Treatment of Trauma in Neurodiverse Clients
- Jun 1
- 8 min read
Written by Samantha Hepworth as part of her Masters in Holisitic Mental Health Program
The Neurodiversity Paradigm
The term neurodiversity refers to any natural variation in neurocognitive processing
(McLennan et al., 2025). This can include neurodevelopmental conditions such as Autism
spectrum disorder (including the diagnosis previously termed Asbergers Syndrome); Attentiondeficit
hyperactivity disorder (ADHD); DiGeorge syndrome; Down syndrome; Dyscalculia;
Dysgraphia; Dyslexia; Dyspraxia; Misophonia; Hyperlexia; Measles-Irlen syndrome; Intellectual
disabilities; Mental health conditions like bipolar disorder, obsessive-compulsive disorder;
Prader-Willi syndrome; Sensory processing disorders; Social anxiety (a specific type of anxiety
disorder); Tourette syndrome; and Williams syndrome (Cleveland Clinic, 2025; YouGov, 2024).
The neurodiverse paradigm shift has emerged as a counter to the medical model of disability
for how practitioners view neurocognitive differences. It reframes viewing neurocognitive
differences from being something that needs to be managed or repaired and instead uses a
strengths-based, identity-affirming approach to treatment and management of the symptoms
that arise from living in a neurotypical world (McLennan et al., 2025).
Additionally, research has shown that certain neurodivergence diagnosis criteria, such
as those for Autism Spectrum Disorder, have historically been biased toward symptoms
observed in Autistic men and not Autistic women or non-binary people which in addition to
other intersectional issues, has resulted in less frequent diagnoses of Autism in those
populations. Another research consideration is the prevalence of understanding of
neurodiversity by the general population. In the US, only 32% of 1148 people polled by YouGov,
a global research data and analytics group, felt they could define the term neurodivergent,
which this study defined as “Neurodivergent is an umbrella term for people whose brains work
in an atypical fashion” (YouGov, 2024). The study also showed that after being provided the
definition, 20% of those polled identified as neurodivergent and 47% of respondents said they
knew someone who was neurodivergent. However, a majority of those polled had never heard
of many of the diagnoses that are encompassed by the umbrella term, neurodiversity, including
dyspraxia, dysgraphia, dyscalculia, Meares-Irlen Syndrome, misophonia, rejection sensitive
dysphoria (RSD) and synesthesia. Neurodivergent folks have increased difficulty obtaining
education, employment, and socializing with peers, they are also overrepresented within youth
justice and criminal justice systems (Wilson et al., 2024).
Neurodiversity and Resiliency: Why it’s difficult to research
trauma in neurodiverse populations
While there is ample research showing the connections between neurodivergence and
adversity or negative life outcomes, these papers often underrepresent the heterogeneity of
outcomes in neurodiverse populations due to varying levels of resiliency across neurodiverse
populations (Black et al., 2024). Resiliency, which is often defined as experiencing adversity and
then demonstrating positive adaptation, is difficult to define within neurodivergent
populations. What constitutes adversity within neurodivergence? As every neurodivergent
person experiences their neurodiversity within a world of systemic barriers, it is hard to argue
that any neurodiverse person lives without facing adversity. Furthermore, what is considered a
positive adaptation: does it encompass employment, education, independence, mental health,
well-being, or quality of life? Are these positive adaptions defined by neurotypical researchers
or by the neurodivergent people being researched? In the literature review from Black et al.
(2024), very few studies were explicit in their definition of resiliency and how they
conceptualized that definition within the research. The literature review found that the most
impactful bio-psycho-social factors (35%) for resilience in neurodiverse populations were
environmental factors such as familial, peer, and community support. So, while many of the
studies focused on trait-based resilience questionnaires, these do not adequately measure
environmental resiliency and are not necessarily the correct measures of resiliency in this
population. Many of the findings correlated with that of neurotypical research, that
perseverance and coping skills play a large role in resilience in this population.
In clinical practice, this means that focusing on creating environmental support
networks can be key in creating resilience for neurodivergent clients experiencing trauma.
While focusing on individual level factors may help, it is this understanding of social support
systems which has the greatest opportunity in improving resiliency outcomes.
Neurodivergence and Adverse Childhood Experiences (ACEs)
Recent research has also shown a correlation between neurodivergence and adverse
childhood experiences (ACEs) (Wilson et al., 2024). This study was groundbreaking in that it
researched ACEs in an 18+ population, moving away from the more common research method
of studying neurodivergent children, which often relies on reports from parents which can
suffer from a social desirability bias, shame or other factor that leads to underreports of ACEs.
Additionally, this type of research can exclude neurodiverse children who are diagnosed later in
life or misdiagnosed with a different condition as children. Maladaptation of the stress
response system, including in the sympathetic nervous system, (SNS) is thought to be a key
piece in understanding the correlation between ACEs and negative adulthood outcomes and
experiences.
Neurodivergent populations also may face higher rates of ACEs because harsh verbal or
physical punishment that may be seen as the norm for correcting what has previously been
labelled abnormal behavior but is now understood to be normal variations on neurocognition.
Some neurodivergent populations also have communication differences or need consistent care
and support which can reduce access to help when a caretaker is responsible for the ACEs. For
neurodivergent folks, prolonged stress responses may arise not just from ACEs but also from
additional stress from differences around sensory processing, communication, social
navigation, and emotional regulation that are more stressful due to their unique cognitive
systems compared to their Neurotypical peers. This combination can lead to a double jeopardy
for neurodivergent folks as heightened stress over prolonged periods is correlated with the
development of cardiovascular disease and cancers, leading to higher levels of these illnesses
within neurodivergent populations.
Wilson and their team (2024) found a significant correlation between being
neurodivergent (either formally diagnosed, self-diagnosed or suspecting neurodivergence) and
have a higher ACE score. Out of 4180 households that completed the study, the most common
ACE among neurodivergent respondents was verbal abuse (44.7%) which was almost double
compared to their neurotypical counterparts (21.4%). The most common ACE among
neurotypical respondents was physical abuse (21.7%) but the Neurodivergent respondents
reported physical abuse at almost double the rate (38.3%). 73.5% of Neurodivergent individuals
had experienced at least one ACE compared to 48.1% of neurotypical individuals.
Neurodivergent individuals were also nearly five times more likely to “experience 4 + ACEs than
no ACEs, over as likely to experience 2–3 ACEs than no ACEs, and over 1.6 time) more likely to
experience 1 ACE than no ACEs” Wilson (2024). Given the interconnection between
experiencing ACEs and trauma, understanding the increased risk is important in evaluating and
treating trauma in neurodivergent clients.
Autism and PTSD
While Autism Spectrum Disorder is only one of many ways a client can be
Neurodivergent, it is one area where research has just started to explore how presentation of
neurocognitive differences can directly contribute to trauma (Beck, 2024). Many Autistic folks
often face social adversity and discrimination due to their neurocognitive differences in
processing and struggles understanding and adhering to societal expectations, the impacts of
which are similar to those experienced by other minority groups. These stressors are not only
found to be a key contributor in emotional dysregulation but can cause traumatic exposure
over time. The emotional dysregulation can also compound in a way that results in additional
traumatic experiences with involuntary sedation, termination of healthcare services, and police
involvement. Some researchers suggest that neurocognitive differences around working
memory, cognitive inflexibility, rumination as well as social perception may make autistic
people more likely develop PTSD as a result of trauma and adversity. Additionally, the
socialization gaps often faced by those with Autism can create restricted social networks and
increased difficulty maintaining relationships which can then have a snowball effect on
weakening resiliency.
Assessment and Treatment of PTSD in Autistic Clients
Autism and PTSD have several shared diagnostic criteria including decreased attachment
to people or objects, flattened affect, repetitive play or speech, and withdrawal from social
interactions (Beck, 2024). The most common symptoms experienced by Autistic adults without
intellectual disability are re-experiencing the trauma and hypervigilance. Diagnosis of PTSD in
clients who have both autism and an intellectual disability becomes much more difficult but
one of the primary indicators of sexual trauma is the client shifting into a parasympathetic state
and engages in fight (aggressive behavior) or flight (running away).
During intake, clinicians should explore past and current exposure to traumatic events
and discrimination and how this has impacted the client. Clinicians should inquire about past
experiences that may have created distrust around medical professionals, including involuntary
mental health treatments or mishandled terminations of care. Clinicians should observe for skill
regression, increased withdrawal, irritability, or aggression in clients as well as increased
suicidality and changes in sleep patterns. Interventions focused on cognitive behavioral therapy
and mindfulness can be helpful in working with both Autistic clients and their caregivers. These
interventions can aid in emotional regulation, which is an area in which many Autistic children
and adults struggle, especially in the face of ongoing social adversity. Helping clients find easily
accessible safe places and creating realistic supports them in their daily living. Clinicians may
also want to work with clients to develop internal awareness of increasing distress and practical
mindfulness practices that can be implemented when they feel overwhelmed. As social
networks, connection and belonging can be pain points for Autistic clients, it is recommended
clinicians build out resource lists of autism-affirming social spaces or creating spaces within
their own practice for Autistic clients and community members to interact in a safe, structured
environment.
Treatment of Trauma Neurodiverse Children
This is important in our understanding of trauma as it is well understood that trauma is
recorded both cognitively and physically in the body. Recognizing that clients may have a
different way that their brain processes and store information or processes emotions is crucial
in selecting the most appropriate treatments.
As emphasized above, ACEs are more common in neurodivergent clients than in their
neurotypical counterparts (Wilson et al., 2024). It is therefore important to assess for ACEs and
risk of ACEs in working with neurodiverse children. The data shows that preventing ACEs can
reduce suicide attempts among high school students by up to 89%, reduce misuse of pain
medications by up to 84%, and reduce persistent feelings of sadness and hopelessness by up to
66% (CDC, 2026). Preventing ACEs can also improve future outcomes around conditions that
impacted by prolonged stress responses such as heart disease and depression. An important
finding from one research study performed in Austrailia around children with either Autism or
an intellectual disability was that there was a level of assumption of trauama informed care
built into some of the services being offered (Kalisch et al., 2025). This revealed an area where
treatment teams may be underserving clients by assuming everyone on the team was aware of
the trauma and the appropriate trauma-based interventions. Clinicians in this study may have
contributed to the lack of appropriate resources by not including trauma-based interventions in
the list of recommended services.
Conclusion
In conclusion, this paper examines the different ways that trauma and neurodiversity
have been researched. The research that has been done, focuses overwhelmingly on Autism
and this excludes many neurodivergences. It also clearly established the need for trauma
informed protocols for neurodiverse clients but has not yet taken the next step into pursuing
that research. Any clinician working with neurodiverse clients needs to take into account how
neurocognitive differences may change presentation of trauma symptoms and treatments of
trauma.
References
Beck K. B. (2024). Trauma and Social Adversity in Autism: Considerations and Directions for
Clinicians and Researchers. The Pennsylvania journal on positive approaches, 13(2), 23–
Black, M. H., Helander, J., Segers, J., Ingard, C., Bervoets, J., De Puget, V. G., & Bölte, S. (2024).
Resilience in the face of neurodivergence: A scoping review of resilience and factors
promoting positive outcomes. Clinical Psychology Review, 113, 102487.
Kalisch, L.A., Lawrence, K.A., Howard, K. et al. (2025). Recommendations Provided to Families of
Neurodivergent Children with Histories of Interpersonal Trauma across Two Clinical
Assessment Services within a Major Metropolitan Children’s Hospital in Melbourne,
Australia. Journ Child Adol Trauma 18, 467–480 https://doi.org/10.1007/s40653-024-
00684-9
McLennan, H., Aberdein, R., Saggers, B., & Gillett-Swan, J. (2025). Neurodiversity: A scoping
review of empirical research. Neurodiversity, 3.
Neurodiversity in the U.S.: 19% of Americans identify as neurodivergent. (2024). Retrieved May
in-united-states-19-percent-americans-identify-neurodivergent-poll
Wilson, C., Butler, N., Quigg, Z., Moore, D., & Bellis, M. (2024). Relationships between
neurodivergence status and adverse childhood experiences, and impacts on health,
wellbeing, and criminal justice outcomes: findings from a regional household survey
Treatment of Trauma in Neurodiverse Clients 11
study in England. BMC medicine, 22(1), 592. https://doi.org/10.1186/s12916-024-
03821-1
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