Complex Trauma in Childhood and Autism: Overlapping Traits and the Importance of Addressing Trauma First

When conducting an autism assessment, a full understanding of the child's developmental history is very important to guide any potential differential diagnoses. Childhood traumatic experiences are often a reason I suggest delaying an autism assessment, until direct intervention for trauma has been pursued.

Childhood trauma can have profound effects on a person's development, sometimes leading to behaviors and traits that resemble autism or other neurodiversity. This overlap can complicate the diagnostic process, particularly when symptoms align with both post-traumatic stress disorder (PTSD) and autism as outlined in the diagnostic manuals we use - DSM-5-TR. Understanding the intersection between complex trauma and autism is crucial in ensuring an accurate diagnosis and effective intervention.

The Overlap Between PTSD and Autism Traits

The DSM-5-TR outlines distinct criteria for both PTSD and autism, but some symptoms of complex trauma—especially when it occurs in early childhood—can closely mimic autism traits. Here’s how:

1. Social Differences (A1-3)

   • PTSD (DSM-5-TR): Social withdrawal, difficulties in trusting others, hypervigilance, avoidance of social situations due to fear or anxiety as a direct result of past or current trauma. Under a PTSD diagnosis, this is covered under Criterion C (avoidance) and Criterion D (negative alteration in cognitions and mood).

   • Autism (DSM-5-TR): Difficulty with social reciprocity, challenges in understanding social cues, struggles with forming peer relationships.

   • Key Difference: In trauma, social withdrawal often stems from fear, whereas in autism, it is more related to inherent differences in processing social interactions.

2. Differences with Emotional Regulation (A1)

   • PTSD: Emotional dysregulation is common, including outbursts, dissociation, and extreme mood swings triggered by trauma reminders. Under a PTSD diagnosis, this is covered under Criterion B (intrusion symptoms) and Criterion D (negative alteration in cognitions and mood).

   • Autism: Challenges in emotional regulation can manifest as meltdowns or shutdowns due to differences in processing emotions.

   • Key Difference: Emotional responses in trauma are typically tied to specific triggers, whereas in autism, differences in regulation are more consistent across different situations.

3. Repetitive Behaviors and Routines (B1-3)

   • PTSD: Trauma survivors may develop repetitive behaviors as a coping mechanism, such as self-soothing actions, rigid routines to maintain a sense of safety, or hyperfixation on certain activities as a distraction from distress. Under a PTSD diagnosis, this is covered under Criterion C (avoidance) and Criterion E (alterations in arousal and reactivity).

   • Autism: Repetitive behaviors (e.g., stimming, strict adherence to routines, restricted interests) are a core feature of autism and are neurologically driven rather than a learned coping strategy.

   • Key Difference: In trauma, rigidity in routines is often rooted in fear and control, whereas in autism, it is an intrinsic need for predictability.

4. Sensory Sensitivities (B4)

   • PTSD: Heightened sensory responses may result from hypervigilance, leading to exaggerated startle responses, difficulty with certain textures or sounds, and a low threshold for stress. Under a PTSD diagnosis, this is covered under Criterion C (avoidance) and Criterion E (alterations in arousal and reactivity).

   • Autism: Sensory processing differences are a defining feature of autism, often presenting as either hyper- or hypo-sensitivity to stimuli.

   • Key Difference: Sensory sensitivities in trauma tend to be context-dependent, triggered by reminders of past experiences, whereas in autism, they are persistent across all environments.

     
     

The Link Between Autism and Trauma

Research indicates that autistic individuals are more likely to experience trauma due to factors such as heightened sensory sensitivities, differences with social communication, and an increased likelihood of parenting stress, being bullied or misunderstood. These vulnerabilities can contribute to a higher prevalence of PTSD in autistic individuals compared to the general population.

Why Addressing Trauma First Is Crucial

When a child presents with traits resembling autism, but has a history of trauma, it is essential to first address the impact of trauma before pursuing an autism diagnosis. Here’s why:

1. Trauma Treatment Can Alleviate Symptoms: Many trauma-related symptoms, such as social withdrawal, sensory reactivity, and emotional dysregulation, can improve with therapy (e.g., trauma-focused cognitive behavioral therapy, EMDR). If these symptoms lessen, an autism diagnosis may not be necessary.

2. Avoiding Misdiagnosis and Misguided Interventions: Misdiagnosing trauma as autism can lead to inappropriate interventions that do not address the core issues. For example, environmental modifications for autism may not be effective if the root cause is trauma-induced social avoidance and these concerns may never be directly addressed.

3. Ensuring an Accurate Autism Diagnosis: If a child continues to show autism traits after trauma has been addressed, then an autism assessment is warranted. This ensures that the diagnosis is based on neurodevelopmental differences rather than trauma-related adaptations.

   
   

Final Thoughts

While complex trauma and autism share overlapping traits, they stem from fundamentally different causes—one from environmental adversity and the other from neurodevelopmental differences. A careful, trauma-informed approach is essential in determining whether a child’s differences are trauma-based or truly indicative of autism. By prioritising trauma recovery first, we can ensure a more accurate diagnosis and appropriate support for the child’s long-term well-being.

Please reach out to me if you would like support and guidance in supporting your child who has endured trauma.