Is it Autism, Trauma, or Both? Part Two: Questions to Ask in a Developmental Assessment

Childhood trauma can interrupt development in ways that have long-lasting effects on mood, sleep, executive function, learning abilities, and social interaction. Autism can also change how a child develops—and with some similar-looking effects. Differentiating between the two is important, not just because a diagnosis may impact service eligibility for a child, but because it may change the nature of the interventions you recommend.  

The Effects of Developmental Trauma

While most developmental delays are the result of unknown causes, some delays may occur because a child has been exposed to environmental and psychosocial factors such as maltreatment, poverty, or domestic violence. For some children, a delay may later be characterized as autism (Khan & Leventhal, 2023). That’s particularly true of delays in these areas:

• Motor skills 
• Emotional regulation 
• Behavior 
• Speech and language

How trauma presents depends in part on the developmental stage a child is in at the time of the adverse event. It may also depend on the child’s capacity for coping and the support resources available to the child. Trauma symptoms may appear right away, or they may be delayed for weeks or months.

When a child experiences trauma during a critical period of brain development, the results might include:

• disrupted attachments; 
• a change in self-regard or self-identity; 
• alexithymia, or trouble recognizing or naming emotions; 
• a change in emotional control, such as numbing or lower tolerance for frustration; and 
• loss of a sense of safety or security (Cruz et al., 2022).

Many experts classify these effects as developmental trauma disorder, though this condition isn’t specified in the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition Text Revision (DSM-5-TR). The American Psychiatric Association (APA) does note that PTSD in children younger than six may have a distinct presentation. Among the symptoms the DSM-5-TR mentions are:

• problems with concentration; 
• sleep disturbance; 
• impairment in relationships 
• socially withdrawn behavior; 
• irritability or anger; and 
• avoidance of activities, places, conversations, or situations that bring back memories of a traumatic event (APA, 2022). 

Trauma can also affect a child’s flexibility and sensory sensitivities and can change the way children play. Researchers report that children’s play often becomes “ritualistic” and “repetitive.” Elements of the traumatic event may show up either explicitly or symbolically. (D’Elia et al., 2022).  

Similar Autistic Traits 

Autism is highly heterogenous, in that it can look different from person to person. Even so, autistic infants, toddlers, and young children may also have:

• differences in their attention or concentration abilities; 
• sleep disruption; 
• repetitive play patterns; 
• preference for sameness and routine; 
• differences in social interaction and communication; 
• sensory differences; and  
• mood difficulties such as intense frustration and anxiety (Alrehaili et al., 2023).  

Looking closely at a characteristic or behavior may help you determine whether it is linked to autism or to trauma. For example, children may repeatedly recreate a play scenario with a negative narrative “ending” if they are using play to process a traumatic experience. That’s different from an autistic tendency to repeatedly line up or arrange toys and other objects of interest. 

Questions You Can Ask 

To clarify whether a developmental delay may be connected to autism, to trauma exposure, or to both, you may want to ask questions like these: 

• Have elements of a child’s life or history set up an ongoing state of fear or terror that might interrupt mastery of age-appropriate competencies or cause social or behavioral difficulties? 
• Does a lack of interest in peers seem to stem from social withdrawal, from an attachment difficulty, or from a difference in social–emotional reciprocity? 
• If a child isn’t sharing emotions or expressing affection, is it part of an overall reduction in positive feelings, or does it appear to be connected to a more general pattern of social communication differences? 
• Does social communication or emotional reciprocity change as a child becomes more comfortable in an environment?
• Does a pattern of repetitive play seem to be related to avoiding or experiencing intrusive memories?
• If a child experiences an emotional “outburst,” was it sparked by irritability, by a sensory experience, or by a disruption in routines?
• If a child has sleep difficulties, are nightmares involved?
• Are behaviors and abilities consistent across settings and over time?
• When might an exposure to trauma have occurred?
• What developmental tasks might have been impacted, given the timing of the trauma exposure?
• What skills or competencies might a child have missed because of developmental disruption?
• What supports in the child’s own personality or in the environment surrounding the child might add risk or resilience potential?
• How do the child’s traits and behaviors change in response to intervention or treatment?

In addition, it’s vital to gather information about a child’s early developmental history, personal and family strengths, and the parent or caregiver’s concerns. You may want to consider using a trauma screening tool, a resilience assessment, or a measure of adaptive functioning such as the Adaptive Behavior Assessment System, Third Edition (ABAS®-3), in addition to validated autism assessments, to help you create as clear a picture of the child’s experience as possible.

Working with a multidisciplinary team, including a speech–language pathologist and an occupational therapist, will help you conduct a thorough and comprehensive evaluation. If you do find evidence of trauma exposure, you may want to explore resources offered by the National Child Traumatic Stress Network.  

Key Messages 

Autism and trauma can both affect a child’s developmental path. To differentiate between the two, you may need to work with parents, caregivers, health professionals, and early childhood educators to build a developmental timeline that identifies when behaviors and characteristics first emerged. If you know a child experienced trauma during a critical developmental window, you can also consider which tasks and competencies may have been affected. Validated assessments can help you structure much of this data-gathering, but you may also need to consider family and contextual factors to help you create a clear picture of a child’s history, needs, and resources.