Crossroads of Adverse Childhood Experiences, PTSD, and Autism Symptoms
Without a specific, objective diagnostic test for autism spectrum disorder (ASD), clinicians can struggle to distinguish behavioral symptoms of ASD from depression, anxiety, post-traumatic stress disorder (PTSD), or other behaviorally-based disorders. Should the 7 year-old boy who is shy, engages in repetitive play, and prone to violent bursts when overwhelmed receive a diagnosis of ASD? Could he be struggling with PTSD? Could it be both?
Research has shown that up to 70% of people who are diagnosed with autism also have a co-occurring mental health disorder. Depression, anxiety and obsessive-compulsive disorder are most common among autistic* individuals, and approximately 3% are affected by PTSD, according to recent research.
It’s common to hear about PTSD in veterans or abuse survivors, however any number of experiences may be perceived by an individual as traumatizing, and can lead them to experience symptoms of PTSD. Child trauma is often referred to as Adverse Childhood Experiences (ACEs) and can include divorce, physical or emotional abuse / neglect, sexual abuse, domestic violence, substance abuse, mental health issues in the home, incarceration of a parent, and others. The experience of trauma might be compounded for children with autism, who may have strong sensitivities to touch, sound, light, or change in routine. As with ASD, PTSD has several domains of symptoms that fall into a spectrum of severity. For example, an individual struggling with PTSD may re-experience a traumatic episode through flashbacks or nightmares; they might feel emotionally numb or avoid people, places and things that remind them of the trauma; and/ or they might experience “hyperarousal” and feel jumpy, have trouble sleeping, and be easily irritated or angered. They may experience any combination of these symptoms, and find some more impairing than others.
While PTSD and ASD are separate conditions, they are not mutually exclusive, and little is known about what experiences autistic individuals find traumatizing and how they process and cope with these traumatic experiences. Recent research has shown that autistic children are more likely to experience adverse childhood experiences (ACEs) than typically developing children.
Delays in receiving the appropriate treatment(s) can occur when clinicians do not recognize, or misclassify, the symptoms of ASD and PTSD in children. “We know that early diagnosis and intervention are crucial for both ASD and PTSD,” says Amanda Bennett, MD, MPH, a developmental pediatrician at Children’s Hospital of Philadelphia and researcher at CAR. Dr. Bennett will be presenting on the intersection of ASD and ACEs in a webinar hosted by CHOP Violence Prevention. “We hope that by learning how to distinguish between symptomology, clinicians will feel confident to refer patients and families to the appropriate resources and specialists, or even make a diagnosis themselves,” explains Dr. Bennett. For more information and to register, please visit CHOP’s Violence Prevention Initiative.
** Please note, CAR uses both person-first and identity- first language. Recent research has demonstrated that “autistic” is the preferred term in the autism community, with many others preferring “on the autism spectrum” or “person with autism”(Kenny et al., 2016, "Which terms should be used to describe autism? Perspectives from the UK autism community" Autism).