Empathy goes a long way. While it is important that we always keep in mind both the fact that autism and attachment difficulties due to trauma can present in similar ways and the complexities that arise where young people with autism have experienced trauma, I’ve learnt that thinking empathetically about how I use my ‘toolbox’ can help tailor support for young people.
Relationship-based recovery from trauma takes time and being ‘autism friendly’ whether there is a diagnosis or not often helps.