Journal of Autism and Developmental Disorders

https://doi.org/10.1007/s10803-020-04437-z

BRIEF REPORT

Brief Report: Gender Differences in Experiences of Peer Victimization

Among Adolescents with Autism Spectrum Disorder
Jessica L. Greenlee1,2 · Marcia A. Winter2 · Isabel A. Marcovici2

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Abstract
Peer victimization (PV) is a common problem for many adolescents with autism spectrum disorder (ASD) and can negatively
impact the mental health and well-being of these youth. Results of the current study of 105 adolescents with ASD (n = 50
girls, 55 boys) indicated that girls and boys experience similar types of PV at similar frequencies. However, relational vic-
timization accounted for a significant portion of variance in anxiety symptoms, above and beyond social communication
deficits and restricted and repetitive behaviors, in girls but not in boys. Findings provide preliminary evidence suggesting
that the impact of PV on mental health symptoms may be different for girls and boys with ASD, highlighting the need for
more research focused on understanding potentially unique social processes for adolescent girls with ASD.

Keywords Peer victimization · Adolescence · Autism spectrum disorder · Girls · Mental health

Peer interactions and relationships have long been viewed for youth with ASD. Adolescents with ASD are victimized
as a key feature of adolescence, and developmental sci- at exceptionally high rates (46–94%), much more frequently
ence highlights both the positive and negative influences than neurotypical (NT) youth (10–15%) and other disabil-
peers can have on adolescent mental health and well-being ity groups (14–24%; Sreckovic et al. 2014; Troop-Gordon
(Brown 2004). For adolescents with autism spectrum dis- 2017; Twyman et al. 2010). However, empirical research has
order (ASD), a heterogeneous neurodevelopmental disor- focused mainly on boys and has yet to determine whether
der characterized by impairments in social communication, adolescent girls with ASD have similar experiences as boys
and persistent patterns of restricted, repetitive behaviors with ASD and how those experiences impact their well-
(5th ed.; DSM-5; American Psychiatric Association, APA being. Therefore, the purpose of the current study is to
2013), this socially complex and demanding period may be examine gender differences in PV experiences in a sample of
especially challenging. A growing body of literature sug- adolescents with ASD and to explore whether such experi-
gests that peer victimization (PV), or the experience of being ences are associated with ASD and mental health symptoms
the target of another’s aggressive or bullying behavior and similarly for girls and boys.
social exclusion (Juvonen and Graham 2001), is a problem Past research suggest several factors associated with PV
in youth with ASD, including key characteristics of ASD
[i.e., deficits in social communication, and restricted and
* Jessica L. Greenlee repetitive behaviors (RRBs)]. Some studies have found a
[email protected]
positive association between social deficits and PV (higher
Marcia A. Winter level of impairment, more PV), while others have found a
[email protected]
negative association or no association at all (see Sreckovic
Isabel A. Marcovici et al. 2014). In addition, more severe RRBs, a core feature
[email protected]
of ASD and one that can make youth with ASD stand out
1
Present Address: The Waisman Center, The University from their peers, has also been associated with PV (Adams
of Wisconsin-Madison, 1500 Highland Ave., Madison, et al. 2014). Thus, although social communication deficits
WI 53705, USA and RRBs appear to be important to the social lives of youth
2
Department of Psychology, Virginia Commonwealth with ASD, the precise association between ASD symptoma-
University, 808 West Franklin St., Box 842018, Richmond, tology and victimization remains unclear.
VA 23284, USA

13
Vol.:(0123456789)
 Journal of Autism and Developmental Disorders

Adding to the lack of clarity is the scarcity of research et al. 2013) and adolescent (Adams et al. 2014) report of
that includes adolescent girls with ASD. Research in youth PV. However, these associations between PV and youth
with ASD has focused primarily on boys’ experiences, either outcomes relied on male dominated samples (e.g., see Ung
using all male (e.g., Adams et al. 2016), or mostly male et al. 2016), leaving questions as to whether and how PV is
samples (e.g., 85% male in Cappadocia et al. 2012; 90% in associated with mental health outcomes for girls with ASD.
van Roekel et al. 2010; 84.5% in Sterzing et al. 2012). How- Given the preliminary evidence suggesting that adoles-
ever, mounting evidence suggests that the social behaviors cent girls and boys with ASD may have different experiences
and challenges of girls with ASD are unique compared to of PV, combined with gaps in the literature surrounding the
boys (Dean et al. 2017) and that the phenotypic presenta- effects of PV on girls with ASD, the current exploratory
tion for girls is different from the classic presentation of study had three primary aims: (1) to describe both the overt
ASD, including less rigidity and fewer repetitive behaviors, and relational PV experiences of adolescent girls and boys
more acceptable narrow special interests, greater likelihood with ASD; (2) to explore how ASD symptoms (social aware-
of having a close friend, and less likelihood of presenting ness, cognition, communication, motivation, and RRBs) are
as socially aloof (Happé 2019). This alternative phenotypic associated with PV experiences similarly or uniquely for
presentation may have important implications for girls’ adolescent girls and boys; and (3) to examine how ASD
social functioning, how they relate to peers, and potentially symptoms and PV are related to mental health co-morbid-
their experiences of PV. While research establishing PV as a ities in youth with ASD, focusing on whether patterns of
critical issue impacting the health and well-being of children associations may be different for girls and boys.
and youth with ASD has been essential, there is a need for
research aimed at understanding the potentially distinct peer
experiences of girls’ with ASD. Method
Sex differences in experiences of PV have been found
in NT youth, with most reports suggesting that boys are Setting
involved in more overt, or physical forms of victimization
(i.e., pushing, hitting, kicking, etc.) whereas girls are more This study used data collected as part of the Teens and Par-
likely to experience subtle, indirect forms of “relational vic- ents (TAP) Study, which examined the impact of peer and
timization” such as spreading rumors, gossiping, exclusion, family factors as they relate to mental health comorbidities
ignoring, etc. (e.g., Card et al. 2008; Carbone-Lopez et al. for youth with ASD. Eligible families were recruited through
2010). Preliminary evidence suggests sex differences in PV the Interactive Autism Network (IAN), an online network
may also be true for adolescents with ASD but it is unclear linking the autism community with research opportunities
how difference may manifest. For instance, one study of (Daniels et al. 2012), as well as through online advertise-
school-aged children with ASD found boys to be blatantly ment on social media and local autism advocacy and support
socially excluded while girls were more covertly overlooked groups, and flyers placed in local schools and community
by their peers (Dean et al. 2014). Girls with ASD have also centers.
reported via semi-structured interviews that they experi-
enced high levels of relational aggression within friendships Participants
(Sedgewick et al. 2016). Qualitative research further high-
lights the unique peer social experiences of girls with ASD, Participants included adolescents (ages 13–17) with an exist-
describing both the importance of and challenges associated ing diagnosis of ASD (DSM-IV-TR or DSM-V criteria) and
with friendships. For example, girls and women with ASD their primary caregivers (PCs)/legal guardians. The PC and
describe being bullied, picked on, and facing difficulties the adolescent needed to live together, speak English flu-
as they navigate social relationships (Bargiela et al. 2016; ently, and have sufficient reading skills (as self- and PC-
Cresswell et al. 2019; Cridland et al. 2014; Sedgewick et al. reported) to complete the study procedures independently.
2019; Sproston et al. 2017). Thus, preliminary evidence sug- Individuals were excluded if they had a comorbid intellectual
gests that the peer context, and PV in particular, may look disability (or were considered to be non-verbal) or a genetic
unique for girls with ASD. disorder such as Fragile X Syndrome or Downs Syndrome.
In addition to factors associated with PV in youth with A total of 167 adolescent-caregiver dyads participated in
ASD, research has also focused on the potential negative the TAP study, 50 of whom identified as female adolescents.
impact of such experiences. PV has been linked to anxiety, To account for the unequal sample sizes between males and
depression, loneliness, and increased risk for suicidal idea- females, 40% (n = 55) of the participants who identified
tion in youth with ASD, using both parent (Cappadocia et al. as male were randomly selected as the comparison group
2012; Shtayermman 2007; Sterzing et al. 2012; Storch et al. for the current study, composing a final sample of 105 par-
2012; Ung et al. 2016; Van Schalkwyk et al. 2018; Zablotsky ticipants. Independent samples t-tests and chi-square tests

13
Journal of Autism and Developmental Disorders

revealed that girls and boys did not differ significantly on any Results
demographic variable except adolescent age [t(103) = 3.28,
p < 0.001, ­Mdifference = 0.78]; see Table 1 for a description of Aim 1. Boys’ and Girls’ Experiences of Peer
the study sample. Victimization

Overall, 88.0% of girls and 70.9% of boys [t(103) = 0.81,

Procedure p = 0.42] reported experiencing at least one instance of PV.
As shown in Table 2, girls and boys generally reported simi-
The TAP study was approved by the Institutional Review lar types of victimization experiences with a few notable
Board of a University in the southeastern US. All data were exceptions; girls reported fewer instances in which another
collected online via REDCap (a secure web-based database teen ‘hit, kicked, or punched in a mean way’, ‘chased like
system; Harris et al. 2009). In order to determine eligibility, he or she was really trying to hurt me’, ‘said mean things to
PCs completed an online pre-screening survey. If deemed me when I tried to be their friend’, and ‘made fun or teased
eligible, participants were prompted to continue to the study me when I talked to them’ compared to boys. Girls endorsed
consent page. Electronic consent (e-consent) processes were more experiences of relational aggression than boys did,
specifically designed for consenting and assenting partici- whereas boys reported more instances of overt victimiza-
pants remotely using computer-based documentation via tion than girls, albeit not statistically significant (Table 2).
REDCap. Once all PC measures were completed and sub-
mitted, the adolescent portion of the study launched. Prior
to completing the study, adolescents were asked to read an Aim 2. Associations of Peer Victimization with ASD
electronic assent document and indicate via a check box that Symptoms
they agreed to participate in the study. The PC and adoles-
cent each received a $10 e-gift card for their time. Descriptive statistics for all study variables can be found
in Table 3. A series of univariate analysis of variance
(ANOVA) tests revealed that girls and boys in the current
Measures sample did not differ in PC-reported social communication
skills or RRBs. Partial correlations amongst study variables
PCs and adolescents were asked to independently complete controlling for adolescent age revealed different patterns
a series of questionnaires lasting approximately 20–30 min of associations with PV by adolescent sex (Table 3). In
each. PCs answered demographic questions about them- particular, relational victimization was correlated with all
selves (e.g., relationship to the adolescent, age, employ- aspects of social-communication as well as RRBs for girls
ment, education, race), their adolescents (e.g., diagnosis such that higher levels of impairments were associated with
information, age, grade, special education status, etc.), and more relational victimization. Compared to girls who did
their families (e.g., income, number of people in the house- not report experiencing relational victimization, relation-
hold). Adolescents reported their recent experiences of PV ally victimized girls had higher mean impairment in social
using the 12-item Peer Experience Questionnaire-Revised cognition [t(48) = 2.82, p = 0.007, ­Mdifference = 4.50], social
(PEQ-R; Prinstein et al. 2001). The relational and overt communication [t(48) = 2.87, p = 0.006, ­Mdifference = 7.91],
victimization subscales (sum scores) of the PEQ-R were social motivation [t(48) = 3.30, p = 0.002, ­Mdifference = 6.41],
used in the present study (α = 0.87 and 0.86, respectively). and RRBs [t(48) = 2.70, p = 0.01, ­Mdifference = 4.76] but not
Adolescents also completed the 25-item short version of the social awareness [t(48) = 1.48, p = 0.15, ­Mdifference = 1.73].
Revised Children’s Anxiety and Depression Scale (RCADS; Only social communication was associated with relational
Ebesutani et al. 2011; Sterling et al. 2015) to assess general victimization for boys and there were no differences in ASD
mental health difficulties. Subscale anxiety and depression symptoms between boys who reported relational victimiza-
scores were used in the current study (α = 0.91 and 0.85, tion experiences and those who did not. Experiences of overt
respectively). Finally, PCs completed the Social Respon- victimization were not associated with ASD symptoms in
siveness Scale-2 (SRS-2; Constantino and Gruber 2012), a girls or boys.
65-item measure that yields several subscales: social cog-
nition (α = 0.75), social communication (α = 0.88), social
awareness (α = 0.66), social motivation (α = 0.85), and RRBs Aim 3. ASD Symptoms, Peer Victimization,
(α = 0.84). Because different components of social commu- and Mental Health
nication may be associated with peer relationships in unique
ways, and those associations may be different for girls and Girls and boys differed in mental health symptoms, with girls
boys, we examined the components separately. (Mdepression = 13.19, SD = 6.80; Manxiety= 18.94, SD = 12.13)

13
 Journal of Autism and Developmental Disorders

Table 1  Caregiver and Demographic items Male (n = 55) Female (n = 50)

adolescent demographic
characteristics by adolescent sex Primary caregiver and family
Age, M years (SD, range) 43.44 (5.05, 33–54) 44.70 (6.39, 33–62)
Marital status, n (%)
Single, never married 6 (10.9) 3 (6.0)
Married, living with spouse 43 (78.2) 34 (68.0)
Divorced 4 (7.3) 11 (22.0)
Widowed 2 (3.6) 2 (4.0)
Annual household income, n (%)
$10,000 or less 1 (1.9) 1 (2.0)
$10,000–20,000 4 (7.5) 4 (8.0)
$20,001–40,000 10 (18.5) 17 (34.0)
$40,001–60,000 4 (7.5) 11 (22.0)
$60,001–80,000 13 (24.1) 6 (12.0)
$80,001–100,000 8 (14.8) 4 (8.0)
$100,001 and greater 14(25.9) 7 (14.0)
Missing (n = 1, 1.8%)
Education, n (%)
High school degree 6 (10.9) 3 (6.0)
Associates or technical school 4 (7.3) 11 (22.0)
Some college 8 (14.5) 13 (26.0)
College degree 24 (43.6) 15 (30.0)
Master’s degree 8 (14.5) 7 (14.0)
Doctorate or Medical Doctor 5 (9.1) 1 (2.0)
Family size M (SD) 4.05 (1.06) 3.9 (1.04)
Adolescent
Age, M years (SD) 14.36 (1.21) 15.14 (1.21)
Race, n (%)
African American 2 (3.6) 0 (0.0)
White/Caucasian 43 (78.2) 44 (88.0)
American Indian or Alaskan Native 0 (0.0) 1 (2.0)
Native Hawaiian or other Pacific Islander 1 (1.8) 0 (0.0)
Mixed/multiple endorsed 3 (5.5) 3 (6.0)
Other 6 (10.9) 2 (4.0)
Special education status (yes), n (%) 15 (27.3) 8 (16.0)
Grade in school, n (%)
6th grade 2 (3.6) 0 (0.0)
7th grade 9 (16.4) 4 (8.0)
8th grade 14 (25.5) 7 (14.0)
9th grade 14 (25.5) 10 (20.0)
10th grade 10 (18.2) 10 (20.0)
11th grade 3 (5.5) 14 (28.0)
12th grade 2 (3.6) 3 (6.0)
Missing 1 (1.8) 2 (4.0)
Diagnosis, n (%)
Autism spectrum disorder 16 (29.1) 20 (40.0)
Autism 16 (29.1) 10 (20.0)
Asperger’s Syndrome 10 (18.2) 12 (24.0)
High-functioning autism/ASD 5 (9.1) 5 (10.0)
PDD-NOS 8 (14.5) 3 (6.0)

13
Journal of Autism and Developmental Disorders

Table 2  Prevalence of peer Peer victimization item Prevalence (%)

victimization experiences in the
current sample Girls (n = 50) Boys (n = 55)

Hit, kicked, or pushed me in a mean way 4.0 23.6*

Threatened to hurt or beat me up 12.0 23.6†
Chased me like he or she was really trying to hurt me 6.0 20.0*
Grabbed, held, or touched me in a way I didn’t like 20.0 21.8
Left me out of what he or she was doing 67.3 54.5
Left me out of an activity or conversation I really wanted to be included in 64.0 58.2
Did not invite me to a party or other social event even though he or she 34.0 29.6
knew I wanted to go
Would not sit near me at lunch or in class 42.0 34.5
Did not talk to me on purpose 56.0 56.4
Teased or made fun of me when I tried to hang out with other teens 36.0 38.2
Said mean things to me when I tried to be their friend 22.4 38.2*
Made fun of me or teased me when I talked to them 24.0 41.8*
Relational victimization 76.0 67.3
Overt victimization 28.0 36.4†

Prevalence indicates the percentage of subjects who indicated any experience with an item; overall preva-
lence of endorsing any experience of peer victimization was 82.0%
*Significant difference between boys and girls, p < .05; †p = .06

Table 3  Descriptive statistics and partial correlations between peer victimization, ASD symptoms, and adolescent mental health symptoms
Variable Males Females
Overt victimization Relational Mean (SD) Range Overt victimization Relational Mean (SD) Range
victimiza- victimiza-
tion tion

Social Awareness .10 .15 12.42 (4.14) 4–23 .16 .23 12.48 (3.57) 3–19
Social Cognition .16 .18 19.64 (5.70) 2–32 − .01 .45*** 18.84 (5.15) 6–27
Social Communication .19 .31* 33.84 (11.42) 11–58 .12 .39** 32.68 (8.92) 11–48
Social Motivation .16 .24 16.44 (5.77) 5–28 − .20 .37** 17.62 (6.43) 1–28
Restricted and Repetitive .03 .14 19.27 (7.52) 1–34 .01 .35* 20.12 (5.66) 10–30
Behaviors
Anxiety Symptoms .22 .14 14.36 (9.00) 1–37 − .03 .48*** 18.94 (12.13) 2–43
Depression Symptoms .13 .10 10.60 (5.25) 1–23 .05 .46*** 13.20 (6.80) 1–30
Mean (standard deviation) 1.4 (2.68) 4.51 (4.86) – – 0.62 (1.56) 5.22 (4.61) –
Range 0–15 0–20 – – 0–8 0–17 –

*p < .05; **p < .01; ***p < .001; †p = .05

reporting more depression [t(102) = 2.19, p = 0.03] and anxi- Girls

ety symptoms [t(90.02) = 2.18, p = 0.03] compared to boys
(Mdepression = 10.60, SD = 5.25; Manxiety= 14.36, SD = 8.99). Results indicated that the addition of PV (step 2)
Mental health symptoms were not associated with adoles- accounted for a significant increase in explained variance
cent age. To explore whether ASD symptoms and experi- in girls’ anxiety symptoms compared to ASD symptoms
ences of PV predicted mental health symptoms, a series of alone (△R2 = 0.09). While impairment in social-communi-
hierarchical linear regressions were conducted separately for cation skills was a significant predictor of girls’ anxiety in
boys’ depression and anxiety symptoms and girls’ depres- model 1, it was no longer significant once PV was entered
sion and anxiety symptoms (4 models total). ASD symptoms into the model. For girls, more relational victimization was
were entered in the first step of each model and experiences associated with more anxiety symptoms above and beyond
of PV were entered in the second step (Table 4). the effects of social impairment and overt victimization.

13
 Journal of Autism and Developmental Disorders

Table 4  Hierarchical linear regression for adolescent anxiety and depression symptoms
Variable Female Male
Model 1 Model 2 Model 1 Model 2
B SE B β B SE B β B SE B β B SE B β

Anxiety symptoms
RRB 0.48 0.37 0.22 0.44 0.36 0.21 − 0.44 0.27 − 0.37 − 0.38 0.28 − 0.32
SCI 0.25 0.10 0.42* 0.18 0.10 0.30 0.26 0.08 0.73** 0.23 0.09 0.66**
Overt Victimization − 0.84 0.97 − 0.10 0.32 0.48 0.10
Relational Victimization 0.90 0.33 0.34** 0.07 0.27 0.04
R2 .37 .46 .22 .23
F for change in R2 13.80*** 3.64* 7.10** 0.40
Depression symptoms
RRB 0.43 0.22 0.36† 0.41 0.22 0.34† − 0.28 0.16 -0.40 − 0.22 0.16 -0.32
SCI 0.07 0.06 0.21 0.03 0.06 0.10 0.15 0.05 0.72** 0.13 0.05 0.60*
Overt Victimization 0.12 0.59 0.03 0.18 0.28 0.09
Relational Victimization 0.46 0.20 0.31* 0.16 0.16 0.14
R2 .28 .37 .20 .23
F for change in R2 9.25*** 3.08† 6.24** 1.194

SE standard error, RRB repetitive and restricted behaviors, SCI social-communication impairment
*p < .05; **p < .01; ***p < .001; †p = .05

A different pattern of results emerged for girls’ depression Discussion

symptoms. The first model examining ASD symptoms as
a predictor of depression symptoms was significant, pri- The purpose of the present study was to describe the PV
marily driven by RRBs (albeit not statistically significant experiences of adolescents with ASD and the associa-
as an individual predictor, p = 0.05). The addition of PV tions between PV and youth ASD symptoms and mental
in model 2 did not account for more variance in depres- health outcomes. Specifically, this study aimed to address
sion symptoms (△R2 = 0.09, p = 0.05), although relational gaps in the literature pertaining to the experiences of ado-
victimization remained a significant independent predictor lescent girls with ASD by exploring the associations of
of depression symptoms. ASD symptoms, depression, anxiety and PV separately
for adolescent girls and boys with ASD. Results of this
cross-sectional study align with previous research that has
Boys found the prevalence of PV to be high in samples of youth
with ASD (e.g., Maïano et al. 2016; Schroeder et al. 2014),
Results indicated that the addition of PV (step 2) did not regardless of adolescent gender, and it adds to the growing
account for a significant increase in explained variance literature suggesting that PV is a primary concern for the
in boys’ anxiety symptoms compared to ASD symptoms well-being of youth with ASD.
alone (△R2 = 0.01). Impairment in social-communication There were no statistically significant differences in
was a significant predictor of boys’ anxiety symptoms experiences of overall overt or relational victimization
in model 1 and remained the only significant predictor between boys and girls in this sample; they reported simi-
after PV was entered into the model. A similar pattern of lar frequencies of exclusion experiences (girls: 34–67%,
results was present for depression symptoms. The addition boys: 34–58%). This is unlike previous reports in school-
of PV (block 2) did not account for a significant increase age children that found boys with ASD more likely to be
in explained variance in boys’ depression symptoms com- rejected and excluded than girls with ASD (Dean et al.
pared to ASD symptoms alone (△R2 = 0.03). Impairment 2014). This may, in part, reflect the general increase in
in social-communication was a significant predictor of relational victimization often found across adolescence
boys’ depression symptoms in model 1 and remained the (Casper and Card 2017; Troop-Gordon 2017). It may also
only significant predictor after PV was entered into the suggest gender-specific changes in PV experiences during
model.

13
Journal of Autism and Developmental Disorders

the transition to adolescence. The changing social norms expectations results in social rejection and exclusion for girls
of all adolescent girls likely stem from multiple sources with ASD (Tierney et al. 2016).
ranging from broader, societal expectations that define In addition, relational victimization was a significant pre-
socially acceptable behavior to micro-level expectations dictor of anxiety symptoms and—at a trend level—depres-
of a friend group that become more narrow, less flexible, sion symptoms only in girls. Previous research suggests
and less willing to accept non-conforming behavior. Ulti- that verbally-fluent adolescents with ASD perceive social
mately this may reflect increases in relational victimiza- rejection as distressing and anxiety provoking as NT youth
tion for NT girls and girls with ASD alike. We also know (Sebastian 2015). Given evidence that girls with ASD are
that adolescence is a developmental period that girls with more likely to present as socially-appropriate compared to
ASD have emphasized as particularly challenging (Tier- boys, adopt compensatory social behaviors, and may be as
ney et al. 2016). It may be that girls’ social compensatory socially-motivated as NT girls (Dean et al. 2017; Happé
behaviors minimize peer rejection and exclusion during 2019; Sedgewick et al. 2016), adolescent girls with ASD
childhood, but that as the social context increases in com- may also be more likely to identify and internalize relational
plexity across adolescence, girls with ASD have difficulty victimization and subsequently experience greater distress
meeting both broadly defined social norms and more spe- in the face of such events. Thus, the unique association
cific inter-group expectations. If they lack the more sophis- between relational victimization and girls’ mental health
ticated skills needed to navigate the increasingly subtle symptoms likely results from a combination of complex,
and nuanced social encounters characteristic of female gendered social norms during adolescence and the poten-
social groups, the result may be an increase in exclusion tially distinct phenotypic expression of ASD in women and
through adolescence. Peer exclusion may, in turn, restrict girls. Girls with ASD who are aware of their social differ-
access to and participation in peer activities, thereby lim- ences and attribute experiences of PV to causes that are
iting opportunities to practice critical social skills, form internal (i.e., themselves) rather than external (i.e., others)
same-age friendships, and learn peer-group norms while may be especially likely to develop feelings of sadness, lone-
reinforcing the “benefits” of social withdrawal, ultimately liness, or social anxiety, and use more maladaptive coping
increasing the risk for mental health symptoms. Longitu- strategies such as isolation, rumination, and opposition that
dinal research aimed at understanding the specific impact contribute to internalizing symptoms (Mazurek and Kanne
of peer exclusion for both boys and girls with ASD will be 2010; Zimmer-Gembeck 2016).
important moving forward. The association between relational victimization and
Although rates of overt and relational PV did not differ mental health symptoms may also be indicative of a cycle in
between boys and girls in the current sample, there were dif- which negative peer experiences and social isolation contrib-
ferent patterns of associations between PV and ASD symp- ute to mental health problems, which may further intensify
toms. Relational victimization was associated with more difficulties with peers (Sedgewick et al. 2018). Internalizing
impairment in all aspects of social functioning (i.e., social symptoms have been concurrently linked to PV in NT youth
cognition, motivation, awareness, and communication) as but also act as both a risk factor and consequence of PV
well as RRBs in girls, while in boys relational victimiza- across time, providing empirical support for a vicious cycle
tion correlated only with impairment in social communica- in which PV and internalizing symptoms contribute to each
tion. These findings may suggest that for girls with ASD, other (Reijintjes et al. 2010). Understanding the processes
more severe social impairments across the board (e.g., social through which this cycle develops and continues across ado-
cognition: turn-taking in conversation, non-verbal commu- lescence for youth with ASD will be important for targeted
nication; motivation: low self-confidence when interacting intervention development. For instance, some research sug-
with others and avoidance of social interaction; awareness: gests that individual differences in adolescent’s sensitivity
picking up on social cues; communication: taking things to rejection may help explain the link between PV and men-
too literally and difficulty understanding tone of voice and tal health. Experiencing peer rejection and exclusion may
facial expressions) as opposed to challenges in one specific result in a heightened sensitivity to future experiences of
area of social functioning may make participating in, or even exclusion such that an adolescent learns to anticipate these
mimicking the social behaviors of girls more challenging types of peer experiences, and withdraws from the peer
and thus, lead to relational PV. Given that girls are socialized environment to prevent negative experiences; this increases
to participate in small, intimate groups with heavy language feelings of loneliness, isolation, and risk for mental health
demands that value conforming to group interests, girls with symptoms, which leads to further peer rejection (Zimmer-
ASD may be more likely to encounter peer situations where Gembeck 2016). A similar but alternative hypothesis is that
more complex social skills are required (Dean et al. 2013). the negative cycle between PV and internalizing problems
It may be that difficulty understanding the subtle rules of is strongest for youth with ASD who have a high sensitiv-
female-to-female relationships as well as gendered social ity to rejection. Answering questions like these will be an

13
 Journal of Autism and Developmental Disorders

important step for research and intervention development Wisconsin-Madison. The content is solely the responsibility of the
moving forward. authors and does not necessarily represent the official views of the
National Institutes of Health.
The present study is exploratory in nature and findings
should be interpreted in light of the sample size and other Author Contributions JLG designed and directed the project. MAW
limitations. Causal interpretations of the results cannot be was involved in planning the project and supervised the work. IAM
made given the cross-sectional nature of the study. Internet- helped collect and manage the data. JLG took the lead in analyzing
based data collection methods precluded confirmation of the the data and drafting the manuscript with support from MAW and
IAM. All authors contributed to editing and revising the manuscript
adolescent’s ASD diagnosis, relying solely on parent-report and approved the final document.
of diagnostic information and ASD symptomatology such
as social-communication deficits, and online-based studies
may be influenced by sampling bias. In addition, there is
References
recent research that questions whether some common PV
questionnaires, including the PEQ-R used in the current Adams, R. E., Fredstrom, B. K., Duncan, A. W., Holleb, L. J., &
study, provide the most accurate representation of experi- Bishop, S. L. (2014). Using self- and parent-reports to test
ences of adolescents with ASD. For instance, a recent quali- the association between peer victimization and internalizing
symptoms in verbally fluent adolescents with ASD. Journal of
tative study by Fisher and Taylor (2016) found that although
Autism and Developmental Disorders, 44, 861–872. https​://doi.
a majority of their sample reported experiencing PV, the org/10.1007/s1080​3-013-1938-0.
examples adolescents with ASD used to describe these expe- Adams, R., Talyor, J., Duncan, A., & Bishop, S. (2016). Peer victimiza-
riences often differed from the examples commonly included tion and educational outcomes in mainstreamed adolescents with
autism spectrum disorder (ASD). Journal of Autism and Develop-
in questionnaires.
mental Disorders, 46, 3357–3566. https​://doi.org/10.1007/s1080​
Nevertheless, findings underscore the need for additional 3-016-2893-3.
research aimed at understanding the complex associations American Psychiatric Association. (2013). Diagnostic and statistical
among these variables for both boys and girls with ASD. manual of mental disorders (5th ed.). Arlington, VA: American
Psychiatric Publishing.
For instance, it could be that adolescents with ASD who
Bargiela, S., Steward, R., & Mandy, W. (2016). The experiences of late-
have depression and/or anxiety symptoms are at increased diagnosed women with autism spectrum conditions: An investiga-
risk for PV. A recent study that included adolescent girls tion of the female autism phenotype. Journal of Autism and Devel-
with ASD, with intellectual disability, and NT youth found opmental Disorders, 46, 3281–3294. https​://doi.org/10.1007/
s1080​3-016-2872-8.
that internalizing symptoms at age 13 predicted PV experi-
Brown, B. B. (2004). Adolescents’ relationships with peers. In R. M.
ences at 15 but not vice-versa (Tipton-Fisler et al. 2018). Lerner & L. D. Steinberg (Eds.), Handbook of adolescent psychol-
Longitudinal research aimed at understanding the direc- ogy (2nd ed., pp. 363–394). Hoboken, NJ: Wiley.
tion of effects amongst these variables will be important for Cappadocia, M. C., Weiss, J. A., & Pepler, D. (2012). Bullying experi-
ences among children and youth with Autism Spectrum Disorders.
intervention development. Furthermore, additional research
Journal of Autism and Developmental Disorders, 42, 266–277.
aimed at understanding the risk factors for PV specific to https​://doi.org/10.1007/s1080​3-011-1241-x.
adolescent girls with ASD is warranted. Given that experi- Carbone-Lopez, K., Exbensen, F. A., & Brick, B. T. (2010). Correlates
ences of relational victimization contributed significantly to and consequences of peer victimization: Gender differences in
direct and indirect forms of bullying. Youth Violence and Juvenile
anxiety symptoms in girls after accounting for impairments
Justice, 8, 332–350. https​://doi.org/10.1177/15412​04010​36295​4.
in social-communication, it may be, for example, that the Card, N. A., Stucky, B. D., Sawalani, G. M., & Little, T. D. (2008).
peer context (i.e., PV) acts as a mechanism through which Direct and indirect aggression during childhood and adolescence:
ASD symptoms such as social-communication impairments A meta-analysis review of gender differences, intercorrelations,
and relations to maladjustment. Child Development, 79(5),
are linked to internalizing symptoms in girls with ASD. Cur-
1185–1229.
rently, our understanding of PV and its impact on mental Casper, D. M., & Card, N. A. (2017). Overt and relational victimi-
is based in a narrative centered on the experiences of boys zation: A meta-analytic review of their overlap and associations
with ASD. This study provides preliminary evidence for the with social–psychological adjustment. Child Development, 88,
466–483.
potential unique peer experiences of adolescent girls with
Constantino, J. N., & Gruber, C. P. (2012). Social Responsiveness
ASD and the negative affect of PV on their mental health. Scale-Second Edition (SRS-2). Torrance, CA: Western Psycho-
logical Services.
Acknowledgments Data used in the current study is from a larger Cresswell, L., Hinch, R., & Cage, E. (2019). The experiences of peer
study, the Teens and Parents (TAP) Study. The authors would like to relationships amongst autistic adolescents: A systematic review of
acknowledge the adolescents and their caregivers for their contribu- the qualitative evidence. Research in Autism Spectrum Disorders,
tions to this study. In addition, the authors would like to acknowl- 61, 45–60. https​://doi.org/10.1016/j.rasd.2019.01.003.
edge the following funding sources: Autism Speaks (Grant #10654), Cridland, E. K., Jones, S. C., Caputi, P., & Magee, C. (2014). Being
the Eunice Kennedy Shriver National Institute of Child Health and a girls in a boys’ world: Investigating the experiences of girls
Human Development of the National Institutes of Health under Award with autism spectrum disorders during adolescence. Journal of
Number T32HD007489 and U54 HD090256, and the University of

13
Journal of Autism and Developmental Disorders

Autism and Developmental Disorders, 44, 1261–1274. https:​ //doi. Sebastian, C. L. (2015). Social cognition in adolescence: Social
org/10.1007/s1080​3-013-1985-6. rejection and theory of mind. Psicologia Educativa, 21(2),
Daniels, A. M., Rosenberg, R. E., Anderson, C., Law, J. K., Marvin, 125–131. https​://doi.org/10.1016/j.pse.2015.08.004.
A. R., & Law, P. A. (2012). Verification of parent-report of child Sedgewick, F., Hill, V., & Pellicano, E. (2018). Parent perspective on
autism spectrum disorder diagnosis to a web-based autism reg- autistic girls’ friendship and futures. Autism and Developmental
istry. Journal of Autism and Developmental Disorders, 42, 257– Language Impairments, 3, 1–12. https​://doi.org/10.1177/23969​
265. https​://doi.org/10.1007/s1080​3-011-1236-7. 41518​79449​7.
Dean, M., Adams, G. F., & Kasari, C. (2013). How narrative diffi- Sedgewick, F., Hill, V., & Pellicano, E. (2019). ’It’s different for
culties build peer rejection: A discourse analysis of a girl with girls’: Gender differences in the friendships and conflict of
autism and her female peers. Discourse Studies, 15(2), 147–166. autistic and neurotypical adolescents. Autism, 23, 1119–1132.
https​://doi.org/10.1177/14614​45612​47147​2. https​://doi.org/10.1177/13623​61318​79493​0.
Dean, M., Harwood, R., & Kasari, C. (2017). The art of camouflage: Sedgewick, F., Hill, V., Yates, R., Pickering, L., & Pellicano, E.
Gender differences in the social behaviors of girls and boys (2016). Gender differences in the social motivation and friend-
with autism spectrum disorder. Autism, 21, 678–689. https​:// ship experiences of autistic and non-autistic adolescents. Jour-
doi.org/10.1177/13623​61316​67184​5. nal of Autism and Developmental Disorders, 46(4), 1297–1306.
Dean, M., Kasari, C., Shih, W., Frankel, F., Whitney, R., Landa, R., Shtayermman, O. (2007). Peer victimization in adolescents and
et al. (2014). The peer relationships of girls with ASD at school: young adults diagnosed with Asperger’s Syndrome: A link
Comparison to boys and girls with and without ASD. Journal of to depressive symptomatology, anxiety symptomatology and
Child Psychology and Psychiatry, 55(11), 1218–1225. suicidal ideation. Issues in Comprehensive Pediatric Nursing,
Ebesutani, C., Chorpita, B. F., Higa-McMillan, C. K., Nakamura, B. 30(3), 87–107. https​://doi.org/10.1080/01460​86070​15250​89.
J., Regan, J., & Lynch, R. E. (2011). A psychometric analysis of Sproston, K., Sedgewick, F., & Crane, L. (2017). Autistic girls and
the Revised Child Anxiety and Depression Scales—Parent Ver- school exclusion: Perspectives of students and their parents.
sion in a school sample. Journal of Abnormal Child Psychology, Autism and Developmental Language Impairments, 2, 1–14.
39(2), 173–185. https​://doi.org/10.1007/s1080​2-010-9460-8. https​://doi.org/10.1177/23969​41517​70617​2.
Fisher, M. H., & Taylor, J. L. (2016). Let’s talk about it: Peer vic- Sreckovic, M. A., Brunsting, N. C., & Able, H. (2014). Victimization
timization experiences as reported by adolescents with autism of students with autism spectrum disorder: A review of preva-
spectrum disorder. Autism, 20(4), 402–411. lence and risk factors. Research in Autism Spectrum Disorders,
Happé, F. (2019). What does research tell us about girls on the autism 8, 1155–1172. https​://doi.org/10.1016/J.RASD.2014.06.004.
spectrum? In B. Carpenter, F. Happé, & J. Egerton (Eds.), Girls Sterling, L., Renno, P., Storch, E. A., Ehrenreich-May, J., Lewin, A.
and autism: Educational, family and personal perspectives (pp. B., Arnold, E., et al. (2015). Validity of the revised children’s
10–15). New York: Routledge. anxiety and depression scale for youth with autism spectrum
Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., disorders. Autism, 19(1), 113–117.
& Conde, J. G. (2009). Research exectronic data capture Sterzing, P. R., Shattuck, P. T., Narendorf, S. C., Wagner, M., &
(REDCap)—A metadata-drive methodology and workflow pro- Cooper, B. P. (2012). Bullying involvement and Autism
cess for providing translational research informatics support. Spectrum Disorders. Archives of Pediatrics and Adolescent
Journal of Biomedical Informatics, 42, 377–381. https​://doi. Medicine, 166, 1058. https ​ : //doi.org/10.1001/archp ​ e diat​
org/10.1016/j.jbi.2008.08.010. rics.2012.790.
Juvonen, J., & Graham, S. (Eds.). (2001). Peer harassment in school: Storch, E. A., Larson, M. J., Ehrenreich-May, J., Arnold, E. B.,
The plight of the vulnerable and victimized. New York: The Jones, A. M., Renno, P., …, Wood, J. J. (2012). Peer victimiza-
Guilford Press. tion in youth with Autism Spectrum Disorders and co-occurring
Maïano, C., Normand, C. L., Salvas, M.-C., Moullec, G., & Aimé, A. anxiety: Relations with psychopathology and loneliness. Jour-
(2016). Prevalence of school bullying among youth with Autism nal of Developmental and Physical Disabilities, 24, 575–590.
Spectrum Disorders: A systematic review and meta-analysis. https​://doi.org/10.1007/s1088​2-012-9290-4.
Autism Research, 9, 601–615. https​://doi.org/10.1002/aur.1568. Tierney, S., Burns, J., & Kilbey, E. (2016). Looking behind the
Mazurek, M., & Kanne, S. (2010). Friendship and internalizing mask: Social coping strategies of girls on the autistic spectrum.
symptoms among children and adolescents with ASD. Journal Research in Autism Spectrum Disorders, 23, 73–83. https​://doi.
of Autism and Developmental Disorders, 40(12), 1512–1520. org/10.1016/j.rasd.2015.11.013.
Prinstein, M. J., Boergers, J., & Vernberg, E. M. (2001). Overt and Tipton-Fisler, L., Rodriguez, G., Zeedyk, S. M., & Blacher, J. (2018).
relational aggression in adolescents: Social–psychological Stability of bullying and internalizing problems among ado-
adjustment of agressors and victims. Journal of Clinical Child lescents with ASD, ID, or typical development. Research in
Psychology, 30(4), 479–491. https​: //doi.org/10.1207/S1537​ Developmental Disabilities, 80, 131–141.
4424J​CCP30​04_05. Troop-Gordon, W. (2017). Peer victimization in adolescence: The
Reijintjes, A., Kamphuis, J. H., Prinzie, P., & Telch, M. J. (2010). nature, progression, and consequences of being bullied with a
Peer victimization and internalizing problems in children: A developmental context. Journal of Adolescence, 55, 116–128.
meta-analysis of longitudinal studies. Child Abuse and Neglect, https​://doi.org/10.1016/j.adole​scenc​e.2016.12.012.
34(4), 244–252. https​://doi.org/10.1016/j.chiab​u.2009.07.009. Twyman, K., Saylor, C., Saia, D., Macias, M., Taylor, L., & Spratt,
Roekel, E., Scholte, R. H. J., & Didden, R. (2010). Bully among E. (2010). Bullying and ostracism experiences in children with
adolescent with autism spectrum disorders: Prevalence and per- special health care needs. Journal of Developmental and Behav-
ception. Journal of Autism and Developmental Disorders, 40, ioral Pediatrics, 31, 1–18. https​://doi.org/10.1097/DBP.0b013​
63–73. https​://doi.org/10.1007/s1080​3-009-0832-2. e3181​c828c​8.
Schroeder, J., Cappadocia, M. C., Bebko, J., Pepler, D., & Weiss, Ung, D., McBride, N., Collier, A., Selles, R., Small, B., Phares, V.,
J. (2014). Shedding light on a pervasive problem: A review of et al. (2016). The relationship between peer victimization and
research on bullying experiences among children with autism
spectrum disorders. Journal of Autism and Developmental Dis-
orders, 44(7), 1520–1534.

13
 Journal of Autism and Developmental Disorders

the psychological characteristics of youth with autism spectrum Zimmer-Gembeck, M. J. (2016). Peer rejection, victimization, and
disorder. Research in Autism Spectrum Disorders, 32, 70–79. relational self-system processes in adolescence: Toward a trans-
https​://doi.org/10.1016/J.RASD.2016.09.002. actional model of stress, coping, and developing sensitivities.
Van Schalkwyk, G., Smith, I., Silverman, W., & Volkmar, F. (2018). Child Development Perspectives, 10(2), 122–127. https​://doi.
Brief report: Bullying and anxiety in high-functioning adoles- org/10.1111/cdep.12174​.
cents with ASD. Journal of Autism and Developmental Disor-
ders, 48(5), 1819–1824. Publisher’s Note Springer Nature remains neutral with regard to
Zablotsky, B., Bradshaw, C. P., Anderson, C., & Law, P. A. (2013). jurisdictional claims in published maps and institutional affiliations.
The association between bullying and the psychological func-
tioning of children with Autism Spectrum Disorders. Journal
of Developmental and Behavioral Pediatrics, 34, 1–8. https​://
doi.org/10.1097/DBP.0b013​e3182​7a7c3​a.

13