Understanding the link between autism and self-harm from a forensic lens

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition characterized by social communication difficulties, restricted interests, and repetitive behaviors. Individuals with ASD, particularly females, are at an increased risk of self-injurious behavior (SIB), which can sometimes be misinterpreted as signs of physical abuse. This case report describes a 17-year-old female with ASD and ADHD and limited verbal language skills who presented to the emergency room with multiple skin lesions resembling second-degree burns, raising concerns of child abuse. Initial assessments by the emergency and dermatology teams were inconclusive, and plastic surgeons suggested the lesions were burns. However, forensic specialists noted inconsistencies with burn patterns, including the absence of blisters and redness around newer lesions. A review of the patient's psychiatric records revealed a history of repetitive self-harm, specifically aggressive scratching. Additional history from the family confirmed that the injuries were self-inflicted. Distinguishing between self-harming injuries and physical abuse in patients with ASD can be challenging, especially since both can coexist. This necessitates thorough assessment and experienced forensic consultation to avoid misdiagnosis, which can lead to significant legal and emotional consequences. To conclude, accurate diagnosis of self-harm versus abuse in patients with autism requires detailed investigation, consideration of psychiatric history, and forensic expertise. Moreover, early and correct diagnosis is crucial to prevent misattributed allegations of abuse and facilitate appropriate medical and psychiatric care for individuals with ASD.