The comorbidity between autism spectrum disorder and post-traumatic stress disorder is mediated by brooding rumination
Authors: Golan Ofer , Haruvi-Lamdan Nirit , Laor Nathaniel , Horesh Danny 
Published: July 2021

Autism spectrum disorder is a neurodevelopmental condition characterized by social communication difficulties and restricted, repetitive behaviors. Autism spectrum disorder is highly co-morbid with other neuro-psychiatric disorders such as attention deficit hyperactivity disorder, anxiety, and depression. However, research on post-traumatic stress disorder among individuals with autism spectrum disorder is scarce. Furthermore, the understanding of shared mechanisms underlying autism spectrum disorder co-morbidity with other conditions may assist in both diagnostic and intervention efforts with affected individuals. This short report examined the role of brooding and reflective rumination as mediators between autism spectrum disorder and post-traumatic stress disorder. A total of 34 adults with autism spectrum disorder (with no intellectual impairment) and 66 typically developing controls, comparable on age and gender, filled out the PTSD Checklist for DSM-5 and the Rumination Response Scale. The results indicated increased post-traumatic stress disorder symptoms, as well as elevated brooding levels, in adults with autism spectrum disorder, compared to typically developing controls. Brooding, but not reflective rumination, mediated the association between autism spectrum disorder and post-traumatic stress disorder symptoms. Rumination and cognitive inflexibility, which are common in autism spectrum disorder, may exacerbate post-traumatic symptoms among traumatized individuals who have autism spectrum disorder. Interventions targeting brooding rumination and cognitive flexibility may assist in alleviating post-traumatic symptoms in individuals with autism spectrum disorder. Future studies should examine other psychological mechanisms which may underlie the autism spectrum disorder–post-traumatic stress disorder co-morbidity. Lay abstract Autism spectrum disorder is a neurodevelopmental condition characterized by social communication difficulties and restricted repetitive behaviors. Individuals with autism spectrum disorder are often diagnosed with other psychiatric conditions, including attention deficit hyperactivity disorder, anxiety, and depression. However, research on post-traumatic stress disorder among individuals with autism spectrum disorder is scarce. Nonetheless, studies have shown that those with autism spectrum disorder may face an increased risk of exposure to traumatic events. Separate lines of research in autism spectrum disorder and post-traumatic stress disorder have shown that the two may share several vulnerability factors. One of those is ruminative thinking, that is, one’s tendency to re-hash thoughts and ideas, in a repetitive manner. This article examined the role of two rumination types as potential factors connecting autism spectrum disorder and post-traumatic stress disorder: brooding (continuously comparing one’s current condition to one’s desired condition) and reflection (an introspective effort to cognitively solve one’s problems). A total of 34 adults with autism spectrum disorder (with no intellectual impairment) and 66 typically developing adults completed questionnaires assessing post-traumatic stress disorder symptoms and rumination. The results showed increased post-traumatic stress disorder symptoms in adults with autism spectrum disorder, compared to typically developing adults. Brooding rumination was also higher among those with autism spectrum disorder. Finally, brooding, but not reflection, served as a mechanism connecting autism spectrum disorder and post-traumatic stress disorder, that is, those with autism spectrum disorder showed increased brooding, which in turn predicted more post-traumatic stress disorder symptoms. This study has potential clinical implications. Rumination and cognitive inflexibility, which are common in autism spectrum disorder, could exacerbate post-traumatic symptoms among individuals with autism spectrum disorder who experience traumatic events. Interventions targeting brooding rumination and cognitive flexibility may assist in alleviating post-traumatic symptoms in individuals with autism spectrum disorder.