Trauma Informed ABA: When Autism and Past Trauma Overlap

Key Takeaways:

• Trauma presents differently in autistic individuals, making recognition crucial. 
• Trauma-informed ABA supports healing through safety, empathy, and autonomy.
• PTSD is more common and harder to diagnose in autistic individuals.

‍What is trauma?

‍A traumatic event is an experience that causes physical, emotional, or psychological harm and threatens a person’s sense of safety.

Trauma is common, with about 60% of men and 50% of women experiencing at least one traumatic event in their lifetime, according to the National Institute of Mental Health and the World Health Organization (WHO).

Trauma and Post-traumatic Stress Disorder (PTSD)

Trauma and PTSD are not the same thing. Trauma is the emotional response to a distressing or life-threatening event.

PTSD is a mental health condition that can occur when trauma symptoms continue and begin to affect daily life. Trauma reflects the impact of the event, whereas PTSD is diagnosed when symptoms such as flashbacks, nightmares, and anxiety last for more than a month and significantly interfere with functioning. Importantly, not everyone who experiences trauma will develop PTSD.

Autism and Trauma

Individuals with developmental disabilities, including autism, experience trauma at higher rates. Research shows that 60–70% of autistic children have faced at least one traumatic event, compared to about 25% of neurotypical children.

Recognizing trauma in autistic individuals often requires watching for shifts in behavior or emotional patterns, as signs may look different from those seen in neurotypical people.

Behavioral and social changes:

• Increased aggression or self-injury, which may appear as meltdowns (fight) or shutdowns (freeze).
• Skill regression, such as losing speech or self-care abilities.
• Withdrawal, social anxiety, or reluctance to interact due to feeling unsafe or rejected.
• More frequent repetitive behaviors.
• New or increased agitation, hyperactivity, or distractibility.

Emotional and cognitive changes:

• Difficulty regulating emotions, leading to intense reactions.
• Strong negative beliefs about oneself, others, or the world.
• Trouble experiencing positive emotion.
• Rising anxiety or distress, often tied to triggers or reminders of the event.

Physiological and other changes:

• Changes in sleep or appetite, including nightmares.
• Hyperarousal, such as being easily startled or constantly on alert.
• Avoiding people, places, or activities linked to the trauma.
• A “fawn” response, appearing compliant or calm while actually feeling overwhelmed, which may be misread as coping.

These shifts can signal trauma and should be approached with care, understanding, and support.

Trauma Informed ABA: An Approach to Autism & Trauma & PTSD

Trauma-informed ABA is a gentle, compassionate approach that combines Applied Behavior Analysis (ABA) with an understanding of how trauma affects a person’s behavior and emotional well-being.

Instead of viewing behaviors as problems to remove, it considers them as possible trauma responses and focuses on supporting healing, safety, and skill development.

Common Practices of Trauma Informed ABA

Safety, empathy, trust, and compassion form the foundation of Trauma-Informed ABA. Key practices include:

• Comprehensive Assessment: Begin with a thorough evaluation, including the individual’s trauma history gathered through caregiver interviews and collaboration with other professionals, to identify triggers and sensitivities.
• Establish Safety and Trust: Create a predictable, calming, and supportive environment by using routines, soothing strategies, and positive, consistent communication.
• Prioritize Choice and Control: Offer choices during activities and sessions to promote autonomy, comfort, and respect.
• Empathetic and Collaborative Approach: Listen with empathy, validate family concerns, and work closely with them to set goals and make decisions together.
• Modify Interventions: Avoid restrictive or punitive strategies. Focus instead on positive reinforcement, teaching helpful replacement skills, and adapting interventions to the individual’s needs.
• Recognize Trauma Responses: Train staff to identify trauma-related behaviors and avoid actions that may unintentionally re-traumatize the individual.
• Focus on Skill Building: Emphasize developing meaningful skills such as self-advocacy to help the person communicate their needs more effectively.
  Continuous Reflection: Regularly review progress, analyze data, and involve the client and team in ongoing discussions to improve support and outcomes.

Autism and PTSD

Research from the National Institute of Health (2020) and the National Autistic Society (2022) suggests a strong connection between autism and PTSD. Autistic individuals face a higher risk of experiencing traumatic events and are more vulnerable to developing PTSD symptoms.

This increased risk is influenced by factors such as social stress, sensory sensitivities, and challenges in social situations. Because autism and PTSD can share similar signs, symptoms are often misinterpreted or overlooked.

Recognizing PTSD in autistic individuals can be difficult, but it is essential for proper support. The most important indicator is a noticeable change in behavior or the appearance of new, intense symptoms after a specific traumatic event.

A key distinction is that autistic traits are lifelong and stable, whereas PTSD symptoms arise after trauma and tend to fluctuate, becoming worse with triggers and easing at other times.

PTSD or Autism?

Recognizing PTSD in autistic individuals requires attention to both standard PTSD symptoms, such as re-experiencing events, avoidance, and hyperarousal, and autism-specific indicators, including new aggression, regression, increased stereotypies, self-injury, and heightened sensory sensitivities. Identifying PTSD can be challenging, as these behaviors often overlap with existing ASD traits and other co-occurring conditions, and standard diagnostic criteria may not fully apply. A careful, nuanced assessment is therefore essential.

Factors to consider include:

• Reason for behavior: While social withdrawal can occur in both conditions, the underlying cause differs. In ASD, it stems from developmental differences, whereas in PTSD, it is a response to trauma.
• Communication barriers: Individuals with limited verbal skills may struggle to express traumatic experiences or distress, making PTSD harder to detect.
• Underlying cause: ASD is a neurodevelopmental condition, while PTSD is an anxiety disorder triggered by a traumatic event.
• Exacerbation of symptoms: Trauma can intensify existing ASD traits, such as repetitive behaviors or communication difficulties.
• Diagnostic overshadowing: Clinicians may mistakenly attribute trauma-related stress reactions to ASD, leading to untreated PTSD symptoms.

Recognizing PTSD in Autistic Adults & Children

Re-experiencing

Autistic Adults with PTSD: Intrusive memories, nightmares, or flashbacks.

Autistic Children with PTDS: Intrusive memories, nightmares, or flashbacks.

Avoidance

Autistic Adults with PTSD: Avoiding people, places, or topics related to the trauma. Can also involve an intense retreat into repetitive behaviors or solitary activities.

Autistic Children with PTDS: Avoiding people, places, or topics associated with the trauma.

Negative alterations in mood and cognition

Autistic Adults with PTSD: Exaggerated negative beliefs, difficulty experiencing positive emotions, feelings of detachment, depression, or low self-esteem.

‍Alterations in arousal and reactivity

‍Autistic Children with PTSD: Hypervigilance, sleep disturbance, difficulty concentrating, irritability, angry outbursts, or increased startle response.

New or worsening behaviors:

Autistic Children with PTSD: New aggression, new oppositional behavior, separation anxiety, new fears (e.g., of the dark), regression in developmental skills like speech or toileting.

‍PTSD and Autism Treatment

Traumatic experiences can differ for autistic individuals. In addition to traditional trauma, they may include chronic stress from social exclusion, difficulties with change or routine, and overwhelming sensory events.

Treatment approaches for co-occurring PTSD and autism often involve adapting standard evidence-based therapies to meet the unique needs of autistic individuals:

• Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): A widely recommended PTSD therapy that can be modified for autistic individuals. Adaptations might include using visual aids, graphic tools, or interactive apps to help children express their experiences and emotions.
• Eye Movement Desensitization and Reprocessing (EMDR): Research indicates EMDR can reduce PTSD symptoms in adults with autism, and preliminary studies suggest potential effectiveness for children as well. While early studies have limitations, results are promising.
• Prolonged Exposure Therapy: This involves gradual, controlled exposure to trauma-related stimuli in a safe environment to reduce distress. The approach can be adapted to be more accessible for autistic individuals.

5 Considerations: PTSD and Autism Treatment

1. Adaptations: Therapies should be tailored to each individual’s needs, including communication style, language processing, sensory sensitivities, and intense interests.
   
   
2. Simultaneous treatment: Addressing PTSD and autism together may be more effective than treating each separately.
   
   
3. Modified therapy delivery: Practical adjustments can improve accessibility, such as:
   

• Allowing extra time for sessions and consent procedures
  
  
• Training staff on non-verbal communication and autistic behaviors
  
  
• Conducting sessions in comfortable or alternative settings, such as outdoor walks
  

4. Behavioral interventions: Techniques like Applied Behavior Analysis (ABA) can help develop targeted strategies to manage trauma-related behaviors.
   
   
5. Comorbidities and individualized care: Other co-occurring mental health conditions should be addressed, and treatment must be personalized, as strategies effective for one person may not work for another.

When to Seek Professional Help

• Persistent symptoms: If PTSD symptoms last longer than a month and significantly impact daily life, it’s important to seek a professional assessment.
  Severe distress or impairment: Seek help if symptoms cause intense emotional distress or interfere with work, school, relationships, or daily functioning.
• Uncertainty due to overlapping traits: When it’s unclear whether behaviors stem from trauma or autism, a professional can help differentiate the causes and recommend appropriate support. This is particularly important because some trauma responses can resemble autistic traits, and vice versa.
• Escalating mental health concerns: Seek support if anxiety, depression, substance use, or other mental health issues are worsening.

Reach out to Grateful Care ABA to begin personalised, nuanced care.

FAQ’s

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1. What is trauma? Trauma is an event that threatens a person’s physical or emotional safety and causes distress or fear.

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2. How is trauma different from PTSD? Trauma is the emotional response to a harmful event, while PTSD is a mental health condition that occurs when trauma symptoms last more than a month and impact daily life. Not everyone who experiences trauma develops PTSD.

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3. Are autistic individuals more likely to experience trauma? Yes. Around 60–70% of autistic children experience at least one traumatic event, compared to about 25% of neurotypical children.

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4. How can I recognize trauma in an autistic child or adult? Trauma may appear as increased aggression, self-injury, loss of skills, more repetitive behaviors, social withdrawal, sleep changes, nightmares, anxiety, emotional outbursts, or avoidance of certain people or places.

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5. What is Trauma-Informed ABA? Trauma-Informed ABA is a gentle, compassionate approach that combines ABA with an understanding of trauma’s effects on behavior, focusing on safety, trust, empathy, and emotional well-being.

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6. How does Trauma-Informed ABA support healing? It creates safe, predictable environments, gives individuals choice and control, builds trust, adapts strategies to avoid re-traumatization, teaches helpful skills, and involves families in planning.

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7. Can autistic people develop PTSD? Yes. Autistic individuals are at higher risk, and PTSD can be harder to recognize because symptoms may overlap with autism traits.

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8. How can you tell the difference between autism traits and PTSD symptoms? Autism traits are lifelong and consistent, while PTSD symptoms appear after a specific traumatic event and may change based on triggers. New or worsening behaviors after an event are often key signs.

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9. What treatments help with autism and PTSD together? Helpful treatments include Trauma-Focused CBT, EMDR, modified exposure therapy, trauma-informed ABA, and sensory or communication accommodations. Treatment should be personalized.

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10. When should someone seek professional help? Seek help if symptoms last more than a month, daily life becomes difficult, behaviors suddenly worsen, you’re unsure whether symptoms relate to autism or trauma, or anxiety or depression increases.

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‍11. Where can I get help? Contact Grateful Care ABA for personalized, trauma-sensitive support.