Expert consensus regarding indicators of a traumatic reaction in autistic youth: a Delphi survey.

Experts agree that trauma in autistic children may look different than in other children and is often missed. They identified 22 important signs including typical trauma symptoms (nightmares, avoiding reminders) but also autism-specific changes like becoming more dependent on others, losing previously learned skills, and self-harm behaviors. The experts stressed that assessing trauma in autistic children requires specially designed tools and input from multiple people who know the child.

This Delphi study sought expert consensus on trauma indicators in autistic youth, recognizing that trauma sequelae may be under-recognized in this population. Seventy-two experts in autism and/or childhood trauma participated in a two-round survey evaluating 48-51 potential trauma indicators. Twenty-two indicators reached consensus (>75% endorsement), including traditional PTSD symptoms like intrusions, avoidance, and negative mood changes, but also autism-specific presentations such as increased reliance on others, adaptive and language regressions, self-injurious behavior, and non-suicidal self-injury. Experts emphasized the need for tailored diagnostic measures, developmentally informed criteria, and multiple informants to improve diagnostic accuracy in autistic youth.

Clinicians should use tailored assessment approaches when evaluating trauma in autistic youth, incorporating both traditional PTSD criteria and autism-specific indicators. Assessment should involve multiple informants and developmentally appropriate measures to improve diagnostic accuracy and avoid under-recognition of trauma sequelae.

This is a consensus study based on expert opinion rather than empirical data. The study does not provide information about the diagnostic accuracy or clinical utility of the identified indicators in real-world settings.

It has been suggested that the sequelae of trauma are under-recognized in youth on the autism spectrum. We aimed to generate expert consensus regarding important trauma indicators, including but not limited to traumatic stress symptoms, in autistic youth. We recruited 72 experts in autism and/or childhood trauma. Via a 2-round Delphi survey, experts commented on and rated the importance of 48 potential indicators, drawn from PTSD criteria and a broader literature on traumatic sequelae in autism.

A revised list of 51 indicators, 18 clinical guidelines developed from expert comments, and summaries of expert qualifications and ratings from Round 1 were submitted to a second round (n = 66; 92% retention) of expert review and rating. Twenty-two indicators reached consensus (>75% round 2 endorsement). Many, but not all, reflected PTSD criteria, including intrusions (e.g., trauma re-enactments in perseverative play/speech), avoidance of trauma-reminders, and negative alterations in mood/cognition (e.g., diminished interest in activities) and in arousal/reactivity (e.g., exaggerated startle). Experts also identified increased reliance on others, adaptive and language regressions, self-injurious behavior, and non-suicidal self-injury as important indicators.

Consensus guidelines emphasized the need for tailored measures, developmentally informed criteria, and multiple informants to increase diagnostic accuracy. Expert consensus emphasizes and informs a need for tailored diagnostic guidelines and measures to more sensitively assess traumatic reactions in autistic youth.