Abuse Risks for Children with Disabilities

About 15% of the world’s population (measuring those aged 15 years or older) live with some form of disability. Around 95 million children under the age of 14 are estimated to have a disability. 

Due to a number of factors, children with disabilities may be more vulnerable to maltreatment, including medical neglect and sexual violence. According to various studies:

• Roughly 9 per 1000 children are victims of child abuse and neglect in the United States.
• In 2015, slightly over 14% of child victims of abuse and neglect had 1 or more reported disabilities.
• Abuse is 3.4 times more likely to occur against children with disabilities than children without disabilities. 
• Sixty-five percent of rapes and sexual assaults against people with disabilities were committed against those with multiple disability types.
• Incidences of violent victimization against persons with disabilities are 2.5 times the rate for those without a disability.

Risk Factors

According to STM Learning’s Medical Response to Child Sexual Abuse, there is no single risk factor that places a child at specific risk for abuse or neglect. In terms of children with disabilities, an abuser’s actions are sometimes responses to the child’s non-normative condition. With an ableist mindset, the abuser may other the child, viewing them as lesser or someone who needs fixing.

Substance abuse on the caregivers’ part is a well-known risk factor for maltreatment of all children. Other identified risk factors include parents’ poor coping skills, psychiatric conditions, financial stressors, poor impulse control, and a history of violence. 

Because they may be perceived as unable to understand sexual matters, some children with disabilities may be offered less sex education or no sex education at all, particularly if their disability limits the time they spend in the classroom. Isolating the child increases risks by limiting the child’s knowledge and awareness of appropriate behaviors. Overall, a lack of information about abuse can contribute to higher risk for maltreatment.

Indicators of Child Sexual Abuse

Behavioral Indicators

Behavioral indicators encompass a variety of patterns, all of which may be the abused child’s response to the stress of what they are experiencing. These are changes that occur subsequent to the first act of abuse, including grooming.

Patterns may encompass, but are not limited to, new or unusual fear of specific individuals or places, aggression, withdrawal, regression in adaptive skills, change from usual behaviors, wariness of physical contact, and destructive acts. Defensive behaviors such as the covering of the eyes or ears, extreme reluctance to accept assistance, onset of sleeping in the fetal position or needing to sleep with parents, withdrawal, and self-imposed isolation might signal abuse. Additional signs of abuse include onset of emotional lability, easy agitation, and fearfulness during bathing or toileting.

However, these behaviors simply reflect the child’s stress, meaning they do not identify what the child’s underlying stressor is. Changes in mood and conduct, rather than any specific behavior or change, are usually of greater concern. However, if the child has been sexually abused for a long period of time, the behavior may have been evident for a while and is not recognized as “new,” thus not being identifiable as a sign of abuse.

Reenacting sexually abusive or explicit conduct on others or oneself is a common sign that abuse has occurred. If the child is characterized as unreliable or not trustworthy, exhibited changes may go unrecognized. Careful and thoughtful attention to all possibilities is warranted.

Physical Signs and Symptoms

Physical signs and symptoms may be multivariate or completely absent. Complaints of headaches, chest and abdominal pain, or fatigue are not unusual in victims of child sexual abuse. Victims may also complain of discomfort in the genital area, dysuria, or painful defecation. Physical findings of bruising, bleeding, anal tearing, or vaginitis are often what raise initial concerns of sexual abuse. One must also recognize the importance of psychological changes, which may appear abruptly or emerge over time; they are an essential part of determining how the child has been affected.

In response to unrecognized abuse, the child may, among other responses, display frequent moodiness, sullenness, anger, terror, anxiety, and depression. Some children may have nightmares or daymares and traverse into re-experiencing. A psychiatric evaluation by practitioners experienced in PTSD and children with disabilities would be needed.

Children with disabilities require an appropriate and complete medical evaluation considering all possibilities in order to determine their association with possible child sexual abuse, abuse of other types, or other unrelated medical conditions. Overall, the most important factor is recognition of changes in the child’s normal health, habits, and moods.

Disclosure by the Child

A child’s verbal disclosure about sexual contact, including disclosure using sign language, is typically the most helpful information in ascertaining what has happened to the child and who was involved. A child who has a disability that significantly influences communication skills or a cognitive disability is likely to have more difficulty communicating what occurred and who was involved.

Disclosures must be interpreted in the context of the child’s cognitive and behavioral ability. Any physical disability (eg, motor, sensory, auditory, visual) may influence the timing and content of the disclosure, as well as the child’s reluctance or inability to disclose.

Responding to Abuse

Sexual abuse, which can occur alongside or independent of physical abuse, occurs at a higher rate among children with disabilities than among those without. Children in this population are more vulnerable to abuse as an outcome of numerous societal and cultural factors, lack of communication, and increased stress on parents and other caregivers. 

When evaluating a child with a disability, modifications in communication and examination techniques are required. Physical and mental health care must be equal in quality and availability for children with and without disabilities.

This blog was written by STM Learning’s editorial staff for educational purposes only. It is not intended to give specific medical or legal advice. For expert information on the discussed subjects, please refer to STM Learning’s publications.