Autism, Trauma, and Stress

This recent study on autism and PTSD offers some relatable paragraphs about stress and trauma.

It is well documented that individuals with Autism Spectrum Disorder (ASD) experience high rates of psychiatric co-occurrence, with other conditions—attention-deficit/hyperactivity disorder (ADHD), anxiety, and depression being the most commonly diagnosed (Joshi et al., 2012). Recently it has been suggested that individuals with ASD are at an increased risk of experiencing potentially traumatic events and being significantly affected by them (Haruvi-Lamdan et al., 2018; Kerns et al., 2015).

A review that examined trauma and PTSD among adults with intellectual impairments discussed the difficulty to differentiate between stressful life events and traumatic events, and argued for broadening the examination of different types of events and experiences that may potentially be perceived as traumatic (Martorell & Tsakanikos, 2008). Another review, by Kerns et al. (2015), indicated that individuals with ASD may experience a variety of stressful situations (e.g. intense sensory stimuli, changes in routine, medical ordeals) as traumatic. Various characteristics of sensation, perception, social awareness, and cognition, which are unique to individuals with ASD, may determine which events would be experienced by them as traumatic. A recent article discussed this issue and focused on traumatic subjective perception of three groups of patients who are at risk to developing PTSD, one being ASD (Brewin et al., 2019). The authors argued that these groups’ PTSS are often overlooked and suggested adding an “altered perception” subtype to PTSD criteria in the future. Specifically, it is possible that social stressors are a significant source of vulnerability for individuals with ASD (Haruvi-Lamdan et al., 2018; Hoover, 2015). Several studies suggest that social demands are more often appraised as stressful by individuals with ASD compared with typical individuals (Gillott & Standen, 2007; Jansen et al., 2003). Individuals with ASD experience greater social isolation and distress compared with their typical peers (Tani et al., 2012). Therefore, it is reasonable to assume that some social interactions are experienced as particularly stressful, and even traumatic, among this population.

Source: Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An unexplored co-occurrence of conditions – Nirit Haruvi-Lamdan, Danny Horesh, Shani Zohar, Meital Kraus, Ofer Golan, 2020

Via:

Glad to see a topic important to the community getting some research and validation.

Related:

In other words, autistic people are indeed traumatised by a wider range of things than the teams were expecting. And diagnostic teams should be considering PTSD after a wider list of possible triggering events.

Source: Ann’s Autism Blog: Autism, Bullying, Post Traumatic Stress Disorder and Behaviour. The links?

People who enter services are frequently society’s most vulnerable-people who have experienced extensive trauma, adversity, abuse, and oppression throughout their lives. At the same time, I struggle with the word “trauma” because it signifies some huge, overt event that needs to pass some arbitrary line of “bad enough” to count. I prefer the terms “stress” and “adversity.” In the book, I speak to the problem of language and how this insinuates differences that are not there, judgments, and assumptions that are untrue. Our brains and bodies don’t know the difference between “trauma” and “adversity”-a stressed fight/flight state is the same regardless of what words you use to describe the external environment. I’m tired of people saying “nothing bad ever happened to me” because they did not experience “trauma.” People suffer, and when they do, it’s for a reason.

Source: Psychiatric Retraumatization: A Conversation About Trauma and Madness in Mental Health Services – Mad In America

This scene is quite similar to how I experience an autism sensory overload. When sounds, lights, clothing or social interaction can become painful to me. When it goes on long enough it can create what is called a meltdown or activation of the “fight-flight-freeze-tend-befriend” (formerly known as “fight or flight”) response and activation of the HPA axis; a “there is a threat in the environment” adrenaline-cortisol surge.

This makes seemingly benign noises a threat to my well-being and quite possibly real physical danger to my physiology. Benign noises become painful, and if left unchecked, enough to trigger a system reaction reserved for severe dangers. This is what days can become like on a regular basis for myself and many on the spectrum.

“Let me stick a hot poker in your hand, ok? Now I want you to remain calm.”

That is the real rub of the experience of sensory meltdowns. The misunderstanding that someone with Autism is just behaving badly, spoiled or crazy. When the sensory overwhelm is an actual and very real painful experience. It seems absurd to most people that the noise of going to a grocery store could possibly be “painful” to anyone. So most people assume the adults or children just want attention, or they can’t control their behavior. In work situations I get accused of all kinds of things. And when I leave a noisy situation like a party to step out to take a break, people will notice that I’m “upset”. They will assume or worry that I must be upset at something or someone. And that’s just if I do take a break. If I can’t take a break or get my life out of proper oscillations and can’t avoid noise or sensory/emotional overload, then I can get snappy, defensive, irritated and under very unfortunate circumstances even hostile.

What the stress of noise means, in the autism’s world of an over-sensitive physiology and ramped up stress experiences, is that that pain is warning of us of real damage being created in our bodies. So this anxiety and reactivity isn’t necessarily just perceived but is actually happening. We are not being overly dramatic or a brat (what those with Autism are often accused of). Damage to our physiology is what noise can actually do.

Source: Autistic Traits and Experiences in “Love and Mercy” The Brian Wilson Story – The Peripheral Minds of Autism

Autism, Stress, and Flow States

Many people with autism are stressed individuals who find the world a confusing place (Vermeulen, 2013). So how does someone with autism achieve a sense of flow? McDonnell & Milton (2014) have argued that many repetitive activities may achieve a flow state. One obvious area where flow can be achieved is when engaging in special interests. Special interests allow people to become absorbed in an area that gives them specialist knowledge and a sense of achievement. In addition, certain repetitive tasks can help people achieve a flow like state of mind. These tasks can become absorbing and are an important part of people’s lives. The next time you see an individual with autism engaging in a repetitive task (like stacking Lego or playing a computer game), remember that these are not in themselves negative activities, they may well be reducing stress.

If you want to improve your supports to people with autism from a stress perspective, a useful tool is to identify flow states for that person and try to develop a flow plan. Remember, the next time you see a person repeating seemingly meaningless behaviours, do not assume that this is always unpleasant for them – it might be a flow state, and beneficial for reducing stress.

Source: What is ‘flow’?

Flow state is a term coined by Csikszentmihalyi to describe “the experience of complete absorption in the present moment” (Nakamura and Csikszentmihalyi, 2009). It is widely viewed as highly positive and many texts advise readers on how to attain it when performing tasks. Autistic people are sometimes puzzled that flow seems to be regarded as somewhat elusive and difficult to experience, since the common autistic experience of complete engagement with an interest fits the definition of flow well. Thus, it is not hard to find accounts of autistic detailed listening that seem to describe a flow state:

“When I work on my musical projects, I tend to hear the whole score in my head and piece every instrument loop detail where they fit. It relaxes me and makes me extremely aware of what I’m doing to the point that I lose track of time.”

Source: Autistic listening

I’m autistic and started a team at work called “Flow Patrol”. Flow seems to be a common autistic fascination, a special interest in itself. I suspect monotropic minds are more prone to flow.

See also:

Dandelions, Tulips, Orchids and Neurological Pluralism

While reading up on the stress model of autism, I came across the Dandelions, Tulips, and Orchids framing via @peripheralminds.

According to empirical studies and recent theories, people differ substantially in their reactivity or sensitivity to environmental influences with some being generally more affected than others. More sensitive individuals have been described as orchids and less-sensitive ones as dandelions.

Although our analysis supports the existence of highly sensitive or responsive individuals (i.e. orchids), the story regarding ‘dandelions’ is more complicated because they can be further divided into two categories. If we consider ‘dandelions’ as the metaphorical example of the low-sensitive group, what plant species best reflects the medium-sensitive group? Sticking to the well-known flower metaphor, we suggest ‘tulips’ as a prototypical example for medium sensitivity. Tulips are very common, but less fragile than orchids while more sensitive to climate than dandelions. In summary, while some people are highly sensitive (i.e. orchids), the majority have a medium sensitivity (i.e. tulips) and a substantial minority are characterised by a particularly low sensitivity (i.e. dandelions).

Source: Dandelions, tulips and orchids: evidence for the existence of low-sensitive, medium-sensitive and high-sensitive individuals | Translational Psychiatry

Most of us have genes that make us as hardy as dandelions: able to take root and survive almost anywhere. A few of us, however, are more like the orchid: fragile and fickle, but capable of blooming spectacularly if given greenhouse care. So holds a provocative new theory of genetics, which asserts that the very genes that give us the most trouble as a species, causing behaviors that are self-destructive and antisocial, also underlie humankind’s phenomenal adaptability and evolutionary success. With a bad environment and poor parenting, orchid children can end up depressed, drug-addicted, or in jail-but with the right environment and good parenting, they can grow up to be society’s most creative, successful, and happy people.

At first glance, this idea, which I’ll call the orchid hypothesis, may seem a simple amendment to the vulnerability hypothesis. It merely adds that environment and experience can steer a person up instead of down. Yet it’s actually a completely new way to think about genetics and human behavior. Risk becomes possibility; vulnerability becomes plasticity and responsiveness. It’s one of those simple ideas with big, spreading implications. Gene variants generally considered misfortunes (poor Jim, he got the “bad” gene) can instead now be understood as highly leveraged evolutionary bets, with both high risks and high potential rewards: gambles that help create a diversified-portfolio approach to survival, with selection favoring parents who happen to invest in both dandelions and orchids.

Source: The Science of Success – The Atlantic

For in the story of the figure of speech from which this book draws its enigmatic title—the metaphor of orchid and dandelion—lies a deep and often helpful truth about the origins of affliction and the redemption of individual lives. Most children—in our families, classrooms, or communities—are more or less like dandelions; they prosper and thrive almost anywhere they are planted. Like dandelions, these are the majority of children whose well-being is all but assured by their constitutional hardiness and strength. There are others, however, who, more like orchids, can wither and fade when unattended by caring support, but who—also like orchids—can become creatures of rare beauty, complexity, and elegance when met with compassion and kindness.

While a conventional but arguably deficient wisdom has held that children are either “vulnerable” or “resilient” to the trials that the world presents them, what our research and that of others has increasingly revealed is that the vulnerability/resilience contrast is a false (or at least misleading) dualism. It is a flawed dichotomy that attributes weakness or strength—frailty or vigor—to individual subgroups of youth and obscures a deeper reality that children simply differ, like orchids and dandelions, in their susceptibilities and sensitivities to the conditions of life that surround and sustain them. Most of our children can, like dandelions, thrive in all but the harshest, most bestial circumstances, but a minority of others, like orchids, either blossom beautifully or wane disappointingly, depending upon how we tend and spare and care for them. This is the redemptive secret the story herein reveals: that those orchid children who founder and fail can as easily become those who enliven and thrive in singular ways.

Source: The Orchid and the Dandelion: Why Some Children Struggle and How All Can Thrive

I’m always on the look out for new ways of thinking about and designing for neurological pluralism, especially when it comes in threes. Dandelions, tulips, and orchids designate low-sensitive, medium-sensitive, and high-sensitive people. I like the way this aligns with caves, campfires, and watering holes, the red, yellow, green of interaction badges, and the three speeds of collaboration.

Like many of my fellow autistics, I’m a cave orchid. I’m high-sensitive and need just the right sensory environment. I need deep spaces for deep work.

One of the more interesting ideas emerging from attention capital theory is the surprising role environment can play in supporting elite cognitive performance.

Professional writers seem to be at the cutting edge of this experimentation, but I wouldn’t be surprised if, in the near future, we start to see more serious attention paid to constructing seriously deep spaces as our economy shifts towards increasingly demanding knowledge work.

Source: Simon Winchester’s Writing Barn – Study Hacks – Cal Newport

When I get the right sensory environment, I can put the power of autistic special interest to work.

I’ll likely work dandelion, tulip, and orchid framing into my neurological pluralism advocacy, but first some more reading.

See also: