- Hi, everyone, welcome back to Aspergers From The Inside.
You're here with Paul.
I make weekly videos showing the human side of autism.
So make sure you hit subscribe to get the latest content.
So this week's Patron's Choice video
is on autism, trauma and PTSD,
post-traumatic stress disorder.
Now, if it's not immediately clear to you
why this is such an important topic,
don't worry, it soon will be.
Let me put it very simply.
If you wanna understand autism,
you need to understand trauma.
We know that trauma can cause autism-like symptoms.
So while autism and PTSD can look startlingly similar
from the outside,
there are some crucial differences that we need to know.
As we'll see, the lessons we learned from polyvagal theory
and the principles of trauma informed care are essential
for improving autistic mental health.
So what's the difference?
How do they overlap?
And why do they look so similar?
First, we'll get clear
on what we mean by the words autism and trauma.
Next we'll look at the reasons
for why there is such a significant overlap
in symptoms and behavior using a Venn diagram
to break it down so you can clearly see the difference.
We'll explore some of the reasons that trauma is so common
among autistic people,
and what good autistic mental health looks like.
Finally, I'll share five core principles
of trauma informed practice that you need to know
when working with any autistic individual.
So what is autism and what is trauma?
Firstly, just to be clear, autism and trauma
are two very different things.
I've heard people say that autism is just trauma,
and I can kind of see how someone might come
to that conclusion given the huge overlap
that we'll see later, but let's be very clear.
Autism is not trauma.
Trauma does not cause autism.
To put it simply, the key difference is that autism
is a condition you're born with.
Our brains are literally wired differently.
Whereas trauma is something that happens to you,
an event or series of events that has a lasting impact,
best understood as a kind of psychological injury
that can be healed over time.
Autism is a pervasive
lifelong neurodevelopmental condition.
And what that essentially means
is that our brains develop differently,
and that affects everything.
It means that we have a variety of preferences
and behaviors that are unusual, to say the least,
and this results in most notably challenges
in social communication and interaction among other things.
What we usually refer to as trauma or PTSD
are symptoms that arise from an incident
that overwhelms a person's ability to cope.
According to the book "Principles of Trauma Therapy,"
an event is traumatic if it is extremely upsetting,
at least temporarily overwhelms
an individual's internal resources,
and produces lasting psychological symptoms.
To get some clarity around this,
I asked autistic clinical psychologist, Steve Braun,
who regularly works with both autism and trauma,
if there is an easy
yet accurate way for us to understand this.
Steve told me that in research and clinical practice
there's a helpful distinction between simple trauma
and complex trauma, with the complex type
being more relevant to autism.
Simple trauma is when the person experienced
a single distressing event like a car crash,
and complex trauma is where the person
experienced multiple negative events over a long time.
For example, growing up in an abusive
or neglectful home situation.
In terms of diagnosis,
someone who continues to be distressed
by a traumatic experience and finds it hard to move on,
may qualify for a DSM-5 diagnosis like PTSD.
Here's what the World Health Organization
has to say on the matter.
Complex PTSD is characterized
by severe and persistent problems in affect regulation,
beliefs about oneself as diminished, defeated, or worthless,
accompanied by feelings of shame, guilt or failure
related to the traumatic event,
and difficulties in sustaining relationships
and feeling close to others.
These symptoms cause significant impairment
in social, family, educational, occupational,
or other important areas of functioning.
Wow, when I read this, the first thing I think of
is that for many people, these three things
basically define the autistic experience,
problems regulating your emotions,
believing that you're broken,
and endless chain of broken relationships.
Autism and trauma are two very different things
but to help us start to pull them apart,
let's look at the ways in which they're similar.
First off, both experience social difficulties.
Different life experiences
make it difficult to relate and communicate with others,
leading us to feel out of step with normal people.
They sometimes call Asperger's wrong planet syndrome.
And at times it literally feels like we must be alien
stuck in a world full of these strange little humans.
How are we supposed to relate to our peers?
As a result, we may isolate ourselves
or avoid social interactions due to experiences of stigma,
misunderstanding or judgment from others,
both struggle with feeling overwhelmed
and difficulty regulating emotions in general,
often accompanied by high daily anxiety levels.
Ask any parent and they'll tell you about autistic outbursts
that seem to come from nowhere.
Sometimes certain emotions are a surprise to us too.
Self-soothing stems are part of normal human behavior
that people try to do to calm themselves down
when they feel anxious.
In the case of autistic stimming, this might also be a way
of releasing energy or maybe even a sensory behavior.
If the world is not safe,
then seeking certainty and insisting on routine
can be a way to try and manage anxiety.
We have sensory and cognitive differences.
So instead of avoiding distressing reminders
of a traumatic event, the autistic person
may be avoiding unpleasant sensory situations
or tasks that are cognitively difficult
or draining or anxiety producing.
We can manage triggers that could otherwise overwhelm us
by, for example, staying home and avoiding crowds
or planning everything in advance
so that there are no unwelcome surprises.
Both can have repetitive thoughts, obsessions,
interests or repetitive behaviors.
Concentration and attention can be affected
by intense thoughts or interests or memories,
whether due to special interests or
memories of a negative event.
Differences in our attention
and executive function also make concentrating
on certain things, very challenging.
So, for example, I can maintain laser focus
on complex mental problems for hours and hours,
but two minutes of small talk
and I'm already struggling to stay with it.
Dissociation is a type of disconnection,
like feeling that your body isn't really yours
and that you're only really observing it from the outside.
It may be a protective response to ongoing high levels
of anxiety or distress, but there are also instances
of autistic dissociation occurring without any trauma.
I have a friend who described his childhood
like watching life on TV.
It just wasn't quite real somehow.
And another who remembers people talking to her as a child,
but she never talked back.
She just didn't realize that she was part of the show
that she was supposed to participate in life
that was going on in front of her.
So as you can see, there's a huge overlap
between PTSD symptoms and observable autistic behavior.
In fact, this is precisely why diagnosis based on behavior
can be so inconsistent, and why diagnostic overshadowing
where PTSD symptoms are dismissed as just autistic behavior
or vice versa, can be such a huge problem.
Unfortunately, incorrect and or unhelpful diagnoses
can be extremely damaging for autistic people,
especially late identified autistic women
who may receive half a dozen different diagnostic labels
but no effective help.
We know that behavior is only a symptom.
So to be helpful, we need to look deeper
to what is causing the behavior in the first place.
So before moving on, let's take a look
at some of the reasons for such a huge overlap.
We know that traumatic events cause a lot of stress.
We also know that our body,
specifically our autonomic nervous system,
responds to stress in a certain way.
We literally call it a stress response.
When in this heightened state, our ability to relax,
to socialize, to connect and even to communicate
with the people around us is dramatically reduced.
Stephen Porge's polyvagal theory
describes this phenomenon exceptionally well.
It's a natural survival strategy designed
to help keep us alive in the face of danger,
something that could kill us.
We need to react and respond straightaway,
no time to stop and think about our feelings, just run.
Right now your life is in danger.
In that sense, one way to think about a stress disorder
is a little bit like an auto-immune disease.
The functions of our body that are designed to keep us safe
and healthy are working in overdrive
causing massive problems.
In the case of autism,
our differences also mean we find it difficult to socialize,
to connect and to communicate with most people.
So, we may already exhibit these behaviors
even without any stress or trauma.
And now for the elephant in the room
that we haven't talked about yet.
On top of everything we've discussed so far,
the autistic experience of living in a world
that wasn't designed for us
means that a lot of us are also highly stressed and anxious.
If shaking hands is enough to overwhelm
your ability to cope, for example,
then living in a world where people regularly
expect you to shake hands,
and don't understand when you try to say no
is extremely stressful and anxiety producing,
leading to the heightened stress response
and associated symptoms we discussed earlier.
Some have even suggested that the experience
of being autistic in this world is traumatic in itself.
Humans are really good at spotting the odd one out
and keeping their distance.
Ostracism, misunderstanding, stigma, rejection, exclusion
and invalidation begin at a very early age.
We also know that adverse childhood experiences
have been shown to have a tremendous negative impact
on future experiences.
But instead of being too prescriptive,
I'm gonna ask a challenging question.
What if going to school or some other everyday situation
is extremely upsetting
and regularly overwhelms a child's internal resources
in line with the definition
of a traumatic experience that we saw earlier?
What lasting psychological symptoms might we expect?
So with that in mind,
let's take a look at the right-hand side
of the Venn diagram, the PTSD specific symptoms.
Other PTSD symptoms include flashbacks, self-hate,
self-blame, persistent negative emotional state,
inability to experience positive emotions.
And most importantly, the criteria
that these symptoms were not observed
before the traumatic experience.
This is particularly problematic,
especially for young children.
We know that trauma causes autism-like symptoms,
and that childhood trauma also affects development.
So if autistic behavior looks so similar
and there was no opportunity to observe typical development,
how can you tell which is which, or if it's both?
Now, I'm the first one to admit
that the distinction here isn't super clear at all.
You could very well argue
that symptoms such as depression, anxiety,
and low self-esteem are so extremely common
in the autistic population, that they really belong
in the middle overlap section.
But then again, the prevalence of trauma,
especially childhood trauma is also extremely common.
The reason I've separated them out here
is because I personally believe
that the reality of extremely poor
autistic mental health in general
makes us more likely to suffer from conditions
like depression, anxiety, or even PTSD, right?
Even if not directly related to autism.
So, notice that there are two distinct layers here,
and it's incredibly important to distinguish
between the two.
Firstly, there's autism itself,
and then there's the stress response
and mental health conditions on top of that.
So let's ask the next logical question.
What does a healthy autistic person look like?
One without negative self-talk,
without depression, stress or anxiety?
In other words, once trauma is healed
and depression and anxiety are managed, what's left?
I invite you to imagine a person full of self-confidence,
loving life, engaging with the world
with a strong sense of identity and self-worth,
someone who still has extreme sensory sensitivities,
who still engages in stimming behavior,
who still focuses intently
on a select few passions and interests,
through which they find life and energy.
Imagine someone who loves to be social,
but on their own terms,
highly empathic, who loves connection,
but doesn't always look you in the eye
or even respond verbally at all.
Even regular meltdowns can be a part
of an atypical emotional regulation process.
Sometimes we just need to shut down and recharge.
There are so many ways that healthy autistic people
can express themselves, but it's hard to see
because most of us carry significant
mental and emotional wounds
from a lifetime of negative experiences and interactions.
The good news is that these wounds can heal,
we can be healthy autistics,
we can even learn to embody an authentically,
socially appropriate version of our true selves.
But obviously, society has to be a bit flexible
to meet us halfway for that to happen.
Fortunately, as it turns out, there are a lot of proven ways
that you can help.
The Blue Knot Foundation is Australia's national center
for excellence, for complex trauma.
In their resource, talking about trauma,
a guide for primary healthcare providers,
they refer to five core principles
of trauma informed practice, safety,
trustworthiness, choice, collaboration, and empowerment.
Here's what they had to say about them.
The above principles may seem so basic
as to be taken for granted,
but people who experience trauma,
especially complex interpersonal trauma,
do not take them for granted.
This is because their basic sense of safety,
right to be respected and ability to make choices
has been violated.
Wow, what a powerful sentence.
I suspect that almost every autistic person
would relate strongly to that sentence.
They also go on to provide some tips to guide interaction.
I'll share just a few.
Your approach and style should be empathic at all times.
Attune to their verbal and nonverbal communication,
recognize that a person's problematic behaviors
and responses may be their attempts to protect themselves
and to cope with stress.
Now, I don't know about you,
but when I read those words, my whole body relaxes.
Imagine if the world were filled with people like this.
How much less stressful would life be in general?
I recently started working
with a mental health professional,
and in her introduction, she said,
you're the expert on your own life.
Wow, I didn't realize how stressed I was,
but on hearing those words, my anxiety dropped
from maybe a seven to about a three out of 10.
I hear this reaction from so many in our community.
Finally, someone who understands, who doesn't judge me,
who isn't going to hurt me,
someone who takes my boundaries seriously.
We do not take these basic things for granted
because for us, they are not as common as you think.
In fact, the more I reflect on this,
the more I realize two things, firstly,
how much I appreciate it,
how much of a difference it makes for me, personally,
when someone I interact with does these things.
And secondly, the massive shift that I see
in the autistic individuals that I work with
when I make it a point to show them these basic courtesies.
They respond as if I'm the first person
in their entire life to be kind
and understanding and empathetic,
to listen and understand and respect their ability
to make choices without trying to push them.
Okay, let's wrap up by quickly recapping the main points
we've covered in this video.
Number one, if you want to understand autism,
you need to understand trauma.
Number two, trauma can cause autism-like symptoms,
which is one of the reasons they often look so similar.
Three is that polyvagal theory
helps us understand the physiology behind trauma and PTSD,
including our body's stress response
and how we can heal over time.
Number four, many autistic people
have also experienced trauma.
So the fact that trauma, PTSD and poor mental health
in general is so common in the autistic community,
unpicking which is which is essential so that we can work
towards good autistic mental health.
And finally, number five,
trauma informed principles benefit everyone.
There are some great resources
around trauma informed practice.
So if you're working with autistic people,
please make sure you take this issue seriously.
It will mean the world to us if you do.
Finally, a big thank you to our Patron community
for voting for this topic, and for your supportive patience
while I took the time to research it properly.
If you'd like to have your say
in next month's Patron's Choice video,
you can become a cup of coffee supporter of this channel
for less than a dollar a week.
So that's it for me.
Thank you for watching, especially
for those of you joining us live,
make sure you subscribe to the channel.
Let me know in the comments if this video resonated for you,
and I will see you all next week, bye.