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Autism and trauma: 

  • How professionals unintentionally re-traumatise autistic children / teens / adults

  • What professionals can do to support autistic people's mental health 

No matter what intervention or level of input professionals provide, it's vital to give just as much consideration to HOW they're interacting and communicating with Autistic people. This is just as important (if not more important) as therapy goals, activities, tasks. The intervention is IN the relationship - without emotional safety, there are no therapy outcomes)

But why...?

...Because of trauma. 

As a group of people, Autistic kids / adults have histories of complex trauma. Autistic children who end up in specialist settings / schools have typically experienced years of trauma due to being in mainstream schools that aren't set up for them and cause re-traumatisation. These kids are punished for not sitting still, told off for messy handwriting and fidgeting, poor attendance because their underlying distress is ignored and they're the ones to blame, instead of addressing the barriers in the environment that are causing this distress.

When Autistic individuals aren't allowed to self-regulate and apply sensory strategies this leads to worse mental health problems. Kids are taught that they're the problem. They're taught to be 'resilient' and forced to tolerate distressing environments (known as desensitisation which is ineffective, painful and abusive). 

The trauma of being triggered by the physical environment

Examples of inflexible rigid rules:
 
  • no movement breaks
  • no fidget toys
  • no stimming because it 'distracts others'
  • uniforms that are made of fabrics that trigger sensory overwhelm
  • noise sensitivity - leading to meltdowns and behaviours adults deem as challenging

Kids breach school rules / behaviour policies because they cannot cope with the inflexible rules that schools impose on them. The irony being autistic kids are labelled as inflexible thinkers, yet they are placed in systems that impose inflexible. strict rules. They may fail exams because they can't access the curriculum because they simply cannot learn in the prescribed ways that neurotypical kids can and are labelled as 'stupid' or 'lazy'

Autistic children are said to have rigid, inflexible thinking. The irony is that schools are the ones with rigid, inflexible rules.

Being repeatedly triggered by the environment to the point of sensory overload / meltdowns is its own type of trauma. This results in adults misunderstanding the child's distress who often react by punishing them, sanctioning them, labelling them as being 'challenging' or gaslighting them (telling them that how they think, feel and act is wrong when in fact it is completely understandable that how they feel is totally valid).

The trauma of being socially rejected

Person holding up a white piece of paper over their mouth with a smile drawn on to represent masking
Autistic people have been socially rejected, teased and bullied throughout their lives by peers and adults, which in response, a set of coping mechanisms are learnt like masking which leads to devastating mental health problems. It's also common to observe Autistic kids / teens use explicit language (swearing, racial / sexist language) in some social situations, which can be a form of masking and/or a way to seek control - "if I reject them before they reject me I'll be OK". But again, adults misunderstand the reasons for this language and label them as 'rude' and having social deficits.

Some psychological therapies re-traumatise Autistic people

Well-intended professionals cause harm to Autistic people without meaning to. Certain psychological therapies to help autistic people such as CBT (Cognitive Behavioural Therapy), MBT (Mentalisation Based Therapy), DBT (Dialectical Behavioural Therapy), or Exposure Therapy (desensitisation). 
 
Behavioural therapies are rooted in behaviourism which all share the goal which is to change how a person thinks, feels, or behaves. The assumption is that the client has "faulty thinking" and "cognitive deficiencies / distortions" (mindblindness). This also assumes that the therapist delivering the therapy does not have faulty thinking, which assumed the way the therapist thinks, feels, and acts is 'right'. In the context of autism and working with Autistic clients, this is The Double Empathy Problem playing out in the therapy room. If the therapist is neurotypical, this can be a problem because they have no idea how it feels to experience the world as their client does. This leads to gaslighting and invalidation which worsens the client's difficulties and inevitably leads to poorer self-esteem / mental health difficulties. When an Autistic teen / adult enters a therapy where they're told how they think, feel, and act is wrong, it repeats a historical trauma for that person because yet again there's another person in their life telling them they need to change.

What happens when Autistic people feel dismissed?

If the person feels unheard, unseen, ignored, dismissed, then their trust with the adult is broken. Their attachment system will close off. Their shame will grow bigger. They will continue to doubt their reality. They will continue to think they're the one that needs to change. They'll grow up into adults with significant mental health difficulties. They'll continue to deny their own feelings, because they've been conditioned to gaslight themselves. They'll continue to have poor self-esteem and think "what's wrong with me?" when these therapies aren't working. Their masking increases. Where these therapies / therapists are trying to work toward better mental health, the exact opposite happens: it damages their mental health.

This is not to say that ALL these therapies are equally as bad or damaging. As with alot of therapies, there will be components which might be helpful. A common phrase in recovery communities is "take what you like and leave the rest". E.g. DBT is often recommended for people with Borderline Personality Disorder (BPD) which as the emerging research is now showing, many autistic women are being misdiagnosed with BPD due to the huge overlap of traits with autism. DBT teaches self-regulation / sensory strategies (distress tolerance) to manage dysregulation, non-judgmental stances, communication / assertiveness / self-advocacy. CBT might be useful in helping the person become aware of their internal scripts / beliefs that might be contributing to their difficulties, and help the person begin to recognise that they way they talk to themselves isn't compassionate or nurturing.
For those who feel challenged by this (probably those who are not autistic...), you might be thinking "so, what, we just don't help autistic people with their anxiety? We just don't do therapy then? We just leave them to suffer? There's nothing with a behavioural approach if it's reducing their anxiety - surely changing how they think is the whole point, otherwise they're stuck with the same unhelpful thought patterns?" .       
  ...of course it's OK to help autistic people manage their anxiety. The WHAT essentially stays the same, which is to help the person, but it's the HOW that differs. It's the approach and the lens in which we are viewing the autistic person through.
 
You can help the person manage their anxiety without invalidating and dismissing their struggles. Learning to recognise feelings of excitement, sadness, anxiety and distress is important. Learning what your body feels like when you are in these states is important. Learning how to self-soothe, what sensory strategies will help you, your triggers, recognising thoughts that aren't serving you anymore, writing affirmations for yourself...these are all ways to work with anxiety in a nurturing way. None of them assign judgment or tell someone how they should feel. 

Autistic children need Autistic role models. Finding a therapist who is Autistic (or neurodivergent) is a perfect match, and can be incredibly healing and powerful.

If neurodivergent therapists are hard to find, at least find someone who UNDERSTANDS autism, how this relates to trauma, and how sensory/executive functioning/communication differences may impact on therapy - and the therapeutic relationship. When seeking a therapist, ask them what their experience is with working with autistic clients. 

How to provide an affirming, validating environment

Things to say / do:

Things to NOT say / do:

  • VALIDATE their experience

  • Affirm their reality

  • "You have every right to feel that way"

  • "What happened to you was not OK"

  • "It's OK you feel [scared, anxious, worried]"

  • Remind them it's OK to have needs

  • "How did that make you feel?"

  • "It's OK to-"

  • Remind them frequently that they're enough

  • Provide reassuring statements

  • "Thankyou for telling me"

  • Be consistent. Say what you mean. Mean what you say.

  • Give them compassion and understanding

  • Use a calm, gentle tone of voice

  • "You're not responsible for other people's feelings"

  • "What do you need?", "what can I do?"

  • Allow silence / pauses

  • "Take all the time you need"

  • "I'm so sorry that happened to you"

  • "That sounds really hard"

  • "I can see you are [upset, struggling, finding this hard]" 

  • Be kind. Be patient. Build trust.

  • Communicate your process, check you've understood: "what I'm hearing is", "have I got this right?"

  • Don't try to fix, change, or give solutions

  • "Don't be [silly / stupid / daft]"

  • "I'm sure that person just meant-"

  • Don't call them "high functioning"

  • "You're too sensitive"

  • Don't make assumptions / assign judgment

  • Don't talk too fast

  • Don't talk too much

  • Don't touch without consent e.g. hand on their shoulder

  • Don't minimise how they feel

  • Don't dismiss their feelings

  • "Replace that with a positive thought"

  • Don't assign judgment to behaviour

  • Don't talk over them / interrupt them

  • "Just ignore it / them"

  • "You'll be fine"

  • "You overthink things"

  • Don't compare their difficulties to other people's

  • "I know how you feel"

  • "You're overreacting"

  • "You probably misunderstood"

  • "You took it personally"

  • "You just need to-"

  • "It could be worse"

  • "You just need to think positive"

Graphic of a person sat holding their legs upto their chest looking down at floor.
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