Beyond the medical and social models: Why sensory differences and trauma must be part of the autism conversation

The conversation around autism has long been dominated by two perspectives: firstly the medical model and lately the social model. Both try to explain autistic behaviours, yet both miss a crucial element: the actual internal experience of autistic individuals. Autism is not just a difference in social communication or environmental interaction; I believe it is fundamentally shaped by sensory processing differences and trauma - two interconnected but distinct factors.

The real question is: why do we keep focusing on external behaviour when we know that behaviour is just the surface of underlying sensory and emotional distress?

The medical model: missing the right deficit

The medical model views autism as a disorder - something to be fixed. It looks at so-called “odd” behaviours and tries to reduce or suppress them. This is often achieved through behaviour-based therapies like ABA (Applied Behavioural Analysis), but commonly used psychotherapies such as cognitive and dialectical behaviour therapy largely align with this as well. The medical model assumes autistic people think or feel incorrectly and that changing the outward signs of autism will improve their quality of life.

But here’s the truth: the behaviours we see in autism are largely expressions of sensory and nervous system distress, not random or “defective” reactions. The brain isn’t malfunctioning; it’s overloaded.

Personally, I’m not necessarily against the concept of deficits - should we focus on the right deficit. Sensory impairments are very real - they impair our ability to feel safe and comfortable in our bodies. Why do we question autistic behaviours like stimming or avoiding touch, yet never question why a person with the flu stays in bed or why someone with hearing loss keeps saying, “Can you repeat that?”

We need to stop asking, “Why do autistic people behave this way?” and start asking, “What experience or emotional state is driving this distress?”

The social model: well-meaning, but incomplete

The social model tries to shift the focus away from pathologising autistic people. It suggests that psychological distress in autism comes from external factors like sensory-unfriendly environments and social exclusion. While this is an important step toward acceptance, it too, overlooks the internal sensory and trauma-based experience of autism.

The social model focuses heavily on adapting the environment and teaching coping skills. But when the nervous system is dysregulated due to unaddressed sensory impairment or trauma, these tools become superficial at best and a real burden in many cases . We’re expecting autistic people to cope with a body that doesn’t feel safe.

A new, integrative model

Part 1: Sensory impairment in autism

Sensory processing challenges are a core feature of autism. All autistic individuals experience sensory differences, with tactile hyper- or hypo-sensitivity being one of the most common. The sensory nervous system doesn’t just react to external triggers - it processes complex internal sensations as well that often feel overwhelming and inescapable. One of my clients described it this way: “The constant tension in my body, which I couldn’t escape, made me want to end my life.”

The distress you see on the outside is only a tiny fraction of what autistic people experience on the inside. This constant internal struggle to find some sense of bodily peace means:

• Social interaction feels secondary to survival.

• Learning is inconsistent due to disharmonic developmental profiles caused by sensory impairments. (see my previous blogpost)

• Simple, everyday environments feel like sensory battlegrounds.

This isn’t just about societal exclusion; it’s about nervous system survival.

How sensory impairments create trauma

Unaddressed sensory issues create trauma. When a child experiences overwhelming sensory input repeatedly - like persistent and undefined inner sensations, noise sensitivity, touch discomfort or movement challenges - without any relief, their nervous system learns to anticipate danger.

This chronic over-activation of the stress response results in:

• Heightened hypervigilance: The nervous system stays on high alert, scanning for potential (sensory) threats.

• Shutdowns and meltdowns: When the brain can no longer cope with incoming signals, it triggers protective mechanisms like freezing or aggressive outbursts.

• Developmental disharmony: When sensory processing is unreliable, key developmental milestones will be missed or only partially reached.

A new, integrative model

Part 2: Trauma in autism - not always sensory trauma

While sensory trauma is a significant factor in autistic distress, it is crucial to understand that not all trauma in autism is sensory trauma. Trauma can stem from a range of experiences, such as:

• Social exclusion and bullying

• Repetitive invalidation and gaslighting (being told your perceptions are wrong)

• Medical trauma from invasive therapies

• Attachment disruptions in early life

These experiences interact with the nervous system in ways that closely mirror PTSD and complex PTSD (cPTSD). When trauma remains unprocessed, it perpetuates nervous system disregulation, making the individual even more vulnerable to sensory overwhelm.

The problem is that autistic behaviours are often viewed as primary symptoms of autism, when in reality they are trauma responses.

Why we keep misunderstanding autistic behaviour

When looking at how autism is diagnosed, we see that it’s based entirely on externally observed behaviours. But these so-called diagnostic behaviours - like repetitive movements, social withdrawal or communication differences - are all behaviours of distress.

Now, map these diagnostic behaviours alongside symptoms of PTSD or cPTSD, and the overlap becomes striking:

• Hypervigilance

• Shutdowns and meltdowns

• Avoidance behaviours

• Repetitive or self-soothing behaviours

Yet, instead of seeing these signs as evidence of trauma and sensory distress, we label them as “autistic traits” and try to manage them with external supports.

We don’t question why someone with the flu stays in bed or why a person with hearing loss cups their ear and repeatedly asks, “Can you say that again?” We know these actions stem from internal experiences.

But with autism, we dissect every behaviour as if it exists in isolation from the sensory and emotional experience of the body.

Repetitive behaviours: misunderstood coping mechanisms

Repetitive behaviours (like hand-flapping, rocking, or humming) are often described as “autistic traits.” In reality, these behaviours are nervous system coping mechanisms. They provide a sensory anchor to help the body self-regulate during moments of overwhelm.

However, these coping behaviours don’t address the underlying sensory dysfunction or trauma. Stimming is like applying a plaster on an infected wound: it perfectly soothes the discomfort temporarily, unfortunately it doesn’t support long-term healing.

The new, integrative sensory-first model

Healing sensory impairment and trauma first

If we truly want to support autistic individuals, we need a new model - one that prioritises sensory healing and trauma resolution before attempting to teach coping strategies or social skills.

This model would involve:

1. Addressing sensory impairments first: therapies like Qigong Sensory Treatment and Safe and Sound Protocol can help the nervous system process sensory input more effectively.

2. Focusing on developmental gaps: healing and supporting the disharmonic developmental profile through Reflex integration therapy, ergo-therapy, occupational therapy, speech therapy, etc…

3. Considering diet and physical health: research confirmas that the nervous system is closely tied to gut health and immune function.

4. Trauma release therapy: working with the body’s trauma patterns to release survival responses and restore a sense of internal safety. Consider therapies like Q-NEI (quantum Neuro Emotional Integration), EMDR (Eye Movement Desensitisation and Reprocessing) or EFT tapping (Emotional freedom technique)

5. Teaching coping strategies last: once the nervous system is regulated, you will see that these skills develop more naturally.

When the body no longer operates in survival mode, coping becomes intuitive rather than forced.

Why this matters

Autistic individuals spend their lives being observed, analysed and measured based on external behaviour. Whether we are suppressing behaviours (medical model) or trying to accommodate them (social model), we still haven’t truly listened to the body.

Autistics don’t need their behaviour analysed. They need their experiences validated, understood and addressed in a proper way.

Sensory trauma and other types of trauma cannot be addressed through behavioural or environmental interventions alone. Healing requires a bottom-up approach, where the body’s sensory and emotional needs are prioritised before teaching external skills.

What are your thoughts?

• Have you seen the effects of sensory challenges or trauma in the children you work with?

• Have you noticed patterns of developmental disharmony that seem unrelated to external factors?