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An exploration of responses to trauma in people on the autistic spectrum

An exploration of responses to trauma in people on the autistic spectrum. Looking at trauma and dissociation through a different lens ESTD-UK York Thursday 21 st March 2019. What do we mean by trauma?. NON-TRAUMATISED V’S TRAUMATISED BRAIN. Post Traumatic Stress Disorder (PTSD).

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An exploration of responses to trauma in people on the autistic spectrum

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  1. An exploration of responses to trauma in people on the autistic spectrum Looking at trauma and dissociation through a different lens ESTD-UK York Thursday 21st March 2019

  2. What do we mean by trauma?

  3. NON-TRAUMATISED V’S TRAUMATISED BRAIN

  4. Post Traumatic Stress Disorder (PTSD) 3 PTSD clusters defined in the ICD 11 • Re-experiencing of past trauma in the here and now • Avoidance of traumatic reminders • A sense of threat

  5. Symptoms of PTSD • Upsetting dreams, reliving events in here and now, • Being reminded then spacing out, moments when lose control and act as if in the past, • Memory so strong that you lose track of surroundings, • React to others as back in the past, Flashbacks even for a moment • Internal reminders, External reminders • Being on guard • Jump/startled.

  6. Vulnerability factors for PTSD • Women at greater risk than men • Experiencing or witnessing a terrifying event • Dissociation • Inherited mental health risk (family history of anxiety and depression) • Cognitive vulnerabilities • Low IQ • Temperament ( inherited feature of personality) • The way your brain regulates chemicals and hormones that your body releases in relation to stress • A job that increases the risk of being exposed to traumatic events (eg. military/ first responder)

  7. Complex PTSD ( CPTSD) Additional disturbances in ‘self’ over and above PTSD clusters: • Affect Regulation • Negative self concept • Disturbances in relationships

  8. Symptoms of Complex PTSD • Intense reactions • Long time to calm down • Feeling easily hurt, • Uncontrollable anger, • Reckless behaviour, • Numb, • Difficult feeling pleasure, • World is distant, • Feeling out of body, failure, • Worthlessness, • Shame, • Guilt, • Feeling cut off from others, • Difficult staying close to others, avoidance of relationships

  9. Vulnerability to Complex PTSD “Complex PTSD is likely to occur when an individual has experienced recurring trauma for long periods of time. Trauma is cumulative, repetitive and occurs in interpersonal contexts” (Coutois and Ford ‘ Defining and Understanding Complex Trauma and Complex Traumatic Stress) “A syndrome linked to survivors of prolonged or repeated trauma” (J Herman, Journal of traumatic Stress 1992)

  10. Autism Spectrum Difference

  11. What is ASD “a difficulty of perceiving, thinking, learning and relating” (Professor Tony Attwood) • A life long neurodevelopmental difference which effects how a person perceives and interacts with the world around them. • The presentation of autism is very different from person to person - if you have met 1 person with autism, you have met 1 person with autism!! Differences in sensory processing, communication, relating, memory storage and neurobiology leave a person with autism vulnerable to trauma, abuse and the development of complex PTSD.

  12. Differences in sensory processing “As infants, we all experience flooding. The world is in bits, for which we have not yet formed concepts. The concepts bring the bits together. The concepts form our perception. Perception then becomes the key to closing out all kinds of irrelevant information - the stuff that doesn't fit concepts. So-called ‘normality’ is about becoming ‘closed-minded’. Williams 2003 (An author with ASD)

  13. Differences in communication To be able to communicate we need: • A sender • A receiver • A wish to communicate • A message • A shared means of communication

  14. Differences in relating “If you cannot determine on an individual basis who is safe and who may be a danger, due to being unable to intuitively pick up the signals and read the context of the situation, you are left with two choices: trust everyone or trust no-one” (Hendrickx 2015) “When I was younger and more obviously odd and strange I was thought of as stupid and also badly physically and mentally bullied. I also lost employment. I want to avoid the bullying mostly.” (Female, 49, with ASD - on camouflaging and why she uses it)

  15. Differences in memory storage “While remembering, people with autism actually experience the sensations they had when they first remembered the object, event or situation: they see, hear, feel, smell or taste it (in their mind). The thought about something produces the real experiences they had when they encountered this thing or event for the first time” (Olga Bogdashina 2005)

  16. Differences in neurobiology • Enlarged amygdala • Hippocampus has a reduced volume • Less white matter between the amygdala and frontal lobes. • Exaggerated cortisol response to novel and threatening stimuli • Dysregulation of the Limbic-Hypothalmic-Piturity-Adrenal (LHPA) axis

  17. Wait! There’s more…. “It is likely that symptoms of ASD influence the experience of trauma at all levels - moderating what events the child is exposed to, what they then experience as harmful, and what effects or symptoms they will manifest” (Kerns et al 2015)

  18. Is it ASD / complex PTSD / both? “I have difficulty disentangling PTSD and ASD. Indeed, I find a very high proportion of those with ASD have experienced trauma in many ways including social, sensory and emotional trauma. The problem is that in therapy, should the person have an ASD, there needs to be modifications to take on board, the developmental history, different way of thinking and mind-set of someone with an ASD” (Professor Tony Attwood, personal correspondence)

  19. “A transactional relationship should be considered – Just as ASD may influence all aspects of how trauma is experienced and processed the effects of trauma may, in turn, alter the clinical profile, via new trauma-related symptoms or the exacerbation, of existing ASD-related problems and neurological abnormalities.” (Kerns et al 2015)

  20. Now what?! Take 20 minutes to digest, look at the handouts and have a go on the virtual reality headset. We will then re-group for questions, reflections and discussion.

  21. Reference List • Bogdashina O (2010) Autism and the edges of the known world: Sensitivities, languate and constructed reality. London: Jessica Kingsley Publishers. • Bogdashina O (2005) Communication issues in autism and Asperger syndrome - do we speek the same language?. London: Jessica Kingsley Publishers. • Cloitre M, Shevlin M, Brewin C, Bisson J, Roberts N, Maercker A, Karatzias T and Hyland P (2018) The international trauma questionnaire: development of a self report measure of ICD-11 PTSD and complex PTSD. ActaPsychiatricaScandinavica. 138(6): 536-546. • Fisher J (2007) Psychoeducational aids for working with psychological trauma. Self published. • Forrest D (1996) A glimpse of hell. London: Amnesty International.

  22. Gravitz L (2018) At the intersection of autism and truama. Spectrum News. Availiable at: https://www.spectrumnews.org/features/deep-dive/intersection-autism-trauma/ • Gill L (2017) Understanding and working with the window of tolerance. Availiable at: https://www.attachment-and-trauma-treatment-centre-for-healing.com/blogs/understanding-and-working-with-the-window-of-tolerance • Haines S (2016) Trauma is really strange. London: Jessica Kingsley Publishers. • Haruvi-Lamdan N, Horesh D and Golan O (2017) ASD and PTSD: Co-morbidities, Gaps in research and potiential shared mechanisms. Psychological truama, theory, research, practice and policy. • Hendrickx S (2015) Women and Girls with autism spectrum disorder: understanding life experiences from early childhood to old age. London: Jessica Kingsley Publishers

  23. Hoover D (2015) The effects of Psychological trauma on children with autistic spectrum disorders: A research review. Revised Journal of Autistic Developmental Disorders. 2:287-299. • Hull L, Petrides K, Allison C, Smith P, Baron-Cohen S, Lai M & Mandy W (2017) ‘Putting on my best normal’: Social camoflaging in adults with autism spectrum conditions. Journal of autism and developmental disorders. 47: 2519-2534. • Kerns C, Newschaffer C & Berkowitz S (2015) Traumatic childhood events and autism spectrum disorder. Journal of autism and developmental disorders. 45: 3475-3486. • Lawson W (1998) Life behind glass: A personal account of autism spectrum disorder. London: Jessica Kingsley Publishers • Levine P (2015) Trauma and Memory: Brain and body in a search for the living past. California: North Atlantic books. • Stavropoulos K, Boulourian Y & Blacher J (2018) Differential diagnosis of autism spectrum disorder and post traumatic stress disorder: Two clinical cases. Journal of clinical medicine. 7(71):

  24. Van Der Kolk B (2014) The Body Keeps the Score. London: Penguin Random House. • Williams D (2003) Exposure anxiety - The invisible cage: An exploration of self-protection responses in the autism spectrum and beyond. London: Jessica Kingsley Publishers.

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