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Autism Spectrum Disorder (ASD) and Post-Traumatic Stress Disorder (PTSD) are two very distinct conditions. Unfortunately, they can often intersect in ways that confound diagnosticians and complicate prognosis and treatment. Autistic people process the world around them differently. This tendency can make them more susceptible to trauma.
Understanding this interaction is extremely important for providing them with the best, most effective support.
Understanding Autism and PTSD
Autism Spectrum Disorder (ASD) is the medical term for autism. The National Autism Association defines autism as a developmental disability that is bio-neurological in nature. It generally presents in individuals before the age of three.
The condition affects the brain’s social interaction, communication, and sensory processing development. Individuals with autism typically have difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities
In contrast, Post-Traumatic Stress Disorder (PTSD) is an individual’s response to trauma that progresses into persistent distressing symptoms, such as flashbacks, avoidance of triggers of the traumatic event, emotional dysregulation, adverse changes in thinking and mood, and hyperarousal and hyperreactivity.
How ASD and PTSD Overlap
Many symptoms of PTSD in autism can look similar, leading to misdiagnosis. Both conditions can involve:
- Heightened anxiety and emotional dysregulation
- Sensory sensitivities that trigger distress
- Sleep disturbances
- Social withdrawal and avoidance behaviors
Trauma affects autistic individuals differently. Sensory overload, disruptions in routine, and difficulties interpreting social cues can make everyday interactions incredibly stressful. Situations that might not be traumatic for neurotypical individuals—such as unexpected changes or overwhelming sensory input—can have a lasting impact on someone with autism. Additionally, autistic individuals may struggle to communicate distress, leading to undiagnosed trauma responses.
While PTSD can affect anyone, research indicates that autistic individuals are more likely to experience PTSD symptoms. Although this research hasn’t yet established the prevalence rates definitively, the rates of probable PTSD in autistic communities are as high as 32-45%, compared to only 4-4.5% in the general population. (Rumball et al., 2020; Rumball et al., 2021; Haruvi-Lamdan et al., 2020).
Studies published on PubMed also suggest that PTSD and ASD may share several vulnerability pathways, including height and sensory sensitivity, challenges in emotional regulation, and increased susceptibility to environmental stressors (Haruvi-Lamdan et al., 2018).
Challenges in Diagnosis
Diagnosing Autism or PTSD
For people who have symptoms that could be autism or PTSD, diagnosis requires a comprehensive evaluation from a psychologist. In children, this can be performed by a child psychologist.
During an evaluation, professionals assess:
- Personal History
- Daily Functioning
- Communication Skills
- Repetitive Behaviors
- Mental Health Symptoms
However, distinguishing between these conditions can be challenging. For those who already have one diagnosis, getting the second one can be even harder due to diagnostic overshadowing. That’s when symptoms are attributed to a known condition while another remains undetected.
As a result of diagnostic overshadowing, clinicians may mistakenly attribute PTSD symptoms to autism, delaying proper diagnoses. This error can be highly problematic for people who do not fit the typical autism profile or have co-occurring conditions that mask ASD traits (Nihit Gupta et al., 2023).
Assessment Tools for Accurate Diagnosis
Because Post Traumatic Stress Disorder and autism share overlapping symptoms, professionals use specialized tools to aid in diagnosis. The Autism Diagnostic Observation Schedule (ADOS®-2) is commonly used to assess social communications and behavior in individuals suspected of having ASD.
The Sensory Processing Measure (SPM™-2) evaluates sensory sensitivities that may contribute to trauma-related distress. Since sensory overload can mimic PTSD symptoms, understanding an individual’s sensory profile is crucial for an accurate diagnosis.
A comprehensive evaluation that includes multiple assessment tools ensures better differentiation between PTSD, autism, or both.
Questions You Can Ask
To clarify whether a developmental delay may be connected to autism, trauma exposure, or both, you may want to ask questions like these:
- Have elements of a child’s life or history created an ongoing state of fear or terror that might interrupt mastery of age-appropriate competencies or cause social or behavioral difficulties?
- Does a lack of interest in peers seem to stem from social withdrawal, from an attachment difficulty, or a difference in social–emotional reciprocity?
- If a child isn’t sharing emotions or expressing affection, is it part of an overall reduction in positive feelings, or does it appear to be connected to a more general pattern of social communication differences?
- Does social communication or emotional reciprocity change as a child becomes more comfortable in an environment?
- Does a repetitive play pattern seem related to avoiding or experiencing intrusive memories?
- If a child experiences an emotional “outburst,” was it sparked by irritability, a sensory experience, or a disruption in routines?
- If a child has sleep difficulties, are nightmares involved?
- Are behaviors and abilities consistent across settings and over time?
In addition, it’s crucial to gather information about a child’s early developmental history. This history should include personal and family strengths and the parent or caregiver’s concerns. Consider using a tool for screening trauma, a resilience assessment, or a measure of adaptive functioning, such as the Adaptive Behavior Assessment System (ABAS®-3), in addition to validated autism assessments, to help you generate as clear a picture of the child’s experience as possible.
To conduct a thorough and comprehensive evaluation, it’s best to work with a multidisciplinary team, including a speech–language pathologist and an occupational therapist. If you do encounter evidence of PTSD or other traumas, it is often helpful to explore the resources offered by the National Child Traumatic Stress Network.
Learn more at WPS about how to use Autism Assessment Resources and Screening Tools to enhance your diagnostic process and implement trauma-informed approaches to support individuals with autism and PTSD.