Family Systems Considerations in Autism Spectrum Disorder After Prenatal Trauma and Prior Pregnancy Loss

We present the case of a four-year-old child evaluated for core features of autism spectrum disorder, whose family context included a history of second-trimester perinatal loss 14 months prior to conception and severe maternal motor vehicle trauma at 18 weeks' gestation. This background coincided with parental hypervigilance, anticipatory grief, and complex caregiving dynamics, while early infancy was characterized by severe regulatory disturbances and sensory sensitivities that interacted with parental stress responses. Management utilized a dual approach combining neurodiversity-affirming developmental interventions for the child with Child-Parent Psychotherapy for the parents, where addressing the intersection of historical loss and developmental neurodivergence supported family co-regulation and functional communication gains for the child. This case illustrates how unresolved parental trauma may influence family adaptation following an autism diagnosis, demonstrating that incorporating trauma-informed, family-centered assessment alongside evidence-based developmental interventions may improve caregiver functioning and support the implementation of therapeutic strategies.