By Amy Treadwell, MA, LPC, LCPC
When I first met Toby, my impression of him was that his mannerisms were very bird-like. He perched on the arm of my couch and tilted his head in quick, jerky motions. I playfully asked him, “Are you pretending to be a bird?” He didn’t answer.
Eight-year-old Toby was referred for therapy by his parents, Anna and Taylor. Sitting across from Anna, I read unspoken grief and tension on her face. “It’s like we’re sharing our home with a robot.” Anna and Taylor had adopted Toby at age two, knowing that he had a history of severe trauma and neglect. What they didn’t know was how hard it would be to help him form a secure bond with his new family.
Anna and Taylor had already raised two of their own children, who were happy and thriving, and they had adopted a younger child from foster care who was loving and playful. But Toby felt like a stranger to them, even after years of trying earnestly to connect.
“I had a pet chicken once,” I said. “Her name was Buffy.”
Toby glanced at me and then shifted his gaze to take in the room, gazing intently into a nature painting in on the wall. “He loves fish,” Anna commented. “He’ll watch them for hours.” I offered Toby a selection of toys, which he carefully examined rather than playing with them.
Considering an Autism Diagnosis
Toby’s lack of play, fixations, withdrawal and quirky mannerisms seemed congruent with signs of autism, yet his early developmental trauma and adoption history had me deeply curious about how his Adverse Life Experiences (ACES) might be impacting his social, emotional, and sensory development.
Parents often bring their children to therapy looking for answers. Some kids like Toby may have co-occurring diagnoses such as ADHD, PTSD, and autism that have overlapping symptoms. While research is ongoing about the interplay 
between these factors, there is a high level of co-occurrence between autism and complex developmental trauma.
“Autism Spectrum Disorder (ASD) is a neurodevelopmental condition, while trauma refers to psychological and emotional responses to deeply distressing events. But increasingly, research and lived experiences are showing that these two can—and often do—intersect in powerful and important ways.” Long Island Mental Health and Wellness
Having a clear diagnosis can guide parents in how to respond to their children’s needs at home, and it may be required for kids to qualify for extra support at school. However, seeking a clinical diagnosis is a personal choice, and each family must weigh the pros and cons. Some families have valid concerns about their child receiving a label that may shape how others see them. Other families may find that their child is relieved to have a diagnosis that helps them make sense of their lived experiences. Another factor to consider is that many families may spend months on the waitlist to see an assessment provider, and the cost of testing may vary depending on whether the assessment is performed by a physician, psychiatrist, or neuropsychologist.
Attachment Trauma, Complex Trauma and Complex PTSD
I knew that early adversity was part of Toby’s story, and I wanted to help his parents understand how that might be impacting his social and emotional development in ways that might not be obvious on the surface.
Attachment trauma is “a consistent disruption of physical and emotional safety in the family system. It is not what happens to you, but what happens inside you,” says Heather Monroe, a licensed clinical social worker (LCSW) in Nashville, Tennessee, who specializes in treating relational trauma, according to Psych Central. For adopted children and children in foster care, attachment trauma is not a guaranteed outcome, but awareness of the risk for these children can lead to more nuanced approaches to care.
Another term to consider is complex trauma and the more clinically severe diagnosis of Complex PTSD. Complex trauma encompasses not only the relational aspect of trauma, but also the impact of early adversity on brain development that can lead to delays in emotional regulation, inhibitory control, working memory, and mental flexibility, according to Drs. Kinniburgh and Blaustein, co-developers of the Attachment, Self-Regulation, and Competency (ARC) treatment framework.
“Complex trauma describes both children’s exposure to multiple traumatic events—often of an invasive, interpersonal nature—and the wide-ranging, long-term effects of this exposure. These events are severe and pervasive, such as abuse or profound neglect. They usually occur early in life and can disrupt many aspects of the child’s development and the formation of a sense of self. Since these events often occur with a caregiver, they interfere with the child’s ability to form a secure attachment.” The National Child Traumatic Stress Institute.
These impacts on brain development help explain why there are overlapping symptoms between childhood trauma, ADHD, and Autism. It all goes back to brain development, but understanding why these delays are present critically informs the best path for treatment.
Trauma, Identity, and Relationships
In Toby’s case, we decided to proceed with therapy to address the impact of trauma through the lens of neurodiversity-affirming care. By engaging in child-centered play therapy, Toby was able to develop a sense of felt safety within the play room that helped him rewire his brain for self-acceptance. Another important layer for this family was strengthening parent-child relationships through a modality called TBRI.
“Trust‑Based Relational Intervention® (TBRI) is a holistic, attachment‑based, trauma‑informed model designed to support children and youth who have experienced adversity. TBRI equips caregivers and professionals with practical strategies to address behavioral, emotional, and relational challenges by meeting the needs of the whole child.” Karyn Purvis Institutefor Child Development at Texas Christian University.
Often, children with developmental trauma carry negative core beliefs such as “I am unlovable” or “I’m broken inside.” This blocks them from forming secure attachments with others and contributes to social isolation, creating a self-reinforcing pattern in which attempts to connect may fail due to misunderstanding social cues or having fewer experiences that build social skills. Every failure reinforces those negative beliefs.
Healing developmental trauma requires creating repeated experiences in which children can practice ‘serve and return’ interactions with safe adults and receive consistently warm responses. Just like playing catch, each social interaction has a “back and forth” rhythm that helps children build the neural pathways for social connection. In essence, these interactions help children feel, on an embodied level, “I’m ok with you, and you’re ok with me.”
“Serve and return interactions—responsive, back-and-forth exchanges between a young child and a caring adult—play a key role in shaping brain architecture.” Center for the Developing Child, Harvard University.
I also engaged Toby and his mom in play therapy sessions together to strengthen their bond through serve and return interactions. Anna and Toby practiced solving problems together, experiencing safe touch using TheraPlay techniques, and increasing comfort with eye contact.
Parenting with Self-Compassion
When working with children in therapy, it’s important to also hold space for the parents to process their feelings and experiences. For Anna, parenting a child with such different relationship dynamics from her other children felt exhausting, and when her attempts to connect were met with indifference, she felt discouraged and defeated. I normalized this for Anna, and we worked together to create space for more self-compassion.
Anna’s narrative on the hardest days veered toward thoughts like, “What is wrong with my child?” or “What is wrong with me?” Parenting a child with an invisible disability, like childhood trauma or autism, is often isolating due to a lack of awareness in society of the different needs these children have.
Trauma-informed and neurodiversity-affirming care are both strengths based approaches that reframe behaviors as adaptations or attempts to get needs met. Using a lens of curiosity, Anna began to better attune to her child and gain insight into why he acted in unexpected ways. She was then able to anticipate needs, reduce triggers, and more compassionately respond to her child when big feelings or behaviors emerged.
Healing Complex Trauma through Relationships
I knew Toby was making progress in therapy when he began initiating eye contact more often with me, sharing his favorite music with me, and laughing in session. But the real victory was when his mom shared an update about their relationship outside of therapy.
“We were in the store,” Anna said, “and he asked for a toy, and I said yes, he could get it.” Anna paused before sharing the rest: “And then he gave me a hug, for the first time ever.”
Whatever questions parents have, the child’s greatest need is connection. Therapy can help families connect, heal, and find joy together. Adverse Childhood Experiences do not have to define us, nor do they determine a child’s destiny. And building a strong relationship with your child’s therapist can help even the bravest parents feel less alone.
