Autistic Adults: Provocative Thoughts toward a New Trauma-Informed Work
Fix the environment, not the autism. Transform trauma, let neurodivergence... blossom.
I need to run some ideas by autism researchers and professionals. AND check their validity with my fellow neurodivergents.
I may have a useful view on working with autistic adults. The majority… perhaps nearly all adult autistics who seek professional help have experienced substantial trauma.1 So we don’t know what autism is capable of. Until we address that trauma.
TL;DR: Fix the environment, not the #autism.
Transform the trauma, let the #neurodivergent... blossom.2
Working in collaboration, without norms or judgement.3
And do so urgently, to save autistic lives. Up to seven times as likely to end in suicide.4
Like I said in an earlier post, we don't HAVE to look through the wrong end of the telescope... And "treat" autism. With anything other than respect.
I was an MSW practitioner for some years. My thoughts spring out of some basic concepts… an “elements of change” for neurodivergents, principles from trauma recovery, and my fave… the strengths perspective.5
Some of you may know I’ve been stewing on about CBT, ABA, and therapy for autism this year. Lately, I’ve been reworking a piece on my understanding of autistic joy. And how I began discovering it after diagnosis at 63. And how CBT is so unrelated to my joy.
MAYbe…? Some thoughts came up worth talking about?
Within our community…?
Short and bittersweet…
My journey began in 2011 when life circumstances forced me off all psych meds for misdiagnosed bipolarity.6 After nearly 20 years.
After rough months… very rough months… it became clear they had been masking symptoms of something. With medically induced sleep, dullness, fatigue, weight gain, increased tics…7
After a few more rough years… something else became clear. They had been "masking" my autism+ADHD neurodivergence.8
I had begun my first truly mutually supportive relationship with my future wife… and family. They lived in Indiana woods.
I began to sleep, eat, exercise… breathe better. In that free space, I began to make changes. Reducing sensory distress. Rebalancing my solitude and social contact.9
Most important, trying to remember moments of passionate joy in my complex life. Largely centering around being in Nature… and pursuing my passionate interests.
And then doing what I had to… to encourage more joyful moments. Now. As an adult.
That became my new job. And this was the first job of my neurodivergent life, that actually paid off.
Ok. So quick as I can, my ideas about treatment.
First off, not every adult autistic needs it. There’s a range from thriving to barely surviving. But various forms of trauma seem to be highly prevalent. Any professional has got to be stopped in their tracks considering that three-fourths of us can’t function well enough to work…10
As of this writing, neurodivergent-affirming, non-normative treatment is not the norm. But it is emerging. And there seem to be some shared ideas.11
Autism and neurodiversity can’t be cured… or “recovered” from.
Many adult autistics report surviving trauma. Many others acknowledge trauma… including sensory trauma12… during the course of treatment.
The lifelong pressure to "mask" autistic traits creates its own complex trauma - often unconscious and deeply embedded in daily survival behaviors
Autistic and neurodivergent individuals have unique strengths, including resilience and… likely… neuroplasticity.13
And many if not most folks in the Neurodiversity community are at least entertaining the idea that neither autism nor neurodivergence are inherently disabling.
But the trauma from an unsupportive culture and environment... are.
If I were still a therapist, knowing what I know now?
I’d have begun treating any adult autistic after three intake profiles…
a trauma profile, understanding much may be unacknowledged by the client
a sensory profile, perhaps encouraging experimentation to discover unacknowledged sensitivities. Research shows sensory trauma can develop both from acute sensory overwhelm and from the cumulative strain of constant sensory processing.
a community or emotional support profile, toward discovering the ideal balance for the individual client
I came to diagnosis very late. 63. So change was perhaps doubly hard for me compared to a normed population. What made it possible for me? Unconsciously I was creating what we used to call the Core Prerequisites for Change.14
A safe emotional and sensory environment
Emotional safety for experimentation
Dawning awareness that I needed change
Access to necessary resources
Taking small steps toward progress
But the missing piece for me was the impact of trauma. The consideration of molestation, peer sexual attack, educational bullying, social and emotional difficulties… and unacknowledged sensory trauma.
So in developing a treatment plan, I’d work with basic trauma practice…15
Safety and Stabilization16
Processing Trauma
Integration
The idea is, start by creating unique Elements for Change tailored to each neurodivergent individual based on their specific profiles. Then let progress develop naturally. From there.
Many other considerations occur to me.
Professional Relationship Dynamic
Collaborative rather than traditional hierarchy17
Respecting autonomy needs by acting as a facilitator rather than expert or director
Favoring techniques and solutions created internally by the client, recognizing they are the only expert of their own experience… for real this time
Emphasize the discovery process through natural preferences
Consider that interoception challenges affect self-reporting18
Possible Novel Assessments
Exploring natural preferences and comfort memories as diagnostic tools
Balancing observable behaviors with self-reporting. Exploring both. Considering contradictions of either.
Guided by individual goals rather than norms of productivity, social , self-care and so forth
Survival Focus
Replacing biased productivity goals for therapy with individual passion and survival
Understanding special interests and other autistic or neurodivergent “behaviors” as survival mechanisms, not inconveniences to be overcome
Keeping the high suicide risk in adult autistic population in mind at all times… and how that might influence therapeutic goals to favor survivability over social production or functioning.19
These are early thoughts, drawing from both my modest professional background and personal experience.
I’d really like to hear from:
Practitioners
How do you currently approach trauma work with adult autistic clients?
Would it make sense to shape treatment around a trauma assessment as I’m thinking?
What challenges have you encountered in traditional therapeutic frameworks?
What successes have you found in strength-based approaches?
Autistic Adults
What elements have supported your healing journey?
How has your understanding of your sensory needs evolved?
What would you want therapists to know about supporting autistic adults?
Maybe this conversation could help shape more effective approaches.
Let's keep talking in the comments. What resonates with your experience? What angle might you add?
To give a one-time tip to support this work: https://ko-fi.com/autisticaf
Footnotes
Trauma Prevalence in Autistic Adults
Research shows 72% of autistic adults report experiencing traumatic experiences (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313447/)
Studies indicate nearly 90% of autistic individuals experience at least one adverse life event (https://pubmed.ncbi.nlm.nih.gov/31446685/)
Clinical studies demonstrate significantly elevated PTSD rates in autistic adults seeking professional help compared to general population (https://www.liebertpub.com/doi/10.1089/aut.2019.0024)
68.9% of autistic children have confirmed or suspected trauma or abuse
(https://www.attwoodandgarnettevents.com/blogs/news/understanding-the-trauma-experiences-of-autistic-individuals)32% of autistic adults show signs of PTSD compared to 4% of non-autistic adults
Trauma experiences range from 3-17 different types per individual, including traditional traumas and autism-specific experiences
Note: These statistics reflect broader population studies and may not fully capture the specific experiences of those actively seeking professional help. Additional research is needed to quantify trauma rates specifically among treatment-seeking autistic adults.
Environmental vs. Behavioral Approaches
Research increasingly supports environmental adaptation over behavioral modification for autistic individuals. Studies demonstrate improved outcomes when focusing on changing environments rather than autistic behaviors (https://www.tandfonline.com/doi/full/10.1080/09687599.2019.1680341)
Collaborative Therapeutic Approach
Research demonstrates:
Autistic adults show better outcomes with flexible, collaborative approaches over traditional hierarchical therapy
(https://www.thehealinghaven.net/the-power-of-collaborative-autism-therapy/)
(https://educationresourcesinc.com/neurodiversity-affirming-practices-in-therapy/)
(https://neurodivergentinsights.com/blog/neurodivergent-affirming-practices)Imposing neurotypical norms can harm therapeutic alliance and outcomes
(https://pmc.ncbi.nlm.nih.gov/articles/PMC10561286/)
(https://www.carepatron.com/guides/autonomy-in-counseling)
(https://pmc.ncbi.nlm.nih.gov/articles/PMC2881979/)Effective therapy recognizes client autonomy and embraces neurodivergent communication styles
Success rates improve when therapists avoid "normalizing" behaviors and instead focus on individual goals and preferences
(https://therapistndc.org/neurodiversity-affirming-therapy/)
(https://tandempsychology.com/how-neurodiversity-affirming-therapy-can-help/)
(https://www.thrivingwellnesscenter.com/blog/neurodiversityaffirmingtherapy)
Survival Focus and Suicide Risk
The focus on suicide risk is critically important:
Autistic adults are 3-7 times more likely to attempt suicide than the general population
Risk factors include unemployment, social challenges, and masking behaviors
Mental health conditions affect approximately 80% of autistic adults
The highest risk is among autistic individuals without intellectual disability
Strength-Based Approaches
Current research supports:
Viewing special interests as potential therapeutic tools rather than problems
Focusing on individual goals rather than normative standards
Understanding autistic behaviors as adaptive responses rather than deficits
Creating environments that support natural coping mechanisms
Misdiagnosis in Adult Autism
Studies indicate significant rates of misdiagnosis in autistic adults, particularly regarding:
Bipolar disorder
Depression
Anxiety disorders
Research shows diagnostic overshadowing often delays autism identification (https://link.springer.com/article/10.1007/s10803-019-04220-9)
Medication and Individual Experiences
I report my actual side-effects… in part. Individual experiences with psychiatric medications vary significantly among autistic adults. Some report benefits from certain medications. Others experience adverse effects similar to mine. Medication decisions should be made individually with appropriate medical supervision.
Masking and Mental Health Impact
Research demonstrates clear links between masking and mental health challenges:
Higher rates of anxiety and depression correlate with increased masking behaviors
Masking is linked to increased suicidal behaviors and burnout
The practice leads to exhaustion from constant self-monitoring and adaptation
Higher rates of anxiety and depression correlate with increased masking behaviors
Masking is linked to increased suicidal behaviors and burnout
(https://www.autism.org.uk/advice-and-guidance/professional-practice/autistic-masking)
The practice leads to exhaustion from constant self-monitoring and adaptation
(Higher rates of anxiety and depression correlate with increased masking behaviors
Masking is linked to increased suicidal behaviors and burnout
The practice leads to exhaustion from constant self-monitoring and adaptation
Studies show masking correlates with lower self-esteem and reduced personal authenticity
Environmental Impact on Autistic Well-Being
Research supports the benefits of:
Natural environments in reducing sensory overload
Regular sleep patterns
Proper nutrition
Physical exercise
Studies show these lifestyle factors significantly impact autistic adults' quality of life
Employment Statistics for Autistic Adults
Current employment statistics indicate the situation may be even more severe than "three-fourths":
Global unemployment rates for autistic individuals exceed 80% in many countries
In the United States, unemployment rates reach 85-90% for autistic adults
Only 32% of autistic adults work in any capacity, compared to over 70% of the general population
Of those employed, many are underemployed relative to their skills and education
Important context: These statistics reflect systemic barriers including workplace discrimination, inadequate accommodations, and environmental challenges rather than individual capabilities. Employment rates vary by region, support availability, and how employment is defined in different studies.
Note: These statistics represent broad population studies and may not fully capture part-time work, self-employment, or non-traditional employment arrangements.
Neurodiversity-Affirming Approaches
Current therapeutic best practices emphasize:
Sensory Experiences and Trauma Development in Autism
Research demonstrates that cumulative sensory experiences can create trauma responses in autistic individuals even without traditionally defined traumatic events. Studies show
autistic individuals process sensory information with greater intensity (https://neurodivergentinsights.com/autism-infographics/autismandtrauma)
and their nervous systems may not habituate to sensory stimuli in typical ways (https://www.attwoodandgarnettevents.com/blogs/news/autism-and-trauma)
the prefrontal cortex and amygdala show altered functioning in both autism and trauma responses (https://www.attwoodandgarnettevents.com/blogs/news/autism-and-trauma)
creating a potential cycle where sensory sensitivity increases stress, which in turn amplifies sensory reactivity (https://qbi.uq.edu.au/article/2024/05/study-shows-heightened-sensitivity-ptsd-autism)
Recent research indicates that even mild stress can trigger PTSD-like responses in autistic individuals (https://qbi.uq.edu.au/article/2024/05/study-shows-heightened-sensitivity-ptsd-autism)
with up to 60% experiencing PTSD-like symptoms compared to 6.8% in the general population (https://healthmatch.io/ptsd/cptsd-and-autism).
Sensory Processing and Trauma
(https://stimpunks.org/glossary/sensory-trauma/)
(https://neurodivergentinsights.com/misdiagnosis-monday/ptsd-and-autism)
Neuroplasticity in Autism and Aging
Research suggests autistic individuals may maintain certain forms of neuroplasticity longer than neurotypical peers, particularly in:
Cortical excitability across the age span
Visual processing regions showing resistance to typical age-related decline
Learning patterns that differ from typical neural change patterns
However, neuroplasticity in autism appears complex, with some brain regions showing enhanced plasticity while others show reduced plasticity. More research is needed to fully understand these patterns and their implications for aging and learning.
(https://www.nature.com/articles/s41598-019-55004-1)
(https://www.frontiersin.org/articles/10.3389/fnins.2019.00232/)
(https://www.sciencedirect.com/science/article/abs/pii/S0149763421000774)
Prerequisites for Change
Research identifies key elements necessary for successful change:
A safe physical and emotional environment must be established first
Both psychological readiness and practical resources are required
Small, incremental steps are more effective than attempting large changes at once
(https://positivepsychology.com/readiness-for-change/)
The Three-Phase Trauma Treatment Model
This evidence-based approach is considered the gold standard for trauma therapy:
Safety & Stabilization: Focuses on building emotional regulation skills and creating a secure environment
Processing Trauma: Addresses trauma impacts rather than just trauma details
Integration: Works on incorporating experiences and creating a new future
The process is not strictly linear - clients may need to return to earlier phases as needed.
(https://raqueldubois.com/blog/3-phase-treatment-for-developmental-trauma)
Safety in Therapeutic Settings
Research emphasizes that safety is fundamental to trauma therapy success because:
It allows the nervous system to regulate
Enables access to higher-order thinking
Permits emotional processing without overwhelm
Creates conditions where healing becomes possible
(https://khironclinics.com/blog/feeling-safe-in-trauma-therapy/)
Professional Relationship Dynamic
Research supports a collaborative, non-hierarchical approach when working with autistic clients. Studies show autistic individuals benefit from therapists who engage with their worldview and adapt communication styles to match client preferences. This approach increases therapeutic engagement and outcomes.
(https://www.linkedin.com/pulse/radically-person-centred-approach-working-autistic-people-stevens)
The importance of interprofessional collaboration in autism care is well-documented. Effective treatment often requires coordinated efforts across multiple disciplines, with emphasis on respecting client autonomy and preferences.
(https://pmc.ncbi.nlm.nih.gov/articles/PMC10700230/)
(https://www.skillpointtherapy.com/the-art-of-autism-8-collaborative-strategies-for-success/)
Assessment Considerations
The emphasis on interoception challenges affecting self-reporting is well-documented. Written information and visual aids can help autistic clients better understand and communicate their experiences. Setting clear expectations and providing structure while remaining flexible to individual needs improves therapeutic outcomes.
Suicide Risk in Autism
Recent research shows varying levels of risk:
Autistic people without intellectual disability are more than 5 times more likely to die by suicide
(https://www.uq.edu.au/news/article/2024/09/suicide-rate-higher-people-autism)
Overall, autistic adults are almost 3 times more likely to die by suicide compared to non-autistic people
For autistic adults without intellectual disability who also have ADHD, the risk increases to 7 times higher
Studies show 60% of late-diagnosed autistic adults report having experienced suicidal thoughts
The risk is particularly high for autistic women, contrary to patterns in the general population
If you or someone you know needs support, please contact suicide prevention services available 24/7.