Developmental trauma as acquired neurodivergence: A discussion on identity & belonging

April is Neurodiversity Celebration Month and Child Abuse Prevention Month, making it the perfect time to explore the intersection between developmental trauma and neurodivergence. 

Definitions 

Neurodivergent is used to describe an individual whose brain structure or function differs from the majority. The term is most commonly used in reference to neurodevelopmental differences, such as autism and attention deficit hyperactivity disorder (ADHD). Most neurodiversity advocates also recognize acquired forms of neurodivergence, such as schizophrenia and traumatic brain injuries (Dundon, 2023). Approximately one-fifth of the global population has a form of innate or acquired neurodivergence (Goldberg, 2023). 

Developmental trauma (DT) describes the impact of repeated exposure to adverse experiences (e.g., abuse, neglect, or discrimination) during sensitive periods of child development (Cruz et al., 2022). DT causes neurological changes that affect cognition, regulation, attachment, and behavior (Cruz et al., 2022). DT is considered a public health crisis in the U.S., with an estimated one in eight children experiencing abuse or neglect by the age of 18 (Kavanaugh et al., 2017). 

DT as Neurodivergence 

DT causes neurological changes that alter the way an individual perceives, processes, and responds to their environment (Kavanaugh et al., 2017). Although the concept of acquired neurodivergence is somewhat controversial, some experts posit that these neurological differences qualify DT as a form of neurodivergence (Dundon, 2023). However, neurodivergence is a sociocultural classification and a personal identity, not a medical diagnosis. Thus, the decision of whether to identify as neurodivergent should be left to the individual, not researchers or health care providers.  

Implications for Individuals With DT 

Recognizing DT as a form of neurodivergence may help those impacted better understand how it affects their life, give them language to adequately describe their experiences, and empower them to identify and advocate for their needs. Identifying as neurodivergent may create opportunities for people with DT to gain a sense of community and belonging by connecting with other neurodivergent individuals who understand the challenges and strengths associated with having a mind that works differently.  

However, some people with DT may reject the neurodivergent classification, citing that it feels incongruent with their lived experience. Additionally, the neurodivergent label could further perpetuate bias and stigma among racial minorities and other marginalized groups, who would then be impacted by overlapping systems of oppression (Dundon, 2023). Both perspectives are valid and important to consider. 

Implications for Clinicians 

Occupational therapy practitioners (OTPs) play a pivotal role in helping clients understand how trauma impacts their daily lives. Acknowledging the lingering effects of trauma can facilitate a shift from shame and frustration to empowerment and agency. Viewing DT through the lens of neurodiversity reframes the associated neurological changes as an acceptable human variance, destigmatizes the client’s response to trauma, and eliminates the notion that they are defective in some way. The OTP can then collaborate with the client to address their concerns in a trauma-informed, neurodiversity-affirming way.  

Ultimately, it is up to the client to decide how to view and discuss their experiences and identities. The role of the OTP is not to adopt a stance on whether DT is a form of neurodivergence, but to affirm whatever identities their clients hold. Doing so is essential to creating a safe and inclusive space for all clients — especially those who have experienced trauma.  

References 

Cruz, D., Lichten, M., Berg, K., & George, P. (2022). Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Frontiers in Psychiatry, 13, 1–14. https://doi.org/10.3389/fpsyt.2022.800687 

Dundon, R. (2023). A therapist’s guide to neurodiversity affirming practice with children and young people. Jessica Kingsley Publishers. 

Goldberg, H. (2023). Unraveling neurodiversity: Insights from neuroscientific perspectives. Encyclopedia, 3, 972–980. https://doi.org/10.3390/encyclopedia3030070 

Kavanaugh, B. C., Dupont-Frechette, J. A., Jerskey, B. A., & Holler, K. A. (2017). Neurocognitive deficits in children and adolescents following maltreatment: Neurodevelopmental consequences and neuropsychological implications of traumatic stress. Applied Neuropsychology: Child, 6(1), 64–78. https://doi.org/10.1080/21622965.2015.1079712 

Perry, B. D., & Winfrey, O. (2021). What happened to you? Conversations on trauma, resilience, and healing. Flatiron. 

Madison Dewey, OTD, OTR/L, is a Pediatric Occupational Therapist and a recent graduate of Washington University School of Medicine's Occupational Therapy Program. She conducted her doctoral capstone project at FamilyForward in St. Louis, MO, where she explored the intersection between developmental trauma and neurodivergence in pediatric populations.  

Ashley Wagner, OTD, OTR/L, is the Director of Occupational Therapy at FamilyForward's Developmental Trauma Center in St. Louis, MO, and serves as a member of the AOTA Ethics Commission. 

Catherine R. Hoyt, PhD, OTD, OTR/L, FAOTA, is an Assistant Professor of Occupational Therapy, Pediatrics, and Neurology at Washington University School of Medicine, a former member of the AOTA DEI Committee (2021–2024), and an Early Intervention Specialist.