Patients with autism, Williams syndrome, and Down syndrome are all socially vulnerable, but in "markedly different" ways. Understanding these differences might help tailor specific interventions to keep these populations safe from abuse and exploitation.
That’s the conclusion of a recent study by Marisa H. Fisher, Ph.D., and her colleagues, published in the August issue of Research in Autism Spectrum Disorders. The study looked at 103 parents or guardians who reported information on adolescents and adults with autism spectrum disorder (n = 29), Williams syndrome (n = 38), or Down syndrome (n = 36) (Res. Autism Spectr. Disord. 2013;7:931-7).
Dr. Marisa H. Fisher
Patient ages averaged between 24-25 years across syndromes, and 67% of respondents were mothers, though no differences in responses was found based on the type of guardian or parent that was polled, wrote Dr. Fisher of the Vanderbilt Kennedy Center, in Nashville, Tenn.
All respondents completed a 30-item Social Vulnerability Questionnaire. Developed by Dr. Fisher, this scale assessed the degree of emotional bullying experienced by the patient (teasing, taunting); the patient’s risk awareness (for example, the ability to detect and avoid victimization); the degree of social protection (the existence or lack of a peer network); perceived vulnerability (physical traits that could make the patient a target); parental independence; and credulity (reasons why the patient might "fall for" certain types of victimization).
The respondents also answered an open-ended question, which simply asked for an example of a time that the patient had been victimized in the past, "to determine the percentage of individuals who had ever experienced some form of victimization in their lifetime and the different types of victimization experienced within each condition."
Based on answers to the last question, the authors found that fully 73% of respondents could detail at least one instance of victimization, including teasing or persuasion (35%), money or theft (32%), or physical or sexual abuse (21%).
All three groups experienced all of the above forms of victimization at roughly equal rates, according to the survey, wrote the authors, with many patients experiencing more than one form.
Next, the authors looked at results from the social vulnerability questionnaire.
Looking at risk awareness profiles, the investigators found that patients with autism and Down syndrome were less risk-aware than were their peers with Williams syndrome.
For example, "individuals with [autism spectrum disorder and [Down syndrome] were less likely to tell a parent or authority figure if something questionable happened and were less aware that they had a disability," they wrote.
In the realm of perceived vulnerability, the fact that Down syndrome patients were more likely to look different from and be smaller than same-age patients made them especially vulnerable.
However, in terms of social protection, it was the patients with autism who were less likely to have friends or to be considered a part of a social group, and therefore more vulnerable to the victimization that preyed upon this weakness.
Finally, when it came to parental independence, it was the parents of patients with Williams syndrome who were most likely to leave their children alone for an extended period of time and to allow them to be with members of the opposite sex unsupervised.
According to Dr. Fisher, the finding that all patients are victimized, but for different reasons, means that antivictimization interventions must be tailored to the specific needs of different groups.
For example, for individuals with autism spectrum disorders, "A strong peer network would seem an important protective factor for decreasing bullying and other interpersonal violence."
Perhaps one way to reduce vulnerability to victimization experienced by people with autism spectrum disorders might be to provide social skills interventions and ways to increase friendships.
"Conversely, the social vulnerability of individuals with Williams syndrome seemed related to increased independence from their parents," she wrote.
"Most successful, then, might be programs such as those designed to teach individuals with Williams syndrome how to appropriately respond to strangers."
She concluded, "By identifying different correlates relating to social vulnerability in these conditions, intervention research should now focus on improving programs aimed at reducing victimization and vulnerability for individuals with [autism spectrum disorders], [Williams syndrome], and [Down syndrome.]"
The authors cited several limitations, including the relatively small sample size. They disclosed no conflicts.