Child abuse, and how systems of care ought to approach it, is a tangled subject. When autism enters the picture, those tangles turn into knots. Yet, the statistics regarding the experience of abuse among autistic youth (and adults) are remarkable.
A study of adult women retrospectively reflecting on childhood experiences brought forth an alarming coincidence between autism traits and adverse childhood experiences. In a sample of 1,077 individuals, among those with higher levels of autistic traits, 40 percent reported sexual abuse, 23 percent emotional or physical abuse, and 10 percent met the criteria for PTSD (Roberts et al., 2015).
Further, research examining records from social agencies found that children diagnosed with autism are at approximately twice the risk of having cases of indicated child abuse compared to their typically developing peers (McDonnell et al., 2019). The study found that those without an intellectual disability were more likely to weather physical abuse, and those with an intellectual disability, in addition to autism, were also more likely to be neglected.
According to the study, "tantrums," aggression, and hyperactivity were found to correlate with abuse in both populations, yet it's tricky to determine the exact relationship. When youth experience abuse or otherwise have unmet needs or are experiencing violence, they often act out in response.
Another study in Tennessee found that more than twice as many reports were made for abuse of autistic youth than neurotypicals, yet those reports were a third less likely to lead to further investigation of abuse for families involving autistic youth (Fisher et al., 2019). Despite this, the study found abuse was nearly equal whether the child was neurotypical or autistic.
One might ask why a connection between autism and abuse exists, as we explore how to approach it. Some might suggest that the behavioral challenges facing families with an autistic child might influence rates of abuse, but there is little evidence to support this point.
Another explanation may be intergenerational trauma. It is well-established that autism runs in families, meaning that parents of autistic youth are also more likely to have experienced abuse. Research investigating adverse childhood experiences among autistic children and their parents found that both reported, on average, a significantly greater number of adverse childhood experiences. Similarly, a study of 527 autistic youth found trauma carried by the parents, as reflected by meeting the criteria for post-traumatic stress disorder, to be a significant risk factor for abuse (McDonnell et al., 2022).
Please note that a vast majority of autistic parents do not go on to abuse their children, regardless of adverse childhood experiences. Many parents of autistic children (whether autistic or neurotypical themselves) are phenomenal parents.
In most parts of America, child abuse investigation and intervention work like this: An initial report is made to a child abuse hotline. If the report is "accepted" and further action is deemed necessary, the state's child protective agency will investigate. This often involves interviews with youth, their families, and other adults in their lives, as well as steps such as examining living quarters. Once this is completed, reports are either substantiated or unfounded. If unfounded, no further action is taken. If substantiated, the family may be offered (or mandated to) family preservation services such as regular meetings with a case worker, parenting classes, or drug/alcohol treatment. When it's believed that the child can not safely remain in the home while this care plan is initiated, they may be placed to live with a relative, a foster parent, in a group home, or in residential treatment.
The system is grinding for everyone, regardless of neurotype.
Each family's situation is unique. Still, care systems may not be prepared to approach the especially complex picture that comes into play when autistic youth make contact with child protective services. Family and cultural narratives that scapegoat the autistic child and an overemphasis on autism risk a downplay of abuse, leading to a lack of intervention or inappropriate intervention. Myths that autistic youth do not have the same sort of empathy as neurotypical youth, and communication barriers make it especially difficult for these youth to advocate for themselves in a system where self-advocacy is already extremely tough.
In addition, if intergenerational trauma or the needs of neurodivergent families are not taken into account, services offered might not address the right challenges while potentially causing harm in the process. Sensory sensitivities, meltdowns, shutdowns, and coping with a world created from a blueprint of neurotypical brains can be stressful to navigate for anyone. Without a solid understanding, case workers risk missing out on providing the appropriate support.
At present, there are few autism-specific initiatives within the child welfare system. How systems of care service neurodivergent youth and education of actors throughout the child welfare system are initiatives with merit. Similarly, neurodiversity-affirming resources for families may serve to decrease stress, empower youth, and help parents understand themselves and their children's needs, thereby potentially preventing abuse. All children deserve kindness and safety.
References
Andrzejewski, T., DeLucia, E. A., Semones, O., Khan, S., & McDonnell, C. G. (2023). Adverse childhood experiences in autistic children and their caregivers: Examining intergenerational continuity. Journal of Autism and Developmental Disorders, 53(7), 2663-2679.
Fisher, M. H., Epstein, R. A., Urbano, R. C., Vehorn, A., Cull, M. J., & Warren, Z. (2019). A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder. Autism, 23(5), 1335-1340.
McDonnell, C. G., Andrzejewski, T., & Dike, J. (2022). Intergenerational trauma: Parental PTSD and parent‐reported child abuse subtypes differentially relate to admission characteristics in the autism inpatient collection. Autism research, 15(4), 665-676.
McDonnell, C. G., Boan, A. D., Bradley, C. C., Seay, K. D., Charles, J. M., & Carpenter, L. A. (2019). Child maltreatment in autism spectrum disorder and intellectual disability: Results from a population‐based sample. Journal of child psychology and psychiatry, 60(5), 576-584.
Roberts, A. L., Koenen, K. C., Lyall, K., Robinson, E. B., & Weisskopf, M. G. (2015). Association of autistic traits in adulthood with childhood abuse, interpersonal victimization, and posttraumatic stress. Child abuse & neglect, 45, 135-142.
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