In one of Asasumasu’s earliest and most painful memories, she is a 3-year-old facing a teacher who wraps her legs around the preschooler’s chair to prevent her from going anywhere. The teacher gives instructions: “Sit. Stand. Look at me.” If Asasumasu follows the instructions, she earns a fraction of an M&M. If not, the teacher pulls her body into position or forces her eyes open.
The technique, part of a standard type of autism therapy, has become contentious. Critics have compared it 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. Many adults have been vocal about their traumatic memories of undergoing this type of treatment as children. “My earliest memories are of adults prying my eyes open and making me look at them,” Asasumasu says. “To this day, if somebody says, ‘Look at me,’ it’s like, ‘I’m never looking at you again.’”
Maltreatment can cause lasting damage, leading to severe stress, depression, anxiety and post-traumatic stress disorder (PTSD). Most studies have not shown an increased incidence of PTSD among autistic people. That may be because the PTSD criteria were not written for people with autism or because trauma in this group is more likely to lead to anxiety, depression and other mental health issues than to PTSD, Kerns says. What’s more, there are no reliable tools for screening autistic children for trauma, which is defined as an event or events that affect a person negatively, sometimes in an ongoing way.
Meanwhile, researchers are crafting therapies. Hoover, for example, is adapting a technique called trauma-focused cognitive behavioral therapy. The 12-week program aims to get children talking about what happened to them and to teach them how to manage their fears around those experiences. Because many children with autism may not understand verbal instructions or remember what they are supposed to practice outside of therapy, Hoover created visual schedules for them to keep at home and ramped up involvement by caregivers. The modified program also enlists children’s special interests — say, Spider-Man or Harry Potter — to help them tell their stories.
“Individuals who exploit and abuse children know which children are more likely to be a good victim.” Kristen Seay
The modified method appears to help — at least anecdotally, Hoover says. Parents are reporting positive results, and autistic children who undergo the therapy are showing improved scores on the UCLA Child/Adolescent PTSD Reaction Index, a self-report questionnaire that screens for PTSD in children and teenagers. Hoover is writing a manual for the technique and says he gets multiple inquiries each week from centers around the world that want training. He and his colleagues have been collecting data on the therapy from several dozen children for the past year, and they have plans for a controlled trial.
McDonnell, meanwhile, is preparing to measure the potential benefits of the standard trauma technique on children with autism. Other teams are trying community and grassroots programs that aim to teach people about abuse, sexuality and other topics to help them stay safe.
Many autistic people come up with their own strategies. Adrienne Lawrence, a 36-year-old attorney and author in Los Angeles, California, learned she has autism about a year ago. But she has long known that she operates on logic rather than nuance to decipher her world. If, for example, a man trying to date her tells her his mother died, she assumes that simply means his mother died, and she misses that he is trying to sleep with her by playing on her sympathy. If he apologizes and says he will not lie again, she assumes he means it. The reason autistic people face so much abuse, Lawrence says, is that so many non-autistic people lie, not that autistic people miss those lies.
Lawrence has always created rules to help her navigate the world and has adopted new ones since learning she is on the spectrum. For example, she has developed specific guidelines to help her spot and avoid sexual harassment, which she has experienced at work, including specifying which types of behavior are appropriate in different situations. “Previously, I would use my 10 years of criminology study to do a statistical and logical analysis in my head as to whether it was safe to enter a man’s home, considering the facts particular to the specific situation. Now I do not rely so heavily on stats and logic but simply ensure meetings are in public places.”
For Asasumasu, life started to get better in high school, when she learned to fight back. She also befriended students she calls “weird” and “scary,” which kept bullies away. She now studies aikido, a defensive martial art that helps her wait to assess a situation before judging whether it is a threat, though she has continued to experience abusive relationships into adulthood.
Like Lawrence, she relies on pattern recognition to predict and avoid abuse. “Somebody who is rude to waiters and mean to pets is definitely going to try to hit you at some point,” she says.
Ultimately, Asasumasu says, it is society, not autistic people, that must change. “We should be able to deal with the fact that there’s more than one way of being,” she says. “For all the kinds of civility you hear in the general world, you never hear, ‘Hey, maybe don’t be a jerk to people who are different from you.’”
If you or someone you know is experiencing abuse, help is available. Click here for a child abuse hotline, here for help with child traumatic stress and here for a domestic violence hotline.