Clinicians’ retrospective perceptions of failure to detect sexual abuse in a young man with autism and mild intellectual disability^*

* All authors have contributed to, seen, and approved of the manuscript, and agree to the order of authors as listed on the title page.

ABSTRACT

Background: Individuals with intellectual disability (ID) and autism spectrum disorder (ASD) are at increased risk of sexual abuse. However, little is known about facilitating detection and disclosure. One year after discharge from a specialised psychiatric ward, a young man with mild ID and ASD disclosed previously unknown sexual abuse. The aim of the present study was to explore clinicians’ perceptions of their failure to detect abuse.

Method: Interpretative phenomenological analysis was used to explore five staff members’ perceptions, with data being collected through an individual, semi-structured interview.

Results: Staff reported behaviours that, in retrospect, they understood as possible indicators of abuse and/or attempts by the patient to disclose. Factors contributing to non-detection included insufficient trauma sensitivity, lack of exploration, and diagnostic overshadowing.

Conclusions: Symptoms of trauma should be routinely explored in individuals with ASD and ID referred for psychiatric assessment – even in the absence of known trauma or abuse.

KEYWORDS:

• Autism spectrum disorder
• intellectual disability
• sexual abuse
• trauma
• post-traumatic stress disorder
• PTSD

Acknowledgements

We would like to thank Patricia Howlin for her helpful suggestions in the preparation of this manuscript and for vastly improving its language during the final revision. We would also like to thank the anonymous referees for their highly constructive input, Trine Lise Bakken for her helpful input during the first revision, and the patient’s mother for reading and providing feedback on an earlier draft of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Arvid Nikolai Kildahl http://orcid.org/0000-0002-8821-4745

Sissel Berge Helverschou http://orcid.org/0000-0003-3710-6733

Hanne Weie Oddli http://orcid.org/0000-0002-1299-6760

Notes

* All authors have contributed to, seen, and approved of the manuscript, and agree to the order of authors as listed on the title page.

Additional information

Funding

This research was funded by the Oslo University Hospital through the authors’ work as clinicians. The funding body did not impose any restrictions on free access to or publication of the research data.