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Eye Movement Desensitization and Reprocessing (EMDR) Therapy as a Feasible and Potential Effective Treatment for Adults with Autism Spectrum Disorder (ASD) and a History of Adverse Events

Authors:
Ella Lobregt-van Buuren at Dimence Institute of Mental Health, The Netherlands
Ella Lobregt-van Buuren
  • Dimence Institute of Mental Health, The Netherlands
Bram B. Sizoo at University of Amsterdam
Bram B. Sizoo
Liesbeth Mevissen at University of Amsterdam
Liesbeth Mevissen
Ad de Jongh at University of Amsterdam
Ad de Jongh
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Abstract and Figures

The study investigated whether EMDR is a feasible therapy for adults with ASD and a history of adverse events, and whether it is associated with reductions in symptoms of PTSD, psychological distress and autism. Participants received 6 to 8 weeks treatment as usual (TAU), followed by a maximum of 8 sessions EMDR added to TAU, and a follow-up of 6-8 weeks with TAU only. Results showed a significant reduction of symptoms of post-traumatic stress (IES-R: d = 1.16), psychological distress (BSI: d = 0.93) and autistic features (SRS-A: d = 0.39). Positive results were maintained at follow-up. The results suggest EMDR therapy to be a feasible and potentially effective treatment for individuals with ASD who suffer from the consequences of exposure to distressing events.
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Vol.:(0123456789)
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Journal of Autism and Developmental Disorders (2019) 49:151–164
https://doi.org/10.1007/s10803-018-3687-6
ORIGINAL PAPER
Eye Movement Desensitization andReprocessing (EMDR) Therapy
asaFeasible andPotential Effective Treatment forAdults withAutism
Spectrum Disorder (ASD) andaHistory ofAdverse Events
EllaLobregt‑vanBuuren1,6· BramSizoo1· LiesbethMevissen2,3· AddeJongh3,4,5
Published online: 25 July 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
The study investigated whether EMDR is a feasible therapy for adults with ASD and a history of adverse events, and whether
it is associated with reductions in symptoms of PTSD, psychological distress and autism. Participants received 6 to 8 weeks
treatment as usual (TAU), followed by a maximum of 8 sessions EMDR added to TAU, and a follow-up of 6–8 weeks with
TAU only. Results showed a significant reduction of symptoms of post-traumatic stress (IES-R: d = 1.16), psychological
distress (BSI: d = 0.93) and autistic features (SRS-A: d = 0.39). Positive results were maintained at follow-up. The results
suggest EMDR therapy to be a feasible and potentially effective treatment for individuals with ASD who suffer from the
consequences of exposure to distressing events.
Keywords EMDR· Trauma· PTSD· Autism spectrum disorder· ASD· Diagnostic overshadowing
Introduction
Until now the feasibility and effectiveness of trauma-focused
treatment for adults with autism spectrum disorder (ASD)
has not been studied systematically, despite studies sug-
gesting an elevated risk for experiencing adverse events and
revictimization (Kerns etal. 2015). ASD can be character-
ized as a different way of sense-making and as a problem
with self-regulation, which is reflected in problems in social
communication and interaction and restricted and repetitive
patterns of behavior or interests (De Jaegher 2013). These
problems make individuals with ASD more susceptible
to psychosocial consequences of exposure to trauma and
adverse events (Roberts etal. 2015). For example, Wood
and Gadow (2010) hypothesized that ASD-related sensory
hyper-reactivity to daily stimuli, social confusion, incompre-
hension and rejection by others may lead to clinically sig-
nificant anxiety. It has been argued that exposure to adverse
events inhibits the ability to detect violations (DePrince
2005) and exacerbates already impaired emotion regula-
tion problems in youth with ASD (Mazefsky etal. 2013).
These factors may negatively influence the ability to cope
with future stressors and elevate the risk of revictimization
(Classen etal. 2005; Culatta etal. 2017).
For a good understanding of our study, it is important
to clarify the terms ‘trauma’ and ‘adverse events’. First, in
order to define trauma, we have used criterion A in rela-
tion to post-traumatic stress disorder (PTSD) in accordance
with the Diagnostic and Statistical Manual DSM-5 (2013).
The term adverse events is used to refer to a broader con-
cept of negative or distressing events. With regard to the
latter, there is a growing body of research that pertains to
the prevalence of exposure to adverse events in children with
ASD, and the consequences in terms of physical and mental
* Ella Lobregt-van Buuren
e.lobregt@dimence.nl
1 Centre forDevelopmental Disorders, Dimence Institute
ofMental Health, Nico Bolkesteinlaan 1, 7416SBDeventer,
TheNetherlands
2 Accare, Centre forChild andAdolescent Psychiatry,
Pluryn,Nijmegen, TheNetherlands
3 Department ofSocial Dentistry andBehavioral Sciences,
Academic Centre forDentistry Amsterdam (ACTA),
University ofAmsterdam andVU University, Amsterdam,
TheNetherlands
4 School ofHealth Sciences, Salford University, Manchester,
UK
5 Institute ofHealth andSociety, University ofWorcester,
Worcester, UK
6 Dimence Institute ofMental Health, PO Box5003,
7400GCDeventer, TheNetherlands
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Of the 30 articles, two were RCTs, 31,32 three were pilot RCTs, [33][34][35] three were non-randomised controlled trials, [36][37][38] three were qualitative, 39,40 one was retrospective analytical cross-sectional, 41 four were surveys, [42][43][44][45] four were service evaluations [46][47][48][49] and ten were before-after comparison studies. [50][51][52][53][54][55][56][57][58][59] Two of these articles were from the same trial. ...
... 41,42 Only one study included participants with intellectual disability. 48 Twenty studies reported on co-occurring mental health conditions at baseline: obsessive-compulsive disorder (OCD), 31,52 depression, 34,39 anxiety, 33,55 post-traumatic stress disorder (PTSD), 37 stress, 35 eating disorders 49 and a combination of mental health difficulties. 32 31,33,36,48,50,51,59 Six papers reported on staff perspectives of how to adapt and deliver better care for autistic people across the lifespan. ...
... Certainty of evidence (1) design reported statistically significant improvements in PTSD symptoms and psychological distress following EMDR + TAU compared to TAU only. 37 The effect remained stable at 6-8 weeks follow-up. The study showed a low drop-out rate and, although all participants found EMDR sessions stressful, most indicated that they would choose the therapy again. ...
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Background Autistic people have a high likelihood of developing mental health difficulties but a low chance of receiving effective mental healthcare. Therefore, there is a need to identify and examine strategies to improve mental healthcare for autistic people. Aims To identify strategies that have been implemented to improve access, experiences of care and mental health outcomes for autistic adults, and to examine evidence on their acceptability, feasibility and effectiveness. Method A co-produced systematic review was conducted. MEDLINE, PsycINFO, CINHAL, medRxiv and PsyArXiv were searched. We included all study designs reporting acceptability or feasibility outcomes and empirical quantitative study designs reporting effectiveness outcomes. Data were synthesised using a narrative approach. Results A total of 30 articles were identified. These included 16 studies of adapted mental health interventions, eight studies of service improvements and six studies of bespoke mental health interventions developed for autistic people. There was no conclusive evidence on effectiveness. However, most bespoke and adapted approaches appeared to be feasible and acceptable. Identified adaptations appeared to be acceptable and feasible, including increasing knowledge and detection of autism, providing environmental adjustments and communication accommodations, accommodating individual differences and modifying the structure and content of interventions. Conclusion Many identified strategies are feasible and acceptable, and can be readily implemented in services with the potential to make mental healthcare more suitable for autistic people, but important research gaps remain. Future research should address these and investigate a co-produced package of service improvement measures.
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... Eye Movement Desensitization and Reprocessing (EMDR) therapy is another preferred method for treating PTSD in the general population. One study examining the use of EMDR in adults with ASD and a history of trauma did show significant improvement in PTSD symptoms when compared to treatment as usual (Impact of Event Scale-Revised: d=1.16), however study limitations included small sample size (n=27), lack of control group, inability to blind participants, and researcher bias, as the therapists providing the intervention also completed the measures (32). The use of EMDR in children and adolescents with PTSD has been shown to reduce scores on the PTSD symptom scale from 60 ± 8.7 to 24 ± 10.1, p= 0.001) in this age group, though the study was limited by small sample size (n=30), absence of a control group and lack of follow-up measurements beyond six weeks (33). ...
... The use of EMDR in children and adolescents with PTSD has been shown to reduce scores on the PTSD symptom scale from 60 ± 8.7 to 24 ± 10.1, p= 0.001) in this age group, though the study was limited by small sample size (n=30), absence of a control group and lack of follow-up measurements beyond six weeks (33). Despite the limitations of these studies, it is possible the EMDR would be beneficial in children and adolescents with co-occurring ASD and PTSD, though further research would be necessary (32,33). ...
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Traumatic experiences contribute significantly to behavioral and mood dysregulation syndromes presenting for treatment to behavioral health settings. Individuals with Autism Spectrum Disorder (ASD), Intellectual Disability (ID) and developmental delay experience traumatic events more frequently than their typically developing peers. However, measures used to identify trauma related disorders and treatment thereof are based on typically developing individuals. Regardless of the baseline characteristics of individuals who experience trauma, trauma exposure is the result of multiple interdependent environmental, social, and familial characteristics. We used the “ecological systems analysis approach” to structure our review of the impact of trauma on those with ASD and ID. In addition, the COVID-19 pandemic which exposed the global population to a collective trauma, has also catalyzed investigations into the challenges faced by members of society most dependent on social services. Children with ASD and ID were among those vulnerable individuals, and the COVID-19 pandemic has allowed researchers to better understand the impact of a collective trauma on those individuals. It is imperative that we understand current research and recommendations for identifying and treating trauma-related disorders in individuals with developmental disorders to best inform clinical practice and directions for future research in this area.
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... This is one of the first studies demonstrating that EMDR treatment indeed is feasible as well as promising with regard to its efficacy in patients with ABI, cognitive disorder and PTSD. Although no controlled studies are available on the efficacy and feasibility of EMDR in patients with ABI and PTSD, controlled studies are available of EMDR on PTSD symptoms in other patient groups with comorbid disorders, like severe psychotic disorder (van den Berg et al., 2015), autism (Lobregt-van Buuren et al., 2019) and intellectual disability (Karatzias et al., 2019;Mevissen et al., 2017). In those studies, EMDR was also shown to be feasible, acceptable, and effective (van den Berg et al., 2015) or potentially effective (Karatzias et al., 2019;Lobregt-van Buuren et al., 2019;Mevissen et al., 2017). ...
... Although no controlled studies are available on the efficacy and feasibility of EMDR in patients with ABI and PTSD, controlled studies are available of EMDR on PTSD symptoms in other patient groups with comorbid disorders, like severe psychotic disorder (van den Berg et al., 2015), autism (Lobregt-van Buuren et al., 2019) and intellectual disability (Karatzias et al., 2019;Mevissen et al., 2017). In those studies, EMDR was also shown to be feasible, acceptable, and effective (van den Berg et al., 2015) or potentially effective (Karatzias et al., 2019;Lobregt-van Buuren et al., 2019;Mevissen et al., 2017). ...
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... Sopena et al., 2023) andLobregt-van Buuren et al. (2019) found that EMDR can significantly reduce PTSD symptoms in autistic individuals. In addition to quantitative findings, qualitative research emphasises the importance of trauma-focused interventions for autistic individuals. ...
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Disparities in adversity among children with autism spectrum disorder: A population-based study
Article
Aim: People with autism spectrum disorders (ASDs) experience disparities in health. An important but overlooked risk factor for health disparities in the ASD population is adverse childhood experiences (ACEs). The purpose of this study was to identify the prevalence of ACEs among families of children with and without ASD, using a population-based sample. Method: Data from the 2011 to 2012 National Survey of Child Health were analyzed to estimate prevalence of ACEs among families of children with and without ASD, age 3 to 17 years (ASD=1611; estimated population=1 165 34). The child's ASD status was obtained from parent report; ACEs were assessed with the modified Adverse Childhood Experiences Scale. Bivariate and multinomial logistic regression analyses were utilized to investigate the relationship between ACEs and childhood ASD status. Results: ASD status among children was significantly and independently associated with higher probability of reporting one to three ACEs (adjusted relative risk ratio [aRRR] 1.53; 95% CI: 1.16-2.0; p<0.010) and four or more ACEs (aRRR 1.99; 95% CI: 1.35-2.91; p<0.010). Interpretation: Children with ASD may experience a greater number of family and neighborhood adversities, potentially compromising their chances for optimal physical and behavioral health outcomes. Assessment and reduction of ACEs among families of young people with ASD could potentially contribute to the reduction of population health disparities.
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