Recognizing signs of abuse in profound autism

Profound autism and vulnerability to abuse

For families of children with level 3 autism, ensuring their safety is the top priority—but one that can feel out of reach. Children who are nonverbal or have significant intellectual disabilities face unique challenges that make them more vulnerable to abuse or neglect, and recognizing the signs isn’t always easy.

In this Q&A, Dr. Joanna Mevers provides guidance on identifying possible warning signs of abuse and offers practical steps caregivers can take to ensure their child’s safety.

What are the common signs of abuse in children with level 3 autism?

Identifying abuse and neglect can be complicated in kids with level 3 autism. Many children in this population struggle with self-injury or aggression, so if they have a mark on them, it’s not always clear if it’s because they hurt themselves or because someone else hurt them.

The most common thing that we look out for are physical signs of abuse like bruising. Bruises that look like fingerprints could suggest that someone held the child down by their wrist or arm. Bruising with a distinct shape might indicate that a specific object was used.

You might see scratches or bruises in areas of the body that are difficult for the child to get to themselves. For example, many kids with level 3 autism have self-injurious behaviors and often target their heads. In those cases, you might expect to see a head injury, but a torso injury might be unusual for that child. So, you need to pay attention to both the shape of the bruises that you are seeing, and the pattern for that particular child.

What about the signs of neglect?

Signs of neglect can look a little bit different. You may see a kid who’s not clean or well cared for. Maybe there’s a rash because their diapers are not being changed quickly enough. But this can be complicated as well, because many autistic kids refuse to take showers or baths due to sensory issues or behavioral challenges.

On the behavioral side, what are some red flags that caregivers should look out for?

A lot of autistic people are very routine-oriented, so if you see them shift away from a routine, that’s a potential indicator. If your kid is usually happy to go to school, and then all of a sudden they try to avoid school, that would be an indicator that something happened. Again, this is tricky with this population because we see a lot of avoidant behaviors generally, so you really have to know that individual and know what is atypical for them. 

I have also seen situations where parents have reported regression with toilet training and other kinds of skills. You might notice an increase in challenging behaviors (aggression, self-injurious behavior, destructive/disruptive behaviors), but that has to be looked at through the context of the child’s baseline behavior.

It can be difficult to prove that abuse or neglect are happening without hard evidence, but if  you suspect that’s what’s going on, trust your instinct and your gut. You’re probably right, and to the degree that you’re able to get your child out of that situation, you should.

If a parent or caregiver suspects that their child is being abused or neglected, what are the next steps they should take?

First, do some investigation. If your child is in a program or setting outside the home, reach out to supervisors and ask specific questions:

• Is my child ever alone with a staff member? 
• What kind of training do the people have who are working with my child? 
• Have they been trained on level 3 autism and managing challenging behaviors?
• What safety procedures do they have in place in case of a behavioral outburst? 
• Is there video footage I can review?
• Can I come in and observe the program for a day?

Often, these things happen unintentionally. Maybe a person doesn’t know how to safely manage an aggressive outburst or lacks the proper support from the other staff members. Your goal should be to understand how well-equipped the setting is to work with your child’s unique needs. The more significant your child’s needs, the more expertise and specialization they should have. 

Of course, parents are often left in situations where this expertise doesn’t really exist, and so they have to make very difficult choices about where they send their child. If you find evidence of abuse, you need to report it. If it’s occurring in a school, make a report through the school district. If it’s in a private clinic setting, report it to the clinic or to the professional board where your provider is licensed. Most professional boards can then do an investigation into that provider. 

What proactive steps can caregivers take to reduce the likelihood of abuse and recognize it when it’s happening?

Communication is key. Teaching your child verbal and nonverbal ways to express discomfort early on can be very helpful in these situations.

Another great thing you can do is a daily body scan. Every day when you send your kid to school in the morning and when they return in the afternoon, look over their body from head to toe. That gives you full documentation that shows that they came home with a bruise that they didn’t have before. You can then go to their school or program and say, “I know this happened on your watch, can you explain it to me?” If it’s a kid with level 3 autism, a supervisor should be able to provide clear context for how that might have happened.

Another approach is to seek treatment if your child does have challenging behaviors. Reducing aggressive and self-injurious behaviors is going to reduce the likelihood that they’re susceptible to abuse or neglect.