This is the internet weblog of Bix Frankonis.

Someones Are Actually Looking At Autism And PTSD

This morning, Spectrum announced that a piece by Lauren Gravitz from last September had won second place in the Awards for Excellence in Health Care Journalism. That piece? “At the Intersection of Autism and Trauma”, a look at the links between autism spectrum disorder and post-traumatic stress disorder.

For almost two months, I have been looking for a way to follow up a post I wrote about the “mini-traumas” of the monotropic brain. My reaction to the Gravitz piece was so intensely visceral, I gave myself a stomach ache.

In my post about traumas, I suggested that a study indicating connections in the autistic brain are more persistent than those in neurotypical brains perhaps could helps explain the whys and hows of everything from sensory sensitivities to the itensity of meltdowns.

If the autistic/monotropic brain is one that holds onto connections for longer periods of time than typical brains, is there an avenue of inquiry here into whether or not that helps explain sensory sensitivities? A typical brain might be momentarily put off, say, by bright lights, but if the autistic brain essentially can’t shake things off is it possible that it’s dealing not just with the sensory input of the bright light in a single discrete moment, but instead cumulatively over the course of that moment, and the next one, and the next one? Could a brain that can’t switch tracks simply be holding onto its reaction to stimulus in a way that inevitably increases the pressure?

I wanted to know how such connection persistence might relate to how trauma is laid down in the brain, creating what the neurotypical world might view as autistic reactions and responses that don’t seem commensurate with or proportional to the stimulus or stressor at hand.

Along comes the Gravitz piece, which doesn’t necessarily directly attack that particular question but is in the same orbit.

Abuse, sexual assault, violence, natural disasters and wartime combat are all common causes of PTSD in the general population. Among autistic people, though, less extreme experiences — fire alarms, paperwork, the loss of a family pet, even a stranger’s offhand comment — can also be destabilizing. They can also be traumatized by others’ behavior toward them.

Then there’s the part that might have started me crying (which likely then later explains my stomach ache).

In speaking with participants about causes of trauma, she has heard “everything from sexual abuse, emotional abuse and horrendous bullying, to much broader concepts, like what it’s like to go around your whole life in a world where you have 50 percent less input than everyone else because you have social deficits. Or feeling constantly overwhelmed by sensory experience — feeling marginalized in our society because you’re somebody with differences.” In other words, she says, “the experience of having autism and the trauma associated with that.”

As I indicated above, when I asked my questions about autism amd trauma, I did so in that context of monotropism and the suggestion that autistic brains hold connections for longer, wondering if that’s a potential mechanism for trauma being laid down in the brain more easily. Gravitz asks the central question.

This line of research is still in its earliest days: It is still difficult to tease apart correlation from causation. In other words, does autism predispose someone to post-traumatic stress, or are people with autism more vulnerable to experiencing traumatic events? Or both? Scientists simply don’t know the answers yet — although some studies do indicate that autistic children are more reactive to stressful events and, because they lack the coping skills that help them calm down, perhaps predisposed to PTSD.

What I was positing in my earlier post perhaps was that it’s sort of a merging of those two ideas of predisposition and vulnerability. If our autistic brains’ connections are more persistent, stressors cut more deeply and make us more vulnerable not just to the current event but to future events triggering the sensation of that earlier psychological cut.

Gravitz and the people she spoke with for the piece rightfully are concerned not just with the potential links between autism and PTSD but how you treat an autistic person for that condition.

“There are a number of core features of autism that make usual psychotherapies somewhat more complicated,” Hoover says. Typical children tend to be reluctant to talk about their traumatic experiences, but they generally give in because they know it’s good for them, he says. “Children on the spectrum are often less willing — because they’re exceedingly anxious, and because they’re not able to see the forest for the trees.” He notes that autistic children can be so keyed into the present, and so tied to routine, that they have a difficult time participating in treatment that intensifies their anxiety in the moment, even when they know it might help in the long run.

It’s hardly just about autistic children, and there’s more to it than the above dscription, as those studies I’ve mentioned a few times about seem to indicate.

Traditional therapeutic forms, methods, and formats are socially performative and therefore themselves a potential (or, for me, a likely) additional autistic stressor. If autistic people indeed are both predisposed and more vulnerable to the laying down of trauma in their brains, the therapuetic process itself needs to take care not to introduce further trauma.

I suppose that when I was thinking about “the mini-traumas of the monotropic brain”, I must not have googled for autism and PTSD, else I would have found the Gravitz piece earlier. So I’d like to thank the Association of Health Care Journalists for giving it an award, which gave Spectrum a reason to post about it, bringing it to my attention.

Along with also, of course, thanking Lauren Gravitz for writing it, I hope that she follows up on it at a later date, perhaps looking into whether there indeed are links between those “persistent connection” studies and the traumas of autism.