Treating traumatized children with intellectual disabilities: Tailoring Trauma-Focused Cognitive Behaviour Therapy for a vulnerable population.

BACKGROUND: Children with intellectual disabilities are at heightened risk for traumatization, though underserved due to silos of care, diagnostic overshadowing, and lack of adapted treatment. Trauma-Focused Cognitive Behavioural Therapy (TF-CBT), an evidence-based childhood trauma therapy, is described with recommended adaptations for use with children who have intellectual disabilities. METHOD: We present a suggested theoretical and clinical guide for treating children with mild to moderate intellectual disabilities. We explicate key functional domains of intellectual disabilities-comprehension, executive functions, and generalization-as the basis for tailoring the treatment model. RESULTS: Therapy recommendations are organized into a heuristic 'matrix' of resources and adaptations to TF-CBT components, based on clinical experience and research literature, illustrated with composite case vignettes. CONCLUSION: Children with intellectual disabilities are a uniquely vulnerable population historically excluded from clinical trauma interventions and research but can respond to adapted care. Considerations for future research and dissemination are discussed.

The Interactive Trauma Scale: A Web-Based Measure for Children with Autism.

This study examined the feasibility, acceptability, and psychometric characteristics of a web-based touchscreen app prototype designed to assess self-reported trauma exposure and symptoms in children with autism spectrum disorder (ASD). The prototype was piloted with 20 clinically referred children previously diagnosed with ASD and having various known trauma exposures. User satisfaction and reported ease of use was high. The measure was sensitive to reports of teasing and bullying, endorsed by 75% and 70% of participants, respectively. Validity was assessed via comparisons with the UCLA Posttraumatic Stress Disorder Reaction Index and analysis of participants' trauma exposures and symptoms. Clinical implications are discussed including issues of trauma screening, diagnosis, and treatment planning for traumatized youth with ASD.

Adverse childhood experiences in children with autism spectrum disorder.

PURPOSE OF REVIEW: Recent years have shown an uptick in studies assessing bullying and other adverse childhood experiences (ACEs) in children with autism spectrum disorder (ASD). This article reviews extant findings, and points to gaps in the literature. RECENT FINDINGS: Children with ASD are bullied by peers at a rate three to four times that of nondisabled peers with negative impacts on academic functioning and mental health symptoms, including increased risk for suicidality. Children with ASD are also at enhanced risk for other ACES, particularly parental divorce and income insufficiency, and as observed in the general population, children with ASD who experience an increased number of ACES are at elevated risk for comorbid psychiatric and medical health problems. Children with ASD with an elevated number of ACES also experience a delay in ASD diagnosis and treatment initiation. There is no evidence of increased risk of child maltreatment within the ASD population. SUMMARY: As bullying and other adverse experiences are common and associated with deleterious outcomes in children with ASD, there is a need for additional research on intervention strategies to prevent and mitigate the impact of these experiences. Ongoing work on the assessment of trauma experiences and PTSD symptoms in children on the spectrum is also needed.