[Posted on 22 January, 2019 by Clare Allely]
There has been relatively little study looking at posttraumatic stress disorder (PTSD) and other trauma and stressor-related disorders in individuals with ASD. Recently, Fuld (2018) highlighted that individuals with ASD may be at higher risk for experiencing stressful and traumatic life events. There are a significant number of studies which do strongly support this. For instance, it has been found that adult women with ASD report significant rates of sexual abuse with a prevalence rate 2-3 times higher compared to their peers. Although there have been a number of studies finding high rates of abuse in individuals with ASD, surprisingly low rates of PTSD have been reported in this particular group. It has been suggested that some of the potential reasons for this may be the cognitive and language difficulties, impairment in understanding or expressing what occurred and/or labelling an experience as trauma in some individuals with ASD.
A growing number of studies have found that stressful and traumatic life events are a potential underlying risk factor for most of the comorbid psychopathologies which are commonly found in individuals with ASD. It is crucial that there is an increased understanding and awareness that exposure to a stressful and potentially traumatic events may be exhibited in individuals with ASD as symptoms of aggression, difficulties in concentration, social isolation, greater relational difficulties, regression in daily living skills and an increase in the amount of repetitive or stereotypic behaviour. Many of these symptoms are frequently associated with ASD, therefore they may be assessed as part of the diagnosis of ASD rather than being the result of exposure to a traumatic event. The stress and/or trauma underlying these symptoms therefore continues to go unidentified and untreated. There is a very real need for validated clinical tools to help identify and examine traumatic and stressful life events in adults with ASD. It may be appropriate for examiners to have to actively seek information that would rule out any traumatic experiences as opposed to the usual practice of ruling them in during evaluation.
Clinical experience involving work with adult males with ASD (and average IQ and mild adaptive deficits), who are in secure facilities due to violence, seems to suggest that the procedure recommended by the Diagnostic Manual-Intellectual Disability (DM-ID) can be used when identifying and understanding trauma in adults with ASD. The DM-ID guidelines recommend first identifying traumatic events, followed by assessing changes in functioning after exposure to these events. Currently, there are no specific guidelines for assessing trauma in individuals with an ASD. Clinical experience indicates that the approach recommended in the DM-ID may be a useful starting point for clinicians. This guideline may improve the reporting of abuse and trauma, particularly if clinicians aim to rule out trauma, rather than take the more traditional approach which is to rule it in given the substantial abuse that occurs with individuals with ASD and also its under-identification in this particular population.
There is a need for further research investigating the association between trauma and ASD. Future research could investigate the potentially unique perception of traumatic events (particularly from the social domain) in individuals with ASD and also investigate the possibility and ways in which individuals with ASD may exhibit symptoms of traumatic stress in a distinct manner when compared to typically developing individuals and, crucially, the traditional diagnostic criteria for PTSD. This research is essential to the identification of trauma in individuals with ASD. The research would also help address a number of other aspects which there is currently very little known about. For instance, to see whether there are unique symptom profiles in individuals with ASD and to inform the development of appropriate treatment strategies and support. Indeed, Haruvi-Lamdan and colleagues (2018) recently highlighted that there is no intervention programme which focuses on targeting PTSD-ASD comorbidity. Clearly there is much work still to be done in this area.