(Children with disabilities) are far less likely than their non-disabled peers to be included in the social, economic and cultural life of their communities; only a small percentage of these children will ever attend school; a third of all street children are disabled children. Disabled children living in remote and rural areas may be at increased risk." 11

• In societies where there is stigma against those with disabilities, some parents respond with violence because of the shame the child had brought on the family or respond with violence because a lack of social support leads to intense stress within the family.
• Children with disabilities may be killed, either immediately at birth or at some point after birth. The rationale for such killings is either: 1) the belief that the child is evil or will bring misfortunate to the family or the community, or 2) the belief that the child is suffering or will suffer and is better off dead. In 'mercy killings' a parent or caretaker justifies withholding basic life sustaining supports (usually food, water and/or medication).
• When a child with a disability lives in a violent setting, his or her disability often serves to compound and intensify the nature and extent of the abuse.
• Neglect can be a precursor to violence. Parents may respond to the stress of caring for a child with a disability with neglect, rather than active violence. However, when this neglect involves denial of food, medicine and other life sustaining services, it must be considered a form of violence.
• Physical, sexual, verbal and emotional abuse may be carried out by caregivers without the parent's knowledge or while the parent is away. 11

HOW DO YOU PREVENT ABUSE TO CHILDREN WITH DISABILITIES?

In 2005, two of the authors reported (in EP Magazine) the tragedy of the abuse of children with disabilities.4 Almost a generation later, we now recite the continuing misery of the abuse of children (and the not so young) with disabilities. However, now, we also must include the consequences of the plague of increasing drug abuse in families; potentially by those providing the care of children with disabilities.

Repeated research reports emphasize the family's stress, as well as the financial demands associated with the efforts to provide the additional care and supervision for children with disabilities.

• Child welfare professionals should emphasize to parents or caregivers the importance of attending to their personal physical and mental health needs, as well as the needs of their children.
• A limited ability to connect with other parents and social isolation in general may leave these parents unaware that their children are at increased risk of maltreatment, and they may be unprepared to identify and protect their children from risky situations. 12

The Centers for Disease Control and Prevention (CDC) provides an extended internet library regarding the needs of families raising children with disabilities into adult years and beyond. 13 But these efforts can succeed only with a cultural transformed understanding that children (and adults) with disabilities are not some kind of retribution for evil parental (or other family members) past actions and therefore not equal to their counterparts with no disabilities. Otherwise, they are fair game for the warped minds of their abusers!

Remember: Although this bleak picture is true, there are increasing supports for parents of children with disabilities as well as their children. These programs include support by the Arc organizations around the country. It is well recognized that when identified, trauma treatment for child abuse victims can begin a healing process after they are removed from contact with the abusers. It is important to recognize that parents are generally not informed that their child with a disability is more vulnerable to abuse than children without a disability. They should be not only informed, but supported in creating plans to reduce the risk of abuse for their child with a disability. Knowledge is power, and acting on effective methods to reduce the risk of abuse to their child is important. Having such a plan in place has been found to reduce the impact of abuse when it happens. Empowering parents is one important first step to reduce abuse. Another is to empower health providers to whom the parents turn when changes in their child occur (without any known cause). All health providers should be provided the information on the high incidence of abuse of children with disabilities. During patient visits, they should inquire into the possibility of abuse being the cause of the significant.•

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. Nora J. Baladerian, Ph.D. is a Licensed Psychologist with the Counseling Center of West Los Angeles, Director, Disability and Abuse Project of Spectrum Institute, Los Angeles.

References

1. Blider R. CPS (child protective service agencies) caseloads on LI call 'unacceptable.' Newsday, pg. 2,3, February 11, 2020.
2. National Child Alliance. National statistics on child abuse. Available from: national- childrensalliance.org/media-room/nca-digital-media-kit/national-statistics-on-child-abuse Accessed January 30, 2020.
3. Ammerman RT, Baladerian NJ. Maltreatment of children with disabilities. Chicago: National Committee to Prevent Child Abuse, 1993; in Sobsey D, Randall W, et al. Gender differences on abused children with and without disabilities. Child Abuse & Negl. 1997, 21:707-20.
4. Waldman HB, Perlman SP. Abuse of children with disabilities. EP Mag 2005;35(6):63-68.
5. Children's Bureau. National Child Abuse and Neglect Data System. Summary of key findings calendar year 2000. Available from: Hyperlink calib.com/nccanch/prevmnth/scope/ncands.cfm Accessed May 9, 2002.
6. Administration for Children and Families. Child maltreatment 2002. Available from: acf.hhs.gov/program/ch/publications/cm02/figure5_htm Accessed: April14, 2004.
7. Prevent child abuse America. Fact sheet: maltreatment of children with disabilities. Available from: preventchildabuse.org/resource/maltreatment-of-children-with-disabilities-2/Accessed: January 30, 2020.
8. Office for Victims of Crime-- What adults need to know about child abuse. What are the signs of child abuse and neglect? Available from: ovc.gov/pubs/helpseries HelpBrochure_WhatAdultsNeedtoKnow.html Accessed January 30, 2020.
9. Harrell E. U.S. Department of Justice, Bureau of Justice Statistics. Crime against persons with disiabities, 2009-2015 – Statistical tables. July 2017. Available from: bjs.gov/content/pub/pdf/capd0915st.pdf Accessed January 30, 2020.
10. Maclean MJ, Sims S. et al. Maltreatment risk among children with Disabilities. Pediatrics, 2017, 139 (4) e20161817.
11. UN Secretary General. Report on violence against disabled children, 2005. Available from: unicef.org/videoaudio/PDFs/UNICEF_Violence_Against_Disabled_Children_Report_Distribute d_Version.pdf Accessed January 30, 2020.
12. Children's Bureau. Child welfare information gate. Available from: childwelfare.gov/pubPDFs/focus.pdf Accessed January 31, 2020.
13. CDC: National Center for Injury Control and Prevention. Essentials for childhood: creating safe, stable, nurturing relationships and environments for all children. Available from: cdc.gov/violenceprevention/childabuseandneglect/prevention.html Accessed January 31, 2020.