Alley Dezenhouse Kelner
Trauma Informed ABA
What is Trauma informed ABA and why is it relevant?
*This post was written with the support of Andrea Stuart, MADS. S/o to Andrea for consolidating a ton of research and supporting the training of the Magnificent Minds team in Trauma Informed Care (TIC).
In ABA we recognize that behaviour occurs in the context of its environment; what we do is shaped by what happens around us. By extension, our history impacts our present and our future behaviour patterns; behaviours that “work” continue and behaviours that don’t “work” are replaced because over time, we adapt and that’s part of the human experience. Our therapeutic goal is always to work towards meaningful change for the client—to teach skills that help them, and from an ethics stand point—to do so while “doing no harm”.
For many, ABA is conceptualized as a field that often ignores the inner workings of the mind, the thoughts, the feelings; and while that may be true in some (misguided) applications a “good” practitioner understands that the private events that we cannot see (what happens in the the mind) inevitably impact how we behave.
Trauma-informed ABA (which has much scientific backing) is an application of ABA that recognizes that someone’s history, their lived experience, has direct impact on how they behave; further it views traumatic experiences as setting events for future behaviour. We can’t seek meaningful change, or meaningful progress, skill development or any meaningful application of our science without understanding that every client comes to us a past—some good, some great, some difficult. Don’t we all?
While diagnosing trauma isn’t part of our field, the recognition that it exists, or at least—the fact that it could exist in our clients, is central to our success as practitioners and even more importantly central to the positive outcomes of clients in our multi-disciplinary programming. Trauma can result from what might be considered “obvious” experiences (living in a war zone, experiencing a natural disaster, physical abuse, homelessness, or neglect) but it can also result from experiences that might not have bee documented or even come up in intake screenings (racism, prejudice, bullying, challenging experiences in school or with previous therapists, divorce, death of a family member, or strained relationships). While it’s common for us to deep-dive into the developmental history of our clients, we rarely (if ever) consider the past lived experiences with the same focus or emphasis.
While in ABA we’re good at looking at behaviour in the context of its immediate surroundings, many fail to take into account the environment that preceded it less directly. We may frequently consider variables like whether the client had breakfast that day and how that might impact his challenging behaviour around snack time, but how often do we consider whether he ever lived in a state of poverty (not knowing when his next meal would arrive), or in a state of deprivation due to neglect in early childhood, or even a state of constant worry/apprehension surrounding food due to severe allergies or perhaps anaphylaxis or control behaviour related to food consumption imposed by parents? How frequently do we consider the possibility that snack at his previous program was highly aversive and even traumatizing due to the smells of the snacks of his peers when he was told “you’re fine and it’s not that bad”, or a challenging experience he had where he was “forced” to try a new food? We can’t possibly develop a comprehensive treatment plan without understanding these and many other variables and while it may not always have trauma-roots, the fact that most of us were never trained in, or even exposed to, this kind of inquiry is holding us back as a field. The fact that many behavioural principles lend themselves to a trauma-informed approach when you truly understand its foundations, is (in my opinion) an added bonus that will help garner buy-in from the practitioners who are reluctant to consider aspects of the human condition that cannot be measured by traditional means.
While admiitedly, we’re not all attuned to application of trauma informed care (TIC), I have yet to work with someone who by all other accounts is “living with their head in the sand”. Even if their training wasn’t terribly mental health focused, we all know that learning history is important; even the misguided and by the book practitioners aren’t totally ignorant. We’ll often say “this behaviour clearly worked in another setting” and the truth is, our whole science is predicated on the idea that when behaviour works we keep doing it, and when it doesn’t work we adapt and yet we rarely see this approach through the lens of potential trauma history. We like to concern ourselves with the variables we can mitigate (control) right now, but without looking backwards to the variables we can’t control (they already happened) and in so doing we aren’t acting from a place of trauma-informed care.
Accepting the idea that trauma may have impacted learned behaviour is an important first step that asks practitioners to challenge themselves to think outside the traditional ABA box but which does not ask practitioners to do away with evidence based, research backed strategies. It’s not enough to recognize one particular challenging behaviour that occurs in a particular context and say “wow someone really did a number on you”; and actively work to repair. We need to be looking at every client and every behaviour and ruling out the possibility of trauma (or at the very least, stress and anxiety motivated behaviour) just the way we rule out medical factors.
While there are measures for looking at more obvious forms of trauma which yield data (which most people in ABA can get behind), it also takes a willingness to view behaviour form the lens of how it may have been informed by early experiences and the emotions surrounding these experiences (even attachment styles)—-that’s where some (many) practitioners will have to pivot from their current perspective “I can treat anyone by simply looking at their observable behaviour patterns”. The truth is that trauma manifests in the body and the mind; so yes, there will be some observable behaviours but there will also be some thoughts that you cannot observe but nevertheless impact progress. Trauma can not only impact behaviour right now, it can also impact child development; since we tend be comfortable analyzing child development (gaps in skills and even visual analysis of skill progression over time) it’s not a stretch to start pivoting and challenging ourselves to consider trauma as a key factor in the history of at least some of our clients.
When we fail to account for possible trauma we may find ourselves scratching our heads thinking particular occurrences of challenging behaviour happened “without warning” “with no clear antecedent” when in reality, it’s most likely that the setting event (trigger) was clear as day if you knew what to look for. We widely recognize the impacts of stimulus-stimulus pairing, where an item/event/even person can acquire the value of something else when paired together so it’s not a huge leap to consider that your client (who has a history of being punished and forced to sit in time out every time the bell rings at school because he screams loudly to signal his discomfort) engages in “challenging behaviour” whenever the school bell rings at your (different) location. Without looking at the trauma piece we could end up assuming it’s the loud noise itself he’s reacting too, rather than the association between the bell, the scream and the punishment that followed.
The other important piece of the puzzle here is that what’s traumatizing for one isn’t traumatizing for all. While there are obvious forms of trauma as described above, we also have less obvious (even subtle) forms of trauma; a scary trip to the dentist, a teacher who expects her student with ADHD to “sit still” and punishes him when he can’t, or who places a client in “time out” for attention seeking challenging behaviour, further isolating him/her and sending the message that their communication attempt is not valid, their wishes are not respected, and their consent not necessary.
While I could go on and on about therapeutic procedures that don’t align with a trauma informed care model (of ABA), I’ll unpack that in another post when I discuss how ableism can contribute to trauma in the neurodiverse population. If you’re a clinician with experience and training in trauma-informed ABA I would LOVE to connect!