Risk of coercive sexual victimization *associated* with neurodevelopmental disorders

The paper by Vide Ohlsson Gotby and colleagues [1] represents an important contribution to the idea that 'vulnerability' is very much part and parcel of various childhood neurodevelopmental disorders (NDDs), and such vulnerability can have some pretty serious outcomes.

Relying on data from the Child and Adolescent Twin Study in Sweden (CATSS) - an initiative that is no stranger to discussions on this blog (see here for example) - researchers set about looking at any *association* between NDD status and risk of "being sexually victimized." Sexual victimisation was defined as "lifetime experiences of coercive sexual touching and/or coercive sex." Importantly, the Ohlsson Gotby results only covered "coercive sexual victimization up to age 18".

Their findings are worrying; as per one example: "In females, ASD [autism spectrum disorder] was associated with an almost threefolded increased risk of coercive sexual victimization." Following further analysis on whether "the association is driven by a general NDD phenotype versus specific diagnoses" authors concluded that: "General NDD symptom load, rather than specific ASD or ADHD [attention-deficit hyperactivity disorder] symptoms, seems to be a moderate vulnerability factor for coercive sexual victimization."

I appreciate that this is an uncomfortable topic. In light of all the talk about 'female autism' (see here) and issues such as camouflaging and the like (see here) potentially impacting on the rates of autism in girls and women, added to the age limit imposed by authors, it's highly likely that the Ohlsson Gotby findings are only the tip of the iceberg. Further investigation is required to see how prevalent such issues are across a lifetime, and importantly, what protective factors there might be against such a vulnerability. Whether also, minus any sweeping generalisations, there may be an intergenerational 'effect' (see here) is also an important question to answer. And having mentioned the word 'vulnerability' quite a bit already, more evidence is emerging on this topic [2].

Another important point to mention about the data derived from Ohlsson Gotby et al is their focus on boys as well as girls. They discuss how the [statistical] magnitude of the results obtained looking at males was not the same as with girls, but I'm inclined to again suggest that there may be some under-reporting of such issues. Being male and being diagnosed with autism and/or ADHD is not likely to be a protective factor against sexual victimisation.

And finally something rather shocking from the authors: "We speculate that an evocative gene-environment correlation might account for this observation [general NDD symptom load being related to sexual victimisation], such that sexual perpetrators actively target NDD individuals." Parents, caregivers and others with a vested interest in the care of those with NDD need to be particularly vigilant it seems.

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[1] Ohlsson Gotby V. et al. Childhood neurodevelopmental disorders and risk of coercive sexual victimization in childhood and adolescence - a population-based prospective twin study. J Child Psychol Psychiatry. 2018 Mar 23.

[2] Williams DM. et al. Can you spot a liar? Deception, mindreading, and the case of autism spectrum disorder. Autism Res. 2018 Apr 27.

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