PTSD and Autism - from Autism Discussion Page

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PTSD and Autism

It has amazed me how long it has taken for the field to accept sensory processing dysfunctioning in autism spectrum disorder. For years, the field of psychology practically ignored the sensory issues. Applied Behavior Analysis ignored it while forcing children to obey and stay in situations that were overwhelming for them. If the children “acted out”, we made them “stick it out”; so their acting out behavior was not reinforced by escaping the unwanted situation. Over twenty years ago when I first started incorporating sensory processing strategies into my “behavior plans”, the psychologists all looked down on it because you could not observe it and measure it. Agencies would try and stop me from using the strategies because they were not “evidenced based.” Sensory processing problems were not “real.” They were in the business of “changing behavior”. Treating autism was nothing more than “changing their behavior.” The child’s internal experiences were not recognized, considered, nor valued. The ends (changing behavior) justified the means (extinction, punishment, forcing compliance.” Sensory processing issues were not “real.” Even though adults on the spectrum were writing extensively about these traumatizing experiences, the psychologists still claimed they were not real.

Sensory dysfunction in autism is being recognized now. Finally after many years of people on the spectrum speaking out and demanding to be listened to, this experience is being taken serious. However, another topic not mentioned much in autism spectrum disorder is Post Traumatic Stress Disorder. Since most PTSD is caused by extreme sexual or physical abuse, and war time emotional trauma, it is not often suspected in ASD. However, I see evidence of it, and many of the self reports of adults on the spectrum relate experiences that seem very similar to post traumatic stress. Post traumatic stress occurs when there is severe insult to the nervous system. It results in changes in both brain chemistry and suspected structural changes in the brain. The person exhibits generalized anxiety, depression and isolation, panic attacks for no apparent reason, and sometimes rages.

PTSD can come from one of more emotional traumas, or long term distress from severe sensory processing dysfunction. Many of the nonverbal people on the spectrum, who also experience severe sensory defensiveness, are often experiencing intense physical and emotional trauma from the overwhelming sensory insult to their nervous systems. Since the child never knows when the “sensory bombardment” is going to occur, it often attacks without warning, leaving the child helpless in defending against it. The constant “fight or flight”, panic reaction has long term effects on the nervous system; leaving the individuals battling stress and anxiety for many years. Each time the nervous system experiences intense sensory bombardment, the “stimulus characteristics” of the event becomes associated with the severe “panic response.” At other times in the future, when these common stimuli occur again it can produce an immediate “panic reaction” that was originally associated with the traumatic event. For these individuals, immediate panic occurs, for no apparent reason. Neither the person, nor those around him, may understand why the “panic reaction” occurs. This response can occur when a given sound, color, or smell occurs that was originally associated with the traumatic event. Our sensory memories are very intense. When your sensory experiences are very intense and inconsistent, like those experienced by people with sensory processing disorders, such overwhelming emotion can be associated with, and set off easily, by simple sensory memories.

So, when working with severely impaired individuals on the spectrum, tread very lightly. Be very respectful of their comfort zones. Be very careful of how you touch them, talk to them, and press them. Their nervous systems are very vulnerable and easily traumatized. Their reactions can be very guarded, and intense. They can be very emotionally reactive, and need you to be very calm, gentle, and compassionate. Always be looking for “defensive reactions” and immediately pull back when you see it. Never press the child into situations they are scared of. Guide them, but let them pace their actions. Let them feel “in control” so they can immediately end any situation of “panic.” Learn what touch, words, actions, and stimulation helps them feel safe and secure. Always listen and understand first, before intervening and redirecting their actions. Always assume that underlying their defensive reactions is intense emotional upheaval. Be respectful and compassionate, allow them to pull back, escape and rebound. Teach them coping skills for dealing with these intense experiences, but most importantly teach them to feel safe in your presence, and to trust following our lead.

This series on “labels, diagnoses, and co-occurring disorders” can be found in the green book, “Autism Discussion Page on Anxiety, Behavior, School and Parenting Strategies.”