Professor Receives NIH Grants to Study Alcohol Use, Peer Relationships among Autistic Youth.

Emily Rothman, professor of community health sciences, has received two grants from the National Institutes of Health (NIH) to examine underage alcohol use and peer relationship behavior among autistic youth.

The two-year grants from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute of Mental Health (NIMH) total almost $1 million, and will enable Rothman to gain a deeper understanding of the challenges that autistic adolescents and young adults experience, as well as the types of interventions that are needed to prepare this population for successful transition into adulthood.

Approximately 1 in 59 youth in the U.S. are autistic. NIH and the U.S. Centers for Disease Control and Prevention consider autism to be a developmental disorder, though autistic self-advocates typically view autism not as a disease or disorder that needs to be treated, cured, or prevented, but as a form of neurodiversity that should be accommodated.

Accordingly, Rothman’s research takes the approach that it is important to understand the needs of autistic individuals and provide better programmatic supports for them to improve health. The mortality risk for autistic individuals is twice that for neurotypical people. The data that Rothman will collect will inform future interventions and services that can help autistic youth lead heathy adult lives. She will conduct both studies with Laura Graham Holmes, a postdoctoral associate in the Department of Community Health Sciences.

“Our team is going to study all kinds of adolescent risk behavior by autistic youth and do what we can to ensure that they get what they need to stay safe, be healthy, and have more equitable access to the resources and services that they need to thrive,” says Rothman.

Both NIH studies build upon research that Rothman conducted last year to understand autistic youths’ thoughts and experiences on healthy dating relationships. Through this research, she also learned that their parents and health providers are also seeking more information about adolescents’ underage alcohol use and services that can address the issue.

For the NIAAA project, Rothman aims to fill some of the gaps in knowledge on underage alcohol use by autistic adolescents, including why and how they consume alcohol, the context and consequences of their alcohol use, and whether those factors vary in comparison to alcohol use among neuro-typical youth.

“The assumption for too long has been that autistic adolescents and young adults don’t use alcohol,” says Rothman. “Some people have conjectured that autistic youth tend to be ‘rule-followers,’ or pointed out that some may not have the capacity to go out. Others believe that autistic people perhaps don’t have friends and aren’t invited to parties or bars, or take medications that necessitate alcohol abstinence.

“Each of these could be correct,” says Rothman. “But we just don’t know to what extent this is true.”

She says it’s possible that some autistic adolescents may be at greater risk of consuming alcohol and exhibiting other adolescent risk behaviors because of the ways in which they are socially vulnerable.

In the concurrent NIMH project, Rothman and Holmes will interview transition-age autistic youth, parents, and service providers and experts who work with autistic youth to understand the youths’ relationships beyond dating—including their connections and interactions with friends, classmates, coworkers, and roommates. She will also examine their experiences with physical, sexual, emotional, and financial aggression.

Studies show that autistic adolescents typically encounter challenges with social isolation, fewer health services, and difficulties finding employment, as well as harassment and manipulation. Furthermore, the negative treatment that autistic youth often receive can directly impact their risk of depression, anxiety, and self-harm, says Rothman.

The data from this study will inform a new online group intervention called Healthy Peer Relationships on the Spectrum (HEARTS) that will equip youth with healthy peer relationship skills and enable them to discern quality relationships, trustworthiness, perceived degrees of intimacy, and conflict resolution.

“Autistic adolescents and young adults need and deserve more than just social skills classes—meaning, more than lessons about how to have conversations or make eye contact with neurotypical people,” says Rothman. “This project aims to address something equally important about how all people navigate our social worlds—which is whether the relationships that we do get into are healthy, supportive, mutual, and respectful.”

She notes that these lessons are vital for all people.

“It is really important to our team that autistic research participants understand that we do not consider them less-than just because they might benefit from relationship coaching,” says Rothman. “Relationships can be hard for everyone.”

As a leading researcher in intimate partner violence who has sought to reduce health disparities in youth dating and sexual violence, and substance abuse, Rothman says her next career goal is to develop and evaluate these types of interventions that promote healthy peer relationships for autistic youth.

“Autistic people aren’t only patients and research participants—they are also our students, faculty, staff, and members of the surrounding community,” says Rothman. “I would love to see BUSPH setting new standards for how to value, accommodate and elevate those who are autistic or neurodiverse.”

—Jillian McKoy