Symptom Presentation of Children with Autism Spectrum Disorder after Maltreatment and Trauma

Background: Children with disabilities are 3.4 times more likely to be maltreated than nondisabled peers, with children diagnosed with Autism Spectrum Disorder (ASD) encompassing a significant proportion of these children (Sullivan & Knutson, 2000). Families with a child with ASD experience several maltreatment risk factors, including increased parental stress, limited social support, increased isolation, and financial burden. Although children with other disabilities may experience more frequent episodes of maltreatment, victims with ASD may go unidentified due to impairments in verbal communication and existing externalizing behaviors that may mask common red flags of trauma. Paradoxically, there are several characteristics of ASD that may exacerbate posttraumatic stress response in this population, such as pre-existing anxiety-related conditions and poor emotion regulation abilities. Despite this knowledge, very few studies have examined posttraumatic response in individuals with ASD and results are inconsistent.

Objectives: This study examined how children with ASD respond to trauma and maltreatment compared to typically developing children. It also explored similarities and differences in symptom presentation compared to children with ASD who have not experienced maltreatment or trauma.

Methods: Participants included a nationwide sample of parental guardians of children ages 3-12 years who are a) a victim of maltreatment or trauma, or b) have a diagnosis of autism spectrum disorder, which resulted in three participant groups: ASD trauma, TD trauma, ASD no trauma. Parents completed the Adverse Childhood Experiences Survey to assess for experiences of abuse, neglect, witnessing domestic violence, or trauma. Parents also completed the Trauma Symptom Checklist for Young Children to measure emotional-behavioral and posttraumatic stress symptoms, the Social Responsiveness Scale to measure autism-related symptoms, and items of the Repetitive Behavior Scale to measure for self-injurious, compulsive, and ritualistic behaviors. Two-way MANOVAs were conducted to assess for differences in symptom presentation between the three groups. Analyses included moderators to assess the impact of age, trauma type, and verbal ability on posttraumatic stress response.

Results: Data collection and data analysis are ongoing and will continue to identify significant group differences. Preliminary analyses suggest that children with ASD who have experienced trauma will demonstrate elevations in anxiety- and emotion dysregulation-related posttraumatic stress symptoms. Within this group, it is also predicted that victims with increased social cognition and social awareness will experience stronger posttraumatic stress symptoms than those with decreased social cognition and awareness. Lastly, preliminary data suggests that victimized ASD participants with lower age and reduced verbal abilities are suspected to demonstrate higher levels of externalizing symptoms compared to the victimized typically developing and non-victimized ASD groups.

Conclusions: To our knowledge, this study is the first study to compare posttraumatic stress response between children with autism and typically developing peers. It is hoped that these results will contribute to a gap in the literature regarding posttraumatic response in children with ASD. By understanding how this vulnerable population responds to maltreatment and traumatic experiences, psychologists and practitioners may be better equipped with the knowledge needed to identify victims and provide appropriate care.