The Link Between Autism and Abuse

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I myself can’t remember being bullied nonstop due to my autism in my youth. There was one summer I attended a magic camp during the day and while I myself don’t recall the experience, my parents say I was picked on by this group of older kids who would often call me “retard” and repeatedly dunk me in the pool. I was eventually saved when my second oldest sister, who was attending the same camp, beat the ringleader of the group and they never picked on me again-she was a bit of a badass.

For other kids, and even adults, suffering from autism, it’s much worst though. Warning: You might want to take several deep breaths before and while reading this post, as most of it you will find disturbing. Consider reading this with someone you know if you think it’ll make it a little better.

When Kassiane Asasumasu, now 37, was 5 years old, she remembers other children taking her stuff and lying to her about it because they knew she was face-blind and wouldn’t be able to tell on them. When she was 10, she attended a slumber party where the other girls poked her, froze her underwear and made a game out of seeing how many times they could make her cry, causing a 48-hour meltdown. The next year, some classmates locked her in a locker, and she got in trouble for kicking the door open to free herself. Kassiane was diagnosed with autism at age 3 and says most of her childhood memories were of other kids being mean to her. She cried every day of elementary school – sometimes so hard she threw up. In middle school, teachers told her mother they thought she would be at risk of committing suicide, but she didn’t feel like any adults in her life ever supported her beyond that. She was unable to ignore her tormentors even when encouraged by her teachers; at home, her parents punished her instead of her seven siblings for their transgressions.

As hard to accept as it is, experiences like hers are a terrible reality for many people with autism. Studies suggest that children with autism are up to 3 times as likely as their neurotypical peers to be targets of bullying and physical and sexual abuse. This maltreatment can cause severe stress and trauma, but it too often goes unrecognized or unreported. Therapies to treat trauma in people with autism are mostly experimental, so the victims are largely left to fend for their own safety and health, which I feel just makes the situation worse. Christina McDonnell, assistant professor of clinical psychology at Virginia Polytechnic Institute and State University in Blacksburg, says children with autism who have experienced maltreatment or other forms of violence are very vulnerable, not just because they’re more likely to experience them, but also very little is known about how to best support them. She and others say one important way to develop better support systems for people with autism is to listen to them about how society harms them. Catherine Corr, assistant professor of special education at the University of Illinois at Urbana-Champaign, says we need to do some of the hard work to find out what’s happening in school or systems that allows this to happen, and she thinks information from people who’ve experienced bullying will be really beneficial to understanding how these systems have failed them.

Maltreatment is a broad term that includes neglect and emotional, physical and sexual abuse. The fact that children with disabilities are particularly vulnerable to it has been replicated in previous studies for decades, but studies specific to children with autism are scarcer. When McDonnell was a graduate student in 2014 studying child abuse, she observed developmental problems, like autism, in a significant amount of children with maltreatment cases under investigation by U.S. state social-services departments. She also saw a disconnect in the scientific literature: studies of traumatic stress in instances of maltreatment rarely considered the autism diagnosis, and autism researchers had barely started exploring the possible maltreatment of their participants. The few studies that were done had mixed results, with some suggesting that children with autism were more likely than their typical peers to be neglected or abused and to be involved with child protective services, while others didn’t show an association between autism and an elevated risk of abuse.

Dr. McDonnell and her colleagues decided to investigate the link and tapped into autism surveillance data and records from the South Carolina Department of Social Services, comparing patterns of abuse and neglect from almost 5000 children with and without autism born between 1992 and 1998. They found that almost 1 in 5 autistic children in the state and 1 in 3 with both autism and intellectual disability were reported to be maltreated. Even after adjusting for other factors, autistic children remain up to three times as likely as their neurotypical peers to experience maltreatment. McDonnell was understandably alarmed by this; I know I would be if I were in her shoes. Unfortunately, I am not in the analytical group – as a spectrum individual, I am in the target group.

Neglect in particular is a problem for both kids with autism and kids with both autism and intellectual disability. Kristen Seay, assistant professor of social work at the University of South Carolina in Columbia, says neglect is the most common type of maltreatment documented by child protective services. What makes the problem worse is the fact that children with autism often have needs families with few resources may find difficult to meet. McDonnell’s team found that autistic children are also vulnerable to physical abuse, with primary caregivers in the immediate family being the most common perpetrators. A broader range of offenders-family members, babysitters, and childcare providers-may be more likely to target autistic children or those with intellectual disabilities than other children. A different team of researchers in Tennessee found that autism more than doubles a child’s chances of referral to child protective services. The lead researcher, Zachary Warren, a clinical psychologist at Vanderbilt University in Nashville, says we should have a heightened awareness this represents a tremendously vulnerable population. I couldn’t agree more.

When Nancy Nestor’s son was 3, a year before being diagnosed with autism, she noticed he would come home from school muttering names other kids were calling him. As time went on, he continued to be bullied, but also received compassion from others. His mother still listens to him talk to himself to find out what’s going on with him. Daniel Hoover, a child and adolescent psychologist at the Kennedy Krieger Institute in Baltimore, Maryland, says physical attacks by peers may leave autistic children with face wounds, shoulder displacements, and large scratches on the body. In 2018, he and a colleague found children with autism are bullied three to four times as often as those without disabilities, including their siblings.

Parents may sometimes notice instances of bullying the children don’t. When Nancy Nestor’s son P. was in elementary school, his peers made him the prisoner in a game of “cops and robbers” and during a middle-school field trip to Colonial Williamsburg, he was put in a stockade. P. didn’t understand; he was just happy to be included in something. Research also suggests autistic children tend to consider a broader range of behaviors offensive than their parents, like making fun of or saying something bad about a celebrity they really like. People with autism often find everyday experiences stressful because they see the world in a literal way and may not pick up certain nuances of what people say and do, making them lose their ability to trust. Connor Kerns, a psychologist who runs the Anxiety Stress and Autism program at the University of British Columbia in Vancouver, Canada, says there’s a kind of chronic potential trauma being in a world where you only understand half of what’s going on due to missing many social cues, making you constantly feel out of the loop. Other studies show children who are anxious or introverts are even more likely to experience trauma.

One of the chief reason abusers may choose autistic children as targets is they often lack the communication skills to report abuse or to be believed if they do. Seay remembers a girl with an intellectual disability who told her family she was being sexually abused at school. The school administrators were notified, but both sides doubted her story until her typically developing sibling reported the same thing was happening to her. What makes this problem worse is the fact that children with autism are exposed to many different adults through service systems, which raises the chance of encountering someone who will mistreat them. Corr says another way it persists is because educators aren’t trained to recognize signs of abuse in these children or they’re afraid of only making things worse for the child if it’s reported. She adds there’s a fear that if the child is reported to the child-welfare system, a child with a disability will be worse off and if folks in child welfare aren’t necessarily trained to think about kids with disabilities, what happens to those kids when they enter it?

In one of Asasumasu’s earliest and most painful memories, she was 3 and facing a teacher who wrapped her legs around her chair to prevent her from moving, and would give her specific instructions to follow. If she didn’t comply, the teacher would pull her body into position or force her eyes open; if she did, she earned part of an M&M. Critics have compared this to gaslighting in abusive relationships because it teaches children to comply and perform specific behaviors for rewards instead of speaking out when they feel uncomfortable and a number of adults have been vocal about their traumatic memories of undergoing this type of treatment as children, including Asasumasu. Maltreatment can cause lasting damage, leading to severe stress, depression, anxiety and PTSD. Most studies haven’t shown an increased incidence of PTSD among people with autism, and Kerns says it may be because the criteria for it wasn’t written for people with autism or because trauma in this group is more likely to lead to anxiety, depression, and other mental health issues. There are also no reliable tools for screening children with autism for trauma. I’m glad I didn’t have teachers like that when I was in school.

Despite the limitations, researchers are crafting therapies. Hoover is adapting a technique called trauma-focused cognitive behavioral therapy, a 12-week program aimed at getting children to talk about what happened to them and teaching them to manage their fears around those experiences. Because many autistic children may not understand verbal instructions or remember what they’re supposed to practice outside of therapy, he created visual schedules for them to use at home and ramped up caregivers’ involvement. It also enlists the special interests of these children to help them tell their stories. Parents are reporting positive results from it and autistic children undergoing this therapy are showing improved scores on the UCLA Child/Adolescent PTSD Reaction Index, a self-report questionnaire screening for PTSD in children and teenagers. Hoover is also writing a manual for the technique and gets multiple inquiries a week from centers around the world that want training on it. He and his colleagues have been collecting data on the therapy from several dozen children for the past year and have plans for a controlled trial. McDonnell is preparing to measure the potential benefits of the standard trauma technique on autistic children, and other teams are trying community and grassroots programs aiming to teach people about abuse, sexuality and other topics to keep them safe.

People with autism have come up with their own strategies as well. Adrienne Lawrence, a 36-year-old attorney and author in Los Angeles, learned she had autism only a year ago, but has always known she operates on logic instead of nuance to decipher the world and often misses various social cues. She says the reason people with autism face so much abuse is so many non-autistic people lie, so many autistic people may miss those lies. She’s always created rules to help her navigate the world and has adopted new ones after her official diagnosis, like guidelines for spotting and avoiding sexual harassment, which she experienced at work. She now makes sure she meets people in public places. For Asasumasu, life got better in high school because she learned to fight back and befriended other students she calls “weird” and “scary”, which helped keep bullies away. She now also studies aikido, a defensive martial art which helps her wait to assess a situation before judging if it’s a threat, although she has continued experiencing abusive relationships in adulthood. She also relies on pattern recognition to predict and avoid abuse. She says it’s ultimately society that must change, not people with autism, and we should be able to deal with the fact that there’s multiple ways of being; for all the kinds of civility you hear about in the general world, you never hear people telling others to not be jerks to people different from them.

One of my own strategies was developed when I was very young – I’ve found that what has worked for me tends to work for both people with autism and the general population; my parents refer to this as “being the canary in the mine.” As a visual learner I was always attracted to movies and television episodes; in fact this attraction helped me overcome early spoken language deficits.  Therefore, finding television episodes to illustrate situations has always been a learning tool.  If you want an example of someone who hears about someone they know experiencing abuse, there is an episode of Full House called “Silence is Not Golden” where Stephanie learns one of her classmates is being abused by his father. I’m sure it’s available for purchase online. For dealing with anxiety and depression, I implore you to check out the hit Broadway musical, “Dear Evan Hansen”; it’s helped me with my feelings of anxiety and depression and I’m sure it can help yours, one reason it’s now my favorite musical ever. I’m also fortunate to have a loving and observant family who has my back day to day. My sister was only 10 when she beat up the kids who were bullying me. Without this support, instead of writing about the targets in this article, I could have been writing about my own abuse. Talk to the vulnerable people in your life, and if you are a target, speak out. Change is possible.