When most people hear the term “post-traumatic stress disorder” or PTSD, they probably picture adult war veterans, abuse survivors, or natural disaster victims. These things can cause PTSD, but sadly, many children face this condition, too ― including children with autism spectrum disorder (ASD). But is there a link between autism and PTSD?
At first glance, these two conditions may appear unrelated, but an intricate interplay between them can greatly affect the lives of children who experience them. This article will dive into the complex relationship between autism and PTSD, offering valuable insights, explanations, and practical coping strategies.
What is PTSD?
Post-traumatic stress disorder is exactly what it sounds like – a psychiatric disorder caused by experiencing traumatic events. Exposure to trauma doesn’t guarantee the development of PTSD. It’s estimated that about 70% of adults in the United States go through a traumatic situation at least once, and roughly 20% experience PTSD afterward.
According to the Diagnostic and Statistic Manual of Mental Disorders (DSM-5), someone must have been exposed to “actual or threatened death, serious injury, or sexual violence” to qualify for a PTSD diagnosis. The person might have:
- Been threatened or harmed directly
- Witnessed others die or be threatened/harmed
- Found out that a loved one died or was threatened/harmed (according to the DSM, if a loved one died, the “event(s) must have been violent or accidental” to cause PTSD)
- Been exposed to details of traumatic events at work ― for example, a social worker may develop PTSD after repeatedly handling severe abuse cases
Symptoms of PTSD
The criteria for PTSD state that symptoms should:
- last longer than a month,
- cause significant problems with functioning socially, occupationally, and in other areas of life, and
- not be caused by another health condition or a substance like medication.
These symptoms fall under four categories: intrusion symptoms, avoidance, changes in thoughts and mood, and changes in arousal and reactivity.
The most common intrusion symptoms include:
- Frequent, distressing memories
- Frequent dreams related to the traumatic experience (children may have scary dreams without specifically trauma-related content)
- Flashbacks, or the patient feeling/acting like the event is happening again. In the most severe cases, they may lose awareness of their surroundings (children may revisit the situation through playing).
- Emotional and/or physical reactions to things that “resemble or symbolize” the experience. For example, a combat veteran may be distressed by fireworks resembling gunfire.
The most common symptoms of avoidance in PTSD include:
- Avoiding thoughts, feelings, and memories associated with the trauma
- Avoiding places, activities, people, objects, etc., associated with the trauma
Changes in Thoughts and Mood
The person should show at least two of these changes in thoughts and mood:
- Inability to remember an important part of the event (but not because of drugs, alcohol, or head injury)
- Extremely negative beliefs about themselves, others, and the world. For example, the person with PTSD may think, “Nobody can be trusted,” “Nowhere is safe,” “I deserve to have bad things happen to me,” etc.
- Unrealistic blaming of the event and/or its consequences on themselves or others
- Prolonged negative emotional states, such as fear, anger, shame, etc.
- Lack of interest in previously enjoyable activities
- Feelings of estrangement or detachment from other people
- Inability to experience positive emotions (happiness, love, satisfaction, etc.)
Changes in “Arousal and Reactivity”
The person should also show at least two of these symptoms of changes in “arousal or reactivity”:
- Increased irritability, anger, and/or aggression
- Self-destructive or risk-taking behavior
- Hypervigilance, or constantly watching out for danger even in situations that are probably safe
- More intense reactions to being startled
- Trouble concentrating
- Trouble falling or staying asleep
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AUTISM STIMMING: CAUSES, MANAGEMENT, AND TYPES
Autism and PTSD: What are the Risks?
There hasn’t been much research into the relationship between autism and PTSD. There’s some evidence that autistic people are at greater risk for PTSD. Some suggest it’s because they aren’t as equipped to handle stress, have higher chances of experiencing trauma, or because a wider range of events registers as trauma for them.
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.
However, researchers suspect that “challenging behavior and complex cognitive and language impairments, increased caregiver stress, lower levels of family social support, and higher rates of caregiver isolation” play a major role.
A 1998 study found that rates of sexual abuse are twice as high for children with developmental disabilities compared to typically developing children. Neurodiverse kids could be vulnerable to predators because of loneliness, difficulty distinguishing between appropriate or inappropriate behavior, and/or inability to report the abuse because of communication difficulties.
What Counts as Trauma?
There’s been a lot of debate among psychologists about whether the DSM’s definition of trauma is broad enough.
Although bullying (usually) doesn’t meet the DSM-5 criteria, some research shows that it can produce traits of PTSD in the general population and the autistic population. Harassment and bullying are big problems for children with ASD. A Kennedy Krieger Institute study of 1,200 kids on the spectrum revealed that 63% had been bullied by peers.
Individuals with autism often have higher stress responses to situations that don’t bother neurotypical people. Therefore, some professionals have considered 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 published by Wiley Online Library surveyed 59 adults with autism, asking whether they had experienced trauma and whether they showed signs of PTSD afterward. A total of 35 participants said they had gone through a situation they considered traumatic but wasn’t classified as such under the DSM’s standards.
Some of the non-DSM traumas included:
- Parents’ divorce
- Death of a loved one (not by violence or accident)
- Death of a pet
- Social difficulties
- Police visit the house
- Abandonment by a family member
- Mental health issues
- Autism diagnostic process
22 of the 35 participants said they’d experienced PTSD symptoms, and 15 of those 22 said they currently experienced symptoms.
Right now, there aren’t definitive answers about how, why, or even if people with autism are truly more predisposed to PTSD. It’s also unclear whether rates of PTSD are significantly higher in autistic people than in the general population. Still, it’s possible for someone to have both disorders, so you should watch for signs in your son or daughter.
What Does PTSD Look Like in a Child with Autism?
PTSD is hard to diagnose in children with ASD because traits may overlap. In both conditions, you might find repetitive play, social withdrawal, intense anxiety, sleep issues, etc.
This is especially true in very young children because PTSD is diagnosed based on changes in behavior after experiencing traumatic events. Some children may have suffered trauma at such a young age that it’s hard for parents to tell whether their behavior has changed. Signs of autism also typically appear early in life, making the diagnosis process more complicated.
There’s still more to learn about how PTSD may manifest in people with autism specifically. But, along with the symptoms from the DSM, let’s explore some other hints your kid may show.
Regression is when an autistic person starts to lose skills ― such as verbal, social, or motor skills ― they had previously mastered. This sometimes happens at an early age, leading to a child’s autism diagnosis in the first place, but it can also happen later in life. Trauma is only one possible cause for regression. Sometimes, it’s just how one’s autism presents itself; it can also be due to a life change or burnout.
Worsened Sensory Issues
Most kids with ASD are either hypersensitive or hyposensitive to stimuli like noises, lights, touch, etc. If someone has PTSD, they may be more prone to sensory overload and startle more easily.
It’s common for some autistic children to dislike being touched because of sensory issues. But be wary if one who used to like physical affection no longer does ― especially if they now avoid a specific person or people.
Children who don’t have the words to describe their emotional state may complain of headaches, tummy aches, and other ailments when dealing with stress and anxiety.
Changes in Stims
Stimming is a normal behavior for people on the spectrum, but watch out for changes. Autistic people might stim to reduce anxiety, so increased stimming could cause concern. New self-harm behaviors, like head-banging or scratching, could also appear after trauma.
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My Child Might Have Autism and PTSD – What Do I Do?
If you’re worried your son or daughter is struggling with post-traumatic stress disorder, ask your healthcare provider about a PTSD screening. If you know they have been through something serious, the screening could help determine whether that’s the cause of their behavior. Or you may see signs of potential trauma but not know what could’ve caused it. Screenings typically include interviews to determine if someone has had traumatic experiences.
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 mandatory reporters, meaning they’re required by law to report suspected/known child abuse. In 18 states and Puerto Rico, all adults are considered mandatory reporters.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is one of the most evidence-backed treatments. Trauma-focused CBT (TF-CBT) involves challenging distorted thoughts, learning calming techniques, and discussing the trauma.
The therapist uses play, such as games or drawings, to help children process their trauma. This method is mainly used with very young children.
Sometimes, clinicians may decide that antidepressants are the best option for treating trauma symptoms.
Some people find relief in a group of peers who have gone through similar struggles. A peer support group isn’t a substitute for counseling but can help trauma survivors build connections and feel less alone.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
TF-CBT is the most common technique, but it can be difficult for children with limited speech and children who struggle to identify and understand emotions ― issues many kids with autism deal with. Likewise, children on the spectrum might not get much out of support groups if social situations stress them.
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.
According to this article, a counselor could:
- Offer home-based services
- Use more visual aids, such as gradient scales, to describe degrees of emotion
- Keep appointment times regular and predictable as much as possible
- Provide sensory toys or allow children to bring their own
- Emphasize the possibility of a “happy ending” after trauma ―
“this correlates well with the documented effectiveness of social stories, narratives and role-playing in therapy involving individuals with ASD.”
- Be mindful of how often society dismisses the emotions of autistic people
- Involve other trusted caregivers
Exploration into autism and PTSD is still in the early stages. 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.
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AUTISM STIMMING: CAUSES, MANAGEMENT, AND TYPES
Q: Can individuals with autism develop PTSD?
A: Individuals with autism can develop PTSD, especially if they have experienced a traumatic event.
Q: What are some signs of PTSD in individuals with autism?
A: Signs of PTSD in individuals with autism may include increased anxiety, withdrawal, changes in behavior, and regression in skills.
Q: How can I support a loved one with autism and PTSD?
A: By providing a safe and understanding environment, seeking professional help, and connecting with support networks, you can support your loved one with autism and PTSD.
Q: Is there a cure for autism-PTSD?
A: There is no cure, but individuals can learn to manage their symptoms and lead fulfilling lives with the right interventions and support.
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.