EMDR for Autistic Adults: Adapting the Approach

Autistic adults are considerably more likely than non-autistic adults to have experienced bullying, exclusion, abuse and other adverse events. They are also, historically, less likely to be offered therapy for the effects. Distress is often read as simply part of being autistic, rather than as a response to something that happened, and the trauma goes unaddressed. It is worth being clear about the aim. The target of this work is trauma. Autism is not something EMDR sets out to change. A study by Lobregt-van Buuren and colleagues, published in the Journal of Autism and Developmental Disorders (2019), examined whether EMDR is workable for this group. Autistic adults with histories of distressing events were followed through three stages: a baseline period of their usual care, then up to eight EMDR sessions added to it, then a further period of usual care alone. That structure helps show whether change coincides with the EMDR rather than with time or with ongoing support. The results were strong. PTSD symptoms fell substantially, with a large effect size, and general psychological distress fell as well. The gains were maintained at follow-up. The researchers also recorded a modest reduction in scores measuring autism-related features. That deserves careful reading. The likeliest explanation is not that EMDR changed anyone's autism, but that carrying less trauma left people less overwhelmed, so behaviours driven by distress and overload eased. Making EMDR work well for autistic clients does take adjustment. A survey of 103 EMDR therapists by Fisher and colleagues, published in Autism (2023), catalogued 124 separate adaptations in use. The recurring themes were practical: stay flexible, communicate plainly, use visual aids where they help, do not assume standard rating scales will suit everyone, and take accumulated smaller experiences seriously rather than looking only for one major event. The authors describe the result as a toolbox rather than a single protocol. The limitations are worth stating. The treatment study was small and was not a randomised trial, and the survey reflects therapist opinion rather than measured outcomes. Larger and better-controlled research is needed. Even so, the direction of travel matches what the research keeps finding elsewhere. The obstacle was rarely that these clients could not benefit. It was that the standard format was not designed with them in mind, and that their distress was too readily assumed to be simply part of who they are. Sources: Lobregt-van Buuren, E., Sizoo, B., Mevissen, L., & de Jongh, A. (2019). 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. Journal of Autism and Developmental Disorders, 49(1), 151 to 164. Fisher, N., van Diest, C., Leoni, M., & Spain, D. (2023). Using EMDR with autistic individuals: A Delphi survey with EMDR therapists. Autism, 27(1), 43 to 53.