Let me start by saying that all trauma is perceived because trauma is defined by the mind and body’s response to intense experiences that threaten or cause harm.  Trauma defines our individual emotional and physical response to these events and doesn’t define the event itself.  This should not downplay the significance or impact of trauma.  While traditional definitions describing traumatic experiences includes various types of assault and abuse, more and more young children are having experiences outside of those definitions that can be referred to as traumatic because of the resulting symptoms. Some call these adverse responses to these experiences ‘perceived trauma’ because they do not involve abuse or assault, but something is traumatic if it causes a person to experience certain symptoms.  More and more children are perceiving various experiences (sensorially and emotionally) as overwhelming and extreme and report resulting symptoms consistent with traditional forms of trauma, like PTSD, anxiety, and depression.  In addition, some children are more susceptible to being affected by these experiences, while other children may be less sensitive to them.  In individuals with autism, they’re finding increased rates (32%-45%) in reporting of PTSD resulting from perceived traumatic experiences. “Although research has yet to establish clear prevalence rates, the rates of probable PTSD in autistic people (32-45%) are higher than those in the general population (4-4.5%)” (Rumball et al. 2020; Rumball et al. 2021; Haruvi-Lamdan et al. 2020).  These adverse experiences can lead to a number of psychological diagnoses in addition to PTSD symptoms.  “Exposure to adverse events and trauma does not automatically result in PTSD and has been found to be associated with many other forms of psychopathology, with the strongest link to anxiety and depression (69).” Chapter 3: Autism, Adverse Events, and Trauma (Ella Lobregt-van Buuren, Marjolijn Hoekert, and Bram Sizoo.) https://www.ncbi.nlm.nih.gov/books/NBK573608/

Clinically, we see many children who perceive these adverse experiences as ‘traumas’ who DO NOT have a diagnosis of autism or ASD but are nonetheless highly sensitive individuals.  They have many of the same heightened sensitivities and difficulties regulating their emotions as individuals with ASD, but can be social, empathetic, warm, and emotionally connected.  Many of these perceived traumatic experiences happen within the first 3-4 years of life and involve a child’s caregiver(s).  The absence of consistent nurturing, empathetic and supportive experiences, or the presence of heightened emotional states and impulsive or physical reactions can lead to anger, frustration, low self-esteem, anxiety, and fear within the caregiver-child relationship, and can be the beginning of these patterns.   “The underlying mechanism is that the child was harmed by someone who was supposed to care for and protect him or her, so the child is understandably afraid to trust others (especially those in caretaking roles) who might also hurt him or her. As a result, the child develops extreme defense mechanisms to safeguard himself or herself from letting others get close (Goodman, 2013; Iwaniec, 2006; Owen, 2012)“ https://www.academia.edu/75184116/PTSD_from_Childhood_Trauma_as_a_Precursor_to_Attachment_Issues?email_work_card=title.  

“Whereas the differentiation among physical, sexual, and emotional abuse is fairly straightforward, it is much more difficult to discriminate among imperfect parenting, parental mistakes, and emotionally abusive parental behavior (Messman-Moore & Coates, 2007; Wright, 2007)… Of the five primary parenting scales coded, affective communication errors (e.g., simultaneous conflicting signals, nonresponse, or mismatched response) were the most strongly related to infant disorganization…  In particular, hostile-self-referential parenting is associated with disorganized-avoid-resist infant attachment patterns and possibly later controlling strategies among school-age children and adolescents. These children demonstrate both internalizing and externalizing problems, as well as perceptual biases and social deficits in peer relationships, which interfere with the adaptive development of interpersonal competencies.” https://www.academia.edu/23698346/Childhood_Emotional_Abuse_and_the_Attachment_System_Across_the_Life_Cycle_What_Theory_and_Research_Tell_Us?email_work_card=title

This does not mean we should demonize or blame caregivers of children with these challenges. They are usually doing the best they know how to, and often manifest caregiver patterns  from their own upbringings.  Instead, it means that we all need to be more aware of how sensitive many children are,  how they see the world differently than we do, and how we need to adapt to these sensitivities.  The adults in these children’s lives should focus on the child’s emotional perception of a learning experience or process, and not the adult’s own desired outcome of the experience.   By focusing on process over product we can help children begin to ‘see’ the world as a less threatening and overwhelming place, helping them learn from the wealth of social-emotional experiences around them. 

Hypersensitive children, with and without ASD, may develop rigid, impulsive, or rapid escalation of fight or flight responses from these and future experiences. They learn to perceive the world with a strong negativity bias, and are more likely to get overwhelmed/overstimulated during small conflicts or disagreements, and when things don’t go the way they expected or are out of their control. Children with heightened emotional and sensory sensitivities, which lead to these perceptions and chaotic internal states, often become progressively more rigid, defiant, and reactive.  Sometimes they even exhibit anti-social behavior but are actually still craving social connections.  Because so many of these, often undiagnosed, children go on to exhibit social and behavioral difficulties that can be similar to ‘high functioning’ ASD, parents and professionals end up seeking out behavioral therapies for them, like ABA or CBT.  It’s important we remember to effectively treat current behaviors driven by past experiences and traumas that only a psychodynamic framework can be successful in doing so.

Behavioral methodologies like CBT and ABA do not attempt to address past experiences, they focus on modifying current behaviors and symptoms while choosing to ignore the developmental, foundational and core elements driving the behaviors (symptoms). If we start to acknowledge that the majority of these pediatric ‘behavioral’ challenges are driven by a child’s perception of past experiences, then our responses/interventions to them should be informed by the child’s history and development, and should be administered in an understanding, empathetic, and analytical manner while primarily focusing on improving relationships. As a result, only using behavioral interventions without addressing the core underlying past experiences and the familial relationships leading to the behaviors, can make the behavior worse.  For most children, when things get worse, the next step is medication.  While medication is necessary in many instances, it leaves the cause of the behavior perpetually unaddressed.

Psychodynamic vs Behavioral
One of the main differentiating factors between a psychodynamic intervention and behavioral intervention is that a psychodynamic one identifies and deals with our past experiences where a behavioral one looks at current behaviors and directs us to make changes to them without trying to treat what’s led to them from our past.
While we cannot change our pasts, we can develop deeper and different understandings of the past.  This new understanding can change how we think and feel about our past, which ultimately will change how we respond to current situations that have an emotional connection to the past.
Whether it be big or small connections, most people are unaware of how these subconscious mechanisms are constantly driving our perceptions of the world around us and many of our decisions. For young children, this can look different depending on each child, their interests, their needs, and their developmental abilities. For all children, working through these experiences must be a voluntary process driven by empathy and understanding from the adults around them.

Many of these challenges early in life affect a child’s attachment with their caregivers which can also impact other relationships and behavior. While there are many types of insecure attachments that have been identified, there is only one secure attachment. In order to help a child develop a more secure attachment(s), it is essential that play-based, nurturing, supportive activities are provided by each caregiver on a daily basis.  Each caregiver should utilize similar empathetic, understanding, and supportive language and responses to the child’s challenging or maladaptive behaviors.  These opportunities for children to have fun, make decisions, and be the leader in a constructive manner with their caregivers will help strengthen their relationships and attachments. Mindful responses from caregivers will improve and deepen these core relationships around conflict and challenging moments.

All Children, but especially those who have experienced these traumas, benefit from us seeing them as individuals with their own set of feelings, needs, wants, and desires.  These needs may be different from their peers, and we must modify our expectations for these children until they are able to understand, work though, and cope with their own internal emotional states.  Unfortunately, it is these children who are usually expected to meet certain expectations, and when they don’t, they are made to feel worse about themselves than they already do. Places like 20-30 child classrooms, compliance based learn environments, and demand-reward or consequence management styles at home aggravate these children’s systems further by trying to impose a set of ‘cookie cutter’ expectations on them, instead of treating them as individual human beings with their own unique set of needs. 

It’s important that children who have experienced these ‘perceived traumas’ are provided comprehensive support in all of their ‘learning environments’. Unfortunately, for highly sensitive children, a single person in their life triggering these trauma-based patterns can be enough to perpetuate the cycle.  This could be a rigid or intense teacher, a nanny who has their own take on discipline, or an emotionally inconsistent or reactive caregiver.  However, when all the people in a child’s life are supporting that child by understanding their needs, being empathetic and understanding, and providing them with nurturing and support, as well as healthy boundaries, then we can help children work through some of these past experiences.  They can begin to experience and respond to the world around them in a more thoughtful, adaptive, and regulated manner.  Focusing on the child’s social-emotional health, not only their behaviors, is the difference between making progress or exacerbating current emotional challenges.  The Greenspan Floortime Approach® is one such framework that allows children to explore this on their own terms and work through these challenges developing in calm, balanced, and flexible understanding of the world. 

Learn how to APPLY The Greenspan Floortime Approach®.  Register for the Professional or Caregiver/Parent Course at www.stanleygreenspan.com. Parents and Professionals can also receive Greenspan Floortime® Expert Tele-Coaching with additional video analysis and feedback.   For in-person Greenspan Floortime® based OT, SLP, Social Group Programs, and coaching contact The Floortime Center®, www.thefloortimecenter.com.  

*Learn about how Dr. Greenspan’s Greenspan Floortime® is different from ICDL’s DIR®Floortime