byUniversity College London

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Autistic children and adults may be experiencing PTSD at higher rates than official diagnoses suggest, with their symptoms misdiagnosed or dismissed as being autism traits because of "diagnostic overshadowing," finds a new analysis by UCL researchers.

The study,publishedinClinical Psychology Review, reviewed diagnosed PTSD (post-traumatic stress disorder) rates in over 190,000 autistic people globally, and compared them with other evidence of PTSD symptoms prevalence.

Thesystematic reviewand meta-analysis pulled together evidence from 30 studies, 17 involving children and 13 involving adults.

It found that among autistic individuals, clinical PTSD was diagnosed at rates similar to those in the general population. However, previous research examining the prevalence of PTSD symptoms independent of diagnosis reported much higher rates among autistic people.

For instance, formal PTSD diagnoses in autistic individuals as part of a clinical assessment are reported at rates similar to non-autistic populations (1.11% for autistic children or young people vs. 0.6 to 3.9% in the general population, and 2.06% for autistic adults vs. 2.8% in the general population). Yet screening-based reviews indicate that "probable PTSD" symptoms might be present in 14% ofautistic childrenor young people and 44% of autistic adults.

The researchers say this indicates that current PTSD diagnostic manuals that are used for formal diagnoses, such as the DSM (Diagnostic and Statistical Manual of Mental Disorders) and ICD (The International Classification of Diseases), may not fully account for the kinds of experiences autistic people find traumatic. Such experiences include bullying, physical restraint, sensory overload, and emotional neglect, all of which are excluded from traditional trauma definitions. Thus, using these criteria may miss trauma in autistic people and underestimate how common it is.

Lead author Dr. Hassan Mansour (UCL Psychology & Language Sciences, now at North London NHS Foundation Trust) said, "Our findings suggest that PTSD in autistic individuals is being missed, not because symptoms are absent, but because current diagnostic criteria may not accurately reflect how trauma is experienced or expressed in this population.

"Future diagnostic manuals and research should include autism-sensitive methods to improve identification, diagnosis, and access to appropriate support."

The study also highlights a problem known as "diagnostic overshadowing," where many PTSD symptoms, including hypervigilance, emotional shutdown, or disrupted sleep, are often misattributed to autism itself. This misinterpretation can mean trauma goes undetected and untreated, leaving people without access to much needed mental health support.

Researchers say the consequences of this underdiagnosis are potentially significant. On an individual level, untreated PTSD can lead to chronic anxiety, depression, or suicidal ideation and harm. Each of these are challenges already disproportionately faced by autistic individuals.

While on a systemic level, misdiagnosed or overlooked trauma can lead to increased strain onmental health services, repeated referrals, and the use of inappropriate interventions that fail to treat the root cause of distress.

These issues may also contribute to higher rates of psychiatric hospitalizations and poorer long-term outcomes for autistic people. An estimated 79% of autistic people will experience at least one mental health difficulty in their lifetime.

Dr. Mansour said, "There is a clear need to update existing diagnostic manuals, which are not currently designed with autistic individuals in mind. Making these manuals more inclusive and establishing autism-specific PTSD guidelines could hopefully improve mental health outcomes and ensure that autistic people receive the support they need more quickly, while also reducing pressure on health care services."

To more accurately diagnose autistic individuals, researchers are calling for:

More information: Hassan Mansour et al, Prevalence of Post-Traumatic Stress Disorder (PTSD) in autistic children or young people (CYP) and adults: A systematic review and meta-analysis, Clinical Psychology Review (2025). DOI: 10.1016/j.cpr.2025.102621 Journal information: Clinical Psychology Review

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