In case someone who knew me ever wondered what was wrong with me and why this and why that and couldn’t figure out why i’m such weirdo. Please read this text and also this. Thank you!
Traumatic events such as abuse, bullying, and exposure to violence are commonplace among typically developing children and occur at least as often among those with autism spectrum disorder (ASD). Children with ASD are vulnerable to traumatization due to their deficits in social communication and emotion regulation.
Research on posttraumatic symptoms among children with ASD is reviewed. Bullying has received much attention while there is a paucity of research on other types of trauma. Anxiety, social isolation, and developmental regression are associated with trauma. Further research is needed to clarify the symptom presentation and frequency of PTSD. Sensitive self-report measures are needed as well as validation of existing measures for assessing trauma in this population.
Posttraumatic stress disorder is described in the DSM-5 as a syndrome arising from witnessing, directly experiencing, or being otherwise exposed to serious physical or sexual violence, threats to bodily integrity, or death of family members (American Psychiatric Association 2013). The central symptom pattern is as follows: (a) re-experiencing of traumatic thoughts or images through memories, dreams, or intrusive thoughts; (b) negative cognitive and mood states related to the trauma; and (c) alteration of physical arousal related to the trauma. Other types of adjustment difficulties, including impairment of relationships and attachment, avoidance of traumatic reminders, and behavior and emotional problems are labeled “trauma related symptoms” while they may not meet full criteria for PTSD (Goenjian et al. 1995; Perkonigg et al. 2005). Trauma effects children differently at each stage of development and can interfere with the acquisition of developmental milestones (Lieberman et al. 2011; Trickett et al. 2011). Males and females are exposed to violence and abuse at about the same rate (US Department of Health and Human Services Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau 2015). However, there are gender differences in the expression of trauma-related symptoms. Males on average tend to display more externalizing behavior and females tend to display more internalizing behavior with heightened susceptibility to PTSD especially following sexual abuse (Darves-Bornoz et al. 1998; Evans et al. 2008; Walker et al. 2004). Broad and long-lasting negative health effects have been found in those exposed to trauma in childhood (Felitti et al. 1998).
Given the high percentage of traumatic exposures among youth, it is likely that a significant proportion of those with autism spectrum disorder (ASD) have been exposed to trauma with resulting mental health symptoms. Several factors may set them up for traumatization. They are more socially isolated, less accepted and liked by peers, and more often excluded and ridiculed (Carter 2009; Rotheram-Fuller et al.2010). Children with ASD lack the social support networks that have been shown to protect or buffer children from the effects of peer bullying (Bauminger and Kasari 2000; Estell et al. 2009). Children with ASD have been shown to become more angry and upset in response to bullying than typically developing children, which could lead to more targeted aggression directed toward them (Rieffe et al. 2012). Language delays may get in the way of reporting abuse or expressing reactions to trauma (Cook et al. 1993). Verbal expression and processing form a key part of most therapies for trauma in children but may be difficult or impossible for children with autism (Howlin and Clements 1995). Perhaps because of these developmental vulnerabilities they show high rates of co-morbid anxiety and other emotional and behavioral problems (Konst and Matson 2014; Vasa et al. 2014). They may therefore be expected to have more severe emotional reactions to traumatic events.
As with childhood trauma, ASD is being increasingly diagnosed, a trend that gained momentum with the labeling of a wider range of symptoms as pertaining to autism in the DSM-IV (American Psychiatric Association 1994). Recent CDC estimates in the USA indicate a prevalence rate of 1 in 68 children being identified with ASD in 2010 based on national survey data, whereas similar surveillance methods identified a rate of 1 in 150 children in 2002 (Centers for Disease Control and Prevention 2014). Estimates vary based on method of assessment, country or region studied, and definition of ASD but have shown a general trend of increasing prevalence that may be starting to level off (Tsai 2014). The increased prevalence rate is most likely due to changes in diagnostic criteria but may also reflect genetic and/or environmental factors (Simonoff 2012). ASDs are characterized by pervasive developmental deficits in social communication and interaction as well as rigid, repetitive patterns of behavior, interests, or activities. The DSM-5 groups those diagnosed into three severity levels based on functional behavior. At the lower-functioning end of the spectrum are those who require “very substantial support” due to severe deficits in verbal and non-verbal communication and often display markedly impairing rigidity and repetitive behavior. At the higher-functioning end are individuals who show difficulty initiating and maintaining successful social contact, may be quite inflexible in behavior and routines, and have difficulty organizing and transitioning between activities (American Psychiatric Association 2013).
Outside of the growing literature on bullying which comprises the majority of studies of potential trauma in children with ASD, there is little clear information about the rate or effects of traumatization in this population. The purposes of this article are to review the literature regarding the types of traumatic exposure and symptoms occurring in children with ASD, address measurement problems arising in the assessment of this population, and to make recommendations for further investigation efforts.
Trauma in Children with ASD
For the purposes of this review, Psychinfo and PubMed were searched using the following autism related keywords: autism, Asperger, PDD, and PDD–NOS in combination with trauma-related keywords: posttraumatic/post–traumatic, PTSD, child abuse, child neglect, interpersonal violence, child maltreatment, domestic violence, peer victimization, and bullying. Reference lists in the identified articles were also searched for relevant articles.
Articles were selected for review if they were: (a) empirical research published in a peer-reviewed journal of any date up to the current issue; (b) non-dissertation; (c) reported in English; (d) clearly identified ASD in children and youth; and (e) reported a quantifiable assessment of PTSD or specified emotional, behavioral, and/or functional problems associated with potentially traumatic experiences. Case studies, purely theoretical, position, or clinical papers without quantitative data were excluded from this research review.
There is a clear divide in the literature between studies of bullying (used interchangeably here with peer victimization) and studies of child trauma, abuse, and other maltreatment. This distinction was followed in presenting articles for this review. Twenty-two studies of bullying were found that met criteria A–D above. Of these, 11 also met criterion E by reporting measured emotional, behavioral, or functional outcomes of bullying, the central purpose of the review. These 11 were selected for inclusion. Of the 10 bullying studies that did not meet criterion E, most focused on predictors of bullying rather than outcomes.
The literature search revealed eight studies of non-bullying child trauma in children with ASD that met criteria A–C above. Two of these studies were excluded from formal review as they did not adequately identify autism as separate from other developmental disabilities and did not report on emotional or behavioral outcomes of trauma. Given the relative paucity of studies and wide differences in methodology, no quantitative analysis of reviewed articles was attempted.
Peer victimization/bullying studies account for the majority of empirical articles about potential traumatization of children with ASD. Two recent reviews summarize much of the available research on incidence, causal and contributory factors, and recommendations for prevention and intervention practices (Schroeder et al. 2014; Sreckovic et al. 2014).
Prevalence estimates vary depending on time frames and reporters but by all reports, children with ASD are bullied more often than peers with other disabilities and more often than non-disabled peers (Sreckovic et al. 2014), those with intellectual disabilities alone (Zeedyk et al. 2014), and their typically developing siblings (Nowell et al. 2014). One estimate summarizing data from a variety of studies (Storch et al. 2012) indicates that broad-scale parent and children surveys report 44–77 % of ASD children being bullied within a 1-month period, as compared to a rate of 2–17 % in self-report surveys of typically developing children (van Roekel et al.2010). Another estimate based on a large parent survey suggests that as many as 94 % of children with ASDs and non-verbal learning disorders are bullied at some point in the past year as rated by mothers (Little 2002).