Why Trauma-Informed Care Must Be Sensory-Informed (And Vice Versa)

A male presenting caucasian child in an orange t-shirt looks very unhappy about the teal-colored ice cream held in front of his face. His mouth is turned downwards and he is frowning.
Virginia Spielmann, PhD, OTR/L

How ignoring the trauma-sensation connection fails clients – and what truly integrated therapy looks like.

The Ice Cream Meltdown That Changed Everything

Marco stared at the melting vanilla cone in his therapist’s hand, his breath shallow. "Just touch it," she encouraged. "It’s just ice cream." But to Marco, it wasn’t. The moment his fingers brushed the sticky goo, his body recoiled like he’d been burned. To an outsider, it might look like "overreacting." To a skeptical observer, even "manipulation." But his scream wasn’t defiance—it was terror written in the language of nerve endings.

Later, the team would piece together why: the texture was an unwelcome echo of the medical tape that had held his IVs during years of hospitalizations. His body remembered what his words couldn’t yet explain.

This is the heart of trauma-informed sensory care: the body keeps score, and the senses sound the alarm.

The Problem with "Just Get Used to It"

Traditional therapy often treats trauma and sensory struggles as separate issues. A child like Marco might see:

  • An occupational therapist working on "tactile tolerance" through play
  • A trauma counselor addressing his medical PTSD through narrative/play type talk therapy
  • A behavioral specialist treating his "socially inappropriate" behaviors with exposure tasks

But none of these approaches, alone, could reach the core issue: his nervous system had learned that stickiness meant danger.

A Better Way: Weaving Safety, Attachment, and Sensory Wisdom

1. Safety First—Before Any "Work" Begins

Before Marco could explore textures, he needed to trust that:

  • His "no" would be respected
  • His body’s signals would be believed
  • He could exit any activity without penalty

We started with what felt safe: honoring consent 100% of the time, rhythmic swinging, deep pressure hugs, and his favorite—crashing into piles of pillows. These weren’t just "sensory tools." They were anchors his nervous system could cling to when the world felt overwhelming.

2. The Language of the Body

Marco didn’t need words to tell us about his trauma. His body spoke for him:

  • The way he stiffened at sudden touches (even gentle ones)
  • How he’d dissociate when smells reminded him of the hospital
  • His compulsive need to control every detail of play

Instead of forcing him to "use his words," we gave him other ways to communicate:

  • Non-traditional graphics relying more on pictures than text (point to the section that fits how you feel)
  • A "safety kit" with noise-canceling headphones and a soft scarf he could hide under
  • Choices—always choices—about what to touch, when, and how
A grid of three graphics outlined in a heavy black line. On the left side the graphic is of four red crosses and the word YUCK in purple letters. In the middle are yellow circles and dots and the word OK in big green letters. On the far right is flowers of different colors and the word AWESOME in yellow letters.
Graphic used with permission from Autism Level Up - please visit www.autismlevelup.com for lots of fantastic resources.

3. Rewriting the Story

Slowly, we helped Marco’s body learn new associations. Sticky textures didn’t have to mean pain. Together, we:

  • Made a "body storybook" with photos of him exploring textures on his terms
  • Used popsicle sticks as "bridges" to touch messy things from a distance first
  • Celebrated tiny wins (like the day he high-fived with sticky hands and didn’t panic)

Why This Worked (The Science Behind the Story)

Marco’s healing wasn’t magic—it was neuroscience. His progress wove together:

  • Attachment science: Building trust and felt safety through predictable, attuned care
  • Sensory integration: Helping his brain process touch and make sense of what he was sensing (completely eradicating panic in response to confusion)
  • Trauma healing: When Marco chose to touch the slime himself - when his nervous system initiated the action rather than just enduring it - something profound shifted. This wasn't desensitization; this was sensory re-authoring.

The neuroscience behind this is clear:

  1. Top-down regulation: When Marco directed the tactile experience, his prefrontal cortex could modulate threat responses
  2. Predictive coding update: Self-initiated touch created mismatches with his body's trauma predictions (aka “this could be fun!”)
  3. Interoceptive recalibration: His insula began registering sticky textures as information rather than danger

This is why agency isn't just therapeutic - it's neurologically transformative. As Marco's therapist, our role wasn't to guide exposure but to:

  • Increase his sense of control ("You tell me when")
  • Honor his body's pace (seconds of engagement are a great start)
  • Protect his right to retreat (safety wasn't negotiable)

The result? Not just tolerance, but embodied self-trust. That sticky high-five wasn't compliance - it was Marco's nervous system declaring: "I can be safe here."

Most importantly, we followed his lead. Marco wasn’t a puzzle to solve. He was a person to partner with.

What This Means for Families and Clinicians

If you’re supporting a child like Marco:

  1. Listen to the body first. Behaviors are clues, not problems.
  2. Safety isn’t optional. No therapy works without it. Consent is a non-negotiable. 
  3. Small steps matter. Healing isn’t linear.

And to the professionals reading this: we have to work together. Trauma lives in the senses. Sensory struggles are shaped by trauma. Our processes must reflect that truth.

The Birthday Cake Moment

Months later, Marco stood grinning at his sister’s birthday party—hands buried in frosting, laughing as he smeared it on his cheeks. The stickiness that once meant pain was now pure joy.

That’s the power of trauma-informed sensory care: not just surviving, but reclaiming delight.