EP34: Is It Autism or Trauma? Or Both?

Are my traits or symptoms related to autism? Or are they caused by trauma? This is one of the top questions asked by individuals going through the process of identifying their neurodivergent identity in adulthood.

Join me as we explore how autistic and trauma traits intertwine and differ, with a focus on familial mental health challenges and their impacts.

Get clarity on trauma, autism, and PTSD with insights from researchers and therapists working in the field. Gain a deeper understanding of attachment disorders like reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) in children.

Watch this episode on YouTube.

If you'd like to know more about topics discussed in this episode, check out:

"Autism and Attachment Disorders — How Do We Tell the Difference?" by Claire Davidson et al.

"Parental Psychiatric Disorders and Autism Spectrum Disorders" by Elina Jokiranta et al.

"The Long-Term Impact of Parental Mental Health on Children’s Distress Trajectories in Adulthood" by Christina Kamis

"Exploring Potential Sources of Childhood Trauma: A Qualitative Study With Autistic Adults and Caregivers" by Connor M. Kerns et al.

"Autism and Reactive Attachment/Disinhibited Social Engagement Disorders: Co-occurrence and Differentiation" by Susan Dickerson Mayes et al.

"Genetic Overlap Among Autism Spectrum Disorders and Other Neuropsychiatric Disorders" by Yoshiro Morimoto et al.

"PTSD and Autism" by Megan Anna Neff

"Family History of Mental and Neurological Disorders and Risk of Autism" by Sherlly Xie et al.

Theme music: "Everything Feels New" by Evgeny Bardyuzha.

All episodes written and produced by Kristen Hovet.

Send in your questions or thoughts via audio recording for a chance to be featured on the show! Email your audio clips to kristen.hovet@gmail.com through WeTransfer.

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Transcript

Kristen Hovet: 1:06

Today I'm talking about trauma, attachment disorders, and autism; how they overlap and how they differ; as well as familial mental health challenges or the mental health diagnoses that often run in families where there is autism. I've touched on some of these topics before, but mainly as parts of episodes on other topics, so I wanted to do a deeper dive this time around. While you'll find a lot of content about all of this on YouTube, on podcasts, and in other locations online, there's always new information coming out and always new ways of synthesizing or putting the information together, so I wanted to try my hand at covering it. Before we get into this topic, you'll probably notice I don't have my Other Autism neon sign behind me. I've packed it away. I'm getting ready to move in June and I've just started doing a lot of packing beforehand in preparation, because I know it's going to be a really busy time.

Kristen Hovet: 2:13

Also, I'd like to remind everyone that The Other Autism now has a Patreon with bonus content for paid Patreon members. Bonus content currently includes additional podcast mini episodes, behind- the- scenes photos and videos, and audio- only reading episodes where I'm currently going through 20,000 Leagues Under the Sea, one chapter at a time. Why am I reading this apparently random book? Well, these reading episodes have been requested. Specifically, I've had listeners ask for reading episodes or meditation episodes, and since reading is more my jam, I went with that option. Also, several listeners report currently going through burnout and just wanted some easy listening. I also thought it would be a great opportunity to explore some classics that I've never read, that are part of the public domain and therefore I can use them without any copyright issues.

Kristen Hovet: 3:09

Being a paid member of Patreon helps fund this podcast and I have hopes that eventually it will be a thriving community of The Other Autism listeners. I know a lot of podcasts and other online content creators have Patreon accounts and they're always trying to get you to join, so it can be annoying. I totally get it, as a podcast consumer myself, but it's one of the main ways to fund the work we do. A huge, huge thank you to those who have already joined and I really appreciate that you're willing to give it a try, and I also appreciate those who send in recommendations and ideas for future Patreon member-only content. If you just can't be convinced to join Patreon, please consider leaving a rating and or a review, if you haven't done so already. You can do that on Apple Podcasts, on Spotify, I think allows you to just leave the star rating as long as you've listened to the podcast. The other thing you could do is share this podcast with those who might find it interesting or helpful and basically just keep doing what you're doing.

Kristen Hovet: 4:18

I also want to try something new. I'm putting out a call for anyone who wants to to send in a question or a comment or really anything you want to tell other listeners via audio recording. This can be messages of support, it can be your diagnosis story or parts of it, and you can send your audio clips to kristen dot hovet at gmail dot com through WeTransfer, which is a website that is totally free to use. Just record something on your phone or your computer. Go to wetransfer dot com that's W-E-T-R-A-N-S-F-E-R dot com, upload the file, enter my email address, and send. I can't promise that all audio clips will be used, but all will be listened to and considered for airing on the show. Feel free to share as much or as little about yourself as you're comfortable with.

Kristen Hovet: 5:17

Okay, let's start with a definition. According to Connor M. Kerns and his team, trauma is defined as, quote, an event or circumstance that is experienced as physically or emotionally harmful or life-threatening and has lasting adverse effects on functioning and well-being, end quote. When it comes to discussions of trauma and autism, autistic people in this day and age will almost certainly have significant trauma and resulting mental health impacts. We may even have formal diagnoses of post-traumatic stress disorder or PTSD, or we may have been told by a therapist or psychologist that we have complex PTSD or that we have experienced complex trauma. Basically when there's repeated trauma over and over and over again, often from very early on in life, such that it presents a bit differently than PTSD and has a deeper and longer-term impact on the person's entire personality and way of being. The problem that many late-diagnosed autistic people have is figuring out if their traits are linked to this trauma or to being autistic.

Kristen Hovet: 6:27

As I've said before in past episodes, if you are autistic, your traits are almost certainly linked to both autism and trauma, especially as a late- diagnosed autistic individual, because being late- diagnosed usually means you're also high- masking, or at least you mask more often than autistic individuals who are identified as autistic earlier in life. Being high- masking means you've suppressed core attributes of yourself, both consciously and unconsciously, as a way to fit in and be accepted by others. It means you've tamped down your true self time and time again because you don't feel safe to be yourself and you are made to feel shame about yourself and your traits. But some still wonder if they're autistic at all. Maybe all of their traits can be explained by trauma, or so their thinking goes.

Kristen Hovet: 7:26

This is when it helps to have a psychologist include others in your assessment or diagnosis process, such as parents or grandparents or aunts and uncles, who have known you since you were a newborn or very young and who are very perceptive and can answer questions about traits you had before you experienced trauma. If this is just not possible, I'd advise looking into traits and characteristics that are associated with autism but not with PTSD and vice versa. According to Dr. Megan Anna Neff, an autistic and ADHDer psychologist who runs the website NeuroDivergent Insights, these autistic traits include repetitive behaviors and self-soothing through use of routines, difficulty reading or understanding neurotypical or non-autistic social cues, sensory differences as core to your human experience from as far back as you can remember, and the existence of special interests or very deep interests that sort of also mark your core experience.

Kristen Hovet: 8:28

For those who are just learning about these subjects, I think it's important to briefly cover some of the overlapping traits between PTSD and autism. Again using Dr. Neff's work, individuals who have PTSD and autistic individuals can share the following overlapping traits or characteristics: Dissociation, difficulty with intimacy, increased risk of being victimized by others, negative beliefs about the self and the world, difficulty managing intense emotions, high rates of substance abuse, depression, self-harm and or suicidality, hypervigilance or fight or flight response that's easily triggered. Difficulties controlling some impulses, executive functioning difficulties, sleep issues, stimming, and heightened awareness or sensitivity to sensory input. I will note that these traits are temporary in those with PTSD alone, whereas they exist in autistic individuals as core to who they are, with no clear beginning and no clear end. Actually, the traits never end really, unless the person has been forced to try to tamp them down or hide them. It's also important to note that not everyone with PTSD and not everyone who's autistic experiences all of these. They may experience just a few. Traits that specifically point to PTSD and not autism include clear evidence of the presence of a traumatic event or several events, avoidant behaviors, intrusive memories and flashbacks that a person cannot control, and the presence of nightmares. There are probably more, but those are the top ones, again using Dr. Neff's work. Hopefully that's given you a bit of clarity between PTSD and autism.

Kristen Hovet: 10:19

But what about attachment disorders? It's important to start by saying attachment disorders are not the same as attachment styles. Discussions about attachment styles, which include secure, anxious, avoidant, and disorganized, have really taken off lately. But it's important to keep in mind that, while certain attachment styles likely overlap with attachment disorders, attachment disorders are psychiatric diagnoses specifically in children. Attachment disorders include reactive attachment disorder, or RAD, and disinhibited social engagement disorder, or DSED, but these are only present in children and both are associated with clear evidence of abuse, neglect, or other extremely insufficient or unstable care, according to Claire Davidson and her team in an article titled Autism and Attachment Disorders, How Do We Tell The Difference?

Kristen Hovet: 11:16

Signs and symptoms of both reactive attachment disorder and disinhibited social engagement disorder tend to dissipate or go away when the child enters a supportive, nurturing environment and or as they get older, which obviously is not the case with autism. According to Davidson and her team, both reactive attachment disorder and disinhibited social engagement disorder are marked by a failure to develop social relationships that match what is expected of a child at their age and developmental level. Reactive attachment disorder, or RAD, is characterized by a, quote, failure to seek and accept comfort and associated dysregulation in emotions and social relationships, end quote. A child with RAD shows very few or almost no displays of positive emotion and several episodes of extreme negative emotion. They show very little social or emotional responses to others and they don't seek comfort from others. These are very sad, very disengaged little children.

Kristen Hovet: 12:32

Disinhibited social engagement disorder or DSED, while it can be diagnosed in the same child, is characterized by, quote, socially indiscriminate behaviors and failure to respect social boundaries, end quote. A child with DSED basically doesn't have any sense of stranger danger or caution around new people. They will go to anyone to apparently seek comfort, whereas a child without DSED will show clear preference for primary caregivers such as parents. A child with healthy attachment seeks affection and comfort from their primary caregivers and will be wary and shy of strangers or new people.

Kristen Hovet: 13:10

So according to what I read, a child can have both of these attachment disorders and they can kind of move between the sets of kind of symptoms or characteristics. So they can go from being very, very isolated, very, very detached to then being kind of like all over everyone indiscriminately and not having preference for any particular caregiver or person. It's kind of odd to see. I think I've seen kids who have these traits and i t's kind of alarming because you don't expect it. Like the typical behavior for a young child is to be, you know, very wary and they'll like cling to their parents, and they'll not want to go to new people and they'll have a clear bond with their parents. Like that's kind of typically what we see.

Kristen Hovet: 14:05

I have to say that when I was reading about these two attachment disorders, I also kept thinking that kids with attachment disorders are probably more likely to grow up to develop personality disorders. I did a quick Google search and apparently this does seem to be a thing. Interesting. I had to force myself to not go into that further, but I just wanted to note that. So, while both RAD and DSED are caused by abuse and neglect, there's no evidence that autism is caused by abuse or neglect. In fact, autism is highly heritable and in most content I read these days is treated as a genetic difference or inherited neurotype. It is possible for an autistic child to also be diagnosed with an attachment disorder like RAD or DSED, but typically what happens as a child gets older is that they'll lose their RAD and or DSED traits yet maintain their autistic ones. While autism and attachment disorders are not causally linked,

Kristen Hovet: 15:09

as far as we know, autistic children may be more likely to develop attachment disorders than neurotypical children, but more about that later. While autistic children are at a greater risk of experiencing abuse and neglect while growing up, secure attachment between autistic children and their parents is actually super common, whether the parents are autistic themselves or neurotypical. Davidson and her team state that while the majority of autistic children have excellent relationships with their families, there is a significant subset of autistic individuals whose families appear to exhibit a wide array of heritable neurodevelopmental conditions and or mental health challenges running through them, through the generations. It may be that, quote, abuse and neglect are more likely to arise when an already struggling family, in which the parent or parents may also have neurodevelopmental problems, has a child whose complex neurodevelopmental symptoms make parenting challenging, end quote. So what are these neurodevelopmental and I'll add mental health conditions that could be impacting these families?

Kristen Hovet: 16:20

In addition to autism itself, which we know to run in families because of its super high heritability, other conditions seen in these families include attention deficit- hyperactivity disorder or ADHD, schizophrenia spectrum disorders (such as schizoaffective disorder and delusional disorder), obsessive compulsive disorder, affective disorders (such as major depressive disorder and bipolar disorder), anxiety disorders (such as generalized anxiety disorder, panic disorder, social anxiety disorder, and phobias), personality disorders, eating disorders, substance use disorders, and childhood disorders (such as oppositional defiant disorder and conduct disorder). So, of course, these different conditions appear in a lot of different families, regardless of whether there's autism in those families. However, the research shows that these conditions tend to happen more often in families that already have neurodiversity, that already have autism and ADHD. There seems to be some type of genetic overlap and, with a lot of these conditions, they are actually identifying some of those genes, which is really interesting, and I think in the years to come we'll see more and more of these genes being identified.

Kristen Hovet: 17:47

We know from the research and clinical accounts that having mental health challenges in families impacts children's health and well-being, whether that child's autistic or neurotypical. Increased psychopathology in parents, according to the researcher Christina Kamis, is associated with poorer parental functioning or abilities, greater conflict with their children, more overall dysfunction in the home, and more severe discipline. So I want to state these findings in really clear language: Parents with mental illness or psychiatric conditions tend to be less successful at parenting or have more struggles with parenting, have more fighting or negative interactions with their children, their children have more behavioral and psychological problems of their own, and these parents are more inclined to punish their children in harsher ways compared to parents without these conditions. These negative experiences can be very traumatic for the children and lead to poor overall life outcomes, regardless of the neurotype of the child. I want to add here that I suspect these parents are also less likely to have adequate support, especially in the case where they're not properly diagnosed or not receiving appropriate and adequate treatments.

Kristen Hovet: 19:10

But back to trauma. So for autistic individuals, trauma of any kind tends to hit us harder than it hits non-autistic individuals. In other words, autistic people are more hurt by or more negatively impacted by trauma across their entire life course, for a variety of reasons, and therefore they're also more likely to develop trauma-related disorders like PTSD and attachment disorders. So first of all, let's talk about some traumas that are unique to autistic individuals, starting in childhood and sometimes occurring frequently or repeatedly across the life course.

Kristen Hovet: 19:49

Autistic individuals, according to Connor M. Kerns and his team, are more likely to experience being trapped or entrapment, social exclusion, and traumatic incongruities, defined as incongruities or severe mismatches between sensory, social, and executive processing styles of the autistic person and their external and social environments. Let's break these down further because I think just listing it like that doesn't tell the whole story. So trauma related to being trapped or entrapment includes trauma resulting from, quote, feeling physically and psychologically restricted and, at a meta-level, socially stymied, prevented by society from being able to pursue a full life, end quote. These types of entrapments include literal physical restraint or sedation and generally various types of physical and medical restraint or control. It includes loss of autonomy, far more scrutiny than that experienced by neurotypical peers, restrictive learning environments, loss of the ability to make decisions about one's life, segregated schooling, and so on, as well as, quote, a dearth of employment opportunities or appropriate education, vocational training, housing, and other social services for autistic individuals, particularly those without intellectual disabilities, end quote.

Kristen Hovet: 21:21

Trauma related to social exclusion includes trauma resulting from bullying, being kept apart from others or feeling a lack of social belonging, teasing, intimidation, isolation, differential treatment, subtle and ongoing exclusions, which I think some have called microaggressions, repeated discrimination and minority stress, not being believed regarding experiences of maltreatment or discrimination, lack of support or protection from family or peers, and betrayal in romantic relationships, which can be, quote, particularly devastating given their difficulties connecting with others in general, end quote. Importantly under this category of social exclusion traumas, caregivers and parents of Black autistic children reported concern about their children being dually targeted by authority figures for both their race and autistic traits. And, finally, trauma related to traumatic incongruities include trauma resulting from particularly painful sensory experiences, such as some medical appointments, fire alarms, and so on, that cause intense distress, physical pain, or severe anxiety; transitions or changes that lead to the person experiencing unpredictability in day-to-day life; and chronic social confusion, including the, quote, reduced ability to understand and predict others' intentions and actions, end quote. And I'd note that others here refers to mainly neurotypicals and their intentions and actions. It's typically harder for us to read neurotypicals. We can actually read each other quite well.

Kristen Hovet: 23:07

Interestingly, this category of trauma also includes repeated experiences of lack of directness and honesty from others. So autistic individuals are known for tending to be quite direct and honest, and this is often at odds with neurotypical ways of being. While some autistic people, especially the high- masking among us, have learned to mimic neurotypical ways in this regard, it's still exceedingly challenging to be in environments where the majority of people communicate indirectly or passively and where many white lies or even more serious lies are repeatedly told. There's a lot of work that has to go into figuring out what's going on all the time if you're in this type of environment. It's very draining. There's a clear incongruity here between the autistic person's internal abilities and preferences and the overall offerings of life in the predominantly neurotypical world.

Kristen Hovet: 24:05

In addition to the above three categories of traumas that are more unique to autistic people, autistic people are also more likely to experience what's been called traditional sources of trauma, including physical, sexual, and emotional abuse; environmental instability, including housing instability or homelessness, exposure to others' mental illness and witnessing others' suicidality or suicide attempts; and injury and illness, which includes medical trauma, chronic physical pain, and intense sensory challenges. Overall, being autistic can shape a person's vulnerability to all of the above-mentioned stressors via, quote, communication barriers (which may limit abuse allegations and convictions), social naivete and a desire for social acceptance (which enhance a child's vulnerability to manipulation), and sensitivities to sensory input and novel experiences (which can exacerbate the shock of injury, illness, and medical treatments), end quote.

Kristen Hovet: 25:09

While we're focused here on trauma and vulnerability to trauma and life stressors, I also want to note that research has also found unique sources of resilience and resistance to adversity displayed by autistic people, but I don't have time to get into that today. For now, it's enough to say that while we have unique vulnerabilities to trauma, we also have unique cognitive differences and abilities that can actually be protective or reduce the impacts of some traumas and stressors. It's especially helpful when we have the support we need and people around us who love us and support us, no matter what. Well, that's all I have for you today. Thank you so much for being here. Until next time, bye.