How Does Autism Affect You – Although I set up this series to distinguish autism from common misdiagnoses, this week’s topic is more complex. You can see from the Venn diagram that there is a lot of overlap between PTSD and autism! In addition to many shared experiences, they also happen at an alarmingly high rate.
Occurs (vs. misdiagnosis). Misdiagnosis occurs when a person’s PTSD is correctly diagnosed while their underlying neurotype (autism) is missed. When they occur simultaneously, it creates some additional complexity in the clinical presentation. I will cover these topics as well as give clinicians some ideas on how to adapt traditional trauma treatment for the autistic person.
Contents
- 1 How Does Autism Affect You
How Does Autism Affect You
Due to the co-occurrence of Autism and PTSD, this is probably a rare misdiagnosis (probably correct), but autism can be missed. PTSD is rarely misdiagnosed; however, when PTSD is used for
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Our field has much to thank for recent advances in trauma-informed care and treatment. I am grateful for the work of Dr. Burke Harris, Bessel Van der Kolk, and countless others to raise awareness of trauma. I am grateful for the work being done to create trauma-informed spaces as more therapists, educators, and medical providers work from a trauma-informed lens.
While I am afraid to downplay these major advances, I believe it is important to consider the potential risk of trauma becoming the new “it” lens through which the mental health field views everything.
I have spoken to countless people whose autism was missed because their symptoms were explained by the framework of PTSD or C-PTSD. In our zeal to help heal trauma, we (the mental health field) are vulnerable to making trauma the new “lens” through which everything is understood. sensory and dysregulation experiences in trauma.
There are many reasons why it is difficult to separate autism from PTSD; below is a list of overlapping features that can make it difficult to distinguish between the two:
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The nervous system/amygdala is on hyper-vigilance after trauma as a way of trying to protect itself from future harm. This looks similar to the sensory profile of a hypersensitive autistic.
The installation around the amygdala, the “safety alarm”, becomes more sensitive after trauma. Research on the amygdala and autism is mixed, but many of us have greater involvement of the amygdala in certain activities (ie, eye contact).
Related to brain chemistry (amygdala) and sensory profile, it becomes more difficult to self-soothe and regulate difficult emotions.
These substances can be a powerful way of regulating an overactive nervous system. Both groups are at increased risk for substance abuse disorders.
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This is a common response to trauma and can also be a response to sensory overload. Average between the two groups.
Autistic people are 3-7 times more likely to die by suicide. Suicide is also more common among trauma survivors.
Trauma survivors are at greater risk of re-victimization. Similarly, recent research has shown that females with autism and gender diverse individuals are more likely to experience violent victimization. Some risk factors include a challenge with social reasoning, a lack of contextual cues, and a tendency to take things literally. In one study, adults with autism were 7.3 times more likely to admit to experiencing sexual assault by a peer during adolescence (Weiss & Fardella).
Given the large overlap, it’s easy to see how an autism diagnosis might be overlooked in favor of a PTSD diagnosis, especially if there is a history of trauma. And most neurodivergent people experience trauma, whether it’s the big T-trauma of victimization or the small trauma of marginalization, bullying, and discrimination. This brings us to point 2, the intersection of trauma and autism:
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Autistics are more likely to experience PTSD than the general population, especially women, bisexuals and BIPOC autistics. Research shows that women with autism have a dual vulnerability – they are more vulnerable to victimization and more vulnerable to developing PTSD after a traumatic event. Females with autism are 1.5 times more likely to be victimized than their male peers. In addition to being more vulnerable,
There are various theories as to why this is: a more active amygdala, an inflexible nervous system, difficulty in regulating emotions, and our tendency to receive sensory experience with greater intensity. Indeed, Rumball et al. (2020) found that we develop PTSD at higher rates even when criterion A is not met (to non-clinicians, this means less severe trauma).
💙 Rambol et al. (2020) study found that approximately 60% of autistics reported possible PTSD in their lifetime (compare this to 4.5% of the general population) (Rumball, 2020).
A 2020 study found that 32% of their autistic participants had probable PTSD compared to 4% of the non-autistic population.
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💙 Fenning et al., 2019 research found that children with autism have a more reactive nervous system. This is consistent with similar research that has determined that the autistic nervous system is less flexible (Tappa and Alvarez, 2019). Less flexible nervous systems have a harder time coping with acute stressors and may contribute to increased hyperactivation of the nervous system after trauma.
💙 We are more vulnerable to social victimization and marginalization. In Haruvi-Lamdan et al., 2020, females with autism (but not males) reported more negative life events, especially social events, than typical adults.
💙 Our sensory profiles mean that many of us absorb sensory experiences with greater intensity. Thus, memories and sensations are encoded in our minds and bodies with greater intensity.
This dual vulnerability is rarely discussed as part of Autism Awareness or in the clinical trauma literature. The lack of awareness around this is unfortunate because any good trauma treatment must consider the neurotype underlying the trauma experience. Unfortunately, few clinicians are trained in how to do the trauma-informed work of autism. Now let’s get back to that topic…
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As the statistics above show, autism/PTSD is occurring at unimaginable rates. When autism is missed, trauma treatment has a negative effect. It is very important to treat autistic trauma with an adapted neurodivergent approach. Just as our path to trauma is not a neurotypical path, neither can our treatment be the same as neurotypical treatment.
Grounding and relaxation techniques are the building blocks of any effective trauma treatment. It is important that a person has the tools and skills to help them re-anchor themselves when trauma hijacks their body. Because our nervous systems are less flexible than the alistic nervous system, it is harder for us to return to baseline once activated. If progress is slow, that’s okay; again, we need more work to recover after hijacking our nervous system.
We need more attention to our sensory profile (grounding, bodywork, encouraging natural forms of movement, etc.). Our sensory system is probably in extreme overdrive. Our bodies are already a difficult place for many of us; Trauma is like throwing gasoline on a sensitive sensory system. Somatic experiences and other body-based approaches to trauma should be considered. However, given the intensity of the bodily experience, consideration should be given to autonomy and empowerment for the client to move at their own pace.
Exposure therapy is often considered the gold standard for the treatment of PTSD. However, this can be quite dysregulating for the Neurodivergent person if not adopted. If used, it is important that it is customized and customer-led. Please don’t overwhelm your autistic clients. Sensory experiences beyond our control are not fixed; we must control the sensory experience. Adequate attention to pacing and recovery is essential. Initial treatment should focus on increasing perceptual and regulatory skills before working through exposure.
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CBT aims to deal with unhelpful beliefs about the world and oneself. The clinician must realize that these “maladaptive patterns” are not only formed in trauma, but are also the result of years of social marginalization (often at the unconscious level). Thus, it is possible that attempting to reframe some of these negative beliefs may have the effect of restoring increased shame and confidence in the beliefs. Tightening the straps can also result in a loss of trust in the therapeutic relationship. The three levels of autism, according to the DSM-5, are in need of support, in need of substantial support, and in need of tremendous support.
Each of these three levels is described in detail in the manual. Furthermore, all individuals who receive an autism diagnosis can be further assessed according to the level they exhibit. It depends on how severe the symptoms are and the level of support they need in their daily lives.
Each level is organized where the least severe starts at level 1 and the most severe ends at level 3. There are no higher levels than the levels listed.
Level 3 is a description of a person with the most severe characteristics found in Autism Spectrum Disorder. Level 1 is the opposite, as it describes a person with the mildest symptoms.
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A person who falls into the Level 1 category will have social problems that require a certain level of help.
A diagnosis of Level 1 autism can vary from rapid to slow. Because of the mild symptoms, many psychiatrists may worry about misdiagnosing other similar disorders.
Mild autism can resemble things like ADHD
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