The percentage of autistic sexual assault survivors is uncertain, Emily Rothman says, given that some choose not to disclose it. She’s working to fix the lack of training for counselors to help autistic survivors by developing an online module with information. Photo courtesy of BU School of Public Health

Therapy

Helping Autistic Survivors of Sexual Assault

BU’s Emily Rothman is devising online training for counselors

Many autistic people do not prefer to be called “people with autism,” the construction favored by other groups with medical or socioeconomic challenges. If that simple etiquette is unknown by the broader population, imagine the lack of awareness about the needs of autistic and neurodiverse survivors of sexual abuse—including among trauma counselors.

“The tendency to blame oneself can be even that much more acute than it is for non-autistic people,” says Emily Rothman, a Sargent College of Health & Rehabilitation Sciences professor and chair of occupational therapy, whose research has focused on health equity and marginalized populations. “Saying to yourself, there’s something wrong with me, I probably deserved this—questioning whether it really was a sexual assault or not—maybe I agreed to it, maybe I just don’t remember or maybe the way that I say no is wrong.” This “self-gaslighting,” Rothman says, increases the isolation that survivors feel.

As for the training available to counselors to help autistic survivors, “there isn’t any,” says Rothman, who also has appointments at the School of Public Health and the School of Medicine and is an expert in sexual and intimate partner violence and trauma.

She’s working to fix that by developing an online module, to go live early next year on a BU website, with information for college counselors on how to better help autistic survivors of sexual assault. Rothman is designing the module with Gina Scaramella (SSW’95), a consultant to businesses, governments, and donors on sexual violence programs, and Laura Graham Holmes, a Hunter College Silberman School of Social Work assistant professor. The work is funded by the nonprofit Organization for Autism Research. 

The percentage of sexual assault survivors who are autistic is uncertain, Rothman says, given that some choose not to disclose it. But the module can and will address other matters that might be unfamiliar to counselors, starting with a primer on autism. That primer will note that it’s neither an intellectual disability nor a mental disorder, but a developmental disorder (although it can occur in people with mental health challenges). 

The team is assisted by a six-person advisory group of autistic people, including Val Erwin, a Bowling Green State University doctoral student who is writing her dissertation on college sexual assault survivors with disabilities. Erwin counseled sexual assault survivors while getting her master’s degree and working at a women’s center, and from talking to survivors, both at her campus and those who had transferred from elsewhere, she says, and she saw a pattern of counselors skirting discussion of disabilities.

Erwin says she thinks many counselors “don’t know how to bring it up,” describing their approach as “‘I don’t want to talk about disability, because that will re-stigmatize you.’” Whereas, “if the school would have thought, oh, you have a disability and you’ve had this [assault] experience—let’s help you with both,” that might have spared some survivors from having to drop out or seek mental health hospitalization. “There would have been help before some of these things escalated.”

To be sure, some survivors prefer not to disclose their autism, Rothman says. So the module’s (tentative) text suggests how counselors might broach the topic: “Lots of the students who come to see me tell me that they have anxiety, depression, ADHD, autism, or are experiencing other differences. If you feel comfortable telling me if any of those apply to you or think it might help our work together, feel free to let me know, even if it is something you suspect but do not have a diagnosis.”

A study Rothman coauthored last year underscores the need for better services. It sampled more than 250,000 students—about 1,400 of them autistic—at 78 colleges and universities, finding that sexual assault caused grades to plunge for 36 percent of non-autistic college-student survivors, and 80 percent for autistic survivors. 

“They’re not sure where to turn or how to get help or how to feel better,” Rothman says. “And all of our systems on college campuses and in the world are set up to help non-autistic people.” For example, making a counseling appointment can be challenging for autistic people, who may have difficulty with executive function.

“You have to make the appointment, locate the office, show up there at the right time,” she says. “You have to announce yourself.… That could be totally overwhelming and enough to make you not want to do it. So if you don’t have an option for people to Zoom in instead of showing up in person, right there you’re going to probably lose a lot of your autistic audience.”