All Swedish court cases from 2004 and 2006 concerning alleged child sexual abuse (sexual harassment excluded) were identified through criminal registers. Fourteen cases (1 boy) concerned a child with a neuropsychiatric disorder. The diagnostic groups were mental retardation (10 cases), autism (3 cases), and ADHD (1 case). Psychiatric experts were engaged in only two cases. When experts were involved, the courts focused on credibility issues. When the courts applied neuropsychiatric arguments in the absence of an expert, they used developmental arguments. When the authors found that significant neuropsychiatric issues were not discussed by the court it concerned interpretations of symptoms and developmental standpoints. The results illustrate the complexity and pitfalls of drawing conclusions about associations between symptoms and personality characteristics on one side and accuracy of sexual abuse allegations on the other. Moreover, the results highlight the importance of a high quality system for providing courts with adequate neuropsychiatric knowledge. (Published Abstract)