This study shows the adaptive response of children and adolescents with autism to the dramatic experience and aftermath of an earthquake. The literature presents strong evidence that children and adults in the general population experience PTSD after an earthquake (Roussos et al. 2005
; Shannon et al. 1994
; Goenjian et al. 1995
; Jia et al. 2010
) but completely lacks studies describing the ways that people with autism respond to a natural disaster. Indeed, this is the first study to address this area of interest. It included the majority of the children and adolescents with autism that were followed by a specialised centre in the exposed area and a comparison group of peers with autism followed in two nearby municipalities that were not directly affected by the earthquake.
Compared with studies conducted within the general population, for which self-report scales and psychometric scales based on DSM-IV PTSD criteria are available, no available diagnostic instruments specifically assess PTSD in individuals with ID or ASD. The presentation of PTSD is influenced by the degree and cause of ID, social circumstances, social and communication skills, the nature and timing of the traumatic experience and its subsequent management. The paucity of literature suggests that PTSD is frequently undiagnosed in individuals with ID and may be misattributed to other causes, with the risk of inappropriate interventions (Turk et al. 2005
). There is great diversity of functional abilities among individuals with autism, and ASDs make up one of the largest diagnostic subgroups within the population of individuals with ID.
Little is known about autistic individuals’ responses to trauma, apart from case reports that focus more on abuse than exposure to disasters (Cook et al. 1993
). Behavioural symptoms, such as self-injury (Tomasulo and Razza 2007
), are presented as a symptom of PTSD in individuals with ID, but self-injurious behaviour is a well-known and common sign of ASD, so it cannot be regarded to as a specific indicator of post-traumatic distress in most people with ASD and a history of self-aggression.
Facing these methodological issues, we decided to focus our attention on adaptive behaviour rather than symptoms by using the VABS survey form, a well-recognised instrument with demonstrable reliability and validity on both typically developing individuals and those with disabilities. It is also the prominent measure for assessing adaptive functioning in children with autism (Newsom and Hovanitz 1997
). Previous research has found that children with autism present a characteristic pattern of adaptive behaviour, as measured by the VABS (deficits in the Socialisation domain, relative deficits in the Communication domain, and relative strengths in the Daily Living domain) (Fenton et al. 2003
Our results clearly demonstrate that the adaptive behaviour of children and adolescents with autism declined dramatically in the first months after an earthquake. The decrease in VABS scores was statistically and clinically significant in all the dimensions examined (i.e., communication, daily living, socialisation and motor skills, though some differences were found between children and adolescents). The disruptive impact of exposure to an earthquake is clearly shown by the comparison of VABS socialisation scores for the exposed and unexposed participants: exposed participants showed a 30% decrease after 6 months compared with the baseline and a score 15% lower than the baseline after 1 year of follow-up. These results clearly reflect the dramatic life changes facing the participants and their families, who since April 2009 have faced uncertainty about their housing, work, health services, environment and social relationships. Families’ relocation to the newly built outskirts of the town entailed a radical change in the network of services and relationships previously available to individuals with autism.
Of course, our study suffers from some limitations. A partial one is the relatively small sample of subgroups of exposed participants, although it should be kept in mind that the fewer factors included in a design, the more power it will have to detect significant effects. Because MANOVA for repeated measurements is basically a testing technique, p values were used to evaluate longitudinal relationships. An important weakness of our study is that it fails in describing the earthquake impact on caregivers and interventionists. What we do know about the impact of trauma in children is that response to traumatic events are mediated by caregivers and significant others in the child’s life, so that what we may be seeing may be an artifact of impaired caregiver functioning: this is an important goal for future research. A further potential limitation of the study lies with the use of parental responses to assess participants’ adaptive behaviour changes: because both parents and professionals contributed to the intervention, both are prone to bias (in either direction). Another potential weakness of the study design is not having a control group from a location farther than the control cities of Lanciano and Vasto, which are only 170 km from the epicentre: for an earthquake of 6.3 degrees on the Richter scale, this distance is difficult to classify them as “not affected”. Indeed, even the children in most distant cities are somewhat exposed to the psychological impact of the disaster trough the TV screens, and their fellowship feelings with the children in the disaster affected regions.
Our results demonstrate that after a partial throwback to relatively stable life conditions and immediate, intensive interventions after the disaster, children and adolescents with autism showed a clear tendency to recover their adaptive functioning, although a complete recovery likely will take a longer time. This finding is encouraging for persons with autism and their families and caregivers, and indicates that not all is lost after a disaster, even in objectively hard conditions: people with autism can struggle through emergencies and disruptive changes, gathering strength from unexplored or unexpected psychological resources.
In conclusion, if recognition of and early intervention for mental health issues can ameliorate the negative psychological effects of disasters on children and adolescents in the general population (Baren et al. 2008
), the same must be assumed for children and adolescents with ASD.
Past traumatic exposures are important in moderating the impact of the current disaster (Wolmer et al. 2005
): however, only four out of 60 participants had a definite history of past trauma, so that such hypothesis cannot be supported by sound data analysis from our study.
People with pre-existing health problems, particularly people with special needs (such as autism), suffer very much from disasters: however, further studies are required, controlling people with autism with typically developing in order to determine any disproportionate change specific to the diagnosis and commensurate to the severity of autism. Our study demonstrates that resiliency and the recovery of pre-disaster functioning in youngsters with autism largely depends on their immediate inclusion in routine, intensive rehabilitation programmes and the steadying, as far as possible, of daily life routines. Public health services may consider collaborating with community partners, families and health services providers to improve post-disaster coping in people with ASD (Eisenman et al. 2009
). Overall, while considering our findings as preliminary, we strongly recommend further research in this understudied area of interest.