A mixed methods investigation of the association between trauma and mental health outcomes in autistic adolescents
Embargo Date
2028-05-11
OA Version
Citation
Abstract
Autistic youth experience disproportionately high rates of potentially traumatic events and co-occurring mental health conditions (CMHCs), including anxiety and depression. Despite the growing body of research suggesting that potentially traumatic events are associated with CMHCs in autistic youth, little is understood about how trauma manifests in autistic youth or the potential mechanisms through which trauma may influence mental health outcomes in this population. This dissertation investigates the processes that may influence autistic adolescents’ experience of trauma and its impact on mental health outcomes using a mixed-methods, community-engaged approach. In Study 1, a multisystemic resilience framework was used to examine how individual, family, and community factors might mediate the association between adverse childhood experiences (ACEs) and CMHCs (anxiety or depression) in autistic adolescents (ages 12–17), using cross-sectional data from 1,456 autistic youth in the 2022–2023 National Survey of Children’s Health. Using structural equation modeling, the direct effect of ACEs on CMHCs in autistic youth was tested, as well as potential indirect effects through individual (adaptive functioning, executive functioning), family (parenting stress, family resilience), and community factors (food and financial assistance use, neighborhood safety and support), which were modeled as latent variables. Youth who experienced more ACEs were more likely to have anxiety or depression. ACEs were associated with greater challenges across all individual, family, and community factors; among these factors, executive functioning challenges and food and financial assistance use were significant mediators of the association between ACEs and CMHCs.
In Study 2, semi-structured qualitative interviews with 19 autistic youth (M=17.3 years, range: 14–21) who had experienced trauma and 14 parents were conducted to build an in-depth understanding of autistic youths’ experiences of trauma, including how youth recognize and appraise traumatic events. Participants described trauma as an ever-present and inescapable experience for autistic youth, with autism-related characteristics (e.g., sensory processing, executive functioning) and aspects of the developmental context of adolescence (e.g., peer rejection disrupting belonging and identity) shaping how and why youth interpreted experiences as traumatic. Parents and youth also described that identifying trauma was a complex, active process that was often delayed from when the traumatic event occurred.
Together, the findings from the two studies advance an understanding of trauma and its association with mental health outcomes in autistic youth and suggest that comprehensive trauma-informed interventions for this population may benefit from multi-tiered strategies addressing individual, family, and community-level processes.
Description
2026