We do not want to think about, talk about, or be involved in any way with the topic of child neglect and abuse.
Discussions of child maltreatment are usually brief and in response to a national or local story of children who have experienced sexual abuse. After a few brief statements of dismay, disgust, and outrage, the topic is usually changed to a more positive or neutral topic such as work, sports, or the weather.
As a result, most people are not aware of information from the Child Welfare Information Gateway (2010a):
- Neglect is the most common form of child maltreatment, followed by physical abuse, then sexual abuse, and finally psychological abuse. (Psychological abuse is very likely the most common type of abuse. However, evidence of psychological abuse is difficult to obtain, and incidence data reflect ability to prove rather than actual occurrence.)
- The vast majority of maltreatment perpetrators are parents (80%), relatives (6%), and other adults known to the family (4%).
- The mere presence of a disability significantly increases the incidence, duration, and impact of maltreatment.
What most professionals do know is that they are "mandatory reporters" of child abuse. What they may not know are the signs of maltreatment, the process of reporting suspected maltreatment, the barriers to the reporting process, or even what happens following a report. Even if a professional knows how to recognize and report suspected cases of maltreatment, the professional is much less likely to know how to prevent maltreatment from occurring.
This lack of professional awareness increases the frequency, duration, and impact of maltreatment experienced by children with disabilities. Professionals can change that reality by knowing the extent of the problem, why it occurs, and its impact on children; recognizing and reporting maltreated children; and using personal and system-level strategies and resources to prevent the maltreatment of children with disabilities.
Prior to the 1980s, most studies of child abuse did not include children with disabilities (Westcott & Jones, 1999). In the course of the past 30-plus years, investigations of maltreatment have evolved to consider people with disabilities in relation to incidence, prevalence, risk factors, contexts, impact, prevention, and support provisions (Hughes et al., 2012; Jones et al., 2012; Stalker & McArthur, 2010). As a result of this research, we now know that children with disabilities are three times more likely to experience maltreatment than their nondisabled peers (Sullivan & Knutson, 2000). This rate indicates that at least 25% of children with disabilities will experience one or more forms of maltreatment between birth and 18 years of age (Jones et al., 2012).
There are several risk factors associated with this extremely high rate of maltreatment (Durity & Oxman, 2006; Hibbard & Desch, 2007; Kendall-Tacke, Lyon, Tailferro, & Little, 2005; MacDougall, 2000; Shelton, Bridenbaugh, Farrenkopf, & Kroeger, 2008; Sullivan, Vernon & Scanlon, 1987):
- Interpersonal isolation and social immaturity.
- Insufficient knowledge concerning what constitutes maltreatment, "risky" situations, and their own emerging sexuality.
- Inadequate vocabulary and communication skills needed to convey an experience of maltreatment.
- Over- or undercompliant behavior during interactions with a large and diverse number of adults on whom they are dependent for their basic needs (such as mobility, communication, hygiene, etc.).
- Child protective service workers' lack of knowledge and skills to investigate reports of maltreatment effectively.
- Parents' and professionals' lack of awareness of the high risk for maltreatment.
Research concerning the impact of the experience of maltreatment for children with and without disabilities (Shakeshaft, 2004; Sullivan & Knutson, 2000; Wang & Holton, 2007; Willis & Vernon, 2002), indicates that, as a group, they demonstrate:
- Poor physical health: chronic fatigue, altered immune function, hypertension, sexually transmitted diseases, obesity.
- Social difficulties: insecure attachments with caregivers, which may lead to difficulties in developing trusting relationships with peers and adults later in life.
- Cognitive dysfunctions: deficits in attention, abstract reasoning, language development, and problem-solving skills, which ultimately affect academic achievement and school performance.
- Behavioral problems: aggression, juvenile delinquency, adult criminality, abusive or violent behavior.
It is clear, then, why professionals should be concerned for the safety of their students. Unfortunately, the information does not identify the barriers that professionals experience in recognizing and reporting their suspicions that a child is being maltreated.
Pinpointing a Problem
Problem recognition is the first step to problem resolution. Recognition that a child may be experiencing maltreatment requires knowledge of the child's typical appearance and patterns of behavior, plus the indicators of maltreatment. This recognition is particularly difficult in relation to children with disabilities. Because of their limited knowledge about disabilities, child abuse professionals may mistakenly attribute maltreatment-related behaviors and/or physical indicators to a child's disability. Similarly, special education professionals with limited knowledge of child maltreatment may miss—or misinterpret—the behavioral and physical indicators of maltreatment. Unfortunately, this lack of a common knowledge base for child abuse professionals and special education professionals serves to increases the incidence, duration, and impact of maltreatment of children with disabilities.
The Child Welfare Information Gateway document Recognizing Child Abuse and Neglect: Signs and Systems (2007) provides a concise description of child and parent behaviors associated with the four major types of maltreatment (neglect, physical abuse, sexual abuse, and emotional abuse). The document also provides a description of the general signs that child maltreatment may be occurring.
- Shows sudden changes in behavior or school performance.
- Has not received help for physical or medical problems brought to the parents' attention.
- Has learning problems (or difficulty concentrating) that cannot be attributed to specific physical or psychological causes.
- Is always watchful, as though preparing for something bad to happen.
- Lacks adult supervision.
- Is overly compliant, passive, or withdrawn.
- Comes to school or other activities early, stays late, and does not want to go home.
- Shows little concern for the child.
- Denies the existence of—or blames the child for—the child's problems in school or at home.
- Asks teachers or other caregivers to use harsh physical discipline if the child misbehaves.
- Sees the child as entirely bad, worthless, or burdensome.
- Demands a level of physical or academic performance the child cannot achieve.
- Looks primarily to the child for care, attention, and satisfaction of emotional needs.
Parent and Child Behaviors
- Rarely touch or look at each other.
- Consider their relationship entirely negative.
- State that they do not like each other.
Speech-language pathologists and audiologists may be well positioned to recognize when a child may be experiencing maltreatment: They have an in-depth knowledge of children with disabilities, observe and interact with children over extended periods of time, understand children's "typical" communication and behavioral patterns, have access to children's records, and work collaboratively with other adults who interact with the children (teachers, parents, aides, administrators, etc.).
Unfortunately, significant barriers hinder reporting (Alvarex, Kenny, Donohue, & Carpin, 2004; Kenny, 2001; 2004)—insufficient knowledge of the indicators of abuse or how to report suspicions; fear of incorrectly reporting a child as being maltreated and the consequences of that action; and lack of confidence in child protective services to investigate the report or protect the child effectively.
The decision to report is frequently even more difficult when the child denies the maltreatment or pleads with the professional not to tell anyone because of what might happen to the child and the child's family if the maltreatment becomes known. Each state has established laws requiring professionals to report their suspicions of maltreatment (Child Welfare Information Gateway, 2010b). These laws protect professionals if the suspicion proves to be incorrect. But the reporting decision is often uncertain because professionals don't know how to report or what happens following a report of suspected maltreatment.
What to Do
Fortunately, professionals can address these uncertainties by calling the Childhelp Hotline at 1-800-4-A-CHILD (voice, video relay services, or TTY). SLPs and audiologists are urged to call the Childhelp Hotline if they suspect—but are not yet sure—that a child is being maltreated. Childhelp Hotline counselors will help callers decide how to act for a child's safety and well-being. Confidential hotline calls can be made 24/7.
Qualified counselors listen, respond, and share resources for children or adults who are experiencing maltreatment or who are concerned about reporting that a child is being maltreated. Hotline counselors listen to the caller's concerns, address questions, and help develop short-term plans of action that use resources throughout the United States and Canada—including state-specific information about who, how, and when to call to report a suspicion of child maltreatment.
Professionals who are ready to make a report of suspected child maltreatment should refer to the Child Welfare Information Gateway's (2010b) "Mandatory Reporters of Child Abuse and Neglect: Summary of State Laws", which provides phone numbers and protocols for each state. Differences between states are significant, but in general, a professional is to make a report if he or she "suspects or has reasons to believe a child has been abused or neglected" or if the professional knows of "conditions that would reasonably result in harm to the child."
The key word in this information is "suspicion," because the professional is only to share misgivings that a child is experiencing—or will likely experience—maltreatment, and is not to investigate, gather evidence, or query a child. During the reporting process, the person making the report will be asked to share the name and age of the child, the name of the individual suspected of maltreating the child, the individual's relationship to the child, and a description of the maltreatment. Some states require the reporter to give his or her name, but others do not.
In some states, under specific guidelines, the confidentiality of the reporter can be maintained. In most instances, the younger the child and the more immediate and life-threatening the maltreatment, the more likely an investigation will be initiated. In some states, any report of a suspicion of maltreatment involving a child with disabilities evokes an investigation.
According to the Child Welfare Information Gateway (2010a), 61% of reports of suspected maltreatment resulted in an investigation in 2010, and 20% of the investigations resulted in a confirmation of, or risk for, maltreatment.
In the vast majority of cases, states do not allow child protective services or the police department to disclose the results of an investigation to the reporter of suspected child maltreatment. This lack of follow-up information and/or the perceived need to repeatedly report suspicions that a particular a child is being maltreated—because nothing seems to happen following a report and the reporter fears the child continues to be harmed—represents a major barrier to the reporting process (Alvarex, Kenny, Donohue, & Carpin, 2004; Kenny, 2001; 2004).
Professionals also must work to prevent, rather than simply recognize and report, suspected cases of child maltreatment; to do otherwise is comparable to putting seatbelts in a car only after individuals have been injured in an accident. Child maltreatment prevention must be carried out at a personal and systems level.
At the personal level, prevention begins with a conversation. Because most child abuse and special education professionals are unaware or poorly informed about the exceptionally high incidence of maltreatment experienced by children with disabilities, those who have information are in a unique position to initiate a prevention conversation.
The book by Heath and Heath (2010), Switch: How to Change Things When Change Is Hard, provides a blueprint for the conversation. The authors indicate that conversations should begin by emotionally connecting with the individual (emotion), then sharing a few points of critical information (knowledge), and suggesting a very short "to-do" list (path):
Ask a peer to watch the "11th Commandment" YouTube video by Collin Ray (Childhelp, 2009) with you. This four-minute captioned video presents an emotionally powerful message about the types and realities of child maltreatment.
During the conversation, share a few essential child maltreatment facts (from this article or other resources listed in the sidebar online).
At the close of the conversation, ask the individual to do three things:
- Have a conversation with a peer about the prevention of maltreatment of children with disabilities.
- Call 1-800-4-A-CHILD when concerned that a child may be experiencing maltreatment.
- Ask if the peer knows of a "Bright Spot" who should be recognized for his or her knowledge, experiences, and work with children with disabilities and in the area of child abuse (Johnson, 2010).
Each conversation that you initiate prevents child maltreatment by increasing awareness and understanding, while simultaneously providing individuals the basic knowledge they need to observe, understand, and respond to children who are being harmed. If you are not willing to have a conversation about child maltreatment, you are not prepared to help a child.
Child maltreatment can be addressed at a systems level by sharing a few key resources and strategies and by asking three questions of administrative leaders:
- What is our policy concerning the prevention, reporting, and support of children with disabilities who have experienced maltreatment?
- When will our parents and staff be provided with opportunities to learn how to prevent, recognize, report, and support children with disabilities who have experienced maltreatment?
- What programs do we offer to children with disabilities that teach them how to be safe, what to do if they are maltreated, and about their own emerging sexuality?
We can reduce the incidence, duration, and impact of maltreatment experienced by children with disabilities and improve the children's performance if we:
- Enhance early intervention and early childhood programs to include the six protective factors (nurturing and attachment, knowledge of parent and child development, parental resilience, social connections, concrete support for parents, social and emotional competence of children) that prevent child maltreatment (Child Welfare Information Gateway, 2012b).
- Implement the "Speak Up Be Safe" (Childhelp, 2012) curricula for the prevention of bullying and abuse and the assurance of internet safety.
- Give children, parents, and peers the opportunity to learn the strategies for personal safety, self-protection, confidence, and advocacy identified on the Kidpower Teenpower Fullpower International website (Kidpower, n.d.) and described in The Kidpower Book for Caring Adults: Personal Safety, Self Protection, Confidence, and Advocacy for Young People (Van der Zande, 2012).
- Include statements and objectives in Individual Family Service Plans and Individualized Education Plans to ensure the safety—as well as the success—of children. This strategy is being piloted by Hands and Voices, the nation's largest organization of parents of children who are deaf/hard of hearing, via its "Observe, Understand and Respond: The O.U.R. Children's Safety Project" (Hands and Voices, n.d.).
Child maltreatment is a difficult topic to consider, discuss and study. But the unpleasantness for professionals pales in comparison to the horrific, life-changing experience of children who are experiencing the maltreatment. This experience is even worse for children with disabilities because they lack understanding of what they are experiencing, the language and communication skills to convey that they are being harmed, and sufficient self-advocacy and self-protection skills to stop the maltreatment.
The Division for Communicative Disabilities and Deafness (DCDD) of the Council for Exceptional Children (CEC) has selected the topic of maltreatment of children with disabilities as a 2012–2013 Special Project. DCDD is drafting policy statements, designing webinars, and establishing working groups to inform and challenge CEC leadership to address aggressively the horrific reality of maltreatment experienced by children with disabilities. SLPs, audiologists, and ASHA are encouraged to join with DCDD to ensure the safety and success of children with disabilities.