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Keywords
complex post-traumatic stress disorder,
autism spectrum disorders,
evidence-based practice,
cognitive-behavioural therapy
Abstract
The term Complex Post-Traumatic Stress Disorder (CPTSD), (Herman, 1992) describes the clinical presentation of individuals exposed to repeated trauma. Clinical experience and prevalence studies support the increased vulnerability of individuals with Autism Spectrum Disorders (ASD) to repeated trauma. This paper offers hypotheses regarding the manner in which individuals with ASD may process trauma, and the manner in which the core features of ASD may effect subsequent clinical presentations. Evidence-based practice arising from the psychotherapeutic treatment of both neurotypical and individuals with ASD is reviewed. An emphasis on the value of modifying cognitive-behavioural therapeutic approaches and a description of methods to do so, to address the need of individuals with ASD and CPTSD, is highlighted.
It is little wonder that parents of children with Autism Spectrum Disorder (ASD), a complex neurodevelopmental disorder with potentially multiple genetic, environmental, pathophysiological, precipitants and perpetuates, struggle to understand how best to respond to divergent opinions regarding methods to optimize the quality of their child's (children's) life.
Valerie Paradiz (2002), the mother of Elijah and author of Elijah's Cup, speaks directly to this dilemma regarding the validity and reliability of the current Diagnostic and Statistical Manual (DSM-IV-TR; American Psychiatric Association (APA), 2000) criteria for ASD. She exclaims:
The professional literature on autism, which I rely on for information about Elijah's way of life, is impossible to embrace wholeheartedly. Elijah fits the diagnostic picture and yet he is framed by a language that cannot shake its negativities and technicalities, a language so cautiously self-involved with clinical precision that it overlooks the problem of its own ephemeral standards and presumptuous conventions. (p. 60)
The increase in prevalence of mental health concerns in individuals with ASD is well documented (Deb, Thomas, & Bright, 2001; Kim, Szatmari, Bryson, Steiner, & Wilson, 2000). Ghaziuddin (1998) reported that 56 percent of a small cohort (n = 35) of individuals with ASD had psychiatric disorders including attention deficit disorders with hyperactivity, oppositional defiant disorders, Tourette syndrome, depression, obsessive compulsive disorder, generalized anxiety disorders, separation anxiety and learning disabilities. Interestingly, no cases of Post-Traumatic Stress Disorder (PTSD) were included in his cohort. Although not well studied in individuals with ASD, the prevalence of emotional,...