Autism is characterised by differences in social communication style, difficulties interpreting the thoughts, feelings and actions of others, a vulnerability towards emotional overwhelm and dysregulation, heightened or diminished sensitivity to sensory stimuli, having a narrower range of interests, somewhat rigid thinking style, and some avoidance of socialising. Autism often co-exists with other neurodevelopmental, physical and mental health conditions.
Assessing the psychological and physical impact of a traumatic event on autistic people requires special consideration. Autism can affect how individuals report an incident, their psychological response to trauma, and pain-related issues. Therefore, it is essential for both clinicians and legal professionals to recognize and understand the unique needs of this client group.
Autism and Trauma Response
Since the late 1980s/early 1990s psychological and neuroscientific research has vastly enhanced our understanding of the impact of psychological trauma on human beings however, the vast majority of this research has been carried out on neurotypical populations. Assessment of the psychological impact of trauma in autistic people is complicated by the overlap in typical signs and symptoms relating to their neurodiversity and those of a traumatic response to an event.
For example, people who have been traumatised often isolate themselves for protection, whilst autistic individuals often isolate themselves due to feeling overwhelmed by social engagement. Traumatised people may find it very difficult to articulate what they have been through, and autistic people may have difficulties with communication more generally. Similarly, both autistic people and those who have been severely traumatised can typically display emotionally dysregulated behaviour.
Trauma is likely to impact autistic people more strongly than neurotypical people for several reasons. Deficits in information processing and problem-solving skills mean the autistic person may struggle to use effective coping strategies. A tendency to be easily overwhelmed by environmental stimuli means that an event that is manageable to a neurotypical person, may be completely overwhelming to an autistic person. A rigid thinking style may mean it is difficult to think flexibly about what has happened and let go of unhelpful thoughts. Communication difficulties mean that reporting and processing the event through talking may not be possible. This can make it challenging for clinicians and legal professionals to accurately assess their trauma-related symptoms. This can lead to an underestimation of the severity of their trauma-related symptoms, which can result in inadequate treatment and support.
Autistic individuals may experience difficulties in cognitive processing due to differences in brain function and connectivity. These difficulties can have significant implications for the way they perceive and respond to traumatic events. Individuals with autism may have difficulties in understanding and interpreting the cause-and-effect relationship between the traumatic event and its consequences. They may also have difficulties in processing and integrating sensory information related to the trauma, which can lead to sensory overload and increased distress. These cognitive processing difficulties can affect the individual’s ability to comprehend the nature and severity of the trauma, its impact on their lives, and the need for appropriate support and intervention.
Autistic individuals may have difficulties with emotional regulation. For instance, individuals with autism may have difficulties in recognizing, interpreting and regulating emotions. In the context of traumatic events, these difficulties in emotional regulation can lead to heightened emotional responses, such as intense fear, anxiety, or anger. Individuals may experience prolonged distress following a traumatic event, which can lead to the development of other trauma-related disorders. It has been suggested that neurodivergent individuals may be at increased risk of developing PTSD due to difficulties with emotional regulation.
It is important to note that emotional dysregulation may manifest differently in neurodivergent individuals compared to neurotypical individuals. For example, individuals with autism may exhibit atypical emotional responses, such as a lack of emotional expression or inappropriate emotional reactions. Clinicians and legal professionals should be aware of these differences and consider the individual’s neurodivergent condition when assessing their emotional response to trauma.
Autism and Pain
Pain assessment in individuals with autism can be challenging due to communication difficulties and sensory processing issues. Medical professionals need to consider several factors when assessing pain in autistic individuals to provide appropriate pain management. Autistic individuals may have difficulty communicating their pain due to limited verbal skills, a lack of understanding of pain, or a preference for non-verbal communication. The use of alternative communication methods, such as visual aids or pictorial scales, to facilitate pain assessment may be helpful.
Sensory processing difficulties can also be a significant barrier to pain assessment in autistic individuals. Autistic people frequently have either heightened or diminished sensitivity to pain, which needs to be carefully considered in tailoring any pain assessment and management plan. For example, individuals with hypersensitivity to touch may find traditional pain assessment methods such as palpation or examination uncomfortable or distressing, and alternative methods such as observing pain-related behaviours may be more appropriate. It is also important to recognise that whilst an autistic individual may appear to show incongruent responses to pain, this does not necessarily indicate malingering or exaggeration.
Finally, autistic individuals often have difficulty coping with unfamiliar environments or situations, which can impact their ability to communicate their pain and distress levels accurately. Medical professionals should assess the individual’s social and environmental context and use this information to tailor any assessment and management plan. For example, using familiar surroundings or caregivers during pain assessment may help reduce anxiety and improve pain communication.
Key Learning Points
Assessing a neurodivergent individual following a traumatic event, for psychological or physical difficulties, requires careful consideration of factors that may affect their psychological and physical well-being. The following should be considered:
- Cognitive processing: Autistic people may experience difficulties in processing and making sense of the traumatic event, which can affect their ability to understand the nature and severity of the trauma and its impact on their lives.
- Emotional regulation: There may be difficulties associated with the regulation of emotions and autistic individuals may have a heightened emotional response to traumatic events, leading to prolonged and intense distress.
- Communication barriers: Autistic claimants may experience difficulties in expressing their feelings, emotions, and pain sensations verbally, making it challenging to communicate their symptoms accurately.
- Sensory issues: Autistic individuals often have sensory processing issues, which can make them hyper or hypo-sensitive to certain stimuli, leading to heightened or decreased pain sensitivity.