The vast majority of folks will, in some unspecified time in the future, expertise a traumatic occasion, however solely 3.9-5.6% will develop a post-traumatic stress dysfunction, or PTSD (WHO, 2024).
In autistic folks, PTSD could also be particularly pronounced via maladaptive coping and traumatic recollections. Autistic people are likely to exhibit excessive avoidance coping, attentional bias in the direction of threatening stimuli, and different autism-associated traits or tendencies that, regardless of being precursors of PTSD, are sometimes dismissed as a ‘regular’ a part of ASD (Ehlers & Clark, 2000; Lage et al., 2024).
This could result in a ‘diagnostic overshadowing’ bias, which signifies that the PTSD-related challenges and distinctive options of PTSD in autistic folks go unrecognised. Quinton and colleagues (2024) from King’s School London convey this bias into the highlight of their evaluate of the strategies of PTSD evaluation and the core signs of PTSD in autism.
Autistic people are weak to PTSD, but their trauma is commonly misunderstood—underscoring the necessity for higher understanding and therapy in ASD.
Strategies
The authors adopted PRISMA pointers and the inclusion standards as in Rumball (2019). The evaluate included research printed in English and samples with formal diagnoses of PTSD and ASD. The authors reviewed a variety of research: cross-sectional, case research, case-control, experimental, longitudinal, and randomised managed trials.
A complete of 18 research had been included within the evaluate. These had been the brand new research recognized after Rumball’s evaluate (2019). For high quality evaluation, the researchers used the modified Newcastle-Ottawa Scale and Joanna Briggs Institute guidelines.
Outcomes
All research on this systematic evaluate had an evaluation of PTSD in autistic folks. Three of the 18 research had been case research; the opposite 15 will likely be known as “group research” (like in Quinton et al., 2024). Most research had blended genders, with the proportion of girls/women starting from 15.4% to 61.92%. Three research out of seven that thought-about the position of gender reported intercourse variations, reported that autistic girls had considerably extra PTSD signs, while different research discovered no intercourse variations.
Evaluation and Prevalence of PTSD
Group research balanced using questionnaires and open-ended questions/interviews to evaluate trauma publicity in autistic folks. Instance occasions/experiences included difficulties socialising, being bullied, being deserted, experiencing abuse, and following an autism intervention. Total, autistic populations had greater trauma publicity and adverse social occasions than their non-autistic friends. Additionally, autistic folks had extra PTSD signs than their non-autistic counterparts. These signs had been intrusion, adverse cognition, thought suppression, rumination, and poorer working and on a regular basis reminiscence.
The evaluate recognized these measurement instruments used throughout the research to evaluate PTSD signs in autistic folks:
- PLC-5 (PTSD guidelines for DSM-5);
- Impression of Occasion Scale-Revised;
- Tailored Anxiousness Problems Interview Schedule;
- Self-report {of professional} psychiatric prognosis;
- PTSD-specific merchandise from Baby and Adolescent Symptom Stock;
- UCLA post-traumatic stress dysfunction response index for DSM-5.
The authors estimated that round 5.14% of autistic youngsters and adolescents reported present PTSD prognosis and 5.22% reported lifetime PTSD prognosis. Amongst autistic adults, as much as 20% reported a PTSD prognosis of their lifetime.
Remedy of PTSD
The evaluate recognized 4 research that regarded on the therapy of PTSD in autistic folks.
Eye Motion Desensitisation and Reprocessing (EMDR) is a remedy the place sufferers briefly give attention to trauma recollections whereas present process stimulation of the left and proper sides of the physique via guided eye actions. EMDR goals to cut back the depth and emotional impression of traumatic recollections. One research on this evaluate (Lobregt-van Buuren et al., 2019) confirmed that EMDR decreased PTSD signs and psychological misery, and, subsequently, could also be an efficient therapy choice for autistic folks with PTSD.
In the meantime, three case research thought-about different therapy choices, together with Narrative Publicity Remedy, tailored CBT, trauma-informed care, and exposure-based intervention. The latter was discovered to be distressing because it worsened the participant’s avoidance signs (Kildahl & Jørstad, 2022). Different interventions confirmed some advantages for lowering signs together with self-harm, however some outcomes weren’t reported (e.g., for tailored CBT).
Variations that had been undertaken to tailor interventions for autistic folks included dedicating extra time to remedy and knowledgeable consent completion. Workers members had been knowledgeable about non-verbal communication in autism, and one research carried out classes throughout outside walks for contributors’ consolation.
High quality evaluation of included research
The evaluate reviews that the majority research had been of top quality, however a number of areas require extra consideration:
- Potential choice bias in the direction of the inhabitants who has an official prognosis.
- On-line research had a predominantly feminine pattern, whereas in-person research concerned predominantly male contributors.
- Most research didn’t differentiate between intercourse and gender, limiting gender inclusivity.
- Research are likely to recruit autistic folks with good verbal skills and higher-than-average IQ.
- Not one of the research had been participatory.
EMDR remedy reveals potential as a therapy for PTSD in autistic folks, whereas different interventions require variations to fulfill autism-specific wants.
Conclusions
The authors concluded that since Rumball’s evaluate in 2019, educational curiosity in PTSD in autistic folks has elevated, however the discipline continues to be in its infancy. The charges of PTSD within the autistic inhabitants had been corresponding to these in neurotypical populations, however symptom prevalence was greater in autistic cohorts. Extra analysis is critical to grasp the aetiology variations between autistic folks with PTSD and their non-autistic counterparts. The authors emphasised that it’s essential to:
perceive particular cognitive strengths and vulnerabilities that autistic folks have in relation to the event and upkeep of PTSD
– Quinton et al., 2024, p. 29
Moreover, researchers ought to account for a way these variations could impression the evaluation and therapy of PTSD in autistic folks, as:
this may in the end result in efficient methods to diagnose and deal with PTSD in autistic youngsters and adults
– Quinton et al., 2024, p.32
This underscores the significance of contemplating the distinctive cognitive profiles of autistic people, to enhance outcomes for these with PTSD.
Autistic people face greater charges of trauma and PTSD signs than non-autistic friends; highlighting the pressing want for analysis into autism-specific signs, tailor-made PTSD assessments, and efficient remedies.
Strengths and limitations
This evaluate has a number of strengths, comparable to transparency, a transparent analysis query, and use of validated instruments to evaluate research high quality.
The authors raised a limitation of excluding individuals who self-identify as autistic, suggesting a bias in the direction of a restricted variety of people who can afford to get recognized. Within the UK, solely 4.9% of individuals with referrals for autism evaluation get the appointment throughout the beneficial timeframe (NHS, 2024). The choice is a non-public evaluation that prices, on common, round £2,000, in accordance with Gesher Evaluation Centre (2024). Nevertheless, I might argue that there’s an extra subject with belief in self-diagnosis; e.g., autistic people report clinicians’ distrust as one of many key limitations to receiving a well timed prognosis (Lewis, 2017). It is very important bridge this hole by rising the affordability and accessibility of formal autism evaluation and thru recognising self-diagnosis in participant recruitment.
Present literature additionally seems to have restricted pattern range. For example, the research solely included people with excessive IQ and good verbal skills, which creates a biased view of PTSD within the autistic group. There was additionally an fascinating sample of extra females participating in on-line research, whereas extra males participated in in-person research. I might be eager to grasp the explanations behind such distribution; e.g., is feminine “camouflaging” concerned in on-line participation? Or, probably, do autistic males/boys obtain extra assist than autistic girls/women? Lastly, I appreciated that Quinton and colleagues famous that the majority research had been gender-binary, calling for extra gender-inclusive analysis observe.
Future analysis ought to think about gender inclusivity, variations in verbal capability, and IQ biases to foster a deeper, extra nuanced understanding of PTSD amongst autistic people.
Implications for observe
This evaluate opens up avenues for future investigation of the distinctive signs of PTSD and its aetiology within the autistic inhabitants, in addition to the person variations inside the autistic populations (e.g., IQ, gender, race, and many others.). Moreover, the subjective expertise of trauma is, maybe, much more vital than what ‘objectively’ qualifies as ‘traumatic’. One approach to deal with this hole is thru qualitative research, which weren’t included within the evaluate however have a robust potential to unveil the distinctive experiences of the autistic inhabitants.
As for medical implications, there may be rising proof that EMDR is perhaps a promising therapy. Nevertheless, clinicians ought to pay attention to the potential harms of exposure-focused remedies on account of their propensity to boost avoidance signs that keep PTSD. Moreover, clinicians working with people with ASD must be conscious of the ‘diagnostic overshadowing’ bias. For example, reflecting on the foundation causes of sure difficulties being on account of potential trauma or related to the autistic profile. This may be supplemented with the prevailing measures, comparable to PLC-5, however additional improvement of autism-specific scales is warranted. Lastly, when enquiring about potential traumatic experiences, medical practitioners ought to account for variations in what’s skilled as traumatic by people with ASD and construct a formulation accounting for these variations.
This evaluate paves the way in which for exploring how PTSD manifests in ASD and the way greatest to deal with it, whereas additionally urging rigorous, inclusive research that honour particular person strengths and variations.
Assertion of pursuits
No battle of curiosity to declare.
Hyperlinks
Major paper
Quinton, A. M. G., Ali, D., Danese, A., Happé, F., & Rumball, F. (2024). The evaluation and therapy of post-traumatic stress dysfunction in autistic folks: a scientific evaluate. Evaluation Journal of Autism and Developmental Problems. https://doi.org/10.1007/s40489-024-00430-9
Earlier systematic evaluate
Rumball, F. (2019). A scientific evaluate of the evaluation and therapy of posttraumatic stress dysfunction in people with autism spectrum issues. Evaluation Journal of Autism and Developmental Problems, 6(3), 294-324. https://doi.org/10.1007/s40489-018-0133-9
Different references
Ehlers, A. and Clark, D. M. (2000). A cognitive mannequin of posttraumatic stress dysfunction. Behaviour Analysis and Remedy, 38(4), 319-345. https://doi.org/10.1016/s0005-7967(99)00123-0
Gesher Evaluation Centre. (2024, Jul 29). How a lot does a non-public autism evaluation price?
Kildahl, A. N. and Jørstad, I. (2022). Put up-traumatic stress dysfunction symptom manifestations in an autistic man with extreme mental incapacity following coercion and scalding. Journal of Mental & Developmental Incapacity, 47(2), 190-194. https://doi.org/10.3109/13668250.2021.1995930
Lage, C., Smith, E. S., & Lawson, R. P. (2024). A meta-analysis of cognitive flexibility in autism spectrum dysfunction. Neuroscience & Biobehavioral Opinions, 157, 105511. https://doi.org/10.1016/j.neubiorev.2023.105511
Lewis, L. F. (2017). A blended strategies research of limitations to formal prognosis of autism spectrum dysfunction in adults. Journal of Autism and Developmental Problems, 47(8), 2410-2424. https://doi.org/10.1007/s10803-017-3168-3
Lobregt-van Buuren, E., Sizoo, B., Mevissen, L., & Jongh, A. d. (2018). Eye motion desensitization and reprocessing (EMDR) remedy as a possible and potential efficient therapy for adults with autism spectrum dysfunction (ASD) and a historical past of adversarial occasions. Journal of Autism and Developmental Problems, 49(1), 151-164. https://doi.org/10.1007/s10803-018-3687-6
Nationwide Well being Service. (2024, Nov 14). Autism Statistics, October 2023 to September 2024.
World Well being Group. (2024, Could 27). Put up-traumatic stress dysfunction.
