Autism or Trauma (CPTSD)? How Clinicians Tell the Diffe… — Transcript

Dr. Thatcher explains how clinicians differentiate autism from trauma (CPTSD), highlighting overlaps, differences, and evaluation strategies.

Key Takeaways

Autism and trauma can look similar but have distinct developmental origins and motivations behind behaviors.
Early developmental signs and collateral history are crucial for accurate autism diagnosis.
Sensory sensitivities and social withdrawal occur in both but arise from different internal mechanisms.
Understanding empathy differences and behavior awareness helps distinguish autism from trauma.
Many individuals experience both autism and trauma, requiring nuanced clinical evaluation.

Summary

Dr. Thatcher discusses the common confusion between autism and trauma symptoms during clinical evaluations.
He emphasizes the importance of developmental history to identify autism, focusing on early signs like repetitive movements and fixations.
Collateral information from family or childhood artifacts is valuable in adult assessments when direct history is unavailable.
Trauma and autism share overlapping symptoms such as sensory sensitivities and social withdrawal but differ in underlying causes.
Sensory issues in autism stem from neurodevelopmental processing, while in trauma they are often trigger-based.
Social withdrawal in autism is due to social confusion and overload, whereas in trauma it is a protective response to betrayal.
Differences include motivation and awareness behind behaviors; autistic individuals often understand why they react, trauma survivors may not.
Empathy expression differs: autistic people may struggle to express empathy, trauma survivors may overextend it to avoid conflict.
The video stresses the frequent coexistence of autism and trauma and the need for careful, compassionate evaluation.
Dr. Thatcher provides questions viewers can ask evaluators to clarify diagnosis between autism, trauma, or both.

Chapters

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When someone comes into my office and says, "I think I might be autistic," sometimes what we find during the evaluation process is something completely different. I've done over 2,000 evaluations looking at autism, ADHD, trauma, and one of the more common questions that I get,

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especially when working with adults, is how do you tell the difference between autism and trauma? And I think that's a really important question because on the surface these two things can look very similar to one another. Withdraw, sensory overwhelm, emotional shutdown,

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and difficulty connecting with other people. But what's behind those behaviors is often very different. In this video, I'm going to walk you through what I look for as an evaluator when I'm trying to figure out autism versus trauma or CPTSD,

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otherwise known as complex post-traumatic stress disorder. And we'll look at the overlap between these two issues along with what sets them apart. So, by the end of this video, you're going to have a clearer sense of what fits your own

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experience. So, here's how we're going to go about that. First, we're going to look at early developmental signs that would pop up in regards to autism. Then, we're going to look at where trauma and autism overlap and how those similarities can often

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lead to confusion and misdiagnosis. And if you wait till the end of this video, I'm going to give you a list of questions that you can ask your own evaluator. And these questions are geared for how to clarify between if you

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have trauma, autism, or if you have both. Hi, I'm Dr. James Thatcher. I'm a licensed psychologist at Forest Psychological Clinic. And here's what I look for as an evaluator when distinguishing between trauma and autism. When I'm looking at autism, one

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of the first things that I do is I ask a lot of questions about developmental history. So, I'm going into their childhood and what I'm looking for is was that person's brain wired differently long before any sort of

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trauma would have occurred. The things I would be looking for are repetitive movements. So, walking on their toes, hand flapping, finger posturing. Another thing that I would be looking for is any language stereotypes. So, echolalia. Are they scripting as in saying their

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favorite lines from movies or cartoons? Another thing I look at is like fixations or intense interests of something that they just constantly look up, that they learn a lot about, they're talking a lot about. And another area that I would look at that would indicate

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their brain is wired a little bit differently is a need for routine. They need to stick to a routine, something very predictable, and you need to follow it step by step. And these kinds of patterns aren't caused by trauma.

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They're neurodevelopmental. They're just how the brain works for folks who are on the autism spectrum.

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Now, when I'm evaluating adults, what I really like to do is to have collateral information, right? So, someone that knew them when they were younger, like a parent or an older sibling or a friend.

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But now and again I don't have that. Now and again I can't get that collateral information. So what I ask the patient to do is to try and dig up anything that can help jog their memory of when they

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were younger like an old photograph or any journals or diaries that they took when they were younger or report cards.

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And I worked with an adult one time that this was the case. They didn't have a parent or an older sibling that could come in. So what they did was they brought in some old childhood photographs and we went through them

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together. There were some where they were walking on their toes. There were some where they were spinning in place.

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So it was obviously showing some motor stereotypes. And I remember at one point she showed me a photograph of her where she was covering herself like this.

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She was covering her private parts. It choked a really powerful memory for her and she started crying. She hadn't connected with that trauma that she just experienced in that moment for decades.

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It came back to her. She remembered why she was holding herself that way.

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And in her case, it turned out that she had both autism and trauma. And because she had been showing autistic traits earlier on in her life and then layering that trauma experience and series of experiences on top of that, it can

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become hard to see which symptoms are coming from where. And I see that a lot to where these two different conditions often coexist with one another. So having an evaluator that's able to tease that out with a lot

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of care and compassion, especially when you're talking about trauma, that's going to be essential. So now let's talk about the overlap where trauma can look like autism. There are lots of different areas in trauma that can overlap with

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what looks like autism. And this is where things can start to get a bit complicated. So let's start with sensory sensitivities. So sensory sensitivities in folks with autism is how the brain processes sensory input.

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So bright lights, loud noises, food textures can all be very overwhelming for someone that's on the spectrum. And in trauma, these sensitivities can be trigger-based. So, a door slamming or a raised voice or a certain smell can bring the person

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back into a fight or flight sort of mode, can bring them back into that traumatic memory and then get overwhelmed with it and start to shut down. So, from the outside observer, it might look like sensory overwhelm, but what's going on

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internally, the cause of these things are different. Social withdrawal is another common overlap between these two issues. Someone on the autism spectrum may begin to isolate because social interactions are confusing and draining.

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Someone with trauma may start to isolate or withdraw because people have started becoming associated with pain and betrayal. One is about sensory and cognitive overload where the other one is about emotional protection. I remember one time I had an older patient

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come in where her spouse was sure that she was on the spectrum. She wasn't socializing anymore. She wasn't going to family events. She was getting easily overwhelmed out in the community. But only when we started

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digging into the history a little bit more did we discover there weren't any developmental differences when she was younger. What we did find was a long history of emotional neglect and betrayal and trauma. She wasn't avoiding people because she didn't

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understand them. She was avoiding people because she couldn't trust them. And that's trauma. That's not autism. So, now let's talk about the differences between these two issues, between trauma and autism. The why behind the behavior.

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And that's kind of the distinction that I look for is motivation and awareness. So after an emotional outburst, someone with trauma might ask themselves, why did I do that? Why did I react that way?

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Why did I react so out of proportion with the situation? They know it was disproportionate. They know they overreacted, but they can't explain why.

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People with autism often do know why they got upset. A rule was broken. Something is different in the routine. There was a last-minute change to a plan that they didn't expect.

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Their special interest was dismissed and they felt that this is deeply important to them. This ties back to more black and white sort of thinking or really strong sense of justice and fairness. So while the behavior may look the same,

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so while they still may be snapping at someone or shutting down, what's happening internally and their awareness of that is different. One is a nervous system reacting to danger, whereas the other is a mind reacting to inconsistency or misunderstanding.

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Another key area of difference is empathy expression. So folks on the autism spectrum often feel deep empathy for others but can struggle with how to express that. Whereas trauma survivors may overextend empathy in order to avoid any sort of conflict or rejection. And

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this is...

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one another. Research is showing that women are four times more likely to develop PTSD or complex PTSD than neurotypical women.

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So, why is that? Why do they develop trauma so much more than neurotypical women? Well, in many cases, it's due to the social naivity, not picking up on social cues, not understanding when someone is dangerous to be around, when

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they're being groomed by someone. You know, they can be overly trusting and not really pick up on the signs that this situation or this particular person is dangerous. And many of the women that I've worked with over the years and

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evaluated have trauma histories very similar to this. And these women were often targeted and manipulated and groomed because they didn't know how to navigate a world that punishes these differences.

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And these overlaps that I'm talking about doesn't mean that one thing caused the other. But what it does mean is that clinicians should slow down and carefully consider both. Thanks for sticking with me. I know this is a

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heavier topic to talk about, but now let me share those questions that you can ask your evaluator when you're interested in seeing if you have trauma or autism or both. So, here's four different questions that I would ask if

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you're looking for an evaluation to really look at these two conditions. First question is, is the evaluation going to look at just autism, just trauma, or are you going to be able to look at both areas? Another question

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that I would ask is, are you going to explore my early developmental history even if I can't give you collateral information, say like if your parents or an older sibling won't be able to to participate for one reason or another.

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Another one would be how do you differentiate between sensory sensitivities and trauma triggers? And another one would be to ask, can you help me understand what's driving my behaviors? What's driving these symptoms? Is it that they're coming from

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trauma responses more? How the brain is wired related to autism or both? And these questions are going to open the door for a much more accurate evaluation and a deeper understanding of yourself when you get the results back. The unfortunate truth

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is a lot of autistic folks have trauma. And teasing them apart isn't about labeling.

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It's understanding where this pain comes from and where your wiring begins. So, if this video resonated with you, especially if you feel some of the trauma symptoms that you or a loved one have been experiencing may have been

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masking some autism symptoms, please check out this video. The hidden signs of autism in girls, perfectionism, and social burnout can hide the real

Topics:autismtraumaCPTSDcomplex post-traumatic stress disorderclinical evaluationdevelopmental historysensory sensitivitiessocial withdrawalempathyDr. James Thatcher

Frequently Asked Questions

How do clinicians differentiate autism from trauma during evaluations?

Clinicians look at early developmental history, behavioral motivations, and collateral information to distinguish autism's neurodevelopmental traits from trauma's emotional and trigger-based symptoms.

Can a person have both autism and trauma?

Yes, many individuals experience both autism and trauma, which can complicate diagnosis, requiring careful and compassionate evaluation to tease apart symptoms.

What are common overlapping symptoms between autism and trauma?

Both can show sensory sensitivities and social withdrawal, but in autism these arise from neurodevelopmental differences, while in trauma they are often responses to triggers or emotional protection.

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