Autism and PTSD: What’s the Connection?

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.

Understanding 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

Are autistic individuals at higher 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.

Autistic children may be at higher risk of being abused by caregivers. A Tennessee Child Abuse Hotline 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.

Studies have 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:

Common causes of trauma in autistic children

Bullying may not meet DSM-5 criteria, but research suggests it can trigger PTSD traits, especially in autistic individuals.

A 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.

One 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 the signs in your child.reases 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.

Can trauma cause autism?

Trauma does not cause autism, but it can impact how autistic traits are expressed or how a child copes day to day.

Autism is a neurodevelopmental condition believed to have genetic and neurological roots that begin before birth.

However, children who experience trauma, such as abuse, neglect, or extreme stress, may show behaviors that overlap with autism symptoms, like social withdrawal or communication difficulties.

This can sometimes make diagnosis more complex. It’s important for professionals to consider both trauma history and developmental differences when evaluating a child.

While trauma can’t cause autism, addressing emotional stress through the right support can make a big difference in your child’s well-being.

Can PTSD look like autism?

Yes, PTSD can sometimes look like autism, especially in children. Both conditions may involve challenges with communication, emotional regulation, social interaction, and repetitive behaviors.

A child with PTSD might avoid eye contact, struggle with changes in routine, or become overwhelmed in certain environments, behaviors that can also be seen in autism.

However, the root causes are different: autism is a lifelong neurodevelopmental condition, while PTSD is a response to trauma.

Because of these overlapping signs, it’s essential to get a thorough evaluation from professionals who understand both conditions.

This helps ensure your child gets the right diagnosis and support tailored to their specific needs.

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.

Autism and PTSD in Adults

Autism and PTSD in adults can sometimes overlap, but they are two different conditions. 

Adults on the autism spectrum may be more vulnerable to developing post-traumatic stress disorder (PTSD), especially if they’ve faced bullying, sensory overload, or long-term misunderstandings throughout their lives.

Because autistic individuals often experience the world more intensely, stressful or traumatic events can have a deeper impact.

Unfortunately, PTSD can go unnoticed in autistic adults, as symptoms like emotional shutdowns, anxiety, or avoidance may be mistaken for autism-related behaviors. 

Recognizing both conditions is key to getting the right support.

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.

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

• Cognitive Behavioral Therapy (CBT): Trauma-focused CBT challenges distorted thoughts, teaches calming techniques, and discusses trauma.
• Play therapy: Uses play, like games or drawings, to help very young children process trauma.
• Medication: Antidepressants may be prescribed in some cases.
• 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.

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: 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 cause autism?

A: No, PTSD does not cause autism. Autism is a neurodevelopmental condition present from early childhood, while PTSD is a response to trauma that can develop at any age.

Q: How do autistic people deal with stress?

A: Autistic individuals may cope with stress through routines, stimming, or retreating to quiet, familiar environments. Supportive strategies like sensory tools, mindfulness, and clear communication can also help manage stress effectively.

Q: Is stimming a symptom of PTSD?

A: Stimming is not a core symptom of PTSD, but repetitive or self-soothing behaviors can occur in response to trauma or anxiety. These behaviors may resemble autistic stimming but serve a different psychological purpose.

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References

Research Mapping of Trauma Experiences in Autism Spectrum Disorders: A Bibliometric Analysis, 2023

PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms, 2018

A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder, 2018

Interpersonal Trauma and Posttraumatic Stress in Autistic Adults, 2021

IAN Research Report: Bullying and Children with ASD