Trauma diagnoses during emergency psychiatric evaluation among youth with and without autism spectrum disorder

Abstract

Autistic youth are more likely to experience traumatic events and may be more likely to develop trauma-related symptoms. However, accurately identifying trauma-related symptoms in autistic youth can be challenging. We examined post-traumatic stress disorder (PTSD) and other trauma-related diagnoses in youth with and without autism spectrum disorder (ASD) in a large, pediatric psychiatric emergency department (ED) in a diverse urban setting. Between March 2019 and November 2021, 2728 patients presented at our emergency psychiatric ED. Youth with ASD were 42% less likely to receive trauma-related diagnoses (prevalence ratio 0.58, 95% CI 0.41, 0.80) compared with youth without ASD. One possible explanation for this finding is that trauma-related symptoms are under-detected in youth with ASD during emergency psychiatric evaluations. There is a need for trauma screening and diagnostic instruments specifically tailored to the unique needs of youth with ASD to ensure optimal assessment and care.

Lay abstract

Autistic youth are more likely to experience maltreatment, victimization, and other traumatic events. However, it can be difficult to identify trauma-related symptoms in autistic youth, especially in those with limited verbal communication. In this study, we compared the prevalence of trauma-related diagnoses given to youth with autism spectrum disorder (ASD) to those given to youth without ASD who presented to a specialized pediatric psychiatric emergency department. We found that youth with ASD were 42% less likely to receive trauma-related diagnoses than youth without ASD. As there is evidence that youth with ASD are no less likely to experience traumatic events compared with youth without ASD, one possible explanation for this result is that trauma-related symptoms are missed during emergency psychiatric evaluations. Developing trauma screening instruments specifically designed for the needs of youth with ASD is an outstanding need.

Keywords

autism trauma psychiatric co-morbidity

Get full access to this article

View all access options for this article.

References

Brenner

Pan

Mazefsky

Smith

K. A.

Gabriels

(2018). Behavioral symptoms of reported abuse in children and adolescents with autism spectrum disorder in inpatient settings. Journal of Autism and Developmental Disorders, 48(11), 3727–3735. https://doi.org/10.1007/s10803-017-3183-4

Donnelly

L. J.

Cervantes

P. E.

Okparaeke

Stein

C. R.

Filton

Kuriakose

Havens

Horwitz

S. M.

(2021). Staff perceptions and implementation fidelity of an autism spectrum disorder care pathway on a child/adolescent general psychiatric inpatient service. Journal of Autism and Developmental Disorders, 51(1), 158–168. https://doi.org/10.1007/s10803-020-04509-0

Gudiño

O. G.

Weis

J. R.

Havens

J. F.

Biggs

E. A.

Diamond

U. N.

Marr

Jackson

Cloitre

(2014). Group trauma-informed treatment for adolescent psychiatric inpatients: A preliminary uncontrolled trial. Journal of Traumatic Stress, 27(4), 496–500. https://doi.org/10.1002/jts.21928

Haruvi-Lamdan

Horesh

Golan

(2018). PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms. Psychological Trauma, 10(3), 290–299. https://doi.org/10.1037/tra0000298

Haruvi-Lamdan

Horesh

Zohar

Kraus

Golan

(2020). Autism spectrum disorder and post-traumatic stress disorder: An unexplored co-occurrence of conditions. Autism, 24(4), 884–898. https://doi.org/10.1177/1362361320912143

Hoover

D. W.

(2015). The effects of psychological trauma on children with autism spectrum disorders: A research review. Review Journal of Autism and Developmental Disorders, 2(3), 287–299. https://doi.org/10.1007/s40489-015-0052-y

Hoover

D. W.

Kaufman

(2018). Adverse childhood experiences in children with autism spectrum disorder. Current Opinion in Psychiatry, 31(2), 128–132. https://doi.org/10.1097/yco.0000000000000390

Kerns

C. M.

Newschaffer

C. J.

Berkowitz

Lee

B. K.

(2017). Brief report: Examining the Association of Autism and Adverse Childhood Experiences in the National Survey of Children’s Health: The important role of income and co-occurring mental health conditions. Journal of Autism and Developmental Disorders, 47(7), 2275–2281. https://doi.org/10.1007/s10803-017-3111-7

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

10.

Kerns

C. M.

Robins

D. L.

Shattuck

P. T.

Newschaffer

C. J.

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), 50–58. https://doi.org/10.1111/jcpp.13666

11.

Kildahl

A. N.

Helverschou

S. B.

Bakken

T. L.

Oddli

H. W.

(2020). “If we do not look for it, we do not see it”: Clinicians’ experiences and understanding of identifying post-traumatic stress disorder in adults with autism and intellectual disability. Journal of Applied Research in Intellectual Disabilities, 33(5), 1119–1132. https://doi.org/https://doi.org/10.1111/jar.12734

12.

Kuriakose

Filton

Marr

Okparaeke

Cervantes

Siegel

Horwitz

Havens

(2018). Does an autism spectrum disorder care pathway improve care for children and adolescents with ASD in inpatient psychiatric units? Journal of Autism and Developmental Disorders, 48(12), 4082–4089. https://doi.org/10.1007/s10803-018-3666-y

13.

Lai

M. C.

Kassee

Besney

Bonato

Hull

Mandy

Szatmari

Ameis

S. H.

(2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. Lancet Psychiatry, 6(10), 819–829. https://doi.org/10.1016/s2215-0366(19)30289-5

14.

Lewis

S. J.

Arseneault

Caspi

Fisher

H. L.

Matthews

Moffitt

T. E.

Odgers

C. L.

Stahl

Teng

J. Y.

Danese

(2019). The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. Lancet Psychiatry, 6(3), 247–256. https://doi.org/10.1016/s2215-0366(19)30031-8

15.

S. T.

Chien

W. C.

Chung

C. H.

Tzeng

N. S.

(2024). Increased risk of acute stress disorder and post-traumatic stress disorder in children and adolescents with autism spectrum disorder: A nation-wide cohort study in Taiwan. Frontiers in Psychiatry, 15, Article 1329836. https://doi.org/10.3389/fpsyt.2024.1329836

16.

Lytle

Hunt

Moratschek

Hall-Mennes

Sajatovic

(2018). Youth with autism spectrum disorder in the emergency department. Journal of Clinical Psychiatry, 79(3), Article 17r11506. https://doi.org/10.4088/JCP.17r11506

17.

McDonnell

C. G.

Boan

A. D.

Bradley

C. C.

Seay

K. D.

Charles

J. M.

Carpenter

L. A.

(2019). Child maltreatment in autism spectrum disorder and intellectual disability: Results from a population-based sample. Journal of Child Psychology and Psychiatry, 60(5), 576–584. https://doi.org/10.1111/jcpp.12993

18.

McGonigle

J. J.

Venkat

Beresford

Campbell

T. P.

Gabriels

R. L.

(2014). Management of agitation in individuals with autism spectrum disorders in the emergency department. Child and Adolescent Psychiatric Clinics of North America, 23(1), 83–95. https://doi.org/10.1016/j.chc.2013.08.003

19.

Mehtar

Mukaddes

(2011). Posttraumatic stress disorder in individuals with diagnosis of autistic spectrum disorders. Research in Autism Spectrum Disorders, 5, 539–546. https://doi.org/10.1016/j.rasd.2010.06.020

20.

Peterson

J. L.

Earl

Fox

E. A.

Haidar

Pepper

Berliner

Wallace

Bernier

(2019). Trauma and autism spectrum disorder: Review, proposed treatment adaptations and future directions. Journal of Child & Adolescent Trauma, 12(4), 529–547. https://doi.org/10.1007/s40653-019-00253-5

21.

Quinton

Ali

Danese

Happe

Rumball

(2024). The assessment and treatment of post-traumatic stress disorder in autistic people: A systematic review. Review Journal of Autism and Developmental Disorders. https://doi.org/10.1007/s40489-024-00430-9

22.

Rumball

(2019). A systematic review of the assessment and treatment of posttraumatic stress disorder in individuals with autism spectrum disorders. Review Journal of Autism and Developmental Disorders, 6, 294–324. https://doi.org/10.1007/s40489-018-0133-9

23.

Rumball

Happé

Grey

(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), 2122–2132. https://doi.org/10.1002/aur.2306

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB