The relationship between autism spectrum disorder (ASD) and trauma is complex and often misunderstood, despite its significant impact on the autistic community. Research consistently indicates that autistic individuals are at greater risk of experiencing adverse events as traumatic and developing symptoms associated with posttraumatic stress disorder (PTSD).
Earlier research estimated PTSD rates among autistic individuals at relatively low levels, with substantial variation across studies; however, Rumball (2019) noted that the available evidence was limited and that PTSD may have been under-recognized in autistic populations. Newer, modern studies suggest a much larger number of autistic individuals having probable PTSD, placing their estimate at 45% (Rumball et al., 2020). Research by Peterson et al. (2019) suggests that even though there is a clear need for support, and evidence-based practices for treating trauma do exist, they are not always applied, adapted, or studied in this population. Clinicians may not be trained to recognize trauma-related symptoms in autistic clients, and many are not trained or comfortable treating it (Adams and Young, 2020). This leaves autistic individuals going through the aftermath of traumatic events and adverse life experiences without the appropriate care.
Trauma in Autism
Autistic individuals show increased vulnerability to experiencing trauma symptoms and the development of PTSD due to both “traditional” and autism-specific stressors. Research indicates that autistic people are at higher risk of victimization, maltreatment, and bullying (Peterson et al., 2019). There may also be a neurobiological component to this vulnerability. Kerns et al. (2015) proposed that differences in neurobiological systems involved in threat processing and stress regulation, including amygdala–prefrontal circuitry and the hypothalamic–pituitary–adrenal axis, may contribute to increased vulnerability to trauma-related symptoms in autistic individuals.
Furthermore, some internal or external experiences that many neurotypical individuals find neutral can create a repeated or constant distressing experience for autistic individuals. According to Haruvi-Lamdan, Horesh, and Golan (2018), “The unique characteristics of sensation, perception, social awareness, cognition, and global understanding in ASD may alter what events and stimuli are experienced as traumatic, and subsequently also the nature and severity of posttraumatic sequelae.” In other words, usual fears, sensory overstimulation, changes in routine, social demands, awareness of differences, and hypersensitivity to environmental stimuli are repeated sources of distress for autistic individuals. Over time, these experiences may lead to an accumulation of “small traumas,” which are experiences that may not meet the conventional definition or diagnostic criteria for PTSD but nonetheless result in significant and lasting psychological distress (Shapiro, 2018). Further research is needed to better understand and quantify the impact of these everyday experiences.
Recent research by Prosser et al. (2026) explains another factor that may contribute to the experience of trauma symptoms in the autistic population. The study found that autistic adults report high levels of “negative appraisals,” which include alienation, shame, and fear after a traumatic event. Negative appraisals are persistent, maladaptive interpretations of oneself, others, or the world that arise in response to stressful or traumatic experiences (Ehlers and Clark, 2000). These feelings, along with the everyday risk factors this population may experience, can make recovery more complex.
Diagnosing Trauma in Autism
A significant challenge in providing treatment for PTSD in autistic individuals is diagnostic overshadowing. Because some PTSD symptoms, such as social withdrawal, flattened affect, disturbances in arousal and reactivity, and sleep difficulties, can overlap with traits of autism, clinicians may have difficulty distinguishing trauma-related symptoms from autistic characteristics (Peterson et al., 2019). In addition, Adams and Young (2020) identified barriers to psychological treatment for autistic individuals, including limited practitioner knowledge and skills, difficulties accessing services, and insufficient tailoring of interventions to autistic needs. Together, these challenges may contribute to the under-recognition and undertreatment of trauma-related symptoms and reduce opportunities for appropriate, trauma-informed care.
Moving forward, the clinical community needs to develop and validate screening tools that can more reliably identify trauma-related symptoms in autistic individuals. Peterson et al. (2019) emphasized the importance of developing measures of trauma reactions specifically for autistic populations and adapting assessment procedures to account for differences in communication, interpretation, and social awareness. One example is the Childhood Adversity and Social Stress Questionnaire (CASSQ), developed by Kerns et al. (2025) to assess stressful experiences and traumatic stress symptoms in autistic children. Recent research has provided initial evidence for the validity of the parent-report version of the CASSQ, although further research with more diverse and clinical samples is needed (Kerns et al., 2025). Similar autism-informed tools may help clinicians distinguish trauma-related symptoms from traits of autism, potentially reducing diagnostic overshadowing and facilitating more appropriate trauma-focused care.
Trauma Therapy for Autism
Additionally, there is a clear need for trauma therapy that is responsive to the unique needs of autistic clients. Because clinicians are ethically obligated to practice within their scope of competence, they should seek specialized training, supervision, and consultation to develop the knowledge and skills necessary to provide effective, evidence-based care for this population. Successful trauma treatment for autistic clients requires flexibility and thoughtful adaptation of standard treatment protocols to align with each client’s communication style, cognitive abilities, sensory needs, and emotion regulation capacities. Some examples of adaptations are as follows:
- Clinicians may need to allow additional processing time, increase the number of sessions devoted to memory processing, and modify therapeutic pacing based on the client’s needs.
- When appropriate and with the client’s consent, involving a trusted caregiver can enhance treatment by providing additional context regarding the traumatic event, supporting communication between the client and clinician, facilitating emotion regulation, and reinforcing therapeutic skills outside of sessions.
- Visual supports and other individualized communication strategies can further improve engagement and assessment. Traditional measures, such as the 0–10 Subjective Units of Disturbance (SUD) scale used in EMDR therapy, may need to be adapted. Possible modifications include using visual aids, hand gestures to indicate intensity, simplified emotional categories (e.g., positive, negative, or neutral), or individualized rating systems based on the client’s interests and preferences.
- Establishing a predictable session structure, including a visual agenda and planned opportunities for preferred or regulating activities, can also promote a sense of safety, reduce anxiety, and support participation throughout the therapeutic process; however, the clinician should also be flexible about following the set agenda, monitoring the client’s engagement and distress and modifying the agenda accordingly.
- For more adaptations for treating trauma in autistic clients specifically using EMDR therapy, see the Autism Research Institute webinar, “EMDR Therapy and Autism,” by Amanda Tami, LPC-S, BCBA.
Effective trauma treatment for autistic individuals requires clinicians to move beyond a standard protocol and instead provide individualized, strengths-based, and neurodiversity-affirming care. By adapting evidence-based interventions to meet each client’s unique needs while maintaining fidelity to core therapeutic principles, clinicians can improve access to effective trauma treatment and promote more meaningful therapeutic outcomes for autistic clients.
Written by Amanda Tami, LPC-S, BCBA, Gabriela De Los Santos, and Nick Zelissen
References
Adams, D., & Young, K. (2020). A systematic review of the perceived barriers and facilitators to accessing psychological treatment for mental health problems in individuals on the autism spectrum. Review Journal of Autism and Developmental Disorders, 8(4), 436–453. https://doi.org/10.1007/s40489-020-00226-7
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345.
Haruvi-Lamdan, N., Horesh, D., & Golan, O. (2018). PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 290–299. https://doi.org/10.1037/tra0000298
Kerns, C. M., Newschaffer, C. J., & Berkowitz, S. J. (2015). Traumatic childhood events and autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(11), 3475–3486. https://doi.org/10.1007/s10803-015-2392-y
Kerns, C. M., Zaidman-Zait, A., Robins, D. L., Shattuck, P. T., Mazefsky, C. A., Newschaffer, C. J., & Berkowitz, S. J. (2025). Psychometric properties of the Childhood Adversity and Social Stress Questionnaire, Parent Report (CASSQ-PR), a measure tailored to assess stressful experiences and traumatic stress symptoms in autistic youth. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0002007
Peterson, J. L., Earl, R. K., Fox, E. A., Ma, R., Haidar, G., Pepper, M., Berliner, L., Wallace, A. S., & Bernier, R. A. (2019). Trauma and autism spectrum disorder: Review, proposed treatment adaptations and future directions. Journal of Child & Adolescent Trauma, 12(4). https://doi.org/10.1007/s40653-019-00253-5
Prosser, R., Rumball, F., King, D., & Steel, C. (2026). Post-traumatic stress disorder in autistic and non-autistic adults: The impact of appraisals on reactions to traumatic events. Autism: The International Journal of Research and Practice, 30(3), 605–625. https://doi.org/10.1177/13623613251403405
Rumball, F. (2019). A systematic review of the assessment and treatment of posttraumatic stress disorder in individuals with autism spectrum disorder. Review Journal of Autism and Developmental Disorders, 6(3), 294–324. https://doi.org/10.1007/s40489-018-0133-9
Rumball, F., Happé, F., & Grey, N. (2020). Experience of trauma and PTSD symptoms in autistic adults: Risk of PTSD development following DSM‐5 and non‐DSM‐5 traumatic life events. Autism Research, 13(12). https://doi.org/10.1002/aur.2306
Shapiro, F. (2018). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures (3rd ed.). Guilford Press.