Challenges in determining whether youth with autism spectrum disorder have been sexually abused: implications for forensic interviewing

Abstract

Purpose

The purpose of this paper is to educate forensic interviewers about autism spectrum disorder (ASD) and tools for interviewing youth with ASD when there are concerns of child sexual abuse (CSA).

Design/methodology/approach

Research is reviewed to discuss risk factors for CSA in youth with ASD, why CSA is often not recognized and research-based strategies for forensically interviewing youth with ASD.

Findings

Youth with ASD are at increased risk of CSA compared to neurotypical peers, but recognition of CSA in youth with ASD can be difficult. Forensic interviewing strategies can help interviewers obtain reports of CSA from youth with ASD.

Practical implications

Given the increase in prevalence of ASD and the increased risk of CSA, forensic interviewers need to have information about ASD, about why CSA may not be recognized, about risk factors for CSA and, especially, about how to accommodate for ASD when conducting forensic interviews.

Originality/value

This paper provides a novel framework for considering evidence-based practices for forensically interviewing youth with ASD when there are concerns of CSA. Specifically, this paper includes multiple, but related areas, in one article including research related to ASD, risk factors for CSA in those with ASD, obstacles to identifying CSA and the implications of this research for specific strategies regarding how to forensically interview youth with ASD when there are concerns of CSA.

Citation

Goldberg Edelson, M. (2023), "Challenges in determining whether youth with autism spectrum disorder have been sexually abused: implications for forensic interviewing", The Journal of Forensic Practice, Vol. 25 No. 2, pp. 152-165. https://doi.org/10.1108/JFP-08-2022-0044

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that presents early in a child’s life [typically before three years of age; American Psychiatric Association (APA), 2013]. There are two main categories of deficits according to the APA (2013):

1. social-communication/interaction deficits; and

2. behavioral deficits, specifically the presence of restricted, repetitive patterns of behaviors, interests or activities.

Under the former category, difficulties with social-emotional reciprocity, using and understanding nonverbal communication and developing, maintaining and understanding relationships can exist. The latter category can include stereotyped or repetitive movements (e.g. rocking, hand-flapping), insistence on sameness, restricted or fixed interests (perseverations) and hyper- or hyporeactivity to sensory stimuli. In addition, difficulty with theory of mind (ToM), the ability to understand the perspectives, cognitions and emotions of oneself and others, is often present (Sevlever et al., 2013) as is concrete thinking, the inability to think beyond the immediate context or about abstract concepts (Hobson, 2012).

The APA (2013) notes that ASD presentation varies widely among those who are diagnosed. For instance, the severity of ASD impairment can range from mild (requiring little to no support) to severe (requiring very substantial support). Moreover, some individuals with ASD have typical language abilities, whereas others have significant language impairments with up to 50% of those with ASD being functionally nonverbal (Mash and Wolfe, 2019). Although many sources note that the prevalence rates of intellectual disabilities in those with ASD are as high as 70%–75% (Mash and Wolfe, 2019), others have noted that these rates have been determined using largely invalid methods or are based on nonempirical claims (Edelson, 2006).

ASD prevalence varies by country. The Centers for Disease Control and Prevention (CDC) reports that the prevalence of ASD has increased significantly, and currently, 1 in 44 children are diagnosed with ASD in the USA [Centers for Disease Control and Prevention (CDC), 2021a]. Worldwide, prevalence rates in Asia, Australia and New Zealand range from 0.8 to 93/1,000, whereas in Europe and the Middle East, the prevalence rates are less variable, ranging from 1.1 to 31.3/1,000 (Chiarotti and Venerosi, 2020). ASD occurs in all ethnic and socioeconomic groups but is diagnosed four times more often in males than females [Centers for Disease Control and Prevention (CDC, 2021a)]. The symptoms of ASD make children and adolescents (hereafter referred to collectively as youth) vulnerable to child maltreatment, and it is important to be able to obtain forensic information to determine if abuse has or has not occurred.

Some forms of child maltreatment result in forensic evidence that is easy to detect. For example, physical abuse of children leads to injuries that can be seen and documented (Faller, 2020). However, when child sexual abuse (CSA) occurs, there is rarely medical evidence (Faller, 2020; Lewis et al., 2014). Therefore, the reliance on forensic interviews (FIs) is particularly important and is often the only evidence of CSA. For this reason, the focus here will be on the use of forensic interviewing strategies to accommodate youth with ASD when there are concerns of CSA.

There are many different FI protocols currently used (Azzopardi et al., 2019) In the USA, the most frequently used protocols include the National Institute of Child Health and Human Development protocol (Lamb et al., 2007); National Children’s Advocacy Center (NCAC) protocol (Carnes et al., 1999); Corner House’s Anatomy Identification, Touch Inquiry, Abuse Scenario, Closure (RATAC) protocol (Anderson et al., 2010); the American Professional Society on the Abuse of Children (APSAC) protocol (APSAC Taskforce, 2012); the Cognitive Interview (Fisher and Geiselman, 1992); and Tom Lyon’s Ten Step model (Lyon, 2021).

All were created to ensure evidence-based, nonbiased or suggestive interview protocols that are developmentally sensitive. However, each of these FI protocols were developed for use with neurotypical youth. In the UK, Maras’ Witness-Aimed First Account (WAFA) interview created for use with adults with ASD has been shown to obtain detailed and accurate information from individuals with ASD who have difficulty responding to free narrative invitations seen in many protocols (Maras et al., 2020). Moreover, other researchers have demonstrated modifications to FIs that can and should be made when interviewing youth with ASD (Krackow, 2018).

The purpose of the present paper is to discuss the issues that forensic interviewers should know about why youth with ASD may be at risk for CSA, obstacles to the recognition of CSA in youth with ASD and FI strategies or tools that can be used to modify protocols, if needed, when there are concerns of CSA in youth with ASD.

It is important to note that the job of forensic interviewers is not to determine the accuracy of the child’s statements. An FI is a part of a broader child abuse investigation (Newlin et al., 2015) with determinations of the accuracy of the child’s statements left to law enforcement, child protective services (CPS) personnel, juries or judges. Forensic interviewers are responsible for using evidence-based strategies to maximize obtaining accurate information from the child.

It should also be noted that the mental health community has pathologized ASD by diagnosing it as a mental illness as part of a psychiatric conceptualization (APA, 2013). For example, deficits in social communication seen in ASD are determined in comparison to neurotypical communication and fails to account for the diversity of communication styles (Williams, 2021). The author wishes to acknowledge this shortcoming of the literature and in the conceptualization of ASD.

Vulnerability of autism spectrum disorder youth to child maltreatment and child sexual abuse

According to the CDC, the US prevalence rates of CSA is 1 in 4 girls and 1 in 13 boys [Centers for Disease Control and Prevention (CDC), 2021b]; worldwide prevalence rates range from 8% to 31% for girls and 3% to 17% for boys (Barth et al., 2012).Approximately 90% of CSA is perpetrated by a known, trusted person in the child’s life [Centers for Disease Control and Prevention (CDC), 2021b]. Studies that have compared rates of CSA and child maltreatment between neurotypical and neurodivergent youth (including those with ASD) have reported increased risk for the latter group.

Youth with neurodivergent disorders such as ASD are at a significantly increased risk of child maltreatment and CSA compared to neurotypical peers. Sullivan and Knutson (2000) conducted an epidemiological study of over 50,000 neurotypical and neurodivergent children aged 5–18 years and found that the prevalence rate of child maltreatment was 9% in neurotypical children and 31% for those with neurodivergent disorders. This translated to 3.4 times increased risk of abuse in neurodivergent youth. When CSA was examined specifically, neurodivergent youth were at a 3.14 times increased risk of CSA compared to their neurotypical peers.

Moreover, ASD severity seems to predict the degree of risk. Ohlsson Gotby et al. (2018) conducted a longitudinal study of 4,500 twin youth that included an examination of the links between ASD and CSA. They found that for every 1 standard deviation unit increase in ASD scores on a screening measure for ASD, there was an increase in the probability of reporting that CSA had occurred; for males, this increase was 74% per each standard deviation unit increase in ASD scores, and for females, this increase was 42% per standard deviation unit (Ohlsson Gotby et al., 2018). In other words, those with the highest number of ASD traits had the greatest risk for CSA.

It can be argued there are issues in youth with ASD that increase the risk of CSA:

• challenges in interpreting social and emotional cues;

• challenges with communication;

• ToM deficits; and

• increased need for social supports.

It is worth reiterating that there is a great deal of variability in ASD presentation; therefore, not all youth with ASD will have all or even any of these risk factors.

Youth with ASD may have difficulty interpreting social and emotional cues that can help discern safe from unsafe people (Edelson, 2010; Ohlsson Gotby et al., 2018). A study of neurotypical children aged 5–11 years revealed that sexual offenders often tried to establish emotional rapport with the child as a tactic prior to offending (Katz and Barnetz, 2015). Similarly, emotional processing challenges such as difficulty reading the emotion of others, determining deceptive from genuine emotions and communicating one’s own emotions may allow sexual abusers to manipulate youth with ASD to sexually abuse them (Edelson, 2010; Ohlsson Gotby et al., 2018).

There may also be communication difficulties that can interfere with the reporting of CSA if it occurs. Referential communication refers to the ability to communicate verbally to another person about a referent (an event, object or topic to which a person is referring; Sidera et al., 2018). Referential communication is important for social connection and is an especially important form of communication when someone is the only witness to a crime. To report CSA if it has occurred, one must have good referential communication skills.

ToM deficits are common in youth with ASD (Lecheler et al., 2021) and are often linked to referential communication impairments (Sidera et al., 2018). ToM refers to the ability to make inferences or attributions about one’s own and others’ thoughts, feelings, perceptions and beliefs (Lecheler et al., 2021; Sevlever et al., 2013; Sidera et al., 2018). Individuals with ASD who have ToM deficits can be at risk for CSA because of an inability to understand the motives, emotions or deceptions of CSA offenders (Lecheler et al., 2021).

Pragmatic (i.e. social) communication can also be impaired; this refers to the ability to use language in social interactions with others. Pragmatic language deficits in youth with ASD can result in their being socially isolated relative to their neurotypical peers (Adams and Gaile, 2020) which can increase their risk of being targeted by sexual offenders. This is especially true for youth with ASD who desire social interactions but lack the skills to successfully develop social relationships with peers. Many child sexual offenders are skilled at identifying vulnerable children (Leclerc and Proulx, 2018); and, therefore, socially isolated children may be particularly vulnerable to CSA.

Youth with ASD who appear to have referential and pragmatic communication difficulties may be seen as “ideal” targets by sexual offenders because of the perception that these communication difficulties may prevent some youth from meaningfully disclosing CSA should it occur (Edelson, 2010; Ohlsson Gotby et al., 2018; Sevlever et al., 2013). Moreover, because of ToM deficits, they may assume that others know that CSA is occurring and therefore may not disclose it.

The final risk factor for CSA is not because of ASD challenges per se, but because of the effects of having ASD. Depending on the severity of ASD symptoms, some youth with ASD require significant support from multiple service providers (Sevlever et al., 2013). Opportunistic sexual offenders may deliberately place themselves in positions where they serve as support providers for vulnerable youth such as those with ASD (Edelson, 2010; Sevlever et al., 2013). The greater the severity of ASD, the greater the risk of CSA (Ohlsson Gotby et al., 2018); therefore, those with the greatest need for support will be exposed to more support providers, thus increasing their risk of CSA.

Obstacles to recognition of child sexual abuse in youth with autism spectrum disorder

When CSA occurs in youth with ASD, it may be difficult to identify. This can be because of:

• misattributing signs of CSA to ASD;

• confusion in interpretation of sexual behaviors that could be present both in cases of CSA and for non-CSA related reasons;

• the overlap of ASD symptoms with those of post-traumatic stress disorder (PTSD) and depressive or anxiety disorders; and

• the possibility of false allegations of CSA.

Edelson (2010) noted that changes in behaviors that occur in response to CSA might be misattributed to changes in the frequency or intensity of behaviors associated with ASD. For example, if CSA has occurred, youth with ASD may perseverate more on things that remind them of the CSA, may engage in coping behaviors such as increases in self-stimulatory or repetitive behaviors in an attempt to block out environmental stimuli or to self-soothe or may begin avoiding places that are new to a greater degree than previously depending on where the CSA took place. All of these behaviors may be believed to be part of a changing presentation of ASD, rather than because of CSA (Edelson, 2010).

Some believe the presence of sexual behaviors in children and adolescents are indicative of CSA (Wamser-Nanney et al., 2019). However, there has not been an established unique link between sexual behaviors and CSA. Cavanaugh Johnson (2015) has long-discussed how many forms of sexual behaviors are developmentally normative. Youth with ASD may display normative sexual behaviors at later ages than their neurotypical peers, and their sexual behaviors may be more pronounced (Edelson, 2010) or normative sexual behaviors may be displayed publicly (e.g. masturbation; Edelson, 2010). Each of these issues might lead to the suspicion that CSA has occurred when it has not.

Furthermore, the presence of sexual behaviors can be because of trauma, but not uniquely to trauma from CSA. For example, sexual behaviors have found to be present in children who were physically abused (Merrick et al., 2008). Finally, the presence of sexual behaviors can be seen in response to CSA (Wamser-Nanney et al., 2019). Thus, the presence of sexual behaviors is not uniquely diagnostic of CSA.

In addition, Brenner et al. (2018) noted that CSA and other forms of child maltreatment can result in mental health issues whose symptoms look similar to those of ASD. Youth exposed to any form of trauma may develop PTSD, some of the symptoms of which include hypersensitivity to sensory stimuli, difficulty with social interaction and repetitive behaviors, similar to characteristics of ASD (Brenner et al., 2018). Similarly, depressive or anxiety disorders, which may follow trauma, are often characterized by social isolation or withdrawal, sleep problems, irritability and perseverations, also seen in those with ASD (APA, 2013). Thus, because of the overlap in mental health reactions to trauma and the presentation of ASD, it can be difficult to tease apart whether CSA has occurred (Brenner et al., 2018).

Finally, it is important to acknowledge that, although rare, there may be false allegations of CSA that can result in difficulty in determining if CSA has occurred. According to Faller (2007), intentional false allegation rates for any type of child maltreatment have been found to be approximately 4%, with 6% of CSA allegations specifically determined to be false. However, the majority of false allegations do not come from children or adolescents. Faller (2007) cited a study from Canada in which there were only 2% of false allegations of child maltreatment made by children themselves and none were with regard to CSA.

No studies could be found that assessed the rate at which neurodivergent children, such as those with ASD, make false allegations of CSA. However, a study by Li et al. (2011) assessed the ability of youth with ASD to lie convincingly compared with neurotypical children. Li et al. found that children with ASD had significantly greater difficulty than neurotypical children maintaining a lie consistently, specifically in response to “what” questions (asking for the narrative of an event). This led Li et al. (2011) to conclude that children with ASD were not particularly effective at lying. It is, therefore, likely that if youth with ASD make false allegations of CSA, the narrative of the allegation would be inconsistently maintained and easily detectable as false.

Strategies for forensically interviewing youth with autism spectrum disorder

Before discussing specific forensic interviewing strategies for use with youth with ASD, it is important to note three things. First, research has found that youth with ASD can give narrative reports of events, often as well as their neurotypical peers (Henry et al., 2020). Henry et al. (2020) analyzed 104 transcripts of interviews from children with ASD or neurotypical children aged 6–11 years about a witnessed event. They found that the children with ASD did not differ from the neurotypical children in length of narrative, semantic diversity of the grammar elements in the story, the coherence of the narrative or the accuracy of what was reported. However, it has been found that children with ASD report fewer details in their narratives than do neurotypical children (Henry et al., 2020; Krackow, 2018).

Second, there appears to be mixed evidence regarding whether individuals with ASD, compared with neurotypical individuals, have deficits in episodic memory that will affect how best to cue recall of autobiographical events. Brien et al. (2021) stated that autobiographical memory comprises both episodic memory (memory of events that happened) and semantic memory (memory for the information about one’s life and the source of that information) and noted that individuals with ASD may have episodic memory deficits compared to neurotypical individuals. However, Maras et al. (2020) found that individuals with ASD did not have impairments in episodic memory or accuracy but showed decreased metacognitive monitoring (the ability to control what to report) compared to neurotypical individuals. Thus, use of FI strategies to help with recall should be determined on a case by case basis.

Finally, there are models for modifying interview protocols to suit both the purpose of the interview and the specific population being interviewed. Two examples of this are the standard interview method developed by Powell and Brubacher (2020) and the WAFA developed by Maras et al. (2020). Krackow (2018) stated that it is important to adapt FI strategies with individuals with ASD to maximize the accuracy of the information reported.

With this in mind, what follows are suggested evidence-based strategies that can be used in FIs to increase the likelihood of getting episodic narrative information with as many details as possible from youth with ASD when there are concerns of CSA. Not all strategies will be necessary or appropriate for all children and adolescents. The goal is to provide a toolkit of strategies for forensic interviewers to consider when interviewing youth with ASD.

Importance of narrative event practice

Almost all major forensic interviewing protocols include narrative event practice (NEP) with a neutral topic as part of their protocol prior to the substantive portion of the interview. Evidence has shown that including NEP in the FI results in children and adolescents providing significantly more details in the substantive part of the interview than when NEP is omitted (Anderson et al., 2014).

Brubacher et al. (2011) have found that NEP is particularly important when interviewing children about repeated events and that having two episodically focused NEP opportunities has been found to increase the likelihood of obtaining episodic reports of repeated events compared to only one NEP opportunity (Danby et al., 2017). Because children and adolescents may experience multiple incidents of CSA (Roberts and Powell, 2001), including at least one, but preferably two, NEP opportunities in the rapport-building stage of an FI is important to maximize the likelihood of obtaining narrative reports of episodic rather than scripted memories of CSA in the substantive part of the interview.

For youth with ASD, the NEP can also be used to model concretely what to expect during the substantive part of the interview (i.e. providing accounts of events in free narrative format). Understanding the structure of the FI questions is important. Two of the challenges for some children and adolescents with ASD is understanding typical rules of conversation (pragmatic communication) and ToM deficits (Krasny et al., 2003). Therefore, being able to model what is expected in response to questions in the NEP may help youth with ASD understand how to respond to questions that will be asked in the substantive portion of the interview and that the interviewer’s job is to obtain information.

Furthermore, although not routinely practiced during the typical NEP, including invitations to provide sensory, cognitive, emotional and source monitoring information during NEP can additionally help youth with ASD know how to answer these types of questions in the substantive part of the interview as well. Krackow (2018) notes that it is important to train youth with ASD how to provide specific episodic reports, and the NEP can help serve that function.

Because of concrete thinking and ToM deficits that are often present in youth with ASD (Hobson, 2012; Lecheler et al., 2021), making the link between the NEP and the substantive part of the interview explicit can help with narrative training as Krackow (2018) suggests (e.g. telling the child, “just like you told me everything about playing with your friends yesterday including what you saw and heard, what you were thinking, and what you were feeling, I want you to tell me everything about what happened with Uncle Jimmy including what you saw and heard, what you were thinking, and what you were feeling”). Qi et al. (2018) found that video modeling can successfully increase social communication in individuals with ASD. Therefore, it is likely that using NEP can serve both to increase narrative details in the substantive part of the interview (Anderson et al., 2014) and as an explicit model for the communication demands in an FI (Krackow, 2018; Qi et al., 2018).

Some youth with ASD may have difficulty responding to free narrative invitations because of differences in how memories are encoded and/or retrieved. Bordingnon et al. (2015) reported that youth with ASD had reduced flexibility in how episodic memory was maintained and organized compared to neurotypical youth. Souchay et al. (2018) suggest that autobiographical memory deficits, specifically, might reflect a number of factors including difficulty with self vs. other representation (ToM deficits) which can result in sparse episodic details involving oneself. Finally, recall of autobiographical events might best be elicited with cues for semantic rather than episodic memory (Brien et al., 2021; Miller et al., 2018).

One theory that can help explain the difficulty with episodic memory reports in individuals with ASD is the Fuzzy Trace Theory (Miller et al., 2018). According to this theory, individuals can encode autobiographical memories at various levels of details. For example, one might encode memories as “gist” traces which are general or vague representations of the memory or as detailed memories traces which are often encoded verbally. Because of episodic memory difficulties in some individuals with ASD, a narrative of autobiographical memories may seem to lack coherence or may seem inconsistent, but this can be because of gist-based processing, rather than detailed verbal episodic coding. Given this, there may be impoverished verbal memories which may result in narratives of youth with ASD looking less reliable or having missing details compared with neurotypical youth (Miller et al., 2018).

One protocol that offers an alternative to traditional narrative invitation prompts for individuals with difficulty providing detailed or accurate narratives is the WAFA (Maras et al., 2020). Instead of NEP, the interviewer and the interviewee engage in a conversation about a neutral topic followed by an “engage and explain” stage in which the purpose and the nature of the interview are discussed. During the beginning of the substantive part of the interview, the interviewee is asked to “self-segment” the information to be recalled (i.e., having the individual identify all discrete details of an event prior to seeking narrative reports). Maras et al. (2020) found that for individuals with ASD, more detailed and accurate information was obtained using the WAFA than with traditional free narrative invitations.

Importance of rapport-building

In addition to NEP, rapport-building occurs in the presubstantive stage of the interview. Rapport is defined as a relationship between the interviewer and child in which the child feels respected and safe (Saywitz et al., 2015). Saywitz et al. (2015) found that rapport-building during the early stage of an FI was shown to increase the number of details children provided in the substantive part of the interview.

For youth with ASD, rapport-building may need to look different than with neurotypical youth because of the potential difficulty with socioemotional communication, decreased interest in social interactions and the adjustment to unfamiliar people and places (Krackow, 2018). For this reason, rapport-building may need to occur over multiple sessions using an extended interview model.

Use of an extended interview model

Originally developed by the NCAC, the extended interview model began as a planned follow-up interview when a child did not make a disclosure of abuse in the FI but for whom there were strong indicators that abuse had occurred (Cronch et al., 2006). It has since been modified as a preplanned, multiple session, nonduplicative interview when there are reasons to suspect that a child might require more than one session to engage successfully in the FI process.

When deciding when to plan an extended interview model, one should consider where the child is in their process of disclosure, their emotional readiness to talk and the timeframe with regard to the recall of what occurred (Duron and Remko, 2020).

Moreover, given a preference for familiarity often seen in those with ASD (Szarko et al., 2013), an unfamiliar setting with an unfamiliar interviewer may not be conducive to disclosing CSA if it has occurred. Familiarity of examiner has been shown to increase the performance of children with ASD on a standardized psychoeducational test (Szarko et al., 2013) and a similar finding might be expected for productivity during an FI. Finally, the extended interview model also allows for greater rapport development over time (Krackow, 2018).

Strategies to address language challenges

Because of the presence of concrete thinking (Hobson, 2012), it is important to stay concrete and specific in the use of language during the FI, even with adolescents (Murphy, 2018). One way to stay concrete is to use names, not pronouns. Some children and adolescents with ASD have pronoun reversal in their expressive language (Overweg et al., 2018). This means they may use a pronoun such as “you” when they mean “I” or vice versa; this can make it difficult for a forensic interviewer to know to whom the child or adolescent is referring. In addition, Overweg et al. (2018) found that children with ASD aged 6–11 years had more difficulty than did neurotypical peers in interpreting pronouns which often led to pronoun reversals in receptive language as well.

Because of pragmatic communication issues (Krasny et al., 2003), youth with ASD may be difficult to interrupt or redirect and may interrupt the interviewer as they ask questions. Depending on the degree of pragmatic language deficits, interviewers might consider adding or modifying instructions about how to engage in an interview. For example, if, during NEP, the interviewer notes the child or adolescent has difficulties with pragmatic language, they might instruct the child as follows: “Today, we’re going to talk about safety issues. I’m going to ask you questions and let you tell me everything you can about what I ask. I’ll wait and listen while you talk. When you’ve said everything about what I asked, you can stop talking, and wait and listen while I ask another question.” Alternatively, switching to a “self-segmentation” of events strategy prior to the NEP might be beneficial if there are difficulties providing the narrative (Maras et al., 2020).

To address referential communication difficulties, forensic interviewers can use pairing (Garcia et al., 2022) which involves linking a person or place with an event. For example, if a child can identify a person or a place, that person or place can be paired with or anchored to an event (e.g. “tell me what happened with Sally” or “tell me what happened in the bedroom”). The use of pairing can also help the child stay focused on one memory event to keep the conversation focused on one referent at a time.

Once a narrative has been obtained, the use of sensory, cognitive, emotion and source-monitoring questions as follow-up to the narrative as well as clarifying post-narrative questions (“Wh” questions) can take place (Lyon, 2021). Because of concrete thinking and possible difficulty with episodic memory, youth with ASD may not disclose information until the “correct” question is asked (what will trigger their memory given the way that it has been encoded; Brien et al., 2021). Therefore, the interviewer can invite extra information from the child before moving on (e.g. “Sometimes, I don’t ask the right question to find out everything that happened, so I want to let you know that if you have more to say about [name of event in child’s words], even if I didn’t ask the right question, you can tell me now”).

When there are difficulties with referential and pragmatic communication and possible episodic memory deficits (Brien et al., 2021; Miller et al., 2018; Souchay et al., 2018), the child may interrupt their narrative with information that does not appear relevant. If this occurs frequently, the interviewer might consider either changing the free narrative invitation slightly (e.g. “Tell me everything about what happened when [name of event in child’s words] but only what happened during that [event]”) or may consider omitting the word, “everything.” However, including “everything” in the free narrative invitation has been shown to produce significantly greater details when used in FIs (Henderson et al., 2020). Therefore, the omission of the word should be used judiciously and only if it seems to be the only strategy that works to limit the amount of irrelevant information.

Strategies to address sensory sensitivities and behavioral and emotional challenges

Murphy (2018) discussed the use of obtaining a “sensory profile” with adults who have ASD, and a similar strategy could be used for youth with ASD. A sensory profile provides information about the degree to which an individual with ASD has hyper- or hypo-acute sensory systems. Individuals with ASD may have either hypo-acute (too little stimulation) or hyperacute (too much stimulation) sensory systems, and this can vary across sensory modalities (APA, 2013). A sensory profile can help the forensic interviewer ensure that the interview room does not cause sensory discomfort for youth with ASD. For example, for those who have hyperacute visual and/or auditory sensory systems, it is important to ensure that the interview room is not overwhelming (e.g. too bright, does not have busy decorations, and that noise outside of the interview room is minimal; Krackow, 2018).

It is also important to remember that the youth’s behavior in the interview room might be a response to hyper- or hypo-acute sensory systems. Case-Smith et al. (2015) noted that children with ASD who have sensory processing difficulties and are in the presence of certain sensory stimuli can become distressed, avoidant, anxious or nonresponsive. Furthermore, first-person accounts of youth and adults with ASD suggest that poor eye contact (often present in those with ASD) may be because of difficult emotional reactions, feeling invaded and to sensory overload (Trevisan et al., 2017) Therefore, it is important to try and obtain information about sensory processing problems in advance of the FI to ensure that, to the extent possible, the interview room does not lead to emotional dysregulation because of sensory stimuli (Krackow, 2018).

If possible, a sensory profile for the child or adolescent can be obtained from the parents or guardians prior to the FI. If obtaining a sensory profile is not possible in advance of the FI, interviewers should consider asking the child or adolescent at the beginning of the interview if there is anything in the interview room that bothers them that could be altered to reduce sensory discomfort (Krackow, 2018).

If a child or adolescent engages in behavior that interferes with the interview or shuts down during the interview, it can be a response to heightened anxiety or dysregulation. Murphy (2018) suggests that allowing for alternative forms of communication may make it easier to discuss the content of the interview. Alternative forms of communication could include writing responses on paper, using a laptop or tablet (for those who are independent typists) and the use of visual aids such as having the child or adolescent draw as a way to facilitate the interview (Wolfman et al., 2018).

It is important to note that facilitated communication (FC) should never be used as part of an FI. FC was developed for use with individuals with cerebral palsy in Australia to help individuals with movement challenges communicate and was adopted for use with individuals with ASD (Biklen et al., 1992). FC involves having a facilitator help an individual point to letters, words, or select symbols that stand for words on a device or visual aid by steadying the arm or should of the individual while they reportedly communicate. However, research has failed to find empirical evidence demonstrating that the “communication” from FC comes from the individual with ASD and not the facilitator (Saloviita, 2018).

Finally, if youth with ASD become anxious or emotionally dysregulated during an FI, strategies such as taking a break, activities to help regulate emotions such as switching topics or breathing exercises can be tried (Krackow, 2018) As youth with ASD may have perseverations (APA, 2013), having the child discuss the object of their perseveration may be a good strategy to lower anxiety. The risk in this, however, is being able to redirect the child back to the focus of the FI. Ultimately, if the child is too anxious or dysregulated to continue an FI, it should be stopped (Newlin et al., 2015). A decision can then be made about scheduling a follow-up interview with or without the use of an extended interview model.

Conclusions

There is ample evidence that children and adolescents with ASD are at increased risk for CSA, yet there may be obstacles to recognizing if CSA has occurred; thus, the best way to determine if CSA has occurred for youth with ASD is to conduct an FI. Research suggests that there may be differences between youth with ASD and neurotypical youth both in how events are encoded and the cues needed to retrieve information. In addition, language, cognitive, behavioral and sensory challenges may be present in individuals with ASD. Each of these possibilities needs to be anticipated prior to conducting an FI with youth with ASD and accommodations made, if needed.

When FIs are conducted with youth with ASD, there are strategies that can be used to increase the likelihood that FIs can be used successfully to help obtain accurate information that law enforcement, CPS personnel, judges and juries can use to determine if CSA has occurred. While there is no one-size-fits-all model for an FI given the heterogeneity of ASD, there are strategies and tools that can be tailored to each individual child or adolescent. These strategies include the use of an extended interview model, explicitly linking NEP to the substantive portion of the interview, using “self-segmentation” rather than narrative invitations initially, being mindful of the use of language (such as staying concrete in the language and avoiding pronouns), obtaining a sensory profile and offering alternative methods of communication.

Research shows that many children and adolescents with ASD can produce narratives that are coherent and accurate. The strategies discussed here are tools that can be used when needed to maximize the likelihood of getting details and the best possible forensic information to determine whether or not CSA has occurred.

Implications for practice:

• The prevalence of children diagnosed with ASD is increasing, and these children are at increased risk of being sexually abused compared to their neurotypical peers.

• There is rarely medical evidence of CSA; therefore, the best way to assess whether CSA has occurred is to engage in an FI with a child or adolescent for whom CSA is suspected.

• Most youth with ASD are able to be forensically interviewed when there are concerns of CSA, but they may require modifications to maximize the likelihood of obtaining accurate and complete information.

• Although the main FI protocols in use have been developed for neurotypical children, there are many strategies that can be implemented to maximize the likelihood of obtaining accurate, detailed and forensically sound information from youth with ASD when there are concerns of CSA.