Emily Rothman, autism researcher and professor and chair of occupational therapy at College of Health & Rehabilitation Sciences: Sargent College. Photo by Bob O’Connor

Relationships

Helping Autistic Adults Have Healthy Relationships

Emily Rothman’s online course seeks to strengthen both romantic and platonic connections

Relationships are tricky, period. It doesn’t matter if they’re romantic or platonic: both have their unspoken rules and expectations, and figuring out what those are—and how they vary from person to person—can feel like a guessing game.

It’s even harder if you’re neurodivergent. For individuals on the autism spectrum, dating and making friends can require a little extra work to navigate hidden nuances. 

Enter HEARTS, or Healthy Relationships on the Autism Spectrum, a virtual course for autistic adults developed by Emily Rothman, a professor and chair of occupational therapy at College of Health & Rehabilitation Sciences: Sargent College.

Back in 2020, Rothman, a former domestic and sexual abuse preventionist, received funding from the National Institutes of Health to make a career pivot to autism research after learning about a family member’s autism diagnosis. Her research, combined with her background in violence prevention, soon led her to the topic of healthy relationship promotion for autistic adults. 

“Adult autism intervention is a relatively new field, and there was a big gap [regarding] healthy relationships and sexual violence prevention,” she says. “All people are interested in learning about how to have healthy relationships,” she adds. With the course, “we just break the information down in a way that speaks to someone’s experience as an autistic person, and deliver it in a manner that feels accessible to their way of acquiring new information.”

Rothman developed HEARTS with the help of former BU School of Public Health senior postdoctoral associate Laura Graham Holmes, who remains involved in the project. AANE, a Watertown-based autism nonprofit, is a partner. Rothman and Graham Holmes also meet quarterly with their five-member “autistic advisory board.” (“We don’t do anything without consulting the board,” Rothman says.) 

Pilot classes began in 2020. Each HEARTS course is six weeks long and consists of weekly 90-minute online classes. They’re open to any autistic person 18 and over. Each course has around 15 students, Rothman says, with participants dialing in from the United States, Canada, and as far away as Israel. The classes cover topics like active listening, recognizing abusive or controlling relationships, setting boundaries, reconnecting with old friends, and dealing with rejection and trying again. Optional weekly homework includes activities such as “diagnosing” healthy or toxic relationships among characters in movies and TV shows. 

Each course is taught by an autistic instructor. (They are joined by a non-autistic coteacher trained in domestic and sexual violence prevention.) Rothman and Graham Holmes quickly identified the importance of employing autistic people to lead the courses. In preliminary research interviews with autistic young adults, “people kept saying, ‘We’re tired of non-autistic people telling us about how bad our social skills are’ or that ‘You’re supposed to make eye contact,’” Rothman says. “They’d ask, ‘Autistic people are whole and complete—why aren’t they teaching classes?’”  

Earlier this year, Rothman and her colead Susan White received a second grant from the NIH to conduct HEARTS courses as a three-year randomized control trial. The trial period began mid-April and will conclude in 2026. The results will illustrate the impact and feasibility of the HEARTS curriculum. 

Until then, Rothman has student feedback to rely on. Recently, she received an email from a former HEARTS participant. The student wrote that thanks to the course, she felt brave enough to try dating. She ultimately met someone and fell in love—and they were moving in together. “This was a really stable and excellent partnership for her, and she wrote that she was so grateful and thankful for the class,” Rothman says. “I was like, ‘No, no, that was all you—you made this happen, not the class!’ But it was a really nice message to get.

“I’ve been a researcher for 20-plus years, and this has been the most rewarding experience [of my career]. It’s an amazing, positive feeling.”

Note: the autism community prefers identity-first language to refer to autism diagnoses as opposed to person-first language (e.g. “autistic people” vs. “people with autism”). Learn more about both here.