Autism Spectrum Disorders and Sexual Abuse

by Meredith S. Donlan

What is autism?

Autism is a developmental disorder caused by a complex combination of genetic and environmental factors; however, it is not yet fully understood by researchers. The disability was originally identified by Leo Kanner in 1943. It is characterized largely by challenges in communication, impaired social ability, and repetitive behaviors. While these are the core characteristics of the disorder, there is a vast breadth of severity and significant variability in their expression. For example, some individuals with autism can be quite verbal with limited fluidity in their language while others are entirely nonverbal and must communicate via alternative communication modes such as sign language or alternative and augmentative devices (AACs range from picture and symbol communication boards to electronic devices such as Dynavox or iPad and are used to enhance communication when verbal discourse is insufficient) (ASHA, 2016).

Along with the considerable expanse of autism behaviors and severity, there is a related spectrum of disorders that includes Asperger’s Disorder, Rett’s Syndrome, and Children Disintegrative Disorder (APA, 2000). These, together with autism, are referred to as Autism Spectrum Disorders (ASD). The latest studies estimate that approximately 1 in 68 children are diagnosed with some form of ASD, according to latest estimates from CDC’s Autism and Developmental Disabilities Monitoring (ADDM) network. That same study shows that ASD is reported to occur in all racial, ethnic, and socioeconomic groups, and is about 4.5 times more common among boys (1 in 42) than among girls (1 in 189).

Is there a correlation between sexual abuse and children with disabilities?

Several studies show that children with a variety of physical and mental disabilities are sexually abused more often than children without (Sobsey, 1994). Sullivan & Knutson (2000) note that children with any type of disability are 3.44 time more likely to be victims of some type of abuse, whether neglect, physical, or sexual. Studies also reveal that children with behavioral disorders and intellectual disabilities specifically are at an even higher risk for abuse.

Why is there a correlation between sexual abuse and children with disabilities?

Researchers suggest that the most likely reason for this correlation is heightened vulnerability to such abuse. In other words, children with disabilities are likely easier targets because of their physical or mental challenges. Further, children with disabilities often require a higher level of personal care from adults, and this increased time alone with children can also provide more opportunities for potential offenders.

Sadly, although research show that children with some form of disability are targeted far more often than children who are not classified as disabled, the above abuse statistics
mayunderstate the actual incidences of abuse due to several factors. Parents and caregivers themselves are sometimes the abusers, and thus would not report an incidence for fear of consequences. Secondly, even if parents suspect that abuse has taken place, they may fear reporting the offense if it means potentially removing their child from his/ her group home and leaving him/her without living arrangements. Finally, and perhaps most prevalent, the abused children may not report the incident because they do not fully understand what is considered an abusive act, and/or are have difficulty articulating the details of the abuse, as sometimes their disability prevents them from effectively doing so (Knutson & Sullivan, 1993).

Are children with ASD as likely to experience sexual abuse as children with other disabilities?
To date, there have been few studies conducted specifically linking the rates of sexual abuse and ASD. However, the few that have been done are quite telling. For example, MeredythEdelson (2010) authored a research article that comprehensively detailed the factors that increase the risk of sexual abuse in children with ASD and how the recognition of such abuse can be ignored or misattributed to the behavioral challenges of autism. Her two main arguments allege that children with autism may be targeted for abuse by sexual offenders who view them as vulnerable, and when children with autism experience sexual abuse, they may show it in ways which are misattributed to the very diagnosis of autism.

Why are ASD children more vulnerable?

There are several reasons why children with ASD may be even more vulnerable to sexual abuse than children with other disabilities. There are certain communication and social difficulties characteristic of ASD that may be interpreted by sexual offenders as vulnerabilities that are easy to exploit. These characteristics are of particular concern.

Numerous studies have been conducted on sexual abuse predators and the “selection techniques” they employ to target potential victims. These techniques fall into four broad categories, two of which are particularly relevant to children with ASD: “easy prey” and situational characteristics (e.g. opportunity) (Stevens, 1997).

Children with ASD (particularly those who are nonverbal) are particularly desirable targets for potential sexual offenders because of the perception that they would be unable to disclose the abuse if it were to occur (Edelson, 2010). This is an incorrect assumption, for many nonverbal children with ASD are able to communicate in alternative modes such as sign language or electronic devices.

Even verbal children with autism may have difficulty reporting abuse due to their need for referential communication. Referential communication requires a speaker to provide enough specific information to a listener so that the listener knows to what the speaker is referring (Edelson, 2010), which is particularly important in communicating information not already known by another party. Therefore, if a verbal child with ASD attempts to disclose sexual abuse, they may not have the referential communication skills to
effectively communicate what happened to them.

Lastly, children with ASD commonly have difficulty interpreting emotions of others. This often prevents them from identifying safe from unsafe individuals (Edelson, 2010). Having difficulty interpreting emotions of others can be even more problematic when the potential abuser is deceptive with his/her emotions. One study found that high functioning children with autism were less able to identify deceptive facial expressions and even less able to understand the concept of and reasons for deceit (Dennis et al., 2000).

Children with ASD may be at a greater risk of being sexually abused because of their desire to be accepted socially. High functioning children with autism tend to be aware of their social difficulties and thus feel a deep desire to connect with others. If the offender portrays him/herself as a “friend,” the victim may see this as a social relationship he/she desires (Edelson, 2010).

The second selection technique posing a concern regarding children with ASD is opportunity because these children often receive a greater deal of specialized services from adults (e.g. service providers, foster care providers, transportation providers) than do typically developing children. The opportunities for sexual abusers may be increased due to the increased amount of time alone with the child.

While there is no research specific to children with ASD living in institutional settings, Goldman (1994) found that children with developmental disabilities who live in such environments may have a greater risk for abuse than those living with their families and receiving outpatient services. Again, this is due to increased contact with opportunistic offenders.

There has, however, been one study conducted on the rates of sexual and physical abuse within the ASD population receiving treatment in community mental health settings. Researchers found that the rates of sexual abuse among these ASD children are much higher than those reported among those served through the special education system (Mandell at al., 2005).

Another factor worth noting is that sexual offenders who target children reveal cognitive distortions that allow them to justify their offending and not consider it wrong or harmful (Burn & Brown, 2006). One cognitive distortion is the “objectification” of their victims, meaning they view them as objects rather than people. Some children with autism exhibit repetitive or stereotyped behaviors that are seen as unusual or robotic to others or sometimes, less human. These qualities further increase the risk of sexual abuse of children with ASD.

In addition to the vulnerabilities seen by potential offenders, Brown-Lavoie et al. (2014) found that children with ASD may also be more susceptible for sexual victimization due to a lack of sexual knowledge within the ASD population. They conducted a study with
adults with ASD to examine sexual knowledge and risk of victimization in adults with high functioning ASD. They found that individuals with ASD have less actual sexual knowledge and experience more sexual victimization that individuals without ASD (Brown-Lavoie et al., 2014). Sexual knowledge includes defining sexual activities, STIs, contraception, and reproductive health. Furthermore, they found that this increased risk of sexual abuse is partially mediated by their level of actual knowledge of sexual behavior. The results showed that individuals with ASD were between two and three times more likely to experience sexual abuse than the control group.

The same study found that one reason for a lack of sexual knowledge is the absence of formal sexual education from educators (Brown-Lavoie et al., 2014). Individuals with ASD lack education in this format possibly because they are being removed from the class for various reasons or that the curriculum is not adapted to their level of understanding (Henault, 2005). Due to this lack of sexual education, inappropriate sexual contact from an offender may not be recognized as abuse by a child with ASD.

Additionally, individuals with ASD often have impairments in social cues and/or understanding intention, as well as limited peer interactions. These factors may result in individuals with ASD missing or misunderstanding opportunities for gaining sexual knowledge through peer interaction (Brown-Lavoie et al., 2014).

Lastly, many parents of these individuals were found to lack confidence in discussing sexual behavior with their children for fear it will increase adolescents’ sexual interest or behavior (Edelson, 2010). Also, some caregivers or parents may believe individuals with ASD to be “asexual,” however, several studies have proved this is an incorrect assumption (Hellemans et al. 2007).

How can we detect the occurrence of sexual abuse through behaviors?

Because children with ASD face an increased risk of sexual abuse, it is vitally important that caregivers are able to identify signs that abuse has occurred. However, due to some of the symptoms of ASD, behaviors of abused children may not be recognized as evidence of abuse.

Autism research has shown that children who are nonverbal exhibit more behavioral difficulties than those with verbal communication abilities, likely because it is frustrating to attempt to communicate to others and not be able to effectively convey one’s message (Dominick et al., 2007). A study by Mandell et al. (2005) found that common behavioral responses to sexual abuse include sexually acting out, assaultive behavior, running away from home, urine incontinence, and suicidal behavior. Even verbal children who cannot effectively communicate that which happened may begin to exhibit behavioral difficulties but again, they may be misattributed to the ASD itself (Edelson, 2010).

In addition to behavioral challenges, autistic children who have been sexually abused may turn to repetitive or stereotypic behaviors, often referred to as “stimming,” because the behavior acts as a self-soother for the child. Again, an increase in these behaviors can
also be attributed to an increase in severity of the ASD. A pressure to “fix” or stop these behaviors adds additional complications, as the caregivers may completely disregard an environmental or situational reason for their increase (Edelson, 2010).

What are the implications of this information?

When it is suspected that a typically developing child has been sexually abused, there are certain protocols to follow. Child Abuse Assessment Centers (CAACs) offer medical examinations and forensic interviews (Edelson, 2010). In order to make a valid determination, the child must be able to participate adequately in the entire evaluation. Unfortunately, children with ASD may not be able to participate effectively within the current protocols because of the lengthy, one-time interviews with assessors the children have not previously met. Most children with ASD prefer consistent routines and familiar environments and people. These interviews, therefore, are inadequate for assessing children with ASD.

Furthermore, these standard forensic interviewing techniques also place an emphasis on open-ended questions designed to elicit free narratives, requiring a child to have sufficient verbal skills and the ability to engage in referential communication and conversational discourse (Edelson, 2010). Again, these are characteristics with which children with ASD have difficulty.

Lastly, the ineffectiveness of current protocols may be due to the fact that children with ASD (also typical children) have short attention spans and are not accustomed to situations like forensic interviews. Edelson (2010) notes is would be helpful to require several interviews, which may help address the issue of short attention spans and the need to be familiar with environment and/or interviewer.

Edelson (2010) notes how important it is that researchers identify strategies to prevent sexual abuse of children with autism, develop protocols to accurately assess if abuse has occurred, to educate people with ASD about sexual health and abuse, and to ensure that children with ASD are taught to use augmentative and alternative means of communication effectively.

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