Can childhood PTSD be mistaken for autism?

Can childhood PTSD be mistaken for autism?

As any parent or teacher knows, interpreting a child’s behaviour isn’t always easy, especially if it goes outside the ‘norm’. Sometimes a child’s behaviour is a sign of a cognitive disorder, but since many conditions share symptoms, getting an accurate diagnosis can take time.

This is especially true with childhood PTSD. Awareness of PTSD in children has been fairly limited until recently, which means symptoms can sometimes be mistaken for more familiar childhood diagnoses. For example, a child’s response to trauma can sometimes mirror the signs of Autism Spectrum Disorder (ASD). What look like typical autistic traits, such as repetitive play, difficulty communicating with others, or outbursts of anger or frustration, might actually be the child’s way of dealing with intrusive thoughts and feelings after trauma.

If a child’s behaviour can be explained by autism, and there’s no knowledge of a trauma having taken place, it’s possible for a PTSD diagnosis to be missed. By mimicking autism, PTSD can hide in plain sight.

Source: Stavropoulos KK-M, Bolourian Y, Blacher J. Differential Diagnosis of Autism Spectrum Disorder and Post Traumatic Stress Disorder: Two Clinical Cases. Journal of Clinical Medicine. 2018; 7(4):71.]

The good news is that PTSD can be treated – but getting the right diagnosis is crucial. This article looks at the similarities and differences between PTSD and autism, and what you should do when faced with a diagnosis that doesn’t feel quite right.

Why might PTSD be mistaken for autism?

Autistic children may find it hard to communicate with others or struggle to recognise how other people are feeling. They may be sensitive to loud noises or bright lights, and feel anxious in unfamiliar situations. Children with PTSD may behave similarly, but for different underlying reasons.

Autism researcher Professor Katherine Stavropoulos and colleagues created the below graphic to show the overlap between the signs of autism and PTSD:

One in 13 children in the UK are thought to have PTSD, and updated research from 2021 shows around one in 57 children in the UK are on the autistic spectrum, so why would the latter be a more likely diagnosis? The answer is usually because childhood trauma goes undiscovered. Children who experience trauma when they are young may display autism-like behaviours that fit the timeline for an ASD diagnosis, which tends to occur around early school-age. In the absence of trauma-informed assessment, autism can sometimes be the default diagnosis. Training professionals to spot the signs is crucial.

Can you have PTSD and autism?

Yes. It’s possible for autistic people to experience PTSD and C-PTSD, just like anyone else. While children may be misdiagnosed with autism instead of PTSD, both adults and children who have autism and PTSD may struggle to get the additional diagnosis. Studies suggest that autistic people may be at a slightly higher risk for developing PTSD, but reported rates are often low. One reason for this is that PTSD may look different in autistic people.

Professor Connor Kerns, from the University of British Columbia in Vancouver, thinks the criteria used to diagnose PTSD may not be sensitive enough to spot signs in autistic people:

“It seems possible that it’s not that PTSD is less common, but that we’re not measuring it well, or that the way traumatic stress expresses itself in people on the spectrum is different… You want to be cautious about applying neurotypical definitions – you could miss a lot.”

Getting treatment for PTSD and autism

If you think you, your child or someone else has PTSD and/or autism, you’re probably anxious about making sure they get the right help. Speaking to a medical professional is the first step.

There are several effective treatments for PTSD. NICE guidance (updated in 2018) recommends trauma-focused psychological treatments for PTSD in adults, and trauma-focused cognitive behavioural therapy (CBT). You may also want to explore group and individual therapy, holistic non-pharmacological therapies, or talk to your doctor about treatment with appropriate prescription drugs.

For children with PTSD, treatment is likely to focus on CBT and play therapy.

Since autism isn’t a medical condition, there’s no treatment, though some people may need support with certain activities. If someone is autistic and has PTSD, the blurred boundaries between the two means it often makes sense to try to address both together.

Please remember, these aren’t meant to be medical recommendations, but they’re tactics that have worked for others and might work for you, too. Be sure to work with a professional to find the best methods for you.

 

For more information on Autism, please visit the National Autistic Society website. They are the UK’s leading charity for people on the autism spectrum and their families. Since 1962, they have been providing support, guidance and advice, as well as campaigning for improved rights, services and opportunities to help create a society that works for autistic people.

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Treatments for PTSD

It is possible for PTSD to be successfully treated many years after the traumatic event occurred, which means it is never too late to seek help. For some, the first step may be watchful waiting, then exploring therapeutic options such as individual or group therapy – but the main treatment options in the UK are psychological treatments such as Eye Movement Desensitisation Reprogramming (EMDR) and Cognitive Behavioural Therapy (CBT).

Traumatic events can be very difficult to come to terms with, but confronting and understanding your feelings and seeking professional help is often the only way of effectively treating PTSD. You can find out more in the links below, or here.