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Understanding The Connection Between Autism and PTSD

May 24, 2024

When most people hear the term “post-traumatic stress disorder” or PTSD, they probably picture adult war veterans and abuse survivors. Unfortunately, many children on the spectrum face this condition, too. But is there a connection between autism and PTSD?

While autism and PTSD may seem unrelated, they can significantly impact the lives of children who have both. This article explores the intricate connection between these conditions, providing valuable insights, explanations, and practical coping strategies.

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What is PTSD?

PTSD, or post-traumatic stress disorder, is a mental health condition resulting from traumatic experiences. About 20% of adults in the U.S. develop PTSD after a traumatic event, but exposure to trauma doesn’t guarantee it.

The DSM-5 outlines criteria for a PTSD diagnosis, requiring exposure to threats of death, serious injury, or sexual violence. Symptoms must last over a month, significantly impact daily life, and not be caused by other factors.

Intrusion Symptoms:

  • Distressing memories
  • Trauma-related dreams
  • Flashbacks or reliving the event
  • Emotional or physical reactions to reminders

Avoidance Symptoms:

  • Avoiding thoughts, feelings, and memories associated with the trauma
  • Avoiding places, activities, people, and objects associated with the trauma

Changes in Thoughts and Mood (at least two):

  • Inability to recall part of the event
  • Negative beliefs about oneself, others, and the world
  • Blaming oneself or others for the event
  • Persistent negative emotions
  • Loss of interest in enjoyable activities
  • Feeling estranged from others
  • Inability to experience positive emotions

Changes in Arousal and Reactivity (at least two):

  • Increased irritability, anger, or aggression
  • Self-destructive behavior
  • Hypervigilance
  • Intense reactions to being startled
  • Trouble concentrating
  • Sleep difficulties

Does Autism Raise the Risk of PTSD?

There hasn’t been much research into the relationship between autism and PTSD. However, there’s some evidence that autistic people are at greater risk for PTSD.

Some suggest these may be the reasons:

  • they aren’t as equipped to handle stress, 
  • they have higher chances of experiencing trauma, 
  • a wider range of events registers as trauma for them.

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Autistic children may be at higher risk of being abused by caregivers. A Tennessee Child Abuse Hotline study found that kids with ASD were reported to the hotline 2.5 times more than neurotypical children.

This could be because children with ASD come into contact with more potential reporters, like therapists and educators, than neurotypical kids.

A 1998 study found that rates of sexual abuse are twice as high for children with developmental disabilities compared to typically developing children

Potential reasons why autistic children could be vulnerable to predators include:

  • loneliness,
  • difficulty distinguishing between appropriate or inappropriate behavior,
  • inability to report the abuse because of communication difficulties. 

Potential Causes of Trauma in Autistic Children

Psychologists debate if the DSM’s trauma definition is broad enough.

Bullying may not meet DSM-5 criteria, but research suggests it can trigger PTSD traits, especially in autistic individuals. A Kennedy Krieger Institute study of 1,200 kids on the spectrum revealed that 63% had been bullied.

Autistic individuals may react strongly to less extreme situations. That led to questions about whether things that are less extreme than death, serious injury, or sexual violence are enough to trigger PTSD symptoms in autistic people.

A 2020 study surveyed 59 adults with autism, revealing that 22 of 35 who faced non-DSM traumas reported PTSD symptoms. 

Non-DSM traumas included:

  • parents’ divorce,
  • illness, 
  • non-violent death of a loved one, 
  • pet loss,
  • bullying,
  • social challenges,
  • family abandonment, 
  • mental health issues, and 
  • the autism diagnostic process.

Currently, it’s uncertain why or if autism increases PTSD risk, and rates compared to the general population are unclear. However, individuals can have both disorders, so be attentive to signs in your child.

Signs of PTSD in Autism

Some PTSD and autism traits overlap, which makes them challenging to diagnose in children with autism.

This is especially true in very young children, as PTSD diagnosis relies on behavior changes after trauma, which may be hard to discern in early life. Autism signs also emerge early, complicating diagnosis.

Understanding how PTSD manifests in individuals with autism is ongoing. Besides DSM symptoms, here are additional signs to consider for your child:

  • Regression:
    • Loss of previously mastered skills, like speech or social abilities.
    • Can occur due to various factors, including trauma, autism presentation, or life changes.
  • Worsened Sensory Issues:
    • Heightened sensitivity or insensitivity to stimuli.
    • Individuals with PTSD may experience increased sensory overload and startle easily.
  • Touch Avoidance:
    • While some autistic children dislike touch due to sensory issues, watch for a sudden aversion, especially towards specific individuals.
  • Physical Discomfort:
    • Children may express stress and anxiety through complaints of headaches, stomach aches, or other ailments.
  • Changes in Stims:

Monitoring these signs can aid in identifying potential PTSD in individuals with autism.

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Treating Autism and PTSD

First and foremost, it’s always best to consult professionals when it comes to your child’s mental health. If you’re worried that your child is struggling with post-traumatic stress disorder, ask your healthcare provider about a PTSD screening.

If you discover that they have been the victim of a crime, it’s important to contact law enforcement.

In most US states, professionals like therapists, teachers, and clinicians are required by law to report suspected/known child abuse. In 18 states and Puerto Rico, all adults are considered mandatory reporters.

Unfortunately, treatments for PTSD in people with autism are not well-researched. Standard approaches for children and adolescents with PTSD include:

  1. Cognitive Behavioral Therapy (CBT):
  • Trauma-focused CBT challenges distorted thoughts, teaches calming techniques, and discusses trauma.
  1. Play Therapy:
  • Uses play, like games or drawings, to help very young children process trauma.
  1. Medication:
  • Antidepressants may be prescribed in some cases.
  1. Support Groups:
  • Peer groups provide connections for those with similar experiences.

For individuals with both autism and PTSD, adapting treatments is a challenge.

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), a common technique, may be tricky for children with limited speech or difficulty understanding emotions. Support groups might not benefit those stressed by social situations.

Modifying Typical Therapies for Autism and PTSD

A study published by Psychology in the Schools examined how typical therapies, particularly CBT, might be modified for people with autism or an intellectual disability. 

Modifying therapies for autism may include:

  • offering home-based services,
  • using visual aids to describe degrees of emotion,
  • keeping regular and predictable appointment times,
  • providing sensory toys,
  • emphasizing positive outcomes after trauma,
  • acknowledging emotions,
  • involving trusted caregivers.

The therapist should consider the child’s unique strengths and limitations, remaining flexible throughout the process.


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There’s Still a Lot To Learn

Do kids with ASD really have a greater risk of developing post-traumatic stress? What are the differences in how autistic people and neurotypical people experience and process trauma? How can clinicians best treat autistic patients?

Unfortunately, we don’t yet have conclusive answers to these questions.

Remember not to neglect your emotional health. Feeling guilty and overwhelmed is easy when your loved one goes through something terrible.

Seek your mental healthcare if needed, and don’t be afraid to lean on family, friends, and other supporters. With the help of your child’s professional team, both of you can make it through.

FAQs

Q: Can trauma cause autism?

A:  Several research studies propose that individuals who have undergone childhood trauma might display symptoms resembling autism, including challenges in social interactions, communication, and engaging in repetitive behaviors. It’s important to note that this does not imply that trauma causes autism.

Q: Is there a connection between complex PTSD and autism?

A: Complex PTSD and autism share similar symptoms. This can lead to confusion for clinicians who may misinterpret communication and social challenges. It’s possible for a child with autism to also develop PTSD.

Q: What are some signs of PTSD in adults with autism?

A: Signs of PTSD in adults with autism may include increased anxiety, withdrawal, changes in behavior, and regression in skills.

Q: Can PTSD symptoms in individuals with autism improve over time?

A: Yes, with appropriate therapy and support, many individuals with autism and PTSD can experience reduced symptoms.

References:

Research Mapping of Trauma Experiences in Autism Spectrum Disorders: A Bibliometric Analysis, 2023
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10178446/

PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms, 2018
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7683380/

A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder, 2018
https://journals.sagepub.com/doi/abs/10.1177/1362361318813998

Interpersonal Trauma and Posttraumatic Stress in Autistic Adults, 2021
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8992908/

IAN Research Report: Bullying and Children with ASD
https://www.kennedykrieger.org/stories/interactive-autism-network-ian/ian_research_report_bullying

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