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Full paper: https://www.tandfonline.com/doi/full/10.1080/09687599.2021.1983416

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Nothing about us without us
Who: Heselton
Journal: Disability & Society
Published: 2021
Title: Childhood adversity, resilience, and autism: a critical review of the literature

Autism, Childhood Adversity & Resilience

Autistic children experience more adversity and more mental health challenges than their non-autistic peers, but this isn’t well understood by researchers or clinicians. Autistic adults can provide insight into their experience of adversity and its influence on their mental health.

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Childhood adversity, resilience, and health has not been well studied in autistic children.

Autistic children have a higher rate of mental health challenges than neurotypical children, and the reasons for this is not completely understood. Current research which views autism as a disorder to be treated does not consider the influence of being autistic on an individuals mental health.

The neurodiversity lens allows us to consider autism as an identity which might have an impact on how one experiences adversity and resilience, and thus on ones mental health.

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Adversity:

Adverse childhood experiences (ACES) include sexual, physical, and psychological abuse, domestic or community violence, parental death or injury, parental mental illness or addiction, bullying/victimisation by peers, parental divorce or separation, and natural disasters. ACES are linked to poorer physical and mental health outcomes in adulthood.

Trauma can happen once, or can occur repeatedly over time. Evidence suggests that prolonged trauma is more damaging that one instance of trauma. The perception and impact of trauma differs between individuals.

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Adversity Among Autistic Children:

Autistic children experience more adverse experiences than neurotypical children, most commonly family distress including financial issues, divorce, parental death, and parental mental health issues, and neighbourhood violence, and repeated victimisation by peers, including physical assault.

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Mental Health Challenges of Autistic Children:

Autistic children are much more likely to have mental health challenges than neurotypical children, however, they are also more likely to be underdiagnosed with mental health conditions.

Research has found that clinicians are less likely to diagnose an autistic child with a mental health condition even when they meet the diagnostic criteria, as their symptoms may be attributed solely to being autistic.

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This is worrying: if a child’s challenges are not identified, then the underlying causes (such as adversity) cannot be addressed. This can exacerbate an individuals mental health challenges.

The most commonly diagnosed conditions are attention disorders, anxiety, depression, and behavioural disorders, although this differs with age. Autistic children diagnosed with anxiety also report high levels of depressive symptoms and suicidal ideation.

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Autism & Adversity:

Autistic people might experience trauma differently, leading to a more significant impact. They might also experience different traumas to neurotypical people, such as overwhelming sensory experiences.

Autistic people might also display trauma symptoms differently, for example as an increase in autism-related traits, which then may be overlooked by clinicians.

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Also, symptoms of PTSD, such as distractibility, sleep problems, agitation, and avoidance of social situations, may also be present already in autistic children, leading to PTSD symptoms being missed or being dismissed as autistic traits.

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There is a clear link between adversity and anxiety, depression, and suicidal behaviours in autistic individuals.

Studies have shown that while not every individual who experiences adversity develops symptoms, every individual with symptoms reports adversity.

Autistic young people experience high levels of suicidal behaviours, and this can be predicted by depression and PTSD, but not by anxiety. Over a third of autistic people diagnosed with anxiety aged 8-15 years report thoughts of suicide. Childhood adversity can lead to depression & anxiety, and thus suicidal ideation.

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Resilience:

Resilience is ones ability to prevail over adverse life experiences. Very little is known about resilience as experienced by autistic individuals.

It’s important to understand resilience as this will help to develop support for those who are at risk of adversity.

Autistic people might experience resilience differently to neurotypical people, and these differences might explain the contradictory results of research in this area.

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An individuals concept of wellbeing is cultural and individual. Understanding autism through a lens of neurodiversity allows us to consider the culture of autism & the meaning of wellbeing for autistic people.

Understanding how autistic people experience resilience will help to develop interventions which nurture internal protective factors and facilitate an environment of external protective factors to support autistic individuals.

Some interventions designed for neurotypical people have been adapted for autistic people with positive results, such as positive self-talk, emotional management skills, and problem-solving.

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Neurodiversity:

Seeing autism as a disorder means that clinicians and researchers will focus on reducing autistic traits.

Often, the distress autistic people feel is due to feeling different within a society which does not accept or value difference, rather than due to autistic traits.

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Understanding autism as a neurological difference with distinct abilities will help to foster more appropriate mental health supports which respect & integrate an individuals unique autistic traits into the process, instead of trying to change them.

It is essential to rely on autistic individuals to make meaning of their own experiences of adversity & resilience.

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What Next?

Future research needs to look into mental health as a result of autistic-specific experiences of adversity and resilience. This research must utilise the perspective of autistic individuals and must have a positive impact on the autistic community.

Research must prioritise the voices of autistic people & their lived experiences. The research must be collaborative to prevent data being (mis)interpreted through a neurotypical lens.