Practical Strategies for Trauma-Informed Intervention in Students with Communication Disorders

Recent research indicates that a growing number of students are coming to school with backgrounds that include traumatic experiences.^1,2 Experiences that can induce trauma in students include but are not limited to:

• Being highly mobile and having interrupted school opportunities
• Experiencing homelessness and chaos
• Living in crime-prone areas
• Experiencing neglect and/or abuse
• Being of immigrant or refugee status with previous experiences like being forced to flee from the home country due to war, natural catastrophes, persecution, etc. (Most of these students have to learn English when they come to the U.S.)

To create safe spaces for these students and foster inclusion that promotes equity and access to the school curriculum, we must engage in trauma-informed services.

Common Causes of Trauma

Neglect is the most commonly occurring form of maltreatment. Neglect is not necessarily tied to poverty, as some may think. Many forms of neglect occur amidst an adequate supply of resources. When children experience maltreatment in the form of neglect, abuse, or both, they often have long-lasting physical, emotional, and cognitive consequences resulting from their exposure to traumatic events. This is called complex trauma.³

Students’ who have experienced complex trauma may present deficits in narrative cohesion, narrative coherence, expository content, expository structure, and expository coherence. Recent research has shown a relationship between neglect due to maternal depression in mothers experiencing poverty and negative impacts on their children’s developing language.

Chaos is another form of trauma that may occur at the microsystem level, or in children’s family environment. Family environments that change rapidly, and chaos within those environments, can negatively impact children’s language and executive functioning skills. Specifically, such trauma can negatively impact their vocabulary, reading, and phonological awareness skills.

For these students, communicating within the normal discourse of the classroom, self-regulating their learning, and following classroom routines may be challenging indeed. They frequently show deficits in social-pragmatic skills and the ability to accept others’ perspectives.

As stated, given recent worldwide events (natural disasters such as fires and floods; experiences in war and refugee camps; the COVID-19 pandemic), many children on SLPs’ caseloads are currently experiencing chaos.

Trauma-Informed Intervention Strategies

1. Provide the student with some control over the context. For example, present the therapy activities for the session at the beginning. Let the student decide the order of the activities. This gives students some sense of control over the session. Students with traumatic backgrounds usually feel a lack of power or control in their lives, so giving them choices helps them feel more secure. 
2. Respect the student’s boundaries by being consistent. For example, you may have a rule that students must raise their hand if they want to speak in the therapy session. This must be enforced consistently to be effective. If reinforced inconsistently, it can have a negative impact. Students will feel safest if you ensure that they raise their hand every single time they want to speak, as they can anticipate and plan for what is expected of them.
3. Allow students to play. Even 5-minute play breaks, in addition to recess, can help allow students to express themselves through hands-on, physical play.
4. Incorporate art, music, and physical movement into therapy. Many students, for example, can express themselves better through drawing than by verbalizing what has happened to them.
5. Discuss the language of feelings. Help students label and describe feelings with a wide range of descriptors that move beyond the typical “happy-sad-mad.” Show them how to express their feelings constructively rather than through tantrums or physical violence (e.g., hitting the clinician or other students).
6. Use puppets to model social interactions. Students may sometimes express themselves with greater ease through the use of puppets and can learn social interaction skills like turn-taking, topic maintenance, and greeting others through this form of interaction, as well.
7. Use social stories to help students develop a theory of mind and appropriate interactions with others. Students from trauma-filled backgrounds are often in “survival mode,” and have difficulty seeing things from others’ perspectives. Because of this, they can appear self-focused and uncaring of others. This can make it difficult to develop and maintain friendships! Social stories help students view events from the perspective of those who they are interacting with, and helps the students be more empathetic. This leads to more friendship opportunities.
8. Incorporate dialogue journals to help students write out their emotions and experiences. Through the reciprocal process of dialogue journaling with students, professionals can become more aware of students’ emotional needs and how to meet them.
9. Encourage students to create a vision for the life they want by taking a “Trip to the Future.” or example, one young teen I work with named “Danny” was very severely abused by his father. Danny is a sex offender who is out of Juvenile Hall and is living in a group home. I help him think of his goals, which involve going into the Air Force after he turns 18.Are his current actions moving him toward joining the Air Force? Displays of aggressive behavior toward his teacher is probably not advancing those ambitions. With Danny and other young persons involved in the criminal justice system, I help them visualize what they want for their lives and make sure their current actions are moving them toward those goals.
10. Focus on narrative skills. Model narratives by talking about activities relevant to the student. Discuss what happened before, during, and after the activities took place.
11. Make storybooks about routine events in students’ lives such as getting ready for school or making dinner. Include drawings or photos of the student’s actions, and then retell the stories to “cement” them in memory.
12. Demonstrate the use of positive self-talk to develop a growth mindset. They can learn to choose between learned helplessness (a result of the trauma) and the ability to work hard and make good choices to experience positive consequences.
13. Create a comfortable setting. Instead of seating students at a traditional table, try sitting on bean bags, plush chairs, or simply on the floor. Removing the formal boundaries of a table encourages students to be relaxed and express themselves freely.
14. Start each therapy session with a “high and low” of the day. This approach encourages students to express their achievements while also allowing for conversations addressing emotionally challenging topics about which they may not otherwise initiate a conversation.
15. Become comfortable with limited eye contact from students, even those who would developing typically. It can be difficult for students to look at you directly while sharing their feelings or experiences.
16. Try to observe your students interacting with their peers during recess and break times. The observations allow you to gain a deeper understanding of the student’s socio-emotional well-being at school.

Anticipated Outcomes

The use of these strategies will increase the odds of:

• Students becoming more cooperative in carrying out therapy tasks
• Older students (teenagers) becoming more engaged during therapy and feeling increasingly motivated to generalize therapy targets into settings outside the therapy room
• Students focusing better during therapy sessions and being less distractible
• Greater gains in students’ speech and language skills

To learn more from me, check out my MedBridge courses.