247 - Characteristics of Adults with Intellectual and Developmental Disabilities Referred to a Child Advocacy Center

Publication Number: 2238.247

Lucy Kohlenberg, Yale-New Haven Children's Hospital, New Haven, CT, United States; Minsoo Choi, Yale-New Haven Children's Hospital, Milford, CT, United States; Sundes Kazmir, Yale School of Medicine, New Haven, CT, United States

Background: Individuals with intellectual and developmental disabilities (IDD) are significantly more likely to experience sexual abuse than those without IDD, with up to one in three individuals with IDD victimized during adulthood. Despite this risk, adults with IDD face considerable barriers to trauma-informed medical evaluations for suspected sexual abuse. The multidisciplinary, pediatric-centered Child Advocacy Center (CAC) model is the gold standard for responding to child sexual abuse, but no comparable model exists for adults. As a result, adults with IDD are occasionally referred to CACs, where providers may lack adult-specific training.

Objective: This study describes adults with IDD referred to a pediatric CAC to better understand their clinical presentations and disclosure patterns and to inform future development of specialized care pathways for this population.

Design/Methods: We conducted a retrospective chart review of patients aged ≥18 years with underlying IDD evaluated at a single CAC between 2013-2025 for suspected sexual abuse. Extracted data included demographics, type of IDD diagnosis, referral source, housing environment, relationship to perpetrator, and abuse disclosure details. Analyses included descriptive statistics and qualitative coding of clinical narratives.

Results: Thirty-seven adults met inclusion criteria, with ages ranging from 20–67 years (median 27), and 84% (31/37) identifying as female. The most common diagnoses were intellectual disability, developmental delay, cognitive impairment, and autism spectrum disorder. One-third (12/37) resided in institutional settings. Nearly all referrals originated from law enforcement. Disclosed abuse most frequently involved penile–vaginal or oral penetration, with alleged perpetrators often peers, relatives, and facility staff.

Conclusion(s): This study highlights a population of young adults with IDD—median age 27—who continue to rely on pediatric systems for sexual abuse evaluation due to the absence of adult-focused, trauma-informed models. Pediatric CACs can play a pivotal bridging role but require enhanced provider training, accessibility adaptations, and collaboration with adult-serving agencies. Integrating this population into child abuse pediatrics and developmental-behavioral pediatrics fellowships, and leveraging med-peds expertise, may help close critical care gaps. Future work will focus on developing best-practice guidelines for adults with IDD within or beyond the CAC framework.