Autism Spectrum Disorder and Post-Traumatic Stress Disorder: An Unexplored Co-Occurrence of Conditions

For nursing students

Study summary

Autistic adults face a much higher risk of trauma and post-traumatic stress disorder (PTSD) than has often been recognized, according to a 2020 study by Nirit Haruvi-Lamdan, Danny Horesh, Shani Zohar, Meital Kraus, and Ofer Golan, published in the journal Autism. The researchers noted that although people with Autism Spectrum Disorder (ASD) are known to face increased risk of potentially traumatic events, especially social victimization such as bullying, exclusion, or being taken advantage of, the overlap between ASD and PTSD had barely been studied before this paper.

To investigate, the team compared 25 adults with ASD to 25 typical (non-autistic) adults matched for age and gender, for a total of 50 participants, in a study conducted in Israel. Every participant filled out self-report questionnaires about potentially traumatic events they had experienced, sorted into social events (like rejection or harassment) and non-social events (like accidents or illness), and then reported PTSD symptoms connected to whichever event they found most distressing.

The results were striking. Thirty-two percent of the ASD group met criteria for "probable PTSD," compared with just 4% of the typical adult group, an eightfold difference. Adults with ASD also reported more PTSD symptoms overall, and two symptom clusters stood out in particular: re-experiencing (intrusive memories, flashbacks) and hyperarousal (feeling on edge, exaggerated startle response, trouble sleeping). Interestingly, the elevated hyperarousal symptoms were mainly found in women with ASD, suggesting gender may shape how PTSD shows up in autistic adults.

The type of event that felt most distressing also differed sharply between groups. Sixty percent of ASD participants chose a social event as their single most distressing life experience, compared with only 20% of typical adults. Combined with the finding that ASD participants, especially women, reported more negative life events overall and more social ones specifically, this points to social victimization as a central and possibly underappreciated trauma pathway for autistic adults.

Finally, the study looked at what happened when ASD and probable PTSD occurred together. Adults with both conditions showed poorer social skills than autistic adults without probable PTSD, suggesting that trauma may compound the social difficulties already associated with ASD, or that weaker social skills increase vulnerability to social trauma and its aftereffects. Because this is a cross-sectional study, the researchers cannot say which direction the relationship runs.

For nursing students, this research is an important reminder that trauma histories in autistic clients can be easy to miss if clinicians rely on generic trauma checklists that do not explicitly ask about social victimization. Because autistic adults may communicate distress differently, or may not spontaneously describe socially embarrassing or confusing experiences as "trauma," structured, direct questioning about social events, such as being excluded, mocked, manipulated, or misunderstood, may be necessary to uncover PTSD risk that would otherwise go undetected. In the Canadian context, where nurses assess autistic clients across primary care, mental health, and developmental-services settings, this underscores the value of trauma-informed screening that names social victimization explicitly.

It is worth being cautious about how far these findings can travel. This was a small study of only 50 adults, all recruited in one country, using self-report symptom questionnaires rather than structured clinical diagnostic interviews, so "probable PTSD" is a screening-level finding rather than a confirmed diagnosis. The sample likely represents autistic adults capable of completing self-report measures, so it may not reflect the experiences of nonspeaking autistic people or those with intellectual disability. Even so, the size of the gap between groups, 32% versus 4%, is large enough to suggest that trauma and PTSD deserve far more clinical attention in autism care than they currently receive, particularly around social victimization and possible gender differences in symptom presentation.

For educators

Teaching and appraisal notes

This 2020 study by Haruvi-Lamdan, Horesh, Zohar, Kraus, and Golan, published in Autism: The International Journal of Research and Practice (24(4), 884-898; DOI 10.1177/1362361320912143), addresses a genuine gap in the literature: despite well-established evidence that autistic individuals face elevated rates of victimization and adverse life events, the co-occurrence of ASD and PTSD had rarely been examined directly. The Israel-based research team recruited 25 adults with ASD and 25 typical adults, matched on age and gender, in a small comparative cross-sectional design.

Methodologically, the study relied on self-report measures: participants catalogued potentially traumatic life events across social (e.g., victimization, exclusion) and non-social (e.g., accidents, illness) categories, then reported PTSD symptoms tied specifically to their self-identified most distressing event. This design choice is worth flagging in class discussion; anchoring PTSD symptom report to a single "worst event" is a common trauma-research convention, but it means the study captures symptom burden relative to one index event rather than cumulative or complex trauma exposure, which may be especially relevant for a population reporting elevated rates of chronic social stressors.

The central finding, 32% probable PTSD in the ASD group versus 4% in typical adults, is a substantial effect size for a comparative psychiatric prevalence study, even accounting for the small sample. Symptom-cluster analysis found re-experiencing and hyperarousal elevated in the ASD group overall, with hyperarousal specifically concentrated among autistic women, a sex-differentiated pattern that invites discussion of how autism's female phenotype and gendered socialization may interact with trauma response. The behavioral marker that social events were the most commonly nominated "worst event" for ASD participants (60% vs. 20% for controls) triangulates well with the broader autism-victimization literature and strengthens the plausibility that social-relational trauma, rather than trauma in general, is the key driver of elevated PTSD risk in this population.

The finding that co-occurring probable PTSD was associated with poorer social skills than ASD alone is clinically important but should be presented to students as correlational, not causal; the cross-sectional design cannot distinguish whether trauma degrades social functioning, whether weaker baseline social skills increase vulnerability to victimization and subsequent PTSD, or both in a reinforcing cycle.

For class discussion, instructors should foreground the study's limitations alongside its findings: N=50 total is small even for a comparative pilot study; "probable PTSD" reflects a self-report screening threshold, not a structured clinical diagnosis; the ASD sample was necessarily verbal and capable of completing self-report instruments, limiting generalizability to the full autism spectrum, including nonspeaking or intellectually disabled adults; and the single-country recruitment further narrows generalizability. Students may also benefit from considering this paper alongside the authors' later work exploring rumination as a possible mediating mechanism, which offers an explanatory pathway this initial paper could only gesture toward. Overall, the paper is best used to teach careful appraisal of prevalence claims drawn from small comparative samples, and to sensitize future clinicians to trauma screening gaps in autism care.