Treating Sexual Abuse and Trauma with Children, Adolescents, and Young Adults with Developmental Disabilities: A Workbook for Clinicians

This book was published as part of the Childhood Trauma Treatment Program's (CTTP) efforts to train professionals to assess and treat childhood trauma and abuse. CTTP is supported by the Advocate Family Care Network, which is a division of Advocate Health Care. The preface of the book identifies that CTTP's overall mission is to “assess and provide therapy and counseling for children, adolescents, and families that have experienced sexual abuse, maltreatment, psychological trauma, and sexual behavioral problems, to teach clinicians who provide these services, and to prevent child sexual abuse through special workshops for adults” (p v). As part of this mission, CTTP stated that they were “compelled to create a user-friendly treatment manual for clinical professionals so they may feel better equipped to treat children, adolescents, and young adults with developmental disabilities, who experience sexual abuse” (p v). Although this workbook deals primarily with developmental disabilities, many of the exercises may also be applicable to a more general population of traumatized youth.

The book is addressed primarily to masters- or doctoral-level trainees or clinicians. Of the book's 174 pages, roughly 45 pages follow traditional textbook style. The remaining portions of the book are devoted to patient worksheets and potential clinical module outlines. The second part of the book is not intended to be all-inclusive, but rather a general guide to show how these types of exercises can be used and how an individual may progress through the healing process. The authors note that the term “developmental disabilities” is a broad category of conditions, which they define as including disorders such as cerebral palsy, Down syndrome, autism spectrum disorder, attention deficit/hyperactivity disorder, nonverbal learning disorder, and fetal alcohol syndromes. The book covers individuals with these disorders who are moderate to high functioning.

For a book of this nature, it is surprising that the authors did not identify themselves or provide their biographies, either in the introduction or on the dust jacket. This leaves the reader unaware of the authors' past clinical experience, personal research, or additional training that may make them qualified to write such a book. Although this may have been intentionally done to keep the focus on the material rather than on the authors' backgrounds, it potentially diminishes the usefulness of the book for a forensic reader who may wish to cite or quote recognized experts in the field.

This book may serve as a good primer for trainees or individuals early in their career, particularly those who treat patients with a history of sexual abuse. This book is not meant as a forensic text which is evident from the brief discussion in Chapter 3 on the difference between a trauma assessment and a forensic evaluation. Readers hoping to gain some insight into how to conduct a forensic interview with a potentially traumatized child with developmental disabilities will not find this book helpful. It deals primarily with treatment and how to conduct treatment interventions. It may provide some benefit to a forensic expert who wishes to identify an example of a relevant text on the treatment of trauma in young individuals with developmental disabilities in court. The forensic expert might also use some of the cognitive behavioral worksheet examples to explain to a jury aspects of how treatment is conducted with such patients. This book is too basic, however, to be used in court as an in-depth informative text. For example, there are only 38 references for the entire 174-page book.

Chapter 4, which focuses on trauma treatment modules and preparing for trauma treatment, is a bit weak in that only two specific trauma-focused therapies are discussed: trauma-focused cognitive behavioral treatment (TF-CBT), and integrative treatment of complex trauma (ITCT). Although these are recognized forms of trauma treatments, there was very little discussion as to why these particular modalities might be more appropriate for individuals with disabilities or why other commonly used treatments, such as prolonged exposure therapy, may not be appropriate. Unfortunately, this limitation is prevalent throughout most of the book. Although developmental disabilities are the stated focus of the text, there is little in-depth discussion on the research base to support the use of these techniques in individuals with disabilities. Further, other than a few very basic recommendations (e.g., use language that can be understood, being mindful of sensory input limitations, and consider using cognitive testing or speech therapy evaluation results to better tailor approach), there is very little guidance provided to the reader on how these treatment approaches are to be modified specifically for this population. There are sections that discuss developmental disabilities, but they are often cursory in nature, akin to what may be found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

In summary, this is a basic cognitive behavioral treatment workbook. Future editions of the book may benefit from further developing sections describing the research base supporting the content and specific applications of targeted treatment modalities for this population. It may be an appropriate initial foray for trainees, but more seasoned forensic psychiatrists will likely find this book too basic.

• © 2020 American Academy of Psychiatry and the Law