By Kristie Lindblom, MA
In the summer of 2021, I arrived at a group home in southwestern Pennsylvania to meet with a new client. After signing in at the front desk, 17-year-old David* was escorted through heavy doors by a staff member. I knew going in that David had a tough life. He had been brought into foster care four years earlier after suffering physical abuse from his father. His mother had left him when he was just a baby, and his grandparents struggled to offer the resources and support he needed. Those four years were spent in and out of foster homes, group homes, and psychiatric hospitals. Before even coming into care, David had been given an autism diagnosis, but his father “didn’t believe in mental health” and refused to provide David with therapy or education around his diagnosis. When David experienced meltdowns related to overwhelm, his family attempted to “discipline” the autism out of him, often giving bruises and black eyes in the process. David’s paperwork described him as violent. He’d been known to make threats to staff and cause damage to property. Restraint was a strategy employed for him often.
The David who walked through those doors appeared nothing like he was described. He had a lanky frame, and a hesitant, friendly smile. He willingly sat with me and listened intently as I described my role. He had been referred to me so that I could work with him over the coming months to prepare him for a permanent, stable home. To do this we would work together to give David a voice, honor his past, understand who his attachments and connections were, answer his questions, and look to a future in which all of that could be integrated. David was on board and our two-year journey together began.
As I worked with him, it was not lost on me that David was almost the same age as my own son, who is openly autistic. As I read more about David’s history, I noted that with each year of David’s life, I thought about what my child was doing at that same time. When David’s mom left him, my son was going to Mommy and Me playgroups. When David would escape into the woods alone when his father would rage, my own son would explore the forests near our home during weekly, child led nature walks we organized with other families. When David’s abuse internalized profound shame about who he was, my son was given a sensory corner to recover from meltdowns. When David was getting bullied by the kids on his street and lashing out against them with violence because no one would protect him, my child was attending a private Jewish Day School that valued his presence and included him in the community. When David was finally beaten hard enough that authorities separated him from his father, my own child spent his first week away from us at a STEM conference for the National Youth Leadership Forum. It was maddening that where one child was being repeatedly traumatized, in part because of who he was, another was able to receive appropriate safety and care due to mere circumstance.
After two years of working with David, my rage about his treatment peaked when I sat through a court hearing listening to a judge admonish him for what was, to my trained eye, a clear incidence of his sensory needs not being met leading to him shutting down, unable to speak or move. His foster family did not pick up on this as a shut down and read it as defiance. They became exasperated and escalated the situation, leading David to violently lash out. He was kicked out of the foster home and, with nowhere else to put him, the county placed him in a group home for independent living.
I sat next to David in a hearing before a family court judge a few weeks later. David was ashamed and spoke respectfully to the judge. Rather than finding David support, the judge admonished him in open court, threatening him that now that he was an adult, the next time it happened police could be called, and he could go to jail. In real time, it hit me that every system that was meant to protect him had failed him. The next day I wrote a letter to the judge on David’s behalf and implored him to view David’s behavior through the lenses of neurodivergence and trauma.
Sadly, David’s experience is not singular. Autistic children are 2.4 times more likely to be in foster care than their neurotypical (NT) peers. (1) What’s more, in large epidemiologic studies in the USA, the overall prevalence of ADHD in children in foster care was found to be around 17%, a considerably higher rate than the general population, estimated at around 3.4%.(2) It is true that lack of education around neurodivergence makes parenting neurodivergent (ND) kids stressful for families and difficult to manage effectively. ND kids need to be parented differently than their NT peers. Many parents of these children will tell you: traditional parenting methods based in compliance simply don’t work. Unfortunately, some parents may simply not have the skills and resources to parent ND youth, which may result in neglect or abuse. Alternatively, families may voluntarily place ND children in foster care because they can’t handle the children’s behavioral problems. Due to a failing insurance system in America, parents may relinquish custody so that their children can obtain Medicaid-funded or residential care that they otherwise cannot afford. Thus, children like David become disparities within the system.
What’s worse, once in the system, like David, these youth continue to be failed by policies that are supposed to be helping. Current medical best practices are always observed and thought to be ideal, despite past experiences demonstrating these kids’ needs are different. We often see compliance misinterpreted as healing, and poor behavior is misunderstood. Beyond that, the goals of State placement are “Stability” and “Permanency” before all others, which can sometimes lead to the unintended consequences of foster children who are emotionally under-nourished and over-medicated. Due to the nature of the system, youth often receive inconsistent care and therapies. Working adjacent to the system while parenting my own neurodivergent child marked this stark contrast.
The umbrella of neurodivergence is often complex, and it should be acknowledged that trauma is considered an acquired neurodivergence. At the same time, those with neurodivergent brains will often experience identity related trauma resulting from navigating a society not built for them. This is compounded for kids like David, who also have otherwise adverse childhood experiences that result in trauma related changes in their brain. This is why, though April is Autism Awareness month, we practice neuro-affirming care year-round.
All people deserve neuro-affirming care. At The Children’s Home of Pittsburgh’s Counseling and Family Support Services, we believe in a strengths-based and rights-based approach to developmental differences. We aim to provide support and adaptations that affirm the neurodivergent identities of our clients. We provide training to staff and families that centers the voices of neurodivergent people and not just the staff who work with them. In practice, this looks like, valuing all forms of communication, reducing pressure to conform to neurotypical norms such as making eye contact, respecting sensory differences and accommodating needs related to them, offering clear and direct communication, utilizing social stories that meet Carol Gray’s 10.2 criteria, and creating spaces in which there is no need to mask neurodivergent traits.
We also recognize that for neurodivergent youth in our foster care system, their neurodivergence may be compounded by trauma. Our teen support group actively practices neuro-affirming strategies and normalizes social differences for participants to create an environment in which youth are able to be open about the totality of their identities. Our workers work with families to consider sensory related supports in the home, such as helping them to purchase a sensory swing. Lived experience is prioritized as we work to support parents around best practices for their children.
The Children’s Home Counseling and Family Support Services knows that care is not trauma informed without also being neuroaffirming, and we lead in our field with that mission. Our Trauma Lead has presented at statewide conferences to educate workers across the state about how to best support, advocate for, and affirm youth like David. Our “Under the Umbrella” training was developed with input from adult autistic folks and has been provided to parents, colleagues, and other professionals. In fact, it will be back by popular demand at this summer’s statewide SWAN Permanency Conference. As part of our trauma informed mission, we are committed to listening to the lived experiences of neurodivergent adults and will continue to advocate with and for neurodivergent children and youth to amplify their voices and meet their support needs. As we take these steps, our goal is to ensure all of our current and future programming is accessible to all, regardless of neurotype.
*David’s name has been changed to protect his identity.
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Cidav Z. et al. J. Autism Dev. Disord. Epub ahead of print (2017)
- Polanczyk G., Salum G., Sugaya L., Caye A., Rohde L. Annual Research Review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J. Child Psychol. Psychiatry. 2015;56:345–365. doi: 10.1111/jcpp.12381.
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4, Rumball, F. (2019) ‘A Systematic Review of the Assessment and Treatment of Posttraumatic Stress Disorder in Individuals with Autism Spectrum Disorders’, Review journal of autism and developmental disorders, 6(3), pp. 294–324. doi: 10.1007/s40489-018-0133-9.
- Rumball, F., Happé, F. and Grey, N. (2020) ‘Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM‐5 and Non‐DSM‐5 Traumatic Life Events’, Autism research, 13(12), pp. 2122–2132. doi: 10.1002/aur.2306.
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