\n\u201cThese experiences don’t go away. They live in our subconscious and they are often triggered by the proximity of another person in an intimate relationship. Like I have [experienced] with my wife, who I absolutely adore. But feeling cornered or closed in, or any of those sorts of feelings can trigger me to feel really uncomfortable\u2026 All the sensory things that go along with somebody being close to you, with someone’s breath on top, you know, breathing on you, and it\u2019s pretty uncomfortable if you’ve been exposed to sexual abuse.\u201d<\/span><\/i><\/p>\nDr. Wenn Lawson, autistic author, professor, and advocate (Interview, August 2023)<\/i><\/strong><\/p>\n<\/blockquote>\nSuicide rates in autism range from 11% – 66% and significantly more premature deaths are caused by suicide in autism than in the general population (Hedley & Uljarevi\u0107, 2018; K\u00f5lves et al., 2021; Kirby et al., 2019).Trauma derived from sexual abuse during childhood is a significant and specific risk factor for suicidal ideation in adulthood (Bahk et al., 2017). Feelings of shame and guilt rooted in sexual abuse have been implicated in suicide risk and some therapies proactively address these targets to decrease depressive and suicidal symptoms in trauma survivors (Olliver et al., 2022; Kealy et al., 2017; Sekowski et al., 2020; Alix et al., 2017). The high rates of sexual victimization, trauma, and suicidality in autism merit specific and immediate investigation into their intersection. To allow comprehensive investigation and intervention development, deliberate action must be taken to remove the shame and guilt that surround these topics.\u00a0<\/span><\/p>\n\n\u201cI would say decreasing the shame around [sex] is the most important thing we can do. [We need to] make it something that is okay to talk about. [That] requires teaching kids how and with whom to talk about it appropriately. If we can make it something that’s okay to talk about, to ask questions about, to notice – \u2018Oh, I see that this thing is happening. What is that?\u2019 – Then that provides the opportunity for education. For fewer high risk situations, for asking for help when it’s needed, and for reporting when something terrible does happen.\u201d<\/span><\/i><\/p>\nAmanda Tami, LPC, BCBA (Interview, August 2023)<\/i><\/strong><\/p>\n<\/blockquote>\n<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div>
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Risk Factors<\/strong><\/h2>\nSexual knowledge and education<\/strong><\/h3>\nLack of sexual knowledge is a significant predictor of sexual victimization, but actual knowledge partially mediates that risk (Joyal et al., 2021; Chianese et al., 2021; Brown-La. voie et al., 2014) For example, a 2021 study on psychosexual knowledge and education found that autistic adults had less sex-related knowledge and higher rates of victimization compared with neurotypical respondents (Chianese et al., 2021). Research also shows that autistic adults and caregivers universally report dissatisfaction with the sexual education provided by schools due to a lack of autism accommodations in the content and teaching style (Hannah & Stagg, 2016; Barnett & Maticka-Tyndale, 2015; Lehan-Mackin et al., 2016). In most cases, primary responsibility for sexual education falls to parents and caregivers who lack professional materials and support and may feel uncomfortable discussing such topics (Lehan Mackin et al., 2016; Kenny et al., 2020). A 2019 literature review found that caregivers of autistic children frequently omit critical information about relationships and sexual health, like how to decline unwanted sex, not pressure others to have sex and correct condom usage (Solomon et al.; Holmes & Himle, 2014; Mehzabin & Stokes, 2011; H\u00e9nault, 2006). Compoundingly, more than half of healthcare providers note that their lack of training and access to accurate information hinders providing sufficient psychosexual education to autistic patients (Holmes et al., 2014: Volkmar et al., 2006).\u00a0<\/span><\/p>\n\n\u201cFor a lot of people, there is no good sex education. And then you add an autism diagnosis to that and [they need to consider] how you teach someone, potentially with communication challenges, something that you’re not allowed to talk about, in a way that they will understand\u2026 For all people, I think that first and foremost, consent needs to be addressed.\u201d<\/span><\/i><\/p>\nAmanda Tami, LPC, BCBA (Interview, August 2023)<\/i><\/strong><\/p>\n<\/blockquote>\nDue to this lack of social support and education, many autistic individuals turn to the internet for information about relationships and sexual interactions (Chianese et al., 2021). Internet sources are not always verifiable, and many sites promote unrealistic and sometimes unsafe conceptions of what intimacy, romance, and sexual interactions look like (Solomon et al., 2019; Pecora et al., 2016). Without complete sexual knowledge and social understanding, autistic individuals may not understand that what they see online is not acceptable or safe in real life (Hooley et al., 2020; Weiss & Fardella, 2018; Latvala et al., 2022). Rates of sexual perpetration by autistic individuals are similar to the non-autistic population (Young & Cocallis, 2023; Weiss & Fardella, 2018; Dewinter et al., 2016). However, the intersection of sexual knowledge, victimization, and perpetration is complex. For example, parent-report studies consistently record autistic children as less experienced in typical sexual behaviors while simultaneously displaying inappropriate sexualized behaviors. These may include allowing or seeking physical contact with family members\/friends, touching themselves or others inappropriately, and intrusive dating behaviors that can be interpreted as stalking (Dekker et al., 2017; Ginevra et al., 2017; Stokes et al., 2007; 2005).<\/span><\/p>\n\n[We often] try to find the things we can relate to on the internet that we might not be able to find in everyday life connecting to other people\u2026 So [if someone is really] into My Little Pony, they will type into a search engine something about horses, ponies, anything to do with riding. And very quickly things to do with pornography will come up. And unfortunately, that means that they watched things which are pretty scary\u2026 modern day porn is pretty aggressive and misogynistic and does not talk about consent and respect or any of those things. And then they think, \u2018Oh, well, this is what you have to do\u2019 and may attempt to do that on somebody else, which can get them into a lot of trouble.\u201d<\/span><\/i><\/p>\nDr. Wenn Lawson, autistic author, professor, and advocate (Interview, August 2023)<\/i><\/strong><\/p>\n<\/blockquote>\nPerpetrators of sexual victimization are often related to or trusted by autistic individuals, making it especially difficult for the victim to recognize abuse or manipulation (Pearson et al., 2022). Up to 50% of affected children are abused by someone the family trusts and instances have been recorded within sports teams, religious institutions, hospitals, and other places and organizations generally trusted by parents and caregivers (Indiana Center for Prevention, 2022; Blakemore et al., 2017; Daniels-White et al., 2023). There is a glaring need for autism-specific education around consent, self-awareness and relationship skills. To best protect autistic children, such education must take place at every level, from individuals and families to clinicians and hospitals.\u00a0<\/span><\/p>\n\n\u201cThe sex education [programs] \u2026 might tell you how to not get pregnant\u2026 but that is not teaching you consent, respect, mutuality. It\u2019s not teaching you how precious and beautiful a relationship could be. And it’s certainly not teaching in the way that autistic young people learn.\u201d<\/span><\/i><\/p>\nDr. Wenn Lawson, autistic author, professor, and advocate (Interview, August 2023)<\/i><\/strong><\/p>\n<\/blockquote>\nGiven the rate of sexual victimization, lack of education, and vulnerability of many autistic children and adolescents, caregivers and practitioners strongly assert the need for autism-specific sex education curricula and safety guidelines ( Barnett & Maticka-Tyndale, 2015; Lehan-Mackin et al., 2016). This is especially important for autistic individuals with profound disabilities and their families. The discussion of sexual victimization in autism is still in its infancy and there is much to be done to safeguard this population. Members of the autism community must continue to build acceptance and understanding around autistic sexuality and call more attention to the social and educational constructs that make this population vulnerable to abuse. As investigations into experiences of sexual victimization in autism continue, we will be able to create specific education and support programs for individuals, families, schools and practitioners.\u00a0<\/span><\/p>\n\n\u201cA rewrite on how we work with traumatized young people, especially autistic young people is really important\u2026 One in thirty-eight kids will be somewhere on the spectrum. There are many more of us now. And yet the world’s education systems and traditional ways of relating in a society haven’t changed. They’re not keeping up with what the young people actually need. So that’s pretty scary.\u201d<\/span><\/i><\/p>\nDr. Wenn Lawson, autistic author, professor, and advocate (Interview, August 2023)\u00a0<\/i><\/strong><\/p>\n<\/blockquote>\n