Neuro-Affirming Approaches: Best Practices in Supporting Autistic Clients Who Have Experienced Trauma

Editor's note: This text-based course is a transcript of the webinar, Neuro-Affirming Approaches: Best Practices in Supporting Autistic Clients Who Have Experienced Trauma, presented by Christina Marsack-Topolewski, PhD, LMSW.

Please also use the handout with this text course to supplement the material.

Learning Outcomes

After this course, participants will be able to:

• Recognize the prevalence of trauma as experienced by individuals with autism.
• Explain reasons for increased trauma experiences among individuals with autism.
• Identify strategies to support individuals with autism who have experienced trauma.

Introduction

Welcome, and thank you for making time out of your busy schedule to be here today. I am really excited to talk with you about this topic. I find that the more I think about trauma in the autistic population, the more I see it. Once we start truly seeing this connection, we can often become more vigilant in looking for it, and in noticing how it may be presenting in the clients and consumers we work with every day.

Before we go further, I want to name a limitation up front. I wish there were a one-size-fits-all approach to this work, but there isn't one. What we do is complex and wide-ranging, and as we start to think about the autism spectrum, that same complexity holds true. This is a spectrum condition, and we are going to see wide variation in symptomatology, severity, and characteristics from person to person. I say this not as a caveat to diminish today's content, but because I imagine the work you are all doing is similarly varied, and I want to honor that from the start.

Today, we are going to talk about the increased tendency for individuals with autism to experience trauma, what trauma experiences and posttraumatic stress disorder can look like for this population, and how we move toward not only a trauma-informed care perspective, but one that is genuinely centered in neuro-affirming care. Autism itself falls on a spectrum, with real differences and variation in manifestation from person to person. At its core, this is a social communication disorder, so we can expect to see differences and challenges in social interaction and communication, along with various repetitive behaviors and stereotyped interests that vary from person to person.

There is another piece of this puzzle that I think is especially important as we consider the complexity surrounding autism and trauma together, and that is sensory sensitivity. Many of you likely work directly with sensory sensitivities on a daily basis, and these sensitivities are relevant to trauma for a number of different reasons that we will explore throughout this course.

Autism, Trauma Prevalence, and Exposure

Autism Spectrum Disorder Characteristics

Let's start with a shared foundation. According to the Diagnostic and Statistical Manual of Mental Disorders, autism spectrum disorder is characterized by deficits in social communication and social interaction, along with restricted or repetitive behaviors, interests, or activities. These symptoms must be present during the early developmental period and cause impairment in social, occupational, or other important areas of functioning across multiple contexts (5th ed., DSM-5, American Psychological Association, 2013).

What Is Trauma?

The definition of trauma has been debated for decades, and while there is real variation in what may be perceived as traumatic from person to person, the Merriam-Webster Dictionary defines trauma as a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury (Merriam-Webster Dictionary, 2025).

I want you to pause for a moment with that definition, the way I ask participants to pause during the live version of this course, and ask yourself what comes to mind when you think about trauma and autism. Some of the most common responses I hear echo what I imagine many of you are also thinking: that trauma happens often in this population, that interactions themselves may be traumatic in ways that are not always understood by others, and that there is frequently a lack of understanding around what is actually happening for the person experiencing it. Certainly, trauma is very common within the autism population, and some of these experiences are not always recognized within the current DSM-5 criteria. This creates a real conundrum as we think about recognition, diagnosis, and the increased likelihood of posttraumatic stress disorder in this population. As we move forward together, I want you to hold onto the idea that individuals with autism may have genuinely unique responses to trauma, responses that do not always match what we might expect from the general population.

Overview of Autism

Before we go deeper into trauma specifically, I want to offer some background on autism itself, including its characteristics, the variance in how it manifests, and what we currently know about its prevalence.

Prevalence

New information about autism prevalence continues to emerge, in part because how we quantify and define what falls under this diagnostic umbrella keeps shifting. As of the Centers for Disease Control and Prevention's most recent update from April 2025, we now understand that 1 in 31 children in the United States is diagnosed with autism (Centers for Disease Control and Prevention, 2025). This number has increased substantially over the last three or four decades. Previously, the CDC had estimated a prevalence of 1 in 36 children, based on a sample of eight and nine-year-old children using 2022 data, which represented just over 3.2 percent of the national population at that time. Before that estimate, the number was 1 in 44.

Part of this rise is tied to how we define and categorize autism spectrum disorder, but there are other contributing factors as well. Diagnostic criteria have broadened, awareness has grown, and screening tools and assessment methods have improved significantly, allowing for more accurate identification of children with autism, often at earlier ages. We also see increased survival rates among preterm infants, with other environmental factors contributing to this shift. One of the most important pieces of this puzzle, especially as we think about trauma, is that many individuals remain undiagnosed, misdiagnosed, or underdiagnosed. I believe this matters a great deal in the context of autism and trauma, and in how we think about the provision of relevant services and supports.

Diagnosis Ratio

Currently, findings suggest a ratio of roughly three boys diagnosed with autism for every one girl, and many studies have indicated a ratio closer to four to one (Loomes et al., 2017). Regardless of how someone identifies, whether as a boy, a girl, or as part of the transgender community, this ratio reflects real disparities in how autism has historically been recognized and diagnosed across genders.

Challenges That May Impact Life Experiences

There are certain characteristics common in autism that may increase a person's risk of encountering unsafe situations and make it harder to recognize potential or emerging threats to their own safety. These include social language deficits, a degree of naivety in social situations, and challenges deciphering social cues. I want to be clear that these characteristics are not deficits in a person's worth or capability, but rather real factors that can shape a person's exposure to risk, which becomes especially relevant as we move into our discussion of trauma.

Common Co-Morbidities

To further complicate the picture, there are a number of co-occurring health and mental health conditions commonly seen alongside autism (Beck et al., 2020; Brede et al., 2020; Jadav and Bal, 2022). I want to walk through a few of these individually, because each one interacts with trauma risk in its own way.

ADHD. Attention deficit hyperactivity disorder is frequently seen alongside autism, and even in cases without a formal ADHD diagnosis, many individuals with autism show tendencies toward executive dysfunction that mirror ADHD presentations.

Anxiety. Anxiety shows up often in this population, and it can compound the sensory and social challenges we have already discussed, sometimes making it more difficult to distinguish where anxiety ends and trauma-related symptoms begin.

Depression. Depression is another common co-occurring condition, and like anxiety, it can be difficult to separate cleanly from trauma responses, particularly when a person's history includes chronic social exclusion or repeated adverse experiences.

Eating Disorders. Eating disorders, including anorexia, are seen at elevated rates in this population. I also want to highlight avoidant restrictive food intake disorder, often referred to as ARFID, which is a newer eating disorder involving very selective eating, or in some cases, very little interest in eating at all. ARFID can result in negative outcomes such as poor growth and nutrition, and misdiagnosis with other conditions is common, so this is an important condition to keep on your radar.

Possible Reasons for Co-Morbidities

Why do we see these co-occurring conditions cluster together so consistently? A few possible explanations stand out. Social isolation plays a significant role, as does a strong need to control one's own environment. Many individuals with autism genuinely crave social inclusion, yet face real challenges in obtaining it. Sensory challenges compound these difficulties, and they tend to show up across every setting a person moves through, whether that is work, school, or relationships. Disrupted plans and routines can also contribute meaningfully to this picture, adding another layer of stress to an already complex daily experience.

Other Considerations

Individuals with autism may face challenges across every setting and life stage, from childhood through adulthood, and across school, work, relationships, and parenting. Bullying and social victimization are unfortunately common experiences (Haruvi-Lamdan et al., 2020), and this population also faces heightened safety issues, including an increased risk for abuse. Taken together, these considerations help explain why so many individuals with autism carry a history of trauma, often one that has gone unrecognized or unaddressed for years.

Autism and Trauma

Prevalence of Trauma in the Autistic Community

Establishing a clear prevalence rate for trauma in the autistic community is genuinely difficult, but what we do know points to elevated rates of trauma, traumatic experiences, and posttraumatic stress disorder, including what researchers describe as probable PTSD (Andrejewski et al., 2024; Ruball et al., 2021).

I want to share some specific findings from a study by Ruball and colleagues, published in 2021. In this study, fifty-nine adults with autism completed online questionnaires, and for over 40 percent of that sample, researchers indicated probable posttraumatic stress disorder within the last month alone. Beyond that, over 60 percent of participants reported probable PTSD at some point across their lifetime. I want to pause on this because when we talk about co-occurring conditions in autism, we tend to talk about anxiety, depression, ADHD, and sometimes eating disorders. PTSD is rarely part of that conversation, and it is rarely investigated across the lifespan for this population, whether we are talking about adults or the children and adolescents many of you work with directly. Work published by Andrejewski and colleagues in 2024 offers additional empirical evidence suggesting that adults with autism experience more traumatic events than previously recognized, and that many of these events would not even be captured by our existing diagnostic tools. This likely adds another layer of difficulty in both recognizing and treating trauma within the autism community.

Heightened Vulnerability for Trauma

There is considerable empirical support suggesting that individuals with autism experience a heightened risk for both trauma and PTSD (Haruvi-Lamdan et al., 2020; Reuben et al., 2021). This elevated risk touches many areas: sensory challenges and experiences, opportunities for social exclusion, challenges with social language and interpreting social cues, bullying, sexual victimization, and both child and adult abuse.

One thing I think about often in my own work is that trauma can exacerbate preexisting autistic traits. Take sensory sensitivities as an example. In the event of trauma exposure, a person with autism may experience heightened or amplified sensory sensitivities purely as a result of that trauma, and this can be particularly distressing. We may see hyperarousal, avoidance, behavioral challenges, and social withdrawal as potential resulting realities, all of which can make daily life genuinely difficult to manage, both for the individual and for the families and providers supporting them. This dynamic can also make diagnosis considerably more difficult. If we think about children involved with the child welfare system as a point of comparison, there is substantial evidence to suggest that trauma can look a great deal like ADHD. The same layering effect can happen here, where autism, trauma, and other co-occurring conditions all begin to resemble one another clinically.

Findings published by Golan and colleagues in 2022 indicate that both brooding rumination and cognitive inflexibility are commonly seen in people with autism, and these two traits appear to increase the risk of posttraumatic stress disorder following a traumatic event. It is also worth remembering that what counts as a traumatic event is, at its core, a matter of perception. Trauma to one person may not register as trauma to another, and situations that might not be considered traumatic by someone outside the autism community may genuinely be experienced as traumatic by your client or consumer. Sensory trauma adds yet another layer of difficulty here, since sensory challenges themselves can be a source of trauma, separate from any single identifiable traumatic event (Fulton et al., 2020).

Double Vulnerability

Some of you may already be familiar with the term double vulnerability, which refers to the tendency of people with autism to be more vulnerable both to victimization and to developing PTSD (Haruvi-Lamdan, 2020). This term captures how vulnerabilities can actually amplify one another. An individual can be more susceptible to harm when two or more sources of vulnerability are present simultaneously, and these sources can compound one another in real time. As a result, individuals may experience more adverse consequences and may be more frequently victimized than we might otherwise expect.

I also want to name gender explicitly here. Gender inequalities often place women in positions of greater vulnerability, at higher risk for sexual violence and other forms of abuse and coercion. Double vulnerability is not unique to autism either. We see similar amplification effects for individuals with other juvenile-onset conditions and across a range of other clinical scenarios as well.

Processing Trauma

There are additional sources of challenge specific to processing trauma within the autistic community. Communication differences can make it harder to recognize or name a trauma experience in the first place. Some individuals with autism may also have unique trauma histories or experiences that differ meaningfully from what we typically expect, and co-occurring conditions, particularly difficulties with emotional regulation, can complicate the processing of trauma even further.

Traumatic Life Events

DSM-5 Recognized Traumatic Events. One tool I find genuinely useful here is the Life Events Checklist, often referred to as the LEC-5 (Weathers et al., 2013). This is a seventeen-item, self-reported measure of traumatic life events. I want to underscore that word, self-reported, because we know self-report can be genuinely difficult for many subgroup populations, and certainly for many individuals who identify as autistic. The LEC-5 allows respondents to indicate whether an event happened directly to them, whether they witnessed it, whether they learned about it happening to someone close to them, whether it occurred as part of their job, or whether it did not happen to them at all. Examples of events on this checklist include transportation accidents, physical assault, sexual assault, other unwanted or uncomfortable sexual experiences, life-threatening illness or injury, natural disasters, and assault with a weapon.

In the study by Ruball and colleagues that I mentioned earlier, among their sample of fifty-nine adults with autism, 247 typical traumatic events were reported in total. Physical assault was reported by 24 percent of the sample, or eight of the fifty-nine participants. Sexual abuse was reported by 34 percent of the sample, or eleven participants. There were also reports of the sudden death of a close friend or family member, at 6 percent, and even a small number of reports related to participants' own suicide attempts, at 3 percent (Ruball et al., 2021; Weathers et al., 2013). When we look at exposure to multiple types of trauma within this same sample, 10.2 percent reported two types of trauma, 13.6 percent reported three types, just over 20 percent reported four types, just over 10 percent reported five types, and almost 12 percent reported six types. Taken together, four or more trauma types were reported by almost 43 percent of this sample, which is a striking figure to sit with.

Non-DSM-5 Traumatic Life Events. Ruball and colleagues also identified a number of atypical traumatic life events that did not meet DSM-5 Criterion A, meaning they would not be formally recognized as traumatic under current diagnostic standards, yet were reported as distressing and traumatic by participants nonetheless. These included bullying, non-traumatic bereavement, and trauma related to mental health struggles, such as experiences with anorexia or what participants described as breakdowns. Other frequently reported non-DSM-5 events included abandonment by a significant person, such as a parent or spouse, and stress due to social challenges (Ruball et al., 2021; Weathers et al., 2013).

This last category, stress due to social challenges, deserves particular attention. Work published by Haruvi-Lamdan and colleagues in 2020 found that 60 percent of their autism sample identified a social event as their most distressing experience, compared to only 20 percent of a general population comparison sample. This tells us that the social piece of this puzzle is enormous, and it also tells me how much the work of speech-language pathologists matters here. The vocabulary building, social communication skill development, and receptive and expressive language work that many of you do every day genuinely helps ensure better safety for the individuals you serve, giving them additional tools to self-report an adverse experience or to know where to turn for help if something happens.

Practice Directions

Assessment, Screening, and Awareness. There is real recognition of the complexity involved in assessing individuals with developmental and language delays, including those with autism. Appropriate self-report measures are needed, but they need to be genuinely comprehensible across a wide range of language and cognitive abilities (Hoover, 2020).

Screening remains an area of real need. Kerns and colleagues examined how often community based providers screened for and treated trauma related symptoms in youth with autism, and I want to share a direct quote from their published findings: "Findings suggest that over half of ASD providers in the US believe that delivery of trauma related services is important and currently inquire about, screen, and/or treat TRS, which again is that trauma related symptoms, in at least some of their patients or students with ASD. Nonetheless, only 10% of providers screened all patients or students for TRS, and approximately 75% felt that more training in trauma identification and treatment for those with ASD is needed" (Kerns et al., 2019). This tells us there is a real need for greater awareness, education, and safety measures, not only among community members and families, but also within the broader autistic community itself, along with expanded training opportunities for the providers who serve them.

Training, Tailored Interventions, and Treatment. Education and training around this topic are needed across the entire lifespan, not just in childhood. For years, a significant share of autism related funding was directed almost exclusively toward services and research for children, yet the vulnerabilities that place someone at risk for trauma do not disappear in adulthood. There is a genuine need to support family members with the information they need to help ensure better safety outcomes, and treatment must be tailored and individualized to account for each person's unique needs, strengths, preferences, and presentation, since symptomatology in this population can vary tremendously from one individual to the next.

Professional training and development matter here too, as do tailored approaches and interventions. Interventions that specifically target brooding rumination and cognitive flexibility may hold real promise in reducing PTSD symptoms (Golan et al., 2022). Supporting sensory needs remains essential, and adapted treatment modalities, including adapted trauma-focused cognitive behavioral therapy for this population, represent an important direction for the field moving forward.

When Trauma Goes Unrecognized

I want to spend a moment on something I think is genuinely underappreciated in this work, which is the trauma of feeling misheard, or of having a trauma experience go unrecognized by the people around you. This can happen for a number of reasons. People with autism often have different triggers and responses than we might expect, and they may experience trauma from events that would not typically be considered traumatic by someone outside the autism community. Examples include forced eye contact, experiences of sensory overload, and social exclusion. In some cases, even certain types of therapy have been named as sources of distress.

In many cases, an autistic person's traumatic experiences may be invalidated, minimized, pushed aside, or simply not considered traumatic at all by a clinician, family member, or other loved one. When someone in a position of trust does not view an experience as traumatic, that experience has a strong tendency to be minimized and set aside entirely, which only compounds the original harm. This is precisely why screening for this population matters so much, and why we need to keep looking for trauma even when it does not present in the ways we were trained to expect.

Case Scenario

Case Example: An Undiagnosed Adult Woman

Let me share a scenario with you. We have a middle-aged woman who is undiagnosed with autism, and in therapy, she discusses many emotional ups and downs. She talks about her parents and describes continuing to feel deep resentment toward them, though there is no indication or report of physical or sexual abuse or neglect. Much of her discussion centers on how difficult her upbringing felt, how disconnected she feels from her family, how lonely she feels around them, and how hypervigilant and on guard she feels in their presence.

On the surface, these examples do not align with what we might commonly think of as traumatic. Yet these experiences continue to live on for her in a very real way. Much of this comes down to both objective and subjective perception and to the meaning each of us makes of our own life experiences. In this case, there is a lack of validation within the family unit, and significant social masking at play. As time goes on, we may find that the pattern of experiences she describes closely resembles trauma we would recognize in other clients, and yet, without actively looking for it, we may miss it entirely.

As clinicians, we can offer trauma-informed, neuro-affirming supports and services in response to a scenario like this, though what that looks like will vary depending on your setting, your role, and the specific client in front of you. Careful, attentive listening to how a client with autism or autism-like characteristics describes their own experiences is genuinely essential here. There is real room for us to grow in how we tailor our therapeutic approaches and assessment tools, considering sensory needs and socialization patterns, and offering greater flexibility in our communication.

Visual supports deserve real emphasis here as well. Visuals can be helpful in so many ways, letting clients know what to expect and what comes next, whether in a speech therapy session, a clinical session, or a group setting at school. Visuals can also be less distracting in a busy social or group setting, since they reduce the need for verbal redirection. They tend to be time-intensive to create at first, but they typically become far less labor-intensive over time, which makes the upfront investment well worth it.

Social stories are one tool I want to highlight specifically. These were developed by Carol Gray, and if you are not already familiar with her work, I encourage you to look into it. Social stories can help teach expressive and receptive language, social cues, greetings, and a wide range of other skills, and in the context of trauma, they can help teach children and adults how to stay safe, or safer, including in the online spaces where so many people now connect and communicate. I also want to name something important that came up when I have taught this content before: some have raised valid concerns that social stories, by encouraging social imitation, could contribute to masking in autistic individuals, and that this masking itself carries its own risks. Masking, sometimes called social camouflaging, involves imitating social behavior in a way that can delay diagnosis and is known to be genuinely fatiguing over time. I think this is an important tension to hold as we weigh the pros and cons of any treatment modality, including social stories, rather than treating any single tool as a universal solution.

Case Example: A Nonverbal Adolescent

Here is a second scenario. Let's say you are working with a fifteen-year-old female with autism who has very limited verbal communication. The verbal communication she does offer is infrequent, and much of it is echolalic. Echolalia refers to the echoing of words, phrases, or sometimes full sentences spoken by another person. For those of you working in speech pathology, or with younger children more broadly, you likely recognize this as a common part of typical language acquisition, since young children often echo, imitate, or copy the words and sounds they hear. For this particular adolescent, echolalia was a common part of her daily communication, and the verbal communication she did offer beyond echolalia was typically routine, delivered in a sing-song manner, such as a rote "good morning."

I share this case because I want to emphasize something important: the work you do matters, and I want to encourage you to keep looking for trauma, even in clients whose communication style makes it harder to identify. We currently believe that trauma experiences in this population are considerably more common than we formerly understood them to be.

Grounding the Work: A Reflection from the Literature

I want to share a quote here that speaks to the heart of much of what I see in my own work. This comes from Fuld, writing in 2018: "Mounting evidence for stress and trauma as a risk factor for comorbidity and the worsening of core ASD symptoms may intimate a shift in the way clinical social workers and other clinical practitioners conceptualize and approach work with this population to include trauma-focused assessment strategies and clinical interventions" (Fuld, 2018, p. 210).

I think often about how stress and trauma are differentiated in neurodivergent populations, and much of that differentiation comes down to perception, or what researchers call cognitive appraisal. Lazarus and Folkman's stress and coping framework, published in 1984, describes stress itself as rooted in cognitive appraisal, and the same holds true for trauma. What is merely stressful to one person may rise to the level of traumatic for another, and social experiences are very much part of that equation. The evidence increasingly suggests that stress and trauma function as genuine risk factors for comorbidity, which in turn can intensify the symptomatology of co-occurring conditions.

I also want to acknowledge how these dynamics can show up in entirely new spaces. We increasingly see individuals connecting with others online, sometimes at all-time highs, and this creates new categories of risk we did not have to consider a generation ago. I think of an emerging adult with autism and moderate cognitive impairment, with a history of adverse childhood experiences and prior involvement with the child welfare system, who was later adopted into a loving home. Even within that loving home, earlier trauma experiences were likely still being processed. In this scenario, she connected with individuals through social media, was asked to meet up in person, and went missing for a week. I also think of a fourteen-year-old student who found many of her connections online as a way to reach the outside world, given how deeply isolated her day-to-day social life felt. She connected with someone claiming to be a teenager from the United Kingdom, was asked to share identifying information, and police later believed the person she had been speaking with was actually an adult man soliciting sex online. These are not one-time, isolated stories. They reflect a pattern occurring across the country and globally, as unsafe virtual experiences increasingly migrate into in-person risk. This raises real questions about how we teach digital literacy and safety with the same intentionality we already bring to teaching physical safety, such as how to cross a street, and how we bring this conversation to families and providers who may rarely discuss the connection between autism and trauma in the first place.

Treatment Options

Trauma-Focused Cognitive Behavioral Therapy. Trauma-focused cognitive behavioral therapy can be adapted effectively for the autistic community (Peterson et al., 2019; Stack and Lucyshyn, 2019). I want to emphasize the word adapted very intentionally here, because the adaptation itself is what matters most. This might mean building sensory breaks directly into a therapeutic modality, carefully considering whether the treatment environment has the right modifications in place, or honestly evaluating whether a given treatment modality is truly appropriate for a specific client, since even a well-established, evidence-based treatment is not automatically the best fit for every consumer.

Social Skills Training. Social skills need to be practiced throughout the lifespan, not simply taught once in childhood and then considered complete. I think of an analogy many of us experienced directly during the pandemic: after working from home for an extended period, many people needed to rebuild a kind of social stamina before returning to in-person interaction. Social skills function similarly. In many cases, these skills, along with related activities of daily living, will increase for a period, remain steady for a time, and then decline simply due to lack of practice, much like a skill that grows rusty without regular use. If you work with populations across the lifespan, including adults living in adult foster care homes or semi-independent living settings, it is worth intentionally building this into ongoing support and staff training, rather than treating it as something that ends once formal schooling does.

Sensory Processing Strategies. Given that trauma experiences can elevate sensory sensitivities, and elevated sensory sensitivities can in turn increase vulnerability to further distress, sensory processing strategies carry real value here. It is not always possible to untangle which came first, the sensory sensitivity or the traumatic experience, but these strategies remain genuinely impactful for everyday adaptive functioning, and especially in the context of trauma. The same holds true for emotional regulation and executive functioning strategies. When these supports are in place, a person has a stronger baseline, essentially a fuller toolbox, for navigating life's inevitable ups and downs. Regardless of whether trauma has occurred, social skills training, sensory processing support, and emotional regulation strategies are generally a good thing.

Supports and Resources

Autism and Mental Health Resources

I want to close with a set of resources that I hope will be genuinely useful in your own practice.

Mental Health America. Mental Health America offers a range of resources related to mental health and developmental disabilities, including materials available through its national training center.

Milestones Autism Resources. Milestones Autism Resources offers a downloadable mental health toolkit, along with trauma-informed training specifically relevant to working with the autistic community. I want to make it clear that I am not endorsing any particular organization here; I am simply sharing resources that are available at no cost.

National Center for Missing and Exploited Children. Given the case scenarios we discussed earlier involving online safety, the National Center for Missing and Exploited Children is an important resource to have on hand for situations where safety in virtual or in-person spaces becomes an urgent concern.

National Child Traumatic Stress Network. The National Child Traumatic Stress Network offers definitions and examples of what might be considered a traumatic experience, including guidance on distinguishing an isolated traumatic event from a chronic one, such as ongoing bullying or repeated discrimination. I want to flag something important here: for your particular client or consumer, an experience may be perceived very differently from these general examples, given individual perception and the elevated co-occurring factors we have discussed throughout this course.

Crisis Support Lines

If you or someone you are supporting needs immediate help, the twenty-four-hour Stay Well Call Line for mental health support can be reached at 1-888-535-6136. The 24-hour Crisis Text Line can be reached by texting HOME to 741741 to connect with a volunteer crisis counselor, or by visiting crisistextline.org. The 988 Suicide and Crisis Lifeline can be reached by calling or texting 988, with additional resources available at 988lifeline.org, including information specifically developed for the autism community.

Conclusion

Trauma within the autistic community is far more common, and far more frequently unrecognized, than many of us were trained to expect. Individuals with autism experience an elevated risk for trauma and posttraumatic stress disorder, shaped by sensory sensitivities, social exclusion, communication differences, and a genuine double vulnerability to both victimization and its lasting psychological effects. Many of these experiences fall outside current DSM-5 recognized criteria entirely, which means that as clinicians, educators, and support providers, our willingness to keep looking, even when a presentation does not match what we expect trauma to look like, matters enormously.

I hope you leave this course with a clearer sense of why trauma screening and trauma-informed practice deserve a central place in how we support autistic clients across the entire lifespan, not just in childhood. I hope you also leave with concrete strategies you can begin using right away, whether that is building in visual supports, thoughtfully adapting trauma-focused cognitive behavioral therapy, prioritizing sensory processing strategies, or simply asking one more question the next time something does not quite add up in a client's story. The work you are doing, in whatever setting you are doing it in, genuinely matters, and it is helping to close a gap in recognition and care that has gone unaddressed for far too long.

Questions

What advice do you have for building protective, preventive skills before trauma ever occurs?

I love this question. Some things need to be explicitly taught rather than learned through observation alone, and this is often true for people with autism, particularly around social skills. Social stories can be wonderful for this. Before I began this deeper work in autism and trauma, I loved social stories for their own sake, but now I think about them even more intentionally: where might we use them to build coping skills, compensatory skills, or simply a stronger baseline for handling life's inevitable bumps in the road, whether or not those bumps ever rise to the level of trauma. Used this way, they can serve as a genuine protective mechanism, reducing vulnerability to trauma, abuse, neglect, and coercion over time.

Who created social stories, and where can I learn more?

Social stories were developed by Carol Gray in West Michigan. I learned about her work nearly twenty-five years ago during my own training, and I remain fascinated by the underlying premise: how do we intentionally teach something that might otherwise be learned only through observation, drawing on ideas like Albert Bandura's social learning theory, when observational learning does not always happen naturally for a given individual, autistic or not.

Do you have examples of how sensory needs and social stories can be built into everyday practice?

Yes, and I received some wonderful examples from attendees during the live version of this course. One provider shared that incorporating sensory activities, such as rolling a car along the floor or stepping on bumpy surfaces during early intervention practice with toddlers, helped therapy run more smoothly once sensory needs were met. Another shared a social story built around getting a haircut, which brings up real sensory considerations, as does brushing teeth, an area where I receive frequent questions in my consulting work with schools. Difficulty with tooth brushing carries both hygiene and social implications, since inconsistent oral hygiene can affect a person in social settings as well.

Could social stories themselves contribute to masking, and could that cause trauma?

This is a genuinely important question, and I am glad it was raised. Masking, also called social imitation or social camouflaging, is a real piece of this puzzle. It tends to be particularly common among individuals with average to above-average cognitive ability, and is often more prevalent among those assigned female at birth. In many cases, masking delays a formal autism diagnosis and can contribute to other difficulties. One well-documented issue with masking is fatigue, and it is entirely possible that this social fatigue occurs simply as a byproduct of ongoing social camouflaging, independent of whether trauma is present. I appreciate this question because it reminds us to weigh the genuine pros and cons of any treatment modality, including one as widely used and generally well-regarded as social stories, rather than assuming any single tool is without tradeoffs.

References

See additional handout.