"If we do not look for it, we do not see it": Clinicians' experiences and understanding of identifying post-traumatic stress disorder in adults with autism and intellectual disability.

Arvid Nikolai Kildahl,Trine Lise Bakken,Hanne Weie Oddli,Sissel Berge Helverschou

doi:10.1111/jar.12734

Abstract

Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post-traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co-occurring ASD and ID. Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma-related symptoms in this population.

Highlights

Post-traumatic stress disorder (PTSD) is a common sequela to experiencing potentially traumatic events such as threatened or witnessed death, actual or threatened serious injury, or sexual violence (American Psychiatric Association, 2013; Ehlers & Clark, 2000)
Informants understood post-traumatic stress disorder (PTSD) in individuals with autism spectrum disorder (ASD) and intellectual disability (ID) as conceptually equivalent to PTSD in others, with causes and expressions differing due to characteristics associated with ASD and ID
Several factors were described as contributing to making identification of PTSD in this population challenging

Summary

Introduction

Post-traumatic stress disorder (PTSD) is a common sequela to experiencing potentially traumatic events such as threatened or witnessed death, actual or threatened serious injury, or sexual violence (American Psychiatric Association, 2013; Ehlers & Clark, 2000). Individuals with co-occurring autism spectrum disorder (ASD) and intellectual disability (ID) are more frequently exposed to potentially traumatic events (Dinkler et al, 2017; Gotby, Lichtenstein, Långström, & Pettersson, 2018; McDonnell et al, 2019; Sullivan & Knutson, 2000) and may be vulnerable to the development of PTSD (Brewin, Rumball, & Happé, 2019; Kerns, Newschaffer, & Berkowitz, 2015; Peterson et al, 2019). Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post-traumatic stress disorder (PTSD). Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma-related symptoms in this population

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