• Being neurodiverse increases your chances of experiencing trauma

  • Amanda Marples explores the complex social, biological and neurological reasons why this is the case

  • We have therapists who specialise in working with neurodiversity, including ADHD and Autism Spectrum Disorder – find them here


Trauma and neurodiversity go hand in hand, sadly. Despite that, it is not a well-researched area. What we do know, is that people with Autistic Spectrum Disorder (ASD) are three times as likely to be exposed to trauma and 80% of adults with ADHD report trauma experiences. We know that ADHD children are at greater risk of burns, upper extremity fractures, and head injuries, and people with ASD are at greater risk of physical and sexual abuse than their neurotypical (NT) counterparts. And this correlation works in both directions: ADHD is diagnosed twice as often in abused children, and prevalence and symptom severity increases with subsequent trauma – an effect that has not been shown in neurotypical population studies.

Perhaps most importantly is the rate at which traumatic experiences develop into Post-Traumatic Stress Disorder (PTSD). Again, studies show that neurodiversity and PTSD are highly co-occurring conditions. One ten-year study found that being ND makes it four times as likely for PTSD to develop, can be triggered by a wider range of events, and result in more severe symptoms.

What’s going on here? Can we point to causes? What’s the impact of this for neurodivergent people, and the people supporting them? And what if anything can be done?

Diagnosis in mental health is pretty subjective. It depends on who is looking and what tool they are using. For example, a clinician using DSM-5 (the principal tool used in the US and Canada) would be unable to diagnose PTSD unless the patient had been exposed to “actual or threatened death”, even if they have core symptoms like flashbacks. 

European clinicians on the other hand tend to use the ICD11, which only requires the traumatic event to be “extremely threatening”, leaving plenty of room for interpretation. This is so key, as PTSD symptoms can absolutely occur without life being threatened, and for ND people it’s far more likely to be the case. For ND people, minor changes to routines or intense sensory experiences (loud noises, flashing lights etc) can indeed be threatening.

Reliance on such strict criteria also muddies the waters as symptoms so often overlap. Avoidance behaviours in PTSD can present as distractibility, which looks like ADHD inattentiveness. High levels of anxiety is common in ND people, which can mirror PTSD arousal symptoms. It’s easy to see how trauma can be missed without careful assessment and an open mind. Differences in diagnostic practices means that it’s hard to draw conclusions, but what is beyond doubt is that where trauma and neurodiversity co-exist, the symptoms of both disorders are worse.


But why this high co-occurrence in the first place? 

The answer is a mix of social, environmental, and neurobiological factors. The social impact of being ND begins early, and hardly needs pointing out. neurodiverse children often look and behave differently and frequently lack close friendships, making them easy targets for bullying, not forgetting that what might be considered mild teasing by neurotypical standards might be devastating for ND children. 

They can also be more difficult for teachers and parents to handle especially if the adults are ND themselves (often the case with parents of ND children), or lack training and understanding. ND children can be disruptive, demand avoidant, prone to aggression and meltdowns and therefore more likely to be yelled at, punished, shamed, and forcefully disciplined. But difficult behaviour from these children is often a reaction to being forced to endure situations they can’t cope with such as noisy, bright classrooms or being expected to interact with peers (there’s evidence that stress hormones are elevated in ASD kids even during play). ND kids are easily traumatised, and often punished for it. It's a double bind and double the trauma.

The pattern continues into adulthood. ND people may have difficulty in interpreting others’ intentions, and they are more likely to be socially isolated. Friends and family are often the first to notice abusive or exploitative behaviour and are essential when it comes to taking action against it. ND adults are also at higher risk of developing addictions which can lead to poor decision-making and increasing the likelihood or accident and injury.

Can trauma cause ND? Yes and no. Certainly, experiencing a single trauma would not cause pervasive neurological change, but during early brain development there is evidence that trauma has an observable impact, particularly in ADHD. Why?

Chronic childhood stress leads to overdeveloped threat systems and underdeveloped systems of organisation, planning, memory, and emotional regulation which are collectively known as the executive functions. It’s these functions that are often impaired in ND brains.

But it isn’t just about impairment. The ND brain is different, and one of those differences is how memories are processed and retrieved, especially in ASD. Researchers believe this may pave the way for PTSD to develop. ASD people tend to remember incredibly rich sensory detail, as opposed to the overall picture, which means that important context is often lost. An emerging theory is that this difference could facilitate the formation of intrusive trauma memories that are sensory laden and extremely vulnerable to environmental triggers.

None of this conclusively indicates causation but it’s hard to dismiss, given the statistics of co-occurrence. Perhaps neurodiversity and trauma really are entirely separate things at least from a neurobiological point of view. It’s really a moot point. What matters is that these conditions rarely travel alone, and where they do show up together, both conditions are more severe and more likely to lead to PTSD.


What can be done? 

If you support or treat ND people, there’s an argument to routinely screen for trauma. Low level emotional regulation work could go a long way to decrease the odds of PTSD developing. If PTSD symptoms are already in evidence, it should be treated as such, even if the diagnostic criteria laid out in DSM-5 are not met. Remember that standard interventions were developed for neurotypical people, so be flexible. The clue is in the name: neurodiverse. Not all ND people are the same. Explore what is needed. Maybe it’s a much slower pace, or a focus on skill building. It may be that time and space for stimming or preferred activities should be factored in. It might also be worth asking your employer for specialised training and education.

If you are neurodiverse and looking for help with trauma, seek an ND-aware therapist. It’s entirely valid (and in fact desirable) to ask a professional about their experience with treating ND people, and what their approaches are. Be clear about what helps you to stay calm and think about the environment. Do you need dim lights? Are you sensitive to strong smells and would prefer a therapist not to wear cologne? Ask for what you need. Find an advocate if that feels too hard. Aim to build networks of safe people, but don’t force yourself – remember you don’t have to do anything you don’t want to do.

And lastly, don’t give up hope. Recovery is absolutely possible with patience, self-acceptance, and the right support.

Amanda Marples is the author of The Healing Workbook: Tips and Guided Exercises to Help Overcome Trauma


Further reading

How Asperger's Syndrome has shaped my life

What we want others to understand about ADHD

6 tips for parents following an autism diagnosis

Understanding autism: why neurodiversity means different, not less

Therapy has been invaluable in navigating my adult ADHD diagnosis


References

Baran Tatar, Z. and Cansız, A. (2019) ‘Childhood physical neglect may impair processing speed in adults with ADHD: a cross-sectional, case-control study’, Psychiatry and clinical psychopharmacology, 29(4), pp. 624–631. doi: 10.1080/24750573.2018.1522714.

Boodoo, R. et al. (2022) ‘A Review of ADHD and Childhood Trauma: Treatment Challenges and Clinical Guidance’, Current developmental disorders reports, 9(4), pp. 137–145. doi: 10.1007/s40474-022-00256-2.

Ferrer, M. et al. (2017) ‘Differences in the association between childhood trauma history and borderline personality disorder or attention deficit/hyperactivity disorder diagnoses in adulthood’, European archives of psychiatry and clinical neuroscience, 267(6), pp. 541–549. doi: 10.1007/s00406-016-0733-2.

Pakyurek, M. et al. (2022) ‘Does attention‐deficit/hyperactivity disorder increase the risk of minor blunt head trauma in children?’, Journal of child and adolescent psychiatric nursing, 35(4), pp. 356–361. doi: 10.1111/jcap.12390.

Peterson, J. L. et al. (2019) ‘Trauma and Autism Spectrum Disorder: Review, Proposed Treatment Adaptations and Future Directions’, Journal of child & adolescent trauma, 12(4), pp. 529–547. doi: 10.1007/s40653-019-00253-5.

Rumball, F. (2019) ‘A Systematic Review of the Assessment and Treatment of Posttraumatic Stress Disorder in Individuals with Autism Spectrum Disorders’, Review journal of autism and developmental disorders, 6(3), pp. 294–324. doi: 10.1007/s40489-018-0133-9.

Rumball, F., Happé, F. and Grey, N. (2020) ‘Experience of Trauma and PTSD Symptoms in Autistic Adults: Risk of PTSD Development Following DSM‐5 and Non‐DSM‐5 Traumatic Life Events’, Autism research, 13(12), pp. 2122–2132. doi: 10.1002/aur.2306.

Rumball, F. et al. (2021) ‘Heightened risk of posttraumatic stress disorder in adults with autism spectrum disorder: The role of cumulative trauma and memory deficits’, Research in developmental disabilities, 110, pp. 103848–103848. doi: 10.1016/j.ridd.2020.103848.