Assessing autism spectrum disorder in children with a background of maltreatment: challenges and guidance

Abstract

There may be some similarities in the presentation of children who have autism spectrum disorder (ASD) and those exposed to maltreatment affecting assessment and diagnosis. Overlapping characteristics include difficulties understanding and maintaining relationships, sensitivity to routine and hyper-reactivity to sensory inputs. Children who have been maltreated are at increased risk of various developmental vulnerabilities with both environmental and genetic factors being relevant. The existing epidemiological evidence has found that looked-after children are more likely to screen positively for neurodevelopmental disorders and there are smaller scale studies in adoptive children finding higher rates of ASD than would be expected in the general population. Other research suggests a predominantly genetic basis for this increased risk in keeping with what is generally understood about the aetiology of autism. Children exposed to profound deprivation in Romanian orphanages were found to be at higher risk of a pattern of traits termed ‘quasi autistic’ which tended to reduce following adoption, but these findings have not been replicated in children experiencing maltreatment in birth families. Reactive attachment disorder (RAD) has some overlapping criteria with ASD, but its prevalence is unknown and children with RAD should be more socially reciprocal and not have the same repetitive and restricted behaviours and interests. We recommend experienced multidisciplinary assessment that considers both the possibility of maltreatment in children with ASD and neurodevelopmental vulnerabilities in children who have been maltreated and advise on assessment and management strategies.

Trauma and psychosocial adversity in youth with autism spectrum disorder and intellectual disability

“…Not only do the deficits in social communication experienced by individuals with ASD increase the difficulty of reporting symptoms of PTSD, some symptoms of ASD can also appear similar to symptoms of PTSD (Figure 1) (9). While individuals with PTSD can experience intrusions such as flashbacks and dissociation, individuals with ASD can experience selfdialoguing and scripting which can present similarly to intrusions (31).…”

“…In addition, co-occurring ASD and PTSD may present with overlapping symptoms (9). For example, individuals with ASD and PTSD may experience recurrent and intrusive recollections which manifest in repetitive play (8).…”

“…Broadly, child maltreatment encompasses multiple categories of abuse and neglect, including physical assault, psychological aggression, and neglect (6), or family interpersonal violence (IPV), nonfamily IPV, non-IPV trauma, separation/loss, acts of commission, acts of omission, contact trauma and noncontact trauma (5). Providers have posited concerns that events that may seem trivial to others can be traumatic for individuals with ASD and ID (7)(8)(9). Given the broad definitions of trauma and maltreatment and the impact of multifactorial individual vulnerability on the risk of developing a trauma associated disorder, this review will discuss the impact of traumatic experiences on those with ASD and ID more broadly.…”