Individual, social, and life course risk factors for experiencing interpersonal violence among autistic people of varying gender identities: A mixed methods systematic review

Background: Interpersonal violence is a widespread yet understudied issue in autism spectrum disorder (henceforth, 'autism'). Characteristic of autism are high rates of gender diversity, and so increased multiple minority group membership. Under minority stress and intersectionality models, minority identity presents greater risk of violence, while demographic variables (e.g., gender, sexuality, race) add to marginalisation and intersect to further enhance risk. However, research investigating risk and contextual predictors has been limited. This review examined individual, social, and life course risk factors associated with experiences of interpersonal violence among autistic people of varying gender identities. Methods: A systematic database search identified 59 studies examining violence: (1) combined physical, sexual, and/or psychological; (2) physical; (3) sexual; (4) psychological; (5) traditional bullying; (6) cyberbullying; and (7) homicide among autistic people of any age and support needs, varying by gender. Final included studies comprised 42,251 autistic (65.79% males, 32.91% females, 0.14% transgender, 0.69% non-binary/gender queer, 0.002% intersex, 0.46% gender n/s), and 269,433 non-autistic participants (32.57% males, 64.45% females, 0.006% non-binary/ gender queer, 2.98% gender n/s), aged 2-81 years. Results: Narrative synthesis of the 59 studies showed a consistent pattern of increased rates of overall and repeated violence across the life course among autistic compared to non-autistic people. Intersectional risk was identified across all socio-ecological levels: individual (e.g., autism-related factors, age, mental health, gender, demographic diversity); proximal social (e.g., parents, peers, partners), community (e.g., home, school, healthcare, police interaction), and broader social (e.g., safety education, violence prevention/support services, specialised care/training, public stigma). Conclusions: Our review indicates that interpersonal violence is a common issue for autistic people, who experience enhanced risk victimisation across the life course, particularly among multiply marginalised people (i.e., gender, race, sexuality, mental health). Our review underscores the importance of examining violence from an intersectionality and minority stress perspective and across socio-ecological contexts, and provides important empirical, legal, and policy implications.