Just the Facts, Please

Please consider these alarming statistics found on the SAMHSA (Substance Abuse and Mental Health Services Administration) website. As reported by the Administration on Children, Youth and Families (ACYF), the number of child abuse and neglect victims in 2015 was 683,000, or 9.2 victims per 1,000 children.


  • Each year, the number of youth requiring hospital treatment for physical assault-related injuries would fill every seat in 9 stadiums

  • 60% of adults report experiencing abuse or other difficult family circumstances during childhood

  • 26% of children in the United States will witness or experience a traumatic event before they turn four

  • 1 in 4 high school students was in at least one physical fight

  • 1 in 5 high school students was bullied at school; 1 in 6 experienced cyberbullying

  • 19% of injured and 12% of physically ill youth have a post-traumatic stress disorder

  • More than half of U.S. families have been affected by some disaster (54%)


Research studies continue to show that traumatic experiences suffered in childhood have a destructive impact on numerous levels, such as altering brain function and compromising the child socially, emotionally, behaviorally, and academically. Toxic levels of stress and anxiety can often be equivalent to deeply traumatic experiences and may present as the child being unresponsive, angry, depressed, distracted, or defiant.


Often, children receiving speech therapy are misdiagnosed with anxiety, behavior, or attention disorders rather than understood to have trauma that’s driving those symptoms and reactions.


1. The ABC’s

Children who have suffered trauma may find it difficult to fully participate and engage in a speech therapy session unless they feel supported and safe. Aside from the intrinsic value of helping the child, it has been shown that the child’s therapeutic performance will be enhanced if the child is less anxious. Therapeutic outcomes and lowering stress go hand in hand.


If you see that the child is finding it difficult to respond to cues during the session, don’t jump to the conclusion that a child is disinterested or defiant. Instead, consider the source of the problem. There may be a problem at home that is causing distress. Be sensitive and accommodating, and the session will get back on track.


Remain flexible when responding to “good” and “bad” behaviors. It is essential to keep in mind that “trauma babies” often react disproportionately to minor mishaps and are quite vulnerable to becoming easily frustrated or triggered. By adopting a trauma-informed perspective, you will relate to the child with openness and curiosity.


The sense of being out of control is a hallmark of traumatic experiences and post-traumatic stress disorder. Therefore it behooves the therapist to establish and adhere to a precise and predictable routine throughout the session. This predictability will provide the child with a sense of stability and promote calm. Consider as well that, since words may not sink in for a trauma baby, she may need other sensory cues as well.

2. Don’t Judge the Trauma

One of the cardinal rules of working with those who have suffered trauma is that the trauma shouldn’t be judged. Although from the perspective of the therapist, the situation may not seem all that bad, it is the child’s perception that counts. For no apparent reason, that child may feel extremely vulnerable and that his life or safety is at risk.


And sometimes, the trauma may not be borne of one particular incident but rather the culmination of chronic stress. For example, a child whose family lives in poverty may be overwhelmed with the worry that there won’t be enough money to pay the rent, or enough money to buy food.

Such incessant stressors can be the cause of trauma. So, rather than assuming that this child is a problem, it would be far more helpful to ask, “What may this child be going through to cause such behavior”?


3. Build the Relationship

You as a speech therapist intuitively know that it is critical to establish and maintain a good relationship with your clients. When it comes to children who have suffered trauma, this need is amplified. The connection will do more for the child than you realize. Aside from enhancing therapeutic outcomes, you may become another solid pillar in this child’s shaky life.


Don’t be afraid before jumping into the session to spend a moment or two developing that rapport, asking questions which the child will be comfortable answering. While the time you spend trying to establish a connection with the child may detract from the lesson plan, it may prove invaluable in the long run.


4. Help the Child Through the Therapy Session

A. Focus on Support

Assuming that you aren’t doubling as a mental health therapist, it isn’t your place to focus on what caused the trauma nor on the specifics of the situation. Instead, all of your attention should be directed to providing support for the child who is suffering. Reacting with flexibility and empathy doesn’t require that you dig deeper into the trauma nor explore the details.


B. Recognize the Child’s Need for Control

Children who have suffered trauma have experienced a lack of control. It is critical to provide ways for these children to exercise their choice and control within an activity. One way is to find materials that promote the opportunity for the user to choose which activities and materials to use.


Also, don’t unilaterally set goals for the child; instead, include the child in the process. In so doing, you will promote a sense of control which the trauma baby so desperately needs. In much the same vein, choose games and exercises that will practically assure the child’s success.


And finally, rather than telling the child she is succeeding, make this success experiential. As trauma is such a sensory experience, kids who have suffered trauma need more than words; they need positive experiences to heal.


C. Allow the Child to Self-Regulate

Many children who suffer trauma are plagued with emotionally unavailable parents; therefore, these children have never learned how to soothe themselves. One common consequence is that focusing may be difficult. Help them cope by working breaks such as a stretch or a short game into the session.