Shared Presentations in Trauma and Autism: A Systematic Review of Overlapping Clinical Features

Trauma-related symptoms and autism spectrum disorder (ASD) have been described as sharing several clinical features, yet their relationship remains only partially explored within trauma-focused research. This systematic review examined the association between trauma exposure, post-traumatic symptoms, and ASD, with a focus on symptom overlap and clinical implications. English- and Italian-language quantitative and clinically structured empirical studies examining trauma-related symptoms in relation to ASD in children and adolescents were included. Following PRISMA guidelines and PROSPERO registration (CRD420251062557), literature searches were conducted in PubMed, Scopus and PsycInfo. English- and Italian-language studies examining trauma-related symptoms in relation to ASD in children and adolescents were included. Eleven studies met inclusion criteria, encompassing population-based, clinical, and case-based designs. Across studies, trauma-related symptoms emerged as a salient and often underrecognized dimension in individuals with ASD. Overlapping features were most consistently observed in domains of emotional and behavioral dysregulation, social withdrawal, anxiety, and repetitive behaviors. Clinical and case-based evidence indicated that trauma-related symptom exacerbation may mimic or obscure core autistic features, contributing to diagnostic uncertainty. Overall, the available evidence suggests clinically relevant overlap between trauma-related symptomatology and ASD, although direct evidence on symptom-level phenomenological overlap remains limited and heterogeneous. Systematic assessment of both trauma exposure and neurodevelopmental history is essential to ensure accurate diagnosis and inform tailored clinical interventions.