“If you do the math, according to the PTSD criteria in the DSM-5, you can have 636,000 different combinations of symptoms that that describe PTSD,” says Danny Horesh, head of the Trauma and Stress Research Lab at Bar-Ilan University in Ramat Gan, Israel. Beyond that, however, there’s a wide variety in the way PTSD manifests: It can lead to hypervigilance and anger it can cause recurring nightmares and other sleep issues or it can lead to depression, persistent fear, aggression, irritability or difficulty concentrating and remembering things. After that initial episode, any reminder of it can trigger panic, extreme startle reflexes and flashbacks.
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According to the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, psychiatry’s guide to diagnoses, PTSD usually develops after someone sees or experiences a terrifying or life-threatening event. In the typical population, PTSD is fairly well defined. These researchers have their work cut out for them. “It’s been a call to arms for the field to start looking at this.” “We’re all just trying to put together the pieces and recognize that it’s an important area that requires further study,” she says. The more they dig in, the more these researchers are finding that many autistic people might have some form of PTSD. Kerns and a few other researchers are trying to get a better understanding of the interplay between autism and PTSD, which they hope will inform and shape treatment for young people like Gabriel. “It seemed we were ignoring a huge part of the picture.” “It seems possible to me that it’s not that PTSD is less common but potentially that we’re not measuring it well, or that the way traumatic stress expresses itself in people on the spectrum is different,” Kerns says. One potential explanation, Kerns says, is that, like other psychiatric conditions, PTSD simply looks different in people with autism than it does in the general population. If that were true, Kerns points out, PTSD would be one of the only psychiatric conditions that’s no more common in people with autism than in their typical peers. Until a few years ago, only a few studies had delved into the problem, and most suggested that less than 3 percent of autistic people have PTSD, about the same rate as in typical children. Depression, anxiety and obsessive-compulsive disorder are all known to be more common among autistic people than in the general population, but PTSD had largely been overlooked. “We know that about 70 percent of kids with autism will have a comorbid psychiatric disorder,” says Connor Kerns, assistant professor of psychology at the University of British Columbia in Vancouver, Canada. Yet few studies have investigated that possibility or the psychological aftermath of such trauma, including PTSD. Clinicians suspect that the condition increases the risk for certain kinds of trauma, such as bullying and other forms of abuse. Gabriel’s autism was a contributing factor in most of the harrowing incidents he went through.
For him, it’s overwhelming and confusing.” Gabriel, now 13, started seeing a therapist about five years ago and last year was diagnosed with PTSD.
(Kristina and Gabriel’s last names have been withheld to protect the family’s privacy.) “The world is chaotic and crazy for typically developed people.
“He’s been hurt and had so much disruption in his life that he’s having problems realizing that he has stability now,” says his mother, Kristina. Six months ago, just after his grandmother died, he attempted suicide. Shortly after that, he experienced life-threatening heatstroke when he went to get his Legos from the car trunk and accidentally locked himself in. About three years ago, while at summer camp, he almost drowned. He was mercilessly bullied once he started school, showed signs of depression by age 7 and by 11 began telling his mother he did not want to live.
At age 3, he was sexually abused by a cousin. And for many, those events may add up to severe and persistent post-traumatic stress disorder (PTSD).īefore Gabriel could even talk, his father’s girlfriend at the time told him his mother had abandoned him. Having autism can sometimes mean enduring a litany of traumatic events, starting from a young age.
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