TY - JOUR
T1 - Expert consensus regarding indicators of a traumatic reaction in autistic youth
T2 - a Delphi survey
AU - Kerns, Connor M.
AU - Robins, Diana L.
AU - Shattuck, Paul T.
AU - Newschaffer, Craig J.
AU - Berkowitz, Steven J.
N1 - Funding Information:
Funding was provided by the Eunice Kenney Shriver National Institute of Child Health and Human Development (K23HD087472 to Kerns). The authors have declared that they have no competing or potential conflicts of interest.Key points Autistic children experience above-average rates of adversity and maltreatment. Nonetheless, the diagnosis of post-traumatic stress disorder (PTSD) is relatively rare in this subpopulation. One possible explanation is that current PTSD criteria have reduced sensitivity to detect trauma in those on the spectrum. We aimed to establish expert consensus around important indicators of psychological trauma in autistic youth and clinical guidelines for trauma assessment in this subgroup. There was strong consensus that additional indicators, such as regression and self-injury, should be assessed alongside PTSD criteria in autistic youth, and that ASD-specific measures, developmental considerations, and multi-informant reports are needed to enhance diagnostic accuracy. Results suggest a need for tailored diagnostic criteria and measures to better study and treat traumatic reactions in autistic youth. Autistic children experience above-average rates of adversity and maltreatment. Nonetheless, the diagnosis of post-traumatic stress disorder (PTSD) is relatively rare in this subpopulation. One possible explanation is that current PTSD criteria have reduced sensitivity to detect trauma in those on the spectrum. We aimed to establish expert consensus around important indicators of psychological trauma in autistic youth and clinical guidelines for trauma assessment in this subgroup. There was strong consensus that additional indicators, such as regression and self-injury, should be assessed alongside PTSD criteria in autistic youth, and that ASD-specific measures, developmental considerations, and multi-informant reports are needed to enhance diagnostic accuracy. Results suggest a need for tailored diagnostic criteria and measures to better study and treat traumatic reactions in autistic youth.
Publisher Copyright:
© 2022 Association for Child and Adolescent Mental Health.
PY - 2023/1
Y1 - 2023/1
N2 - Objective: It has been suggested that the sequelae of trauma are under-recognized in youth on the autism spectrum. We aimed to generate expert consensus regarding important trauma indicators, including but not limited to traumatic stress symptoms, in autistic youth. Methods: We recruited 72 experts in autism and/or childhood trauma. Via a 2-round Delphi survey, experts commented on and rated the importance of 48 potential indicators, drawn from PTSD criteria and a broader literature on traumatic sequelae in autism. A revised list of 51 indicators, 18 clinical guidelines developed from expert comments, and summaries of expert qualifications and ratings from Round 1 were submitted to a second round (n = 66; 92% retention) of expert review and rating. Results: Twenty-two indicators reached consensus (>75% round 2 endorsement). Many, but not all, reflected PTSD criteria, including intrusions (e.g., trauma re-enactments in perseverative play/speech), avoidance of trauma-reminders, and negative alterations in mood/cognition (e.g., diminished interest in activities) and in arousal/reactivity (e.g., exaggerated startle). Experts also identified increased reliance on others, adaptive and language regressions, self-injurious behavior, and non-suicidal self-injury as important indicators. Consensus guidelines emphasized the need for tailored measures, developmentally informed criteria, and multiple informants to increase diagnostic accuracy. Conclusions: Expert consensus emphasizes and informs a need for tailored diagnostic guidelines and measures to more sensitively assess traumatic reactions in autistic youth.
AB - Objective: It has been suggested that the sequelae of trauma are under-recognized in youth on the autism spectrum. We aimed to generate expert consensus regarding important trauma indicators, including but not limited to traumatic stress symptoms, in autistic youth. Methods: We recruited 72 experts in autism and/or childhood trauma. Via a 2-round Delphi survey, experts commented on and rated the importance of 48 potential indicators, drawn from PTSD criteria and a broader literature on traumatic sequelae in autism. A revised list of 51 indicators, 18 clinical guidelines developed from expert comments, and summaries of expert qualifications and ratings from Round 1 were submitted to a second round (n = 66; 92% retention) of expert review and rating. Results: Twenty-two indicators reached consensus (>75% round 2 endorsement). Many, but not all, reflected PTSD criteria, including intrusions (e.g., trauma re-enactments in perseverative play/speech), avoidance of trauma-reminders, and negative alterations in mood/cognition (e.g., diminished interest in activities) and in arousal/reactivity (e.g., exaggerated startle). Experts also identified increased reliance on others, adaptive and language regressions, self-injurious behavior, and non-suicidal self-injury as important indicators. Consensus guidelines emphasized the need for tailored measures, developmentally informed criteria, and multiple informants to increase diagnostic accuracy. Conclusions: Expert consensus emphasizes and informs a need for tailored diagnostic guidelines and measures to more sensitively assess traumatic reactions in autistic youth.
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U2 - 10.1111/jcpp.13666
DO - 10.1111/jcpp.13666
M3 - Article
C2 - 35817758
AN - SCOPUS:85133698366
SN - 0021-9630
VL - 64
SP - 50
EP - 58
JO - Journal of Child Psychology and Psychiatry and Allied Disciplines
JF - Journal of Child Psychology and Psychiatry and Allied Disciplines
IS - 1
ER -