Review Journal of Autism and Developmental Disorders (2023) 10:576–594

https://doi.org/10.1007/s40489-022-00310-0

REVIEW PAPER

A Systematic Review of Sexual Violence Among Autistic Individuals

Janey E. Dike1 · Elizabeth A. DeLucia1 · Olivia Semones1 · Theresa Andrzejewski2 · Christina G. McDonnell2

Received: 24 November 2021 / Accepted: 11 March 2022 / Published online: 22 March 2022
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022

Abstract
This study systematically reviewed the sexual violence literature among autistic individuals by identifying prevalence rates,
assessment approaches, and outcomes of sexual violence exposure, as well as risk and protective factors. Overall, 22 articles
met inclusion criteria. Nine studies reported elevated rates of sexual violence in autistic samples as compared to non-autistic
peers, particularly with regard to adult victimization. Evidence emerged for increased risk among autistic girls and women.
Results suggest autistic individuals experience similar trauma outcomes to non-autistic peers, though risk factors specific
to autistic groups emerged. Further research is needed to capture more diverse samples among autistic populations and to
assess for trauma outcomes and interventions to address sexual violence.

Keywords Autism · ASD · Sexual violence · Trauma · Sexual victimization

Sexual violence is a significant global public health concern et al., 2021). Given the high prevalence of sexual violence
that broadly refers to sexual activity without consent. More and its significant negative sequelae, the development of
specifically, the Centers for Disease Control and Prevention interventions to support those who have experienced sexual
(CDC) define sexual violence as a “sexual act that is com- violence is a critical research and healthcare priority.
mitted or attempted by another person without freely given There are striking inequities and disparities in sexual
consent of the person being harmed, or against someone violence rates, which are higher in minoritized communi-
who is unable to consent or refuse” (Basile et al., 2014). ties. Black individuals in the USA are more likely to expe-
Sexual violence involves a range of experiences, including rience sexual violence with respect to other racial-ethnic
completed or attempted penetrative and non-penetrative acts, groups (McLaughlin et al., 2019). Research estimates that
unwanted sexual contact, and non-contact unwanted sexual sexual minorities face significantly elevated rates of lifetime
experiences. Sexual violence is highly prevalent (Abrahams sexual violence (20.8–74.9%; Blondeel et al., 2018). These
et al., 2014), and is associated with a range of negative psy- disparities in sexual violence require urgent intervention,
chological and physical health consequences across the lifes- and they may beget ongoing inequities in health outcomes
pan. For example, child sexual abuse is a key risk factor for and compounded intersectional experiences of vulnerability
the development of psychopathology, including increased and disparity (see Armstrong et al., 2018).
likelihood of posttraumatic stress disorder (PTSD), mood,
anxiety, and substance use disorders, and sexual revictimiza-
tion (Noll, 2021). Sexual abuse is the most synergistically Sexual Violence and Autism
reactive of all adverse childhood experiences, meaning that
sexual abuse is likely to co-occur with other types of adverse A critical aspect of identity that has been understudied in
experiences to increase risk for negative outcomes (Briggs sexual violence research is autism. Autism spectrum dis-
order (ASD) has historically been defined as a neurodevel-
opmental disorder characterized by social communication
* Janey E. Dike difficulties and restricted, repetitive behaviors (APA, 2013).
janeyd@vt.edu
However, in contrast to the medical model (i.e., definitions
1
Department of Psychology, Virginia Polytechnic Institute of ASD based on the Diagnostic and Statistical Manual for
and State University, Blacksburg, VA 24061, USA Mental Disorders [DSM]), neurodiversity and social models
2
Department of Psychology, University of Wyoming, Laramie, of disability center autism as a core aspect of identity. In this
WY 82071, USA

13

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Review Journal of Autism and Developmental Disorders (2023) 10:576–594 577

review, we consider autism within these frameworks, and experienced by autistic individuals. Relatedly, autistic adults
as such we use identity-first language (autistic person rather have identified the development of trauma-focused care
than person with autism, and disabled person rather than approaches is a top priority for mental health research that
person with disability) and non-medicalized language (e.g., they would like for researchers and practitioners to empha-
autism and “on the spectrum” rather than ASD or autism size (Benevides et al., 2020). Thus, understanding sexual
spectrum disorder) to be consistent with the neurodiversity violence in autism is a critical research and clinical priority.
framework, social models of disability, and preferences
expressed by the autistic community (Bottema-Beutel et al.,
2021; Kapp et al., 2013). Aims of the Review
Despite the fact that societal stigma, ableism, and exclu-
sion may place disabled individuals at increased likelihood The goal of the current systematic review is to ascertain
of experiencing victimization (McGilloway et al., 2020), dis- the state of the literature on sexual violence among autistic
ability is a broad and heterogeneous category and it is criti- individuals across the lifespan. Our specific aims are to (1)
cal to consider the unique experiences of autistic individuals. identify studies that have analyzed rates of sexual violence
However, there is a paucity of research that has considered in autism to inform prevalence, (2) summarize participant
sexual violence in autism. The most recent meta-analysis sociodemographic characteristics in existing studies, to con-
on sexual violence and disability identified only 4 studies sider whether prior research has been inclusive of a range of
focused on autistic individuals (Mailhot Amborski et al., identities among autistic individuals, which is particularly
2021). Much of the existing research on autism and trauma essential because of the pervasive exclusion of minoritized
or violence has focused on maltreatment or adverse child- individuals in autism research, (3) identify methodological
hood experiences broadly, finding significantly higher rates characteristics of prior studies, including sexual violence
of traumatic experiences among autistic people (see Hoo- assessment approaches, (4) review the sequelae of sex-
ver, 2015; Kildahl et al., 2019; for reviews). Although this ual violence among autistic individuals, and (5) consider
research may be informative for understanding sexual vio- whether risk or protective factors (those associated with
lence in autism, sexual violence is associated with a unique increased or decreased likelihood of sexual violence and
and/or more severe set of negative sequelae (Noll, 2021). sequelae) and intervention strategies have been identified.
Moreover, autistic individuals may experience the negative
sequelae associated with sexual violence to a more signifi-
cant degree, and/or in a qualitatively different manner than
non-autistic individuals. Autistic individuals may be more Method
likely to experience a higher level of posttraumatic stress
and related symptoms after experiencing a trauma, perhaps Search Methods
due to heightened vulnerability to emotion regulation dif-
ficulties, sensory processing differences, and systemic dif- The search was conducted according to PRISMA guidelines
ficulties with accessing support and receiving appropriate and pre-registered on Prospero (blinded for review). Search
interventions, all of which may potentiate negative sequelae terms were selected for the two primary variables of inter-
after traumatic event exposure (Hoover, 2015; Kildahl et al., est, autism, and sexual violence exposure, with decisions
2019). Autistic adults may present with posttraumatic stress informed by keywords used in related reviews and literature.
symptoms that are not fully captured by current diagnostic Searches were conducted across four databases in August
criteria and symptom measures, such as decreases in com- 2020: PsycINFO, PubMed, ERIC, and Medline.
munication that are not “core” symptoms of PTSD as tradi-
tionally conceptualized (Mehtar & Mukaddes, 2011). Selection Criteria
Beyond identifying rates and negative consequences of
sexual violence in autism, it is critical to identify protective Regarding inclusion criteria, studies were limited to those
factors, as well as those associated with risk, to inform inter- that were peer-reviewed and printed in the English language.
vention and identify who may be at particular risk for sexual Studies were included if participants had an autism diagnosis
violence to develop more personalized support strategies. (or met criteria for an autism classification as determined
There are few empirically validated assessment, prevention, by investigators) and had been exposed to sexual violence.
or intervention approaches to address traumatic stress, such Participants of all ages were included. Excluded studies were
as sexual violence, for autistic youth and adults (Hoover, single-case designs, case studies, reviews, and studies on
2015; Kildahl et al., 2019). Thus, unaddressed trauma may broader sexual experiences that did not fall under sexual
partially contribute to high rates of co-occurring mental violence or studies that did not parse out sexual violence
and physical health concerns and healthcare disparities from broader trauma.

13

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578 Review Journal of Autism and Developmental Disorders (2023) 10:576–594

All screening of titles, abstracts, and full-text analyses (1; 4.55%; Dewinter et al., 2016); Australia (1; 4.55%; Pec-
were conducted using Covidence software. One researcher ora et al., 2019); France (1; 4.55%; Paul et al., 2018); and
(JED) conducted the initial search process and title/abstract Istanbul (1; 4.55%; Mehtar & Mukaddes, 2011).
review. Next, one researcher (JED) coded all articles Regarding age, 13 studies (59%) included youth
screened for full-text review while two other researchers (age ≤ 21 years; Bleil Walters et al., 2013; Brenner et al.,
(EAD, ODS) split co-coding responsibilities, such that 2018; Cederborg et al., 2009; Christoffersen, 2020; Dewin-
each article screened for full-text review was examined by ter et al., 2016; Greger et al., 2015; Hall-Lande et al., 2015;
two independent authors. Results indicated excellent initial Kennedy et al., 2019; Mandell et al., 2005; McDonnell
agreement (percent agreement = 77.78%). Disagreements et al., 2019; Mehtar & Mukaddes, 2011; Ohlsson Gotby
were resolved via an additional author (CGM). Articles that et al., 2018; Paul et al., 2018). Eight studies included adults
met criteria were examined for primary and secondary study (age ≥ 18) (36.36%; Bargiela et al., 2016; Brown-Lavoie
outcomes, including prevalence rates of sexual violence, et al., 2014; Griffiths et al., 2019; Hartmann et al., 2019;
reported outcomes (sequelae) following exposure, method- Pecora et al., 2019; Rumball et al., 2020, 2021; Weiss &
ological features (study design, participant characteristics, Fardella, 2018) and one included college students (4.55%;
assessments used), and whether risk and resiliency factors Brown et al., 2017).
(related to exposure or exposure sequelae) or intervention With attention to sex and gender, one study included only
strategies were identified. The reference lists of full-text girls/women (4.55%; Bargiela et al., 2016), two included
included articles and studies that cited the full-text included only boys/men (9.09%; Bleil Walters et al., 2013; Dewinter
articles were also searched to identify any additional papers. et al., 2016), and 14 used samples consisting of men/boy and
women/girl identities (63.64%; Brenner et al., 2018; Brown-
Lavoie et al., 2014; Cederborg et al., 2009; Christoffersen,
Results 2020; Greger et al., 2015; Kennedy et al., 2019; Mandell
et al., 2005; McDonnell et al., 2019; Mehtar & Mukaddes,
Database searches yielded 481 studies to be screened. 2011; Ohlsson Gotby et al., 2018; Paul et al., 2018; Rum-
After removing 170 duplicates, 311 underwent the title ball et al., 2020, 2021; Weiss & Fardella, 2018). Only four
and abstract screening. Of these, 72 full-text articles were studies (18.18%; Brown et al., 2017; Griffiths et al., 2019;
assessed for eligibility by two independent researchers. Six- Hartmann et al., 2019; Pecora et al., 2019) included partici-
teen studies fulfilled all eligibility criteria and were included pants who identified as non-binary. One study (4.55%; Hall-
in the systematic review. After the secondary citation search, Lande et al., 2015) did not report the sex or gender of par-
six additional studies were found to meet inclusion crite- ticipants. Regarding identity terminology, 10 studies utilized
ria, and thus, 22 total studies were analyzed for the review the term “gender” when collecting demographic information
(see Fig. 1 for visual of this process). Key aspects of studies (Bargiela et al., 2016; Brown et al., 2017; Christoffersen,
are summarized in Table 1. Additional study information 2020; Hartmann et al., 2019; Kennedy et al., 2019; Mandell
(location, detailed sociodemographic characteristics, and et al., 2005; McDonnell et al., 2019; Mehtar & Mukaddes,
autism measurement) is summarized in the text (and also 2011; Rumball et al., 2020, 2021), four used the term “sex”
in Table 2). (Brown-Lavoie et al., 2014; Dewinter et al., 2016; Greger
et al., 2015; Ohlsson Gotby et al., 2018), two did not specify
Location and Sociodemographic Characteristics whether “gender” or “sex” was used to collect demographic
of Participants identity information (Bleil Walters et al., 2013; Cederborg
et al., 2009), three used the terms “sex” and “gender” (Bren-
Regarding location, the majority (31.82%, n = 7) of the ner et al., 2018; Paul et al., 2018; Weiss & Fardella, 2018),
reviewed studies were conducted in the USA (7; Bleil Wal- and two inquired about both sex or gender assigned at birth
ters et al., 2013; Brenner et al., 2018; Brown et al., 2017; and current gender identity (Griffiths et al., 2019; Pecora
Hall-Lande et al., 2015; Hartmann et al., 2019; Mandell et al., 2019).
et al., 2005; McDonnell et al., 2019). Less than one-fourth Only eight out of the 22 studies reviewed (36.36%)
of studies were conducted in the UK (5; 22.73%; Bargiela reported on race and ethnicity. Of these studies, six
et al., 2016; Griffiths et al., 2019; Kennedy et al., 2019; included samples wherein the majority of participants
Rumball et al., 2020, 2021). The remaining studies included (over half) were White (Bleil Walters et al., 2013; Hall-
in the review hailed from eight different countries: Canada Lande et al., 2015; Mandell et al., 2005; McDonnell
(2; 9.09%; Brown-Lavoie et al., 2014; Weiss & Fardella, et al., 2019; Rumball et al., 2020; Weiss & Fardella,
2018); Sweden (2; 9.09%; Cederborg et al., 2009; Ohlsson 2018). Brown et al. (2017) included autistic students and
Gotby et al., 2018); Denmark (1; 4.55%; Christoffersen, reported that 39.2% identified as White and 24.1% identi-
2020); Norway (1; 4.55%; Greger et al., 2015); Netherlands fied as Asian or Asian American, while Hartmann et al.

13

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Review Journal of Autism and Developmental Disorders (2023) 10:576–594 579

Fig. 1  Reported number of

records identified from each Identification of studies via databases and registers
database, screening procedures,
and a final report of included
articles Records identified from*:

Identification
Databases (n = 481) Records removed before
screening:
PSYCInfo (n = 219)
Duplicate records removed
PubMed (n = 142)
(n = 170)
Medline (n = 82)
ERIC (n = 38)

Records screened Records excluded**

(n = 311 ) (n = 239)

Reports sought for retrieval Reports not retrieved

(n = 72) (n = 0)
Screening

Reports excluded:
Reports assessed for eligibility Reason 1: Study does not
(n = 72) include ASD (or related)
population. (n = 22)
Reason 2: Study does not
include parsed out data
related to sexual violence,
assault, abuse, etc. (n = 14)
Reason 3: Wrong study
design (i.e., case study; n =
Studies included in review 16)
Included

(n = 16) Reason 4: Not in English

Reports of included studies language (n = 3)
(n = 16) Reason 5: Correction to
Following forward and backward original manuscript (n =1)
searching of included articles, 6
more articles were added to the
total number of included studies
(n = 22)

(2019) reported that their sample was 32% White, 2% Study Designs
Black or African American, 26% Hispanic or Latino, 2%
Native American, and 4% biracial or multiracial. The majority of studies were cross-sectional and utilized
Only 7 studies (31.8%) reported on some dimensions survey or questionnaire methodologies (n = 11; Bleil Wal-
of socioeconomic status. Two studies (Hartmann et al., ters et al., 2013; Brenner et al., 2018; Brown et al., 2017;
2019; McDonnell et al., 2019) reported on average house- Brown-Lavoie et al., 2014; Dewinter et al., 2016; Griffiths
hold income, and seven reported participant or parent et al., 2019; Hartmann et al., 2019; Paul et al., 2018; Pec-
education or employment (Bargiela et al., 2016; Brown- ora et al., 2019; Rumball et al., 2020, 2021) or interview
Lavoie et al., 2014; Griffiths et al., 2019; Hartmann et al., methods to assess sexual violence exposure (n = 5; Bargiela
2019; McDonnell et al., 2019; Rumball et al., 2020; Weiss et al., 2016; Cederborg et al., 2009; Mandell et al., 2005;
& Fardella, 2018). Christoffersen (2020) reported that Mehtar & Mukaddes, 2011; Weiss & Fardella, 2018). A
2.2% of the comparison group and 2.6% of the disability minority of studies (n = 3) were population-based and uti-
group lived in “disadvantaged areas.” lized state or federal records to examine sexual violence

13

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 580

Table 1  Summary of studies

Year & authors Total N Sample Sexual violence Rate of sexual vio- Rate significantly Gender Id Sequelae of sexual Risk or protective fac-
measures lence among autistic higher than compari- entity differences violence tors identified?

13
participants son group? among AS groups?

Bargiela et al., 2016 14 Autistic girls and Semi-structured 64% Not examined (no Not examined (all Not examined Not examined
women diagnosed interview assessing (9/14) comparison group) women sample)
in late adolescence for sexual abuse;
or adulthood self-report
Bleil Walters et al., 43 (total); 27 (autistic) Autistic and non- Childhood Trauma Mean ranks of Sexual No, mean ranks of Not examined (all- Sexual violence his- Not examined
2013 autistic male Questionnaire Abuse Scale fell comparison group male sample) tory was not signifi-
youth ordered by (CTQ), which within severe/ fell within severe/ cantly predictive of
Juvenile Court into assesses for child- extreme range extreme range depression scores
adolescent sexual hood abuse and (≥ 13) (≥ 13)
offenders program neglect; self-report
Brenner et al., 2018 350 All youth in the Demographic and 2.86% Not examined (no Not examined for History of abuse (not Not examined
autism inpatient Medical Intake (10/350) comparison group) sexual violence specific to sexual
collection (AIC) Form, which asks experiences violence) was
sample about youth’s related to greater
history of sexual irritability, lethargy,
abuse; caregiver intrusive thoughts,
report distressing memo-
ries, and loss of
interest
Brown et al., 2017 37,693 (total); 158 Undergraduate Survey assessed for 8.2% Yes, comparison Sexual victimization Not examined Not examined
(autistic) students forcible fondling, (13/158) group rate = 4.6% higher in autistic
sexual assault, women (61.5%) and
forcible rape, use of non-binary indi-
drugs to inca- viduals (23.1%) as
pacitate, forcible compared to autistic
sodomy, gang rape, men (15.4%)
and sexual assault
with an object; self-
report
Brown-Lavoie et al., 212 (total); 85 Autistic adult Sexual Experiences 78% Yes, comparison No sig. differences Not examined Low actual sexual
2014 (autistic) participants from Survey (SES), group rate = 47.4%; between autistic knowledge associated
community and which assesses for autistic males more men and women with higher rates of
private agencies and sexual victimization likely to report sexual violence
age-matched non- situations; self- sexual victimization
autistic peers report than non-autistic
males; autistic
females more likely
to report unwanted
sexual contact and

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coercion than non-
autistic females
Cederborg et al., 2009 33 (total); 11 (autistic) Children and youths Forensic interviews 72.7% No, comparison group Not examined Not examined Not examined
with intellectual dis- concerning sexual rate of CYIDs with
abilities (CYIDs) abuse; self-report developmental
delays = 100%
Review Journal of Autism and Developmental Disorders (2023) 10:576–594
 Table 1  (continued)
Year & authors Total N Sample Sexual violence Rate of sexual vio- Rate significantly Gender Id Sequelae of sexual Risk or protective fac-
measures lence among autistic higher than compari- entity differences violence tors identified?
participants son group? among AS groups?

Christoffersen, 2020 679,683 Youth from 11 Collected through 27% of sexual abuse Yes, Not examined in Not examined Family vulnerability
national birth police records; victims were OR = 3.8 (95% autistic sample as risk factor for
cohorts (1984– included reports of autistic CI = [3.6, 4.0]) victimization for
1994) rape, sexual abuse, autistic and non-
sexual exploitation, autistic youth, OR
incest, and indecent range = 1.2–2.0;
exposure Alcohol abuse as
risk factor, OR = 1.6
(95% CI = [1.4, 1.9]);
Ethnic minority
status as protective
factor, OR = 0.7 (95%
CI = [0.6, 0.7]) for all
youth
Dewinter et al., 2016 90 (total); 30 (autistic) Adolescent boys Sexual history 6.67% No, comparison group Not examined (all- Not examined Not examined
recruited from pre- measured through a (2/30) rate = 0% male sample)
vious autism study questionnaire, with
or from nationwide sexual victimiza-
study tion as engaging in
any sexual activity
Review Journal of Autism and Developmental Disorders (2023) 10:576–594

against one’s own

will; self-report
Greger et al., 2015 335 (total); 75 Youth data from Assessed with victim 27.3% of those who No, total sample rate Not examined in Autistic youth who Not examined
(autistic) Mental Health in of sexual abuse reported sexual of sexual abuse or autistic groups reported maltreat-
Adolescent Resi- item from the Child abuse or rape were rape = 27%; ment (not specific
dents in the Child and Adolescent autistic OR (p) to sexual violence)
Welfare System Psychiatric Assess- = 1.65 (.125) had higher rates of
research project ment (CAPA); MDD and suicide
self-report attempts than those
with no maltreat-
ment history

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13
581
 Table 1  (continued)
582

Year & authors Total N Sample Sexual violence Rate of sexual vio- Rate significantly Gender Id Sequelae of sexual Risk or protective fac-
measures lence among autistic higher than compari- entity differences violence tors identified?

13
participants son group? among AS groups?

Griffiths et al., 2019 694 (total); 426 Adults recruited from Vulnerability Experi- Forced into sexual Yes, forced into sex- Not examined Elevated rates of Autistic adults who had
(autistic) Cambridge Autism ences Quotient activity by partner ual activity by part- comorbid disorders been in relationships
Research Database, (VEQ), which has (20%), physically ner (control = 9%), in autistic adults were more likely to
Cambridge Psychol- subscales related to forced into sexual OR = 2.73; (not specific to report sexual abuse
ogy participant victimization and activity (26%), physically forced sexual victimiza- by a partner com-
database, and abuse; self-report pressured into sex- into sexual activity tion group), such pared to non-autistic
adverts ual activity (44%), (control = 15%), as depression (294, adults who had been
sexually victimized OR = 2.08; 64%), anxiety dis- in relationships
as a child (30%) pressured into order (198, 43%),
sexual activity GAD (96, 21%),
(control = 23%), and PTSD (73,
OR = 2.66 16%) compared to
No sig. differ- non-autistic groups;
ence in child lower life satisfac-
sexual victimization tion among autistic
(control = 20%, than non-autistic
OR = 1.71) adults
Hall-Lande et al., 9536 (total); 162 Secondary youth data Presence of maltreat- 8.3% of all 314 alle- No, no disability con- Not examined Not examined Not examined
2015 (autistic) from the Minnesota ment found in gations in autistic trol group = 8.4%;
Linking Informa- Social Service group were for other disability
tion for Kids project Information System sexual abuse group = 8.9%
with accepted cases database
of alleged maltreat-
ment
Hartmann et al., 2019 100 Young autistic adults Sexual Experiences Self-reported sexual Not examined (no Not examined Not examined Not examined
and their parents Survey (SES), victimization (62%) comparison group)
who were part of which assesses for v. caregiver report
the Sexuality in the sexual victimization (54%);
Autism Spectrum situations; self- self-reported rape
Study (SASS) report and caregiver (2%) v. caregiver
report report (3%)
Kennedy et al., 2019 113 (total); 15 Youth resided in Assessed for Child 80% of autistic No, comparison group Not examined Not examined Not examined
(autistic) Secure Children’s Sexual Exploitation females rate = 52%
Homes on welfare (CSE), known or (4/5) (25/48)
or criminal orders suspected history

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Review Journal of Autism and Developmental Disorders (2023) 10:576–594
 Table 1  (continued)
Year & authors Total N Sample Sexual violence Rate of sexual vio- Rate significantly Gender Id Sequelae of sexual Risk or protective fac-
measures lence among autistic higher than compari- entity differences violence tors identified?
participants son group? among AS groups?

Mandell et al., 2005 156 Autistic youth in the Caregivers were 16.6% Not examined (no Males less likely to Sexual abuse his- Risk factors signifi-
Comprehensive asked, “Has [child’s (26/156) comparison group) be sexually abused tory related to cantly predictive of
Community Mental name] ever been than females, sexually acting out/ sexual abuse: sexual
Health Services for sexually abused?” OR = 0.3 (95% being assaultive abuse towards others
Children and their CI = [.1–.9]) (OR = 8.6), being (OR = 10.6), running
Families Program sexually abusive away (OR = 5.4),
(OR = 12.3), attempted suicide
suicide-related (OR = 4.4);
issues (OR = 5.1), rates on par with non-
suicide attempts autistic peers
(OR = 6.9), self-
injury (OR = 2.8),
running away
(OR = 4.0), and psy-
chiatric hospitaliza-
tion (OR = 3.3);
rates on par with non-
autistic peers
McDonnell et al., 4988 (total); 316 Children whose Department of Social Not reported No, for autistic only Not examined in Not examined Having an ID associ-
2019 (autistic); 291 medical/educational Services records group, OR = 1.09 autistic or autis- ated with more severe
Review Journal of Autism and Developmental Disorders (2023) 10:576–594

(autistic + ID) records met South indicated reports or (95% CI = [0.33, tic + ID groups and varied experi-
Carolina Autism substantiations of 3.62]) ences of abuse (i.e.,
and Developmen- sexual abuse Yes, for autistic + ID sexual, physical, and
tal Disabilities group, OR = 3.13 emotional abuse)
Monitoring criteria; (95% CI = [1.75,
birth certificate 4.37])
records utilized for
comparison sample
Mehtar & Mukaddes, 69 Youth attendants of Schedule for Affec- 1.45% Not examined (no Not examined Not examined Not examined
2011 Autism Clinic of tive Disorders and (1/69) comparison group)
Child & Adolescent Schizophrenia
Psychiatry Depart- for School-Age
ment, Istanbul Children–Present
School of Medicine, and Lifetime Ver-
Istanbul University sion (K-SADS-PL),
which assesses for
traumatic exposure;
caregiver and/or
self-report
Ohlsson Gotby et al., 4500 Cohort twins recruited Coercive sexual Not reported Yes, for autistic Childhood autistic Not examined Presence of neurodevel-

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2018 in The Child and victimization females, OR = 2.97 traits associated opmental disorders
Adolescents Twin measured by two (95% [CI = 1.32– with later sexual related to sexual
Study in Sweden items adapted from 6.71]) victimization in victimization risk in
the Life Stressor No, for autistic males, males (ß = .340, females and males
Checklist-Revised OR = 4.06 (95% SE = 0.144) and
(LSC-R); self- CI = [0.93–17.73]) females (ß = .216,
report SE = 0.072)

13
583
 Table 1  (continued)
584

Year & authors Total N Sample Sexual violence Rate of sexual vio- Rate significantly Gender Id Sequelae of sexual Risk or protective fac-
measures lence among autistic higher than compari- entity differences violence tors identified?

13
participants son group? among AS groups?

Paul et al., 2018 92 (total); 39 (autistic) Autistic youth Juvenile Victimiza- 5 total sexual victimi- No, comparison Not examined Not examined Not examined
recruited from tion Questionnaire zation experiences group rate = 7 total
autism expert center (JVQ), which sexual victimization
and non-autistic assesses for victimi- experiences
youth recruited zation and aggres-
from private school sion; caregiver
classrooms report
Pecora et al., 2019 459 (total); 232 Adult autistic Sexual Behavior Regretted sexual Yes, autistic females Yes, autistic females Not examined Not examined
(autistic) participants had Scale, Version 3 experience (autistic more likely than more likely than
formal diagnoses (SBS-III), which female = 65.5%, non-autistic autistic males to
of high-functioning includes measures autistic females to engage experience regret
autism or Asperger of sexual knowl- male = 38.1%); in unwanted (OR = 2.64),
syndrome, or were edge, attitudes, engaged in sexual behav- engage in unwanted
non-autistic indi- and behaviors; unwanted sexual iors (OR = 2.56) sexual behaviors
viduals self-report behaviors (60%, and to experi- (OR = 2.55),
33.3%); experi- ence unwanted and experi-
enced unwanted sexual advances ence unwanted
sexual advances (OR = 2.21) sexual advances
(78.2%, 47.6%) No sig. differ- (OR = 3.34)
ences in regretted
sexual experiences
(OR = 1.53)
Rumball et al., 2020 59 Autistic adults Life Events Checklist 35.6% (21/59) Not examined (no Not examined Elevated rates of Not examined
(reporting any (LEC-5), which reported sexual comparison group) PTSD in autistic
autism spectrum assesses for trau- assault; 40.7% adults (not specific
disorder) matic life experi- (24/59) reported to sexual violence
ences; self-report other unwanted history)
sexual experiences
Rumball et al., 2021 82 (total); 38 (autistic) Autistic and non- Life Events Checklist 31.6% (12/38) Yes, comparison Not examined Greater PTSD symp- Not examined
autistic adults who (LEC), which reported group sexual assault tomatology among
completed an online assesses for trau- sexual assault; 50% rate = 0% (0/44); autistic group than
survey matic life experi- (19/38) reported other unwanted non-autistic group
ences; self-report other unwanted sexual experiences after at least 2
sexual experiences rate = 20.5% (9/44) reported traumatic
events
Weiss & Fardella, 87 (total); 45 (autistic) Autistic group: Juvenile Victimiza- 55.6% (25/45) Yes, sexual assault No significant differ- Not examined Social/communication
2018 ages 18–53 years tion Question- reported child by a peer as a ences reported abilities and emotion
(M = 30; SD = 1.48); naire—Adult sexual victimiza- child (OR = 7.3); regulation deficits
male (42.5%); self- Retrospective tion; 46.7% (21/45) sexual assault by were not related to

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reported minority Questionnaire reported adult known adult as an elevated risk
status (15.6%); (JVQ-AR), which sexual victimization adult (OR = 3.07);
IQ (M = 110.22; measures childhood attempted or
SD = 13.19) and adult victimiza- completed rape
tion and perpetra- (OR = 3.01) as an
tion; self-report adult

M mean, SD standard deviation, OR odds ratio

Review Journal of Autism and Developmental Disorders (2023) 10:576–594
 Table 2  Demographic characteristics of studies
Year & authors Location Study design Age Sex or gender Race/ethnicity Socioeconomic Autism measures IQ/cognitive ability
identity status

Bargiela et al., 2016 England Cross-sectional 22–30 years Gender: female Not reported Not reported Formal diagnosis Excluded to IQ > 70
assessment (M = 26.7, (100%); non- confirmed with (100%; M = 111.79)
SD = 2.3) binary not reported Autism Spectrum
Quotient-10 (AQ-
10)
Bleil Walters et al., USA Cross-sectional 15–20 years Male (100%); non- Caucasian (54%), Not reported Formal diagnosis Not reported
2013 assessment (M = 17.90) binary not reported African American prior to study
(35%), and His- using DSM-IV
panic (10%) criteria and the
Asperger’s Syn-
drome Diagnostic
Scale (ASDS)
Brenner et al., 2018 USA Cross-sectional 4–21 years Male (79%); female Caucasian (79%) Not reported Formal diagnosis Non-verbal IQ
assessment (M = 12.89, (21%); non-binary confirmed with (M = 76.4,
SD = 3.34) not reported Autism Diagnostic SD = 29.0); IQ < 70
Observation Scale (42%)
(ADOS-2) and
Social Communi-
cation Question-
Review Journal of Autism and Developmental Disorders (2023) 10:576–594

naire (SCQ)
Brown et al., 2017 USA Cross-sectional Age not reported; Autistic group: male Autistic group: Not reported ASD diagnosis Not reported
assessment undergraduate (59%, n = 93), Caucasian (39.2%; self-reported on
students female (27.8%, n = 62), Asian/ campus climate
44), gender queer Asian American survey
(3.8%, n = 6), (24.1%; n = 38)
transgendered
(1.3%, n = 2),
multiple or other
gender identities
(8.2%, n = 13);
Brown-Lavoie et al., Canada Cross-sectional Autistic group: Autistic group: Not reported Not reported ASD diagnosis Not reported
2014 assessment 19–43 years male (61.7%); self-reported and
(M = 27.83, female (38.2%); verified with the
SD = 4.33) non-binary not AQ
reported; hetero-
sexual (78.71%)

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Cederborg et al., Sweden Cross-sectional 5.4–23.7 years Female (75.8%; Not reported Not reported Diagnostic informa- IQ < 70 (69.7%)
2009 records (M = 13.2) at time n = 25); male tion on ASD
of interview (36%; n = 9); non- and/or DD was
binary not reported obtained from case
files, transcribed
interviews, and
court documents

13
585
 Table 2  (continued)
586

Year & authors Location Study design Age Sex or gender Race/ethnicity Socioeconomic Autism measures IQ/cognitive ability
identity status

13
Christoffersen, 2020 Denmark Cross-sectional 7–18 years Not reported Not reported Not reported ASD diagnosis Not reported
national sexual information
crime records collected from
psychiatric ward
records in the
Danish Psychiatric
Nationwide Case
Register
Dewinter et al., Netherlands Longitudinal assess- Autistic group: Male (100%); non- Not reported Not reported Formal diagnosis of FSIQ range: 76–142
2016 ment 16.64–20.29 years binary not reported autistic disorder
(M = 18.62, or Asperger’s
SD = 0.96) disorder verified
with the ADOS
Greger et al., 2015 Norway Cross-sectional 12–20 years Female (58.5%); Not reported Not reported Asperger Syndrome Not reported
assessment (M = 16.8) male (41.5%); non- Diagnostic Inter-
binary not reported view (ASDI)
Griffiths et al., 2019 England Cross-sectional Autistic group Autistic group: Not reported Not reported Formal autism diag- Not reported
assessment (M = 44 years, female (47%); nosis; AQ-10 was
SD = 14.37) male (40%); used to assess for
transgender/non- autistic traits
binary/other (12%)
Hall-Lande et al., USA Cross-sectional 1–20 years Not reported Autistic group: Autistic group: Formal diagnosis Not reported
2015 statewide records American Indian Free meal lunch identified using
or Alaskan Native eligibility (43.7%); MDE records if
(1.9%), Asian or reduced meal ASD was coded
Pacific Islander (11.8%); ineligible as the primary
(1.2%), Hispanic (29.9%) disability
(1.9%), Black, not
of Hispanic origin
(6.8%), White, not
of Hispanic origin
(88.3%)

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Review Journal of Autism and Developmental Disorders (2023) 10:576–594
 Table 2  (continued)
Year & authors Location Study design Age Sex or gender Race/ethnicity Socioeconomic Autism measures IQ/cognitive ability
identity status

Hartmann et al., USA Cross-sectional 18–30 years Male (52%); female White (32%), Black/ Median parent Formal diagnosis of IQ ≥ 110 (3%);
2019 assessment (M = 22, SD = 3) (47%); transgender African American income = $65,000 ASD confirmed 90–109 (35%);
(1%); heterosexual (2%), Hispanic/ with AQ-10 cutoff 70–89 (54%); < 70
only experiences Latino (26%), score of 6 (1%); unknown
(63%), heterosex- Asian (16%), (6%)
ual mostly (34%), Native American
heterosexual some- (2%), Bi/multira-
what more (2%), cial (4%)
1% (heterosexual
and homosexual
equally)
Kennedy et al., England Cross-sectional 12–17 years Autistic group: male Not reported Not reported SCQ cutoff score Not reported
2019 assessment (66.6%, n = 10); of 13
female (33.3%,
n = 5); non-binary
not assessed
Mandell et al., 2005 USA Cross-sectional M = 11.6 years, Male (69.2%, European-American Not reported Self-reported autism Not reported
national records SD = 3.8 n = 108); non- (70.5%, n = 110) or Asperger’s
binary not reported diagnosis
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McDonnell et al., USA Cross-sectional 2–8 years at start, Autistic and autis- Autistic and autis- Autistic median Records were N = 291 ASD individ-
2019 statewide records 18 years at con- tic + ID groups: tic + ID groups: income: $24,863; screened and uals with IQ ≤ 70
clusion male (84.5%; non-Hispanic autistic + ID coded for diagno-
77.7%); non-binary White (62.1%; median sis based on DSM-
not reported 42.8%), non- income = $21,103 IV ASD criteria
Hispanic African
American (30.1%;
52.4%), Hispanic
(4.5%; 3.1%), non-
Hispanic Other
(3.2%; 1.7%)
Mehtar & Mukad- Istanbul Cross-sectional 6–18 years Male (76.8%, Not reported Not reported Diagnosed with IQ 70–135 (27.5%),
des, 2011 assessment (M = 11.7, n = 53); female ASD subtypes mild mental retar-
SD = 3.3) (23.2%, n = 16); (AD, AS, PDD- dation (MR; 7.2%),
non-binary not NOS) based on moderate MR
reported DSM-IV-TR; (39.1%), severe MR
severity assessed (62.3%)

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with CARS

13
587
 Table 2  (continued)
588

Year & authors Location Study design Age Sex or gender Race/ethnicity Socioeconomic Autism measures IQ/cognitive ability
identity status

13
Ohlsson Gotby Sweden Longitudinal assess- 9 or 12 years old at Females (58%, Not reported Not reported Used Autism-Tics, Not reported
et al., 2018 ment start, 18 years at n = 2598); males AD/HD and
conclusion (42%, n = 1902); other Comor-
non-binary not bidities Inventory
reported (A-TAC) cutoff
score of 4.5
Paul et al., 2018 France Cross-sectional Autistic group: Autistic group: male Not reported Not reported Formal ASD Excluded to
assessment 8–18 years (84.6%, n = 33); diagnosis IQ > 70 (100%);
(M = 13.23, female (15.4%, validated through VCI (M = 92.74,
SD = 2.96) n = 6); non-binary the ADI-R and SD = 25.45);
not reported ADOS-G FRI (M = 94.18,
SD = 14.66)
Pecora et al., 2019 Australia Cross-sectional Autistic group: Autistic group: Not reported Not reported Self-reported formal Not reported
assessment M = 25.13 years, females (58.2%, diagnosis verified
SD = 7.96 n = 135); males with AQ
(41.4%%, n = 96);
unreported sex
(n = 1); female-
identifying
(n = 111); male-
identifying
(n = 95); other-
identifying (n = 26)
Rumball et al., 2020 Britain Cross-sectional 19–67 years Female (61%, White (89.8%, Not reported Self-reported formal ID as exclusion
assessment (M = 39, n = 36); male n = 53), Asian diagnosis verified criteria
SD = 0.49) (39%, n = 23); non- (3.4%, n = 2), with AQ
binary not reported African/Carib-
bean/Black British
(2.7%, n = 1);
Mixed ethnicity/
other (5.1%, n = 3)
Rumball et al., 2021 England Cross-sectional Autistic group: Female (57.9%, Not reported Not reported Self-reported ASD Not reported
assessment 18–68 years n = 22); male diagnosis verified
(M = 32.9) (42.1%, n = 16); with the AQ
non-binary not
reported

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Weiss & Fardella, Canada Cross-sectional Autistic group: Autistic group: male Autistic group: self- Not reported Self-reported autism Excluded to IQ > 80
2018 assessment 18–53 years (42.5%); non- reported minority diagnoses verified (100%); ASC
(M = 30, binary not reported status, not speci- by the ADOS-2 group: M = 110.22,
SD = 1.48) fied (15.6%) SD = 13.19)

ASD autism spectrum disorder, IQ intelligence quotient, M mean, SD standard deviation

Review Journal of Autism and Developmental Disorders (2023) 10:576–594
Review Journal of Autism and Developmental Disorders (2023) 10:576–594 589

(Christoffersen, 2020; Hall-Lande et al., 2015; McDonnell abuse and forced sexual activity as an adult (Griffiths et al.,
et al., 2019). Ohlsson Gotby et al. (2018) included par- 2019).
ticipants involved in a longitudinal study, although sexual Beyond self-report measures, other approaches included
victimization was measured at only one time point. The interviews with the participants themselves (e.g., Greger
majority of studies (77.3%) included a non-autistic com- et al., 2015 used the Child and Adolescent Psychiatric Inter-
parison group. view; Bargiela et al., 2016 developed a semi-structured inter-
view; Cederborg et al., 2009 used forensic interviews). A
Cognitive Ability minority of studies utilized caregiver report through either
interviews or dichotomous caregiver ratings of whether or
The extent to which participants with a range of cognitive not the youth had experienced sexual abuse (Brenner et al.,
abilities were included varied across the reviewed studies, 2018; Mandell et al., 2005; Mehtar & Mukaddes, 2011).
the majority of which did not report on cognitive ability Three studies used population-based ascertainment meth-
scores. Three studies specifically excluded individuals with ods, including social services objective records (Hall-Lande
an IQ below 70 or with an intellectual disability (Bargiela et al., 2015; McDonnell et al., 2019) and legal records
et al., 2016; Paul et al., 2018; Rumball et al., 2020). Four (Christoffersen, 2020).
studies (18.2%) reported on cognitive abilities, with three of
these reporting significant representation of lower cognitive Comparative Studies of Rates of Sexual Violence
scores: Brenner et al. (2018) reported an average non-verbal Across Autistic and Non‑Autistic Groups
IQ standard score of 76.4; Hartmann et al. (2019) reported
54% of participants had a below-average IQ; Mehtar and Nine of the 22 reviewed studies found autistic groups to
Mukaddes (2011) reported 62.4% of participants had an experience higher rates of sexual violence compared to non-
intellectual disability [ID]. autistic groups (Brown et al., 2017; Brown-Lavoie et al.,
2014; Christoffersen, 2020; Griffiths et al., 2019; McDon-
Sexual Violence Assessment Approaches nell et al., 2019; Ohlsson Gotby et al., 2018; Pecora et al.,
2019; Rumball et al., 2021; Weiss & Fardella, 2018). Among
Sexual violence was defined with varying degrees of speci- children and adolescents, autistic youth (1) had higher rates
ficity, with most studies including self-report using a range of unwanted sexual contact than non-disabled students
of measures. Two studies used the Juvenile Victimiza- (Brown et al., 2017), (2) were 3.7–3.8 times more likely to
tion Questionnaire (assesses child sexual victimization; have experienced sexual offenses than non-disabled children
Paul et al., 2018; Weiss & Fardella, 2018), two used the (Christoffersen, 2020), and (3) were significantly more likely
Life Events Checklist (assesses sexual assault defined as to have sexual abuse reports made to child services (when
attempted or completed rape or being forced to engage in youth also had co-occurring ID; McDonnell et al., 2019).
any sexual activity through force or threat of harm; Rum- Childhood autistic traits predicted later sexual victimiza-
ball et al., 2020, 2021), and two used the Sexual Experi- tion in autistic youth, and female autistic youth specifically
ences Survey (items about sexual victimization, coercion, reported elevated rates of sexual victimization compared to
contact, and attempted or completed rape; Brown-Lavoie non-autistic females (odds ratio = 2.97; Ohlsson Gotby et al.,
et al., 2014; Hartmann et al., 2019). One study each used the 2018).
Childhood Trauma Questionnaire (sexual abuse subscale; Autistic adults (1) reported significantly higher
Bleil Walters et al., 2013), Sexual Behavior Scale (contains rates of sexual victimization (78% reported at least one
reports of regretted sexual activity, sexual experiences that instance) relative to non-autistic adults (47.4%; Brown-
participants consented to but did not want to consent to, and Lavoie et al., 2014), (2) were 7.3 times more likely to
unwanted sexual advances or behaviors from others; Pecora endorse sexual assault in childhood by a peer and had
et al., 2019), and select items from the Life Stressor Check- higher scores on a measure of contact victimization than
list (assesses forced engagement in sex or sexual touch; non-autistic adults (Weiss & Fardella, 2018), (3) had
Ohlsson Gotby et al., 2018). One study reported modifying higher rates of several sexual assault items (pressured
measure items to be more gender-inclusive and rewording into sexual activity, physically forced into sexual activity,
sexual contact items to ensure a more explicit meaning, and forced by a partner into sexual activity) than non-
particularly for those who may not self-label specific situ- autistic adults (Griffiths et al., 2019), and (4) endorsed
ations as “victimization” (Brown-Lavoie et al., 2014). One more frequently experiencing sexual assault and uncom-
study developed a new measure, called the Vulnerability fortable sexual experiences (Rumball et al., 2021). Autis-
Experiences Quotient, in consultation with autistic adults tic women were more likely to report unwanted sexual
and other stakeholders to assess common adverse life expe- behaviors and advances than non-autistic women (Pecora
riences autistic adults may face, including childhood sexual et al., 2019).

13

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590 Review Journal of Autism and Developmental Disorders (2023) 10:576–594

In contrast, several studies did not find significant differ- Sequelae of Sexual Violence Among Autistic
ences in sexual violence rates between autistic and non-autistic Individuals
groups. In all-male or strong majority male samples of autis-
tic youth and their non-autistic counterparts, no significant To understand how autistic individuals may experience
group differences were found among samples with relatively sexual violence, several studies examined how sexual
low sexual violence rates (Dewinter et al., 2016; Paul et al., violence was associated with behavioral and mental
2018) or severely elevated rates (Bleil Walters et al., 2013). health symptoms. Sexual violence has been associated
Other autistic youth samples did not report significantly higher with various risk behaviors among autistic individuals,
rates of sexual violence compared to (1) non-autistic groups including self-injurious behavior, suicide-related behav-
(Greger et al., 2015), (2) youth with IDs (Cederborg et al., ior and suicide attempts, running away, being psychi-
2009), or (3) youth without disabilities or with non-autistic- atrically hospitalized, or sexually acting out behavior
related disabilities (Hall-Lande et al., 2015). In one sample, 4 (Greger et al., 2015; Mandell et al., 2005). However,
out of 5 autistic female youth experienced sexual exploitation, the direction of these associations is unclear. Addition-
but the rate was not significantly elevated compared to the non- ally, sexual violence is associated with trauma-related
autistic group (52%; Kennedy et al., 2019). In another, autistic symptoms and other psychopathology, such as depression
male youth did not report significantly greater coercive sexual (Brenner et al., 2018; Greger et al., 2015; Rumball et al.,
violence rates than non-autistic peers (Ohlsson Gotby et al., 2021). Sexual trauma exposure may be more strongly
2018). Although autistic children with ID had significantly associated with posttraumatic stress among autistic
higher rates of reported sexual abuse than non-autistic youth adults, as autistic individuals had greater posttraumatic
and youth without ID, the autistic youth (without ID) did not symptom severity following at least two traumatic events
differ from the comparison group (McDonnell et al., 2019). relative to non-autistic individuals (Rumball et al., 2021).
Among adults, no marked differences were identified among Mandell and colleagues (2005) reported that behaviors
autistic and non-autistic groups in child sexual victimization associated with sexual abuse are similar for autistic and
(OR = 1.71; Griffiths et al., 2019), or regretted sexual experi- non-autistic youth, though prevalence and severity of
ences (OR = 1.53; Pecora et al., 2019). outcomes may vary.

Descriptive Studies of Rates of Sexual Violence Gender Identity and Rates of Sexual Violence
Within Autistic People
Evidence is mixed regarding differential rates of sexual
Six studies examined rates of sexual violence among violence across gender identities. Several studies found
autistic participants (no comparison group). Rates of higher rates of sexual violence among autistic girls and
child sexual abuse according to caregiver report varied, women as well as autistic adults identifying as non-
from 1 in 6 (Mandell et al., 2005) to lower estimates binary (Brown et al., 2017; Mandell et al., 2005; Pecora
of 2.86% (n = 10) out of a sample of 350 autistic youth et al., 2019). Other studies that did not directly compare
(Brenner et al., 2018) and 1.45% (n = 1) out of a sample rates of sexual violence across gender identities reported
of 69 (Mehtar & Mukaddes, 2011). In a sample compar- high rates of sexual abuse among autistic women (Bar-
ing young adults’ self-reports of sexual abuse to parent giela et al., 2016) and high rates of child sexual exploita-
reports, 62% of young autistic adults reported experi- tion among women with scores above autism thresholds
encing sexual victimization (compared to 54% of parent on the Social Communication Questionnaire (Kennedy
reports), and 2% reported experiencing rape (compared et al., 2019). However, other work demonstrated com-
to 3% of parent reports; Hartmann et al., 2019). Among parable rates of sexual violence rates across autistic
a sample of 59 autistic adults, 36% (n = 21) endorsed males and females (Brown-Lavoie et al., 2014; Weiss &
sexual abuse (including rape, attempted rape, or sexual Fardella, 2018). More nuanced results demonstrated that
coercion; an additional 6 participants reported witnessing both autistic females and males reported elevated sexual
or learning about these events), 39% (n = 23) endorsed victimization rates compared to non-autistic peers, but
unwanted or uncomfortable sexual experiences (1 addi- risk only reached significance for autistic females (Ohls-
tionally reported learning about this happening), and son Gotby et al., 2018).
19% of the sample (n = 11) reported sexual violence as
the worst event they had ever experienced. Using objec- Other Consideration of Risk or Protective Factors
tive social services records data, one study reported that
8.3% of allegations were related to sexual abuse (Hall- Very few studies examined factors associated with either
Lande et al., 2015). increased or decreased rates of sexual violence or associated

13

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Review Journal of Autism and Developmental Disorders (2023) 10:576–594 591

negative sequelae for autistic youth in particular. Among differences (Mean sample size = 51.29) as compared to
autistic adults, sexual knowledge partially mediated the studies that found significant elevations of sexual vio-
association between autism diagnosis and sexual violence lence in autistic groups (mean sample size = 171 among
(Brown-Lavoie et al., 2014), suggesting that systematic the six out of eight studies that reported the autistic
failure to provide autistic individuals with appropriate sup- group sample size), suggesting that low power or sam-
port for sexual knowledge may partially underlie increased ple size may have contributed to these non-significant
risk for sexual violence. Other work directly challenges the findings. Alternatively, when considering the age of
potentially stigmatizing notion that individual factors asso- the samples across the significant and non-significant
ciated with autism are related to increased sexual violence findings, it is possible that autistic individuals may be
risk. Weiss and Fardella (2018) found that although autistic particularly vulnerable to sexual violence, or more able
participants reported difficulties with social communication to report sexual violence, as they move into adulthood.
and emotion regulation, these individual variables were not Future research testing these possibilities is critical.
risk factors for experiences of child or adult polyvictimiza- Intellectual disability or other co-occurring neurode-
tion, including sexual assault. With respect to broader sys- velopmental diagnoses may also be critical for under-
temic factors, Christoffersen (2020) identified family vul- standing sexual violence among autistic people. One
nerability, which included factors such as parental violence, study found that although autistic youth without ID did
substance abuse, and chronic unemployment, as prominent not report elevated sexual violence rates, autistic children
risk factors for childhood sexual assault for both autistic and with an ID diagnosis had significantly greater odds of
non-autistic youth. Notably, none of the studies explicitly experiencing sexual victimization. This, in tandem with
evaluated resilience or protective factors, nor intervention the high prevalence rates of sexual victimization among
or support approaches. both autistic and ID youth in the sample studied by Ced-
erborg et al. (2009), as well as the finding that many
neurodevelopmental disorders were related to sexual
Discussion victimization risk (Ohlsson Gotby et al., 2018), suggests
that risk for sexual violence may be transdiagnostic and
The aims of this systematic review were to identify and observed across neurodevelopmental diagnoses.
summarize the existing literature on sexual violence among
autistic individuals. Only 22 studies analyzed the prevalence Gender Identity Differences
or characteristics of sexual violence experiences among
autistic individuals, indicating the urgent need for more Gender identity was related to both rates and type of sexual
research in this important area of inquiry. A critical limita- violence experiences, although results varied across stud-
tion of the reviewed research was the lack of diversity with ies. Rates of sexual violence, regretted sexual experiences,
respect to various aspects of identity. Overall, review results and unwanted sexual behaviors and advances were found to
suggest that there are significant rates of sexual violence be higher in autistic females, as well as non-binary autistic
among autistic people. individuals, than autistic males (Brown et al., 2017; Mandell
et al., 2005; Pecora et al., 2019). Two studies reported no sig-
Rates of Sexual Violence nificant differences in rates of overall sexual violence among
adult autistic males and females (Brown-Lavoie et al., 2014;
Sixteen studies directly compared rates of sexual vio- Weiss & Fardella, 2018). Some gender differences emerged
lence among autistic and non-autistic groups. Of these, among studies that parsed out types of victimization among
50% (n = 8) demonstrated significantly higher rates males and females in both autistic and non-autistic groups.
among autistic individuals. Of these studies, six included Among these results, higher rates of specific types of sexual
adult samples and two included youth samples. Rates of violence were found among autistic females as compared
sexual violence among autistic samples ranged from 8.2 to non-autistic females, including unwanted sexual contact
(Brown et al., 2017) to 80% (Kennedy et al., 2019) across and coercion (Brown-Lavoie et al., 2014), coercive sexual
all studies. Reported odds ratios of sexual violence expe- victimization (Ohlsson Gotby et al., 2018), and unwanted
riences among autistic samples as compared to non-autis- sexual behaviors and advances (Pecora et al., 2019). Simi-
tic samples ranged from 1.09 (McDonnell et al., 2019) larly, Brown-Lavoie et al. (2014) reported that autistic males
to 7.3 (Weiss & Fardella, 2018). Seven studies found no experienced higher rates of sexual victimization as compared
significant differences between autistic and non-autis- to non-autistic counterparts. Reported results on the sexual
tic groups, all of which involved child and adolescent violence experiences of non-binary autistic individuals were
samples. Notably, the autistic group sample sizes were limited to one study, suggesting that further research with
relatively lower among the studies with non-significant minoritized autistic people is urgently needed.

13

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592 Review Journal of Autism and Developmental Disorders (2023) 10:576–594

Sequelae of Sexual Violence as ableism, bias, and exclusion, contribute to inequities

in sexual violence exposure for autistic people across
The studies included in this review further elucidate the lifespan.
the critical connections between experiencing sexual
violence and other adverse outcomes. Results indicated Limitations and Future Directions
associations between sexual violence, as well as more
generalized abuse and maltreatment experiences, and Although this review and growing literature identify
more severe traumatic and depressive symptomatology a critical need for further research and clinical work
(Brenner et al., 2018; Greger et al., 2015; Rumball et al., focused on sexual violence in autism, a number of limita-
2020, 2021). Sexual violence specifically was associated tions should be addressed in future work. First, the wide
with dangerous behaviors such as self-injury, suicide range of definitions and measures used to assess sexual
attempts, running away, and sexually acting out (Mandell violence prevented us from synthesizing results across
et al., 2005). Results overall suggest that autistic individ- disparate studies quantitatively via meta-analysis, which
uals may experience similar sequelae of sexual violence will be essential for informing prevalence as this nascent
as non-autistic individuals, although additional empiri- literature area grows. Additionally, studies that did not
cal research directly examining differences in effects of parse out sexual violence specifically from other types of
sexual violence specifically across diagnostic groups is maltreatment, assault, or trauma were excluded because
critical for informing the unique lived experiences of we were interested in characterizing sexual violence and
autistic people. In fact, one reviewed study found that its negative sequelae in particular (rather than trauma
greater traumatic exposure (i.e., at least two reported or abuse overall). However, future research on polyvic-
traumatic events) significantly moderated the association timization is critical. Regarding limitations of the identi-
between an autism diagnosis and posttraumatic symptom fied research, studies demonstrated a lack of diversity in
severity, supporting that autistic individuals may experi- terms of gender and the inclusion of non-binary gender
ence the symptoms of posttraumatic stress to a greater identities, a critical limitation given that sexual and gen-
degree (Rumball et al., 2021). der minority populations are often more likely to experi-
ence sexual violence (Coulter et al., 2017). The majority
Risk and Protective Factors of studies did not report on the racial-ethnic identity of
participants. Of the studies that did report racial-ethnic
Very few studies examined factors associated with identities of participants, the majority included samples
increased (risk) or decreased (protective) likelihood of that were largely White. Lastly, the majority of reviewed
experiencing sexual violence and associated sequelae. studies were cross-sectional (preventing identification
Among autistic adults, lower sexual knowledge was of directionality among variables) and little research
associated with increased sexual violence risk, and directly evaluated risk or protective factors to inform
sociocommunicative and emotion deficits were not risk personalized intervention.
factors for polyvictimization (Brown-Lavoie et al., 2014; Most importantly, it is critical that future research with
Weiss & Fardella, 2018). These findings suggest that autistic people be intentional about recruiting diverse sam-
prevention strategies that target caregiver and commu- ples in terms of racial-ethnic representation, non-binary gen-
nity teaching of sexual education tailored for (and in der identities, and sexual orientation, as well as cognitive
partnership with) autistic individuals may prove more ability. Methodologically, future research should develop
useful for reducing sexual violence experiences than and validate sexual violence assessment approaches to
efforts targeted at bolstering individual skills. Relatedly, ensure that measures are sensitive for autistic youth and
autistic adults who had been in a relationship were more adults. For example, one study developed a measure of vul-
likely to report sexual violence perpetrated by a partner nerable life experiences in consultation with autistic adults
than non-autistic adults who had been in relationships, to ensure that the questionnaire captured their meaningful
which aligns with potentially increased adulthood vul- lived experiences (Griffiths et al., 2019). Regarding interven-
nerability in autistic individuals and suggests the need tion, the development of treatment and support strategies for
for bolstering education about safe romantic and sexual autistic individuals who have experienced sexual violence is
relationships (Griffiths et al., 2019). One study pointed a critical public health priority. Research that directly evalu-
to contextual family factors such as parental violence, ates risk and protective factors is important for identifying
substance use in the home, or socioeconomic status as factors to target or support within intervention. In addition,
risk factors for autistic and non-autistic children experi- designing clinical trials should be conducted in partnership
encing sexual violence (Christoffersen, 2020). It is criti- with autistic people, particularly those from minoritized
cal that research considers how systemic factors, such communities.

13

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Review Journal of Autism and Developmental Disorders (2023) 10:576–594 593

Declarations Brown-Lavoie, S. M., Viecili, M. A., & Weiss, J. A. (2014). Sexual

knowledge and victimization in adults with autism spectrum
disorders. Journal of Autism and Developmental Disorders,
Conflict of Interest The authors declare no competing interests.
44(9), 2185–2196. https://​doi.​org/​10.​1007/​s10803-​014-​2093-y
Cederborg, A.-C., Danielsson, H., Rooy, D. L., & Lamb, M. E.
(2009). Repetition of contaminating question types when chil-
dren and youths with intellectual disabilities are interviewed.
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