Early trauma and psychotic experiences in autism: a neurodevelopmental framework integrating allostatic overload, symbolisation, and stress reactivity

Abstract

Adverse childhood experiences are common worldwide and are associated with enduring mental and physical health consequences. Autism, a complex and heterogeneous neurodevelopmental condition shaped by both genetic and environmental influences, has a global prevalence of approximately 1% and is associated with increased exposure to adversity, including bullying, social exclusion, and interpersonal misattunement. Such exposures may partially mediate associations between autistic traits and later psychotic experiences independently of genetic liability. Developmental trauma is increasingly recognized as an environmental factor that may shape the emergence of psychotic experiences in autism by interacting with neurodevelopmental differences. Neurobiological findings in trauma-exposed populations implicate dysregulated stress-response systems and alterations in circuits supporting threat detection and affect regulation, including heightened amygdala reactivity, reduced hippocampal volume linked to impaired contextual processing, and altered ventromedial prefrontal functioning. Integrating epidemiological, neurobiological, and developmental perspectives, this paper proposes a framework linking three interrelated mechanisms: (i) dissociation and reduced integration of affective and relational experience, (ii) constraints on symbolisation and narrative meaning-making, and (iii) heightened stress reactivity that amplifies threat-based processing and alters salience attribution. In autistic individuals, pre-existing differences in sensory processing and intersubjective functioning may compound the impact of adversity, lowering the threshold at which anomalous experiences acquire distressing or aberrant meaning, particularly during sensitive developmental periods such as childhood and adolescence. This article is intended as a Perspective that brings together findings from autism, trauma, psychosis, and developmental psychology to generate a theoretical framework and set of testable hypotheses. It does not present a systematic review of the literature or seek to establish causal relationships but rather proposes potential mechanisms through which early trauma may influence the emergence of psychotic experiences in a subgroup of autistic individuals. The model presented highlights trauma as a modifiable environmental pathway with implications for trauma-informed assessment, early intervention, and future multilevel research.