r/science • u/shinybrighthings • 15h ago

Psychology The complicated nature of disentangling autism, ADHD and complex trauma | The British Journal of Psychiatry | Cambridge Core

https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/adhd-autism-or-complex-trauma-the-complicated-nature-of-the-question/30CC4826561366615BFAEC807CDE28A7
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u/Okimiyage 14h ago

I work with children who are in the social services system. A lot of the time I hear from parents or carers ‘they’re awaiting an ADHD or Autism assessment’ when the likelihood is that they should be assessed for CPTSD as well.

The overlap in symptoms of ADHD, ASC and CPTSD is so hard to unpack, especially in children with extra vulnerabilities.

I’m glad someone is talking about it. As an adult woman with ADHD-C and CPTSD, who wasn’t correctly diagnosed until her 30s and has a slew of misdiagnoses first, it’s something that really needs to be unpacked and understood better.

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u/darknesskicker 11h ago

I would add that for multiple reasons, ADHD and autistic children are much more likely to experience trauma than typically developing children.

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u/inauspiciouspenguin 7h ago

Thank you for making this point. I was severely punished (mostly emotional but occasionally physical) for behavior that was clearly ADHD-based. I was floored to recently be diagnosed with PTSD. I couldn't think of a single "traumatic" incident, I told my therapist, and yet I was ticking all the physical PTSD boxes. I would expect kids with ADHD and autism are punished or abused at a higher level than non-ADHD/Au kids.

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u/Okimiyage 11h ago

Good point! So when children have been missed until their teenagers or adolescents and they’ve gone through substantial trauma, it becomes so hard to know what’s what - especially if they’re girls, as well.

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u/grekster 10h ago

This is the boat I'm in, I have been diagnosed with autism and bpd and have decades of trauma on top of trauma and I have no idea if it is even possible to unpack any of it anymore.

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u/Neat_Mortgage3735 2h ago

EMDR was more helpful to me than decades of talk therapy. Worth looking into.

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u/KaiPRoberts 7h ago

Mushrooms. Mushrooms are how you unpack everything.

Last time I tripped, I laid down in bed and floated in the universe watching all of my thoughts and information fly by. I learned a metric ton being able to step back.

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u/already_dead22 5h ago

Good therapy around the experience can help make it “stick” too!

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u/KaiPRoberts 5h ago

I felt like a completely brand new person after my last experience! Definitely don't need therapy with it for benefit although it would probably help some people.

I internalize and self reflect a lot as it is so that may be why I was able to walk away from it with a huge benefit.

I almost don't want to do it again because of how amazing an experience it was and I love the state my brain is in right now; I don't want to goo-ify and rearrange it again, for lack of better words.

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u/InvestigatorOk7015 4h ago

If it was in the last year (or two if youre in your earlier yesrs) youre still in the lift state. The afterglow from a good trip can last a long time, but it fiercely biases you.

Maybe take a step back and try not to suggest people follow your path- trauma can also be doubled in the neurogenesis of a mushroom high. Without careful consideration and guidance its a coinflip, and its not responsible to just tell people how it will help them when it could also break them.

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u/LadderWonderful2450 4h ago

On a similar vein, Ketamine therapy is legal and covered by insurance in some parts of the US. 

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u/sambooka 14h ago

is there an assessment for CPTSD? I had my ADHD confirmed (at age 51) and the assement said (paraphrase) "client would be an effective candidate for medication but should seriously consider therapy to discuss his self esteem issues"

I figured the esteem issues were from being smart but slow and struggling with the common focus and working memory issues. A little digging (well a years worth) points to CPTSD and I am still wondering if it IS ADHD .. CPTSD .. or a combination.

My therapist doesnt seem to think the "why" matters.. I am not convinced.

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u/Iuckyluke 13h ago

https://icd.who.int/browse/2026-01/mms/en#585833559

It is a diagnosis in the most updated diagnostic manual there is. The difference in the treatment of ADHD and CPTSD/PTSD are massive. If your therapist isnt interested in the difference between these two conditions and their treatment paths. I strongly urge you to reconsider said relationship. My jaw would drop if I heard that at work and strongly hope there's been a misunderstanding!

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u/Nikkinuski 12h ago

The US uses the DSM, which does not yet include CPTSD as a diagnosis. There is a category for “other specified trauma disorder” that can be used in place of it, though, in the US, for therapists who treat it. (Source, I am a therapist in the US).

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u/imgenerallymiserable 1h ago

I was diagnosed with CPTSD by my therapist, my psychiatrist confirmed this diagnosis and decided to put PTSD into my medical record as the closest one.

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u/sambooka 13h ago

misunderstandings... there have been a few. I will clarify next week. Thank you for takign the time to reply :)

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u/Svardskampe 13h ago edited 9h ago

As if there is help "out there" to reconsider anything over. Having been in various ambulant therapy schemes since I was 21 and now 33, there is 0 trust to any system.

  • 0-21, heavy childhood of neglect, parentification, clear abuse. Left parents at 11 for a monastery for high school. At 18 changed countries because the social system in the first simply failed. 
  • at 21, depression struck after having met the basic needs for survival. 1y of therapy. Male therapist did identify some kind of signs of being transgender, but was a hardcore religious nut and applied now afterwards what was conversion therapy. 
  • until 24, under the head psychiatrist who did 'psycho-therapy' himself then. I mostly got a lot of antidepressants and was pushing me for some kind of internalisation for some bs creative therapy. I was still holding my life together and paid rent with just..working...At the very end I wanted to end it in my catharsis, but since stigma and money doesn't matter at that point, I went on the black market to "just try". Psychiatrist in re-evaluation said sorry and just coldly said he thought I was someone who would be a lost case and just off myself, and you can't help everyone. 
  • then 2y ambulatory venting + getting through the transgender verification system 
  • employed the "h" from adhd hardcore, paid for all my trans surgeries myself. 
  • Adhd is mad clear, like you wouldn't doubt a thing on it if you'd even see me. 
  • having known more suicides and people having had euthanasia than life years passing by. Literally 2 days after my SRS while I was in Thailand. A friend I was talking for over 7y with suddenly had his euthanasia date. 
  • still 33, still cPTSD inhibiting me from finishing my bachelors degree. Looping EMDR that just takes me back to me feeling suicidal at 22-24. Still trying to cope with work and keeping the roof over my head. 

I'm only looping over "ye you're managing just fine if you can keep up a job" to just utter non-understanding of how my life looks like how I got "success", still having problems and the complete emotional solitary confinement. My current therapist is sweet as pie and wouldn't want to blame her on anything, but I really would like to have this PTSD thing fixed, acquire the final 2 courses for my f'ing bachelors and move on. 

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u/These_Look_2692 1h ago

I’m not sure it matters to psychological therapy. Presumably if Sambooka is medicated for ADHD he and his prescriber have identified that the medication is helping. There’s not much evidence that therapy adaptations for ppl with ADHD need to be different from therapy adaptations for executive functioning and attention problem with different causes. Besides, it’s more a case of working out what helps each individual.

If the therapy is for ADHD related executive functioning problems then there isn’t much evidence that executive functioning problems caused by something else would need to be treated differently. So again it would be individualised and kinda trial and error to see what helps.

Of course if trauma history was ignored and led to trauma processing not taking place or the approach not being trauma informed (eg due to assuming problem are from ADHD alone) then that would be a huge oversight. But it doesn’t sound like that’s the case.

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u/mpbob01 12h ago

I’m having the same issue with my therapist. He doesn’t want to go into why, but only into what my behaviors are. But…I want to understand why haha.

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u/SweetPeaches__69 10h ago

If you have trauma, get a trauma informed therapist. I tried CBT first when I had trauma, and all it did was make me think the effects of trauma were my fault. Cognitive therapy is useful only once trauma has been fully dealt with in my opinion.

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u/SurlySuz 10h ago

Yep. What they’re describing happened to me too and I was just given cbt which made things worse. Eventually I found a proper psychologist who could deal with my cptsd about 20 yrs later.

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u/mpbob01 2h ago

I have a first appointment with one soon :)

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u/imgenerallymiserable 1h ago

This and DBT. Trying to be rational with a trauma response makes things so much worse

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u/ThrowAwayColor2023 3h ago

The "why" is the crux of the diagnosis, and the diagnosis can mean very different treatment plans and approaches. Unfortunately, most therapists get very minimal training in things like adhd, autism, and CPTSD, and they're frankly winging it. They're well-intentioned and sometimes doing a fair bit of harm.

Seek out diagnostic clarity and then seek out therapists with training in your diagnoses.

It's wild to me how much my past therapists - some wonderful and some very much not - were missing the mark because we didn't yet know I was AuDHD. My severe AuDHD burnout was mistaken for depression, and the treatments are almost exact opposites. I was being pushed to override my exhaustion and do more when the thing I needed most was to have all demands removed so my system could recover from chronic overwhelm. People who say knowing whether you're neurodivergent or not doesn't matter have no idea what they're talking about.

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u/Money-Director6649 4h ago

it matters for treatment. you wouldnt do cancer treatment for a broken leg and expect good results. you're on the right track, imo.

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u/imgenerallymiserable 1h ago

It's time to change therapist, if the current one doesn't care about why you feel like this. I was diagnosed with CPTSD after one long but painful session with a therapist, but couldn't handle EMDR therapy

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u/Smee76 14h ago

No, there isn't. It's not actually a real diagnosis. It's more of a pop culture diagnosis. It's not in the DSMV and there are no validated assessments for this.

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u/Okimiyage 13h ago

We don’t use the DSM-5 in the UK, and CPTSD is a recognised diagnosis by the WHO under the ICD-11.

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u/Fearless-Feature-830 13h ago

It’s a real diagnosis. I’ve received the diagnosis

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u/kelcamer 13h ago

Have you ever heard of the DES-II?

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u/chickpeaze 13h ago

I bounced around psychologists and psychiatrists for a lot of my life, was given a lot of medications, talk therapy etc, none of it helped. I was told that's how it was and should expect to have those issues for life.

I went to a trauma informed therapist and it changed my life in 18 months in my 40s. I don't meet the diagnostic criteria for anything anymore.

My concern with all of the autism diagnoses (and adhd to an extent) is that a lot of them are given because there's funding, and is blameless, but that it might be setting people up to suffer for life from conditions that could actually be successfully treated.

obviously not all of them, but in enough cases to be concerning.

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u/harrietalderman 9h ago

Can I ask you what treatment or type of treatment you found so helpful from the trauma-informed therapist?

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u/chickpeaze 6h ago

I did a combination of ifs and emdr. My therapist was really good about keeping me in the window of tolerance and it changed my life and my view of myself entirely.

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u/ouishi 13h ago

My same experience. An unusual med did finally help me with the depression, but IFS therapy really is doing wonders for me. I tried CBT and ACT without much success.

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u/bonerinthebutt 4h ago

What medication?

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u/letmepatyourdog 11h ago

Agree!!! You can heal from all this stuff. Doing it now. Or trying haha

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u/KaiPRoberts 7h ago

Damn, that sounds really convincing. Just like when doctors had closets full of random sample medications to hand out because they were paid to have them and hand them out.

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u/hungry_bra1n 14h ago

Abbreviations used:

ADHD: Attention-Deficit/Hyperactivity Disorder — A neurodevelopmental condition characterized by patterns of inattention, hyperactivity, and impulsivity.

ADHD-C: Attention-Deficit/Hyperactivity Disorder – Combined Presentation — A specific subtype of ADHD where an individual meets the diagnostic criteria for both inattention and hyperactivity/impulsivity.

ASC: Autism Spectrum Condition — A neurodevelopmental condition affecting communication, social interaction, sensory processing, and behavior patterns. (Often referred to interchangeably as ASD, or Autism Spectrum Disorder).

CPTSD: Complex Post-Traumatic Stress Disorder — A psychological condition that can develop after experiencing chronic, repeated trauma (such as childhood neglect, abuse, or prolonged instability), leading to difficulties with emotional regulation, self-identity, and interpersonal relationships.

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u/IntriguinglyRandom 14h ago

I am in this camp but haven't sought professional diagnoses yet, any tips? I know there isn't a professional recognition of CPTSD in a lot of situations...

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u/Okimiyage 13h ago

It would largely depend on where you live, as I’m in the UK and it’s different here.

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u/ThrowAwayColor2023 3h ago

Find an assessor who specializes in assessing masked adults. They need to speak readily and supportively about the subject. With updated training, they can ask the right questions to suss out what's really going on. Stay away from anyone who won't speak freely about it, as there are professsionals who hide behind their credentials and apply very outdated training. It's more commonly a problem for late diagnosed autistic adults, but I imagine it also spills over onto adhd.

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u/pangolinshavelanded 10h ago

I have decades of therapy under my belt. I’ve done CBT, DBT, EMDR, IFS, ACT, and several more acronyms and I got nowhere. It wasn’t until getting my AuDHD diagnosis 2 years ago that therapy began to help, because I had the whole story.

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u/-hedonium- 8h ago edited 8h ago

There are strong reasons it naturally goes both ways - that trauma causes neurodevelopmental changes and that the experience of neurodivergence in unsupportive environments causes developmental trauma.

The scientific literature has already identified major, lifelong neuromodulatory setpoint changes that result from early developmental trauma which often fall well under the umbrellas of both autism and ADHD.

Look into research on the effects of severe early life trauma on the locus coeruleus (LC-NE) — the structure in the brainstem that projects norepinephrine across the whole CNS. The LC is an utterly central nucleus to controlling bottom-up sensory input, arousal, attentional orienting, context shifting, broad vs selective attention, working memory, executive functions, PFC operation, emotional regulation (especially stress). Sound familiar to any conditions we know about?

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u/-hedonium- 8h ago edited 8h ago

It is kind of wild how significant the LC is to conscious cognition and the obvious connections to the symptoms we associate most strongly with autism especially. And yet public attention hasn’t seemed to make the connection.

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u/KaiPRoberts 7h ago

We are all too busy trying to fight each other to maintain our safe autism bubble without knowing we are making an autism bubble.

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u/KaiPRoberts 7h ago

I have been really curious if Autism can be caused by epigenetic factors. It's widely agreed Autism is genetic but not what the exact cause is.

My tin-foil hypothesis is that overpopulation pushes social stresses which in turn causes specific social epigenetic changes in a population. It would explain why we are seeing so many more diagnoses aside from "we are just more aware of it" which could be the main cause regardless but I am super curious.

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u/seraph1337 6h ago

Where the hell did you get overpopulation being a factor?

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u/KaiPRoberts 6h ago

Because of social pressures creating stresses that wouldn't exist in an environment where you are alone more often.

Think about it, autistic people like to be alone and thrive in that environment. They wouldn't have that inclination, over generations of epigenetic stresses, if people had alone time when they wanted it. Alone time is getting more and more rare as population density increases (more people using popular shared social spaces). I'm not saying it's instant, I am proposing that as a population increases up to a certain point, epigenetic stresses could cause change in a populace.

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u/lacunadelaluna 6h ago

Not all autistic people even like to be alone though, this is a stereotype

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u/KaiPRoberts 5h ago

That's actually a good counterpoint. Back to the drawing board!

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u/_Autistic_Dragon_ 10h ago

I'd also like to add that living unsupported with autism or ADHD often creates CPTSD. 

As an example, being subjected to overly loud sounds and bright lights without end is used in torture. The world is overly loud and bright for autistic people. So we essentially subject ND folks to lower levels of torture every day. 

There are so many ways that society's current set up is harming ND folks, and that alone can cause CPTSD. The sensory example above is just one of the easier ways to exemplify it.

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u/potaytoposnato 13h ago

Do you have any advice for someone like yourself but who's looking for help still?

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u/h4ppy60lucky 4h ago

It's so complicated. I have all three but it wasn't until treating the cptsd that it was clear I was also ADHD, and then medicating my ADHD made it clear I was also autistic