Autistic Symptoms in a Traumatized Child: A Natural Experiment in Trauma and Resilience– Part II

Background:

Research on anxiety disorders in Autistic Spectrum Disorders (ASD) has focused primarily on anxiety as a possible co-morbid phenotypic trait.  Few studies examine anxiety as a result of traumatic experiences the child with autism may have, though there is much research on post-traumatic anxiety in non-ASD children.  This results in a lack of professional knowledge about how to recognize or treat PTSD in children with ASDs.  Last year, we reported a case of PTSD surmised in a 4:7 year-old boy (PL) diagnosed with ASD at 3:1 and confirmed at 4:2 (Bernard & Siegel, 2009).   PL’s signs of ASD had spontaneously and substantially remitted by 4:7 (falling below all cutoffs on the ADOS).  We speculated that the pattern of ASD diagnoses related to having undergone 60 invasive general anesthesia procedures followed by two days of complete eye patching to treat retinoblastoma between age 0:9-4:0 years of age, followed by remission. This report follows the same subject to age 5:7.  He has returned to meeting criteria for ASD.  The proximal cause is renewed traumatic experiences:  At 5:2, a new cancer and further invasive medical procedures began, and continue.  This natural A-B-A design allows us to further explore the relationship between signs of ASD and environmental stressors.

Objectives:

The goal of this case study is to add to the literature about recognizing PTSD in the ASD population.  

Methods:

At age 5:7, PL underwent clinical evaluation for ASD, cognitive functioning and PTSD. Previous evaluations of PL at ages 3:1, 4:2, and 4:7 years included comprehensive diagnostic interviews, cognitive evaluations, PTSD evaluation, ADOS, and ADI-R.  He has now been clinically reassessed at 5:7.  PL’s narrow, restricted interests and social responsiveness have waxed and waned dramatically when he has been on and off cancer treatment.  

Results:

During assessments at 4:2 and 5:7 while in cancer treatment, PL met criteria for Autistic Disorder.  At 4:2, he lacked spontaneous communication.  He read upcoming items from the WPPSI manual out loud, but refused to respond to any items.  He labeled areas of his house as familiar street intersections, and evidenced distress when announcing the intersection where the clinic for retinoblastoma treatment was.  At 4:7, when in remission, his language was spontaneous and functional (though slightly echolalic)  and his social behaviors markedly improved.  Then, at 5:7 when cancer treatments had re-started, PL's repetitive interests and behaviors (e.g., drawing maps of parts of Asia, countries bordering the Aegean Sea, adding numbers by 17 or 144) were very marked and he only spoke when queried repeatedly about his drawings.   

Conclusions:

The stress of medical trauma can exacerbate ASD symptoms in a preschool age child. PL's case suggests a need for trauma screening and anxiety assessment in this population, as well as development of empirically-supported treatment methods for psychiatric co-morbidities such as anxiety that may be non-neurodevelopmental in origin.