Ep 21: AuDHD Experience - Trauma, CPTSD & Systems Harm

Episode 21 – Trauma, PTSD & Systems Harm

What if you're not "too much," "too complex," or "treatment resistant"? What if the very systems designed to help neurodivergent people are inadvertently causing harm instead?

In this episode, Aaron explores the deep intersection between neurodivergence and trauma — and why so many AuDHDers, autistic folks, and ADHDers find themselves stuck in cycles of misdiagnosis, invalidation, and burnout.

What we cover

• The difference between big T trauma (PTSD) and complex trauma (cPTSD), and why complex trauma is so prevalent in neurodivergent communities
• Why neurodivergent people are statistically more exposed to trauma, bullying, social exclusion, and adverse childhood experiences (ACEs)
• How diagnostic overshadowing leads clinicians to mislabel trauma responses as personality disorders — or dismiss them entirely
• The structural harms baked into school systems, healthcare, and historical practices like ABA
• How masking, allostatic load, and burnout compound trauma and erode identity
• Why service avoidance is often a reasonable response to repeated invalidation
• The link between systems harm, hopelessness, and elevated suicidality in our communities
• Practical scripts for advocating with GPs, psychologists, and other clinicians when you feel unheard

Key takeaway

The "complexity" so often attributed to neurodivergent clients usually isn't about us — it's about a mismatch between our characteristics, our histories, and systems built for someone else. Understanding trauma and neurodivergence together makes the "complex" much less complex.

Content warning

This episode discusses trauma, complex trauma, interpersonal violence, school bullying, healthcare harm, and suicidality at a conceptual level. Please pause and reach out to a support service if needed:

• Lifeline: 13 11 14
• Beyond Blue: 1300 22 4636
• 13YARN: 13 92 76
• QLife: 1800 184 527
• Emergency: 000

Referenced research

• Stickley (2022) – ACEs and neurodivergence
• Berg (2024) – Adverse childhood experiences in autistic adolescents
• Adams (2025) – Parents on CAMHS: "accumulating harm and waiting for crisis"

You are not too much. You are not defective. You are different — and you are worthwhile.

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Transcript

SPEAKER_00 0:11

What if you're not too much, too complex, or treatment resistant? What if the systems that are designed to help us and serve us are inadvertently doing us harm instead? Hi friends, welcome back to the Audi HD Psych Podcast. I'm Aaron How with Clinical Psychologist, and we are different, not defective. A quick warning before we go ahead, today we'll be speaking about trauma, complex trauma, and systems harm. We'll discuss interpersonal violence, school bullying, healthcare harm, suicidality at a conceptual level. It doesn't describe specific incidents, but it may still bring up strong feelings. If it does, please feel free to pause, slow down, and call a support service in your area. In Australia, that might be 13 Young, Q Life, Beyond Blue, or Lifeline. And if there's an immediate threat to safety or of yourself or others, please call 00 at Australia or your local emergency services number. Now, we often get told that we're treatment resistant or we have complex presentations. And this can be really, really difficult for us to engage in services that help manage our well-being and mental health. So today I wanted to have a little touch into how the systems that are aimed at protecting us can actually inadvertently do neurodivergent people, particularly ADHDers, autistic people, ADHDers, and others harm without meaning to. So first of all, I'll talk about trauma. Statistically, trauma is much more common in neurodivergent people. We have autism, we see alongside autism, much higher trauma rates than in the general community. The same is true for ADHD, but for ADHDs, it's even higher again. There's complexity that leads to us being exposed to significantly more trauma. Now, if anyone's not aware of complex trauma, I've described this in a past episode. We think of trauma as a current immediate threat to my safety and life or life, or the safety or life of those things or people that I hold dear. That's what we refer to as big T traumas, commonly associated with things like post-traumatic stress disorder. However, our nervous systems don't only respond to that type of stress and trauma. We also have complex trauma, recently included in the ICD 11, which is it's not necessarily an immediate threat to my safety right now, but long term it's little little attacks, little nicks, little scratches, little cuts that over time have the same impact on our nervous system and can see us ruminating just like big T traumas. Can see us having really avoidant, aversive responses just like big T traumas. And in our emotional systems, it's much the same. Complex trauma is much more common in our communities than it is in the typical community. And not only are we more exposed to trauma for many reasons, sometimes due to our impulsivity, sometimes due to our inattention, sometimes due to not understanding the social rules and not recognizing that things are threatening to us. We're also often in environments where the risk of trauma is higher. You know, I've shared, I used to be in the Navy for many years and I knew quite a lot of people in the army who I strongly believe in neurodivergent now. So some of our novelty seeking attracts us to environments that are predisposed to trauma. But whether it's big T trauma or little T complex trauma, it impacts our nervous system the same. So as neurodivergents, we might actually be exposed to big T traumas. But also, with the social differences that we have, we can be impulsive and say things that we we think without filtering them. We can not respond when somebody asks us a question. We can respond in the perceived wrong way if we have social and communication differences. And these can often lead to social exclusion, isolation, and the perception of those from the groups around us. And that in itself can become a complex history of stress and trauma, which can lead to us having really unhelpful beliefs about ourselves and often invalid beliefs about ourselves. But also, as I've discussed in the past, many of our diagnostic criteria for OSTIC specifically with autism and ADHD are based in what is often externalizing presentations in educational or healthcare settings or clinical settings. What that means is if there is a stimulus, something that causes me to react, I can either react in the way that I'm driven to, that I impulse that I have, or I can internalize that and suppress that. The externalizing presentation is the impulsive, naughty little boy in a classroom of ADHD, or perhaps it's the monologuing autistic child who's standing there talking about their favorite interest to everybody, regardless of the glazed look that I see you sometimes get in your eyes when I'm talking. But that can lead to social exclusion. That can lead to us just learning that there's something wrong with us. The longer that goes on, the more significant and deeply seated those self-concept impairments can become, and the bigger the impacts they can have on our lives. You might not see those characteristics that are in the diagnostic criteria, but I will still experience stress and often anxiety and often depression, and then at its extremes, suicidality and self-harm and other safety concerns. Why does this matter? Because if the diagnostic criteria don't match my expression of trauma and neurodivergent characteristics, and my neurodivergence doesn't express in the same way as the diagnostic criteria, then it's quite likely that I might not necessarily be seen as traumatized. But also trauma and complex trauma are considered diagnostic confounds for neurodivergence. So if I don't understand neurodivergence well, and how common trauma and complex trauma are, I might have a situation of diagnostic overshadowing, which was discussed in our episode 20, where I assign your difficulties to your trauma, but I don't look for neurodivergence, or vice versa. So there's a questionnaire called the Ace, the Adverse Childhood Experiences Questionnaire, and it's a question about 10 difficult situations in childhood. Neurodivergent children are statistically more likely to have had experiences in these 10 areas of difficulty, and it often leads to anxiety and impairment. You can have a little look at Stickley's 2022 article that actually speaks to that in depth. In the DSM 5, we see the diagnosis of post-traumatic stress disorder, but we don't see the diagnosis of complex post-traumatic stress disorder. What does that mean? That means that clinicians who work under the DSM-5, if you don't have those immediate threats to my safety or the safety of the things that I love, then your experience might be explained away as neurodivergence or as anxiety or as something else. Again, it means that perhaps diagnostic overshadowing has come into play because I don't have a complete picture and so I'm not constructing a sound formulation and treatment plan for you. As I mentioned before, that complex trauma can come in the form of social exclusion and isolation. Many, many neurodivergent children, particularly there's a lot of research out there that speaks to autistic children experiencing bullying across their lives. That is a complex form of trauma and a big T trauma. It can really impact on people's experience the way they see themselves, include sensory differences. And suddenly my school is not just a socially threatening place, it's a sensorally threatening place. And if I have teachers that don't understand neurodivergence and don't recognize that my social and relational style is valid, then teachers may be reinforcing this trauma that I'm experiencing. Why does that matter? Because when I don't see that through the lens of complex trauma, I don't mark it down as trauma, so I'm more likely to make it perhaps a personality disorder. Perhaps I'm going to say you have histrionic personality disorder or borderline personality disorder. Why does this matter? Because borderline personality disorder is considered quite a complex presentation to treat by many people. And when I'm seen as complex, the healthcare system that's attempting to help me can feed back into this loop of I'm broken and there's something wrong with me. And it might actually just be that my trauma isn't understood, my complex trauma isn't understood, my neurodivergence isn't understood. And so if I'm neurodivergent with a complex trauma history, it might all be put down to generalized anxiety disorder and a personality disorder. When in fact it may be an Audi HD presentation in the context of complex PTSD. So why does this matter? Because sometimes the complex cases that we have are less complex when we have a full understanding of you as a human or me as a human, are less complex when we have the correct frame of reference to view people through. And understanding trauma and neurodivergence and how commonly they come together can help us not have that difficulty in providing care. But also as neurodivergent people with trauma histories, it can help us engage with clinicians who have better models of care that serve us. Unfortunately, many of our community don't have that positive experience. They have miss or missed diagnosis, diagnostic overshadowing, and in some cases blatant invalidation of the experience of many autistic ADHDers and Audi HDers. Why does this matter? Because if I go to a service for help and you tell me it's a me thing or I'm too much, I'm too complex, I'm being overly dramatic, why would I engage in that service anymore? Why would I seek help? Then I have perhaps myself with my history and my neurodivergence and a misunderstanding of myself because the systems around me misunderstand me. That's reinforced, and all of a sudden I'm overwhelmed. I'm already masking that we've talked about in a past episode, and that's costing me energy. I'm probably inching closer and closer to burnout. The closer I get to burnout, the less cognitive and emotional capacity I have to engage in the world. And we know that depression is underpinned by hopelessness. If I'm burnt out, if I don't believe in who and what I am as valid, if the systems that are meant to support me reinforce that, then I'm more likely to want some kind of escape from that experience. And so we see significantly increased rates of suicidality and self-harm in neurodivergent communities. Now, that was some pretty heavy content, so please feel free to pause, take a break, grab a drink, take a few deep breaths if you need to, and we'll continue on. In closing there, trauma is more common and more widely experienced in neurodivergent communities than it is in most other communities. I beg your pardon, certainly in the mainstream in general community. So now I'm going to talk about those systems that I referred to before as trauma environments. School system. School system aims to prepare us for the world, to teach us what we need to know to be productive in the environments of productivity that much of the Western world exists in. But if I'm neurodivergent, if I behave in a way that's not the social norm, I'm very likely to experience exclusion and bullying. And, you know, I shared the story about myself in grade two peeing my pants because I believed that once I was told I couldn't have a breach to go to the toilet, that I couldn't ask again. When teachers don't have that front of mind, teachers can become reinforcers of that impaired self-concept and internal trauma, complex trauma. With the ACE study that I mentioned before and the questionnaire that goes along with that, essentially of those ten questions, the more of those that I tick yes to, the worse my life and well-being outcomes are likely to be. The proportion of neurodivergent children who tick three or more or multiple of those difficulties in childhood is again significantly higher than it is in the general population. Berg in 2024, their article talks about a comparison between adolescent autistic folk and their peers and shows autistic children having much higher adverse childhood experiences, contributing to that complex trauma. Those experiences might be things like having people regularly physically abuse me, having people regularly verbally abuse me, or do those things to family members, other forms of assault that I'm exposed to on a regular ongoing basis. Why is that important? I think in a past episode I talked about the accumulation of harm. And with stresses, whether they're big T traumatic stresses or other, and I quote, smaller stresses, the damage caused by them accumulates over time. If you call me stupid, for example, and I'm not calling anybody out there stupid, it's just an example. If you call me stupid once, I might think, well, how rude. If you continue to call me that, I will slowly start to believe it. I'll slowly start to see all the evidence of how stupid I am, and I may even start referring to myself as that. There's stress with each ongoing experience. Include interpersonal violence into that, bullying, exclusion, name-calling, interpersonal violence in a home setting, physical violence, are various forms of assault that neurodivergent people are statistically more likely to experience, then the accumulating harm and stress that I have is significantly higher than that of the average person in the community. Again, why does that matter? Because if we as neurodivergents are more exposed to stress and trauma, we're more likely to have worse outcomes, and therefore we're more likely to accumulate more harm. And there was a phrase from Adam's 2025 study, and it was parents talking about their children's interaction with child and adolescent mental health services. And I just need to look at my notes. The the quote was they felt that they were accumulating harm and waiting for crisis before they would be seen by services. Why is that? Because often, if I don't understand all of the things that are in your experience, I might not actually see what your real experience is. Put everything down to anxiety. I might tell you you're complex. I might even minimize your experience in my head, thinking you're being overly dramatic or other such unhelpful ideas. And if that's the case, then you have more negative experiences with a healthcare professional. And you may say to yourself, well, not just me as a psychologist, that psychologist, or the whole healthcare system is stacked against me and not re-engage, and so your physical health becomes poorer. Add in perhaps inattention and some motivational difficulties because I have negative experiences, so I don't make doctor's appointments when I injure myself. That can compound as well. And I have more physical health difficulties, which can lead to more impaired self-concept, more complex ongoing chronic stresses. Service avoidance is actually reasonable for many neurodivergent people who have been told not that you're neurodivergent with a complex and really, really chronic long-term trauma and stressor history, but instead you have borderline personality disorder. Or there's not really anything wrong with you. Or we actually see this quite a lot in community where we don't fit the profile of mental and physical health difficulties. So we're told that we can't work out what's wrong with you. There's not really anything wrong with you. And there's a growing pool of evidence that shows that lots of neurodivergent people present with difficulties in very different ways to the average person in the community. But if you keep telling me that there's nothing wrong with me or that the thing that's wrong with me is central to me and not about a history of stress that I'm responding to in a completely reasonable and understanding way when you consider that complex stress and trauma history, I'm likely to not engage anymore, or when I absolutely have to, put it off for weeks, months, sometimes years. And so my difficulties increase, my stress increases, my experience of trauma increases, and that becomes a self-fulfilling and self-sustaining cycle. Now, a really great example of things that were likely implemented with the intention of being helpful that were absolutely not is applied behavioral analysis, ABA. ABA is akin, as described by many people, and I happen to agree with this. It's not unlike conversion therapy. I beg your pardon, it has been updated. Originally, many applications of it were not unlike conversion therapy for trans and gay people. Essentially, some of the central criticisms from autistic communities about ABA was that it was punishing people for being autistic and rewarding them for being not autistic or realistic. It was reinforcement of behaviors that were convenient to the communities around us and fitted more into social expectations. Why is that a problem? Because we know that masking contributes to our stress, to our allostatic loads, our cumulative stress load. And we know that masking contributes to negative self-concept and burnout, which in turn can lead to those safety concerns that we've already discussed. So ABA for many people was actually a part of their big T and little T and complex trauma history. And if I was an autistic person who'd been exposed to ABA, why would I go anywhere nearer anyone who I associated with that profession? It would be really hard for me to re-engage in therapeutic intervention. Finally, the issues here that I'm talking about are structural. They're not about us as neurodivergent people. And I would go so far as to say they're not about evil people and evil systems. They're often about well-meaning people who don't understand the full picture, who have an idea of you don't fit in socially, and this is what is normal socially, so I'll teach you to be normal and that'll be good for you. But without our voices in the conversation and saying, actually, that's really harmful to me. It causes me a lot of stress not to stim, to hold up the happy face all day and not have resting bitch face, unquote. To do all of the things that you expect me to do and you're training me to do, and not do all of the things that you're punishing me or giving me aversive stimuli, but when I engage in them, all of my autistic expressions, then you're actually being quite harmful to me. When we stand up and say that, we can actually influence what's going on, hence the power of advocacy. But it is about the systems that we engage in and the harms that come from that. And that's the center of what we're talking about here. When people in systems don't understand us, our frame of reference, our context, and our history. We get told that we're too complex, that we're a lot, that we're making things up sometimes, or that there's not really a problem. We need to just buck up and fit in. And that reinforces our trauma histories. So I just touched on it a moment ago. I started to talk about masking burnout and complex PTSD. And it really is masking is the suppression of ourself, usually in the context of autism, but it's true of all neurodivergence. Arguably, it's true of all differences from the dominant group in societies where I have a characteristic, but it's not the norm. And there's a sense of threat in not fitting in, because we're mammals, we're social creatures, we've survived as a species by fitting in with our group. So to fit in and feel safe, I need to cover up this thing that makes me look and feel other and that other people might reject me for. So I do that and I internalize. And with that internalization comes anxiety, comes potentially depression, that sense of self that I'm broken, there's something wrong with me and different about me. And so I mask, I internalize that I have to wear a mask so there's something wrong with me. And often I'm doing that in many, many ways in many, many areas of my life. I'm suppressing myself and I'm suppressing my actual identity. This often leads to a lot of identity confusion, a sense of I'm a big faky faker, like I'm not real, who am I? Late diagnosis often result in the question of who am I really without my mask. For many people, when I have that as another ongoing stressor, that mask, that can lead me to burnout. I only have so many cognitive resources as a human. My emotional capacity is built in and intimately linked to my cognitive resources. And my behavior is an expression of my intent, my interpretation of the world through my emotional experience and what I have my body do. So I have limited cognitive capacity. If I'm spending 50% of that covering up natural parts of me, 10% of that maybe trying to get through the day while I'm thinking I'm broken, I don't fit in, I'm not good enough, and then 25% of that. Just living my life, making sure that I'm fed and dressed and washed and get to work on time or school on time. I don't have much left to deal with anything significant that comes up. The bullying that I might be experiencing at school, or not even active bullying, just the passive exclusion because I'm different. That might take up that remaining 15% of capacity that I have. And then I reach burnout when that goes on for long periods. Sometimes for not that long periods, that becomes its own form of complex trauma. That becomes its own negative impact on me, my well-being, and my safety. Audi HDers tend to have all of this experience. We tend to have often big T trauma histories, not always. We tend to have complex trauma histories and masking. And often we're a bit too impulsive to fit in with the stereotypes of autistic, or we're a bit too rigid to fit in with the stereotypes of ADHD. So we have an extra angle of how we don't fit in even with our own communities, especially when we don't realize that we're neurodivergent. We can have a lot of burnout, we can have a lot of complex trauma, and we can have a lot of central identity disturbances and concerns and worries and questions about who we are as people at our very core. So the main thing that I wanted to get through today was as always, we are different, not defective. Often when we feel too much or told that we're too much, or in therapeutic settings that we're too complex, and sometimes when then we're told there's nothing wrong with you. That's not actually us making things up or being too much. It's often actually the systems that we interact with being made generally for a different type of person and all of the work that we're doing to try and fit in, often causing us stress but then not being seen, and so we're invalidated and we're not provided the supports that we need. Now, in that case, it's not about you being broken or you being a bad person or you being too much or not enough. It's about a mismatch between the environment that I'm in. In this case, the system that I'm going to for educational support or healthcare support, or I've spoken primarily about those two, but there's more in societies, and me, my characteristics, and my history. And often it's a lack of understanding within the system that leads to that mismatch, not my actual characteristics. So if you felt like you're a little bit too much, I invite you to ask what's your history been? Where you have a legitimate valid concern or worry or stress that's been invalidated by a system. And this isn't a question to try and vilify that system because I believe people are good and people are trying to help, but ignorance is innocence by another word. It's a lack of knowledge. And if systems and the people within systems don't understand me, then they can't provide me the support that I need, and they can contribute to my complex stress and trauma history and my masking and my burnout and my identity concerns, my idea of myself. And that's why we do things like this podcast to advocate. This is what we actually are, and this is how you can provide good services to us. And for those of us who have the capacity and resources available to us who might not be in burnout yet, we can take this information and advocate for ourselves and our communities. We can do so much more as a single community of neurodivergence than we can do individually, and community is powerful for our well-being. So I guess a little final note is don't be afraid to script to get the services that you need. If you have a GP that doesn't quite understand you, or a psychologist or a social worker or any other professional, feel free to construct a script that says something like, I don't think you necessarily understand my past history and stress and how that might be interacting with my mental health, physical health, my overall well-being. And I wonder if we could have a talk about whether we've considered the complex stress and trauma that I've experienced in the context of my health difficulties. And start a conversation with our clinicians. Well, friends, I hope that's been helpful today. Please do give us any feedback that you would like, and we really appreciate it all. Thank you all very much for listening again. There is nothing wrong with you. You are a valid, worthwhile person, and we are different, not defective. We'll see you next time.