Understanding and Treatment of “Autistic Trauma”
As a psychologist who has worked in the autism field for decades, I was deeply moved by Dr. Tasha Oswald’s presentation on autistic trauma at the recent Innovations in Psychotherapy conference put on by PESI and the Psychotherapy Networker.
Although I have seen unique mental health challenges in autistic kids and adults, I could not quite put my finger on what was happening until I gained this understanding of autistic trauma. It is not exactly like Post Traumatic Stress Disorder (PTSD) or Complex PTSD (aka developmental trauma). Because I had no name for this, it was hard to explain the specific source of difficulties often faced by autistic people.
The trauma I kept seeing in my work is essentially this:
“Trauma from repeated hurts that are caused by being autistic in a non-autistic world.”
On the face of it, there’s nothing wrong with being autistic in society. In real life, autistic people are spending the majority of their childhood being told “no” “you are doing it wrong” and “you are so rude”. They rarely get a moment’s peace from the societal rebuke. School becomes a special kind of hell where they face rejection and social ‘failure’ experiences every day. It is hard to completely understand, let alone explain, what that might feel like. It would be like walking around in a country where you don’t know the language or culture. Not only that, but it somewhat looks like you do so everyone expects you to get it right. In real life, you keep feeling all you are doing is getting it wrong.
Learning from the experts
As a psychologist, there is a reason we do professional development. The field is constantly changing and we are responsible to keep up with the science as it emerges. I was glad of the opportunity to spend time with Dr. Oswald and gain important insights about autistic trauma experiences and treatments. Dr. Oswald’s neurodiversity-affirming approach offers a fresh perspective, challenging the traditional medical model and highlighting the often-overlooked experiences of autistic individuals. This article aims to share the key insights I gained from Dr. Oswald’s talk, including the various sources of autistic trauma, the limitations of the medical model, and the importance of embracing a social model of disability. By understanding and addressing autistic trauma, we can create a more inclusive and supportive world for neurodivergent individuals.
Medical model vs. social model of autism
The understanding of autism is undergoing a crucial shift, moving beyond the limitations of the medical model and embracing a neurodiversity-affirming perspective. This evolving perspective recognizes the unique challenges autistic individuals face, including the often-overlooked experience of “autistic trauma.”
Understanding autistic trauma: beyond isolated events
Dr. Tasha Oswald, a leading expert in neurodiversity-affirming therapy, emphasizes that autistic trauma extends beyond single traumatic events. It encompasses the chronic stress and emotional distress that can arise from a variety of sources, including:
- Sensory overload: The heightened sensory sensitivities experienced by many autistic individuals can lead to overwhelming and distressing experiences in everyday environments. Imagine the constant bombardment of noise in a crowded shopping mall, the scratchy feeling of certain fabrics against the skin, or the flickering fluorescent lights overhead. These sensory experiences, which might be easily filtered out by a neurotypical person, can be intensely distressing for an autistic individual, leading to anxiety, meltdowns, or shutdowns.
- Social misunderstandings: Difficulties with social communication and interaction can result in repeated experiences of rejection, bullying, and isolation. Autistic individuals may struggle to interpret social cues, understand unspoken rules, or engage in reciprocal conversation. This can lead to misinterpretations, social faux pas, and feelings of being different or “weird.” These experiences can accumulate over time, leading to social anxiety, withdrawal, and a deep sense of loneliness.
- Internalized ableism: Autistic individuals may internalize negative societal messages about autism, leading to feelings of shame, self-doubt, and low self-esteem. Messages that portray autism as a deficit or a disorder to be cured can be deeply harmful. Autistic individuals may start to believe that they are broken, flawed, or burdensome, leading to self-stigma and a negative self-image.
- Masking: The effort to suppress autistic traits and conform to neurotypical expectations can be emotionally exhausting and lead to feelings of inauthenticity and disconnection from oneself. Masking can involve suppressing stimming behaviors, forcing eye contact, mimicking social behaviors, or constantly monitoring and adjusting one’s behavior to fit in. This constant effort can take a significant toll on an individual’s mental health and well-being.
- Pathologizing autistic traits: Autistic individuals may be subjected to therapies or interventions that aim to “cure” or “normalize” their behaviors, rather than accepting and supporting their neurodiversity. These therapies can be invalidating and traumatic, sending the message that there is something fundamentally wrong with being autistic.
The limitations of the medical model of autism
The medical model, which dominates diagnostic manuals like the DSM and ICD, defines autism as a disorder characterized by deficits and impairments. This deficit-based lens often pathologizes natural autistic behaviors, such as stimming (self-stimulatory behaviors used for self-regulation) and intense interests, framing them as problematic or abnormal.
Dr. Oswald highlights a problem with the DSM criteria for autism: they were developed without input from the autistic community. She believes that this exclusion has resulted in a diagnostic system that can be invalidating and fail to recognize the experiences of many autistic individuals, particularly those who have learned to mask their traits effectively.
Embracing the social model of disability
In contrast to the medical model, the autistic community advocates for a social model of disability. This model recognizes that disability is not solely an individual’s impairment but is created by societal barriers, attitudes, and lack of accommodations. This perspective shifts the focus from “fixing” the individual to changing the environment to be more inclusive and supportive of neurodiversity.
The prevalence of trauma in the autistic community
Research paints a stark picture: autistic individuals are significantly more likely to experience trauma and develop PTSD than neurotypical individuals. This increased vulnerability stems from several factors:
- Higher exposure to traumatic events: Autistic individuals are more likely to experience bullying, abuse, social exclusion, and discrimination.
- Increased vulnerability to PTSD: Autistic individuals may have difficulty processing traumatic experiences and may be more prone to experiencing hyperarousal, re-experiencing symptoms (flashbacks, nightmares), and avoidance behaviors.
- Autism-specific traumatic reactions: These can include regressions in adaptive functioning, increased reliance on caregivers, and repetitive behaviors that serve as trauma responses.
Sources of autistic trauma: a complex interplay
Dr. Oswald emphasizes that autistic trauma can originate from a complex interplay of various sources, including:
- Traditional trauma: This encompasses experiences like abuse, neglect, and other adverse childhood experiences.
- Social marginalization: This includes bullying, social exclusion, and discrimination based on autistic traits.
- Traumatic incongruities: Mismatches between autistic needs and the environment, such as sensory overload, unexpected changes, and social confusion, can be deeply distressing and traumatic.
- Systemic trauma: The ongoing experience of stigma, bias, lack of access to appropriate support, and the constant pressure to conform to neurotypical norms contribute to systemic trauma.
Invalidation and the power of language
Invalidation, or the dismissal and denial of autistic experiences and needs, is a profound source of trauma. The language used to describe autism can also contribute to internalized ableism and feelings of shame. Dr. Oswald advocates for using respectful and affirming language that recognizes autism as a natural form of human diversity.
Masking: a survival strategy with hidden costs
Masking, while often a necessary survival strategy in a neurotypical world, can have significant long-term consequences. It can lead to autistic burnout, exhaustion, a diminished sense of self, and difficulty in forming genuine connections. Creating safe spaces where autistic individuals can unmask and be their authentic selves is essential for healing and well-being.
Neurodiversity-affirming treatment: a path to healing
Dr. Oswald champions neurodiversity-affirming treatment that:
- Validates and accepts autistic individuals for who they are, honoring their unique strengths and perspectives.
- Supports sensory regulation and helps individuals develop strategies to manage sensory overload.
- Provides social skills support in an authentic and empowering way, focusing on building genuine connections rather than forced conformity.
- Encourages unmasking and self-acceptance, helping individuals embrace their autistic identity.
- Utilizes trauma-informed care that is sensitive to the unique experiences of autistic trauma.
About Dr. Tasha Oswald: a champion for neurodiversity
Dr. Tasha Oswald is a neurodiversity-affirming licensed psychologist and clinical consultant with nearly 20 years of experience working with autistic adults and youth. After completing her PhD in psychology with an autism emphasis, she was awarded an NIH-Funded Autism Research Training Program (ARTP) post-doctoral fellowship. Through this fellowship program, she engaged in interdisciplinary training and research at the world-renowned UC Davis MIND Institute, where she developed and established a therapy group program for young adults on the autism spectrum called the ACCESS Program. She is the founder of Open Doors Therapy, an adult autism specialty practice in California. Dr. Oswald is passionate about empowering autistic individuals to live authentic and fulfilling lives.
