Children with special needs consist of children with a diverse range of diagnoses that include developmental delays (e.g., intellectual disability, Autism spectrum disorder) and congenital and medical conditions (e.g., down syndrome, cerebral palsy). The developmental needs of these children differ from typically developing children, such as in the various aspects of:
- Cognition: e.g., limitations in verbal and non-verbal skills, decision making, and problem-solving
- Social skills: e.g., difficulties with social interactions and understanding others’ perspectives
- Emotions: e.g., limited awareness of own emotions, challenges with emotion regulation
Nonetheless, similar to typically developing children, children with special needs can experience trauma too.
What is trauma?
Trauma is a stressful life experience that overwhelms our ability to cope with difficulties, leading to an impact on our physiological experience, thoughts, feelings, and behaviours. When a child views an event as threatening to the physical safety of themselves or their loved ones, it is understood as a traumatic one for them. The child’s perspective is an important factor that determines the child’s subjective experience of the event and consequently impacts how a child is impacted by trauma. Keeping in mind the different developmental needs of children with special needs, it is important to consider how these might contribute to their understanding of situations which in turn may impact their experience of trauma. For example, a child with special needs may not be able to understand why many people are crying at a loved one’s funeral and may feel scared that other people that he cares about will pass away too.
Tips for assessing for trauma in children with special needs
1. Observe for changes in behaviour
As children with special needs may have language delays, they may have difficulties in expressing their thoughts and feelings accurately. Hence, we may need to rely more on observation of changes in their behaviour and physical symptoms to assess for possible impact of trauma in the child. Changes from their baseline behaviours such as an increase (e.g., more aggression, more repetitive actions) or decrease of behaviours (e.g., withdrawal, reduced social interaction, loss of appetite and/or sleep, regression of existing skills) may be indicative of their challenges in managing a crisis.
2. Gather information from multiple sources
However, some of these children have existing behaviours of concern and it may be difficult to ascertain if changes in their behaviour are part of their typical behaviours or due to difficulties from the trauma. Hence, where possible, it would be useful to gather observations from different people who interact and work closely with the child with special needs to better understand and ascertain possible changes in the child’s behaviour.
3. Use interactive and visual methods
Gathering information from children with special needs via a conversational interview style may be less effective due to their difficulties with understanding and expressing through language. It may be more effective to use interactive and visual methods (e.g., role plays, pictures, drawings, videos) to aid their understanding and explore how they are feeling.
Tips for working with children with special needs impacted by trauma
1. Teach the child coping skills, through:
Repetition and Practice
Engage the child with repeated teaching and practices of coping skills during 1-to-1 sessions of short durations to help the child know how to better support themselves.
Breaking down the steps
Depending on the child’s age and level of understanding, strategies such as breathing in and out, step-by-step muscle relaxation activities/ exercises, hand squeezing, and counting aloud can be adapted to be simpler by breaking them down into smaller steps to help them recall the steps more effectively.
Provide visual and physical prompts (e.g., open-palm gestures, demonstrate the action for them to model after, show pictures) or hand-over-hand guidance (e.g., hold their hands, raise their hands up and down) where needed, to guide their attention in carrying out the strategies accurately. Some examples of visual prompts:
Teach them to point to or tick visual numbers as they breathe in and out each time to help them to complete a minimum number of breathing repetitions
2. To better engage child in your sessions
Make content more relatable for the child
When a child is in a stressful situation, there is often tension in their bodies. Hence, relaxation strategies like the noodle dance, teaches the child to recognize the difference between a tensed and relaxed state.
Use a story to illustrate the noodle dance to make it more relatable for them to remember the steps (e.g., ask the child to imagine that their body is straight and stiff like uncooked noodles, then ask the child to imagine that their body becomes soft like cooked noodles as they wriggle their body towards the ground).
If the child enjoys music and videos, show them videos of the noodle dance to better engage them and allow them to learn and recall the steps faster.
Use colour pencils to make it more fun for the child to draw/write or indicate their mood on the mood spectrum.
Provide more structure in activities.
Add lines on the mood spectrum/ feelings thermometer to divide it into intervals.
As it may be challenging for some children to generate responses, providing options for child to choose from may be helpful for them to express their feelings/thoughts.
3. Work collaboratively with the child’s caregivers
- Explain to caregivers about the child’s experience of trauma, and child’s difficulties in understanding and coping with it.
- Empower caregivers to support their child’s understanding and coping with trauma, through the use of individualised social stories, pictures to aid emotion identification.
- Encourage caregivers to practise the taught strategies (e.g., redirection of their attention, calming methods such as the noodle dance, joint compression, counting aloud and deep breathing) regularly with their child at home.
- Share information with caregivers about community resources that they can reach out to for assistance (e.g., school psychologist/counsellor, family service centres (FSCs), hospitals).
The contributors are Psychologists at MINDS Fernvale Gardens School.
This article was first published on Trauma Network for Children’s Quick Bytes Newsletter and is republished with permission.
The Stay Prepared – Trauma Network for Children (TNC) programme is a joint collaboration between KK Women’s and Children’s Hospital (KKH) and Temasek Foundation. It aims to enhance the psychosocial capability of the Singapore community to support children and youth after crises or traumatic events. For more resources, visit the Trauma Network for Children Website at www.childtraumanetwork.sg.
Carkhuff, R.R. Helping and human relations, Vol. 1, New York: Holt, Rivehart & Winston, 1969.