Publications of Interest is our quarterly column where we present a summary of recent articles on a topic of interest to our members. This quarter we have a new volunteer coordinator of this column, Charlotte Creasey. We welcome Charlotte (pictured below). Charlotte is a student member, and when asked to introduce herself had the following to say:
“I’m a first-year student on a Masters course in Integrative Counselling, just about to start my first ever placement in the new year. I’m a dissociative survivor myself and have been inspired to train as a counsellor through the wonderful work my therapist has done with me, as well as the works from others (largely ISSTD members!) that I’ve read or listened to as part of my own recovery. I hope to help other survivors one day, and I’m so excited to be able to volunteer for the ISSTD.”
This is Charlotte’s first column and focuses on trauma in populations who are autistic or who have ADHD.
Douglas, S. and Sedgewick, F. (2023) ‘Experiences of interpersonal victimization and abuse among autistic people’, Autism, 00 (0), pp. 1-14. DOI: 10.1177/136236132312056.30
Abstract: Intimate partner violence and sexual assault are under-researched experiences in autistic people’s lives. Recent research, however, has shown that autistic people are more likely to have been victimized than non-autistic people. This research, therefore, sought to explore the firsthand accounts of a range of autistic people about intimate partner violence and sexual assault. Twenty-four autistic adults with lived experience (6 male, 15 female, 3 non-binary) aged 25-61 years took part in semi-structured interviews online. They were asked about their experiences of intimate partner violence and sexual assault, whether and how they felt being autistic interacted with those experiences, and what recommendations they would have for improving education in the future. Almost all participants had repeated experiences of intimate partner violence and sexual assault, regardless of gender, and there were clear similarities in their stories. Six themes with subthemes were identified. These were ‘experiences of abuse‘, ‘autism used against you‘, ‘poor family models‘, ‘impact of/on friendships‘, ‘handling trauma‘, and ‘recommendations for future practice‘. Autistic people experience many of the same patterns of abuse as non-autistic people do, but there are unique autism-related vulnerabilities and outcomes. We found that there were a variety of responses to these experiences, and call for greater understanding so that autistic victims can be better supported.
Hanson, L. (2023) ‘A Qualitative Analysis of Treatment Providers’ Understanding and Assessment of Trauma and Autism’, Graduate School of Professional Psychology: Doctoral Papers and Masters Projects, 504. Available at: https:/ /digitalcommons.du.edu/capstone_masters/504 (Accessed: 26 November 2023).
Abstract: Patients with autism spectrum disorder (ASD) are particularly vulnerable to traumatic experiences and further development of post traumatic stress disorder (PTSD). Underlying traumatic stress is commonly missed and remained untreated in the autism population. In a previous pilot study, Hanson and Richards (2021) gathered providers’ understandings on trauma and autism The current study is a further, systemic content analysis on archival data from Hanson and Richard’s pilot study. Results from the current content analysis of the responses to Question 1 (How do you assess for trauma in your patients?) revealed that providers assess patients’ trauma primarily by interviewing caregiver and patients, as well as by behavioral observations. Responses to Question 2 (What is your definition of trauma?) indicated that some providers define trauma based on the DSM-V-TR PTSD diagnostic criteria. Finally, results about Question 3 (What would you like to learn, if anything, about trauma as it relates to the neurodiverse population?) revealed standardized trauma assessment measures and treatments normed on patients diagnosed with autism. Implications for future research and practice are discussed.that providers are interested in learning more about trauma in general and assessment and treatment tools specific for individuals with autism. Conclusions from the current study include that there is a need for provider education on trauma and autism, as well as development of standardized trauma assessment measures and treatments normed on patients diagnosed with autism. Implications for future research and practice are discussed.
Langevin, R., Marshall, C., Wallace, A., Gagné, M., Kingsland, E. and Temcheff, C. (2023), ‘Disentangling the Associations Between Attention Deficit Hyperactivity Disorder and Child Sexual Abuse: A Systematic Review’, Trauma, Violence & Abuse, 24 (2), pp. 369-389. DOI: 10.1177/15248380211030234
Abstract:
Background: An association between child sexual abuse (CSA) and attention deficit hyperactivity disorder (ADHD) has been documented. However, the temporal relationship between these problems and the roles of trauma-related symptoms or other forms of maltreatment remain unclear. This review aims to synthesize available research on CSA and ADHD, assess the methodological quality of the available research, and recommend future areas of inquiry.
Methods: Studies were searched in five databases including Medline and PsycINFO. Following a title and abstract screening, 151 full texts were reviewed and 28 were included. Inclusion criteria were sexual abuse occurred before 18 years old, published quantitative studies documenting at least abivariate association between CSA and ADHD, and published in the past 5 years for dissertations/theses, in French or English. The methodological quality of studies was systematically assessed.
Results: Most studies identified a significant association between CSA and ADHD; most studies conceptualized CSA as a precursor of ADHD, but only one study had a longitudinal design. The quality of the studies varied greatly with main limitations being the lack of (i) longitudinal designs, (ii) rigorous multimethod/multiinformant assessments of CSA and ADHD, and (iii) control for two major confounders: trauma-related symptoms and other forms of child maltreatment.
Discussion: Given the lack of longitudinal studies, the directionality of the association remains unclear. The confounding role of other maltreatment forms and trauma-related symptoms also remains mostly unaddressed. Rigorous studies are needed to untangle the association between CSA and ADHD.
Ng-Cordell, E., Rai, A., Peracha, H., Garfield, T., Lankenau, S. E., Robins, D. L., Berkowitz, S. J., Newschaffer, C., and Kerns, C. M. (2022), ‘A Qualitative Study of Self and Caregiver Perspectives on How Autistic Individuals Cope With Trauma’, Frontiers in Psychiatry, 13 (825008), pp. 1-17. DOI: 10.3389/fpsyt.2022.825008.
Background: Coping can moderate the relationship between trauma exposure and trauma symptoms. There are many conceptualisations of coping in the general population, but limited research has considered how autistic individuals cope, despite their above-average rates of traumatic exposure.
Objectives:To describe the range of coping strategies autistic individuals use following traumatic events.
Methods: Fourteen autistic adults and 15 caregivers of autistic individuals, recruited via stratified purposive sampling, completed semi-structured interviews. Participants were asked to describe how they/their child attempted to cope with events they perceived as traumatic. Using an existing theoretical framework and reflexive thematic analysis, coping strategies were identified, described, and organized into themes.
Results: Coping strategies used by autistic individuals could be organized into 3 main themes: (1) Engaging with Trauma, (2) Disengaging from Trauma, and (3) Self-Regulatory Coping. After the three main themes were developed, a fourth integrative theme, Diagnostic Overshadowing, was created to capture participants’ reports of the overlap or confusion between coping and autism-related behaviors.
Conclusions: Autistic individuals use many strategies to cope with trauma, many of which are traditionally recognized as coping, but some of which may be less easily recognized given their overlap with autism-related behaviors. Findings highlight considerations for conceptualizing coping in autism, including factors influencing how individuals cope with trauma, and how aspects of autism may shape or overlap with coping behavior. Research building on these findings may inform a more nuanced understanding of how autistic people respond to adversity, and how to support coping strategies that promote recovery from trauma.
Michna, G. A., Trudel, S. M., Bray, M. A., Reinhardt, J., Dirsmith, J., Theodore, L., Zhou, Z., Patel, I., Jones, P., and Gilbert, M. L. (2023), ‘Best practices and emerging trends in assessment of trauma in students with autism spectrum disorder’, Psychology in the Schools, 60, pp. 479-494. DOI: 10.1002/pits.22769.
Abstract: Children and adolescents with autism have a higher likelihood of being exposed to bullying, abuse, and sexual assault which, through repeated exposure, has been demonstrated to impede academic, social, and physical functioning among this population. However, the complexity of unpacking the characteristics of autism and trauma can pose a challenge for school psychologists in using the most appropriate clinical method of intervention. This paper summarizes the co‐occurrence of autism and trauma in an effort to better inform practitioners and recommends the need for valid and reliable assessments that measure adverse experiences for children with autism. A practitioner assessment guide of childhood trauma and autism spectrum disorder is also provided to facilitate a comprehensive assessment process. We conclude that there is a pressing need for more research examining the relationship between autism and trauma by better understanding the relationship of these constructs, and for the development of more effective assessments to provide more evidence‐based interventions.
Kerns, C. M., Robins, D. L., Shattuck, P. T., Newschaffer, C. J., and Berkowitz, S. J. (2023), ‘Expert consensus regarding indicators of a traumatic reaction in autistic youth: a Delphi survey’, Journal of Child Psychology and Psychiatry, 64 (1), pp. 50-58. DOI: 10.1111/jcpp.13666
Objective: It has been suggested that the sequelae of trauma are under-recognized in youth on the autism spectrum. We aimed to generate expert consensus regarding important trauma indicators, including but not limited to traumatic stress symptoms, in autistic youth.
Methods: We recruited 72 experts in autism and/or childhood trauma. Via a 2-round Delphi survey, experts commented on and rated the importance of 48 potential indicators, drawn from PTSD criteria and a broader literature on traumatic sequelae in autism. A revised list of 51 indicators, 18clinical guidelines developed from expert comments, and summaries of expert qualifications and ratings from Round1 were submitted to a second round (n=66; 92% retention) of expert review and rating.
Results: Twenty-two indicators reached consensus (>75% round 2 endorsement). Many, but not all, reflected PTSD criteria, including intrusions (e.g., trauma re-enactments in perseverative play/speech), avoidance of trauma-reminders, and negative alterations in mood/cognition (e.g., diminished interest in activities) and in arousal/reactivity (e.g., exaggerated startle). Experts also identified increased reliance on others, adaptive and language regressions, self-injurious behavior, and non-suicidal self-injury as important indicators. Consensus guidelines emphasized the need for tailored measures, developmentally informed criteria, and multiple informants to increase diagnostic accuracy.
Conclusions: Expert consensus emphasizes and informs a need for tailored diagnostic guidelines and measures to more sensitively assess traumatic reactions in autistic youth.
Fisher, N., Patel, H., van Diest, C., and Spain, D. (2022), ‘Using eye movement desensitisation and reprocessing (EMDR) with autistic individuals: A qualitative interview study with EMDR therapists’, Psychology and Psychotherapy: Theory, Research and Practice, 95, pp. 1071-1089. DOI: 10.1111/papt.12419
Abstract
Objectives: Eye Movement Desensitisation and Reprocessing (EMDR) is an evidence-based psychological therapy that targets distress associated with trauma and affective disturbance. Few studies have examined EMDR for autistic individuals who have co-occurring mental health conditions, but there is preliminary evidence of effectiveness. The current study explored EMDR therapists’ experiences of working with autistic individuals, and adaptations incorporated into clinical practice to make this more accessible and effective.
Design: A qualitative interview design was used. Data were thematically analysed.
Method: Twenty-three UK-based EMDR therapists at-tended one-off semi-structured qualitative interviews.
Results: Four main themes emerged: (1) the experience of being autistic; (2) factors around accessing EMDR; (3) adapting EMDR; and (4) supervision and support for EMDR therapists. Participants described offering a nuanced and tailored approach; one that retained the integral components of the eight phases of EMDR, while also being flexible and responsive to each client.
Conclusions: Findings reinforce the importance of offering formulation-based psychological therapy that flexes in an evidence-informed way, according to the preferences and needs of autistic individuals. Further research should establish factors influencing accessibility and effectiveness of EMDR for autistic individuals, and the impact of autism- relevant training on the knowledge, skills and confidence of EMDR therapists and clinical supervisors working with this client group.
Kandeğer, A., Boysan, M., Karaoğlan, G., Tekdemir, R., Şen, B., Tan, Ö., Sağlıyan, B., and Selvi, Y. (2023), ‘Heterogeneity of associations between dissociation and attention deficit symptoms’, Current Psychology, 42, pp. 28881-28894. DOI: 10.1007/s12144-022-03826-y
Abstract: Childhood trauma and dissociative experiences are suggested to be predisposing transdiagnostic factors for attention deficit /hyperactivity disorder (ADHD) as well as many psychiatric disorders. Trauma-related symptoms such as motor restless-ness, emotional instability, and concentration problems can mimic, trigger, or exacerbate ADHD symptoms. Moreover, given the relationship between ADHD and trauma-induced distress, it has been suggested that dissociative experiences and attention problems may reveal overlapping characteristics. The aim of this study was to investigate the associations between dissociative experiences and attention deficits by carrying out mixture analysis. A thousand and thirty-seven participants volunteered to the online investigation. Participants completed a test battery that included a sociodemographic form as well as the Adult ADHD Severity Rating Scale (ASRS), Wender Utah Rating Scale (WURS), Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and Somatoform Dissociation Questionnaire (SDQ). Item responses on the DES and attention deficit symptoms as indexed by the ASRS were subjected to latent class analysis. The three-latent-class model outperformed alternative mixture models. Mixture analysis classified the sample into three homogenous subgroups as follows: (1) No/low dissociation or attention problems; (2) Moderate dissociation with attention problems; and (3) High dissociation with attention problems. High dissociators with attention problems were characterized by heightened scores on somatoform dissociation and emotional neglect. No/low dissociation or attention problems latent class reported significantly lower scores on hyperactivity/impulsivity, depression, attention deficit in childhood, and sexual abuse than both moderate and high dissociation latent classes. High dissociators and moderate dissociators significantly differed on conduct problems and physical abuse. We concluded that impulsive hyperactivity, depression, and childhood sexual abuse were common features in heightened dissociation latent classes, as well as attention deficit.