A child’s disability: Risk and vulnerability factors

“Not all forms of disability carry the same level of risk, and not all children diagnosed with the same type of disability experience maltreatment equally. For example, children with disabilities that affect conduct, such as attention deficit/hyperactivity disorder, may be vulnerable to physical abuse by parents or caregivers who may become frustrated by their behavior. Children who rely on adults for their care, as well as children who are nonverbal or hearing impaired, may be more likely than others to experience neglect or sexual abuse”

(Centers for Disease Control and Prevention, as cited in Child Welfare Information Gateway, 2018).

Child risk factors

There is a broad amount of research to verify that children with disability are at increased risk of experiencing abuse or neglect. However, a child’s disability including the impact their disability has on their functioning will influence their vulnerability. When working with a child with disability to assess their risk, it is critical to consider the following risk factors. These risk factors provide information and examples of how different disabilities and functional impairments can increase a child’s risk (adapted from NSPCC, 2018; CDC, 2018; Child Welfare information Gateway, 2018).

Communication barriers

• Children who have speech and communication needs (for example children with non-verbal autism, physical disabilities which impact their ability to speak or acquired brain injury which affects speech) will have additional difficulties in disclosing abuse or other concerns.
• If a child’s caregiver is their communication partner (see practice prompt below) or interpreter and is also the person responsible for abusing or neglecting them, this increases the risk that the child will not have an independent way to disclose abuse to others.

• If a person finds it difficult to understand a child’s speech, they may not realise if the child is trying to disclose abuse or other concerns to them.
• If a person is not equipped or prepared to engage with a child who is non-verbal, this may limit their opportunity to connect meaningfully with a child and reduces the child’s opportunity to disclose abuse or other concerns to them.
• A child with communication barriers may be less likely to receive education or engage in conversations with safe adults about abuse and how to keep themselves safe, which may limit their ability to recognise if they are being abused and how to describe abuse that has occurred to them.

Disempowerment

• A child with disability may feel disempowered or voiceless which can prevent them from disclosing abuse or other concerning behaviours. This may be particularly so if the child’s views have been disregarded previously or other requests go unmet.

Dependency on others

• A child with disability may have contact with multiple network members and professionals on a weekly basis, and may rely on these people for daily support including intimate care (bathing, toileting). This increases an abusive adult’s opportunity to be alone with a child to abuse them.

• A child with disability may lack independence and privacy, and may not understand when another person’s behaviour is inappropriate or abusive.
• A child with disability may be unable to physically defend or protect themselves from abuse.
• A child may be hesitant to disclose abuse or neglect from someone they rely on due to worries that they may not be believed or that any support being provided to them will cease.

Mistaking abuse or neglect for a child’s disability

• Depending on a child’s disability, they may display challenging behaviours such as self-harming, harmful sexual behaviours or other atypical behaviours. These behaviours may be due to a child experiencing abuse or an attempt by the child to disclose abuse or harm, however those around the child may consider these behaviours as part of the child’s disability only.
• A child with disability presenting with bruising may not cause the same level of concern as if similar bruising was seen on a non-disabled child due to the assumption that mobility issues, supportive equipment or a child’s own challenging behaviours may have caused the injuries.

Lack of education

• A child with disability may be less likely to receive meaningful education on relationships, sex, personal boundaries and safety. As a result, they may be less likely to understand or recognise abusive behaviour that is occurring to or around them.

Increased isolation and lack of support

• Some children with disabilities are at increased risk of isolation compared to other children who do not have disabilities. They may have less people in their safety and support network, and less safe adults to disclose worries to.  They also may have less access to and be less visible in the community.
• If a child does not have access to appropriate supports for their disability, this can create difficulty for those caring for the child leading to abuse or neglect.
• Professional responses to a child who is being abused or who discloses abuse may be affected by limited knowledge or understanding on the professional’s behalf in relation to working with children with disability.

Parental Risk Factors

There are a number of family / parental risk factors associated with raising a child with disability that increase the child’s likelihood of experiencing abuse or neglect.

Disruptions in parent – child attachment

A number of factors can impact the bond between a parent and their child who is born or acquires a disability including a negative reaction to the child’s disability, unrealistic expectations for the child’s development or abilities, post-natal depression, and the child exhibiting behaviours associated with their disability that are mistakenly perceived by the parent to be the child’s disinterest in them (Tomison, 1996).

Stress

A parent may experience higher stress levels due to financial costs, concerns for their child’s wellbeing and future, actual or perceived stigma, difficulty managing behaviour and the requirement for them to provide increased levels of support and supervision to their child on an ongoing basis (Child Welfare Information gateway, 2018). Ongoing parental stress can increase the risk of physical harm to a child due to parental frustrations (Tomison, 1996).

Isolation and limited support

A parent who is caring for a child with disability but has little or no support can experience higher levels of parental and family stress. If a parent is isolated or lacks support they may be unable to meet the physical or material needs of their child resulting in neglect.