20Q: Providing Supportive Intervention for Trauma-Exposed Students With Communication Disorders

From the Desk of Ann Kummer

Most parents want their children to have a carefree and happy childhood. As such, they try to shelter their children from frightening or dangerous events. Unfortunately, bad things can still happen, despite the best efforts of parents.

Anyone who keeps up with the daily news knows that the world is a very scary place. The last few years have been particularly traumatic for children. For example, there have been multiple school shootings. In addition, many children are entering the US as immigrants after losing their homes. Finally, the COVID-19 epidemic has caused children to worry about getting the virus. To compound that worry, they have been pulled out of school and separated from family and friends. As a result of these events and others, trauma is now pervasive in students of all ages.

Because this is such a huge problem in the schools, I am thrilled that Dr. Celeste Roseberry-McKibbin agreed to submit this 20Q article to help us support these students, particularly those with both trauma and communication disorders.

By way of introduction, Celeste Roseberry-McKibbin received her PhD from Northwestern University. She is a Professor of Communication Sciences and Disorders at California State University, Sacramento.  Dr. Roseberry is also currently a part-time itinerant speech pathologist in San Juan Unified School District, where she provides direct services to students from preschool through high school.  Dr. Roseberry’s primary research interests are in the areas of assessment and treatment of culturally and linguistically diverse students with communication disorders, as well as service delivery to students from low-income backgrounds.  She has over 70 publications, including 17 books, and has made over 600 presentations at the local, state, national, and international levels.  Dr. Roseberry is a Fellow of ASHA, and winner of ASHA’s Certificate of Recognition for Special Contributions in Multicultural Affairs as well as the Excellence in Diversity Award from CAPCSD. She received ASHA’s Honors of the Association.  She received the national presidential Daily Point of Light Award for her volunteer work in building literacy skills of children in poverty. She lived in the Philippines as the daughter of Baptist missionaries from ages 6 to 17.

This course describes the types of experiences that can cause trauma in a student’s life. The concept of trauma-informed intervention is described. Finally, practical, hands-on suggestions are given for supporting students with communication disorders who have experienced trauma in their backgrounds.

Now…read on, learn, and enjoy!

Ann W. Kummer, PhD, CCC-SLP, FASHA, 2017 ASHA Honors
Contributing Editor 

Browse the complete collection of 20Q with Ann Kummer CEU articles at www.speechpathology.com/20Q

20Q: Providing Supportive Intervention for Trauma-Exposed Students
with Communication Disorders

Learning Outcomes

After this course, readers will be able to: 

• Define childhood trauma and the circumstances that can create it.
• Describe practical strategies for creating a supportive, safe therapy environment that fosters trust.
• List and describe specific activities for improving trauma-exposed students’ social skills, narrative skills, and executive functioning skills (including a growth mindset).

Celeste Roseberry-McKibbin

1. How do you define childhood trauma?

Childhood trauma is a dangerous, frightening, or stressful experience that impacts a child or someone close to them. This can result in emotional and physical reactions that overwhelm the child’s ability to cope; these reactions can persist long after the event.

Trauma can be created by abuse, neglect, or both. According to the U.S. Department of Health and Human Services (2022), in 2018, 678,000 children in the U.S. experienced some form of abuse, neglect, or both. The highest frequency of substantiated reports involved children younger than 12 months of age.

2. How have recent world events created trauma for children?

The COVID-19 pandemic that began in 2020 disproportionately impacted developing countries with fewer resources, causing more families from these countries to become displaced and settle in the U.S. as immigrants or refugees (World Health Organization, 2022). Political turbulence in various countries has created upheaval as well. Today, immigrants account for 13.7% of the U.S. population, nearly triple the share (4.8%) in 1970 (Pew Research Center, 2020). Many children from immigrant families have experienced trauma.

3. What are some other experiences that can induce trauma in students?

Trauma can be induced through neglect, witnessing violence, death of a family member, serious family conflict, and prolonged separation from a caregiver. Living in crime-prone areas and experiencing homelessness can induce trauma. Trauma also occurs when families are highly mobile and children have interrupted school opportunities—this creates chaos in their lives.

4. What are the origins of chaos?

Chaos, one form of trauma, may occur at the microsystem level, or in the child’s family environment. For example, a caregiver may have a “revolving door” of significant others, and thus the child’s family situation may be unstable. “Jordan,” an 8-year-old I worked with, pulled up his shirt during a speech session to show me a scratch on his stomach. It happened when a piece of furniture fell on him during his mother’s fight with her drunk boyfriend. It seemed that in Jordan’s home, there were many different boyfriends who had come and gone.

Chaos may also occur at a macrosystem level. For example, children may experience a war, pandemic, or other outside events that cause trauma.

5. What are some of the communication problems that children may manifest when they have been exposed to trauma?

Trauma exposure can negatively impact problem solving, verbal expression, memory, executive functioning, intellectual functioning, and emotional regulation. It can lead to deficits in narrative cohesion (Ciolino et al., 2021; Rupert & Bartlett, 2022).

Chaos created at a microsystem level, macrosystem level, or both can lead to challenges in reading, vocabulary, phonological awareness, communicating in the classroom discourse, self-regulating learning, and following class routines. Students may show deficits in social pragmatic skills, discourse, and taking other people’s perspectives (Hyter, 2020).

6. Can you specifically talk about the impact of neglect?

Some children experience neglect due to maternal depression; this maternal depression leads to decreased bonding, which has a negative impact on speech and language development (Towson et al., 2020; Treat et al., 2020). Mothers experiencing depression may be unresponsive to their children’s bids for attention. This lack of responsiveness can negatively impact children’s motivation to communicate, and children’s expressive language can be especially impacted (Sultana & Purdy, 2020). They may have restricted verbal expression, lack of affect, and diminished vocabulary skills.

If children’s physical needs are neglected, they may struggle to focus in school. “Trevor,” a child I worked with, always struggled to stay awake in therapy because he was up all hours of the night playing video games on his phone. I’ve worked with many students who were hungry and thus had difficulty focusing.

7. It sounds like my work is really cut out for me. Where do I begin? Can you share some fundamental principles of providing supportive trauma-informed intervention?

Yes. Probably the number one concern is to provide a context in which students feel safe. Students feel safe when we keep our word.

For example, I work part-time as an itinerant SLP in public schools with students ages 3-18. I provide services for male teen sex offenders who are out of Juvenile Hall and in supportive group homes. I was recently talking to a friend in a nearby city who also works with this population. She was sharing how once she told a young man that she’d be there on Wednesday at noon for his speech session. Something came up and she came on Thursday instead. He was very upset and though she explained her reason, he said “but you said Wednesday.” He felt that the SLP had broken her promise.

I’ve found with the juvenile offender population that keeping my word has created trust and a healing bond between me and my clients that has not only helped their speech and language—it has improved their overall behavior. I am careful to never, ever break a promise.

8. In helping students feel safe, is it within professional boundaries to express that you care for them?

Oh yes! I constantly tell the children and teen young men I work with how much I care for and value them. With my teen young men, I buy them lots of gifts—these are gifts that they select on Amazon on my phone during therapy sessions. This has gone a very long way to help them trust me and know that I care for them. My husband and I have taken several of my teen clients on “field trips.” One young man, “Treston,” wants to be a nurse but had never been on a university campus before. With the high school’s permission, my husband and I picked up Treston on a planned day and took him on a tour of the university where I teach full-time. He loved it!

“Ramon” wants to join the Air Force someday. Last weekend, my husband and I picked him up at his group home and took him to our local aerospace museum. He greatly enjoyed the time and was inspired by it.

9. What is another way to help students feel safe?

We can provide them with some control over the context.  For example, with some students, I like to write the day’s therapy activities out on the whiteboard. They can erase each activity as we complete it, thus seeing physically that they are getting closer to the reward at the end of the session.

10. I’m not a psychologist, but I’ve heard that listening can be really helpful.

Agreed! Reflective listening is so hard for us because we want to rush in and fix things. Sometimes students have stories that are very hard to hear.

For example, I was recently walking with “Ramon,” a 15-year-old sex offender working on his /r/ and overall clarity of speech. We were doing carryover activities outside, and out of the blue, as we were strolling along in the sunshine, Ramon said “My uncle just got a life sentence.” I asked Ramon if he would like to talk about it. He said yes. Apparently his 23-year-old uncle “Eric” shot several bystanders in a gang-related drive by shooting when he was 19. I asked Ramon if it was life without parole, and he told me that Eric did have a chance of getting out in 20 years or so. I told Ramon that I could not even begin to imagine how he was feeling, and how sorry I was to hear this. He appreciated it and said that he would never end up like that.

I told Ramon that I was so proud of him for the good choices he was making right now, such as staying in speech, losing weight, working out, not losing his temper, spending time with his grandma, reading his Bible, and attending church. (*note: I am very careful about religion, and do not address it unless my teen clients are interested in it. Several have asked me to buy them Bibles; Ramon wanted one for himself and his grandma, so I provided Bibles for them both.)

11. How can I encourage my students to share events of their lives in a constructive way?

Start each therapy session with a “high and low” of the day.  This encourages students to express their achievements, but also allows for conversations surrounding difficult topics they might not have otherwise initiated conversations about. I’ll never forget a first grader who excitedly shared “My uncle is out of jail!”

12. What are best practices for teaching the language of feelings? Many of my trauma-exposed students are very “shut down.” I want to help them express their feelings constructively.

Help students label and describe feelings with a wide range of descriptors that go beyond the typical “happy-sad-mad” (Roseberry-McKibbin, 2022). Show them how to express feelings constructively rather than through tantrums or physical violence (e.g., hitting the clinician or other students). For example, we can tell students, “I want you to say ‘I feel upset because you turned the page of the book before I was ready.’” We actually did this with a boy who slapped a student clinician hard when she inadvertently prematurely turned the page of a book they were reading.

13. Many of my students who have experienced trauma have difficulty with social skills and theory of mind or taking another person’s perspective. What are some practical ideas for addressing this?

We can use social stories to assist our students in taking the perspective of another person. There are some commercially available social stories that are highly successful in teaching appropriate social skills.

Using puppets to model social interactions is fun and effective for younger children. Sometimes students express themselves more easily through puppets and can learn social interaction skills like turn taking, topic maintenance, greeting others, and other skills.

I have had a lot of fun and success with modeling inappropriate behavior, having children call me on it, and asking them to describe why it is inappropriate. For example, the lesson might be about not interrupting others. I will interrupt and let the children “penalize” me by removing a token from my cup. They love this and further internalize the lesson of turn taking.

14. You said research indicates that students who have experienced trauma may have difficulty with narrative skills. What practical ideas do you have in this area?

Help students make story books about routine events in their lives. Students can draw pictures of themselves getting out of bed, getting dressed, having breakfast (although this isn’t common at my Title 1 school), getting on the bus, coming to school, etc. Students can draw pictures of their after-school routines as well. When the books are created, students can tell stories to “cement” the routines as a foundation for narrative skills.

When I read books with students (even teens), I will often have them draw out the sequence of story events on the whiteboard in the therapy room. I’ve been surprised more than once by teenagers who could not sequence a story in their English Language Arts books. With both children and teens, drawing pictures and telling a story sequentially through these pictures has been very helpful for improving narrative skills (Roseberry-McKibbin, 2022).

15. How can I use play, art, and music in therapy for trauma-exposed students?

Allow students to play. It can help to have even 5-minute play breaks, in addition to recess, for students to express themselves through hands-on, physical play. Children on my caseload love digging through kinetic sand. Playdough is always welcome, and we do paint and art activities as well. Singing songs (for example, when working on target speech sounds) helps children to relax and feel more enjoyment in the therapy session. Drawing pictures with sidewalk chalk outside the therapy room has been fun and an excellent way to target speech and language goals. More recently with the pandemic, my children have enjoyed shaving cream activities at the end of the therapy session. They trace target sounds and words they are learning in the shaving cream, and then spray the table with water, wiping it down at the end. My table is sanitized, the children’s hands are clean, and I’m ready for the next group!

16. It is known that many trauma-exposed students have difficulty with executive functioning skills. What are some practical ideas for supporting these students?

Research mentions difficulty in this area. Executive functioning is the ability to set a goal and plan ahead to reach this goal. What is the plan? What steps are required? What actions must be taken to achieve the desired result?

To bring this to my own clinical experience, I find that for many students I work with, no one has ever helped them have a vision for their future. Most of my students have been abused and neglected, and they do not see how their behavior today impacts their dreams for tomorrow (if they have any). Thus, we carry out an activity that I call Trip to the Future. It involves problem solving and verbal reasoning.

Both Ramon and Treston, teen clients I mentioned earlier, have had their share of behavior issues. For example, Ramon threw a baseball bat at his teacher (I don’t think the Air Force will tolerate this type of behavior). Treston was having major issues with bad grades and lack of discipline.

With these young men, I explicitly discussed how their choices today are impacting their dreams of tomorrow. For example, when Treston was 15, he told me he wanted to be a nurse. I went to the whiteboard and on the left side, had him write down what he wanted in life. He wanted a $100,00 a year salary, lovely home, pedigree dog, vacations to tropical paradises, a hot car, and many other things. I said that these things sounded wonderful! On the right side, Treston wrote down all the current choices he was making: poor hygiene, fighting with his roommates, not studying, disobeying the classroom teacher….the list went on. Treston and I physically stepped back and compared the two lists. Because he is a bright young man, he was able to physically see (in his own writing) how his 15-year-old choices were not supporting his dreams of a nice life. His grades and hygiene have improved substantially, and my heart is so warmed by the progress he is making. I recently brought him a hard copy of our university’s pre-nursing program requirements, and he understands that his high school grades must support his vision of being accepted to a very competitive university nursing program in several years.

In one more example, I worked with Zakari, a young girl who wants to be a zookeeper. We googled this on my phone, and we found out the type of education she would need to realize her dream. We discussed how work habits in elementary school provided the foundation for her future vision.

To summarize, I try to help trauma-exposed students see the connection between their behavior today and how it is impacting their dreams for tomorrow. In the vast majority of cases, no adult in their life has ever done this. Many of my students’ parents are incarcerated, and they are being raised by grandparents who have challenging life issues of their own. Many are doing their very best to just survive.

17. The growth mindset is a popular concept that has gained traction in recent years. How does this apply to trauma-exposed students?

We need to tap into the base of knowledge and core of resilience that trauma-exposed students bring to the educational process. We should view them through the lens of an asset-based stance that focuses on their resilience, determination, talents, and skills that will be key to fulfilling their future hopes and dreams.

To do this, we can train students to use positive self-talk and develop a growth mindset. They can learn to choose between learned helplessness (a result of the trauma) and the ability to work hard and make good choices in order to experience positive consequences. The growth mindset takes good fortune out of the realm of good luck and places it solidly into the hands of students.

To successfully implement a growth mindset, it is important to emphasize hard work and effort, not innate talent, as key to success (Dweck, 2016). Instead of saying “you’re so smart!” we should say things like “You got a good grade on that test because you worked hard and studied for many hours.” “Your /r/ sound is a lot better, and I can tell that you have been practicing your /r/ words at home with your mom.”

18. Do you have any suggestions for modifying my therapy room to support trauma-exposed students?

Instead of seating students at a traditional table, sit on bean bags, plush chairs, or simply on the floor.  Removing the formal boundaries of sitting still at a table encourages students to be relaxed and express themselves freely.  This can be especially effective with younger children, who enjoy the freedom of movement.

Having students’ artwork on the walls with their names on their pictures is another nice way to support students and boost their self-esteem.

19. How can I help support the caregivers of trauma-exposed children?

I work in a highly under-resourced area of our school district, and it can be challenging to even meet caregivers, much less support them. Something that can work well is to email caregivers short videos of their children engaged in therapy tasks (Palafox, 2019). Sending home activities and artwork helps caregivers feel more involved. I find it helpful to have lists of community resources (e.g., free dentists, food and clothing closets) to share with caregivers to help provide basic needs.  

Some years ago, I started a book drive to collect new and gently used books for at-risk children experiencing poverty (see my website lovetalkread.com for how to do this). To date, we have been able to donate over 320,000 free books to families experiencing poverty to support children’s literacy at home. Many caregivers will not check books out from libraries for fear of damaging or losing them. But when given free books, caregivers can read with their children any time. If the caregivers don’t speak English, they can talk with their children about the books in the primary language of the home (Rosa-Lugo et al., 2020; Roseberry-McKibbin, 2022).

20. Any last tips for providing effective, supportive therapy for trauma-exposed students?

Teamwork is absolutely crucial. I could never adequately support my children and families without the services of the psychologists and social workers in our district. I’m so blessed to have great relationships with the principals at my elementary school and at the high security school for teen young men juvenile offenders. A strong, trusting relationship with your principal is critical, especially if you have to involve Child Protective Services. Other members of your professional team can provide emotional and practical support for you and the students and families you serve.

References and Recommended Readings

Campos, I., Hamilton, A.F., & Gonzalez, W. (2020). Every child is unique overrepresentation of linguistically diverse students in special education. In A.F. Hamilton (Ed.), Exploring cultural responsiveness: Guided scenarios for communication sciences and disorders (CSAD) professionals (pp. 69-75). American Speech-Language-Hearing Association.

Ciolino, C., Hyter, Y.D., Suarez, M., & Bedrosian, J. (2021). Narrative and other pragmatic language abilities of children with a history of maltreatment. Perspectives of the ASHA Special Interest Groups, 6, 230-241.

Dweck, C.S. (2016). Mindset: The new psychology of success and how we can learn to fulfill our potential. Ballantine books.

Hyter, Y.D. (2020). Language, social pragmatic communication, and childhood trauma. In D.M. Scott (Ed.), Cases on communication disorders in multicultural populations (pp. 54-87). IGI Global.

Hyter, Y.D. (2021). Childhood maltreatment consequences on social pragmatic communication: A systematic review of the literature. Perspectives of the ASHA Special Interest Groups, 6, 262-287.

National Education Association (2021). How play can help heal trauma. NEA Today, 39(5), 12.

Palafox, P.L. (2019). The heartbeat of speech-language pathology: Changing the world one session at a time. Bilinguistics, Inc.

Pew Research Center (2020). Key findings about U.S. immigrants. https://www.pew.research.org/fact-tank/2020/08/20/key-findings-about-us-immigrants/

Rosa-Lugo, L.I., Mihai, F.M., & Nutta, J.W. (2020). Language and literacy development: English learners with communication disorders, from theory to application (2^nd ed.). Plural Publishing, Inc.

Roseberry-McKibbin, C. (2022). Multicultural students with special language needs: Practical strategies for assessment and intervention (6^th ed.). Oceanside, CA: Academic Communication Associates.

Rupert, A.C., & Bartlett, D.E. (2022). The childhood trauma and attachment gap in speech-language pathology: Practitioner’s knowledge, practice, and needs. American Journal of Speech-Language Pathology, 31, 287-302.

Snow, P. C. (2019). Speech-language pathology and the youth offender: Epidemiological overview and roadmap for future speech-language pathology research and scope of practice. Language, Speech, and Hearing Services in Schools, 50, 324-339.

Snow, P.S. (2021). Psychosocial adversity in early childhood and language and literacy skills in adolescence; The role of speech-language pathology in prevention, policy, and practice. Perspectives of the ASHA Special Interest Groups, 6, 253-261.

Sultana, N., Wong, L.L.N. W., & Purdy, S. (2020). Natural language input: Maternal education, socioeconomic deprivations, and language outcomes in typically developing children. Language, Speech, and Hearing Services in Schools, 51, 1049-1070.

Towson, J., Canty, M., Schwartz, J., Barden, S., & Sims, T. (2020). Adolescent mothers’ implementation of strategies to enhance their children’s early language and emergent literacy skills. Communication Disorders Quarterly, 41(4), 231-241.

Treat, A.E., Morris, A.S. Hays-Grudo, J., & Williamson, A. (2020). The impact of positive parenting behaviors and maternal depression on the features of young children’s home language environments. Journal of Child Language, 47, 382-400.

U.S. Department of Health and Human Services (2022). Child maltreatment report 2020. https://www.acf.hhs.gov/cb/report/child-maltreatment-2020

Westernoff, F., Jones-Vo, S., & Markus, P. (2021). Powerful practices for supporting English learners: Elevating diverse assets and identities. Corwin.

World Health Organization (2022). World health day 2022: Building a fairer, healthier world. https://www.who.int/campaigns/world-health-day/2022.