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Anxiety and Trauma-Related Disorders in Children on the Autism Spectrum

  • Autism Spectrum Disorders (E Brodkin, Section Editor)
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Abstract

Purpose of Review

To summarize recent findings regarding anxiety and trauma-related disorders in children diagnosed with autism spectrum disorder (autism), focusing on the distinct ways in which these conditions may be expressed, as well as advances in evidence-based assessment and treatment.

Recent Findings

Current findings suggest both anxiety and trauma-related disorders may be more prevalent, yet more complicated to address in autistic relative to non-autistic children. Overlapping symptoms and distinct manifestations of these disorders pose challenges for the accurate identification, assessment, and treatment of anxiety and trauma-related disorders in autistic children. Emerging evidence recommends adapting traditional assessment and treatment approaches to better meet the needs of autistic children.

Summary

Recent research suggests autism-centered conceptualizations, which accommodate complexity in how anxiety and trauma-related disorders are experienced and expressed by autistic people, are needed to enhance the psychiatric care of this population.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. American Psychiatric Association, American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA. 2013. https://doi.org/10.1176/appi.books.9780890425596

  2. Maenner MJ, Shaw KA, Baio J. Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2016. MMWR Surveill Summ. 2020;69(4):1. https://doi.org/10.15585/mmwr.ss6903a1

    Article  Google Scholar 

  3. Van Steensel FJ, Bögels SM, Perrin S. Anxiety disorders in children and adolescents with autistic spectrum disorders: a meta-analysis. Clin Child Fam Psychol Rev. 2011;14(3):302. https://doi.org/10.1007/s10567-011-0097-0.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hollocks MJ, Lerh JW, Magiati I, Meiser-Stedman R, Brugha TS. Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis Psychol Med. 2019;49(4)559-572. https://doi.org/10.1017/S0033291718002283This systematic review and meta-analysis examines the prevalence rates of anxiety in autistic adults. This study found high variability in assessment methods and sample selection between studies and concluded that such factors may contribute to reduced accuracy of estimated prevalence rates.

  5. Lai MC, Kassee C, Besney R, Bonato S, Hull L, Mandy W, Szatmari P, Ameis SH. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. The Lancet Psychiatry. 2019;6(10):819–29. https://doi.org/10.1016/S2215-0366(19)30289-5.

    Article  PubMed  Google Scholar 

  6. ••Crane L, Adams F, Harper G, Welch J, Pellicano E. ‘Something needs to change’: mental health experiences of young autistic adults in England. Autism. 2019 Feb;23(2):477–93. https://doi.org/10.1177/1362361318757048. This study highlights young autistic adult's experiences with mental health, mental health services and barriers to receiving support.

  7. Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. The Lancet. 2007;369(9569):1302–13. https://doi.org/10.1016/S0140-6736(07)60368-7.

    Article  Google Scholar 

  8. Kerns CM, Rast JE, Shattuck PT. Prevalence and correlates of caregiver-reported mental health conditions in youth with autism spectrum disorder in the United States J Clin Psychiatry. 2020;82(1). https://doi.org/10.4088/JCP.20m13242.

  9. Gotham K, Brunwasser SM, Lord C. Depressive and anxiety symptom trajectories from school age through young adulthood in samples with autism spectrum disorder and developmental delay. J Am Acad Child Adolesc Psychiatry. 2015;54(5):369–76. https://doi.org/10.1016/j.jaac.2015.02.005.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kent R, Simonoff E. Prevalence of anxiety in autism spectrum disorders. Anxiety in children and adolescents with autism spectrum disorder. 2017;1:5–32. https://doi.org/10.1016/B978-0-12-805122-1.00002-8.

    Article  Google Scholar 

  11. •Simpson K, Adams D, Wheeley E, Keen D. Parent perspectives on the presentation, triggers, impact, and support of anxiety in young children on the autism spectrum. J Child Fam Stud. 2020;29(2):572–82. https://doi.org/10.1007/s10826-019-01576-5This study is the first in the qualitative literature to focus on the perspectives and experiences of parents with young autistic children experiencing anxiety.

    Article  Google Scholar 

  12. Adams D, Clark M, Keen D. Using self-report to explore the relationship between anxiety and quality of life in children on the autism spectrum. Autism Res. 2019;12(10):1505–15. https://doi.org/10.1002/aur.2155.

    Article  PubMed  Google Scholar 

  13. Adams D, Clark M, Simpson K. The relationship between child anxiety and the quality of life of children, and parents of children, on the autism spectrum. J Autism Dev Disord. 2020;50(5):1756–69. https://doi.org/10.1007/s10803-019-03932-2.

    Article  PubMed  Google Scholar 

  14. Adams D, Emerson LM. The impact of anxiety in children on the autism spectrum. J Autism Dev Disord. 2021;51(6):1909–20. https://doi.org/10.1007/s10803-020-04673-3.

    Article  PubMed  Google Scholar 

  15. Adams D, Simpson K, Keen D. Exploring anxiety at home, school, and in the community through self-report from children on the autism spectrum. Autism Res. 2020;13(4):603–14. https://doi.org/10.1002/aur.2246.

    Article  PubMed  Google Scholar 

  16. Ambrose K, Simpson K, Adams D. The impact of anxiety on the participation of children on the autism spectrum. J Autism Dev Disord. 2021;1:1–2. https://doi.org/10.1007/s10803-021-05162-x.

    Article  Google Scholar 

  17. Ferguson BJ, Marler S, Altstein LL, Lee EB, Akers J, Sohl K, McLaughlin A, Hartnett K, Kille B, Mazurek M, Macklin EA. Psychophysiological associations with gastrointestinal symptomatology in autism spectrum disorder. Autism Res. 2017;10(2):276–88. https://doi.org/10.1002/aur.1646.

    Article  PubMed  Google Scholar 

  18. Neuhaus E, Bernier RA, Tham SW, Webb SJ. Gastrointestinal and psychiatric symptoms among children and adolescents with autism spectrum disorder. Front Psych. 2018;22(9):515. https://doi.org/10.3389/fpsyt.2018.00515.

    Article  Google Scholar 

  19. Mazurek MO, Petroski GF. Sleep problems in children with autism spectrum disorder: examining the contributions of sensory over-responsivity and anxiety. Sleep Med. 2015;16(2):270–9. https://doi.org/10.1016/j.sleep.2014.11.006.

    Article  PubMed  Google Scholar 

  20. Kerns CM, Kendall PC, Zickgraf H, Franklin ME, Miller J, Herrington J. Not to be overshadowed or overlooked: functional impairments associated with comorbid anxiety disorders in youth with ASD. Behav Ther. 2015;46(1):29–39. https://doi.org/10.1016/j.beth.2014.03.005.

    Article  PubMed  Google Scholar 

  21. Kerns CM, Kendall PC, Berry L, Souders MC, Franklin ME, Schultz RT, Miller J, Herrington J. Traditional and atypical presentations of anxiety in youth with autism spectrum disorder. J Autism Dev Disord. 2014;44(11):2851–61. https://doi.org/10.1007/s10803-014-2141-7.

    Article  PubMed  PubMed Central  Google Scholar 

  22. •Kerns CM, Renno P, Kendall PC, Wood JJ, Storch EA. Anxiety disorders interview schedule-autism addendum: reliability and validity in children with autism spectrum disorder. J Clin Child Adolesc Psychol. 2017;46(1):88–100. https://doi.org/10.1080/15374416.2016.1233501This study evaluated the psychometric properties of the ADIS/ASA, a measure developed to systematically differentiate anxiety and ASD symptoms. This tool is novel in its assessment of both traditional and distinct expression of anxiety disorders.

    Article  PubMed  Google Scholar 

  23. Kerns CM, Winder-Patel B, Iosif AM, Nordahl CW, Heath B, Solomon M, Amaral DG. Clinically significant anxiety in children with autism spectrum disorder and varied intellectual functioning. J Clin Child Adolesc Psychol. 2020;23:1–6. https://doi.org/10.1080/15374416.2019.1703712.

    Article  Google Scholar 

  24. Kerns CM, Rump K, Worley J, Kratz H, McVey A, Herrington J, Miller J. The differential diagnosis of anxiety disorders in cognitively-able youth with autism. Cogn Behav Pract. 2016;23(4):530–47. https://doi.org/10.1016/j.cbpra.2015.11.004.

    Article  Google Scholar 

  25. Oakley BF, Jones EJ, Crawley D, Charman T, Buitelaar J, Tillmann J, Murphy DG, Loth E. Alexithymia in autism: cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychol Med. 2020;8:1–3. https://doi.org/10.1017/S0033291720003244.

    Article  Google Scholar 

  26. Palser ER, Fotopoulou A, Pellicano E, Kilner JM. The link between interoceptive processing and anxiety in children diagnosed with autism spectrum disorder: extending adult findings into a developmental sample. Biol Psychol. 2018;1(136):13–21. https://doi.org/10.1016/j.biopsycho.2018.05.003.

    Article  Google Scholar 

  27. Mazefsky CA, Kao J, Oswald D. Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Research in autism spectrum disorders. 2011;5(1):164–74. https://doi.org/10.1016/j.rasd.2010.03.006.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Kalvin CB, Marsh CL, Ibrahim K, Gladstone TR, Woodward D, Grantz H, Ventola P, Sukhodolsky DG. Discrepancies between parent and child ratings of anxiety in children with autism spectrum disorder. Autism Res. 2020;13(1):93–103. https://doi.org/10.1002/aur.2220.

    Article  PubMed  Google Scholar 

  29. Keith JM, Jamieson JP, Bennetto L. The importance of adolescent self-report in autism spectrum disorder: integration of questionnaire and autonomic measures. J Abnorm Child Psychol. 2019;47(4):741–54. https://doi.org/10.1007/s10802-018-0455-1.

    Article  PubMed  PubMed Central  Google Scholar 

  30. O’Nions E, Viding E, Floyd C, Quinlan E, Pidgeon C, Gould J, Happé F. Dimensions of difficulty in children reported to have an autism spectrum diagnosis and features of extreme/‘pathological’ demand avoidance. Child Adolesc Mental Health. 2018;23(3):220–7. https://doi.org/10.1111/camh.12242.

    Article  Google Scholar 

  31. Kerns CM, Kendall PC. The presentation and classification of anxiety in autism spectrum disorder. Clin Psychol Sci Pract. 2012;19(4):323. https://doi.org/10.1111/cpsp.12009.

    Article  Google Scholar 

  32. Martin J, Taylor MJ, Lichtenstein P. Assessing the evidence for shared genetic risks across psychiatric disorders and traits. Psychol Med. 2018;48(11):1759–74. https://doi.org/10.1017/S0033291717003440.

    Article  PubMed  Google Scholar 

  33. Livingston LA, Colvert E, Social Relationships Study Team, Bolton P, Happé F. Good social skills despite poor theory of mind: exploring compensation in autism spectrum disorder. J Child Psycho Psychi. 2019;60(1):102–10. https://doi.org/10.1111/jcpp.12886

  34. Kerns CM, Newschaffer CJ, Berkowitz SJ. Traumatic childhood events and autism spectrum disorder. J Autism Dev Disord. 2015;45(11):3475–86. https://doi.org/10.1007/s10803-015-2392-y.

    Article  PubMed  Google Scholar 

  35. Toscano R, Baillie AJ, Lyneham HJ, Kelly A, Kidd T, Hudson JL. Assessment of anxiety in children and adolescents: a comparative study on the validity and reliability of the Spence Children’s Anxiety Scale in children and adolescents with anxiety and autism spectrum disorder. J Affect Disord. 2020;1(260):569–76. https://doi.org/10.1016/j.jad.2019.09.055.

    Article  Google Scholar 

  36. Kerns CM, Maddox BB, Kendall PC, Rump K, Berry L, Schultz RT, Souders MC, Bennett A, Herrington J, Miller J. Brief measures of anxiety in non-treatment-seeking youth with autism spectrum disorder. Autism. 2015;19(8):969–79. https://doi.org/10.1177/1362361314558465.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Vasa RA, Keefer A, Reaven J, South M, White SW. Priorities for advancing research on youth with autism spectrum disorder and co-occurring anxiety. J Autism Dev Disord. 2018;48(3):925–34. https://doi.org/10.1007/s10803-017-3320-0.

    Article  PubMed  Google Scholar 

  38. Rodgers J, Wigham S, McConachie H, Freeston M, Honey E, Parr JR. Development of the anxiety scale for children with autism spectrum disorder (ASC-ASD). Autism Res. 2016;9(11):1205. https://doi.org/10.1002/aur.1603.

    Article  PubMed  Google Scholar 

  39. Scahill L, Lecavalier L, Schultz RT, Evans AN, Maddox B, Pritchett J, Herrington J, Gillespie S, Miller J, Amoss RT, Aman MG. Development of the parent-rated anxiety scale for youth with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry. 2019;58(9):887–96. https://doi.org/10.1016/j.jaac.2018.10.016.

    Article  PubMed  Google Scholar 

  40. Silverman WK, Albano AM. Anxiety disorders interview schedule for DSM-IV: Child version. Oxford University Press; 1996.

  41. ••Perihan C, Burke M, Bowman-Perrott L, Bicer A, Gallup J, Thompson J, Sallese M. Effects of cognitive behavioral therapy for reducing anxiety in children with high functioning ASD: a systematic review and meta-analysis. J Autism Dev Disord. 2020;50(6):1958–72. https://doi.org/10.1007/s10803-019-03949-7This systematic review and meta-analysis found CBT treatment led to moderate changes in anxiety levels in children with high functioning autism spectrum disorder. Specifically, parent involvement and longer treatments (e.g. 12 weeks or longer) were more effective in reducing childrens' anxiety than treatments that did not involve parents or were shorter in duration.

    Article  PubMed  Google Scholar 

  42. ••Wood JJ, Kendall PC, Wood KS, Kerns CM, Seltzer M, Small BJ, Lewin AB, Storch EA. Cognitive behavioral treatments for anxiety in children with autism spectrum disorder: a randomized clinical trial. JAMA Psychiat. 2020;77(5):474–83. https://doi.org/10.1001/jamapsychiatry.2019.4160This RCT study compared standard CBT and TAU to modified CBT for autistic children and found that modified CBT had superior effects over both conditions.

    Article  Google Scholar 

  43. Hunsche MC, Kerns CM. Update on the effectiveness of psychotherapy for anxiety disorders in children and adolescents with ASD. Bull Menninger Clin. 2019;83(3):326–52. https://doi.org/10.1521/bumc.2019.83.3.326.

    Article  PubMed  Google Scholar 

  44. Storch EA, Wood JJ, Guzick AG, Small BJ, Kerns CM, Ordaz DL, Schneider SC, Kendall PC. Moderators of response to personalized and standard care cognitive-behavioral therapy for youth with autism spectrum disorder and comorbid anxiety. J Autism Dev Disord. 2021;7:1–9. https://doi.org/10.1007/s10803-021-05000-0.

    Article  Google Scholar 

  45. Klinger LG, Cook ML, Dudley KM. Predictors and moderators of treatment efficacy in children and adolescents with autism spectrum disorder. J Clin Child Adolesc Psychol. 2021;50(4):517–24. https://doi.org/10.1080/15374416.2020.1833735.

    Article  PubMed  Google Scholar 

  46. Reaven JA, Blakeley-Smith A, Nichols S, Dasari M, Flanigan E, Hepburn S. Cognitive-behavioral group treatment for anxiety symptoms in children with high-functioning autism spectrum disorders: a pilot study. Focus on autism and other developmental disabilities. 2009;24(1):27–37. https://doi.org/10.1177/1088357608327666.

    Article  Google Scholar 

  47. Reaven J, Blakeley-Smith A, Culhane-Shelburne K, Hepburn S. Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: a randomized trial. J Child Psychol Psychiatry. 2012;53(4):410–9. https://doi.org/10.1111/j.1469-7610.2011.02486.x.

    Article  PubMed  PubMed Central  Google Scholar 

  48. •Blakeley-Smith A, Meyer AT, Boles RE, Reaven J. Group cognitive behavioural treatment for anxiety in autistic adolescents with intellectual disability: a pilot and feasibility study. J Appl Res Intellect Disabil. 2021;34(3):777–88. https://doi.org/10.1111/jar.12854This recent study evaluates modified CBT for autistic youth with ID and shows promising preliminary results in terms of its feasibility and efficacy.

    Article  PubMed  Google Scholar 

  49. Reaven J, Reyes N, Pickard K, Tanda T, Morris MA. Addressing the needs of diverse youth with ASD and anxiety in public schools: stakeholder input on adaptations of clinic-based Facing Your Fears. Sch Ment Heal. 2020;12(2):308–22. https://doi.org/10.1007/s12310-019-09351-z.

    Article  Google Scholar 

  50. Reaven J, Meyer AT, Pickard K, Boles RE, Hayutin L, Middleton C, Reyes NM, Hepburn SL, Tanda T, Stahmer A, Blakeley-Smith A. Increasing access and reach: implementing school-based CBT for anxiety in students with ASD or suspected ASD. Evidence-based practice in child and adolescent mental health. 2021;28:1–20. https://doi.org/10.1080/23794925.2021.1941430.

    Article  Google Scholar 

  51. Drmic IE, Aljunied M, Reaven J. Feasibility, acceptability and preliminary treatment outcomes in a school-based CBT intervention program for adolescents with ASD and anxiety in Singapore. J Autism Dev Disord. 2017;47(12):3909–29. https://doi.org/10.1007/s10803-016-3007-y.

    Article  PubMed  Google Scholar 

  52. Ginsburg GS, Kendall PC, Sakolsky D, Compton SN, Piacentini J, Albano AM, Walkup JT, Sherrill J, Coffey KA, Rynn MA, Keeton CP. Remission after acute treatment in children and adolescents with anxiety disorders: findings from the CAMS. J Consult Clin Psychol. 2011;79(6):806. https://doi.org/10.1037/a0025933.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Hsia Y, Wong AY, Murphy DG, Simonoff E, Buitelaar JK, Wong IC. Psychopharmacological prescriptions for people with autism spectrum disorder (ASD): a multinational study. Psychopharmacology. 2014;231(6):999–1009. https://doi.org/10.1007/s00213-013-3263-x.

    Article  CAS  PubMed  Google Scholar 

  54. Williams K, Brignell A, Randall M, Silove N, Hazell P. Selective serotonin reuptake inhibitors (SSRIs) for autism spectrum disorders (ASD). Cochrane database of systematic reviews, 2013;(8). https://doi.org/10.1002/14651858.CD004677.pub3.

  55. Couturier JL, Nicolson R. A retrospective assessment of citalopram in children and adolescents with pervasive developmental disorders. J Child Adolesc Psychopharmacol. 2002;12(3):243–8. https://doi.org/10.1089/104454602760386932.

    Article  PubMed  Google Scholar 

  56. Namerow LB, Thomas P, Bostic JQ, Prince J, Monuteaux MC. Use of citalopram in pervasive developmental disorders. J Dev Behav Pediatr. 2003;24(2):104–8. https://doi.org/10.1097/00004703-200304000-00005.

    Article  PubMed  Google Scholar 

  57. Thorkelson G, Laughlin SF, Turner KS, Ober N, Handen BL. Selective serotonin reuptake inhibitor monotherapy for anxiety disorders in children and adolescents with autism spectrum disorder: a chart review. J Child Adolesc Psychopharmacol. 2019;29(9):705–11. https://doi.org/10.1089/cap.2019.0001.

    Article  PubMed  Google Scholar 

  58. Martin A, Koenig K, Anderson GM, Scahill L. Low-dose fluvoxamine treatment of children and adolescents with pervasive developmental disorders: a prospective, open-label study. J Autism Dev Disord. 2003;33(1):77–85. https://doi.org/10.1023/A:1022234605695.

    Article  PubMed  Google Scholar 

  59. Deb S, Roy M, Lee R, Majid M, Limbu B, Santambrogio J, Roy A, Bertelli MO. Randomised controlled trials of antidepressant and anti-anxiety medications for people with autism spectrum disorder: systematic review and meta-analysis. B J Psych open. 2021;7(6). https://doi.org/10.1192/bjo.2021.1003.

  60. Merrick MT, Ports KA, Ford DC, Afifi TO, Gershoff ET, Grogan-Kaylor A. Unpacking the impact of adverse childhood experiences on adult mental health. Child Abuse Negl. 2017;1(69):10–9. https://doi.org/10.1016/j.chiabu.2017.03.016.

    Article  Google Scholar 

  61. Substance Abuse and Mental Health Services Administration. Concept of trauma and guidance for a trauma-informed approach. 2014. Retrieved May 2021, from http://store.samhsa.gov/product/SAMHSA-s-Concept-of-Trauma-and-Guidance-for-a-Trauma-Informed-Approach/SMA14-4884.

  62. •Hoover DW, Kaufman J. Adverse childhood experiences in children with autism spectrum disorder. Curr Opin Psychiatry. 2018;31(2):128. https://doi.org/10.1097/YCO.0000000000000390This review reports the elevated risk of bullying and other adversities for autistic children, as well as the associated outcomes, such as increased comorbidities and delayed diagnosis and treatment.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Haruvi-Lamdan N, Horesh D, Golan O. PTSD and autism spectrum disorder: co-morbidity, gaps in research, and potential shared mechanisms. Psychol Trauma Theory Res Pract Policy. 2018;10(3):290. https://doi.org/10.1037/tra0000298.

    Article  Google Scholar 

  64. Kerns CM, Newschaffer CJ, Berkowitz S, Lee BK. Brief report: examining the association of autism and adverse childhood experiences in the National Survey of Children’s Health: the important role of income and co-occurring mental health conditions. J Autism Dev Disord. 2017;47(7):2275–81. https://doi.org/10.1007/s10803-017-3111-7.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Berg KL, Shiu CS, Acharya K, Stolbach BC, Msall ME. Disparities in adversity among children with autism spectrum disorder: a population-based study. Dev Med Child Neurol. 2016;58(11):1124–31. https://doi.org/10.1111/dmcn.13161.

    Article  PubMed  Google Scholar 

  66. •McDonnell CG, Boan AD, Bradley CC, Seay KD, Charles JM, Carpenter LA. Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample. J Child Psychol Psychiatry. 2019;60(5):576–84. https://doi.org/10.1111/jcpp.12993This study was the first to show increased risk of childhood maltreatment for children with autism.

    Article  PubMed  Google Scholar 

  67. Golan O, Haruvi-Lamdan N, Laor N, Horesh D. The comorbidity between autism spectrum disorder and post-traumatic stress disorder is mediated by brooding rumination. Autism. 2021;28:13623613211035240. https://doi.org/10.1177/13623613211035240.

    Article  Google Scholar 

  68. Hoover DW. The effects of psychological trauma on children with autism spectrum disorders: a research review. Rev J Autism Dev Disord. 2015;2(3):287–99. https://doi.org/10.1007/s40489-015-0052-y.

    Article  Google Scholar 

  69. Rumball F, Antal K, Happé F, Grey N. Co-occurring mental health symptoms and cognitive processes in trauma-exposed ASD adults. Res Dev Disabil. 2021;1(110): 103836. https://doi.org/10.1016/j.ridd.2020.103836.

    Article  Google Scholar 

  70. Rumball F, Brook L, Happé F, Karl A. Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: the role of cumulative trauma and memory deficits. Res Dev Disabil. 2021;1(110): 103848. https://doi.org/10.1016/j.ridd.2020.103848.

    Article  Google Scholar 

  71. Brewin CR, Rumball F, Happé F. Neglected causes of post-traumatic stress disorder. BMJ. 2019. https://doi.org/10.1136/bmj.l2372.

    Article  PubMed  Google Scholar 

  72. ••Rumball F, Happé F, Grey N. Experience of trauma and PTSD symptoms in autistic adults: risk of PTSD development following DSM-5 and non-DSM-5 traumatic life events. Autism Res. 2020;13(12):2122–32. https://doi.org/10.1002/aur.2306This study assessed PTEs among autistic adults' and found that current DSM-V PTSD criteria do not adequately capture trauma in autistic populations.

    Article  PubMed  Google Scholar 

  73. Kerns CM, Lankenau S, Shattuck PT, Robins DL, Newschaffer, CJ, Berkowitz S. Exploring potential sources of childhood trauma: a qualitative study with autistic adults and caregivers. Autism. In Press.

  74. Kildahl AN, Helverschou SB, Bakken TL, Oddli HW. “If we do not look for it, we do not see it”: clinicians’ experiences and understanding of identifying post-traumatic stress disorder in adults with autism and intellectual disability. J Appl Res Intellect. 2020;33:1119–32. https://doi.org/10.1111/jar.12734.

    Article  Google Scholar 

  75. Stavropoulos KK, Bolourian Y, Blacher J. Differential diagnosis of autism spectrum disorder and post traumatic stress disorder: two clinical cases. J Clin Med. 2018;7(4):71. https://doi.org/10.3390/jcm7040071.

    Article  PubMed Central  Google Scholar 

  76. Brenner J, Pan Z, Mazefsky C, Smith KA, Gabriels R. Behavioral symptoms of reported abuse in children and adolescents with autism spectrum disorder in inpatient settings. J Autism Dev Disord. 2018;48(11):3727–35. https://doi.org/10.1007/s10803-017-3183-4.

    Article  PubMed  Google Scholar 

  77. Fuld S. Autism spectrum disorder: the impact of stressful and traumatic life events and implications for clinical practice. Clin Soc Work J. 2018;46(3):210–9. https://doi.org/10.1007/s10615-018-0649-6.

    Article  PubMed  PubMed Central  Google Scholar 

  78. ••Kildahl AN, Bakken TL, Iversen TE, Helverschou SB. Identification of post-traumatic stress disorder in individuals with autism spectrum disorder and intellectual disability: a systematic review. J Ment Health Res Intellect Disabil. 2019;12:1–25. https://doi.org/10.1080/19315864.2019.1595233This study elucidates the differential manifestation of trauma symptoms in autism.

    Article  Google Scholar 

  79. Kildahl AN, Helverschou SB, Bakken TL, Oddli HW. “Driven and tense, stressed out and anxious”: clinicians’ perceptions of post-traumatic stress disorder symptom expressions in adults with autism and intellectual disability. J Ment Health Res Intellect Disabil. 2020;13:201–30. https://doi.org/10.1080/19315864.2020.1760972.

    Article  Google Scholar 

  80. •Kerns CM, Berkowitz SJ, Moskowitz LJ, Drahota A, Lerner MD, Usual Care for Autism Study (UCAS) Consortium, Newschaffer CJ. Screening and treatment of trauma-related symptoms in youth with autism spectrum disorder among community providers in the United States. Autism. 2020 Feb;24(2):515–25. https://doi.org/10.1177/1362361319847908This article summarizes a survey of health care providers illuminating the lack of knowledge and application of trauma-informed interventions for autistic children and young adults.

  81. Hoover DW, Romero EM. The Interactive Trauma Scale: a web-based measure for children with autism. J Autism Dev Disord. 2019;49(4):1686–92. https://doi.org/10.1007/s10803-018-03864-3.

    Article  PubMed  Google Scholar 

  82. Stack A, Lucyshyn J. Autism spectrum disorder and the experience of traumatic events: review of the current literature to inform modifications to a treatment model for children with autism. J Autism Dev Disord. 2019;49(4):1613–25. https://doi.org/10.1007/s10803-018-3854-9.

    Article  PubMed  Google Scholar 

  83. Morina N, Koerssen R, Pollet TV. Interventions for children and adolescents with posttraumatic stress disorder: a meta-analysis of comparative outcome studies. Clin Psychol Rev. 2016;1(47):41–54. https://doi.org/10.1016/j.cpr.2016.05.006.

    Article  Google Scholar 

  84. Rumball F. A systematic review of the assessment and treatment of posttraumatic stress disorder in individuals with autism spectrum disorders. Rev J Autism Dev Disord. 2019;6(3):294–324. https://doi.org/10.1007/s40489-018-0133-9.

    Article  Google Scholar 

  85. Peterson JL, Earl RK, Fox EA, et al. Trauma and autism spectrum disorder: review, proposed treatment adaptations and future directions. Journ Child Adol Trauma. 2019;12:529–47. https://doi.org/10.1007/s40653-019-00253-5.

    Article  Google Scholar 

  86. Ko SJ, Pynoos RS, Griffin D, Vanderbilt D. NCTSN trauma & IDD expert panel. The road to recovery: supporting children with intellectual and developmental disabilities who have experienced trauma. National Center for Child Traumatic Stress. 2015. https://learnnctsn.org/mod/resource/view.php.

  87. Faccini L, Allely CS. Dealing with trauma in individuals with autism spectrum disorders: trauma informed care, treatment, and forensic implications. J Aggress Maltreat Trauma. 2021;30:1082–92. https://doi.org/10.1080/10926771.2020.1853295.

    Article  Google Scholar 

  88. Huemer J, Greenberg M, Steiner H. Pharmacological treatment for children and adolescents with trauma-related disorders. In Evidence-based treatments for trauma related disorders in children and adolescents 2017 (pp. 385–401). Springer, Cham. https://doi.org/10.1007/978-3-319-46138-0_18

  89. Presenters:, del Pilar Trelles Thorne M, Khinda N, Discussant:, Coffey BJ. Posttraumatic stress disorder in a child with autism spectrum disorder: challenges in management. J Child Adoles Psychopharm. 2015;1:25(6):514–7. https://doi.org/10.1089/cap.2015.29011.mptt

  90. King BH, Rynkiewicz A, Janas-Kozik M, Tyszkiewicz-Nwafor M. Medications to treat co-occurring psychiatric conditions in autism spectrum disorder. In The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions 2020.

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Correspondence to Elise Ng-Cordell.

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Dr. Connor Kerns receives royalties from an edited clinical textbook on anxiety and autism published by Elsevier as well as honoraria and consulting fees for training other clinicians and researchers on the Autism Spectrum Addendum, which she developed. All other authors report no conflicts of interest.

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Ng-Cordell, E., Wardell, V., Stewardson, C. et al. Anxiety and Trauma-Related Disorders in Children on the Autism Spectrum. Curr Psychiatry Rep 24, 171–180 (2022). https://doi.org/10.1007/s11920-022-01331-6

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