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OBJECTIVE: Although many autistic adults show high posttraumatic stress, PTSD is underdiagnosed in this population. This study aims to examine correlates of autistic adults screening positive for PTSD (PTSD +) and predictors of a professional PTSD diagnosis (Diagnosis +) in the PTSD + subgroup. METHOD: Self-identified autistic adults (N = 677) completed an online survey on their demographic characteristics, mental health symptoms, and trauma history. T tests and chi-squares were used to compare subgroups, and logistic regression was used to predict diagnosis status. RESULTS: PTSD + participants were less likely to be employed or to identify as cisgender men, had more mental health symptoms and worse functional impairment, and had experienced a higher number of traumas and more interpersonal trauma. The same was true for Diagnosis + participants, who were also older and more likely to have a marginalized racial/ethnic identity. Among participants who were PTSD +, older age, being a woman or gender minority, being unemployed or on disability, having increased posttraumatic stress, having more co-occurring conditions, and having lower functional impairment predicted being Diagnosis +. The final model explained 35% of variance in diagnosis. CONCLUSION: PTSD is associated with significant impairment in autistic adults, but it often goes unrecognized. In particular, autistic cisgender men might be underdiagnosed with PTSD because of gendered stereotypes. High functional impairment may also increase barriers to obtaining an appropriate diagnosis. Future research should include participant treatment history as a potential factor. Clinicians should be aware of these potential signs of PTSD and diagnostic barriers when working with autistic clients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Background: Many autistic adults report interpersonal traumas (IPTs) such as physical or sexual assault, which are often associated with posttraumatic stress and dissociation. Factors such as gender might make autistic individuals particularly vulnerable to experiencing IPT and negative posttraumatic symptoms. Methods: In this study, 687 self-identified autistic adults completed an online survey on their traumatic experiences and mental health symptoms. Results: Seventy-two percent of participants reported experiencing sexual assault, other unwanted or uncomfortable sexual experiences, or physical assault. Forty-four percent of participants met the criteria for posttraumatic stress disorder (PTSD), including 50% of those who had experienced IPT and 28% of those who had not (odds ratio = 2.50; 95% confidence interval 1.74-3.60). IPT was also significantly associated with higher levels of psychoform (p < 0.001) and somatoform (p < 0.001) dissociation. Autistic cisgender women and gender minorities experienced a significantly higher number of traumas (p = 0.004) and were significantly more likely than cisgender men to experience sexual IPT (p < 0.001) and meet the criteria for PTSD (p < 0.001). There were no significant differences between autistic individuals with and without a professional autism spectrum disorder (ASD) diagnosis. Conclusions: IPT is associated with potentially severe mental health outcomes for autistic adults. Autistic women and gender minorities may be particularly vulnerable to sexual IPT and adverse outcomes. Increased screening for a history of IPT and posttraumatic symptoms is recommended for all autistic adults regardless of ASD diagnosis status. Lay summary: Why was this study done?: Many autistic people experience interpersonal traumas (IPTs) such as sexual or physical assault. These can lead to mental health challenges such as posttraumatic stress disorder (PTSD) or dissociation (a disconnection between individuals and aspects of their perceptions or sense of self). We wanted to better understand what might make autistic adults more likely to experience trauma and how it affects them.What was the purpose of this study?: The purpose was to understand what might make autistic people more at risk of experiencing IPT and PTSD. We also wanted to know if IPT is associated with a higher risk of PTSD or dissociation.What did the researchers do?: Six hundred eighty-seven autistic adults filled out an online survey about their traumatic experiences, PTSD symptoms, and dissociation symptoms. We analyzed their responses to see how often participants reported experiencing different types of trauma and whether they met the criteria for PTSD and clinical dissociation. We then compared trauma experiences and PTSD rates across genders and those with and without a professional autism spectrum disorder (ASD) diagnosis and compared PTSD rates and dissociation rates across participants who had versus had not experienced IPT.What were the results of the study?: Seventy-two percent of autistic adults in this study reported having experienced sexual assault, another unwanted sexual experience, or physical assault. Almost half (44%) met the criteria for PTSD. Most participants (93%) also reported high levels of mind-based dissociation, and 32% reported high levels of body-based dissociation (dissociation that causes negative emotions to be experienced as physical problems such as headaches or trouble moving). Participants who had experienced IPT were almost twice as likely to meet the criteria for PTSD and scored higher on both measures of dissociation. Cisgender women and gender minorities were more likely to experience IPT and meet the criteria for PTSD than cisgender men. Participants with and without a professional ASD diagnosis did not differ.What do these findings add to what was already known?: Most previous research on trauma and PTSD for autistic people was done on children and did not look at IPT specifically or compare people based on their gender or ASD diagnosis. As far as we know, this is the first study on posttraumatic dissociation in autistic adults.What are potential weaknesses in the study?: The findings of this study may not apply to autistic adults as a whole. People who could have participated may not have been interested in the topic, may not have seen study advertisements and so been unaware of the study, or may not have had the time or energy to participate. Findings might have been different if different groups of autistic people participated more.How will these findings help autistic adults now or in the future?: If professionals who help autistic people do not talk to them about trauma, traumatized autistic adults may not get the right support. This study could encourage professionals to screen more autistic people, especially women and gender minorities, for trauma.
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Limitations in our ability to produce two responses at the same time - that is, dual-task interference - are typically measured by comparing performance when two stimuli are presented and two responses are made in close temporal proximity to when a single stimulus is presented and a single response is made. While straightforward, this approach leaves open multiple possible sources for observed differences. For example, on dual-task trials, it is typically necessary to identify two stimuli nearly simultaneously, whereas on typical single-task trials, only one stimulus is presented at a time. These processes are different from selecting and producing two distinct responses and complicate the interpretation of dual- and single-task performance differences. Ideally, performance when two tasks are executed should be compared to conditions in which only a single task is executed, while holding constant all other stimuli, response, and control processing. We introduce an alternative dual-task procedure designed to approach this ideal. It holds stimulus processing constant while manipulating the number of "tasks." Participants produced unimanual or bimanual responses to pairs of stimuli. For one set of stimuli (two-task set), the mappings were organized so an image of a face and a building were mapped to particular responses (including no response) on the left or right hands. For the other set of stimuli (one-task set), the stimuli indicated the same set of responses, but there was not a one-to-one mapping between the individual stimuli and responses. Instead, each stimulus pair had to be considered together to determine the appropriate unimanual or bimanual response. While the stimulus pairs were highly similar and the responses identical across the two conditions, performance was strikingly different. For the two-task set condition, bimanual responses were made more slowly than unimanual responses, reflecting typical dual-task interference, whereas for the one-task set, unimanual responses were made more slowly than bimanual. These findings indicate that dual-task costs occur, at least in part, because of the interfering effects of task representation rather than simply the additional stimulus, response, or other processing typically required on dual-task trials.
