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A new large-scale longitudinal study suggests that children who exhibit a higher number of autistic traits are more likely to develop post-traumatic stress disorder (PTSD) by the age of 18. The findings indicate this elevated risk is not simply because these children are more likely to experience trauma, but because they may have a greater vulnerability to developing the disorder after a traumatic event. The research was published in the Journal of Child Psychology and Psychiatry.
Autism is a neurodevelopmental condition characterized by differences in social communication, interaction, and the presence of restricted or repetitive behaviors and interests. Beyond a clinical diagnosis, autistic traits exist on a continuum throughout the general population, with many people exhibiting some of these traits to varying degrees without meeting the criteria for a diagnosis.
Post-traumatic stress disorder is a mental health condition that can develop after experiencing or witnessing a terrifying event, with symptoms that include intrusive memories, avoidance of reminders of the event, negative changes in mood and thinking, and heightened arousal.
Researchers have previously observed that autistic adults report higher rates of traumatic experiences and PTSD. This led scientists to question whether a connection might begin earlier in life. The rationale for the study was based on several lines of evidence suggesting children with more autistic traits might be at greater risk.
For instance, cognitive characteristics often associated with autism, such as a tendency to focus on details, sensory sensitivities, and difficulties with emotion regulation, are also recognized as risk factors for developing PTSD after a traumatic experience. The study aimed to investigate if childhood autistic traits could predict trauma exposure, a PTSD diagnosis, and other mental health and functional difficulties in early adulthood.
To conduct their investigation, the researchers utilized data from the Environmental Risk Longitudinal Twin Study, a nationally representative project that has followed a cohort of 2,232 twins born in England and Wales during 1994 and 1995. This long-term study allowed the scientists to look at information collected at different points in the participants’ lives. The current analysis focused on a subset of 1,504 participants for whom they had data on both childhood autistic traits and later-life outcomes.
The primary measure of autistic traits was the Childhood Autism Spectrum Test, a questionnaire completed by the participants’ parents when the children were 8, 9, or 12 years old. When the participants reached age 18, they were interviewed in person. During this interview, they were asked about their lifetime exposure to traumatic events. Those who reported experiencing trauma were then assessed for a lifetime diagnosis of PTSD.
The researchers also collected information on their overall mental health using a composite measure called the “p-factor,” which reflects a general liability for psychopathology across eleven different mental health conditions. Finally, they recorded whether each participant was “not in employment, education or training,” a common measure of functional impairment in young adults.
The researchers used statistical models to test for associations between the level of autistic traits in childhood and these four outcomes at age 18. Critically, their analyses accounted for other factors known to influence these outcomes, including the participant’s sex, their family’s socioeconomic status, and their intelligence quotient measured in early childhood. This step was important to ensure that any observed links were not simply explained by these other variables.
To distinguish between a higher risk of experiencing trauma and a higher vulnerability to its effects, they performed the analyses twice: once on the entire sample and a second time on only the subgroup of participants who had reported experiencing a traumatic event.
The results showed that children with higher levels of autistic traits were more likely to report having experienced a traumatic event by age 18. However, this association was no longer statistically significant after the researchers accounted for family socioeconomic status, suggesting that living in more disadvantaged circumstances might help explain this increased exposure to trauma.
The study found a strong and consistent link between childhood autistic traits and a later diagnosis of PTSD. Children with more autistic traits had a significantly higher likelihood of meeting the diagnostic criteria for PTSD by age 18. This connection remained robust even after controlling for sex, intelligence quotient, and socioeconomic status.
When the researchers looked only at the group of young people who had experienced trauma, the association held true. This finding suggests that the increased risk for PTSD is not just a consequence of being exposed to more trauma, but reflects a greater susceptibility to developing the disorder after an event occurs.
Regarding overall mental health, higher autistic traits in childhood were associated with a higher general psychopathology score at age 18 in the full sample. This connection also remained significant after adjusting for the potential confounding variables. This indicates that autistic traits may be a risk factor for a wider range of mental health challenges in early adulthood, beyond PTSD alone.
The analysis of functional impairment found that children with more autistic traits were more likely to be not in employment, education, or training at age 18. However, similar to the finding on trauma exposure, this link disappeared after the researchers accounted for the influence of intelligence quotient and socioeconomic status. This suggests that these other factors play a larger role in shaping educational and employment outcomes for these young people.
The study’s authors acknowledged several limitations. The measure of autistic traits was based on a parent-report screening tool, not a clinical diagnosis of autism, so the findings may not be generalizable to all diagnosed autistic children. Trauma exposure was self-reported retrospectively at age 18, which can be subject to memory biases. While the analysis controlled for key variables, it is possible that other unmeasured factors could have influenced the results. The use of a twin cohort might also limit how broadly the findings can be applied, although the authors note that rates of psychiatric conditions in this sample are comparable to non-twin populations.
Future research should aim to replicate these findings in samples of clinically diagnosed autistic young people. Further investigation is also needed to identify the specific mechanisms that contribute to this heightened vulnerability to PTSD. Understanding which cognitive or emotional characteristics associated with autistic traits drive this risk could help in developing targeted interventions.
The study, “Autistic traits in childhood and post-traumatic stress disorder as young adults: a cohort study,” was authored by Alice M.G. Quinton, Freya Rumball, Angelica Ronald, Helen L. Fisher, Louise Arseneault, Francesca Happé, and Andrea Danese.