Trauma Informed Therapy
Trauma is not what happens to you. Trauma is what happens inside you as a result of what happens to you.
Gabor Maté
Trauma
Trauma is an emotional, psychological or physical response to an event or series of events that are perceived as life‑threatening, overwhelming, or deeply distressing, and that exceed a person’s capacity to cope at the time.Trauma can disrupt safety, trust, self‑concept and the ability to regulate emotions and behaviour.A trauma‑informed approach recognizes the widespread impact of trauma, understands paths for recovery, and integrates this knowledge into policies, practices and interactions to avoid retraumatization and promote safety, choice and empowerment.
Single‑incident (accident, assault, natural disaster)
Example: A car crash causing serious injury; a one‑time physical assault; surviving a major earthquake that destroys a home and community.
Chronic / Repeated (abuse, neglect, domestic violence)
Example: Years of emotional or physical child abuse; ongoing domestic violence between caregivers; prolonged parental neglect and deprivation.
Complex / Developmental (early relational trauma, prolonged adversity) and Secondary / Vicarious (witnessing others’ trauma)
Example (Complex / Developmental) : Early caregiver neglect and instability across childhood; repeated separations or institutional care impairing attachment and development.
Example (Secondary / Vicarious): Emergency workers repeatedly exposed to others’ trauma; family members hearing detailed accounts of a loved one’s abuse or violent death.
Childhood trauma alters brain development by repeatedly activating stress systems, which heightens threat circuitry (amygdala) and weakens regulatory and executive networks (prefrontal cortex and hippocampus). This disruption impairs attention, memory, emotion regulation, sensory processing and social‑cognitive skills, producing hypervigilance, dissociation, learning delays or behavioural dysregulation.
Trauma‑Informed Care in Paediatric Occupational Therapy
Trauma‑informed occupational therapy recognizes that past or ongoing traumatic experiences shape a child’s regulation, sensory processing, behaviour and capacity to engage; it adapts assessment, goals and interventions to promote safety, trust, choice and empowerment while avoiding retraumatisation. Core principles are safety (physical and emotional), collaboration and choice, transparency, empowerment and cultural humility.
Motor Control is defined as the process of initiating, directing, and grading purposeful voluntary movement.
- Fight: mobilised anger, aggression, confrontation, verbal outbursts or attempts to control the situation.
- Flight: rapid escape behaviours, avoidance, restlessness, leaving situations, dissociation through busying or substance use.
- Freeze: immobility, collapse, dissociation, shutdown, quiet withdrawal, inability to move, speak or make choices.
- Physiological: racing heart, sweating, shaking, dizziness, nausea, breathlessness, muscle tension, numbness.
- Cognitive: tunnel vision, intrusive memories, dissociation, poor working memory, catastrophic thinking.
- Emotional/behavioural: anger outbursts, panic, avoidance of places/people, emotional numbing, immobility.
- Relational: hypervigilance to others, mistrust, withdrawal, difficulty with closeness or boundaries.
Big‑T Trauma
Single or repeated events that are life‑threatening or violent and typically meet diagnostic criteria for PTSD (e.g., rape, serious assault, combat, major natural disaster, severe child abuse, sudden death of a loved one). These events overwhelm coping and often require clinical intervention.
Small‑t trauma
Stressful, hurtful, or invalidating experiences that don’t meet criteria for PTSD but still cause significant distress and long‑term impact (e.g., chronic bullying, repeated humiliation, emotional neglect, ongoing micro‑aggressions, repeated medical procedures, frequent instability). Effects can accumulate.
Signs of Trauma in Children
Attachment trauma refers to harm to a child’s developing sense of safety and trust in caregivers caused by caregiving that is inconsistent, neglectful, frightening, abusive, or otherwise fails to meet the child’s emotional and physical needs. Because early attachment relationships shape the brain’s regulation systems and relational expectations, disruptions can produce long‑lasting effects on emotion regulation, relationships and development.
It is caused by prolonged neglect, caregiver unavailability, sudden separation, repeated inconsistent caregiving, physical or emotional abuse, caregiver substance misuse or unresolved trauma, and multiple caregiver changes or institutional care.
It is especially harmful in infancy and early childhood when attachment systems are forming.
Emotional & affective
- Excessive fear, sadness, irritability or anger
- Frequent tearfulness, emotional numbness or flat affect
- Sudden mood swings or intense anxiety
Behavioural
- Regressive behaviours (bedwetting, thumb‑sucking, clinginess)
- Tantrums, aggression, withdrawal or avoidance of reminders
- Increased startle response, hypervigilance or constant scanning for threat
- Risky or self‑harm behaviours in older children/teens
Play & reenactment
- Replaying the traumatic event or themes in play repeatedly
- Nightmares, night terrors or distressed play
Cognitive & attention
- Trouble concentrating, memory problems, confusion or disorientation
- Preoccupation with intrusive memories or fearful thoughts
Physiological
- Sleep problems (difficulty falling/staying asleep), bedwetting
- Changes in appetite or unexplained stomachaches/headaches
- Startle reactions, gastrointestinal complaints, unexplained pains
Social & relational
- Difficulty trusting adults, reluctance to be comforted, clinginess or extreme avoidance of caregivers
- Withdrawal from peers, loss of interest in previously enjoyed activities, social isolation
Developmental & learning
- Decline in school performance, difficulty following routines, slow processing or speech regression in younger children
- Delays in language, motor or social milestones (especially after early trauma)
Regulation & arousal patterns
- Hyperarousal: agitation, insomnia, irritability, hypervigilance
- Hypoarousal/dissociation: numbness, zoning out, "spaced" appearance, detachment
Overlap
- Trauma, ADHD and ASD often overlap. Trauma can cause attention, regulation, and social‑withdrawal problems that mimic or worsen ADHD and ASD differences
See Our Services
Get in touch at info@therapaeds.com.hk to learn more or discuss how we can support you or your child.
