Autism and Aces: Symptom Presentation of Children with Autism Spectrum Disorder after Adverse Childhood Experiences and Trauma.

Background: Families affected by Autism Spectrum Disorder (ASD) experience several risk factors that increase their likelihood of experiencing Adverse Childhood Experiences (ACES), including increased parent stress, financial strain, isolation, and lack of social support (Benson, 2006; Dabrowska & Pisula, 2010; Singer, 2006). In addition, impairments in speech, language, and social skills can create a failure to report these experiences, limiting access to trauma-informed interventions (Levy et al., 2010; McEachern, 2012). Paradoxically, there are several characteristics of ASD that may exacerbate posttraumatic stress symptoms in this population, such as susceptibility to anxiety and poor emotion regulation abilities (Mazefsky et al., 2013). To date, very few studies have examined posttraumatic response in individuals with ASD.

Objectives: This study examined how children with ASD process and respond to ACES similarly or differently than (a) ASD children without ACES and 2) typically developing (TD) children with ACES.

Methods: Participants include a nationwide sample (n=150) of parents of children ages 3-12 years. The study gathered data from a culturally and socioeconomically diverse nationwide sample to measure social, emotional, and behavioral symptoms associated with posttraumatic stress response in children and symptoms commonly associated with an ASD diagnosis. Three study populations were recruited: children with ASD who experienced ACES, children with ASD who have not experienced ACES, and TD children who experienced ACES. Parents completed the Trauma Symptom Checklist for Young Children (TSCYC) to assess emotional-behavioral and posttraumatic stress symptoms, the Social Responsiveness Scale (SRS-2) to assess autism-related symptoms, and subtests of the Repetitive Behavior Scale (RBS-R) to assess self-injurious and compulsive behaviors. Two-way MANOVAs were conducted to assess for differences in symptom presentation between the three groups.

Results: Preliminary data suggest that ASD participants with ACES experience significantly higher symptoms of arousal (p<.05; ACES M=75.5(12.0), NoACES M=56.6(8.9)) and overall posttraumatic stress (p<.05; ACES M=71.8(19.1); No ACES M=51.3(5.5)) than ASD participants without ACES. Compared to TD peers who have experienced ACES, children with ASD who have experienced ACES demonstrate higher, clinically elevated levels of arousal (M= 75.5 vs M=59.4) and total posttraumatic stress response (M=71.8 vs 58.5). Lastly, results indicate that TD children with ACES demonstrate challenges in the use of appropriate reciprocal social behavior that fall in the Severe range (SRS-Total M=86.6(10.0)) similar to children with ASD who have experienced ACES (M=92.8(6.0)) and children with ASD who have not experienced ACES (M=89.7(11.9)). Pending analyses will also explore if increased posttraumatic stress and ASD symptomatology are associated with (a) an increased number ACES, (b) additional comorbid diagnoses, and (c) decreased language abilities.

Conclusions: This investigation is one of the first studies to compare posttraumatic stress response between children with ASD and TD peers. Due to increased vulnerabilities and impaired social communication abilities, it is believed that individuals with ASD may be underreported victims of trauma and maltreatment. Therefore, it is hoped that these results will fill a significant gap in the literature regarding the unique posttraumatic symptom presentation in children with ASD, with the goal of increasing timely identification and professional intervention.