- 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.
