The Autism Society Event and Education Recordings Archive

Individuals with developmental disabilities are at increased risk for abuse as compared to the general population (Gil, 1970; Mahoney & Camilo, 1998; Ryan, 1994). Children and youth with autism spectrum disorders (ASDs) are frequently placed in a variety of “out-of-home” placements or their behavior is so challenging that they are victims of numerous restraints and punitive measures in a poor attempt to manage or “break” them of these behaviors. Many have been in residential treatment facilities and therapeutic foster- care services while several more have been in juvenile justice facilities. During my interactions with these young people, it has become clear to me that most of them exhibited at least moderate signs of Post Traumatic Stress Disorder (PTSD) in addition to their ASDs.

A Brief Overview of Post Traumatic Stress Disorder (PTSD)

According to the DSM-V-TR (APA, 2000), individuals with PTSD respond to the trauma with intense fear, hopelessness, horror, agitation or disorganized behaviors. Diagnostic criteria also include the persistent avoidance of stimuli associated with the trauma and persistent increased arousal. There must also be clinically significant distress or impairment in social, occupational or other important areas of functioning. Other symptoms include; recurrent dreams, dissociative states, reliving of traumatic event and avoidance of the activity, person and/or situations that arouse recollection of the event.

Neurologically, there is evidence that the anxiety, fear and memories associated with PTSD are influenced by the amygdala and hippocampus (Bremner et al., 1997; McEwen & Magarinos, 2004). According to a 2004 report by the National Child Traumatic Stress Network, persistent states of fear in children impair their capacity to benefit from cognitive, social and emotional experiences (Perry, 2001). Exposure to trauma can modify the child’s ability to access different levels of brain functioning, resulting in changes in their perception of time, cognitive style, affective tone, ability to develop solutions to problems, and ability to respond to and understand rules, regulations and laws (Perry, 2001). Extinction memories and lessening the original fear response appear to involve the prefrontal cortex (PFC) area of the brain, involved in tasks such as decision making, problem solving and judgment (Milad & Quirk, 2002).

A Brief Overview of Autism Spectrum Disorders

There are a substantial number of characteristics of ASD that may lend themselves to an increased potential for experiencing PTSD through continued exposure to poor behavior management strategies and repeated negative social interactions. Autism is a Pervasive Developmental Disorder (PDD) that currently affects 1 in every 110 individuals in the United States (CDC, 2009). Characterized by varying impairments in communication, behavioral, social and cognitive functioning (APA, 2000), autism is currently considered to be a spectrum of disorders, including PDD and Asperger Disorder. Specifically, ASDs include a variety of skill deficits that vary both inter- and intra-personally throughout the community. There is clear evidence of universally present and wide-ranging severity of deficits in abstraction abilities in individuals with autism (Szatmari et al., 1995; Prior & Hoffman, 1990; Minshew, Goldstein, Muenz, & Payton, 1992). Individuals with Asperger's or PDD-NOS (Pervasive Developmental Disorder-Not Otherwise Specified) focus on details and struggle to complete the abstract concept (Meyer & Minshew, 2002), which affects their problem-solving and reasoning skills (Minshew, Goldstein, & Siegel, 1997). Theory of Mind, or the ability to attribute mental states to oneself and to others (Baron-Cohen, Leslie, & Frith, 1985), is a hallmark social deficit associated with ASD. Examples of these mental states would be wishing, hoping, dreaming or guessing. It is also the basis for one of the primary cognitive theories of autism (Frith, 1991). Another well-documented and pervasive skill deficit for individuals with ASDs is the ability to demonstrate mental flexibility, or shift from one idea or alternative to another (Ozonoff, Pennington, & Rogers, 1991). This could explain their narrow range of interests or perceived stubbornness by those around them, and may also be one origin of the commonly observed repetitive, restricted or stereotypical behaviors among individuals with ASD (APA, 2000).

Communication deficits may range from a complete lack of verbal communication to deficits in the social or pragmatic use of language to severe impairments in the use or understanding of nonverbal communication (APA, 2000). Lastly, there are marked impairments in the ability to regulate affect, motivation and arousal as well as serious challenges in modulation or temperament of responses to socially based stimuli (APA, 2000; Myles, Dunn, & Orr, 2000). Among the most relevant neurologically based deficits for individuals with ASD that are similar to those of traumatized youth without ASD include both under- and over-growth of the amygdala, which can cause hyper-arousal and a constant state of agitation (Nacewicz et al., 2006; Schumann & Amaral, 2006). Aylward et al. (1999) found reduced volumes of amygdala and hippocampus. In all of these studies, activity associated with mentalizing or attributing social motivation and cause and effect was seen in three brain regions: an anterior region of medial prefrontal cortex/anterior cingulate cortex, an area in anterior temporal lobes close to the amygdala, and the superior temporal sulcus at the temporo-parietal junction.

Conclusions

In terms of policy implications, from a systemic point of view we may need to rethink our criteria for removing children with ASD from their home as well as their placement in any institutional facility. Current evidence suggests clear connections between typically developing individuals and the potential for PTSD in out-of- home placements, and there is no evidence to suggest that individuals with ASD would be any different. In light of documented similarities in brain structure and observable characteristics, it is not unreasonable to think that individuals with ASD might be more traumatized by the same experiences, especially if social deficits are accounted for as well. From the perspective of treatment planning, it would seem that screenings for PTSD could be easily performed on individuals with ASD who are in high-risk situations. It is also possible that interventions for PTSD may be useful in reducing corresponding signs or symptoms in individuals with ASD. Another issue that may become relevant is the use of purely behavioral interventions on individuals with ASD since they often involve the use of negative reinforcement or other techniques that could be perceived as traumatizing. Positive Behavior Supports, cognitive therapies to reduce the influence of traumatic experiences, and increased professional development opportunities are needed in order to address the systemic inadequacies that contribute to the pressing issue. This workshop will present information regarding the characteristics and influences of trauma and PTSD, the neurological overlap with ASD, and practical strategies for reducing problematic behaviors without traumatizing children and youth with ASD.