By Marilynn Larkin
NEW YORK (Reuters Health) - Children with intellectual disabilities and mental/behavioral problems are at greater risk of maltreatment than those with autism, Down syndrome or birth defects, but support for all are needed, researchers in Australia say.
Dr. Melissa O’Donnell of Telethon Kids Institute, University of Western Australia in Subiaco, told Reuters Health, “While previous research has consistently found that children with disabilities are at two to three times increased risk of maltreatment, there were no large studies that looked at a range of disability groups to determine if they had different risks.”
Dr. O’Donnell and colleagues analyzed records of 54,532 children with disabilities born in Western Australia between 1990 and 2010 and found that although children with disabilities make up 10.4% of the population, 25.9% of child maltreatment allegations and 29.0% of substantiated allegations involved a child with a disability.
As reported in Pediatrics, online March 6, 6.7% involved children with intellectual disabilities, 6.6% involved children with congenital defects/cerebral palsy and 4.5% involved youngsters with conduct disorder.
The largest number of allegations were for children with mental/behavioral disorders (15.6%). By contrast, only a small proportion included children with Down Syndrome (0.1%) or autism (0.7%).
After controlling for other risk factors, children with a disability still were at increased risk of maltreatment allegations (hazard ratio 1.74) and substantiated allegations (HR 1.89) versus children without disabilities. The risk was greatest for children with intellectual disabilities (HR 2.14), followed by conduct disorder and mental/behavioral disorders.
The risk was significantly lower for children with autism (HR 0.74). The risk was lower, but not significantly so, for those with Down Syndrome (HR 0.69). Children with birth defects/cerebral palsy were at the same risk of maltreatment allegations as children with no disabilities.
Children with borderline-mild intellectual disabilities had an almost threefold increased likelihood of maltreatment allegations (HR 2.73); those with mild-to-moderate intellectual disabilities were at twofold increased likelihood of allegations (HR 2.01). For those with severe intellectual disabilities, the risk was similar to children without a disability (HR 1.30).
“Disability types most strongly associated with maltreatment often co-occurred with other risk factors such as parents who are young, have mental health issues and (live) in more disadvantaged communities,” Dr. O’Donnell said by email. “These families already face additional stresses and have fewer resources to access services for their children’s special needs.”
“Possible explanations for the lower risk for children with Down syndrome and autism are that these disabilities are comparatively well recognized, understood and supported,” she continued. “Parents tended to be older, better off socioeconomically, and for Down syndrome, the ready availability of prenatal screening means most parents have had the opportunity for prenatal diagnosis and the choice to continue with the pregnancy.”
“Research indicates that family-centered care with coordination of services, continuity of care and respite care are important factors in reducing the stress on families that can result in maltreatment,” Dr. O’Donnell concluded.
Several U.S. experts commented on the research, noting that studies in the U.S. also demonstrated an increased risk of maltreatment for children with disabilities.
Dr. Vincent Palusci of NYU Langone Medical Center in New York City told Reuters Health, “Clinicians need to look at the individual child and their disabilities to best advise parents about their risks for abuse and neglect. Certain issues or behaviors may be more highly associated with the risk of certain types of maltreatment. Boys may be more likely to be physically abused, girls more likely to be sexually abused, and certain ages have more risk as well.”
“This helps the clinician provide the appropriate anticipatory guidance to parents about issues in caring for their disabled child, such as safe environments, proper supervision, who is supervising the child, what role they have regarding discipline or providing hygiene and personal care, etc.,” he said by email.
“One important step for clinicians is to provide a ‘medical home’ where these needs can be addressed by a medical multidisciplinary team. This comprehensive assessment can then be the basis for expanded evaluation and services within the community,” Dr. Palusci concluded.
In email to Reuters Health, Dr. Caroline Kistin of Boston University School of Medicine agreed that providers must recognize the challenges faced by families of children with disabilities. Whether specific interventions in the medical setting can help decrease the unacceptably high rates of child maltreatment among these children requires more study, she said.
Dr. Meggan Goodpasture of Wake Forest School of Medicine in Winston-Salem, North Carolina, told Reuters Health by email, “Clinicians need to help families navigate the often overwhelming and confusing network of referrals and services. It is also important that we provide guidance and education in areas such as appropriate expectations and strategies for addressing challenging or difficult behaviors. Collaborating with community partners such as mental health providers, can assist in our ability to provide truly comprehensive care for families.”