Autism and post-traumatic stress disorder (PTSD) share many traits. New research suggests that those with autistic spectrum disorder (ASD) are at a higher risk of developing post-traumatic stress disorder.
ASD is a neurodevelopmental condition characterised by difficulty in social communication, interactions, and forming and maintaining relationships.[1] ASD is also identified through restricted and repetitive behaviours and interests, which could include a desire for routine, as well as repetitive speech and movements. Hypo or hypersensitivity to sensory stimuli such as lights, sounds, and sensations are also common. How these symptoms present, and the severity of their experience differs between individuals; however, it frequently impacts a person’s daily life and ability to function.
PTSD is a disorder that develops following a traumatic event or chronic adversity. Classically these events could include an accident, abuse, neglect, and witnessing violence. According to the current edition of the Diagnostic and Statistical Manual of Mental Disorders, symptoms of PTSD can include:[2]
- Flashbacks, intrusive memories, and nightmares of the traumatic event
- Suppression of these memories and avoidance of triggers which could remind them of the trauma
- Hyperarousal
- Negative alterations in mood and cognition including aggression and anger
However, there is significant debate as to what constitutes trauma. Trauma is an experience of an event rather than the event itself and so is highly subjective. How a person responds to a threat is based upon their conditioning, attachment type, personality, and identity. Non-DSM-5 traumas could include situations and events such as racism, chronic stress, bullying, moving house, debt, unemployment, or isolation – events that autistic people may have an increased likelihood of experiencing.
ASD and the Experiencing of Trauma
There is a strong correlation between autism and trauma, with recent research demonstrating that PTSD is around 45% higher in individuals with autism spectrum disorder.[3]
People with ASD are understood to be at increased risk of experiencing adverse life events, such as bullying, victimisation, and maltreatment. Co-occurring mental health issues are also common amongst those with ASD, making them more vulnerable to the impact of trauma. For example, recent studies have found that there are increased rates of depression amongst this group as well as elevated rates of anxiety.[4] Connor Kerns, assistant professor of psychology at the University of British Columbia, states, “We know that about 70% of kids with autism will have a comorbid psychiatric disorder.”
A 2015 study led by Connor Kerns investigated the correlation between suicidal thoughts and behaviours in youths with ASD. Approximately 11% of youths displayed suicidal thoughts and self-injurious behaviours with a higher prevalence amongst those with ASD. These depressive behaviours were frequently connected to past trauma and the prevalence of PTSD symptoms.[5]
As previously mentioned, natural disasters, abuse, violence, and sexual assault are all common causes of PTSD amongst the general population; however, for those with ASD, far less extreme events can cause the onset of PTSD symptoms. These could include fire alarms, a comment from a stranger, the loss of a family pet, or a new and unfamiliar situation. All these situations can be intensely destabilising and cause fear and panic for those with autism.
A 2020 study found that over 40% of autistic adults displayed signs of PTSD within the last month due to experiencing a wide range of life events as traumatic.[6] As a broad range of events can be experienced as traumatic for those with ASD, clinical understanding must consider possible non-DSM-5 traumas as a catalyst for the development of PTSD.
There is mounting evidence demonstrating that stress and trauma not only contributes to the onset of PTSD and co-occurring disorders but additionally worsens the symptoms of ASD itself. Therefore, any therapeutic approach needs to consider the nature of childhood stress and daily trauma in order to benefit the mental health of this group.[7]
Having autism can mean enduring a litany of events, starting from a young age, which could be experienced as traumatic. Due to the added complexity of increased chances of suffering from co-occurring mental health issues, these events may contribute towards severe stress and the onset of persistent post-traumatic stress disorder (PTSD).
Trauma Treatment and ASD
How PTSD manifests in autistic people can vary greatly from the general population and can also exacerbate autistic traits, such as panic, immobility, hyperarousal, and a regression of skills or communication. The boundaries between ASD and PTSD can be difficult to distinguish, and alongside the communication and relational issues autistic individuals have, PTSD itself can be extremely challenging to treat.
Additionally, due to the elevated rates of depression and anxiety amongst those with ASD, standard behavioural interventions cannot always effectively address the underlying causes of the trauma and the ongoing experience of it. Various studies have found that for this reason, autistic people are unlikely to receive the help they need for PTSD or trauma related issues.[8]
In order for treatment to be effective both conditions must be treated simultaneously. Due to the disparities in the manifestation of PTSD in those with ASD compared to the general population, autism-specific trauma assessments are currently being implemented and researched innovatively. This new understanding of ASD and its correlation to PTSD will hopefully pave the way to a brighter, calmer, and more interconnected future for these individuals.
If you have a client, or know of someone who is struggling to heal from psychological trauma, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long-lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).
[1] Rumball, Freya et al. “Experience Of Trauma Andptsdsymptoms In Autistic Adults: Risk Ofptsddevelopment Followingdsm‐5 Andnon‐DSM‐5 Traumatic Life Events”. Autism Research, vol 13, no. 12, 2020, pp. 2122-2132. Wiley, doi:10.1002/aur.2306. Accessed 8 June 2021.
[2] Rumball, Freya et al. “Experience Of Trauma Andptsdsymptoms In Autistic Adults: Risk Ofptsddevelopment Followingdsm‐5 Andnon‐DSM‐5 Traumatic Life Events”. Autism Research, vol 13, no. 12, 2020, pp. 2122-2132. Wiley, doi:10.1002/aur.2306. Accessed 8 June 2021.
[3] Rumball, Freya et al. “Experience Of Trauma Andptsdsymptoms In Autistic Adults: Risk Ofptsddevelopment Followingdsm‐5 Andnon‐DSM‐5 Traumatic Life Events”. Autism Research, vol 13, no. 12, 2020, pp. 2122-2132. Wiley, doi:10.1002/aur.2306. Accessed 8 June 2021.
[4] Kerns, Connor M. et al. “Not To Be Overshadowed Or Overlooked: Functional Impairments Associated With Comorbid Anxiety Disorders In Youth With ASD”. Behavior Therapy, vol 46, no. 1, 2015, pp. 29-39. Elsevier BV, doi:10.1016/j.beth.2014.03.005. Accessed 8 June 2021.
[5] Storch, Eric A. et al. “The Phenomenology And Clinical Correlates Of Suicidal Thoughts And Behaviors In Youth With Autism Spectrum Disorders”. Journal Of Autism And Developmental Disorders, vol 43, no. 10, 2013, pp. 2450-2459. Springer Science And Business Media LLC, doi:10.1007/s10803-013-1795-x. Accessed 8 June 2021.
[6] “Autistic People May Not Receive Treatment For PTSD | LDT”. LDT, 2021, https://www.learningdisabilitytoday.co.uk/autistic-people-may-not-receive-treatment-they-treatment-they-need-for-likely-ptsd.
[7] Fuld, Samantha. “Autism Spectrum Disorder: The Impact Of Stressful And Traumatic Life Events And Implications For Clinical Practice”. Clinical Social Work Journal, vol 46, no. 3, 2018, pp. 210-219. Springer Science And Business Media LLC, doi:10.1007/s10615-018-0649-6. Accessed 8 June 2021.
[8] “Autistic People May Not Receive Treatment For PTSD | LDT”. LDT, 2021, https://www.learningdisabilitytoday.co.uk/autistic-people-may-not-receive-treatment-they-treatment-they-need-for-likely-ptsd.
