Research In Action

In a recent ICYMI, I mentioned an article on adverse childhood experiences (ACEs) in children with autism spectrum disorders (ASD). I wanted to review that article a bit more in today's blog post. This article reviews the studies on various types of ACEs reported among children with ASD, including bullying and maltreatment.

Types of ACEs

In the 2011-2012 US National Survey of Children's Health, children with ASD showed increased rates of several ACEs compared to a typically developing control population. Children with ASD more frequently experienced:

• income insufficiency (40%; typically developing control population=20%)
• parental divorce (28%; typically developing control population=20%)
• household mental health concerns (18%; typically developing control population=7%)
• household substance use problems (14%; typically developing control population=10%).

Children with ASD were also more likely to have experienced four of more ACEs (10%) compared to their typically developing control peers (5%). In addition, having 1-2 ACEs, as well as 3 or more ACEs, was associated with prolonged time to diagnosis. Mean age of ASD diagnosis in children with no ACEs was 4.3 years, 1-2 ACEs was 5.2 years, and 3 or more ACEs was 5.7 years. Since we know that early diagnosis and intensive treatment is associated with improved outcomes, this delay to diagnosis and starting therapies could be detrimental for children with ASD.

Bullying

Compared to typically developing peers and peers with other disabilities, children with ASD experienced a higher rate of bullying – physical (33%), verbal (50%), and relational school bullying (31%). Most often, they are the victims of bullying, but reports also show they can be perpetrators as well. Another study revealed that children with ASD were more likely to report suicidal ideation or attempt suicide compared to peers with ASD who did not experience bullying; however, PTSD resulting from bullying has not been as well studied. Aside from a pilot antibullying intervention focusing on children with ASD, interventions have not been targeted to children with ASD. 

Maltreatment

Recent national and international large scale studies revealed that children with ASD were not found to be overrepresented in the child protective services system, with a referral rate of approximately 1.7%, which is consistent with the prevalence of ASD in the general population. 

Post-traumatic stress

Studies have found varying frequencies of PTSD in children with ASD, however a lack of assessment tools designed specifically to identify traumatic stress symptoms in children with ASD limits the study of PTSD within this population. More work in this area is needed. 

For me, the important take-away is that children with ASD are at risk for experiencing multiple ACEs, which potentially delays their diagnosis and treatment of ASD. Just as we discussed previously with ACEs in children with ADHD, if you’re a clinician caring for children with autism, you may want to consider formally screening for ACEs, and to be mindful that the presence ACEs may warrant increased facilitation and social work support to access treatment services.