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Home > The Risk and Prevention of Maltreatment of Children with Disabilities > The Risk and Prevention of Maltreatment of Children with Disabilities : Why are Children with Disabilities at Higher Risk for Maltreatment Than Children Without Disabilities?
The Risk and Prevention of Maltreatment of Children with Disabilities
Why are Children with Disabilities at Higher Risk for Maltreatment Than Children Without Disabilities?Researchers have identified a number of factors related to parents, children, families, service systems, and society at large that increase the potential for maltreatment of children with disabilities (Ammerman, 1997; Burrell, Thompson & Sexton, 1994; Mitchell & Buchele-Ash, 2000; Sobsey, 1994; Steinberg & Hylton, 1998). However, there is disagreement among researchers regarding the legitimacy of certain risk factors. The intention of this section is to describe the major findings in this area. There is general acceptance that no single factor places any child at risk for abuse and neglect. Rather, it is the interaction of factors that seems to be important. Sobsey (1994) proposes the integrated ecological model of abuse to explain the interaction of factors that may lead to abuse or neglect. Sobsey's model (which is based on Bronfenbrenner's ecological model of child development) takes into account cultural and environmental factors as well as characteristics of the parent and child and their interactions. When using this model for abuse prevention, Sobsey focuses particularly on power inequities between the potential offender and potential victim. Some of the factors that place children with disabilities at risk for abuse and neglect are the same factors that place all children at risk (Ammerman & Patz, 1996; Sobsey, 1994; Tomison, 1996). But many factors are more connected to disability-related issues (Tomison, 1996). General Risk Factors for All Children Certain factors related to parents are associated with increased risk of maltreatment for all children. Parental substance abuse is a risk factor identified by many researchers (Sobsey, 1994; Steinberg & Hylton, 1998; Wolcott, 1997). Other parent-related risk factors are poor coping skills, poor impulse control, and a history of violence (Ammerman & Baladerian, 1993; Sobsey, 1994). Parents with low self-esteem or who have been diagnosed with depression may be at greater risk for maltreating their children (Sobsey, 1994; Sullivan & Cork, 1996) as may be parents who were victims of child maltreatment themselves (Jones, Peterson, Goldberg, Goldberg, & Smith, 1995; Sobsey, 1994). Parents who are disabled may be at risk for maltreating their children, especially if they were raised in group care and lacked positive parenting models (Sobsey, 1994). Factors Related to Disability These include factors related to society, stress, families, the children, and non-familial caregivers. Societal risk factors. Many researchers believe that societal attitudes and beliefs play a significant role in placing children with disabilities at risk for maltreatment. Steinberg and Hylton (1998) contend that some institutionalized beliefs, practices, and policies "devalue" children with disabilities. This may be manifested in ways that indicate children with disabilities are not as worthy of social, educational, or professional opportunities as children without disabilities. Children with disabilities may internalize societal attitudes and feel shame or feel less worthy of being treated respectfully (National Resource Center on Child Sexual Abuse, 1994). Sobsey (1994) adds that segregating children with disabilities tends to increase the perception of differences and suggests that ". . . group membership and social distance influence our attitudes about the acceptability of violence. Attitudes about individuals or groups that tend to depersonalize, dehumanize, or distance them appear to make violence against them more acceptable" (p. 307). In addition, myths associated with children with disabilities can increase risk. Sobsey (1994) discusses the myth held by many that children with disabilities are not vulnerable to abuse; belief in this myth can result in a lack of awareness and attention to the problem. Steinberg and Hylton (1998), citing Baladerian (1994), discuss myths such as:
Stress as a risk factor. Many researchers propose that stress is a critical factor in child maltreatment (Ammerman, 1997; Burrell, Thompson & Sexton, 1994; Rycus & Hughes, 1998; Tomison, 1996), while others say that little research supports this theory (Benedict, Wulff & White, 1992; Sobsey, 1994). And while stress may be a risk factor for some families, Sobsey states that most families that have children with disabilities do not, in fact, respond abusively to stress. Those supporting stress as a risk factor point to the increased demands of caring for children with disabilities, which may involve daily assistance with bathing, dressing, eating, transporting, and providing medical care (Ammerman & Baladerian, 1993; Rogow & Hass, 1999; Tomison, 1996). They also discuss the difficulties of coping with challenging behaviors such as temper tantrums, aggressiveness, and noncompliance (Ammerman, 1997; Jones, et al., 1995; Tomison, 1996). Some children with disabilities require much supervision and highly structured and consistent limit-setting (Ammerman & Patz, 1996; Kragthorpe, et al., 1997). In some cases, parents' lack of knowledge about caring for their children with disabilities can be a factor in their ability to cope with their children's needs. This lack of knowledge can result in unrealistic expectations for the children (Ammerman, 1993; Kragthorpe, et al., 1997). A lack of resources can exacerbate a parent's stress. Most often discussed is a lack of social support, resulting in isolation of the family from their community. Sobsey (1994), citing Smith (1984), states that "A large body of research indicates that isolation from society increases risk and inclusion in society decreases it" (p. 160-1). Researchers have also explored the relationship between stress and a lack of financial resources and available services and their contribution to risk of maltreatment (Steinberg & Hylton, 1998). Poverty and/or inadequate supportive services can create stressful situations within a family. Ammerman and Patz (1996) and Rycus and Hughes (1998) specifically mention a lack of access to respite care as a risk factor. Without support for the family, parents may feel isolated, have little personal time for themselves, and become overwhelmed by their responsibilities (Ammerman, 1993; Tomison, 1996). Familial risk factors. Many of the risk factors identified by researchers are specifically related to the family's reaction to the child with the disability. For example, the risk of maltreatment may be higher if the parents view the child as "different" and unlike any other child, if they "mourn" the loss of a "normal" child and become angry (Rycus & Hughes, 1998), or if they see the disability as an embarrassment or perceived punishment (Burrell, Thompson & Sexton, 1994). Another potential risk factor involves unhealthy attachment or disruptions in the bonding and attachment between parent and child. Sobsey (1994) explains that healthy attachment is characterized by mutual pleasure and pain; if one individual suffers, the other suffers, and vice versa. Unhealthy attachment disrupts this mutuality. "Sadly, information given to parents by professionals at the time disability is diagnosed often implicitly or explicitly contains the message-'Don't get too attached to this child.'" (Sobsey, 1994, p.161-2). Disruptions in attachment can occur if there are frequent hospitalizations or if the child is unresponsive or unaffectionate (Ammerman & Patz, 1996; Sobsey, 1994; Tomison, 1996). Some researchers have found that risk for maltreatment is higher for children with mild disabilities, and speculate that this could be because parents have expectations for them that cannot be fulfilled (Ammerman & Patz, 1996; Benedict, Wulff & White, 1992). Some researchers found a higher risk of neglect when parents could not, or did not, provide the level of care required by the child's disability (Ammerman & Baladerian, 1993; Jones, et al., 1995; Rycus & Hughes, 1998). Child-related risk factors. Numerous risk factors related to the child with the disability have been identified. In actuality, many of the factors discussed here are considered "socially mediated effects of disability." This refers to people's response to the child with a disability, rather than to the child or the disability itself. Although some feel that viewing child-related characteristics as risk factors is "victim blaming" (Tomison, 1996), it is important to note these characteristics, especially in conjunction with the many other factors already discussed. Because the care required by some children with disabilities is critical to their survival, many have been taught to obey those in authority and comply with their caretakers' requests or demands (National Resource Center on Child Sexual Abuse, 1994; Steinberg & Hylton, 1998). In fact, some children with disabilities may feel that their bodies don't belong to them (National Resource Center on Child Sexual Abuse, 1994; Steinberg & Hylton, 1998; Tobin, 1992). If a caretaker behaves inappropriately, a child may not complain or resist because he or she believes the caretaker knows what is best. Many researchers have found that some children with disabilities lack the knowledge or understanding to know when behavior is wrong or inappropriate (Ammerman, 1992; Steinberg & Hylton, 1998; Wolcott, 1997). Even if they do recognize behaviors as wrong, some children with disabilities may not attempt to stop the abuse or neglect because they fear losing the relationship; they are emotionally dependent on their caretakers (National Resource Center on Child Sexual Abuse, 1994; Tobin, 1992). In some cases, their disability may prevent them from being able to defend themselves or escape (Ammerman, 1992; Steinberg & Hylton, 1998). Finally, children who have difficulty communicating may be at a higher risk for maltreatment because potential perpetrators may believe they can "get away with it," thinking that the child will not be able to report the behavior (Ammerman & Patz, 1993; Wolcott, 1997). "…[C]hildren with disabilities may be perceived as being relatively 'safe victims.'" (Dr. Frieda Meacham in National Symposium on Abuse and Neglect of Children with Disabilities, 1994). Risk factors for institutional and non-familial abuse and neglect. Although maltreatment is most often perpetrated by family members, children with disabilities often are cared for by others, and the risk for maltreatment is present in these circumstances. Characteristics of institutional abuse include extreme power and control inequities, dehumanizing and detachment from the children, clustering of vulnerable children with those who might harm them, isolation of children, and an abusive subculture (Sobsey, 1994; Steinberg & Hylton, 1998). As with parents, issues of attachment can be factors in the risk for maltreatment by non-family caregivers. Sobsey (1994) states "Often paid caregivers are deliberately discouraged from becoming attached to clients by the ethic of professional detachment and the organizational needs of agencies…. The relatively weak bonds that formulate between staff and the people they serve cannot be expected to deter abuse…" (p. 162).
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