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A sensory diet is a personalized set of activities designed to help children (and adults) with sensory processing challenges regulate their emotions, attention, and behavior. Developed by occupational therapists, sensory diets include a balance of movement, touch, and calming input tailored to individual needs. These strategies can reduce meltdowns, improve focus, and support transitions. Just like a healthy food diet, a sensory diet helps the body and brain function well. It’s not about food—it's about the right kind of sensory input at the right time.

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What is a sensory diet? - The OT Toolbox

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Many times, parents are told that their child with sensory needs would benefit from a sensory diet. Most of the time, they respond with "what is a sensory diet?!" In this article, we'll be talking a bit about what a sensory diet is and how it can be beneficial to kids with sensory needs.

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Helping Children Cope with Traumatic Events

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Helping Children Cope with Traumatic Events

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Below are some resources childcare providers and parents can use in their work with children who have faced a disaster or traumatic event.

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Helping Children Cope with Traumatic Events

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Below are some resources child care providers and parents can use in their work with children who have faced a disaster or traumatic event: Books for Helping Children Cope 100 + Children’s Books to Support Emergency Preparedness, Response and Recovery (PDF download) – Explore books for every age level on helping children cope with disasters, violence or other... Read more »

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What Is Child Trauma?  Northwestern University’s Center for Child Trauma Assessment, Services, and Interventions

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What Is Child Trauma?  Northwestern University’s Center for Child Trauma Assessment, Services, and Interventions

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This resource describes child trauma as an event that is frightening, dangerous, violent, or life-threatening, occurring during childhood (ages 0–18). It highlights that trauma can stem not only from direct experiences but also from witnessing such events or learning that they have happened to a loved one. The site explores how these experiences can exceed a child's coping capacity, leading to overwhelming feelings of helplessness and fear.

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A ( traumatic event is a scary, dangerous, or violent event. An event can be traumatic when we face or witness an immediate threat to ourselves or to a loved one, and it is often followed by serious injury or harm NCTSN Parents and Caregivers Website).

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Look Through Their Eyes – Trauma Resources

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Look Through Their Eyes – Trauma Resources

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This resource hub provides information and tools to help adults understand and respond to childhood trauma. It includes materials from reputable organizations like the American Academy of Pediatrics and the National Child Traumatic Stress Network, aiming to promote awareness and effective intervention strategies.

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Stories for Children That Grownups Can Watch

"Stories" is an innovative set of materials that identify and highlight warning signs resulting from childhood exposure to trauma and violence. The goal is to raise awareness of the need to prevent, identify and treat exposure to trauma and violence in young children and to provide resource information for families. The target audience is infants and children under age of 6, and their parents, caregivers, and service providers.

The information is presented as a collection of tools in a series of interactive DVDs with animated films, support video segments, coloring/activity books, and professional tutorials from leading experts in the field. The core message, which carries throughout the Stories project, is "Bring the kids back into focus... so every child can be safe from the start."

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Stories for Children That Grownups Can Watch "Stories" is an innovative set of materials that identify and highlight warning signs resulting from childhood exposure to trauma and violence. The goal is to raise awareness of the need to prevent, identify and treat exposure to trauma and violence in young children and to provide resource information for families.

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This resource includes a variety of books stories and videos to help caring support young children.

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Explore free, bilingual resources on traumatic experiences that caring adults can use to help children cope and boost their emotional well-being.

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With more young children in the U.S. experiencing trauma, early childhood educators play a critical role in recognizing their needs and fostering positive learning environments. This webinar highlights common behavioral signs of trauma in children and offers practical strategies to build trauma-sensitive classrooms that support healing and growth.

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Webinar: Creating Trauma Sensitive Classrooms

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A sensory diet is a personalized plan of sensory activities designed to help children regulate their emotions, focus, and behavior throughout the day. Just like a healthy food diet includes variety, a sensory diet offers different types of input (like movement, deep pressure, or calming visuals) tailored to a child’s specific needs. It can help with challenges like sensory overload, attention issues, or sleep difficulties. Activities are adjusted based on the child’s mood, environment, and daily needs, and should be developed with guidance from an occupational therapist.

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Do you ever find yourself spinning your pencil, tapping your leg or twirling your hair while trying to do work? These are all ways we subconsciously provide our bodies with sensory input in order to be focused and productive. Many children do not know how or when to provide their bodies with the appropriate input they need.
(Scroll to the bottom for a printable sensory diet template!)
This is where a Sensory Diet comes into play. What is this new diet everyone is talking about? A sensory diet is a personalized action plan that gives your child the unique sensory input his or her body needs at that very moment. The diet can be easily incorporated into a child's daily routine. It is a variety of activities that your child is actively engaged in throughout the day. When participating in these tasks, it helps to regulate emotions and behaviors for optimal function and interactions. A sensory diet is aimed to help a child obtain his or her 'just right' state to perform at their most productive level. For a child who tends to be overstimulated and aroused, a sensory diet will help calm them down so they can be more focused and attentive. For the child who tends to be understimulated, a sensory diet will help alert him or her and provide the energy and the ability to focus.

Some Reasons To Use A Sensory Diet May Include (But Are Not Limited To):

Sensory overload

Sleep disruptions

Emotional meltdowns

Seeking behaviors

Difficulty with transitions

Improve attention, self regulation

Encourages purposeful movement

The tricky part is that our bodies and our needs are constantly changing and evolving, even from day to day. So what does that mean as it relates to a sensory diet? It means if we make (or follow) a sensory diet, that also has to change and evolve simultaneously with your child. This is why it's so important to have an individualized sensory diet.

Creating An Individualized Sensory Diet:

Get ready to play detective and create a personalized sensory diet.

A good place to start is by making a list of activities that your child enjoys that simultaneously helps regulate his or her body. Some things to consider are:

Do weekday behaviors differ from weekend behaviors?

Times of day (ex. morning, after school, evening, bedtime)

Environments (ex. home vs. school)

Where is a space/room my child can be in safely to get regulated

Does my child seem to be under-responsive or over-responsive. This will help guide what activities to use (ex. calming vs alerting)

What sensory activities can I use when we are not home (ex. having dinner out at a restaurant, out for a family day, out with friends)

Any specific triggers that typically upset/agitate my child

Are certain tasks harder than others (ex. fine motor-buttoning, snaps versus gross motor difficulties-bumping into things, difficulty with balance and coordination)

There are endless possibilities for sensory diet activities. And the most important thing to remember is if one activity doesn't work...don't do it! Simply find another activity that provides you with a desired outcome. It is highly recommended to work with an Occupational Therapist with experience and understanding of sensory processing issues.

Here are some examples of sensory diet activities based on specific sensory needs and chronological age. I would encourage you to explore ALL of the activities as chronological age and development often do not coincide. Again, remember that activities can be alerting or calming, based on the child, the day, the moment. In each category I list general guidelines for alerting vs calming, however remember again-every child is different. If something doesn't provide the results you are seeking, modify or stop it!

Sensory Diet Activity Generator
How to use:

1. Select an option from the drop down menu

2. Click a button to choose the age group you would like to see sensory diet activities for

Give it a try!
How Do You Know If Your Child Would Benefit From A Sensory Diet?

These are some things to consider when contemplating implementing a sensory diet. If these things seem like your child, the likely answer is that he or she will benefit from a sensory diet. Again, you can always consult an Occupational Therapist (if you haven't already).

My child doesn't seem to listen

My child has a hard time following directions

My child is always jumping on the furniture

My child plays too roughly with his/her siblings or peers

My child bites, chews and/or licks non food items when excited (or for no apparent reason)

My child cries when it's time to end/change activities

My child struggles to stay in his chair (ex. during meals, at school)

My child doesn't sleep well

My child is easily bothered by sensory input (ex. too loud, too messy, too crunchy, to bright, too itchy, too smelly)

My OT recommended one

My child has a diagnosis of SPD, ADHD, Developmental Delay

Check Out These Sensory Diet Examples:

Here are some hour-by-hour sensory diet examples based on some of the activities listed above:

Example 1: Xavier (Age 9)

Xavier is 9 years old. He has a diagnosis of Autism. He wakes up and is immediately "off the walls"- seeking input. He might benefit from deep proprioceptive input right away and every 1-2 hours after that to keep him modulated throughout the day.

8am he jumps on his trampoline.

10am he crashes into the couch pillows.

12pm he blows up 4 balloons.

2pm he has a thick smoothie through a straw.

4pm he reads a book under a weighted blanket.

6pm he has some crunchy carrots with dinner.

8pm he listens to calming music while watching a lava lamp in a room with calming essential oil.

Just remember, if tomorrow he wakes up and is cranky and irritable (while bouncing "off the walls") his sensory diet activities could possibly need to be totally different.

Example 2: Teagan (Age 4)

Teagan is a 4 year old girl who wakes up lethargic and slow to get her day going. She might need to jump, hop and bounce immediately to get her body alert. She might need this type of input every 2-3 hours to remain alert and attentive.

8am she rubs lotion on her arms & legs with force

10am she completes a puzzle while using the hippity hop to retrieve the pieces

12pm she uses a scooter board in the hallways of her house

2pm she goes on her swing outside, she goes side to side, round and round quickly

4pm she goes outside and log rolls down the hill in her backyard

6pm she crab walks to brush her teeth using a vibrating toothbrush

8pm she stomps back to her room and climbs into bed with her weighted blanket.

Example 3: Rory

Then there is Rory. He is 13 years old with a diagnosis of Sensory Processing Disorder. He wakes up happy, but by the time he is done with breakfast, he is on the verge of an emotional breakdown. He might benefit from some calm auditory or visual input; he might only need this input sporadically throughout the day.

8am he watches a calm projector on the wall with dim lights

10am he throws a balloon up and catches it 10x

12pm he uses noise cancelling headphones while completing a typing activity

2pm he goes outside and rakes the front lawn for 20 minutes while whistling his favorite songs

4pm he plays flashlight tag after he carries the laundry upstairs for his family

6pm he does 15 minutes of yoga ending with down- dog (an inversion).

8pm he takes a warm bath with lavender essential oil and blows bubbles in the bath through a straw.

A healthy food diet consists of a variety of balanced foods. A healthy sensory diet consists of a variety of input (from different senses). It should be closely monitored and continuously adjusted to sufficiently meet the child's individualized sensory needs.
The concept of the sensory diet was originated by Patricia Wilbarger, MA, OTR ( & , 2002). Ideally an Occupational Therapist should be consulted to create and maintain a healthy sensory diet. Even small amounts of input can be very powerful! If used correctly this is a wonderful, beneficial & healthy diet!

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What Is A Sensory Diet With Examples (Free PDF Template Download)

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Do you ever find yourself spinning your pencil, tapping your leg or twirling your hair while trying to do work? These are all ways we subconsciously provide our bodies with sensory input in order to be focused and productive. Many children do not know how or when to provide their bodies with the appropriate input they need.

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https://youtu.be/jNC0Mw3FqUQ?si=vs-Jj1j9KfI1iJGv

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Trauma Coping Toolkit: Soothe Intense Emotions With the 5 Senses

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Information on childhood trauma and screening and assessment tools

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Conducting a Quick Screen for Trauma - Child Interview

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Addressing Childhood Trauma through Trauma-Informed Care – YouTube

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Addressing Childhood Trauma through Trauma-Informed Care – YouTube

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This video covers the principles and practices essential for supporting traumatized children.

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Addressing Childhood Trauma through Trauma-Informed Care

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10 Things About Childhood Trauma Every Teacher Needs To Know

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10 Things About Childhood Trauma Every Teacher Needs To Know

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Understanding Trauma-Informed Teaching:
Students impacted by trauma may show behaviors that mask their struggles, like acting out or having trouble focusing. Trauma-informed teaching helps by creating safe, supportive classrooms through routines, empathy, and positive connections—helping students feel secure, build resilience, and succeed.

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10 Things About Childhood Trauma Every Teacher Needs To Know

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With grief, sadness is obvious. With trauma, the symptoms can go largely unrecognized because they mimic other problems: frustration; acting out; or difficulty concentrating, following directions, or working in a group. Students are often misdiagnosed with anxiety, behavior disorders, or attention disorders rather than understood to have trauma that drives those symptoms and reactions.

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A sensory diet is a personalized plan of sensory activities designed to help children with sensory processing challenges feel calm, focused, and regulated throughout the day. These activities—like swinging, jumping on a trampoline, playing with sensory bins, or using a weighted blanket—offer the sensory input children need to function at their best. Sensory diets help improve focus, emotional control, and daily routines by balancing alerting and calming input. Created with support from an occupational therapist, sensory diets are fun, flexible, and tailored to each child's needs.

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20 Examples of a Sensory Diet - Care Options for Kids

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Discover 20 sensory diet examples to help your child stay focused, calm, and organized with personalized activities designed to meet their sensory needs.

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Childhood trauma assessments help uncover adverse experiences that impact emotional, psychological, and even physical development. These tools guide therapists in creating personalized interventions, while also promoting healing, resilience, and self-awareness. Early identification is key to supporting healthy growth and long-term wellbeing.

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Understanding Trauma: 30 Strategies to Support Students in Your Classroom

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Understanding Trauma: 30 Strategies to Support Students in Your Classroom

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Childhood trauma can significantly impact a child's ability to regulate emotions and cope with stress (Perry, 2009). In a trauma-informed classroom, educators can support students in developing self-regulation skills through activities that encourage mindfulness, relaxation, and self-awareness.

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Trauma: 30 Strategies to Support Children in Your Classroom

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In this article, we explore the implications of Dr. Perry’s work on trauma for teaching and learning, and discuss how to create trauma-informed classrooms.

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 Children and Trauma – American Psychological Association

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 Children and Trauma – American Psychological Association

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This PDF document from the APA discusses the prevalence of trauma among children and adolescents in American society. It outlines the psychological effects of trauma, such as anxiety, depression, and behavioral issues, and emphasizes the importance of mental health professionals in supporting affected children

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Five Ways to Support Students Affected by Trauma

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Five Ways to Support Students Affected by Trauma

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Trauma-Informed & Strength-Based Teaching
Many students experience trauma that deeply impacts their learning and behavior. School can be their only safe space. Trauma-informed and positive psychology practices like creating safe relationships, using calming classroom strategies, building resilience, and focusing on students’ strengths help both healing and growth. Teachers have the power to make school a place of safety, connection, and empowerment.

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For some students, school is not just a place of learning and growth but also a refuge from abuse.

Data suggest that, on average, every classroom has at least one student affected by trauma. According to the National Child Traumatic Stress Network, close to 40 percent of students in the U.S. have been exposed to some form of traumatic stressor in their lives, with sexual assault, physical assault, and witnessing domestic violence being the three most prevalent.

These types of stressors, known as complex trauma, have the added wound of being perpetrated by a person with whom the child or teen has an ongoing relationship. The very people who are supposed to support and protect are those who wound and abuse. This leads to continuing states of grief, loss, abandonment, and neglect as well as persistent anxiety, fear, and depression-all at a time when the brain is in crucial stages of development.

For some young people, school is the only place in their lives where they know they are safe and can form trusted, enduring relationships. It is, therefore, a cruel irony that many students who are affected by trauma also have trouble engaging at school. They may attend school with the best of intentions, hoping to form friendships, feel connected to their teachers, and succeed at the day's tasks. Yet they can find themselves defiant, demanding, and disengaged -unable to learn and confused about why they can't relate and bond with others.

What do the latest scientific findings from the fields of traumatology, neuroscience, and positive education tell us about how to best help students who are affected by trauma? Below, we highlight some of the new practices that teachers can use to not only help students heal but also help them grow.

Healing and repair

The new field of "trauma-informed learning" has made great strides in helping teachers to better understand the developmental, emotional, and social challenges that students who are impacted by trauma face at school. While teachers are not mental health professionals, trauma-informed learning trains teachers in therapeutic approaches that can be woven into the classroom to redress the delayed development, underdeveloped neural pathways, and over-regulated nervous systems that students experience as a result of trauma.

For example, teachers can directly teach students about their body's own stress activation response and help them find techniques to regulate their heart rate, body temperature, and blood pressure. Teaching through rhythm-for example, learning about math to the beat of a drum, reading an English text while riding an exercise bike, or having a disciplinary conversation while walking around the school yard together-is now an accepted classroom technique that assists trauma-affected students to regulate their nervous system through rhythmic movement.

Feeling calmer in class has the knock-on effects of helping students get along better with others, think more clearly, and stay on task. These approaches nurture students' stamina and persistence, allowing them to better deal with frustration, which benefits their social behavior in class and their capacity to take on greater academic challenges. This is indeed a hopeful approach.

Growth and strength

Trauma-informed education has helped teachers to evolve from the question of "What is wrong with this student?" to "What has this student been through?" In the field of positive psychology, we add a further question: "What does this student need to reach their potential?" This allows teachers to extend the focus from what is wrong, to what is needed, to what is possible. Building the mental health and academic capacities of students affected by trauma requires more than repairing psychological disorder and developmental delays-it requires the dual mantra of healing and growth. Of repairing and rising up.

Research by Corey Keyes shows us that healing and growth can be simultaneous processes. We don't always need to wait until something is fixed before we work on building our strengths. Indeed, growing the psychological strengths of a student affected by trauma can be a core part of healing their psychological struggles.

Working with students who are affected by trauma requires schools to assist in providing individual counseling services, safety and crisis planning, behavior plans, self-care plans to address triggers, and case management. Most of these services are not provided by the classroom teacher, yet the teacher is the person who spends the most time with trauma-affected students. A key way in which positive psychology adds to the trauma-informed strategies above is by empowering teachers in the classroom to help their students on a daily basis.

Here are five teaching techniques that you can use in your class, knowing that these approaches also assist your mainstream students.

1. Positive relationships. Trauma-affected students have more relationship challenges to navigate than most. These students can be dealing with harmful relationships at home and then come to school to manage relationships not only with their teachers but also with social workers, police officers, and clinicians-all while living out their daily lives.

It is critical that we help these students feel safe and trusting where possible, so they learn to develop social intelligence and seek out positive bonds with others. Teachers may be the only people who help these students learn what a healthy, supportive relationship feels like. Building relational trust involves simple teaching practices such as smiling, sharing parts of your life with your students, getting to know your students as individuals, and using yourself as a role model of a reliable and regulated adult.

2. Positive physical space. The physical layout and look of your classroom can be used to build positive emotions. Putting up positive visuals and quotes can inspire creative thinking and teamwork in your students. Increased natural light or soft lighting can enhance an open, warm, and relaxing environment.

Consider how the furniture and seating is arranged in your class. Is it helping students to feel safe and connected? You could also bring plants into the room or create a mindfulness corner, a dedicated space that students can visit when they need to regulate their stress response. The corner can include a bean bag, mindful coloring books, squeeze toys, noise-cancelling headphones, and more.

3. Positive priming. Following the research of Barbara Frederickson, you can use simple priming techniques to foster positive emotions such as contentment, pride, awe, and wonder in class.

Brain breaks are one helpful technique. The teachers who work with us have found that brain breaks are most effective when students reflect on the type of energy they need at that moment for learning: Escalating brain breaks build positive energy and emotions such as joy, happiness, and wonder (e.g., clapping games, thumb wars, laughter yoga, racing around the desk), while de-escalating brain breaks build calm emotions such as contentment and serenity, which help a student to feel safe and focused (e.g., silently tracing the movements of a partner, triangle breathing, playing music or repeating mantras, and body movements such as shoulder shrugging or pumping your toes inside your shoes).

You can also use positive primers to boost positive emotion when students first enter the classroom (such as by greeting them with the healthy touch of a handshake or a high five), during transitions (by turning transition routines into a silent game such as "follow the leader"), or during independent work breaks (by having students deliberately savor their accomplishment and share with a peer).

According to Fredrickson's theory, helping your students build up their bank account of positive emotions over time changes their brain to help them learn more effectively, form better relationships, and become more resilient. Next time you are planning a lesson, think about how you can use positive primers throughout the learning experience.

4. Using character strengths. Teaching strengths in schools has been shown to increase achievement and well-being. All students, especially trauma-affected students, need opportunities to identify, recognize, practice, and use their character strengths, which include qualities like kindness, humor, creativity, and bravery.

Ways to help students learn about their own strengths and the strengths of others include strengths surveys (if their literacy skills allow), strengths cards, and strengths spotting exercises-like identifying strengths in their heroes or playing a secret agent game where they are invited to "spy" on a fellow student to identify the strengths of that student. To teach about particular strengths, you could focus on stories in English and Humanities curriculums where characters or historical figures displayed those strengths. Strengths can also be developed through performing arts, sports, and other co-curricula.

5. Building resilience. Sadly, you cannot always impact the life of a student outside of school, but you can teach resilience strategies that help a student affected by trauma to gain a better understanding of their situation and to counteract the negative messages of shame they often internalize.

Students can practice resilience skills through role plays that help them to act out skills such as setting boundaries and verbalizing their feelings, all while in the safety of a classroom. Literature, poetry, and song lyrics can help students identify examples of resilient thinking-for example, Ariana Grande's song "No Tears Left to Cry" following the London terrorist attack at her concert. Analyzing the ways in which media figures, sports heroes, and other high-profile people explain their successes and failures showcases the difference between optimism and pessimism.

Teachers can also use moments in the learning process when students feel frustration or self-doubt to coach them on how to dispute their pessimism and automatic negative thinking ( "I can't do this"; "I'm dumb") to make room for optimism and constructive thinking ( "Maybe I'm tired and I need a break"; "I solved the problem last week and I can do it again"; "It takes me a little longer than others, but I've come a long way"). Learning resilience skills can provide an internal psychological buffer for students when they are outside of school, as well as providing empowering experiences at school.

Every teacher wants to positively impact the lives of their students. For students who are affected by trauma, the teacher plays an even more vital role. The introduction of positive psychology into the classroom has huge potential to change the trajectories of the lives of many of these young people by moving beyond repair to also inspire growth.

Greater Good wants to know: Do you think this article will influence your opinions or behavior?

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Five Ways to Support Students Affected by Trauma

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Teachers can help students recognize their strengths and build resilience.

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Creating a sensory diet involves designing a personalized plan of sensory activities that support a child’s regulation, focus, and emotional well-being throughout the day. These diets help children manage sensory overload, meltdowns, inattention, and other challenges by offering calming or alerting input. Steps include observing behaviors, identifying needs, strategizing interventions, applying activities, and monitoring outcomes. Sensory diets must be flexible and evolve with the child’s development. The Sensory Lifestyle Handbook provides tools and templates to guide this process, making sensory support part of everyday life at home, school, or outdoors.

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How to Create a Sensory Diet - The OT Toolbox

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This article explains how to create a sensory diet and includes resources to make a sensory diet for kids to address sensory needs.

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9 Childhood Trauma Tests & Questionnaires

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9 Childhood Trauma Tests & Questionnaires

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These assessments help identify past traumatic experiences that impact a child's emotional and psychological development. By recognizing signs of trauma—such as behavioral changes, nervous system dysregulation, or low self-esteem—professionals can guide effective, individualized treatment. These tools promote healing, resilience, and personal growth.

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Childhood trauma is a difficult topic to navigate. We don't like to think or talk about children being hurt.

But if we're working with clients who may have been traumatized, we really need to understand it - what it means, how it manifests, and how to identify it.

Accurate childhood trauma tests are an important part of the therapeutic process if we suspect that trauma may have occurred.

In this article, we highlight examples and signs of childhood trauma. We also provide a list of proven childhood trauma tests for clinical practice and research. We end with a look at post-traumatic growth and positive psychology strategies to work with trauma and to foster resilience and positive growth.

Before you continue, we thought you might like to download our three Resilience Exercises for free. These engaging, science-based exercises will help you effectively deal with difficult circumstances and give you the tools to improve the resilience of your clients, students, or employees.

8 Examples of Childhood Trauma

Childhood trauma can take many forms and have lasting effects on an individual's emotional, psychological, and even physical wellbeing (Van der Kolk, 2003).

Below are just a few examples of childhood trauma; each individual's experience is unique.

1. Abuse

Abuse is defined by its intention to harm and can be physical, emotional, or sexual in nature (Terr, 2003). Abuse involves various forms of harm inflicted upon children by caregivers, significantly impacting their wellbeing (Legano et al., 2009).

2. Neglect

Childhood neglect refers to the failure of caregivers to provide for a child's basic needs, including food, shelter, supervision, and emotional support (Gould et al., 2012; Young & Widom, 2014).

Childhood neglect, which also includes emotional neglect, can lead to significant developmental, emotional, and psychological consequences, including difficulties forming healthy relationships, low self-esteem, and increased vulnerability to mental health issues later in life (Legano et al., 2009).

3. Witnessing violence or trauma

Children who witness violence or trauma, such as domestic violence, accidental injury, car crashes, or the death of a loved one, can experience feelings of fear, helplessness, and confusion resulting in trauma, even if they are not directly abused themselves (McCloskey & Walker, 2000).

4. Separation or loss

Loss of a parent through death, divorce, abandonment, or other circumstances can have severe traumatic effects for a child (Benz et al., 2004).

5. Natural disasters

Children who experience or witness natural disasters such as an earthquake, flood, fire, or hurricane may develop trauma-related symptoms, including anxiety, nightmares, and fear of similar events occurring again (Kousky, 2016).

6. Severe illness or hospitalization

Children who experience chronic illness or frequent hospitalizations may experience trauma related to their medical experiences, separation from family, and fear of their own mortality (Stuber & Shemesh, 2006).

7. Bullying

Being exposed to bullying at school, online, or within the community can be traumatic for children, leading to feelings of isolation, low self-esteem, and depression (Vanderbilt & Augustyn, 2010). Interestingly, the findings of this study also suggest that children may be traumatized by bullying even if they are involved in perpetrating or witnessing the bullying.

Understanding childhood trauma and abuse - Tanya Waymire

Tanya Waymire's TEDx talk about understanding childhood trauma and abuse provides a detailed personal perspective.

6 Signs of Childhood Trauma

Signs of childhood trauma are varied, subtle, and nuanced (Terr, 2003). Just as every child is unique, so is their response to adversity and their experience of trauma. Some of the more obvious signs of childhood trauma include:

1. Behavioral changes

Aggression, withdrawal, regressive behaviors (such as baby talk, bed-wetting, or thumb-sucking), acting out, or excessive compliance and clinginess may indicate that a child has experienced some kind of trauma (Milot et al., 2010).

However, more subtle changes, such as changes in appetite, sleeping patterns, ability to concentrate, school performance, and avoidant behaviors, may also indicate that a child may have experienced something traumatic (Perry, 2003).

2. Nervous system dysregulation & hypervigilance

Childhood trauma can dysregulate the nervous system, leading to heightened reactivity to stressors and alterations in brain structure and function, particularly in regions involved in emotion regulation such as the amygdala and prefrontal cortex (Elbers et al., 2018).

This dysregulation can result in hypervigilance, difficulties in managing emotions, increased sensitivity to triggers, and a heightened risk of mood swings, depression, anxiety, panic attacks, hypervigilance, or emotional numbness (Elbers et al., 2018).

3. Difficulty trusting others

Childhood trauma can affect a child's ability to trust others, as it disrupts the development of secure attachment bonds and may lead to a pervasive sense of fear, betrayal, or fear of abandonment (Beaton & Thielking, 2020).

This difficulty in trusting others may manifest as guardedness, avoidance of intimacy, and/or clinginess, resulting in challenges in forming and maintaining healthy relationships (Beaton & Thielking, 2020).

4. Low self-esteem

Children who have experienced trauma may experience feelings of worthlessness, self-blame, shame, or guilt, presenting as low self-esteem (Downey & Crummy, 2022).

5. Physical symptoms

Unexplained aches and pains, headaches, stomachaches, or other physical symptoms without medical cause may also indicate that a child is struggling to process trauma (Roelofs & Spinhoven, 2007).

6. Flashbacks or nightmares

Repeatedly experiencing the traumatic event through flashbacks, nightmares, or intrusive memories is a definite sign that a child is struggling to process a traumatic event (Tareen et al., 2007).

Taking a Closer Look: The ACE Childhood Trauma Test

If you suspect that a child or client has been traumatized, you may want to look a little closer. One childhood trauma test, the Adverse Childhood Experiences (ACE) Test, is a widely used questionnaire that assesses individuals' exposure to adverse experiences during childhood (Felitti et al., 1998).

The ACE Study, which used the ACE Test, revealed significant findings regarding the impact of childhood trauma on health outcomes later in life (Felitti et al., 1998).

This and further studies have found a strong association between childhood trauma as well as a wide range of health problems in adulthood (Felitti et al., 1998; Zarse et al., 2019). These may include mental health issues, a higher likelihood of engaging in risky behaviors, and struggling to form and maintain healthy relationships.

Felitti et al. (1998) and Zarse et al. (2019) further found that childhood trauma was associated with lower educational attainment, reduced job stability, and lower income levels in adulthood. Worryingly, there was also evidence to suggest that the effects of childhood trauma could be passed down to future generations, as individuals who experienced trauma in childhood were more likely to have children who experienced similar adversities.

Overall, there is compelling evidence of the long-term and wide-ranging impact of childhood trauma on physical health, mental health, social functioning, and overall wellbeing, highlighting the importance of early testing, intervention, and trauma-informed care to mitigate these effects.

4 More Childhood Trauma Tests & Quiz Options

There are several other childhood trauma tests and quizzes available that assess different aspects of childhood adversity and its impact on individuals.

Here are a few options.

1. Childhood Trauma Screener (CTS)

The CTS is a concise screening tool designed to identify individuals who may have experienced childhood trauma (Grabe et al., 2012).

It consists of a brief set of questions covering various types of childhood adversity. While it doesn't provide detailed information, you can use it as an initial assessment in situations where you suspect abuse. You can download the CTS to use in your own practice.

2. Brief Adverse Childhood Experiences Questionnaire

This shortened version of the ACE questionnaire focuses on key adverse childhood experiences such as abuse, neglect, and household dysfunction (Wade et al., 2017).

It offers a quick assessment of childhood trauma exposure, making it suitable for initial screenings.

3. The Childhood Trauma Questionnaire-Short Form (CTQ-SF)

The CTQ-SF is a concise self-report measure that assesses childhood trauma experiences, including emotional, physical, and sexual abuse, as well as emotional and physical neglect (Hagborg et al., 2022).

It provides a brief yet comprehensive overview of childhood trauma exposure, suitable for initial screenings.

4. Childhood Experience of Care and Abuse (CECA) Interview

The CECA is a semi-structured interview used to gather detailed qualitative information about childhood experiences of care and possible abuse (Bifulco et al., 1994). It explores parental behaviors, family dynamics, and specific traumatic events, offering rich insights into the impact of childhood trauma on individuals' wellbeing (Smith et al., 2002).

These are just a few examples of childhood trauma tests and quizzes available for assessing different aspects of childhood adversity and its impact. It is important to choose a tool that aligns with the specific therapeutic context of each client. Additionally, the interpretation of results should take context as well as all clinical and individual considerations into account.

Remember that your client is an individual person with unique experiences, so a person-centered approach is required.

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4 Childhood Trauma Questionnaires for Research

If you're undertaking childhood trauma research, you may need more in-depth childhood trauma tests and questionnaires that have been validated for research purposes. Here are a few options.

1. Childhood Trauma Questionnaire (CTQ)

The CTQ is ideal for researching childhood trauma due to its comprehensive assessment of various trauma types, including abuse and neglect (Bernstein et al., 1994).

Its structured format and reliability make it easy to administer, providing valuable data for understanding the prevalence, severity, and impacts of childhood trauma in research studies (Georgieva et al., 2021).

2. Traumatic Events Screening Inventory for Children (TESI-C)

The TESI-C is a self-report measure designed to assess trauma exposure in children and adolescents aged 7 to 18 (Ford et al., 2002). It covers various types of traumatic events, such as accidents, disasters, and interpersonal violence.

3. Trauma Symptom Checklist for Children (TSCC)

The TSCC is beneficial for research due to its ability to assess trauma-related symptoms in children and adolescents, providing valuable insights into their psychological wellbeing (Briere, 1996).

It reliably measures various symptom clusters, including anxiety, depression, post-traumatic stress, sexual concerns, and dissociation, aiding in comprehensive analysis (Wherry & Herrington, 2018).

4. Trauma History Questionnaire (THQ)

The THQ is a comprehensive questionnaire that assesses exposure to various types of traumatic events across the lifespan, including childhood trauma (Hooper et al., 2011).

It covers a wide range of traumatic experiences beyond those typically included in ACE assessments. So, if you're looking for more depth in your assessment, this may be a good option for you.

Explaining Test Scores & Questions

When interpreting childhood trauma test scores and questions on childhood trauma questionnaires, it is crucial to understand the context and implications of each assessment (Sparta, 2003).

You should also read up on the use of the questionnaire, as different childhood trauma tests may have specific guidelines for interpreting scores.

Scores usually reflect the severity or frequency of traumatic experiences reported by the individual, with higher scores indicating greater exposure to adversity during childhood. It is important to interpret scores cautiously, considering individual differences, cultural factors, and the potential for underreporting due to stigma or memory biases.

When explaining test scores to clients or parents, offer a clear and understandable interpretation. Start by discussing what the test measures and why it is relevant to their situation. Then, provide a breakdown of scores, emphasizing strengths and areas for improvement.

Offer support, answer questions, and discuss next steps or interventions based on the results. Use plain language and examples to ensure comprehension and foster trust in the assessment process.

Childhood Trauma & Post-Traumatic Growth

Beyond the profoundly negative impact of childhood trauma, there is an opportunity for post-traumatic growth (PTG). PTG can manifest in various ways, such as increased resilience, greater appreciation of life, enhanced relationships, new perspectives, and increased inner strength (Quan et al., 2022).

It is important to note that PTG is not a simple or linear process, and it does not negate the challenges or negative effects of trauma. It represents a complex and multifaceted process of adaptation and growth in response to adversity.

Some individuals may naturally experience PTG in response to trauma, wherein they undergo positive psychological changes and personal development because of their traumatic experiences (Vloet et al., 2017).

Many, however, will need support and therapy to achieve growth, and the extent of growth can vary greatly among individuals (Henson et al., 2021). Factors that may influence PTG include coping strategies, social support, personality traits, and the nature of the trauma itself (Tedeschi et al., 2004a).

Supporting PTG in therapy involves fostering a therapeutic environment that encourages acceptance, exploration, reflection, and resilience building (Zoellner & Maercker, 2006).

Positive psychology strategies, such as mindfulness and acceptance, a strengths-based approach, cultivating gratitude, and meaning making, can be instrumental in supporting these elements of PTG in therapy (Linley & Joseph, 2004). These strategies foster resilience, promote personal development, and cultivate a sense of meaning and purpose, all of which are necessary for PTG (Tedeschi et al., 2004b).

17 Tools To Build Resilience and Coping Skills

Empower others with the skills to manage and learn from inevitable life challenges using these 17 Resilience & Coping Exercises [PDF], so you can increase their ability to thrive.
Created by Experts. 100% Science-based.

Helpful Resources From PositivePsychology.com

We have several masterclasses that will support you and your trauma clients, and the Realizing Resilience Masterclass© will be particularly helpful if you're supporting clients who need to build their resilience to trauma and move toward PTG. This six-module resilience training provides an in-depth exploration of resilience from a positive psychology perspective.

For further reading, check out our selection of blog articles related to childhood trauma. In particular, you may want to read:

If you're looking for more science-based ways to help others overcome adversity, check out this collection of 17 validated resilience and coping exercises. Use them to help others recover from personal challenges and turn setbacks into opportunities for growth.

A Take-Home Message

Childhood trauma encompasses a range of adverse experiences, including abuse, neglect, witnessing violence, and separation, which can have a profound and lasting effect on a child's wellbeing. Understanding the signs and effects of trauma is crucial for providing appropriate support and intervention to affected clients.

Identifying and implementing appropriate childhood trauma tests to recognize the signs of trauma, such as behavioral changes, nervous system dysregulation, and difficulty trusting others, is essential for clinicians and caregivers to be able to intervene early and effectively to mitigate the impact of trauma and promote healing.

Employing positive psychology strategies can further support the process of post-traumatic growth, foster resilience, and promote wellbeing. Strategies such as mindfulness and acceptance, strengths-based approaches, cultivating gratitude, and promoting meaning making can empower individuals to navigate their trauma experiences, find purpose and meaning in their journey, and ultimately thrive despite adversity.

We hope you enjoyed reading this article. Don't forget to download our three Resilience Exercises for free.

Frequently Asked Questions

Signs of childhood trauma can include

recurring flashbacks or nightmares,

emotional numbness,

difficulty trusting others,

mood swings,

unexplained physical symptoms, and

behavioral issues.

Therapy and self-reflection can help identify underlying trauma.

Beaton, J., & Thielking, M. (2020). Chronic mistrust and complex trauma: Australian psychologists' perspectives on the treatment of young women with a history of childhood maltreatment. Australian Psychologist, 55(3), 230-243.

Benz, U., & Axelrod, T. (2004). Traumatization through separation: Loss of family and home as childhood catastrophes. Shofar, 23(1), 85-99.

Bernstein, D. P., Fink, L., Handelsman, L., Foote, J., Wenzel, K., Sapareto, E., & Ruggiero, J. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. The American Journal of Psychiatry, 151(8), 1132-1136.

Bifulco, A., Brown, G. W., & Harris, T. O. (1994). Childhood Experience of Care and Abuse (CECA): a retrospective interview measure. Journal of Child Psychology and Psychiatry, 35(8), 1419-1435.

Briere, J. (1996). Trauma Symptom Checklist for Children (TSCC): Professional manual. Psychological Assessment Resources.

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Elbers, J., Jaradeh, S., Yeh, A. M., & Golianu, B. (2018). Wired for threat: Clinical features of nervous system dysregulation in 80 children. Pediatric Neurology, 89, 39-48.

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Georgieva, S., Tomas, J. M., & Navarro-Pérez, J. J. (2021). Systematic review and critical appraisal of Childhood Trauma Questionnaire - Short Form (CTQ-SF). Child Abuse & Neglect, 120, Article 105223.

Gould, F., Clarke, J., Heim, C., Harvey, P. D., Majer, M., & Nemeroff, C. B. (2012). The effects of child abuse and neglect on cognitive functioning in adulthood. Journal of Psychiatric Research, 46(4), 500-506.

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Henson, C., Truchot, D., & Canevello, A. (2021). What promotes post traumatic growth? A systematic review. European Journal of Trauma & Dissociation, 5(4), Article 100195.

Hooper, L. M., Stockton, P., Krupnick, J. L., & Green, B. L. (2011). Development, use, and psychometric properties of the Trauma History Questionnaire. Journal of Loss and Trauma, 16(3), 258-283.

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9 Childhood Trauma Tests & Questionnaires

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Learn how to recognize childhood trauma with this detailed guide on proven childhood trauma tests and questionnaires.

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Trauma-Sensitive Schools: These schools prioritize the impact of trauma on learning and behavior. Educators acknowledge the prevalence of adverse childhood experiences, respond with trauma-informed and relationship-focused strategies, and work to prevent re-traumatization while fostering resilience. Join the summit/conferences for more resources or watch the online recording.

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Creating Trauma-Sensitive Schools - Attachment and Trauma Network

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ATN's Trauma-Sensitive Schools Initiative is driven by Experienced Educators who are devoted to creating school-wide trauma-sensitive reform.

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A primer on Adverse Childhood Experiences (ACEs), this resource explains how early trauma increases risk for a range of health and social problems later in life. Also includes prevention and intervention strategies.

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The science of PACEs refers to the research about the stunning effects of positive and adverse childhood experiences (PACEs) and how they work together to affect our lives, as well as our organizations, systems and communities. It comprises:

1. The CDC-Kaiser Permanente ACE Study and subsequent surveys that show that most people in the U.S. have at least one ACE, and that people with four ACEs- including living with an alcoholic parent, racism, bullying, witnessing violence outside the home, physical abuse, and losing a parent to divorce - have a huge risk of adult onset of chronic health problems such as heart disease, cancer, diabetes, suicide, and alcoholism.

2. Brain science (neurobiology of toxic stress) - how toxic stress caused by ACEs damages the function and structure of kids' developing brains.

3. Health consequences - how toxic stress caused by ACEs affects short- and long-term health, and can impact every part of the body, leading to autoimmune diseases, such as arthritis, as well as heart disease, breast cancer, lung cancer, etc.

4. Historical and generational trauma (epigenetic consequences of toxic stress) - how toxic stress caused by ACEs can alter how our DNA functions, and how that can be passed on from generation to generation.

5. Positive Childhood Experiences and resilience research and practice - Building on the knowledge that the brain is plastic and the body wants to heal, this part of PACEs science includes evidence-based practice, as well as practice-based evidence by people, organizations and communities that are integrating trauma-informed and resilience-building practices. This ranges from looking at how the brain of a teen with a high ACE score can be healed with cognitive behavior therapy, to how schools can integrate trauma-informed and resilience-building practices that result in an increase in students' scores, test grades and graduation rates.

1. What are ACEs?

ACEs are adverse childhood experiences that harm children's developing brains and lead to changing how they respond to stress and damaging their immune systems so profoundly that the effects show up decades later. ACEs cause much of our burden of chronic disease, most mental illness, and are at the root of most violence.

"ACEs" comes from the CDC-Kaiser Adverse Childhood Experiences Study, a groundbreaking public health study that discovered that childhood trauma leads to the adult onset of chronic diseases, depression and other mental illness, violence and being a victim of violence, as well as financial and social problems. The ACE Study has published about 70 research papers since 1998. Hundreds of additional research papers based on the ACE Study have also been published.

The 10 ACEs the researchers measured:

- Physical, sexual and verbal abuse.

- Physical and emotional neglect.

- A family member who is:

depressed or diagnosed with other mental illness;

addicted to alcohol or another substance;

in prison.

- Witnessing a mother being abused.

- Losing a parent to separation, divorce or other reason.

Subsequent to the ACE Study, other ACE surveys have expanded the types of ACEs to include racism, gender discrimination, witnessing a sibling being abused, witnessing violence outside the home, witnessing a father being abused by a mother, being bullied by a peer or adult, involvement with the foster care system, living in a war zone, living in an unsafe neighborhood, losing a family member to deportation, etc.

ACEs fall into three large categories:

Adverse childhood experiences

Adverse community experiences

Adverse climate experiences

Resources:
CDC ACE Study site Wikipedia - Adverse Childhood Experiences Study
The 10 ACE Questions (and 14 resilience survey questions)
The Pair of ACEs: The Soil in Which We're Rooted, the Branches on Which We Grow
Why are ACEs significant?

1. The ACE Study revealed six main discoveries:

ACEs are common...nearly two-thirds (64%) of adults have at least one.

They cause adult onset of chronic disease, such as cancer and heart disease, as well as mental illness, violence and being a victim of violence

ACEs don't occur alone....if you have one, there's an 87% chance that you have two or more.

The more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. People have an ACE score of 0 to 10. Each type of trauma counts as one, no matter how many times it occurs. You can think of an ACE score as a cholesterol score for childhood trauma. For example, people with an ACE score of 4 are twice as likely to be smokers and seven times more likely to be alcoholic. Having an ACE score of 4 increases the risk of emphysema or chronic bronchitis by nearly 400 percent, and attempted suicide by 1200 percent. People with high ACE scores are more likely to be violent, to have more marriages, more broken bones, more drug prescriptions, more depression, and more autoimmune diseases. People with an ACE score of 6 or higher are at risk of their lifespan being shortened by 20 years.

ACEs are responsible for a big chunk of workplace absenteeism, and for costs in health care, emergency response, mental health and criminal justice. So, the fifth finding from the ACE Study is that childhood adversity contributes to most of our major chronic health, mental health, economic health and social health issues.

On a population level, it doesn't matter which four ACEs a person has; the harmful consequences are the same. The brain cannot distinguish one type of toxic stress from another; it's all toxic stress, with the same impact.

What's particularly startling is that the 17,000 ACE Study participants were mostly white, middle- and upper-middle class, college-educated, and all had jobs and great health care (they were all members of Kaiser Permanente).

Resources:

ACE Study primer - KPJR Films, which came out with Paper Tigers in 2015 and Resilience in 2016, put together this five-minute overview of the ACE Study.

ACE Study video - Three-minute trailer for a four-hour CD of interviews with ACEs researchers produced by the Academy on Violence and Abuse.

How childhood trauma affects health across a lifetime (16-minute TED Talk by Dr. Nadine Burke Harris)
The Adverse Childhood Experiences Study - the largest public health study you never heard of - started in an obesity clinic
Has anyone else done an ACE Study?

Thirty-six states and Washington, D.C. (infographic) have done one or more ACE surveys. Here are links to some of their reports (some states haven't produced reports).

There are numerous other ACE surveys, including cities, such as Philadelphia; organizations, including the Crittenton Foundation; schools, including Spokane elementary schools; by pediatricians, including Dr. Nadine Burke Harris and Dr. Victor Carrion ( 2011 and 2013); several countries, including England, Saudi Arabia, and a World Health Organization ACE survey of university students in Romania,; and 64,000 juvenile offenders in the Florida juvenile justice system. You can find a list of ACE surveys, including expanded ACE surveys with more questions, in the Resources Section of ACEsConnection.com.

2. What's the neurobiology of toxic stress?

Brain science shows that, in the absence of protective factors, toxic stress damages children's developing brains. Stress is the body's normal response to challenging events or environments. Positive stress - the first day of school, a big exam, a sports challenge - is part of growing up, and parents or caregivers help children prepare for and learn how to handle positive stress, which is moderate and doesn't last long. It increases heart rate and the amount of stress hormones in the body, but they return to normal levels quickly.

But when events or the environment are threatening or harmful - we stumble across a bear in the woods - our brains instantly zap into fight, flight or freeze mode and bypass our thinking brains, which can be way too analytical to save us (Is the bear really mean? Is it more interested in berries or killing me? Should I wait until I see it charge?). With help from caring adults, children also recover from this tolerable stress.

Too much stress - toxic stress - occurs when that raging bear comes home from the bar every night, says pediatrician Nadine Burke Harris. Then a child's brain and body will produce an overload of stress hormones - such as cortisol and adrenaline - that harm the function and structure of the brain. This can be particularly devastating in children, whose brains are developing at a galloping pace from before they are born to age three. Toxic stress is the kind of stress that can come in response to living for months or years with a screaming alcoholic father, a severely depressed and neglectful mother or a parent who takes out life's frustrations by whipping a belt across a child's body.

Resources:
Harvard University Center on the Developing Child
Video: Toxic Stress Derails Healthy Development (2 min)

An Unhealthy Dose of Stress (Center for Youth Wellness white paper)
The Science Behind PTSD Symptoms: How Trauma Changes the Brain Brain Story Certification, Alberta Family Wellness Initiative
3. What are the health effects of toxic stress?

Chronic toxic stress-living in a red alert mode for months or years - can also damage our bodies. In a red alert state, the body pumps out adrenaline and cortisol continuously. Over time, the constant presence of adrenaline and cortisol keep blood pressure high, which weakens the heart and circulatory system. They also keep glucose levels high to provide enough energy for the heart and muscles to act quickly; this can lead to type 2 diabetes. Too much adrenaline and cortisol can also increase cholesterol.

Too much cortisol can lead to osteoporosis, arthritis, gastrointestinal disease, depression, anorexia nervosa, Cushing's syndrome, hyperthyroidism and the shrinkage of lymph nodes, leading to the inability to ward off infections.

If the red alert system is always on, eventually the adrenal glands give out, and the body can't produce enough cortisol to keep up with the demand. This may cause the immune system to attack parts of the body, which can lead to lupus, multiple sclerosis, rheumatoid arthritis, and fibromyalgia.

Cortisol is also extremely important in maintaining the body's appropriate inflammation response. In a normal response to a bee sting or infection, the body rushes antibodies, white blood cells and other cell fighters to the site and the tissues swell while the battle rages. But too much swelling damages tissue. Cortisol controls this fine balance. So without the mediating effects of cortisol, the inflammatory response runs amok and can cause a host of diseases.

If you're chronically stressed and then experience an additional traumatic event, your body will have trouble returning to a normal state. Over time, you will become more sensitive to trauma or stress, developing a hair-trigger response to events that other people shrug off.

Biomedical researchers say that childhood trauma is biologically embedded in our bodies: Children with adverse childhood experiences and adults who have experienced childhood trauma may respond more quickly and strongly to events or conversations that would not affect those with no ACEs, and have higher levels of indicators for inflammation than those who have not suffered childhood trauma. This wear and tear on the body is the main reason why the lifespan of people with an ACE score of six or higher is likely to be shortened by 20 years.

Resources:

Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal, by Donna Jackson Nakazawa

The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, by Bessel Van Der Kolk

The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, by Nadine Burke Harris, 2018.
Scared Sick: The Role of Childhood Trauma in Adult Disease by Robin Karr-Morse with Meredith S. Wiley
Biologial Embedding of Early Social Adversity, Proceedings of the National Academy of Sciences, 2012
PubMed childhood adversity research publications

4. What's epigenetics and how does that relate to historical or generational trauma?

Most people believe that the DNA we're born with does not change and that it determines all that we are during our lifetime. That's true, but the research from epigenetics - the study of how social and other environments turn our genes on and off - shows that toxic stress can actually change how our genes function, which can lead to long-term changes in all parts of our bodies and brains. What's more, these changes can be transferred from generation to generation.

Epigenetics means "above the genome" and refers to changes in gene expression that are not the result of changes in the DNA sequence (or mutations).

Resources:

WhatIsEpigenetics.com - This New York-based blog and news aggregator covers the field of epigenetics and is funded by EpiGentek. It includes backgrounders, including epigenetics fundamentals.

Epigenetics - From the Genetics Science Learning Center at the University of Utah, this section includes explainers and an overview of how the social environment affects your epigenome.

Epigenetics 101: A beginner's guide to explaining everything (TheGuardian.com, 2014)

5. Positive Childhood Experiences and resilience research: If you have a high ACE score, are you doomed? No!

The good news is that the brain is plastic, and the body wants to heal.

The brain is continually changing in response to the environment. If the toxic stress stops and is replaced by practices that build resilience, the brain can slowly undo many of the stress-induced changes.

There is well documented research on how individuals' brains and bodies become healthier through mindfulness practices, exercise, good nutrition, adequate sleep, and healthy social interactions.

Here's a good article that weaves the unified science of human development together: Scars That Don't Fade, from Massachusetts General Hospital's Proto Magazine.

In the last few years, researchers have started to examine the impacts of positive childhood experiences (PCEs) on children and adults. We at PACEs Connection are particularly interested in the interplay between positive and adverse childhood experiences. Here's some of the relevant research:

A team of researchers - Dr. Christina Bethell, Jennifer Jones, Dr. Narangerel Gombojav, Dr. Jeff Linkenbach and Dr. Robert Sege - published research in 2019 that found a dose-response association between positive childhood experiences - such as feeling like family stood by one during difficult times and feeling safe and protected by an adult in the home - and adult mental and relationship health among adults who had experienced ACEs, irrespective of how many ACEs they had. (Bethell and Sege are guest speakers in a PACEs Connection Better Normal webinar Friday, March 26, 2021 from 12 pm PT to 1 pm PT.) Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels | JAMA Pediatrics.

That same year, Bethell, Gombojav, and Dr. Robert Whitaker reported that at each level of ACEs, "the presence of flourishing increased in a graded fashion with increasing levels of family resilience and connection." Family Resilience And Connection Promote Flourishing Among US Children, Even Amid Adversity | Health Affairs

In 2014, Bethell, Dr. Paul Newacheck, Dr. Eva Hawes, and Dr. Neal Halfon found that children with higher ACE scores were less likely to demonstrate resilience, live in a protective home environment, have a mother who was healthy, and live in safe and supportive neighborhoods. However, almost half of the children who had experienced ACEs also demonstrated resilience, and "resilience mitigated the impact of adverse childhood experiences on grade repetition and school engagement." Adverse Childhood Experiences: Assessing The Impact On Health And School Engagement And The Mitigating Role Of Resilience | Health Affairs

In a study published in 2021, Whitaker, Dr. Tracy Dearth-Wesley, and Dr. Allison Herman wrote that "greater childhood family connection was associated with greater flourishing in US adults across levels of childhood adversity." Childhood family connection and adult flourishing: associations across levels of childhood adversity - Academic Pediatrics (academicpedsjnl.net)

Dr. Yui Yamaoka and Dr. David Bard reported in 2019 that "the number of adverse childhood experiences was associated with both social-emotional deficits and developmental delay risks in early childhood; however, positive parenting practices demonstrated robust protective effects independent of the number of adverse childhood experiences." Positive Parenting Matters in the Face of Early Adversity - PubMed (nih.gov)

Among juvenile offenders, Dr. Michael Baglivio and Dr. Kevin Wolff discovered in 2020 that "high ACE scores were associated with increased reoffending, and high PCE scores were associated with decreased recidivism, as measured by both rearrest and reconviction. Further, among juveniles with four or more ACEs who have six or more PCEs, reconviction was 23% lower and rearrest 22% lower when compared to those youth with four or more ACEs and less than six PCEs, controlling for a host of demographic and criminal history measures." Positive Childhood Experiences (PCE): Cumulative Resiliency in the Face of Adverse Childhood Experiences - Michael T. Baglivio, Kevin T. Wolff, 2021 (sagepub.com)

Dr. Michael Baxter, Dr. Eden Hemming, Dr. Heather McIntosh, and Dr. Chan Hellman published research in 2017 that demonstrated that higher ACEs scores were associated with lower hope in a study of caregivers who brought children in for a child abuse medical investigation at a child advocacy center. Exploring the Relationship Between Adverse Childhood Experiences and Hope: Journal of Child Sexual Abuse: Vol 26, No 8 (tandfonline.com)

In 2019, Dr. AliceAnn Crandall, Dr. Jacob Miller, Dr. Aaron Cheung, Dr. Lynneth Novilla, Dr. Rozalyn Glade, Dr. M. Lelinneth Novilla, Dr. Brianna Magnusson, Dr. Barbara Leavitt, Dr. Michael Barnes, and Dr. Carl Hanson observed in a study of adults that "higher counter-ACEs scores [i.e., positive childhood experiences] were associated with improved adult health and that counter-ACEs neutralized the negative impact of ACEs on adult health."ACEs and counter-ACEs: How positive and negative childhood experiences influence adult health - ScienceDirect

A study by Whitaker, Dearth-Wesley, and Herman in 2020 showed that across levels of childhood adversity, greater childhood family connection was associated with greater flourishing among young adults with type 1 diabetes. Childhood Family Connection With Flourishing in Young Adulthood Among Those With Type 1 Diabetes | Pediatrics | JAMA Network Open | JAMA Network

Finally, in 2016, Bethell, Gombojav, Dr. Michele Solloway, and Dr. Lawrence Wissow examined ACEs, resilience, family protective factors, and emotional, mental or behavioral conditions (EMB) in children and youth in the U.S. The authors found that children with ACEs had higher EMB than children without ACEs, but the presence of resilience was significantly associated with lower amounts of EMB for both children with and without ACEs. In addition, the prevalence of EMB was lower when family protective factors were present, even if the child had ACEs, although the presence of two or more ACEs decreased the effect. Adverse Childhood Experiences, Resilience and Mindfulness-Based Approaches: Common Denominator Issues for Children with Emotional, Mental, or Behavioral Problems (nih.gov)

Who's using PACEs science?

Many people, organizations, agencies, systems and communities are beginning to implement trauma-informed, resilience-building practices based on PACEs science.

Pediatricians (here's an update on the Children's Clinic) and public health clinics are screening patients for ACEs. By the end of 2017, between 1,000 and 2,000 pediatricians had integrated ACEs screening into their practices. Here's an article about Kaiser Permanente pediatricians in Northern California who have started screening kids for ACEs. Dr. Jeffrey Brenner, MacArthur genius award winner, recommends physicians adding ACE screening to measurement of other vital signs, such as blood pressure. A rural health clinic in Pueblo, CO, changed its medical practice after it integrated ACEs screening. A family physician in Tennessee educates his opioid patients about their ACEs, and it helps motivate them to heal themselves. The physician also understands that ACEs leads to damage that is chronic and, thus, he treats addictions as he does diabetes, as a chronic disease.

Many schools - including schools in San Francisco, CA, Spokane, WA, San Diego, CA, and Walla Walla, WA - have integrated healing-centered/trauma-informed practices into classrooms, playgrounds and school policies. These schools have seen 90 percent drops in suspensions after one year; after three years, the schools no longer expel students and some no longer even have the need for in-school suspensions. The grades, test scores and graduation rates increased, and the students most benefitted were those with the highest ACE scores. By the end of 2017, several hundred schools across the U.S. were integrating trauma-informed and resilience-building practices based on ACEs science.

Head Start (early childhood education program) in Kansas City has integrated trauma-informed practices in a program called Head Start Trauma Smart. (NYTimes article about the program.)

Home-based early childhood intervention, such as Child First. (NYTimes article about the program.)

Police departments and courts have integrated trauma-informed approaches. Safe Babies Courts have integrated PACEs science in resilience-building practices that provide wrap-around services for families; a year after participating in Safe Babies Courts, 99 percent of the children suffer no further abuse. Some prisons are beginning to educate inmates about PACEs science.

Homeless shelters and the faith-based community are integrating practices based on PACEs research. At the heart of their approach is educating those who are homeless and people in rescue missions about PACEs science; it often changes their whole understanding of their behavior, because they realize that they weren't born bad, that they had no control over what happened to them as children, that they coped appropriately, given what was available to them, and that they can change. Batterers intervention programs that have integrated PACEs science have reduced recidivism rates from what was accepted - 20 to 60 percent - to zero to four percent.

Cities and states are integrating practices based on PACEs science. By the end of 2017, several hundred communities around the U.S. had launched PACEs initiatives. This report on self-healing communities describes how integrating ACEs science drastically reduced youth suicide, teen pregnancy, juvenile arrests, and high-school drop-out rates - all at the same time - in communities in Washington State that integrated practices based on PACEs science.

Research on families shows that interventions - such as Nurse-Family Partnership, Healthy Steps, and Child First - can improve the lives of parents and children. Evidence-based parenting practices (Incredible Years, Triple P Parenting, etc.), increase the health of parents and children.

Resources:

Community Resilience Cookbook (nine case studies of cities and states that are integrating PACEs research)

Growing Resilient Communities provides guidelines and tools for communities to launch and grow local PACEs initiatives, and measure the progress of their work.

What does trauma-informed mean?

According to the Substance Abuse and Mental Health Services Administration (SAHMSA), part of the U.S. Department of Health and Human Services, a trauma-informed approach refers to how an organization or community thinks about and responds to children and adults who have experienced or may be at risk for experiencing trauma. In this approach, the whole community understands the prevalence and impact of ACEs, the role trauma plays in people's lives, and the complex and varied paths for healing and recovery.

A trauma-informed approach asks: "What happened to you?" instead of "What's wrong with you?" It is designed to avoid re-traumatizing already traumatized people, with a focus on "safety first" (including emotional safety), and a commitment to do no harm. But a trauma-informed approach is most successful when an organization or community builds policies and practices based on a foundation of ACEs science.

Resources:
SAMHSA overview of what trauma-informed is and isn't National Center for Trauma-Informed Care
SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach - Introduces a concept of trauma and offers a framework for how an organization, system, or service sector can become trauma-informed. Includes a definition of trauma (the three "E's"), a definition of a trauma-informed approach (the four "R's"), 6 key principles, and 10 implementation domains.

Any legislation or federal policies?

Updates on U.S. state and federal legislation can be found in the State ACEs Resolutions and Laws section of State PACEs Action on PACEsConnection.com. Some examples:
California legislature resolution to reduce ACEs Massachusetts bill on trauma-informed schools Vermont attempt to pass ACEs bill Overview of state, federal legislation
US Department of Health and Human Services guidelines to state health directors (and the letter to state health directors)

All resources:
CDC ACE Study site
A Critical Assessment of the Adverse Childhood Experiences Study at 20 Years (attached)
Wikipedia - Adverse Childhood Experiences Study
The 10 ACE Questions (and 14 resilience survey questions)

Harvard University Center on the Developing Child (neurobiology of toxic stress)

Alberta Family Wellness Initiative (Canada)

ACEsTooHigh.com - News site covering PACEs research and practices

PACEsConnection.com - Social network (with 18,000+ members across sectors) and more than 100 community sites that support ACEs initiatives in cities, counties, states, regions and nations.

WhatIsEpigenetics.com - News site covering epigenetics

Epigenetics - Explainers and backgrounders about epigenetics
National Center for Trauma-Informed Care
Community Resilience Cookbook - Nine case studies of cities and states that are integrating PACEs research)

SAMHSA's Concept of Trauma and Guidance for a Trauma-Informed Approach - Introduces a concept of trauma and offers a framework for how an organization, system, or service sector can become trauma-informed. Includes a definition of trauma (the three "E's"), a definition of a trauma-informed approach (the four "R's"), 6 key principles, and 10 implementation domains.

Videos:

ACE Study video (three minute trailer)

Video: Toxic Stress Derails Healthy Development (2 min)

How childhood trauma affects health across a lifetime (16-minute TED Talk by Dr. Nadine Burke Harris)

Books:

Childhood Disrupted: How Your Biography Becomes Your Biology and How You Can Heal, by Donna Jackson Nakazawa

The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma, by Bessel Van Der Kolk

The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, by Nadine Burke Harris, 2018.
Scared Sick: The Role of Childhood Trauma in Adult Disease by Robin Karr-Morse with Meredith S. Wiley
The Last Best Cure: My Quest to Awaken the Healing Parts of My Brain and Get Back My Body, My Joy, and My Life, by Donna Jackson Nakazawa

For other books, go to the ACEs Connection Books community.

Documentaries:

Paper Tigers - What does it mean to be a trauma-informed school? And how do you educate teens whose childhood experiences have left them with a brain and body ill-suited to learn? This film follows six students through a year in America's first trauma-informed high school.

Resilience - Resilience chronicles how trailblazers in pediatrics, education, and social welfare are using cutting-edge science and field-tested therapies to protect children from the insidious effects of toxic stress.

CAREgivers - How is the professional care provider affected emotionally and physically, and who helps them?

For a list of all documentaries addressing PACEs science, and how to access them, go here.

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If you're interested in becoming more involved in the PACEs science community, join our companion social network, PACEs Connection. Just go to PACEsConnection.com and click "Join". PACEsConnection.com is the leading advocate for information about the science of positive and adverse childhood experiences (PACEs) and the rapidly expanding, global PACEs science movement.

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What is PACEs science? The science of PACEs refers to the research about the stunning effects of positive and adverse childhood experiences (PACEs) and how they work together to affect our lives, as well as our organizations, systems and communities. It comprises: The CDC-Kaiser Permanente ACE Study and subsequent surveys that show that most people...

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Top 10 Play Therapy Activities for a Child with Trauma

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Top 10 Play Therapy Activities for a Child with Trauma

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Top 10 Play Therapy Activities for a Child with Trauma (Aura Institute, 2024)
Play therapy helps children express and process trauma in a safe, age-appropriate way. This expert guide outlines effective activities such as puppet play, sand tray therapy, art, storytelling, and music. These approaches support emotional healing, reduce anxiety, and build trust. Activities like clay modeling, play dough, and role-playing allow children to externalize inner experiences they can't verbalize.

Play is a child’s natural language—and with the right tools, it can promote deep healing.

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Aura Institute - Integrative Trauma & Somatic Therapy Training

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A training and certification program for trauma therapy including mindfulness, meditation, breathwork, Somatic Therapy, Parts Work & Integration, and more.

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100+ Awesome and Easy Sensory Diet Activities

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100+ Awesome and Easy Sensory Diet Activities

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This article offers over 100 easy and effective sensory diet activities to help children with sensory processing needs feel calm, focused, and engaged. Activities include jumping, swinging, heavy work like pushing laundry baskets, water play, chewing crunchy foods, wearing compression clothing, and more. Each activity supports different sensory systems—tactile, vestibular, proprioceptive—and can be calming or alerting depending on the child’s needs. These strategies should always be child-led, flexible, and monitored for effectiveness. A well-chosen sensory diet can improve focus, behavior, sleep, and social interaction.

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This is the ultimate list of sensory diet activities for kids. Many ideas can be done with common household items and are easy to use and put into your routine!
I've been wanting to write this post for a while now, its a big one, filled to the brim with sensory diet activities you can use for your child or toddler. Heck, many of these ideas work for adults, too. So, no matter what your age, the following list will be a great jumping off point for creating a sensory diet or for adding some new activities into the mix. If the whole sensory diet thing is new to you, make sure you read What is a Sensory Diet first!

Before we get started on this incredible list though, I want to announce a brand new, FREE workshop that I'm co-teaching: How to Create a Successful, No-Stress Sensory Diet in 4 Simple Steps. This workshop is live and we've filled it with tons of sensory tips as we share our exclusive sensory plan. Not to mention that there'll be a live Q/A, too! If you think or know that your child has sensory needs, then this workshop is a must. I'll share some more details later in the post, but you can grab your spot now!

And, as promised, I'll also be announcing the winners to the Sensory Solutions Class scholarship! You'll also find this exciting news at the end of the post!

Whew, so much exciting stuff going on today, aren't you glad you stopped in? I am!

I'm thrilled for you to check out this mega list of sensory diet activities, but there are a couple of caveats that are incredibly important to pay attention to first. Please read these before trying any sensory activities with your child...

Sensory Diet Activity Guidelines

Never ever ever force your child to do any sensory diet activity. Sensory activities aren't homework or medicine, and they work best when a child is motivated to participate in them. It's really important to keep in mind that in many cases, kids may be refusing a sensory activity because it is overwhelming to their unique sensory system, even if it isn't to yours. The finger paints that you may think aren't so bad to touch, can actually be perceived as painful to your child.

That's not to say that you can't demonstrate, model, and encourage. That's what we OT's do, we want to push kids out of their comfort zone just a little and follow THEIR lead as much as possible. Experiencing new sensory input can have wonderful effects on their development, but when we force them to do so, its almost a guarantee that it will backfire.

2. This list is meant to inspire, not overwhelm. If you're just getting your feet wet with sensory diets, then take it slow and just pick a few activities that seem really manageable. Try them a few times and see if your child has a positive response. I have focused on keeping these activities simple, with little or no set-up.

3. Your child's sensory needs may change from day to day or even hour to hour, remember that just because a particular activity or strategy didn't work on this list today, doesn't mean it won't tomorrow. The idea is to have a toolbox full of sensory activities that you can pull from as you need to. However, not all activities will benefit your child. There will be some they don't like or seem interested in, ever. That's fine.

If you aren't quite sure what a sensory diet is or if your child needs one, then check out my last post where I explain what sensory diet's are all about. Understanding what they are and who they're for, will help you create a sensory diet that is easy to manage and that really makes a difference in your kid's life. And, if you're concerned your child with sensory "issues" needs more help then head over to sensory integration therapy to find out!

Sensory Diet Activities

You will find that all of the activities are organized into different groups, please note that there is some cross over, and duplications, as appropriate. Many of these activities give sensory input to several senses. While there are categories listed (calming, alerting, etc.), please note that these are generalizations. It is possible your child could have a different response, as everyone's sensory system is unique. Again, make sure you watch how your child responds during and after the activity:

Do they seem calmer?

More attentive?

Are they sleeping better? (Check out sensory tips for sleeping)

Or eating better?

Are they interacting and communicating more with others?

Did they follow directions more easily?

Were they able to learn something quicker?

Making these observations will help you determine how they are responding to a particular sensory diet activity, and when you should use that activity or one similar to it again! AND, if you want a little more guidance and a nifty free printable check out my sensory diet template, and you'll be able to hone in on those beneficial activities even better.

And, you can snag my custom set of sensory diet cards, that include the most powerful and versatile sensory diet activities, for yourself!

Sensory Activities that Improve Attention, Focus, & Engagement

Below, you will find many of the activities include a link to a DIY tutorial or an affiliate link, as some of these tools might be new to you. Everything on this list are sensory tools and toys that I love and use.

(Often called organizing activities because they typically allow kids sensory systems to become more balanced which leads to improved learning, communication, sleep, eating, etc.)

Jumping

Swinging

Riding

Pushing/Pulling Heavy Objects ( Heavy Work Activities)

carrying groceries

pushing empty garbage cans inside

raking leaves

pulling weeds

shoveling snow

pushing grocery cart

carrying a laundry basket

a rope tied to a door knob or heavy object (see image at top)

Vibration (is alerting versus calming when used in short bursts)

Playing active games

Drinking something cold

Swimming

Crashing and jumping into pillows (put all of your pillows or stuffed animals in a pile on the floor)

Playing with textures (Stimulates the tactile sense)

Blowing

Rolling on a large ball on back or belly

Sitting on a large ball

during meals

for homework/in school

Scratching their back vigorously for a few minutes

Spinning (***a very intense sensory experience, best for kids to spin themselves even if they love spinning. Be very cautious of spinning a child, and only do so a few times in both directions. This is important because it will help balance out their system.)

Sensory Activities that are Calming

Wearing Tight Clothing

Wearing compression or weighted vests for 10-20 minutes during difficult times of the day (i.e. transitions)

Quiet time in sensory tent

Playing in sensory bin (tons of ideas, the sky is the limit)

Kneeding playdough or therapy putty

Handling fidget toys ( a wide variety of options)

Squishing and squeezing

squeezing into tight spots or behind furniture

wrapping up tightly in blanket

sleeping in stretchy sheets that are tucked in on sides

laying under a large yoga ball

Sit or stand or a wobble cushion or wiggle seat (great for meals, homework, and crafts)

Using essential oils (different types of oils are used to calm or be alert, check out this get start guide)

Listening to rhythmic or soft music

Wearing noise cancelling headphones

Watching slow moving or soothing images

Drinking something warm

Sucking on a piece of hard candy or a lozenge

Slow rocking

Using heavy or weighed blankets or lap pads ( check out the whole guide for weighted blankets here and how and when to use weighted lap pads.)

Vibration (is calming rather than alerting when used for longer periods of time)

Now that you have this huge list of sensory diet ideas, what's next? How do you know which activities to use with your child and when? How often should you do them?

Those are all very important questions, and I'm going to answer them for you in next week's free workshops that I'm co-hosting (2 days/times available): How to Create a Successful, No-Stress Sensory Diet for Kids in 4 Simple Steps

As an OT, sensory is one of my specialties, in the workshop we'll be giving you our expert know-how with the practicality of real-life mom. This sensory stuff can get overwhelming pretty fast, and for good reason, in the workshop we're going to be putting an end to that! We aren't in the business of wasting time, we have been working hard for months on this for YOU, and it is worth every minute of your time because what you'll learn could be a total game changer for you and your child!

Make sure you save yourself a seat, we don't know when we'll be offering this opportunity again!

Sensory Solutions Class Scholarship

It's time now to announce the two winners of the scholarships for the simple but intensive sensory class I co-teach, Sensory Solutions, that opens in a few weeks!

First, we want to thank everyone that took time to submit an application, it was incredibly difficult to choose the winners, and we ended up extending it to three parents. For those of you that don't see your name below, we aren't going to leave you hanging! We do have the amazing consolation prize of the workshop next week, where we will teach you our four step plan for FREE.

Without further ado, the winners of the scholarship are:

Sara Earl

Dennae Turner

Brandy Millard

Thank you all again, it was a privilege to receive your responses, we hope to see you live in the workshop (remember there's a live Q/A at the end, you'll be able to ask us, your questions!)

More Sensory Diet Activities
Powerful Proprioceptive Activities that Calm, Focus, & Alert Everything Oral Sensory: The Total Guide Sensory Strategies for Wild Kids 13 Easy Sensory Strategies for the Classroom
Did you pin this?

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100+ Awesome and Easy Sensory Diet Activities - Your Kid's Table

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This is the ultimate list of sensory diet activities for kids. Many ideas can be done with common household items and are easy to use and put into your routine! I've been wanting to write this post for a while now, its a big one, filled to the brim with sensory diet activities you can use for your child or toddler.

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30+ Inner Child Worksheets for Healing and Happiness

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30+ Inner Child Worksheets for Healing and Happiness

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Inner Child Healing Workbook
This 34-page workbook helps you explore and heal childhood wounds by connecting with your inner child. It includes exercises to identify trauma, challenge negative beliefs, and practice self-compassion through reparenting. Perfect for anyone ready to nurture their inner child and build emotional healing.

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30+ Inner Child Worksheets for Healing and Happiness - Ambitiously Alexa

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These are the BEST inner child worksheets to help you understand your childhood, the impact it’s had on you, and what you can do about it today.

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Trauma and Learning: Connections and Learning 101

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Trauma and Learning: Connections and Learning 101

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Cathy from AZAFAP shares a personal story to highlight how childhood trauma impacts learning. She emphasizes that safety and connection—not just academic support—are key for healing and growth. Backed by research, she urges caregivers to focus on building trust and regulation before expecting progress in school.

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Trauma and Learning: Connections and Learning 101 | AZAFAP

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I don’t want to bore you with stories from my childhood but, suffice it to say, there was plenty of trauma to go around for me and my 3 sisters. The 4th birth was even blessed with Fetal Alcohol Syndrome. Not fun.

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10 Ways to HEAL ABANDONMENT TRAUMA Caused by Parental Emotional Neglect/Lisa Romano

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10 Ways to HEAL ABANDONMENT TRAUMA Caused by Parental Emotional Neglect/Lisa Romano

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Ways to heal abandonment trauma caused by parental emotional neglect. You can heal from childhood emotional wounds and learn to trust yourself again. You don't have to live in fear of others when you learn to heal your wounded inner child.

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Lisa A. Romano Breakthrough Life Coach Inc

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10 Ways to HEAL ABANDONMENT TRAUMA Caused by Parental Emotional Neglect/Lisa Romano

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Empower Your Team with Trauma Informed Training: Essential Education for Professionals

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Empower Your Team with Trauma Informed Training: Essential Education for Professionals

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This article from the Aura Institute emphasizes the importance of trauma-informed training for healthcare professionals and organizations. Trauma-informed care is not just a technique but a mindset that acknowledges the widespread impact of trauma and promotes a healing environment. Through increased awareness, empathy, and recovery-focused practices, professionals can better support patients and avoid retraumatization. Trauma-informed training also improves team collaboration, communication, and understanding of challenging behaviors. Organizations are encouraged to implement ongoing workshops, team-based education, and continuing professional development to maintain trauma-informed practices. By adopting this approach, healthcare teams can enhance both individual and team efficiency while creating safer, more compassionate care settings.

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Aura Institute - Integrative Trauma & Somatic Therapy Training

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A training and certification program for trauma therapy including mindfulness, meditation, breathwork, Somatic Therapy, Parts Work & Integration, and more.

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Sensory Diet Activities for the Classroom

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Sensory Diet Activities for the Classroom

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Classrooms can be overwhelming for children with sensory processing challenges, making it difficult to focus, self-regulate, or learn. Sensory diet activities for the classroom provide targeted support to help students stay calm, alert, and engaged. Examples include carrying books, fidget tools, movement breaks, alternative seating, and calm-down spaces. Teachers can also adjust the environment with dim lighting, reduced noise, or soothing visuals. These strategies should be individualized and ideally guided by an occupational therapist. Free resources like the Classroom Sensory Strategy Toolkit are available to support implementation

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Practical Sensory Diet Activities for the Classroom - The OT Toolbox

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These sensory diet activities for the classroom support sensory needs in schools, perfect for helping kids learn by meeting sensory needs.

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This resource from the National Child Traumatic Stress Network (NCTSN) highlights the need for trauma-informed practices in schools. It explores how trauma affects children's behavior, learning, and emotional well-being, and offers practical, evidence-based tools to help educators and caregivers support students. The guide also addresses how to recognize trauma symptoms, avoid re-traumatization, care for staff well-being, and implement school-wide strategies that foster safety, connection, and healing.

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This Resource Guide to Trauma-Informed Human Services provides human services leaders at the local, State, Tribal, and Territorial levels with information and resources on recent advances in our understanding of trauma, toxic stress, and executive functioning.

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Child Trauma – Vermont Department of Mental Health

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Child Trauma – Vermont Department of Mental Health

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This page discusses child traumatic stress, which arises when a child experiences or witnesses an event that feels deeply threatening. It emphasizes that trauma is shaped by the individual's perception of the event rather than the event itself. The resource also explores how children of different ages respond to trauma and provides valuable support materials for parents and caregivers.

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Child Trauma | Department of Mental Health

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This article highlights how early trauma including abuse, neglect, and domestic violence profoundly affects children’s behavior, development, and learning. Children like Alex and Chiara may show aggression, withdrawal, or delays in language and play due to dysregulated stress responses. Trauma impacts brain development, attachment, and emotional regulation, often leading to misunderstood behaviors in school. Educators play a critical role by creating trauma-sensitive classrooms, building trust, offering structure, and collaborating with families and specialists. Consistent, compassionate support helps children feel safe, learn self-regulation, and begin to heal.

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Many early childhood educators are likely to encounter young children who have experienced trauma on a daily basis.

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Sensory diet activities: 33 fun ideas for kids who need sensory input

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Sensory diet activities: 33 fun ideas for kids who need sensory input

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This article explains how a sensory diet can support children with sensory processing disorder (SPD), a condition where the brain struggles to interpret sensory input. A sensory diet is a personalized set of fun, daily activities that help children improve how they respond to sensory stimuli. The post includes 33 example activities for different sensory needs—like jumping on a trampoline for proprioception or finger painting for tactile input—and emphasizes the importance of working with an occupational therapist. It also links to trusted resources that help parents and teachers understand and support children with SPD in a positive, non-threatening way.

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Sensory diet activities: 33 fun ideas for kids who need sensory input

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Learning made fun! Check out this collection of 33 sensory diet activities for kids with autism and/or sensory processing disorder!

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The Child Trauma Toolkit for Educators, developed by the National Child Traumatic Stress Network (NCTSN), offers practical guidance for educators working with students affected by trauma. It includes fact sheets on trauma's impact across different age groups, strategies for classroom support, and self-care tips for educators. The toolkit aims to help schools create safe, supportive environments that foster learning and emotional well-being for all students. nctsn.org

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Rachel Durham, Jessica Shiller, Janae McDowell

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This toolkit from the National Child Traumatic Stress Network offers teachers and parents an introduction to and explanation of the physical and emotional impacts of trauma. The toolkit identifies specific observable behaviors by age group to help teachers identify potential trauma exposure in students. The toolkit also includes suggestions for creating trauma-aware classrooms where all students can thrive.

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Trauma & Play Therapy: Holding Hard Stories | Paris Goodyear-Brown, MSSW, LCSW, RPTS | TEDxNashville

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Trauma & Play Therapy: Holding Hard Stories | Paris Goodyear-Brown, MSSW, LCSW, RPTS | TEDxNashville

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Behavior is communication. Through play, children can communicate their deepest darkest trauma without hours of questioning

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Trauma & Play Therapy: Holding Hard Stories | Paris Goodyear-Brown, MSSW, LCSW, RPTS | TEDxNashville

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19 Practical Positive Psychology Worksheets & Activities

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19 Practical Positive Psychology Worksheets & Activities

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These tools help individuals build happiness, resilience, and self-awareness by focusing on personal strengths, gratitude, and goal-setting. Rooted in science, positive psychology activities are used by therapists, coaches, and educators to support personal growth and wellbeing. Regular practice promotes a thriving, meaningful life.

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Humans are hardwired to pay attention to negative experiences.

We have a propensity to attend to, learn from, and use negative information far more than positive information.

As such, many clients are unaware of what influences the happiness in their life from one day to the next. At the heart of positive psychology lies the belief that people can lead happier, more meaningful, and fulfilling lives by moving their focus away from the negative towards a more balanced perspective.

The wealth of research-based exercises available ensures that practitioners have a unique opportunity to help clients experience more pleasure, meaning, and fulfillment.

Many positive psychology exercises are considered classics - and for good reason. While activities such as gratitude journaling and loving-kindness meditation have been shown time and again to lead to positive outcomes, the goal of this article is to provide a variety of new and novel ways to include positive psychology in your work with clients.

The following exercises can be incorporated into several therapeutic settings to help your clients experience the fundamental pillars of positive psychology: the good life, the pleasant life, and the meaningful life.

Before you read on, we thought you might like to download our three Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology including strengths, values and self-compassion and will give you the tools to enhance the wellbeing of your clients, students or employees.

Exercise 1: Self-Care Vision Board

Self-care is the deliberate practice of activities that 'take care' of mental, emotional, and physical health (find 26 mental health exercises here). The ability to attend to and meet personal needs through self-care has been found to increase empathy, immunologic functioning, and has been associated with lower levels of anxiety and depression (Schure, Christopher, & Christopher, 2008).

According to Baker (2003), self-care activities also have the potential to improve self-awareness, self-regulation, coping, and balancing of self and others.

Instructions
Clients should think of as many potential self-care activities as possible, making sure only to include activities they would enjoy completing and that fit with their lifestyle and values. For each activity listed, clients should then find inspiring and positive images and brainstorm words and phrases that correspond with their chosen self-care activities.

Clients can then assemble their vision board and place it in a prominent, visible location to act as a visual representation that reflects ideas for self-care and as a motivator to improve and implement self-care.

You can access a comprehensive rundown of this exercise and practical practitioner advice on the Self-Care Vision Board as part of the Positive Psychology Toolkit©.

Exercise 2: The Guest House Poem

The Guest House poem is a method of explaining mindfulness and the importance of acknowledging and accepting unpleasant emotions. According to Eisenberg et al. (1997), emotion suppression has been associated with both psychological and physiological health detriment.

Indeed, Hayes, Pistorello, & Levin (2012) suggested that attempts to control uncomfortable thoughts, feelings, and emotions by deliberate avoidance are at the core of many psychological problems.

When clients mask their emotional experiences or try to push unpleasant emotions away, they can return amplified. However, by welcoming them as visitors, the intensity and impact of those emotions can be reduced. In the poem, being human is like being a guest house, and emotions are personified as temporary visitors that should be welcomed even if they are unpleasant.

The poem can also be used to explain to clients that emotions are not permanent residents in their guest house; instead, they are transient visitors who can be welcomed, stay for a while, and then leave.

The Guest House by Jelaluddin Rumi

This being human is a guest house.
Every morning a new arrival.
A joy, a depression, a meanness, some momentary awareness comes as an unexpected visitor.
Welcome and entertain them all!
Even if they are a crowd of sorrows, who violently sweep your house empty of its furniture,
still, treat each guest honorably.
He may be clearing you out for some new delight.
The dark thought, the shame, the malice.
Meet them at the door laughing and invite them in.
Be grateful for whatever comes.
Because each has been sent as a guide from beyond.
Reflection Questions

How do you interpret the poem?

What emotions visit you most often? Why do you think that is?

How might it affect you if you welcomed all your emotions rather than denying them?

What benefits could there be in welcoming unpleasant emotions?

Can you relate to the feeling described in the line "violently sweeps your house empty of its furniture"? Have you ever felt this way?

How might you apply the message of The Guest House to your everyday life?

Exercise 3: The Passengers on a Bus Metaphor

Metaphors are efficient, meaningful ways to communicate about experiences and fill the experiential gap between what is or has been, and what can be (Burns, 2017). Within the therapeutic context, metaphors have the express purpose of assisting clients in reaching their goals effectively and efficiently.

The Passengers on the Bus metaphor describes the ways internal experiences seemingly drive our lives. The metaphor can be used to demonstrate the possibility of a life in which such experiences do not determine decisions; rather, they are accepted and sit in the mind temporarily like passengers on a bus.

Passengers on a Bus Metaphor
You are the driver of a bus, the bus symbolizes your mind, and your thoughts are represented by passengers. On your journey, some passengers sit quietly while others make critical and distracting comments, or shout directions as you drive.

You can choose how you react to the passengers just as you can decide how to respond to critical thoughts. You can allow those passengers to shout and chatter noisily, while still keeping your attention focused on the journey towards your goal.

The Passengers on a Bus metaphor can be reintroduced if a client experiences thoughts, feelings, or behaviors during subsequent sessions that may impede or challenge their progress. Referring to the metaphor, the practitioner might ask, "Which passenger is being intrusive and distracting?"

You can access The Passengers on the Bus Group Activity in the Positive Psychology Toolkit©. Adapted for use with groups, this exercise includes details on how to best set up the exercise, three different scenarios for clients to consider, and evaluation questions.

Exercise 4: Sensory Awareness

Sensory awareness is more than merely responding to experiences; instead, it is engaging with - and paying attention to - current sensory information. According to Jones (2011), mindful practices nurture the ability to bring sensory experiences to the forefront of consciousness.

In doing so, space is created in the mind that allows us to stop and smell the roses. Moments of intimacy, the sound of a flowing river, the view of a dramatic landscape, or even reading a good book, can all be immensely gratifying and comforting.

Instructions
Create five columns on a piece of paper, labeling each with one of the five senses: touch, taste, smell, sight, and sound. Clients should then take 15-20 minutes to think about and write down the experiences that give them pleasure through each of their senses.

On completion of this step, clients should regroup and discuss how specific experiences give them pleasure.

Reflection Questions:

Were you surprised by anything you thought to add to your lists?

Are your lists extremely long or short? Why do you think that is?

Which of the items on your list do you experience every day?

Do any experiences provide pleasure, comfort, or enjoyment in more than one category?

How can you increase the number of experiences that give you pleasure, comfort, and enjoyment?

Can you commit to experiencing at least one source of sensual pleasure from each sense every day?

Exercise 5: Positive Reminiscence

Savoring is the awareness of pleasure and the ability to acknowledge, appreciate, and enhance positive experiences. A complementary counterpart to coping, savoring can help clients endure negative life experiences (Bryant & Veroff, 2006). When clients learn to savor the small pleasures in life through deliberate focus, they begin to recognize and retain the good feelings associated with those experiences.

The Positive Reminiscence exercise can help clients develop the skill of savoring and build positive emotions by reliving a positive event from their past. You can access this exercise as part of the Positive Psychology Toolkit©.

Instructions
During the exercise, clients should take time to think about an event from their past that evokes positive emotions, visualize the event in as much detail as possible, and focus on the pleasant feelings that were experienced at the time.

The client's focus should be on reliving the experience to increase both the duration and intensity of positive emotions.

Exercise 6: Gratitude by Mental Elimination

According to Koo, Algoe, Wilson, & Gilbert (2008), affective states are improved to a greater extent after mentally removing positive events when compared to actively thinking about the presence of those events. Simply put, mentally deleting a positive event can help remind clients of how fortunate they are and how life could be if that event never happened.

To begin the Gratitude by Mental Elimination exercise, ask the client to think about something good in their life right now and then take a moment to imagine what life would be like without that one good thing. Clients should then write down the ways in which their life would be different without this one good thing.

You can access the full exercise as part of the Positive Psychology Toolkit©.

Exercise 7: The Self-Compassion Pause

Clients who are high in self-compassion treat themselves with kindness and concern when they experience negative events (Batts Allen & Leary, 2010). Further, practicing self-compassion may allow clients to access positive emotions more easily and improve measures of life satisfaction, social connectedness, and subjective wellbeing (Leary, Tate, Adam, Allen, & Hancock, 2007).

The Self-Compassion Pause can be used as a starting point to help clients create a more self-compassionate attitude. This technique works best as a homework exercise in day-to-day encounters when clients are aware that they are experiencing some form of suffering, like stress or discomfort.

Instructions
Invite clients to pause for a moment and focus on their breathing as they inhale and exhale. Next, clients should place their hands on their body - reminding themselves that while this is a difficult moment, suffering is a part of life. It can be beneficial for clients to create soothing phrases that are personal and meaningful to them, such as "I accept myself as I am" or "May I forgive myself for this mistake just as I would forgive others."

You can find a more detailed breakdown of the Self-Compassion Pause exercise, including practical guidance and background information as part of the Positive Psychology Toolkit©.

Exercise 8: Benefit Finding

Finding positives from a traumatic event can result in a number of positive long-term effects. For instance, understanding that challenging life events can be beneficial has been shown to enhance resilience, spirituality, relationship strength, compassion, and create a new sense of purpose (Affleck & Tennen, 1996).

Instructions
Invite the client to talk about a traumatic event for a few minutes, encouraging the free expression of any and all emotions and thoughts they have about the experience.

On completion of this step, the client's attention should then be focused on the positive aspects of the experience. The practitioner may guide this step by asking questions such as, "What has the experience taught you?" and "How has the experience made you better equipped to meet similar challenges in the future?"

During this exercise, the client will be asked to recall a traumatic life event that may trigger negative thoughts and feelings. As such, it is advisable to follow the advice and guidance provided as part of the Benefit Finding exercise, which can be found in the Positive Psychology Toolkit©.

Exercise 9: Strengths-based Life Story

Strength estrangement is a lack of awareness of one's strengths, or a lack of direction in using one's strengths (Jones-Smith, 2013). Strengths-based life stories can help clients locate the source of their strengths, utilize them to achieve desired goals, and develop a sense of meaning and fulfillment.

During this activity, you will ask clients to write their life story in three parts: the past, present, and future. Clients can be creative, but it is important to emphasize that their focus should be on their strengths in each of the three sections. Upon completion, clients should share what they've written for each part of their life story with the rest of the group or with the practitioner.

Instructions/Writing Prompts
The Past: Write the story of your past. Be sure to describe the challenges you have overcome, and the personal strengths that allowed you to do so.

The Present: Describe your life and who you are right now. How do you differ from your past self? What are your strengths now? How have your strengths evolved? What challenges are you facing? How can you use your strengths to overcome these challenges?

The Future: Write about your ideal future. How will your life be different than it is now? How can you use your strengths to achieve this ideal future? How will your strengths grow? What kind of person do you hope to become? How will you be different than you are now? What would you like to achieve? Finally, how can you go about achieving these things?

Exercise 10: Strengths & Values-based Introductions

The Strengths & Values-based Introductions exercise can act as a motivator and builder of trust among group members, providing clients with an opportunity to get to know one another deeply in a short amount of time.

This strengths-based approach allows clients to tell and retell their stories and, with the therapist's guidance, reintegrate parts of the self that might have slipped from their awareness due to cognitive rigidities or relational insecurities (Rashid, 2014).

In this exercise, clients are invited to highlight their strengths and values through storytelling and to draw parallels from their story to their current life situations. In the process, clients can develop a deeper understanding of their strengths and values in the context of their narratives.

You can access the Strengths & Values-based Introductions exercise as part of the Positive Psychology Toolkit©, where you will also find suggested prompts and guidance questions, advice, and methods to manage common barriers.

In addition, we have an article dedicated to strengths-based therapy further explaining how to use this powerful tool in counseling.

Exercise 11: Important, Enjoyable & Meaningful Activities

Meaning in life is an essential facet of psychological wellbeing with significant implications for both mental and physical health. According to Clarke (1991), the meaning we attribute to our lives is derived in great part through meaningful activity. Similarly, Seligman (2002) suggested that a state of happiness is attainable only through activities that are consistent with noble and meaningful purposes.

When clients focus on activities that benefit others and utilize their unique strengths, they can transcend to higher planes of authentic happiness (Seligman, 2002). In a nutshell, to find meaning in one's life, one must first take part in meaningful activities.

Instructions
In this exercise, clients are invited to complete three important, enjoyable, and meaningful activities in a single day and write about them in detail. These acts should include:

1. A pleasurable activity carried out alone (for example, reading or listening to music)

2. A pleasurable activity completed with others (for example, playing cards or meeting for lunch)

3. A meaningful or important act (for example, visiting an isolated relative).

Exercise 12: Daily Motivational Awareness

To begin the Daily Motivational Awareness exercise, clients should take a few moments throughout the day to think about the things that excite and motivate them to action, then write them down. In doing so, clients have the opportunity to refer back to the activity and reflect upon the extent to which their motivation is self-determined.

The exercise can also be used less formally, for instance, by asking the client to set timers a few times each day and merely doing the exercise without recording the observations.

You can access the exercise as well as part of the Positive Psychology Toolkit©.

Read More: 17 Motivation Tools, Worksheets and Activities for You and Your Clients

Exercise 13: Writing About Intensely Positive Experiences

Writing about intensely positive experiences can result in robust improvements in a variety of indicators of wellbeing. For instance, positive emotional writing has been shown to enhance positive mood, reduce state anxiety, trait anxiety, and perceived stress while also positively contributing to client coping skills (Burton & King, 2004; Isen, 2001).

Instructions
Every day for three days, clients are instructed to choose a positive experience from their life, imagine themselves in that moment, and think about the feelings and emotions that they experienced. Clients should write about their experiences in as much detail as possible, paying particular attention to the positive feelings, thoughts, and emotions that were present at the time.

You can access the full Writing About Intensely Positive Experiences exercise as part of the Positive Psychology Toolkit©.

Exercise 14: The Signature Strengths Action Plan

Clients should take the VIA Character Strengths Survey before working on their action plan (find more positive psychology surveys here).

According to Seligman (2019), one of the most effective ways to develop and enhance signature strengths is to identify one target strength, set a specific and measurable goal related to that strength, and devise a concrete action plan to achieve the goal.

For instance, a client might select curiosity as a target strength and plan to take part in activities that challenge their existing knowledge and skills. Likewise, a client who wishes to focus on the love of learning could aim to learn five new words, including their meaning and usage each week.

Instructions
Clients should pick one of their top five strengths and write down their answers to the following questions:

How do I use this strength already?

In what areas of my life do I use this strength?

What other areas in my life could I use it more?

What are other ways I could use this strength?

What is my plan? What exactly would I like to do? How frequently?

When will this happen?

What will happen if I achieve my goals?

Exercise 15: Finding Your Own Example of Forgiveness

Seligman & Csikszentmihalyi (2000) identified forgiveness as a key positive individual trait. Indeed, several studies indicate that individuals with a propensity for forgiveness show signs of better physical and psychological health. For instance, Berry, Worthington, O'Connor, Parrott, & Wade (2005) found that forgiveness had beneficial effects on systolic blood pressure, diastolic blood pressure, and mean arterial pressure.

Additionally, forgiveness is negatively related to psychological distress and positively associated with life satisfaction and relationship health (Toussaint, Williams, Musick, & Everson, 2001).

Instructions
To begin this exercise, invite clients to describe a story of forgiveness - this could be from a children's story, fable, or movie plot. Clients should then explain why they think the offender committed the transgression and why the victim chose to forgive.

Ask the client to write down the ways in which the victim may have benefitted from the act of forgiveness. The client should then think about a time when they forgave someone and write down the benefits they experienced.

This exercise is adapted from Five Steps to Forgiveness: The Art and Science of Forgiving (Worthington, 2001).

Exercise 16: Colored Candy Go Around

Keywords: Communication, play, engagement
Treatment Modality: Families
Goal: To encourage communication and provide insight into individual and family dynamics.

When families engage in play-based therapeutic activities, they are provided with opportunities to communicate and articulate thoughts and feelings that they may not be comfortable expressing through traditional techniques (Lowenstein, 2010). The Colored Candy Go Around exercise (Arkell, 2010) is a playful and creative way to engage family members, particularly in the early stages of family therapy.

To begin this exercise, the practitioner should distribute 10-15 colored candies (or colored beads if this is preferred) to each family member. Each color represents a specific question, for example:

Green - What words describe yourself or your family?
Pink - What ways do you have fun as a family?
Orange - What things would you like to change about yourself or your family?
Red - What things do you worry about?
Yellow - What things do you like about your family?

Next ask family members to sort their candies by color and invite one person to pick a color at random, stating verbally how many candies of that color they have in front of them (for example, four yellow candies). This family member must then give four answers to the corresponding question; in this case, four things they like about their family.

They can then choose the next family member who will give their answer to the same question, and so on until each person has responded to all of the questions.

(Note that the questions and areas of focus can be tailored to suit each family's needs).
Reflection Questions

Were you surprised by any of your family's answers?

What did you learn about your family that you were not aware of before this exercise?

What actions will you take in the coming week to have more fun with your family?

What actions can you take as an individual to make changes or improvements?

What actions can you take as a family to make changes or improvements?

This exercise is adapted from Creative Family Therapy Techniques: Play and Art-based Activities to Assess and Treat Families (Lowenstein, 2010).

Exercise 17: Progressive Muscle Relaxation Exercise for Children

Relaxation training can be a useful tool to help clients and patients cope with everyday stressors.

Stressful situations reflexively cause the entire skeletal musculature to react immediately, often resulting in prolonged, heightened tension, and a variety of pathological conditions (Smith, 2007).

Progressive muscle relaxation involves tensing and relaxing various muscles throughout the body as a way to reduce or eliminate tension and is an effective way to manage stress in children who may have difficulties concentrating on traditional relaxation techniques. The following exercise can be used to help guide children through the process of progressive muscle relaxation.

Instructions
To begin this exercise, you should ask the child if they can think of a situation that makes them feel worried or nervous. If they are not forthcoming with a situation, the therapist can utilize prompts such as, "How about when you have a big test?" or "How about when someone shouts at you?", and explain that these are all times when they can use this exercise.

Transcript:
"Let's do this together; I'll show you how. Start with your left hand and arm. Take a deep breath and pretend you are squeezing a lemon in your hand. Squeeze it as hard as you can. Imagine you are trying to squeeze all the juice out. [Hold for 5 seconds]. Now pretend you have dropped the lemon on the floor and think or say 'relax.', then let your deep breath out and unclench your fist."

"Feel that relaxed feeling in your left hand and arm. Now, let's tense that same muscle again." [Repeat the same process a second time].

The therapist then guides the child through two sets of deep muscle relaxation of the following muscle groups:

1. Right hand and arm, as above.

2. Arms and shoulders, by stretching the arms out in front, then over the head, and finally relaxed by their side.

3. Shoulder and neck, by pulling the shoulders up to the ears and the head down into the shoulders, like a big shrug.

4. Jaw, by biting down hard on the teeth.

5. Face and nose, by wrinkling the nose.

6. Stomach, by tightening it very tight and making the stomach very hard.

7. Legs and feet, by pushing down on the floor hard with toes spread apart.

8. Now pretend that you're a rag doll, and let your entire body go limp. Notice how good it feels to be relaxed.

You can modify the script to make this exercise more fun by asking the child to imagine themselves as a sleepy cat who needs to stretch his legs, or picture themselves squishing their toes deep into a muddy puddle.

This exercise was adapted from Assessing and Treating Physically Abused Children and Their Families (Kolko & Cupit Swenson, 2002).

Exercise 18: The Quicksand Anxiety Metaphor

Keywords: Acceptance, mindfulness, anxiety
Treatment Modality: Children and families
Time: 10 minutes
Goal: To illustrate the drawbacks of experiential avoidance and the benefits of acceptance and mindfulness for anxiety.

The quicksand metaphor can help clients explore their methods of coping with difficult and unchangeable situations. In doing so, they can begin to understand how their efforts to avoid or escape such experiences may result in becoming even more entangled in it (Stoddard & Afari, 2014).

Put simply, someone struggling to escape quicksand may not realize that the best course of action would be to come into full contact with the quicksand and 'get with it' rather than fight against it.

Instructions
"You are walking in the desert and, suddenly, you step in quicksand and quickly begin to sink. What do you do now?"

You can direct the client's attention toward his or her reactions as their story unfolds. For instance, a more experiential response can be encouraged by asking, "What happens as you try to escape the quicksand?" or "What are the thoughts that come to your mind as you keep sinking?"

After exploring the quicksand metaphor with the client, the practitioner can encourage further discussion by combining the vocabulary of both the metaphorical and actual situations. For instance, "What do you do when you start sinking in your anxiety?"

Throughout this exercise, it is preferable to avoid stating that struggling with quicksand is like struggling with anxiety - in doing so the client may learn through rules rather than through experience (Stoddard & Afari, 2014).

Exercise 19: Last Impressions

Emotional states influence the recall of experiences with similar emotional tones (Tyng, Amin, Saad, & Malik, 2017). When people are feeling positive, they tend to recall pleasant events and vice versa. Further, Redelmeier & Kahneman (1996) found that the last thing that happens in an experience tends to color the memory of the whole experience. It is therefore vital to end sessions with clients on a positive note.

According to Lasley (2015), an effective way to end sessions is by celebrating client successes - no matter how small - and acknowledging their value. To do so successfully, the practitioner must:

1. Deliver the acknowledgment.

2. Listen for the impact.

3. Follow up if the client did not understand the acknowledgment or only received it partially.

Instructions
To carry out this exercise, the practitioner should write a list of positive acknowledgments that can be given to clients verbally at the end of each session. While it is a good idea to make these statements specific and relevant to each of your clients, the following suggestions are a good starting point:

"You sound very connected to your values, and you're honoring them fully. Well done for stepping out of your comfort zone."

"You made excellent progress during the session, particularly [talk about specific insight or achievement]."

"Your commitment to growth is unwavering."

"I want to acknowledge the way you are taking responsibility by acting on what matters most to you."

"I am struck by your courage and your ability to ___."

"I believe in your ability to overcome this challenge."

"I feel grateful that you shared your true feelings."

More Exercises from the Positive Psychology Blog

Check out this article, for more compassion-focused exercises to include in your work with clients.

You can find three coaching kids exercises to help young children understand their emotions and learn to solve problems positively.

Our Positive Psychology Toolkit© contains over 400 science-based positive psychology exercises, interventions, questionnaires and assessments for practitioners like you to use in your therapy, coaching or workplace.

Access a selection of positive psychology group exercises designed to increase positive feelings, behaviors, and cognitions.

This article provides an overview of five practical positive psychotherapy exercises.

For tips and exercises related to forgiveness, check out our article on the topic.

If the above is not enough, we even share free positive psychology PDF's in this article.

If you're looking for more science-based ways to help others enhance their wellbeing, this signature collection contains 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

A Take-Home Message

As a practitioner, you have a unique opportunity to help clients experience more meaning and fulfillment in their lives. I hope that the resources included in this article will help you to promote positive changes in individual clients, families, and groups.

Have you used any of these exercises in your work with clients? Leave a comment below; we would love to hear about your experiences.

We hope you enjoyed reading this article. Don't forget to download our three Positive Psychology Exercises for free.

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19 Top Positive Psychology Exercises for Clients or Students

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We share exercises for practitioners that can help clients, families, & groups experience more meaning and fulfillment.

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Best 15 Inner Child Healing Exercises To Reparent Your Inner Child (+ FREE Inner Child Worksheets PDF)

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Best 15 Inner Child Healing Exercises To Reparent Your Inner Child (+ FREE Inner Child Worksheets PDF)

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Reparenting the Inner Child
Reparenting is a healing approach where individuals become the nurturing, protective caregiver they lacked in childhood. By practicing inner child exercises—like affirmations, journaling, guided imagery, and exploring core beliefs—people can validate their past pain while creating safety and compassion in the present. This process promotes emotional regulation, self-love, and freedom from old wounds.

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Best 15 Inner Child Healing Exercises To Reparent Your Inner Child (+ FREE Inner Child Worksheets PDF)

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(+Inner Child Healing Exercises PDF) Best 15 Inner Child Healing Exercises To Reparent Your Inner Child Exercise 1. Describe The Inner Child Exercise 2. Affirm the Inner Child Exercise 3. Uncover Your Inner Child’s Beliefs Exercise 4. Accept the Wounded Inner Child Exercise 5. Understand Your Wounded Child’s Perspective Exercise 6. Non Dominant Hand Exercise Exercise 7. Use Art therapy Exercise 8. Strengthen Your Adult-Self Exercise 9. Nurture Your Inner Child Exercise 10. Mirror exercise Exercise 11. Allow The Inner Adult To Take Control Exercise 12. Amplify The Positive, Bonding Moments Exercise 13. Discover Your Positive Beliefs Exercise 14. Rewrite Old Memories Exercise 15. Write Your Wounded Child a Letter

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Inner child healing helps individuals reconnect with and nurture the wounded parts of themselves rooted in childhood experiences. Through practices like meditation, journaling, and self-compassion, this approach promotes emotional healing, self-awareness, and healthier relationships. Embracing the inner child fosters resilience and authentic personal growth.

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Inner child healing & tools and techniques for the therapist to help clients grow.

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12 Powerful Inner Child Healing Exercises to Reclaim Your Inner Child

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12 Powerful Inner Child Healing Exercises to Reclaim Your Inner Child

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12 Powerful Inner Child Healing Exercises
This guide shares practical exercises to reconnect and heal your inner child, helping you overcome childhood wounds and build self-compassion. It includes techniques like listening to your inner child, journaling, art therapy, mirror gazing, and self-soothing. The process encourages gentle, loving care and recommends professional support if emotions feel overwhelming. Healing your inner child can lead to greater inner peace, emotional resilience, and self-love.

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12 Powerful Inner Child Healing Exercises to Reclaim Your Inner Child - Inner Child Work

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I wish I knew about these inner child healing exercises sooner. As a young woman, I would have given anything to know that I had a wounded inner child. I was

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Healing Through Play: Top 10 Play Therapy Activities for Children with Trauma

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Healing Through Play: Top 10 Play Therapy Activities for Children with Trauma

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The Aura Institute provides an expert guide on the top 10 play therapy activities designed to support children who have experienced trauma. Play therapy uses a child’s natural language—play—to help them express emotions and experiences they may not be able to verbalize. These activities promote healing, reduce anxiety, and improve emotional well-being. The top techniques include puppet play, sand tray therapy, art therapy, storytelling, role-playing, clay modeling, therapeutic board games, play dough, music therapy, and the teddy bear exercise. Each method offers children a safe and creative outlet to explore their feelings and build resilience. Play therapy can show results in just a few sessions, though long-term support may be needed depending on the child’s unique circumstances. This guide emphasizes the importance of understanding trauma in children and offers accessible ways for caregivers and professionals to support healing through play.

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Aura Institute - Integrative Trauma & Somatic Therapy Training

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A training and certification program for trauma therapy including mindfulness, meditation, breathwork, Somatic Therapy, Parts Work & Integration, and more.

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Effective Play Therapy Techniques for Trauma Healing

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Effective Play Therapy Techniques for Trauma Healing

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Play therapy helps children heal from trauma by offering a safe, creative way to express emotions they can’t put into words. Techniques like art therapy, sand tray play, doll play, and storytelling support emotional release, build resilience, and foster coping skills. A safe environment, trust, and regular evaluation are key to success. This approach empowers children to process trauma and regain a sense of control.

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Effective Play Therapy Techniques for Trauma Healing - Kids First

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Discover effective play therapy techniques for processing trauma and helping children heal and thrive.

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This video introduces the for youth service providers working with unhoused or at-risk youth. It offers practical strategies to create safe, supportive environments by recognizing the impact of trauma and responding with empathy, consistency, and respect. The toolkit is designed to help staff apply trauma-informed practices in real-life settings.

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Trauma Informed Care Toolkit for Youth Service Providers

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A trauma screening tool is used to help identify whether a child has experienced potentially traumatic events and whether they are showing signs of trauma-related stress. These tools can be used in various child-serving settings such as schools, healthcare, and child welfare systems. Screening typically looks for symptoms like nightmares, avoidance, irritability, or behavioral and emotional challenges. The process may involve a self-report by the child (usually age 8 or older), a caregiver-completed form for younger children, or an evaluation by a provider using reports and observations. It’s important that families are informed about the purpose of the screening, how the results will be used, and how it may benefit the child. Engaging caregivers with empathy and clear communication encourages trust and increases the likelihood that children will receive the support they need. Trauma screening is a vital first step in connecting children and families to trauma-informed care and mental health services.

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The National Child Traumatic Stress Network

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What is a Trauma Screening Tool or Process?

Trauma screening is designed to be able to be administered to every child within a given system (such as child welfare) to determine whether he or she has experienced trauma, displays symptoms related to trauma exposure, and/or should be referred for a comprehensive trauma-informed mental health assessment. Trauma screening can include a particular tool or a more formalized process. Trauma screening should evaluate the presence of two critical elements: (1) Exposure to potentially traumatic events/experiences, including traumatic loss, and (2) Traumatic stress symptoms/reactions.

Not all children who experience negative events suffer posttraumatic or trauma-specific reactions as a result. Trauma screening should measure a wide range of experiences and identify common reactions and symptoms of trauma (e.g., PTSD, dissociation), as well as other commonly reported difficulties (e.g., anger, behavior problems, depression, anxiety). With proper training, professionals or paraprofessionals from various child-serving systems-healthcare, schools, home visiting programs, and domestic violence shelters-can administer the screening.

Screening typically covers the following types of traumatic stress reactions:

Avoidance of trauma-related thoughts or feelings

Intrusive memories of the event or nightmares about the event

Hyper-arousal or exaggerated startle response

Irritable or aggressive behavior

Behavioral problems

Interpersonal problems

Other problems based on the developmental needs and age of the child

Types of Screening Tools

Providers may administer trauma screening in a number of ways depending on the age and developmental stage of the child and on the child's relationship with the caregiver and other collateral informants in his or her life. For example, with very young children, it is difficult to screen specifically for "trauma symptoms." Rather, a provider may screen for exposure to traumatic events and social and emotional difficulties, such as attachment difficulties or mood dysregulation. As the child gets older, it may be more appropriate to screen specifically for trauma symptoms.

Most screening tools are developed for use by professionals with a range of training and experience. Providers using a screening tool should consider (1) factors such as the child's age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

Child-Completed Tool (Self-Report). Child-completed tools are appropriate for children, typically ages eight and above, who are able to read and complete the questions. These measures provide the child with an opportunity to verbalize his or her responses aloud or in writing.

Caregiver-Completed Tool. For infants, toddlers, young children (ages 0-8), or children with developmental delays, it is more appropriate to have a caregiver complete the trauma screening either by providing written responses to the items or through an interview by the provider.

Provider-Completed. The caseworker, clinician, or other professional can administer certain tools while reviewing and integrating available information on a child (e.g., court reports, interviews with caregivers and teachers, other questionnaires, and behavioral observations). These tools can be useful in consolidating a range of information in one place so that it is readily accessible.

Engaging Families in the Screening Process

To engage families in the screening process, the individual administering the tool should consider the following:

Explain the purpose and use of the screening tool and process. Say why you need to know this information, how you will use what you gather, how it may benefit the child and family, and who will have access to the information in the future. Emphasize that the information is confidential in most cases, unless the child endorses harm to self or others or the clinician has concerns regarding child abuse.

After the child or family has completed the trauma screening, share the results and show how you are using the information. For example, "It's clear from the forms that you filled out that your daughter is having a really hard time with nightmares and fear of things that remind her of her brother getting hurt. We call this Posttraumatic Stress. To help her, I would like to refer you to a therapist who specializes in treating children with these problems."

Make sure to thank the child for completing the tool or process, particularly if he or she disclosed a new trauma. Explain that the child's feelings and trauma reactions are normal and expected, given what he or she has lived through.

Consider the potential burden of the trauma screening to family members in terms of time and effort, and highlight the potential benefits, such as helping to link them to appropriate providers and services. Some families may be discouraged by the process; others may be comfortable with it. When providers explain the purpose and use of the screening tools and share the results, they enhance the benefits to families.

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Trauma screening should measure a wide range of experiences and identify common reactions and symptoms of trauma.

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A trauma-informed mental health assessment is a structured process used to gather detailed information about a child’s emotional, behavioral, and social functioning following exposure to trauma. This type of assessment helps providers understand the child’s needs, guide treatment planning, and communicate effectively with families and other professionals. Clinicians engage families by explaining the purpose of the assessment, using developmentally appropriate tools, and offering choices to reduce anxiety and build trust. During the process, caregivers and children may complete questionnaires or participate in interviews. Feedback is shared in a supportive, clear way that highlights both strengths and areas of concern, fostering collaboration on treatment goals. Common tools used in trauma-informed assessments include the Trauma Assessment Pathway (TAP), the CANS-Trauma tool, and the Transactional Model, which all help providers gain insight into how trauma impacts the child within their environment. This type of assessment is essential for ensuring children receive appropriate, personalized care to support healing and resilience.

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The National Child Traumatic Stress Network

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What is a Trauma-Informed Mental Health Assessment and Why is it Important?

Trauma-informed mental health assessment offers a structured framework for (1) gathering information across several key domains of functioning, (2) identifying and addressing the needs of children and families exposed to traumatic events, and (3) coding and summarizing this information, so that it can be communicated to families and other providers.

Engaging Families in the Assessment Process

The following practical strategies have been adapted from t he TAP training. Clinicians should facilitate child and family engagement in the process by addressing their concerns, answering their questions, validating their observations, and demystifying the process. When administering measures, describe for caregivers (and children, as appropriate), the purpose and importance of the assessment process and the various tools used to gather information.

Make time in the therapy session to complete measures with family members by putting it on the session agenda and explaining to caregivers how the measures can aid the treatment process and support the development of treatment goals and plans.

Allow the parent and child to choose the language in which they will complete the measures.

Describe the measures as a way you gather information on child and family functioning in order to help them as much as possible. This is not just more paperwork to complete.

Use developmentally appropriate strategies when completing measures with youth, including the following:

Have a dry erase board or chalk board, as an alternative to pencil and paper, for marking answers.

Let them decide the order in which they complete measures, when possible.

Select a fun pen or pencil to use when marking items.

Use visuals to clarify constructs such as frequency (e.g., calendar).

If the child opposes doing the measures, read aloud the items to him or her. This interviewing will allow you to collect additional "data," such as affective and physiological responses (Is he nervous completing the measure? Is she indecisive in responding? Does he fully understand the question?)

For youth, ask follow-up questions to probe more deeply after you have completed the measure.

Offer to complete the assessment over 1-3 sessions and give the child and caregiver some choice in this (e.g., complete all today or one today and one next week?).

Praise all children (and parents) for their "hard work" and patience completing questions.

Check the endorsement of critical items (e.g., hurting oneself) and develop a safety plan.

Take time to explain what will happen next (i.e., how the measures will be scored and how you will review the results with the youth and caregiver).

Clarify that you will re-administer the measures on an ongoing basis, share the results, and use those results as you develop and monitor the treatment plan.

Providing Feedback

Review the purpose of the measures with the child and caregiver.

When applicable, explain that the measures provide information on how the child is doing related to other children.

Highlight the strengths the child exhibits, whether indicated by a measure or domain related to resiliency, or strengths revealed as they were not identified as problematic (i.e., doing well in school). Explain to family members how you will integrate these strengths into the treatment plan to support recovery from trauma.

Assess the child and caregiver's level of interest in the feedback; you may want to provide more or less detailed information and assessment data.

Consider drawing diagrams or pictures to explain results on some measures (e.g., using bar graphs to indicate progress).

Highlight areas where the caregiver and child were consistent in their report on the measures (i.e., both agree the youth client is experiencing problems in school). If they are very consistent, this is a potential strength, indicating that they are "on the same page."

Highlight discrepancies between the child and caregiver report; explain that this suggests child and caregiver experience the same symptom very differently.

Ask the caregiver and child if the results are consistent with their experiences (Does this seem accurate? Does it provide any new information? If they disagree, why?). This helps reconcile differences between caregiver and youth responses or varying responses on different measures.

Share initial assessment results and use this information to engage in collaborative treatment planning with caregivers and youth as appropriate. Summarize the findings, noting two or three main points.

Use the feedback process to provide psychoeducation about trauma reactions with the child and caregivers (e.g., noting common responses to trauma or areas of need that are related to each other) and tie this information to the treatment selected (e.g., "This treatment can help reduce those physical reactions and improve your sleep.").

Remind the caregiver and child that you will re-administer the measures in the future, and that the results will show the progress of therapy, the areas where you may want to continue work, and how helpful the treatment has been for the child and family.

Examples of Trauma-Focused Mental Health Assessment Strategies

The following are three examples of tools and processes that can be used for trauma-informed assessment.

Assessment-Based Treatment for Traumatized Children: A Trauma Assessment Pathway Model. Developed by the Chadwick Center for Children and Families, with funding from the Substance Abuse and Mental Health Services Administration, the Trauma Assessment Pathway (TAP) was designed for children 0 to 18 years of age who have experienced any type of trauma and who may or may not be in the child welfare system. TAP is a multifaceted assessment process enabling clinicians to screen clients and, if appropriate for the treatment setting, to gain an in-depth understanding of the child, developmental level, traumatic experience, and the child's family, community, and cultural systems.

Child and Adolescent Needs and Strengths (CANS) - Trauma Comprehensive Version. The "CANS-Trauma" is a flexible, multi-purpose tool utilized in different capacities depending on the needs of a particular child-serving system (Kisiel, Lyons, et al., 2010). The CANS methodology is intended to gather information on a range of domains relevant to the functioning of the child and caregiving system (e.g., trauma experiences, traumatic stress symptoms, emotional and behavioral needs, risk behaviors, life domain functioning, strengths, and caregiver needs and strengths) and incorporate this information directly into individualized plans of care.

Transactional Model. Spaccarelli (1994) proposed a transactional or interactive model for understanding the effects of child abuse (and its associated events) on the presentation of symptoms. This model examines factors related to the abuse of the child, as well as those associated with the investigation (i.e., disclosure events) and related events that may occur subsequent to the investigation (e.g., placement outside the home and court hearings). This model also incorporates age, sex, and personality factors; social support; and previous coping styles and cognitive appraisal schemes (i.e., the way a child organizes and understands events in his or her world).

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Trauma-informed mental health assessment offers a framework for gathering information, identifying needs, and summarizing information.

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Trauma screening and assessment are essential steps in identifying the needs of individuals who have experienced trauma. Key areas to evaluate include trauma-related symptoms (such as depression, dissociation, or sleep disturbances), past and current mental health disorders, substance use, coping styles, social supports, and risk factors like self-harm or suicide. It's also essential to assess the characteristics and severity of the trauma experienced. Practical tools should consider the child's age, developmental stage, and environment. Resources such as the National Child Traumatic Stress Network's Measures Review Database and ACEs Aware provide access to age-appropriate tools for assessing trauma and related symptoms. These tools also support screening for risks such as sex trafficking and complex trauma. Implementing these assessments thoughtfully helps ensure that children and families are connected with the proper supports and interventions at the right time.

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Introduction What Is Trauma? Stress vs. Trauma Adverse Childhood Experiences (ACES) Complex Trauma Impact on Youth Experiencing Homelessness Trauma-Informed Care 101 Trauma Screening and Assessments Organizations must ensure that individuals have an inclusive space to heal. TRAUMA SCREENING AND ASSESSMENTS
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Early identification of trauma in young children is critical due to their developmental vulnerability. Multiple systems—such as healthcare, Early Intervention, child welfare, Head Start, and early education programs—play a key role in recognizing and responding to signs of trauma. Many now include trauma-related questions during intake, such as those addressing domestic violence or family loss. Pediatric providers are especially positioned to detect early trauma during routine visits and can ask families about stressful experiences while also offering guidance on safety and support. Assessments for young children should be developmentally sensitive, combining caregiver interviews, observations, and standardized tools. They must consider behavioral changes, the child's relationships, available support systems, and possible developmental delays. Standard tools used include the Child Behavior Checklist (CBCL), Trauma Symptom Checklist for Young Children (TSCYC), and PTSD-PAC. Collaborating with professionals such as speech or occupational therapists may also be essential when developmental concerns are identified alongside trauma.

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The National Child Traumatic Stress Network

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Screening and Assessment Within Multiple Systems

Due to the particular developmental risks associated with young children's traumatic experiences, it is essential that vulnerable children be identified as early as possible after the trauma. Many community resources-including health systems, Early Intervention programs, child welfare agencies, Head Start, child care programs, and early education systems-play an important role in identifying children, and in linking them and their families with services.

Some of these systems now try to address possible traumatic experiences by including questions about specific traumas into their intake and/or assessment protocols. For example, both Head Start and Early Intervention intake protocols include questions about domestic violence in families. Other protocols may include targeted questions about accidents, loss of family members, and/or significant medical history. Most young children are seen at regular intervals by providers in the pediatric health care system, enabling repeated opportunities for identifying early childhood trauma. As such, medical providers can also play an important role in diminishing risks and in maximizing protective factors associated with young children's exposure to trauma. They can supply information to prevent accidents and can incorporate questions about stressful and traumatic experiences into their interviews with families.

Focus of Assessment for Young Children

Assessment of trauma in young children must focus on the presenting problem in the context of the child's overall development. This information can be gathered though interviews with the parents and significant caregivers in the child's life, observation of the parent/caregiver-child interaction, and standardized assessment tools. Clinical assessment should include review of the specifics of the traumatic experience including:

Reactions of the child and parents/caregivers

Changes in the child's behavior

Resources in the environment to stabilize the child and family

Quality of the child's primary attachment relationships

Ability of parents/caregivers to facilitate the child's healthy socioemotional, psychological, and cognitive development

When conducting an assessment of a young child, it is also important to assess developmental delays (e.g., gross/fine motor, speech/language, sensory processing), which may indicate that the child could benefit from evaluation and/or services from another professional (e.g., occupational therapist, speech/language therapist, physical therapist). It is often helpful to consult and to work collaboratively with these professionals.

Instruments for Assessing Traumatic Stress in Young Children

Below is a list of some of the standardized instruments used within the NCTSN to assess traumatic stress in young children.

Child Behavior Checklist (CBCL): Achenbach, and Rescorla (2001). Ages 1½-5

Posttraumatic Stress Disorder Semi-Structured Interview and Observation Record: Scheeringa and Zeanah (1994). Ages 0-4

Posttraumatic Symptom Inventory for Children (PT-SIC): Eisen (1997). Ages 4-8

Preschool Age Psychiatric Assessment (PAPA): Egger and Angold (1999). Ages 2-5

PTSD Symptoms in Preschool Aged Children (PTSD-PAC): Levendosky, Huth-Bocks, Semel, and Shapiro (2002). Ages 3-5

Traumatic Events Screening Inventory-Parent Report Revised (TESI-PRR): Ghosh et al. (2002). Ages 0-6

Trauma Symptom Checklist for Young Children (TSCYC): Briere et al. (2001). Ages 3-12

Violence Exposure Scale for Children-Preschool Version (VEX-PV): Shahinfar, Fox, and Leavitt (2000). Ages 4-10

Violence Exposure Scale for Children-Revised Parent Report (VEX-RPR): Shahinfar, Fox, and Leavitt (2000). For parents of preschool-aged children aged 4-10

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Due to the particular developmental risks associated with young children's traumatic experiences, it is essential that vulnerable children be identified as early as possible after the trauma. Many community resources-including health systems, Early Intervention programs, child welfare agencies, Head Start, child care programs, and early education systems-play an important role in identifying children, and in linking them and their families with services.

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What is Trauma Screening and Assessment?

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What is Trauma Screening and Assessment?

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Trauma screening and assessment are key components of trauma-informed care. Screening uses brief, culturally sensitive tools to identify a child's exposure to traumatic events and related stress symptoms, such as nightmares, avoidance, or behavioral issues. This early step helps providers determine if a child may benefit from further trauma assessment or treatment. A trauma assessment is a more in-depth, standardized evaluation used after screening confirms trauma exposure. It helps identify the type of trauma, the child's reactions, and whether they meet criteria for conditions like PTSD. The goal is to guide individualized treatment planning. Effective screening and assessment consider the child's age, development, language, and cultural background. Tools like the Traumatic Stress Screen for Children and Adolescents (TSSCA) and the UCLA PTSD Reaction Index are examples. These practices also help normalize trauma responses and connect families to appropriate services. Staff administering these tools should be trained in their use to ensure accurate results and meaningful support for children and families.

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Overview

Trauma screening involves the use of a culturally competent, standardized, and validated trauma screening tool. A trauma screener is designed to be administered to every child within a given system.

Trauma screening tools are brief and should evaluate the presence of two critical elements: (1) exposure to potentially traumatic events/experiences, including traumatic loss, and (2) traumatic stress symptoms/reaction.

A trauma screening typically covers the following types of traumatic stress reactions:

Avoidance of trauma-related thoughts or feelings

Intrusive memories of the event or nightmares about the event

Hyper-arousal or exaggerated startle response

Irritable or aggressive behavior

Behavioral problems

Interpersonal problems

Other problems based on the developmental needs and age of the child

Why Screen?

If you do not ask, they will/may not tell. Trauma-informed screening and assessment practices help providers identify children's and families' needs early in the intake/therapy process and to tailor services to meet those needs. Trauma exposure and its impact on a child can be varied and may occur over different developmental periods.

Trauma exposure has the potential to impact all domains of functioning, cognition, and emotional regulation. However not all children who experience a traumatic event(s) suffer posttraumatic or trauma-specific reactions as a result. Screening for exposure to trauma can help to gain a better understanding of what a child has experienced and identify or clarify other clinical presentations

The overall goal is for trauma to be factored into eligibility for services, service recommendations, and assessment and treatment planning. Screening for traumatic stress symptoms among those with a history of potentially traumatic experiences can identify children who may benefit from an evidence-based trauma treatment. Staff who administer the screening tool should be trained in the administration, scoring and interpretation of the results

For those mental health providers working in a CMHSP the MDHHS BHDDA Trauma Policy: Section IV states the following:

Screening for trauma exposure and related symptoms for each population. CMHSP, through direct service operations and provider network, shall use a culturally competent, standardized and validated screening tool appropriate for each population during the intake process and other points as clinically appropriate.

Trauma Screening is the first opportunity to normalize the effects of trauma. It is an opportunity for non-judgmental engagement and a transition to trauma treatment. The child and their caregiver can learn about common reactions to stress and normalize some of the reactions they may be experiencing. Trauma Screening can also provide a rationale for further trauma assessment and treatment.

Types of Trauma Screening Tools

What makes a good screening tool? The NCTSN states: providers using a screening tool should consider (1) factors such as the child's age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

There are a variety of screening tools, below are a couple of examples:

University of Minnesota's Traumatic Stress Screen for Children and Adolescents (TSSCA)

Juvenile Victimization Questionnaire (JVQ-R2)

What is a Trauma Assessment?

A trauma assessment typically occurs after a trauma screening has been completed and the child or caregiver has indicated trauma exposure. The assessment utilizes a formal, standardized measure to assess for a range of trauma exposures as well as behavioral reactions/coping skills that may have resulted from the trauma exposure. The assessment measure typically gathers information from both a child/youth and their caregiver.

Why is a Trauma Assessment Completed?

A trauma assessment typically occurs after a trauma screening has been completed and the child or caregiver has indicated trauma exposure. The assessment utilizes a formal, standardized measure to assess for a range of trauma exposures as well as behavioral reactions/coping skills that may have resulted from the trauma exposure. The assessment evaluates the ways in which a child/youth's current functioning might have been affected by the experience of trauma. The assessment measure typically gathers information from both a child/youth and their caregiver.

There are three dimensions of the trauma assessment:

1. Has the child/youth been exposed to potentially traumatizing events?

2. Does the child/youth display symptoms associated with posttraumatic stress?

3. Determining if the youth meets the criteria for a formal diagnosis of Posttraumatic Stress Disorder (PTSD) as per the DSM-IV or ICD-10 diagnostic manuals.
It should be noted a PTSD diagnosis is not required to receive TF-CBT or CPP.

Trauma assessments can help to determine, trauma responses that are currently occurring, whether a child is developmentally on target in their social, emotional, and behavioral functioning; as well as, inform case conceptualization and drive treatment planning. Treatment goals can also be established from the assessment, specifically targeting ongoing trauma responses and identifying any barriers to treatment. A trauma assessment can also monitor progress over time as the child, youth and family proceed through treatment.

Types of Trauma Assessments

What makes a good trauma assessment tool? When reviewing assessment tools the NCTSN states: providers using a trauma assessment tool should consider (1) factors such as the child's age, language skills, and cognitive capabilities; (2) whether the child is among the populations for which the tool has been validated and normed; and (3) if there are other factors that might affect the reliability and validity of the tool for this particular child.

There are a variety of trauma assessment tools, below are a couple of examples:

Young Child PTSD Checklist (YCPC) for children ages 1-6 years' old

UCLA Posttraumatic Stress Disorder Reaction Index for the DSM IV (UCLA-PTSD RI)

The NCTSN also has a database of searchable detailed reviews of screening and assessment measures utilized in the field of child traumatic stress, designed to allow comparison across measures.

Training Qualifications

Trauma Screening and Assessment Learning Collaboratives are provided on a regular basis throughout the year to Community Mental Health Services Programs (CMHSPs) and their provider agencies. To qualify for a Learning Collaborative in our Trauma Screening and Assessment program, you must be a licensed clinician employed by a CMHSP or provider agency.

Please speak with your agency supervisor if you are interested in participating in an upcoming Learning Collaborative.

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What is Trauma Screening and Assessment?

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Trauma screening involves the use of a culturally competent, standardized, and validated trauma screening tool. A trauma screener is designed to be administered to every child within a given system. Trauma screening tools are brief and should evaluate the presence of two critical elements: (1) exposure to potentially traumatic events/experiences, including traumatic loss, and (2) traumatic stress symptoms/reaction.

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Creating a safe space, whether it's a calming place, a trusted person, or a comforting object, can help alleviate trauma symptoms by providing emotional and physical security. While helpful in coping, safe spaces should support, not replace, therapy. Evidence-based treatments like CBT and EMDR help address trauma at its core, leading to long-term healing and recovery.

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Creating a Safe Space After Trauma | Everlast Recovery

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Traumatic events can be devastating for individuals in addiction recovery. Get help by reaching out to Everlast Recovery Centers. Call us at (866) 338-6925.

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: The Impact of Trauma on Fundamental Human Needs - Dr Sam Goldstein

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Trauma often disrupts three core human needs: safety and control. These are vital for emotional well-being, healthy relationships, and decision-making. Trauma can damage trust in oneself and others, create ongoing feelings of danger, and strip away a sense of control over life. Healing involves rebuilding these foundations through therapy, support systems, and self-care. Approaches like CBT, EMDR, and resilience-building practices can help survivors restore what trauma has taken, allowing them to move forward with strength and hope.

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Trust, Safety, and Control: The Impact of Trauma on Fundamental Human Needs - Dr Sam Goldstein

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After forty-five years of clinical practice evaluating and treating thousands of people of all ages, I have come to the realization that trauma of any sort, mental or physical steals away three, often difficult to quantify, fundamental human needs,: trust, safety, and control. These three serve a crucial role in our lives. These needs are deeply interconnected, essential for our emotional well-being, physical and mental health, and overall sense of security. While they may appear as abstract concepts, their significance becomes apparent when we consider how they shape our daily lives in all interactions, relationships, and decision-making processes. Trauma, in its various forms, can profoundly impact an individual’s ability to trust, feel safe, and maintain a sense of control in their life. In this month’s article, I will delve into the importance of trust, safety, and control examining how trauma can disrupt these vital aspects of human existence.

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Trauma can leave us feeling powerless and disconnected, but healing begins by creating emotional safe spaces. The Healing in Your Hands program, developed by Dr. Kate Truitt, utilizes self-Havening techniques, a neuroscience-based method involving gentle touch to calm the brain and mitigate the impact of trauma. These practices support emotional regulation, resilience, and healing by generating calming brain waves and increasing the production of feel-good chemicals. Safe spaces, whether mental, emotional, or physical, help you regain a sense of control and self-compassion. Practicing these techniques regularly can support long-term recovery and personal empowerment.

Self Havening Guided Practice for Enhancing Calm and Wellness with Dr. Kate Truitt [YouTube Video]

An Introduction to the Havening Touch with Dr. Kate Truitt [YouTube Video]

Let’s Talk Trauma with Dr. Kate Truitt [YouTube Video]

Trauma [YouTube Playlist by Dr. Kate Truitt]

The Havening Techniques: New Neuroscientific Insights Shine Light on Ancient Healing Practices [YouTube Video]

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Navigating Trauma: How to Build Your Emotional Safe Space

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Trauma impacts our lives and affects us in countless ways. You have the power to create your emotional safe space and create healing from within.

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Creating Safe Environments for Students Recovering From Trauma

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Creating Safe Environments for Students Recovering From Trauma

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Creating safe learning environments helps students recovering from trauma feel supported, valued, and in control. Key strategies include maintaining consistent routines, incorporating student input into classroom rules, and conducting daily mental health check-ins. Giving students a voice fosters a sense of safety, connection, and hope. Self-care plans also help students prepare for emotional stress, providing tools and strategies to manage emotions during challenging moments. By emphasizing trust, communication, and compassion, educators can create trauma-sensitive classrooms where healing and learning are intertwined.

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An excerpt from the new book The School of Hope looks at how educators can help students who have experienced trauma.

monkeybusinessimages / iStock

To create safety for students we need to make a valiant attempt to listen and respond to the thoughts of every person in our care. When my adopted children arrived, I wanted to have a relationship from the moment they walked in the door. I was unaware of stimuli in the environment that would trigger instability.

The quick way to alleviate possible stressors is to make sure every person has the opportunity to express their needs and concerns as routines, rules, and procedures are developed.

Consistency: Rules, Procedures, and Routines

Routines and norms offer consistency, which conveys safety and stability. It provides predictability that lets us know what's going to happen and when. When going over rules, routines, and procedures, consider allowing people to ask questions and give input in their creation.

As much as possible, co-creating classroom norms allows all students, including those who have experienced trauma, to have a voice in shaping a space that fosters a sense of safety. Creating rules, routines, and procedures with others provides a sense of security, value, and ownership, which enhances personal safety. It gives the person who might have experienced trauma the chance to bring up concerns and helps avoid recreating triggering situations where students felt like they weren't in control. It can stop potential problems from happening.

This safety practice also begins to foster psychological hope in the brain. Setting a collaborative goal gives students ownership of their environment. The class works together daily to achieve the principles set in their goal. Students get to experience how this collaborative goal works to shape the classroom culture. This reinforces the power of setting goals and future planning. This practice shows students they have power to shape and change the world around them and builds hope as students see how their efforts impact the goal principles and classroom culture.

I like to start off the year by having students agree on the community principles they want to use as a goal to create their ideal classroom environment. Students give input on what attributes should form the foundation for classroom interactions. To get them started I provide them with examples by asking questions. Should we be able to trust each other in the classroom? What is necessary to keep you engaged, happy, and safe? From their individual lists, we create a large list of principles on the board. The students then group similar characteristics until we come up with a list of four or five attributes for the classroom.

Classroom ideals might include trustworthiness, humor, collaboration, and kindness. The class then works together to create one rule that will ensure that each of these ideals is honored. For example, trustworthiness might have a rule that we honor each other by being honest even when it's hard. Humor might have a rule that states we use school-appropriate jokes or puns when suitable to make class lighthearted. Collaboration might have a rule that we work together as a class to accomplish goals and to build comradery. Lastly, kindness could have a rule that states we always try to make others feel welcome by acting in a way that shows respect and caring. This allows students to see that the rules work to form a pathway to the goal of keeping them safe, comfortable, and happy.

Once the rules are created, I print out the principles and rules and give a copy to each member of the class. Each of my six classes creates principles and rules they will follow. It's important to go over rules and procedures often to remind people of the way to act in certain situations, to show the structures of consistency that are in place, and to convey to students and staff that safety is a priority.

We can't mitigate all stressors, but students are more likely to demonstrate resilience if they know they have a say and the support of a consistent, caring teacher. Even with a good foundation, however, problems may arise. The best thing we can do in any situation is reaffirm safety and take the time to be curious about behaviors. When students do exhibit challenging behaviors, we can reaffirm safety by approaching them in a calm, respectful way. Rather than asking, "What's wrong with you?" and labeling a kid, we should remain curious and shift the question to, "What's happened to you?"

My own children kept huddling together in my home. Instead of becoming full of frustration, I asked them questions about the huddling behavior. My oldest son, C.J., later told me that huddle-hugging made them feel safe. I continued asking questions and found out they would group together to prevent severe injury. In the past, their father would isolate one of them to abuse, and they knew if they ran and hugged each other he might still hurt them, but not as much as if they were alone. They shared the pain. My children found safety in the clinging hands of their siblings, so when they arrived at my house they clung to each other not to snub their new life but because they wanted safety. This learned behavior was a way to self-soothe and find security during a gigantic change.

Change is hard, but it's even more difficult for those with trauma. Even though my children were in a safe environment, their brains and bodies did not recognize that there was no danger. Consistency over time helps soothe the brain and gives comfort. After a few weeks of following the same routine, listening to my kids, and setting principles for the household environment, my children started to smile, play, and laugh. Your consistent words and actions matter beyond measure!

Communication: Mental Health Check-In

How do you handle your bad days, when hope is a distant star and "Happy" is just a song blaring from a radio? When you are exhausted, stressed, and just don't want to try? You might play video games or read a book. Perhaps you distract yourself with the Internet, YouTube, or Netflix. A jog in the park might make you feel better. We have ways to cope, but do they solve the problem? They numb the pain, but do they remove it?

Coping mechanisms might get you through a tough spot, but it takes more to help foster healing. According to a study done by Pennebaker, Kiecolt-Glaser, and Glaser, "Simply talking about our problems and sharing our negative emotions with someone we trust can be profoundly healing-reducing stress, strengthening our immune system, and reducing physical and emotional distress."

We need to talk more about mental well-being because a lack of communication will block us and stop us from forming connections. Communication helps people deal, heal, and cope with hurts. It also allows us to show students new ways to channel their feelings.

It's important to have numerous opportunities for every person to check in and communicate their mental state. Each chance creates a net to catch, respond to, and assist in healing hurts as they arise. Mental health communication can be done in numerous ways in the classroom and school setting. Teachers can create spaces physically or remotely where every student can check in. Communication allows teachers to gain insight into student safety concerns, feedback, and traumas.

Consider creating a check-in using a Google Form that asks first about a positive part of a student's day. Then inquire specifically about the student's mental state. Using multiple-choice answers can help students feel less intimidated to complete the check-in. Offer choices such as "I'm great," "I'm OK," "I'm struggling," or "I'm having a hard time and would like a check-in." For younger students, consider using happy/sad faces that show varying degrees of emotion from happy to upset. Use an open-ended question to ask if the student has particular needs that can be addressed. You can make a copy of the Google Form I use with my students. Pass out the link, post it in a digital classroom, or create a QR code for students to scan to allow easy access. Provide a few minutes for students to fill out the chart at the start of class. Quickly scan the results for any people in need of a physical check-in and follow up.

The greatest thing of value in a school is the people. Taking the time to check in and help others shows people that they matter. It allows safety to bloom and alleviates fear. Having open conversations about mental health promotes a school culture of mental wellness. Trauma can touch anyone at any time, but with open communication we can be there when it does.

Care: Self-Care Plans and Asset-Based Teaching

When trauma shows up it arrives like an earthquake, which can wreck consistency. Even when it stops, aftershocks occur. Stressful moments are the breeding place of rash decisions. Why? Because without proper planning, we react to the moment. The reality is that over time acute traumas touch all of us: death, sickness, accidents, divorce, and natural disasters, to name a few. Schools prepare and run drills for shootings, fires, and tornados. In California, they even build schools with the knowledge that earthquakes may happen. Addressing mental wellness is just as important as preparing for a fire. It's important to have tools at our disposal to provide care for those we serve. In order to do that, we need to plan for bad days and moments of emotional turmoil.

A self-care plan is an intervention that keeps a person from being completely sucked into an emotional reaction. It can give a sense of control and safety during escalating feelings. Having a self-care plan is like earthquake-proofing a building. It won't stop the earthquake when it hits, but it will give a person a choice in how to respond. Each person creates his or her own self-care plan. It's a preventative measure filled with their favorite self-care activities, self-regulation tools, and ideas for how to utilize the people who support them.

Having a plan takes the guesswork out of what to do and where to turn in a moment of crisis. It helps a person respond instead of react to the situation at hand. It allows them to take time to think about what they want to do and how they want to do it. You can write your own self-care plan and get students to do the same. Having students create individual plans gives teachers tools to support students who show signs of distress and provides teachers with strategies, activities, and tools to help each student.

For example, Jordan struggled with feelings about her dad going back to prison. In her plan, she wrote that her dad being in and out of her life was a stressor and sometimes caused her to shut down. I knew from her self-care plan that I was an adult she relied on and that art was a tool she used to feel better, so after she finished talking, I suggested she take a few minutes to draw when she went back to the classroom. By taking those few minutes, she was able to find a safe space to deal with her feelings. Creating plans with students allows them to utilize their own neuroplasticity to reshape a moment of chaos into one of control.

To begin a self-care plan with a student, have them recognize support structures, people, and hobbies that help them feel better. Start by asking the student to list activities that they currently utilize to help them feel calm or happy. It's best to model an example plan to students as they create their own. I have each of my students fill out this Google Doc when they are creating their plan.

To model, I go through the self-care plan and fill one out for myself. I go through it step by step and explain out loud my thought process for each part. For calming activities, I give students suggestions of activities such as music, exercise, coloring, art, meditation, etc. Next, I have them list one or two people whom they can turn to for help and support. In the same section, they should write down what resources they have access to in the school building. For example, if your school has a school counselor or a focus and recovery (FAR) room, students can utilize those. By writing this list, the student can take mental stock of tools at their disposal in times of turmoil.

Once students complete the support section, they should list stressors or things that might act as a speedbump to their mental well-being. This section will serve as a guide for moments when you might utilize a student's self-care plan. Thinking through a typical school day or school year might help them hone in on specific areas of stress, such as transitions between classes, a specific time of year, or perhaps a situation like a fire drill. Then they should list barriers outside of school that might affect their mental well-being. Lastly, they should create a plan to address each of the stressors and barriers. They can use tools from their feel-good activity list or other strategies they might want to try. Have them list what they could do to cope when they start to feel overwhelmed.

Remind students that they can use their self-care plan even when they are not in your class. They can revise and use it at their discretion as new barriers appear, new coping tools are learned, and new life circumstances arise. That way the next time an earth-shaking moment hits them, they'll have a plan, and it might be just enough to keep their world from crumbling.

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Creating Safe Environments for Students Recovering From Trauma

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An excerpt from the new book 'The School of Hope' looks at how educators can help students who have experienced trauma.

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This collection provides a foundational glossary and practical tools for understanding trauma, Adverse Childhood Experiences (ACEs), and resilience. It includes definitions (e.g., trauma responses, toxic stress, healing-centered practices), self-reflection tools like the ACEs and resilience questionnaires, and trauma-informed strategies for home and classroom settings. Activities guide caregivers and educators in regulating their responses, supporting emotional safety, and co-creating environments rooted in consistency, empathy, and trust.

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Between Therapy Sessions:  - GoodTherapy.org Therapy Blog

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Healing from trauma doesn't end when therapy sessions do; our brains continue to process trauma between visits, which can lead to distressing symptoms like flashbacks or anxiety. To manage this, coping skills are essential. Techniques like body scans help build awareness by noticing sensations without judgment. Containment allows individuals to visualize placing overwhelming thoughts in a secure mental "container" until they're ready to process them. Body movement, such as walking or yoga, helps release tension and build emotional regulation. Practicing these skills consistently can enhance resilience and make trauma healing more manageable between sessions.

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Between Therapy Sessions: 3 Handy Coping Skills for Trauma - GoodTherapy.org Therapy Blog

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At its most effective, healing work for trauma extends beyond the therapy room. Here are some coping skills that can be useful between therapy sessions.

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CHILDHOOD TRUAMA AND ITS EFFECTS ON ADULT LIFE

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Coping with childhood trauma involves more than just managing symptoms; it's about building resilience and reclaiming control. Strategies such as mindfulness, body movement, journaling, and connecting with supportive people can help reduce emotional overwhelm and promote healing. Therapy, especially trauma-informed approaches like CBT or EMDR, can help individuals reframe negative thoughts and process painful memories. Education about how trauma affects the brain empowers people to understand their responses and develop healthier coping mechanisms. With consistent support and self-care, individuals can begin to heal and move forward with strength and hope.

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CHILD HOOD TRUAMA AND ITS EFFECTS ON ADULT LIFE

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Childhood is a foundational period that shapes an individual’s emotional, psychological, and social development. It is during these years that crucial patterns of behavior, thought, and interaction are established, laying the groundwork for the rest

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Trauma is a deeply personal response to distressing experiences, whether sudden loss, disaster, violence, or past abuse. It can impact emotions, thoughts, behaviors, and relationships. Reactions may include shock, fear, anger, or physical symptoms such as headaches and sleep disturbances. Factors such as past trauma, proximity to the event, or lack of support influence how we respond. PTSD may develop in some cases, but it is a treatable condition. Healing takes time and involves patience, self-care, supportive relationships, and often faith or spirituality. Discussing experiences, practicing mindfulness, and seeking therapy are all integral to the journey toward recovery and resilience.

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Coping with Trauma – Mental Health 4 Muslims

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“Just as the body goes into shock after a physical trauma, so does the human psyche go into shock after the impact of a major loss.” –Anne Grant

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Building student resilience and coping with stress 

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Building resilience in young children (birth to age 8) lays the foundation for lifelong emotional strength. The APA's updated lessons for grades 4–8 can be adapted to support younger learners by focusing on simple, engaging activities that teach body awareness, calming actions, and positive thinking. Through guided routines, play, breathing exercises, and emotional expression, children learn to manage stress and safely express their feelings. Strong adult relationships, consistent routines, and creative outlets, such as art and storytelling, are key to helping young children feel safe, connected, and capable during times of change.

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Classroom lessons to help students adapt and grow academically, emotionally, and socially with three resilience-building skills. Part of our COVID-19 Teaching Resources for preK-12 Teachers.

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 Skills For Trauma - Trauma Coping For Kids #Trauma #CopingSkills

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Coping skills are techniques that help manage thoughts, feelings, and behaviors after experiencing trauma. They calm the brain and body, promote clearer thinking, and strengthen emotional resilience. This video outlines eight key types of coping skills: relaxation techniques, grounding strategies, mindful distractions, mindset shifts, emotional or physical release, seeking help, self-care, and resilience-building practices. By practicing these tools, individuals can begin healing and regain control over their well-being.

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8 Types Of Coping Skills For Trauma - Trauma Coping For Kids #Trauma #CopingSkills

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Trauma worksheets are potent tools to help children and teens process emotional pain, build resilience, and develop healthy coping strategies. These printable activities support emotional healing by assisting kids to identify trauma symptoms, manage stress responses, and practice self-care. Worksheets such as the "Trauma Symptoms Checklist,” “My Peaceful Place,” and “Resilience Worksheet” guide children through self-reflection and encourage positive habits, including journaling, deep breathing, and seeking help. By using these worksheets regularly, children can gain a deeper understanding of their experiences and develop the confidence and skills necessary to move forward with strength and hope.

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10 Printable Trauma Worksheets for Kids & Teens

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Trauma worksheets are a helpful therapeutic tool for children and teens suffering from PTSD and extreme stress. Explore some of our best worksheets.

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Traumatic brain injuries (TBIs), often caused by falls or car accidents, can lead to damage in the vestibular system, which affects balance and spatial orientation. This article highlights how trauma can harm both the central nervous system and the inner ear, especially the otolith organs. Symptoms can be complex and challenging to localize, making diagnosis difficult. The European Society for Clinical Evaluation of Balance Disorders emphasizes that detailed patient history and advanced diagnostic tools are essential in managing trauma-induced vestibular issues. Improved understanding and assessments may lead to better, individualized treatments in the future.

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Traumatic brain injury occurs frequently worldwide. Half of traumatic brain injuries are related to falls or motor vehicle accidents. The term “concussion” is often used to describe a minor form of traumatic brain injury. These often involve…

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Trauma can disrupt the nervous system and alter how we perceive our bodies in space, a process known as proprioception. When trauma responses like fight, flight, or freeze are left unresolved, they become "trapped" in the body and can cause dysregulation. Body-centered and polyvagal therapies help reconnect individuals to their internal sensations (interoception) and body awareness (proprioception). Proprioceptive activities, such as stretching, lifting, or balancing, provide calming or energizing input to the nervous system. These movements help regulate emotions, support nervous system healing, and empower individuals to feel safe and in control within their bodies.

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Trauma and Proprioception - Caroline King Trauma Therapy

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Trauma is any distressing event where you feel overwhelmed, powerless or helpless and do not fully use up or reset your instinctive fight, flight, or freeze

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"I Feel Like..." is a digital and printable social story designed to support preschool and special education learners in understanding and expressing emotions through the use of similes and visuals. This resource promotes emotional awareness, communication, and self-regulation, making it ideal for classroom use or at home. Teachers pay teachers

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I can follow recess rules | Preschool Social Emotional Learning Story

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This toolkit introduces the eight sensory systems—beyond the usual five, which include vestibular (balance), proprioception (body awareness), and interoception (internal sensations, such as hunger or pain). Many autistic children show hyperreactivity (overreaction) or hyporeactivity (underreaction) to sensory input, which affects their behavior, learning, and emotional regulation.

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Moira Peña, BscOT, MOT, Occupational Therapist, Holland Bloorview Kids Rehabilitation Hospital Elsbeth Dodman, Honours B.A. Autistic Self-advocate
Chosen terminology: Throughout this toolbox we refer to "persons on the spectrum" or "Autistic persons". We have chosen this language based on the recommendations of one of this toolkit's authors, Elsbeth Dodman, an autistic self-advocate, and in agreement with recent research organization and journal guidelines. These terms encompass the previously used terms of individuals with autism, Asperger's, and Pervasive Developmental Disorder (PDD).

This toolbox also uses the terms hyper- and hyporeactivity instead of the previously used terms of hyper- or hyposensitivity. Research has shown that a person on the spectrum is not necessarily more sensitive to sensory input, but rather the way in which they react to that information is different. For instance, people on the spectrum who react strongly to bright lights do not have more receptors in their eyes. Similarly, someone who is constantly seeking tactile input isn't doing so because they have fewer nerve endings in their skin. It is not that the person is actually receiving more or less sensory information than others, but, rather, their reaction to the sensory input is different

Introduction to sensory processing differences

Sensory processing differences are a common issue for autistic children and often remain problematic into adulthood. Many people on the spectrum show challenges with balancing their reactions to incoming sensory input in at least one sensory area, but it is common to experience issues in multiple senses.

This toolkit is designed to provide autistic persons and their families with an introduction to the 8 sensory systems, questions to help determine the individual's most impacted sensory systems, and to give an overview of strategies to try at home. Additional resources, including an overview of professional treatment options, are provided along with recommended reading and websites.

April is an 18-year-old Autistic woman who really hates sudden loud noises and has difficulty focusing on her surroundings in crowds. This makes going to the grocery store, mall, or outdoor events very difficult. For April, sudden loud noises are frightening and all consuming. April is often very tired and prone to emotional meltdowns by the end of a busy day.

Ben is an 8-year-old boy who has a very limited diet and has difficulty recognizing when he's hungry. He doesn't like the texture of most foods and doesn't find fruits or vegetables visually appealing. Because of Ben's restrictive diet he is often constipated and his pediatrician has confirmed that he is lacking the nutrients his growing body needs.

Sensory Systems

Most people are aware of the five sensory systems of vision, hearing, taste, smell, and touch, but there are three other major sensory systems that the brain is constantly processing as well: vestibular (balance and coordination), proprioception (body position and movement), and interoception (knowing what is happening inside our bodies, like hunger or thirst). Many autistic persons have difficulties in processing multiple sensory systems, although the specific senses affected and intensity of the issues can change throughout development and into adulthood.

Reacting to sensory information

We are all constantly receiving information from our senses throughout the day. This information is usually filtered by the brain so only the most important sensory information receives our attention. For instance, if someone is talking to you, your brain will usually focus your attention so that you are seeing their lips move and hearing the words they say instead of listening to a fly buzzing against the window. At another time in the day, you may have a hard time paying attention to what someone is saying because you are very hungry. In that case, your brain is focusing your attention on what is more important to the health of your body (food), rather than what another person is telling you. By focusing our attention only on the senses that matter at a particular time, our brain keeps us from becoming overwhelmed by sensory information.

How sensory information makes us adjust our behaviour

Our brains are constantly striving to keep us within an "optimal attention and arousal", window, which describes when someone is able to stay calm and alert enough to manage their daily activities to the best of their abilities. Everyone moves above and below this optimal attention and arousal window throughout the day, and it is common to adjust our behaviour throughout the day in an attempt to get back to this optimal state. For instance, in the morning many people drink caffeine or roll down the window on their drive to work so that they can feel more awake. At other times in the day, a person may feel anxious because they have to give a big presentation and so they close their eyes and take deep breaths to make themselves feel more relaxed.

Hyperreactivity vs. Hyporeactivity

Extreme reactions to sensory information can be classified as either hyperreactive (being overwhelmed) or hyporeactive (not reacting to sensory input as one should). In both cases, the person is far from their "optimal attention and arousal" window, which means they are not feeling calm and alert.

April has trouble in crowds because the layers of sounds (people talking, laughing, shouting, music playing, etc.) all get the same priority for her attention, making it hard for her to tell what she's supposed to focus on. She often needs to 'escape' when she is feeling overwhelmed in these situations and either leaves the event or tries to find a quiet place.

If a person's brain is unable to filter out irrelevant sensory information, they can experience sensory overload and their nervous system will move towards the hyperreactivity direction. Being overwhelmed by sensory information can activate the nervous system to go into "fright, fight, or flight". People who are experiencing sensory overload may respond by either freezing in place, acting angry or aggressive towards another person or object, or running away from the source of the sensory input.

Ben prefers tight hugs and strong touch. This input makes Ben feel grounded and helps him know where his body is in space. Ben is often bumping into objects and has trouble putting his coat on.

April loves to put things in her mouth -chewing on toys, pens, coins and straws. April chews on toys and other items to explore the world around her -she enjoys the different feelings and textures as they help soothe and calm her.

On the other hand, when a person is under-reacting or not reacting to sensory input as they should, they can move towards the hyporeactive direction. People with this sensory profile will respond by seeking out sensory input and you may see behaviours like listening to really loud music, chewing on clothing, non-edibles, or possibly some part of their body, or spinning in circles. Autistic persons tell us that they engage in these behaviours to help them feel calmer and more alert.

It is common for autistic persons to be at one extreme or the other at various times during the day. Being able to focus their attention on just one or two sensory systems can be difficult for persons on the spectrum. For instance, in the earlier example of someone talking, an autistic person may have trouble focusing on watching the speaker's lips move or hearing their words because the fly buzzing against the window is getting as much of their attention. Like all of us, autistic persons will adjust their behaviours in an attempt to re-enter their "optimal attention and arousal" window. The major difference is that, sometimes, the behaviour they engage in may cause them to "overshoot" and move too far in the other direction .

Is it hyperreactivity or hyporeactivity: Becoming a sensory detective

It can be difficult to know if the behaviours you are seeing are due to the person on the spectrum being overwhelmed or not reacting enough to the sensory input. Some behaviours look similar (for example, chewing of clothing or non-edibles), can be a coping strategy for being over- or under-stimulated by a person's surroundings.

This is where "becoming a sensory detective" can be helpful. Try to identify the time of day and observe the context immediately before and after the behaviour occurs. Does the behaviour usually start at the beginning of the day or towards the end? Did the autistic person become distressed after being in a loud, crowded place? Do they seem calmer after they engage in a sensory-seeking activity? If so, they were probably overwhelmed and frustrated by the sensory information and engaged in this behaviour to calm themselves down.

Alternatively, was the autistic person very calm before the behaviour and they seemed more alert afterwards? They were probably engaging in the behaviour to "feel something" and bring their attention and arousal up. By observing and taking careful notes, patterns can be unveiled which can give us information as to when it is best to intervene.

The neuroscience behind sensory differences in autism

While researchers have been studying differences in sensory processing for years, it was not until recent scientific advances in neuroimaging that we were able explore the structural differences in the brain. Many of these studies have found evidence that there is great variety in neuroanatomical differences between autistic persons. Despite this lack of consistency, some trends in neuroscience have begun to emerge:

Extra connections in sensory areas: The sensory areas of persons on the spectrum may contain more synapses, or connections, between neurons. If these extra connections are sending messages all at once, then it may lead to the brain being overwhelmed with sensory input. This is thought to contribute to the 'static' that some Autistic persons describe when asked about their sensory experiences.

Differences in connections between brain regions that are further away from each other: If the brain is spending energy maintaining extra connections, then there are fewer resources available to strengthen neural pathways connecting regions further away from each other. For instance, visual information is processed at the back of the brain. Motor planning, however, is located at the top of the brain. A weaker long-distance connection between these two regions may explain the 'clumsiness' that some persons on the spectrum experience. However, long-distance connections can also be stronger in some autistic persons. For instance, recent studies have found that some individuals have stronger connections between sensory areas and the thalamus, a structure that is responsible for relaying sensory signals to the rest of the brain.

Differences in amygdala activity: The amygdala is associated with fear and anger responses. Differences in the strength of the connection between sensory areas and the amygdala may contribute to extreme responses to certain sensory input. Please see the 'Self-regulation' toolkit for more information about the amygdala's role in meltdowns.

Difficulty switching between brain processes: It can take longer for persons on the spectrum to switch from processing one sensory input to another or to process two or more senses at once. Being asked to rapidly switch attention (e.g. watching many moving objects at once) may contribute to being overwhelmed by sensory information.

Determining the autistic person's individual needs

At the end of this toolkit is a table titled 'The 8 Sensory Systems' that is a summary of the most important information for each sensory system. This document is separated from the rest of the toolkit to serve as a quick reference guide when trying to determine the sensory input that is causing a particular reaction. It includes a non-standardized checklist with examples of both hyper- and hyporeactivity responses in each sensory area. This checklist can be helpful for caregivers and clinicians to identify the specific sensory systems that are problematic for the autistic person. It can be used to inform the components of a 'sensory diet' or 'sensory lifestyle'.

A 'sensory diet' or 'sensory lifestyle' is a group of sensory activities that are personalized for the individual with sensory differences and specifically designed to ensure that they are receiving the sensory input their bodies need every day. The purpose of the sensory diet is to enable the development of skills that will support arousal, attention, self-regulation, and balance a person's sensory reactions. The last column of the table contains a list of possible sensory activities. It is important to note that the activities included in a sensory diet are not prescriptive, they are meant to be samples of a wide set of possible options that a parent can choose from with the child's enthusiastic consent. Children will often tell us or show us what they need based on their actions - follow their lead.

April has a hard time with sudden loud noises because the noise is unexpected and she cannot prepare herself for it or know 'this is how long it will last'. When loud noises do come -like an ambulance or fire alarm -she will scream and cover her ears to try and drown out the painful sounds. April may also try to run or tense up as she startles from the sudden loud noise. Even when the noise is gone, she can still be nervous and overly alert.

Examples of extreme auditory reactions

Every person on the spectrum has their own unique preferences for the types of auditory information they find to be pleasant or unpleasant. It can be difficult to determine what noise is triggering their reactions. When becoming a sensory detective to narrow down the options, it is helpful to note the reactions and list details about the context in which the reactions took place (for instance, running away when the school bell rings at recess).

Hyperreactive auditory responses

Hyporeactive auditory responses

Covering ears around unpleasant noises (e.g. sirens) Running away from certain noises or loud settings (e.g. mall) Yelling at or trying to break the source of an unpleasant noise

Putting ear against a noise source (e.g. TV speaker) Creating loud noises (e.g. slamming doors repeatedly) Humming or yelling repeatedly

Notice from the examples above that it is not always clear what is causing the behaviour. For instance, is the person trying to dismantle a clock because they don't like the noise of the alarm (hyperreactive), OR are they trying to dismantle it because they want to create a loud noise and enjoy the sensory input of the plastic cracking (hyporeactive)? Is the person yelling because they are overwhelmed and trying to drown out the other sounds around them (hyperreactive), OR is the person yelling because they are under-stimulated and like hearing their voice at that volume (hyporeactive)? Carefully observing and taking notes about the situation can help when trying to identify patterns of what may be triggering the behaviour.

Issues with predictability: One of the most common complaints from autistic persons is that sometimes a noise can sound far away, and sometimes it can sound like it is right next to them. If a sound (for example, the school bell) is perceived differently each time, then the brain is not able to get used to that noise and it can lead to uncertainty and anxiety.

April helps herself avoid getting overwhelmed by wearing noise-canceling headphones in a crowd. When April gets home she gives herself a few hours to sit quietly on the computer or read by herself in her room to recharge after a long day to avoid meltdowns.

Visual sensory differences

Reactions to visual information are extremely varied in persons on the spectrum. Despite this variety, some patterns for different aspects of visual processing have emerged. Just like with the other sensory systems, many people on the spectrum fluctuate throughout the day between being overwhelmed or not reacting enough to the visual information around them.

While it is not true of everyone, many people on the spectrum experience differences in the way they process all visual information - from bright lights to colours, to objects in motion. There are patterns of both hyper- and hyporeactivity in reactions to many visual tasks (for example, being able to notice changes in colours).

Visual processing plays an important role in social functioning (for example, being able to tell when someone is angry), and a number of differences have been found in the ways that people on the spectrum process faces.

April cups her hands around her eyes when she wants to narrow her field of vision and focus on one thing at a time. By doing this, April helps cut down on some of the information she's taking in.

Gabriella has difficulty with the florescent lights at school because the lights hurt her eyes and are too bright for her to concentrate. She has troubles copying the board notes in class -she finds the lighting makes it hard to focus on the board and her paper.

Examples of extreme visual reactions

Sensory seeking and sensory avoiding behaviours are common in response to visual information, and many times it is clear which sort of behaviour is being displayed just by noticing what the person does or does not pay attention to. Extreme avoidance is usually the result of being overwhelmed by one or more aspects of the visual information around. For instance, crying and running away at the end of movies may indicate that something about the credits moving down the screen is distressing for that person.

Multiple eye-tracking studies have shown that autistic persons tend to spend less time looking at certain things (for example, faces) but can focus intensely on other types of visual information, for instance small details or patterns. Sometimes it is difficult to know if avoidance of looking at something directly is the result of sensory seeking or sensory avoiding behaviour. Are they avoiding looking at something because they find it unpleasant or overwhelming (hyperreactivity), OR are they looking at things out of the corner of their eye because they enjoy the visual sensory input coming from the periphery (hyporeactivity)? Looking at the context can help.

Issues with eye contact: People on the spectrum often spend less time looking at a person's eyes, making it hard for them to know how others are feeling. For some autistic persons, avoiding looking at the eyes prevents them from becoming overwhelmed by the emotional information they convey. For others, it is difficult to interpret the eyes and instead they focus on the mouth to try and figure out how the person feels (e.g. are they smiling or not). Regardless of the root cause, eye avoidance is related to increased anxiety for autistic persons during social interactions.

April's family has printed out and laminated picture cards of beakers which go from empty to full and April points to which beaker she's at -when she points to one that's very full it's time to leave or find a quiet place. This is helpful so she doesn't have to try and use her words when she is overwhelmed.

Gabriella will wear sunglasses in class if the teachers are not able to dim the lights for her or put tissue paper over the fluorescent lights to reduce the amount of light and flickering.

Tactile (touch) sensory differences

The tactile system, or sense of touch, allows us to feel textures, vibrations, temperature, and pain. It uses receptors in the skin and throughout the body to send information about what we have touched. These receptors provide information about the environment and the physical qualities of any object we touch (e.g. smoothness).

Despite being a single "sense", our tactile system is complex and uses four different types of receptors to give us information about what we are touching. It is possible for someone to be outside the 'optimal attention and arousal window' by being hyperreactive in some aspects of touch (e.g. overreacts to a gentle touch) while being hyporeactive in another aspect of touch (e.g. doesn't respond to touching something hot).

It is possible for people on the spectrum to fluctuate between hyper- and hyporeactive responses to different types of touch throughout the day or in specific situations (e.g. always reacts strongly to clothing tags).

Gabriella loves to run her hand along the walls of her home to feel the bumps. She also rubs her face against the rough fabrics to feel it scratch on her skin. Gabriella doesn't like it when people brush up against her or lightly touch her, though. Light touch is painful and makes her feel on edge. This is especially true for clothing tags, which, for Gabriella, feels sharp and itchy.

Examples of extreme tactile reactions

The four major classes of receptors in the skin and body allow for us to interpret different aspects of our environment. Thermoreceptors respond to both heat and cold. Another type of receptor senses light touches, like that of a feather. There are two types of pain receptors, called nociceptors, one that responds to pain like sunburns, while the other responds to pain caused by things like needle pricks. The final class of touch receptors are deeper in the skin and respond to pressure, like being pinched by someone. Any one of these receptors can by hyperreactive or hyporeactive at various points during the day.

Issues with pain: One of the more perplexing aspects of tactile perception issues in people on the spectrum is that they can react to some forms of touch as if they were extremely painful while not reacting to other touch sensations that should be perceived as painful. For some people, the same information (e.g. a gentle touch on the arm) can fluctuate between being very painful sensory input, while, at other times, it can be barely noticed. This inconsistency can lead to anxiety as the person becomes unsure as to how the next touch sensation will feel.

Gabriella uses a small keychain animal with soft fur at school to help her sit quietly and not distract others. By occupying her hands, Gabriella finds she can stay seated longer allowing her to listen to the lesson. She now removes clothing tags before wearing any new clothes.

Olfactory (smell) sensory differences

The olfactory sensory system allows us to smell different odours and also plays a role in our ability to taste. We have multiple receptors in the nose that respond to various scents. Scents that are noxious, like ammonia, bind to certain receptors that respond by causing our nose to sting and eyes to water. Scents we enjoy are usually breathed in deeply, and when smelling food, allows us to better taste what we are about to eat.

Our sense of smell is also strongly tied to memories and emotions. Certain scents can become associated with a pleasant or negative experience, and when a person is exposed to that same smell, they will feel some of the same emotions they felt during that experience. For instance, if someone smells something that reminds them of a time that they felt nauseous, they may feel a wave of nausea every time they are exposed to that smell in the future.

For many people on the spectrum, strong reactions to scents can be on either side of the 'optimal attention and arousal' window, and it is common for individuals to show strong preferences or aversions to specific scents.

Yousef loves to smell things in his surroundings. He will stick his face in shoes left by the door, in the clean laundry basket and will go up to strange animals and put his face in their fur. Yousef loves to explore the world around him through scent and finds smells comforting. Yousef's family doesn't mind it at home but are worried that a strange dog or cat will bite Yousef -or that he might get into chemicals under the sink.

Examples of extreme olfactory reactions

Our sense of smell plays an important role in helping us taste our food. When scents bind to the receptors in our nostrils, a signal is sent to the brain and the smell will be interpreted as pleasurable or not. In the case of foods that we enjoy, the scent can cause our mouths to salivate in anticipation of eating the food. If we smell a food we do not like, for instance one that is rotting, we will often crinkle our nose and move away from the food. It is thought that our sense of smell is so connected with our sense of taste because it allowed our ancestors to determine whether they should reject a food before eating it so they could avoid getting sick.

It can be difficult to tease apart whether a person is avoiding a scent simply because they don't like the scent itself, or if they are avoiding it because they have associated it with an unpleasant memory. In the case of just not liking the scent, it is usually best to learn avoidance strategies (e.g. holding one's breath when walking through the perfume section at a store), or to provide regular access to scents they do enjoy so they can use it to mask the unpleasant scent (e.g. an aroma necklace).

If, however, the person is avoiding a scent because there is a negative memory associated with it, it may be helpful to try and expose them to only the smallest amounts of it while doing something else that they enjoy. This can help create new, positive associations with that scent. For example, if the person avoids the smell of a particular food because they once had a bad experience with it, try to open windows while it is cooking to minimize the scent while engaging in a preferred activity nearby.

Issues with adaptation: When someone walks into an area with a strong scent (e.g. the kitchen when food is cooking), it is common for them to notice the scent right away. As they spend more time in that area, the scent becomes less noticeable. This process is called 'adaptation' and it allows us to stop paying attention to things that are not changing rapidly, like the aroma in a room. Recent studies have shown that some persons on the spectrum do not adapt to scents quickly, meaning that they are just as noticeable as they were when they first walked into the room. This may lead to being overwhelmed and experiencing anxiety when going near areas with strong scents (e.g. kitchen, washroom).

Yousef's family put some of his favorite aftershave on some of his plush toys so that he can carry those when he's out of the house. They are working on teaching Yousef to ask to pet a dog or cat first before approaching it and have put special locks on the cupboards where the cleaning supplies are so that he can't access them.

Gustatory (taste) sensory differences

The gustatory system allows us to taste by using chemical receptors located on the tongue and inside the mouth and throat. These receptors provide information about taste like whether a food is sweet, sour, bitter, salty, savory, or spicy. The gustatory system also provides information about the texture of foods, for instance whether they are soft or crunchy.

Eating challenges are a common complaint for persons on the spectrum. For some people, the taste of certain foods can be so overwhelming that they learn to avoid flavourful foods. For others, they perceive foods as being too bland and consistently choose foods with lots of at least one type of taste (e.g. add salt to foods that are already salty).

For some persons on the spectrum, it is not the taste of the food that they struggle with, but rather its texture. Some textures can be so overwhelming that they can cause the person to feel nauseous.

Ben doesn't like the texture of most foods and doesn't find fruits or vegetables visibly appealing. He cannot stand the slimy feel of mushy foods or the waxy, stringy texture of most vegetables. For Ben these textures are repulsive and not something he wants to put in his mouth.

Examples of extreme gustatory reactions

Some persons on the spectrum are described as "extreme picky" eaters and they struggle to try any new foods. It can be difficult to know what aspects of a particular food a person on the spectrum finds aversive, especially if they are young or not able to communicate their needs. Unfortunately, it can require a lot of trial and error to narrow down what is causing the aversion. Is it the flavour of the particular food? If so, does the food taste better with more/less salt, spices, etc.? Is the person on the spectrum more likely to eat the food if the texture is changed (e.g. mashed potatoes instead of French fries)? In general, starting with bland foods and slowly introducing more variety with some of the same properties as the food they are already eating (same colour, same temperature, same shape) can help expand the autistic person's food repertoire.

Some persons on the spectrum constantly seek gustatory sensory input. These individuals will often put non-food objects in their mouth to explore their texture and taste. This need to put non-food objects in the mouth can be dangerous as objects can be swallowed or be laden with toxic chemicals (e.g. paint). Sometimes giving them regular access to other types of safe objects (like 'chewlery' or chewable jewelry) can help in preventing ingestion of unsafe materials.

Issues with meal time: When someone has an aversion to trying new foods, they can become very anxious before meals which may lead to challenging behaviours before or during meals. Placing additional expectations at meal time, for example, being asked to stay seated for an extended period of time, can lead to further acting out. This, in turn, leads to increased levels of anxiety.

Ben's family makes fruit smoothies for Ben to cut down on the texture of what he's eating. They continue to offer him new foods to try while speaking to a dietitian to make sure Ben is getting what he needs to thrive.

Interoceptive (inside body) sensory differences

Interoception, or knowing what is happening inside the body, is a sensory system that has been recently gaining attention for its connection to common issues in persons on the spectrum. The interoceptive sensory system gives information about whether a person is hungry or full, thirsty, or if they have a stomach ache or full bladder. Interoception issues may also influence sleep-wake cycles.

Many people on the spectrum describe hyporeactive responses in their interoceptive system and have trouble being able to quickly recognize that their body needs something. It can also be difficult for them to know when they are hot or cold. Some people struggle being able to tell if they have a rapid heartbeat or whether they are tense.

Hyperreactive reactions to interoceptive sensory information can also occur. For instance, a person can become hyper-aware of feeling pain or nausea when they are too full, so they respond by avoiding eating.

Not only does Ben have trouble knowing when he is hungry, but he can't always tell when he's in pain. Ben doesn't mind pressing on bruises or picking at scabs. Ben is an active boy and his family is concerned that he might hurt himself while playing and not know to tell them.

Gabriella is a 13-year-0ld girl who loves to wear sweaters because they are heavy and comforting but cannot tell when it's too hot to wear them. Because of this she is at risk of overheating in the summer months.

Examples of extreme interoception reactions

While some people on the spectrum can fluctuate between hyperreactive and hyporeactive reactions to interoceptive sensory information, it is common for individuals to stay consistently on one side of the "optimal attention and arousal" window for certain bodily functions. Unfortunately, constantly being on the hyperreactive or hyporeactive side of interoceptive sensory system can lead to long-term consequences for the person's health. For instance, someone like Ben who is unable to recognize when he is hungry, may end up becoming underweight and malnourished.

Issues with self-regulation: If someone is unable to tell when their heart is racing or that their muscles are tensed up, then they may not be able to recognize that they are building up anxiety levels in a particular situation. This makes it harder to recognize that there is a problem and engage in strategies before a meltdown occurs.

As described in examples listed above, some behaviours are direct opposites and it is easier to tell whether they are the result of hyper- or hyporeactive sensory responses (e.g. whether they are able to notice a full bladder). Other behaviours, though, make it difficult to know which aspect of the interoceptive system is causing the difficulty. For instance, does someone avoid eating because they don't like the feeling of being full (hyperreactivity), OR are they not eating because they don't notice hunger cues (hyporeactivity)? If the autistic person is unable to explain why they engage in certain behaviours, then it can be helpful to watch for changes in behaviour (e.g. when they initiate eating on their own) and keep track of the details surrounding it.

Issues with self-regulation: If someone is unable to tell when their heart is racing or that their muscles are tensed up, then they may not be able to recognize that they are building up anxiety levels in a particular situation. This makes it harder to recognize that there is a problem and engage in strategies before a meltdown occurs.

Ben's family makes sure that meals and snacks are scheduled so he has prompts to eat regularly. They also pack snacks with them so that he has something to eat when they're out. Ben's family keeps an eye on any new bruises to make sure they're healing. Ben has regular doctor's appointments and Ben's family have made sure to tell his family doctor that Ben doesn't always react to pain.

Gabriella's parents make sure that she has a water bottle with her and is drinking a lot during the summer to keep cool and that she stays in during peak hours when it's hottest. Gabriella buys heavier t-shirts and sweaters with detachable sleeves to help her stay cool.

Vestibular (balance) sensory differences

The vestibular system is involved in perceiving movement and balance, with the primary organ of this sensory system being in the inner ear. Tilting our heads provides the brain with information about where the body is in relation to the pull of gravity. This system also uses information from the visual and proprioceptive systems and together they help with coordination, maintaining upright posture, and motor actions like climbing and jumping.

It is common for some people on the spectrum to struggle with not getting enough input from the vestibular system. Difficulties with sitting upright, bumping into objects, or the need to constantly move are all signs that the person may not be receiving enough sensory information from the vestibular system.

It also possible for people on the spectrum to struggle with receiving too much information from their vestibular system. This usually results in avoidance of activities that take their feet off the ground, like jumping or swinging, and avoiding certain types of transit as they can be prone to motion sickness.

Yousef is a 4-year-old boy who loves to jump and spin, especially when he is excited or happy. For Yousef, jumping and spinning is a fun way to express his emotions, which sometimes feel too big for his body to contain. He loves to feel his body in motion and climbs and jumps on the furniture at home or at school.

Examples of extreme vestibular reactions

Young children on the spectrum are often described as being either cautious or fearless with their body movements. Some are hesitant to make big movements and prefer to hold onto handrails or steady themselves against walls when walking. Others move recklessly and may jump from high places without worrying about personal safety. The tendency to move between sensory seeking and avoidance can change during development, with the most extreme behaviours usually occurring early in childhood.

In general, persons seeking vestibular input will move as much as possible and enjoy the sensory experience of quick, large motor actions (like jumping or falling from a far distance). People who try to avoid vestibular input will move more slowly, especially on uneven surfaces (for instance, a hiking trail). Rocking back and forth, for example, can be viewed as a sensory seeking behavior resulting from hyporeactivity to vestibular input. However, autistic persons may also engage in rocking behaviours to calm themselves when overwhelmed by sensory information as the linear repetitive movement can be soothing. It is important to look at the context of the situation when trying to determine whether a person is rocking because they are over- or under stimulated. When the autistic person is unable to communicate why they avoid or seek out vestibular-based experiences, it can be helpful to take note of what is happening before, during, and after the behavior takes place.

Issues with movement: Regardless of whether someone seeks or avoids input from the vestibular system, being at either extreme can impact their ability to move in a smooth and coordinated way. When balance is off due to either too much or not enough feedback from the vestibular system, it makes it hard for the brain to establish consistency, which can lead to increased anxiety levels.

Yousef's family got a small indoor trampoline for Yousef to bounce on to replace his jumping on the furniture. At home and at daycare he sits on a moveable cushion to help him remain seated and still give him room to move. Yousef is now enrolled in a toddler gym class so that he has a chance to be active with other children.

Proprioception (body awareness) sensory differences

The proprioception sensory system takes in information from the muscles, joints, and skin during movement in order to provide information about where each body part is in relation to the rest of the body. It is often described as the ability to "know where your body is in space."

A functioning proprioceptive system will allow someone to put on a backpack or get dressed without looking at their body parts as they move. Proprioception also enables people to control how loosely or tightly they hold an item. For instance, knowing how much pressure to use when writing with a pencil or how hard to throw a ball.

Not only does proprioception allow us to know where our body is while moving, but it also gives us information about the world around us. This system provides the feedback we need to know if we are walking on something hard like pavement or something soft like grass, even if we have our shoes on. The proprioceptive system also relies on vestibular input to help maintain balance when moving.

Ben prefers tight hugs and strong touch. It makes Ben feel grounded and helps him know where his body is in space. Ben is often running into objects and has trouble putting his coat on.

Examples of extreme proprioceptive reactions

It is not common for individuals on the spectrum to be overwhelmed by proprioceptive information. This makes sense as it is difficult to be too in-touch with where your body is and what is happening around it. In fact, activities like mindfulness meditation or yoga seek to better connect you to your body in the moment for this very reason. Being 'body aware' is generally considered a good thing for our brains and can help us relax.

Most reactions to proprioceptive information in people on the spectrum are due to the person wanting more sensory input, not less. Sensory seeking behaviours are common and sometimes include a reliance on other sensory systems to help. For instance, people who have trouble knowing where their bodies are and how to move a body part will often look to try and give themselves more information. Otherwise, extreme actions, like stomping ones' feet, help to provide additional feedback for the body to know where it is in relation to the environment around it .

Issues with pressure: Many people on the spectrum prefer different forms of pressure, whether from heavier clothing or from physical activities that increase muscle effort. These individuals are not getting the sensory input that they need, and so engage in behaviours to help them move to the 'optimal attention and arousal' window. When they do not have the ability to engage in these activities, it can cause them to feel disconnected from their bodies, which can lead to an increase in anxiety.

Ben asks a trusted family member to give him a big hug to help him feel anchored. Ben's family organizes their home so that Ben has lots of room to move in and put a mirror up in the front hall for Ben to guide himself as he puts his coat on.

Multisensory differences

People on the spectrum experience differences in the way they process sensory information and also in the way that sensory information gets combined in the brain. The term 'multisensory integration' refers to two or more senses that are perceived as a single event. For instance, when a person is talking, we combine the visual information of their lips moving with the sound of their words. In certain situations, like in a crowded coffee shop, it can be helpful to focus our attention more on the lips of the person who is talking so we can better put that information together.

But what if this information isn't combined correctly? If you have watched TV when the sound is not in sync with the video, you will likely notice and become irritated by it. This asynchrony can make it difficult to concentrate on the video and many people will change the channel or try to reload the video instead.

Research has shown that some persons on the spectrum don't always integrate information from their visual and auditory sensory systems. For some individuals, the words they hear and what they see don't match up. It can be more confusing for them to try and look at a person and listen to what they are saying. This difficulty may contribute to the tendency to look away from another person's face because the two sources of information can be more confusing than helpful.

Examples of multisensory integration issues

It can be difficult to know whether certain behaviours are the result of issues with one sense or in the way the senses combine and work together. For instance, is a person frequently nauseous because they are reacting to strong odors (olfactory system) or because they have balance issues (vestibular system)? OR do they only feel nauseous if there are strong odors and they are in the car (multisensory)? If someone is struggling being in a big crowd, is it because they are overwhelmed by seeing all the people moving at once (visual system), hearing all the noises at once (auditory system), or because people are bumping into them as they walk past (tactile)? OR will they only respond that way if all three sensory inputs are taking place at the same time? To help tease apart the source of the reaction, it is helpful to see how the person responds when only one of the senses is being tested. For instance, will the person still have a strong reaction if they are standing to the side of a crowded area while wearing noise-canceling headphones? If not, then it probably isn't the visual information that is causing their reaction. This can take time and require careful observations, but it is possible to narrow down the causes of the reaction.

Anxiety Issues and Sensory Differences

Each of the sensory systems discussed in this toolbox has a blue box that describes how challenges with sensory processing can be associated with anxiety. For many people on the spectrum who have issues with processing input from more than one sensory system, situations where multiple sensory inputs need to be processed at the same time can lead to increased levels of anxiety. For instance, if someone is overwhelmed by visual information and reacts strongly to scents, being in a food court in a mall may be more anxiety-inducing than processing either sensory input individually.

As previously described under the interoceptive sensory system, people who struggle to recognize the signals coming from inside their body (like increased heart rate, tensing of muscles, or stomach aches, etc.) may not notice when they are becoming more anxious. This can make it difficult to leave the situation in time before the anxiety reaches a critical level and a sensory meltdown ensues.

It is possible to improve sensory awareness in the interoceptive system and develop skills to mediate anxiety symptoms before they become overwhelming. For more information, please see our 'Self-regulation' toolkit.

Lead Photo by Elia Pellegrini on Unsplash

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This toolkit is designed to provide autistic persons and their families with an introduction to the 8 sensory systems, questions to help determine the individual's most impacted sensory systems, and to give an overview of strategies to try at home. Additional resources, including an overview of professional treatment options, are provided along with recommended reading and websites.

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The Sensory Processing Differences Toolkit is a free, downloadable collection of resources designed to help teens and adults better understand and manage Sensory Processing Disorder (SPD). It includes checklists to identify sensory needs, a self-advocacy guide, daily regulation activities, and tips on developing personalized "sensory diets." Additional resources include a sensory-friendly clothing list and tools for managing sensory challenges in school, work, and daily life. All materials are available for free download under a Creative Commons license and are ideal for individuals, caregivers, and educators seeking supportive, non-clinical strategies.

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How does regulation develop?

The ability to regulate starts to develop when we are a baby. Long before we can self-regulate we need help from our caregivers. When babies start to show distress, their caregivers swaddle, carry, rock and feed them. Caregivers should provide what is required to help the baby to organise their arousal. As these needs are met the infant learns patterns and rhythms. They learn that when they hear mum or dad's footsteps, help is on the way.

Regulation develops over time and with experience. Each time a child experiences dysregulation and is able to regulate they learn what helps them. However, this process starts with co-regulation.

Co-regulation

Co-regulation is when someone else helps another individual to regulate. We usually think of adults helping children. However, adults help adults all the time. Think about when a friend or family member was upset and you gave them a hug. Or, a time when they were angry and you listened. One unique feature of mammals is that we frequently co-regulate. You will see a mother cat regulate its kitten through licking but you would never observe a snake or crocodile doing this with their off spring.

Toddlers need huge amounts of support from their caregivers to regulate and self-soothe. Whilst they are starting to be more a bit independent, the regulation centres of their brain are still developing. Sarah Ockwell Smith suggests that it isn't until after a child's fifth birthday that their brain is developmentally mature enough for them to start to self-soothe or self-regulate. Parents of teenagers would also argue that hormones severely disrupt this skill.

Regulation with the help of caregivers is what teaches children to self-regulate as they get older. They learn what they experience. Co-regulation helps them to develop the brain networks and strategies they need to self-regulate.

Self-regulation

Self-regulation is the ability to stay regulated without the help of others. It is the ability to use your own strategies to either calm down or energise. Some individuals need more help to learn how to self-regulate than others. Often individuals with ADHD and ASD need more support to learn to self-regulate. Sensory regulation strategies can help with self-regulation. As can cognitive strategies. We will explore these further below.

Emotional regulation

Emotional regulation refers to the ability to regulate our emotions. Toddlers and teenagers find this difficult. For toddlers this is because they haven't yet established the language and brain connections to enable them to regulate their emotions. Teenagers find this more difficult as their hormones and brain connections and changing. They need time to get used to these changes.

Neurologically the front part of our cortex (our frontal lobe) is responsible for emotional regulation. The connections to this part of the brain continue to develop into adulthood. The ability to regulate emotions improves as these connections strengthen. Again, some individuals, including those with autism, need more support to develop these connections.

What about sensory regulation strategies?

Sensory regulation strategies are strategies which use the senses to help with regulation. These are often used to support individuals with autism and those who experience sensory processing differences. But in reality, they can be helpful for everyone.

The goal when using sensory regulation strategies is to help the individual to regulate. They are often using the sensory strategy alongside them, so to support co-regulation, initially. The longer term goal would be that they could self-regulate using the strategy. Programmes like the Zones of Regulation can be helpful to teach emotional regulation and how to use sensory regulation strategies.

Sometimes the individual may need to increase their arousal level. This would mean using a sensory regulation strategy that would make them more alert.

Alternatively, sometimes they may need to decrease their arousal level. So, they will need a sensory regulation strategy to helm them to calm down.

What are some examples of sensory regulation strategies?

I will break this section into two parts. Firstly, I will give strategies that can help to increase arousal. Secondly, I will look at ideas to help to calm down. If you want to read more about sensory strategies you could also read this article.

Sensory regulation strategies to help to increase arousal (or alert)

Our sensory diet/brain break movement video playlist is a great place to start!

Movement! Go Noodle have some great songs to follow along with if you're stuck inside. Playgrounds, cycling, scooters and running are good options for being outside.

You can also create fun indoor obstacle courses. This video gives a great example.

Sensory regulation strategies to help to decrease arousal (or calm)

We have some great slow movement and breathing activities here in this playlist

Heavy work is a helpful strategy for calming. We explore this further our blog The Mystery of Heavy Work.

Yoga can be a great option. Cosmic Yoga has some great videos to follow. Each video includes a story which can help children to stay engaged.

Breathing exercises can really help to calm and organise the brains. The Smiling Minds app is free and also has good content for children. The charity scope has also published a product called Mindful Monsters, which includes breathing and relaxation activities designed for children. This monkey video gives a nice breathing sequence for children to follow. Koala goes through 2 minutes of breathing here.

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Sensory regulation strategies - how you can use them to help your child.

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The ability to regulate starts to develop when we are a baby. Long before we can self-regulate we need help from our caregivers. When babies start to show distress, their caregivers swaddle, carry, rock and feed them. Caregivers should provide what is required to help the baby to organise their arousal.

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The Creating a Sensory Diet guide from the Spiral Foundation offers simple steps to help young children feel calm, focused, and balanced throughout the day. It allows caregivers and educators to identify each child's sensory needs and create a plan using "sensory snacks" (quick calming tools) and "sensory meals" (longer, organizing activities, such as swinging or jumping). The plan also includes quiet spaces, helpful classroom changes, and fun leisure activities. This resource supports early childhood emotional regulation and daily routines in home, daycare, and preschool settings.

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This resource helps caregivers and educators identify which daily activities help calm or energize a young child's body and brain. Using a sensory checklist, adults can observe how children respond to various stimuli, such as crunchy snacks, movement, music, or quiet spaces. By noting what soothes or overwhelms a child, this guide supports the creation of personalized sensory routines such as jumping, hugging a pillow, or swinging that help improve focus, mood, and regulation throughout the day.

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This sensory diet worksheet helps caregivers and educators create daily routines that support children's regulation through planned sensory "meals" and "snacks," calming spaces, and helpful environmental supports. Activities like jumping, hugging, or chewing help the body feel "just right" throughout the day. This tool also encourages creating safe "hideout" spaces and adapting the environment, such as using soft lighting or a wobble seat, to reduce sensory overload and increase focus. A personalized sensory diet can help young children feel safe, calm, and ready to learn.

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Supplement - Sensory Motor Preference Checklist

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Supplement - Sensory Motor Preference Checklist

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This self-reflection tool helps adults identify how they unconsciously use sensory strategies, such as chewing gum, fidgeting, stretching, or listening to music, to regulate their alertness throughout the day. By understanding our preferences for oral, movement (vestibular), tactile, visual, and auditory input, we can better empathize with children who rely on sensory behaviors to self-regulate. This tool is especially helpful for educators, therapists, and parents seeking to create supportive, sensory-aware environments for children experiencing trauma or sensory processing differences.

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Supplement - Ways to Provide Deep Pressure and Proprioceptive Input

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Supplement - Ways to Provide Deep Pressure and Proprioceptive Input

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This list outlines practical sensory-based activities that support regulation in children with sensory processing needs, including those impacted by trauma. Strategies are categorized into passive input (like lying under heavy blankets or using weighted items), pushing and pulling activities (such as carrying heavy objects or Tug of War), oral motor input (like chewing gum or using a resistive straw), and movement activities (such as jumping or falling into crash pads). These tools help calm, organize, or energize a dysregulated nervous system and are commonly used in occupational therapy, trauma-informed classrooms, and sensory diets.

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How To Support Your Children With Their Sensory Challenges

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How To Support Your Children With Their Sensory Challenges

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How To Support Your Children With Their Sensory Challenges

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This article from Henry Ford Health explores how to support children with sensory challenges, especially those with autism or ADHD. Sensory processing issues occur when children have difficulty interpreting sensory input, resulting in behaviors such as covering their ears, refusing to wear clothes, or seeking excessive touch. The article explains the distinction between sensory-seeking and sensory-avoidant behaviors, emphasizing that many children exhibit a combination of both. It encourages parents to seek professional help if sensory issues interfere with daily life and suggests a gradual, structured approach to help children tolerate and adapt to sensory input, rather than avoiding it entirely.

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How To Support Your Children With Their Sensory Challenges

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Got a kid who struggles to make sense of sensory input? Learn how to help him overcome sensory struggles.

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Vestibular dysfunction affects the brain and inner ear systems that help control balance and motion. Often caused by head injuries, illness, or neurological conditions, it can significantly impact daily life if left untreated. With an estimated 69 million Americans experiencing vestibular issues, accessible support is crucial. This at-home exercise kit offers a practical and affordable solution for individuals recovering from vestibular dysfunction, concussions, or similar conditions, helping to restore balance and coordination through simple, standardized exercises.

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As a practicing vestibular therapist I looked for toolkits to improve my vestibular care but couldn’t find any tools, let alone a comprehensive kit. There was a lack of tools for vestibular home programs and I needed to do something about it.I began creating at-home tools for my clients who wanted to progress their vestibular recovery, educate themselves, and have consistency. That’s when VIZSTIM was born. I continue to create tools and resources that make vestibular issues easier to treat with at-home exercise programs.Having the right tools on hand improves time management of vestibular rehabilitation and allows for well carried out therapy sessions.

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Assessing Complex Trauma in Young Children

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Assessing Complex Trauma in Young Children

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Complex trauma in infants and young children involves repeated exposure to harm, often in relationships, and can severely impact emotional, behavioral, and physical development. Early, accurate assessment is critical and should examine trauma history, developmental delays, caregiver relationships, and trauma-related symptoms. Best practices include using behavioral observations, interviews, and standardized tools while gathering input from caregivers, teachers, and professionals. A multi-disciplinary, trauma-informed approach ensures children get support tailored to their early experiences and developmental needs.

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Balance Program and Home-Based Program for Emerging Problem Behavior (K. Ruppel & G. Hanley, 2021)

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A Home-Based Program Addressing Emerging Problem Behavior.   (From C. Stokes MS, BCBA, LBT)      

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A Home-Based Program Addressing Emerging Problem Behavior.   (From C. Stokes MS, BCBA, LBT)      

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Two companion resources that teach parents and caregivers how to prevent challenging behaviors by building trust, communication, and cooperation skills. Designed for children aged 3–6, the programs employ a gentle, step-by-step approach to balance child-led play with adult-led tasks.

Goals:

Strengthen parent–child relationships

Teach functional communication

Help children accept disappointment

Build cooperation and persistence

10-Step Process:

1. Promote Play

2. Respond to Name
3–4. Use Words (Part 1 & 2)

3. Accept Disappointment
6–8. Cooperate with Tasks (short to varied)

4. Cooperate Without Bins

5. Cooperate in Daily Routines

Why It Works:

Trauma-informed, positive reinforcement approach

Reduces triggers for problem behavior

Builds skills that generalize to home, school, and community

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A Home-Based Program Addressing Emerging Problem Behavior

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Happy Relaxed Engaged (From C. Stokes MS, BCBA, LBT)      

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Happy Relaxed Engaged (From C. Stokes MS, BCBA, LBT)      

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This Padlet is designed to help you balance nurturing engagement with structured learning while keeping the child's emotional state and autonomy front and center. Will break this down into several resources, making it more user-friendly

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Guidelines on Trauma Competencies for Education and Training [PDF]

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Guidelines on Trauma Competencies for Education and Training [PDF]

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This policy describes competencies that serve as aspirational goals for psychologists. It is meant to guide training programs' curriculum development and psychologists' self-monitoring.

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AMERICAN PSYCHOLOGICAL ASSOCIATION GUIDELINES ON TRAUMA COMPETENCIES FOR EDUCATION AND TRAINING I

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Parent Coaching Guide (K. Ruppel & G. Hanley, 2021) (From C. Stokes, MS, BCBA, LBT)      

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Parent Coaching Guide (K. Ruppel & G. Hanley, 2021) (From C. Stokes, MS, BCBA, LBT)      

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A structured ten-step teaching process for building cooperation, communication, tolerance, and shared control between parent and child. Includes clear goals, practice logs, and strategies for addressing problem behavior through positive reinforcement. Especially useful for trauma-informed parenting and skill-building in children with developmental or behavioral challenges.

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Individualized Features of Reinforcement Meeting (InFORM) Notes  (From C. Stokes, MS, BCBA, LBT)      

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Individualized Features of Reinforcement Meeting (InFORM) Notes  (From C. Stokes, MS, BCBA, LBT)      

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Individualized Features of Reinforcement Meeting (InFORM) Notes

A structured meeting tool used to identify what motivates a specific child and how to use those motivators to encourage positive behavior and learning. InFORM focuses on tailoring reinforcement strategies to the child's preferences, needs, and developmental level, making them more effective and meaningful.

Purpose:

Pinpoint individualized reinforcers that truly motivate the child

Ensure reinforcement is used in a consistent, predictable way

Support skill-building and reduce problem behaviors

Key Features:

Collaborative process involving parents, caregivers, and professionals

Documents preferred items, activities, social praise, and other motivators

Links reinforcement strategies directly to learning and therapy goals

Why It's Helpful:
Personalized reinforcement increases engagement, supports emotional safety, and aligns with trauma-informed care by respecting the child's unique needs and preferences.

COULDN'T GET TO UPLOAD AS PDF SO I COPIED AND PASTED

Individualized Features of Reinforcement Meeting (InFORM) Notes

Date of Interview: ________________________

Respondent: _____________________________

Relationship to child/client: _________________

1. Date of birth and current age: ______-______-______ Child/Client:______________________ Interviewer: ______________________ _____yrs _____mos Male/Female Diagnoses: _________________________________________________________

2. Who is the primary caregiver? ________________________________________

3. Describe general language abilities. How does he/she request to get/do things or not do things?

4. What are the things your child likes least to do, but may be vital for him/her to do?

5. What are the things that you have the most trouble having your child do (or doing with your child) because whatever you try to have your child do them (or do them with your child), he/she is highly uncooperative? (e.g., cleaning up, getting dressed, academics, hygiene tasks, medical check-ups, chores, non-electronic interactive games)

6. Besides being uncooperative with these things, what other problematic behaviors does your child engage in when you try to accomplish these things? From this information, note the activities and materials for the task bin here:

7. How do you and others respond to uncooperative or problematic behavior? What do you do to calm him/her down? Is there anything that once denied inevitably leads to problematic behavior?

8. If he/she could only do one thing for the next hour, what do you think it would be?

9. Describe his/her play skills. What are his/her favorite toys, activities, and interactions? (e.g., particular objects, toy themes, electronics, books, photo albums, specific furniture, music, videos, massagers, social interactions or availability, snacks, to run, roam/meander, particular conversation topics, access to rituals or stereotype)

10. Does he/she prefer to (a) play alone, (b) have someone watch but not interact too much, or (c) play with others? What does the play look like when she is playing with others? From this information, note the materials for the fun bin here, along with preferred interactions:

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Individualized Features of Reinforcement Meeting (InFORM) Notes

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Coursework – Childhood Trauma Resource Collection
Summary: This collection compiles key resources, articles, and tools researched and compiled as part of a previous coursework project on childhood trauma. It covers core topics such as the definition and impact of trauma, signs and symptoms in children, trauma-informed care principles, and effective interventions for both home and classroom environments. The materials also include reference guides, videos, and professional toolkits to support educators, caregivers, and community workers in responding to the unique needs of children affected by trauma.
Who Benefits: Early childhood educators, school counselors, social workers, mental health professionals, parents, and caregivers seeking practical, research-based strategies to support children impacted by trauma.

Attached Materials:

Full PDF of the Childhood Trauma Padlet project

Links to selected videos, articles, and organizational toolkits featured in the original work