AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE & DENTISTRY
Why do we abuse children and adults with disabilities?
BY H. BARRY WALDMAN, DDS, MPH, PHD, STEVEN P. PERLMAN, DDS, MSCD, DHL (HON) LAUREN M. KOENIG AND ALLEN WONG, DDS, ED
In 2020, the World Health Organization (W.H.O.) reported that children with disabilities are almost four times more likely to experience violence than children without disabilities. The review indicated that children with disabilities are:
• 3.7 times more likely than children without disabilities to be victims of any sort of violence;
• 3.6 times more likely to be victims of physical violence;
• 2.9 times more likely to be victims of sexual violence.
Children with mental or intellectual impairments appear to be among the most vulnerable, with 4.6 times the risk of sexual violence than their non-disabled peers. 1
"…children who witness or experience victimization may learn that it is acceptable for a parent, other family member or caregiver to cause emotional and/or physical pain to another person. Research indicates that children who are abused or who witness violence may experience emotional, developmental and/or physical consequences… Those who experience sexual assault or long-term sexual abuse may exhibit difficulties with eating, sleeping and concentrating; feelings of being unclean; mood swings with no apparent cause; nightmares; intrusive thoughts of the assault; flashbacks; and feelings of guilt, anger, fear and shame…Children brought up in a violent home lack the benefits of a nurturing childhood… Over time, if support is not received, these children may demonstrate a general lack of trust, a decrease in self-confidence, and problems with substance abuse, eating disorders, depression and/or mental illness." 2
"Neglect and abuse of children is also present in rural communities. Incidence for all categories of maltreatment except educational neglect was higher in rural counties than in urban counties, with rural children being almost twice as likely to experience maltreatment, including overall abuse, sexual abuse, emotional abuse, and neglect."3
IMPACT OF A CHILD'S DISABILITY ON THE FAMILY AND CHILD ABUSE
Families that include children with disabilities represent a sizeable share of all American households. Living with a child with a disability can have profound effects on the entire family with demands that can last a life time; affecting the health and wellbeing of the child, as well as any other siblings.
Many of these challenges cut across the type and severity of the disability, the age of the person, and the family situation. There is the financial burden associated with getting health, education and social services; as well as buying or renting equipment and devices, making accommodations to the home, transportation, medications, and special foods. While care coordination or case management is often the stated goal, there are many obstacles in implementation.
The day-to-day strain of providing care and assistance leads to exhaustion and fatigue, taxing the physical and emotional state and energy of family members. There are a whole set of issues that create emotional strain, including worry, guilt, anxiety, anger, and uncertainty about the cause of the disability, about the future, about the needs of other family members, about whether one is providing enough assistance, and so on. Grieving over the loss of function of the child with the disability is experienced at the time of onset, and often repeatedly at other stages in the person's life 4
Specifically, what we know about disability and maltreatment:
• Parents can more easily become stressed with the demands placed on them by parenting a child with a disability.
• Youngsters with behavior problems, i.e., AttentionDeficit/Hyperactivity Disorder (ADHD), fetal alcohol and autism spectrum disorders, may be more likely to experience physical abuse because parents can become frustrated by the child's difficult behavior and respond harshly.
• Children who are unable to do things independently are more reliant on adults for their care. These children may be more likely to be sexually abused or neglected by adults.
• Abusers may take advantage of children who have difficulty communicating or who don't understand social situations very well. They may be more likely to experience sexual abuse. 5
THIS IS NOT A NEW PROBLEM
Studies from the 1980s and 1990s of children with disabilities in the U.S. found that: 1) 68% of the children with disabilities were victims of sexual violence; and 2) 32% were victims of physical violence.
In a retrospective study of hospital records over a ten year period with a population of 39,000, 6,000 children or 15% were victims of violence. Of the 6,000, 64% or 3,840 were children with disabilities. Over half the sample or 54% were exposed to multiple forms of violence. 6
Some risk factors (by the National Resource Center on Domestic Violence):
Children with physical disabilities often depend on others to meet some or all of their basic needs. Care providers, including family, and paid or unpaid personal care workers, may be involved in close, frequent contact with the most intimate and personal parts of the individual's life, which can increase the opportunity for sexual or other abusive acts. Youngsters with cognitive disabilities may be overly trusting of others and easier to trick, bribe or coerce. Children who are blind or have low vision may not be fully aware of their surroundings, especially on public transportation or within the community. This can make them more vulnerable to exploitation by others. Some persons with disabilities may have limited vocabulary or communication skills that can pose barriers to disclosing abuse or assault.
Many persons with disabilities are taught in school, through service providers and family members, to do as they are told, to comply with requests of others, and to control difficult behaviors. Quite often, parents, caregivers and special education teachers do not teach children with disabilities about sexuality, abuse prevention, self-protection or personal safety strategies, in an effort to "protect" the child. 2
WHAT CAN YOU DO?
The Centers for Disease Control and Prevention (CDC) suggest how parents can prevent abuse and neglect of children:
• Recognize the possible signs of abuse, such as:
- Sudden changes in, or unusual behavior
- Cuts and bruises
- Broken bones (not due to a medical condition)
- Burns
- Complaints about painful genitals
• Know the signs of possible neglect, such as:
- Constant hunger or thirst (not due to a medical condition)
- Dirty hair or skin
- Chronic diaper rash (not due to a med ical condition)
• Know where your child is and what he/she is doing when he/she is not at home.
• Get to know your child's care givers. Only leave your child with someone you know and who can take care of them in a place where they will be safe from harm and danger.
• Know that your child's school must treat him/her with dignity. Your child should not be punished by being mistreated, restrained, or secluded.
• Take steps to make sure your house is a safe place for your child so he/she will not get injured.
• Communicate to your child about behavior and situations that are safe and not safe.
• Identify and remind your child of safe adults that he/she can turn to. Role- playing and practicing can help young children learn where to go.
TAKE CARE OF YOURSELF
Being a parent is the hardest job you will ever love. It is easy to become overwhelmed, especially if you have a child who has a disability or other special health care needs.
• Be realistic about what your child can and cannot do.
• If you are frustrated, give yourself a time-out to calm down and refocus!
• Ask people who you trust to help you.
• Focus on the positive.
• Make time for yourself.
• Talk to a healthcare professional like your doctor or a therapist if you don't know how to handle your child's behavior. 5
THE BOTTOM LINE
"Here's a somber statistic: Individuals with intellectual and developmental disabilities are far more likely to be abused by someone they know than a stranger…Sadly, because an individual with intellectual and developmental disability may be perceived as an 'easy target,' the likelihood of abuse is four to 10 times higher than in typically developing peers. The abuse is more likely to occur repeatedly, over longer periods of time, and is presumed to be underrecognized and underreported." 7
In short, your child with a disability unfortunately may be being subjected to any number of heinous forms of abuse by members of your family, your friends, care providers, classmates, or just about anyone. Are you able to confront a member of your family if you suspect they are the perpetrator in the abuse of your child? (Note: Approximately 30% of child sexual abusers are family members of the child.8) Why are children and adults with disabilities continuing to be abused? Maybe it's because we are ashamed to even consider that someone close to us is the offender…
However, there is the Federal Child Abuse and Treatment Act (CAPTA) which requires each state to have provisions or procedures for requiring certain individuals to report known or suspected instances of child abuse and neglect. 9
And there mandated reporting of abuse of older adults and adults with disabilities. Every state, with the exception of New York, has mandated reporter requirements but the list of who is included varies considerably. 10
In addition, the federal government and states, the District of Columbia, and some territories all have statutes to protect older adults from physical abuse, neglect, financial exploitation, psychological abuse, sexual abuse, and abandonment. 11 •
NEGLECTING TO PROTECT: Studies in the U.S. from the 1980s and 1990s found that 68% of children with disabilities were victims of sexual violence and 32% were victims of physical violence. Youngsters with cognitive disabilities may be overly trusting of others and easier to trick, bribe or coerce.
ABOUT THE AUTHORS:
H. Barry Waldman, DDS, MPH, PhD is a SUNY Distinguished Teaching Professor, Department of General Dentistry, Stony Brook University, NY. E-mail: h.waldman@stonybrook.edu. Steven P. Perlman, DDS, MScD, DHL (Hon) is the Global Clinical Director and founder, Special Olympics, Special Smiles; and Clinical Professor of Pediatric Dentistry, The Boston University Goldman School of Dental Medicine. Allen Wong is Professor at University of the Pacific, Arthur A. Dugoni, School of Dentistry, San Francisco CA, and Global Clinical Advisor, Special Olympics. Lauren M. Koenig is 3rd year student at Adelphi University, Garden City New York.
References
1. World Health Organization Violence against adults and children with disabilities Available from: who.int/disabilities/violence/en Accessed December 14, 2020.
2. Abramson WH, Mastro I. Kid &TeenSafe: An abuse prevention program for youth with disabilities. Available from: vawnet.org/sites/default/files/materials/files/2016-09/NRC_KTSafe-full.pdf Accessed December 14, 2020.
3. Rural Health and Information Hub. Violence and Abuse in Rural America. Available from: ruralhealthinfo.org/topics/violence-and-abuse Accessed December 15, 2020.
4. Reichman NF et al. Impact of child disability on the family. Available from: family.jrank.org/pages/396/Disabilities-Impact-Disabilities-on-Families.html
5. Centers for Disease Control and Prevention. Safety and children with disabilities (abuse and neglect). Available from: cdc.gov/ncbddd/disabilityandsafety/abuse.html Accessed December 14, 2020.
6. Marge DK A call to action: ending crimes of violence against children and adults with disabilities. Available from: upstate.edu/pmr/pdf/marge.pdf Accessed December 15, 2020.
7. Preventing abuse of your special needs child. Available from: eparent.com/education/preventing-abuse-of-your-special-needs- child/#:~:text=Here's%20a%20somber%20statistic%3A%20Individuals,the%20victim%20to%20be%2 0afraid. Accessed December 15, 2020.
8. Defend Innocence. What if a family member is the perpetrator? Available from: defendinnocence.org/responding-to-child-sexual-abuse/proactive-parenting/manage-emotions/what-if-a-family-member-is-the-perpetrator/Accessed December 15, 2020.
9. Federal Child Abuse Prevention and Treatment Act. Available from: childwelfare.gov/pubPDFs/manda.pdf Accessed December 29, 2020.
10. NNCEA/NAPSA. Mandated reporting abuse of older adults and adults with disabilities. Available from: ncea.acl.gov/NCEA/media/Publication/NCEA_NAPSA_MandatedReportBrief.pdf Accessed December 29, 2020.
11. U.S. Department of Justice. State elder abuse statutes. Available from: justice.gov/elderjustice/elder-justice-statutes-0 Accessed December 29, 2020.
AMERICAN ACADEMY OF DEVELOPMENTAL MEDICINE AND DENTISTRY
The American Academy of Developmental Medicine and Dentistry (AADMD) was organized in 2002 to provide a forum for healthcare professionals who provide clinical care to people with neurodevelopmental disorders and intellectual disabilities (ND/ID). The mission of the organization is to improve the quality and assure the parity of healthcare for individuals with neurodevelopmental disorders and intellectual disabilities throughout the lifespan.