New guide on how to prevent abuse of children with disabilities

Children with disabilities are three times more likely to become victims of abuse and neglect than their non-disabled peers, according to a new report by the American Academy of Pediatrics.

The updated clinical report Maltreatment of Children With Disabilities is published in Pediatrics and includes new research on the incidence of abuse and how some disabling conditions place children at higher risk of maltreatment. 

• Further reading: Trauma informed care and intellectual disability

It expands on the understanding and incidence of abuse of children with disabilities for the first time since 2007 and says there is concern that the incidence of child abuse and neglect is underreported in part because many children with disabilities have communication difficulties and cannot directly report problems.

“As pediatricians, we see families every day who are trying to do their best for their children but may lack the coping skills and resources to help manage stress or difficult circumstances,” said Dr Lori Legano, lead author of the report, written by the AAP Council on Child Abuse and Neglect and AAP Council on Children With Disabilities.

“By asking questions and listening to caregiver concerns, we can help families improve parenting skills, set appropriate expectations for their children and help identify community resources that offer assistance.”

For the purposes of this report, “disability” is described as a full spectrum of significant impairment in any area of motor, sensory, social, communicative, cognitive, and emotional functioning among children and adolescents. According to research, children with milder forms of disability are at higher risk of abuse and neglect than more profoundly affected children – possibly because parents overestimate their capabilities.

“Parenting a child with disabilities is often challenging,” said Dr Larry Desch, an author of the report. “Some children with disabilities respond differently to the usual ways we think about discipline and reinforcing good behavior. This can become very frustrating and add to the caregiver’s stress.”

Families may also be overwhelmed by the complex needs of children with disabilities, in both special health care and educational needs. Often children will need to receive essential medications, therapies, and appropriate educational placement, which can add to financial stress.

AAP recommends that paediatricians can help by:

• Recognising signs and symptoms of child maltreatment in all children and adolescents, including those with disabilities, and understanding mandatory, state-specific reporting requirements for child and adult protective services.
• Using each medical visit as an opportunity to assess family well-being.
• Providing reasonable expectations for parents regarding their children with disabilities, offering concrete suggestions about how to respond to common developmentally based challenges for the child.
• Referring families of children with disabilities to available community resources and agencies that provide services designed to aid families.
• Structuring discussions about appropriate discipline within well-child visits for the child with a disability.

“We encourage parents and caregivers to ask for help,” Dr Legano said. “Pediatricians can offer a nonjudgmental perspective, help families focus on their child’s strengths and guide them through challenging times.”