Autism, ADHD and Trauma
When talking about neurodivergene and trauma, at times the question that arises is what came first. It becomes the chicken and the egg dilemma, wondering what was already happening, what was adding additional burden on the nervous system, and how the two interplay.
But tracing the origin is not always helpful and at times even takes the attention away from the main issue.
That issue being that neurodivergent people are more susceptible to experiences of trauma.
Wait, but why?
While anything that has to do with trauma and/or neurodivergence is never a one sentence answer, as I see it the crux of the problem lies in the fact that neurodivergent people live in a world that is not made for them, equipped with a nervous systems that at times can feel like an exposed wire - highly sensitive, charged, in many cases with little understanding as to why.
Lacking support, accessibility and accommodation in areas that may come with a lot of stigma - for example needing tutoring at school or assistance with organization and planning, or even taking longer to learn something that may come naturally to others - can become a traumatic experience that the body and brain remember for a long time.
Or continuously experiencing misattuned social interactions because of either a lack of instinct as to how to interact with others, or impulsivity that others may find alienating.
Talking specifically about childhood trauma which is inherently relational - meaning it starts and continues in relationships - means looking at where relational ruptures occurred with parents/caretakers. If the caretakers lack knowledge about neurodivergence and how it may present itself, they may inadvertently place unmanageable expectations and demands on their child who continues to grow up knowing they are failing those expectations and internalizing it as "something must be wrong with me".
Which then becomes the core of their identity and affects their sense of self, their relationships with others, their sense of belonging in the world.
The stats
Research shows that the risk of adverse events, and as a result trauma, in higher in autistic people:
“In a population-based study, it was found that children with ASD reported a significantly higher level of exposure to neighborhood violence, parental divorce, traumatic loss, poverty, mental illness and substance abuse in the family. These situational indicators of stress and trauma experienced by the family are called adverse childhood experiences (ACE) and the probability of reporting one or more of them was higher in children with ASD compared to children without ASD.” (Lobregt-van Buuren, Hoekert & Sizoo, 2021)
The same study also mentions that autistic people were not only more likely to experience a higher level of these adverse events, but also a higher number. Meaning more frequent traumatic events as well as a higher level of them. As a result, the study concludes that “adults with ASD are more than four times likely to be diagnosed with PTSD than adults without ASD.”
Research is similar in connecting adverse childhood experiences that could signify experiences of trauma to ADHD, noting that proportionally “children with ADHD have higher ACE exposure compared with children without ADHD.”
How do we differentiate between trauma and autism/ADHD?
ADHD and autism are both neurodevelopmental conditions that have a strong genetic component and can develop as early as in utero. It affects how the brain perceives, stores and processes stimuli. Trauma, or in diagnostic terms PTSD and cPTSD, are traumatic disorders that can develop as a result of consistent traumatic dysregulation in relationships, however neither are developmental nor present at birth.
cPTSD requires a relationship to occur, ADHD and autism do not. These two neurotypes have to do with how a person takes in and processes the world around them.
There are symptoms that overlap between the three, such as difficulty regulating emotions and affect, having a negative self-image and perception, persistent difficulties in relationships, heightened sensory input, impacted working memory and executive functioning struggles (forgetability, distractedness), to name a few.
To spot the difference between these conditions, context is crucial. Looking at how and when each of the symptoms emerges can pinpoint to which condition is likely the culprit. For example looking at negative self-image may mean exploring where it originates. With autistic and ADHD folks it will frequently be tied to not performing to the neurotypical expectations, while with cPTSD it will point to relational ruptures and not having had emotional needs met as a child.
How do we heal?
With any therapeutic treatment, the long term goal is to allow the person to face the truth of who they really are. Whether it is telling the story of trauma and naming the impact living through it has had on someone, or facing the fact that someone's brain functions differently and that it is okay to start unmasking in order to live a more fulfilling life. In the short term working on triggers, sensitivities and executive functioning struggles can help alleviate the immediate symptoms so that deeper self-discovery work can begin.
What is healing about therapy is the therapeutic relationship itself - allowing yourself to be fully seen and heard, and having a model of that kind of relationship to take with you to the outside world. Since trauma, autism and ADHD have to do with consistent and pervasive invalidation and denial of self, having space that allows you to experience the opposite can be profoundly healing.