The Prevalence and Risk Factors of Autistic Experiences of Interpersonal Violence: A Systematic Review and Meta-Analysis

Abstract

Abstract Background: Interpersonal violence is a widespread yet understudied issue in autism spectrum disorder (henceforth, ‘autism’). While the multiple minority stress model suggests gender marginalised groups (e.g., females, transgender, non-binary) are at greater risk, research investigating this model among autistic populations is limited. The current review and meta-analysis examined the prevalence and risk factors associated with interpersonal violence among autistic individuals of varying gender identities. Methods: A systematic database search identified 42 studies examining: (1) a combination of physical, sexual, or psychological violence; (2) physical violence; (3) sexual violence; (4) psychological violence; (5) traditional bullying; (6) cyberbullying; and (7) homicide among autistic people across all age groups and support needs levels, compared by gender. A random-effects meta-analysis with pooled data from 13 eligible studies was undertaken, comprising 4,498 participants (males n = 3,472; females n = 1,026) aged between 2 to 56 years. Results: Analyses indicated overall violence prevalence is increased among females compared to males, d = 0.44, p < .001; 95% CI [0.24, 0.65], across all ages and support needs levels. The largest effect was for childhood maltreatment and negative social events during adulthood, d = 1.07, p < .05, [0.20, 1.93]. Narrative synthesis of 37 studies indicated autistic people were significantly more likely to be victimised by carers and peers compared to non-autistic people. Key risk factors included belonging to a gender or racial minority, having co-occurring mental health issues, and coming from a low-income household. Limitations: The generalisability of findings was limited by the shortage of literature about autistic experiences of violence not involving bullying, participants with high needs, and participants outside of the binary gender. This may also contribute to the high level of heterogeneity (I2 = 87%) found. Conclusions: The results of this review and meta-analysis indicate that interpersonal violence is a pressing issue among autistic people, who appear to face concerningly high rates of victimisation and poly-victimisation across the life course, particularly among multiply marginalised people (i.e., gender, race, mental health, economic). This underscores the importance of exploring violence from an intersectional perspective, across individual and societal contexts, providing support for multiple minority theory.