Compared to males, women are at an elevated risk of their Autism Spectrum Disorder (ASD) going undiagnosed due to their difficulties being mislabeled or misunderstood. Women often require more severe autistic symptoms as well as increased cognitive and behavioral problems to be identified as autism. It has been found that teachers tend to underreport autistic traits in female students compared to male students. Even when girls and women are identified as having autism, they tend to receive their diagnosis, and associated support, later in life as compared to males. This gender bias has serious consequences for the health and wellbeing of women with ASD and has been identified by the autism community as a key problem to be addressed by research.
Individuals with autism, especially girls and women, are much more likely to experience PTSD than the general population. Research shows that autistic girls and women are more vulnerable to victimization and, subsequently more vulnerable to developing PTSD following a traumatic event. Girls and women with autism are 1.5 times more likely to be victimized than their neurotypical peers. In addition to being more vulnerable to victimization, autistic girls and autism are also more vulnerable to developing PTSD following a traumatic event.
When Autism Spectrum Disorder (ASD) and Post Traumatic Stress Disorder (PTSD) co-occur, PTSD is usually accurately diagnosed, but the autism diagnosis may be missed. A diagnosis of PTSD may be used to explain away autistic traits and experiences. There are many reasons it can be difficult to differentiate ASD from PTSD, especially in women. Below is a list of overlapping symptoms that can make it difficult to differentiate between the two diagnoses:
Sensory Sensitivities: The nervous system/amygdala tends to be on hyper-alert after a traumatic event has occurred as a way of trying to protect against future harm. This often looks similar to the sensory profile of an individual with autism who is hypersensitive.
Difficulty Regulating Intense Emotions: Because of increased amygdala activation and their sensory profile, it can be difficult for individuals with PTSD and ASD to regulate difficult emotions.
Increased Risk of Substance Abuse: Substances can be a powerful way to regulate a hyperactive nervous system therefore, individuals with PTSD and ASD are at an increased risk of substance abuse disorders.
Self-Harm Behavior: Self-harm behaviors sometimes present as an attempt to ground, self-soothe, and regulate the nervous system. As a result, self-harm behavior is increased in individuals with PTSD and ASD.
Dissociation: Dissociation is a common trauma response and can also be a response to someone who is experiencing sensory overload.
Suicidality: Individuals with autism are 3 to 7 times more likely to die by suicide. Suicidality is also more common among trauma survivors.
Below are important facts about the intersection of autism and trauma:
- Rumball et al. (2020) study found that approximately 60% of autistics reported PTSD in their lifetime (compare this to 4.5% of the general population).
- Haruvi-Lamdan et al., 2020 study found that 32% of their autistic participants had probable PTSD compared to 4% of non-autistic population
- Fenning et al, 2019 research demonstrated that autistic children had more reactive nervous systems. This aligns with similar research that has identified the autistic nervous system to be less flexible (Thapa and Alvares, 2019). Less flexible nervous systems have a more difficulty time coping with acute stressors and may contribute to increased hyperactivation of the nervous system following trauma.
- Neurodivergent (ADHD/Autism) neurobiology is more vulnerable and reactive. (Beauchaine et al., 2013)
- Individuals with autism are more vulnerable to social victimization and marginalization. In the Haruvi-Lamdan et al., 2020 females with autism (but not males) reported more negative life events, particularly social events than typical adults.
Given the intersectionality between trauma and autism, as well as specific experiences of autism girls and women, Insights Colorado Assessment and Therapy is committed to acknowledging the impact of trauma on the diagnostic and therapeutic process.