Children with disabilities are at least three times more likely to experience abuse and neglect compared to their peers, and a new American Academy of Pediatrics report underscores the role of pediatricians in preventing maltreatment and offers guidance on how they can support families.
“I’m always struck by the numbers of kids that are abused, and how prevalent abuse [is] in the population of children with disabilities,” said Lori Legano, the director of Child Protection Services at NYU Langone Health’s department of pediatrics and the lead author of the report, which was published Monday in Pediatrics.
Legano said the report, which is an update to a 2007 AAP paper, allows busy pediatricians, especially those without specific expertise on child maltreatment or disability, to be more aware of the increasingly well-documented issue and approach it in an informed and sensitive way. The report looked broadly at disability in children and adolescents as “any significant impairment in any area of motor, sensory, social, communicative, cognitive, or emotional functioning.”
The majority of child maltreatment is neglect, and it is even more prevalent among children with disabilities, the report states. Children with less severe conditions, such as some intellectual and learning disabilities, may be at an even greater risk for abuse.
“It could be that if they have a less severe disability, the parent might not have accurate expectations of what they can do,” Legano said. For instance, a child may not follow directions or respond to discipline the way a parent expects, leading to frustration.
The report also details associations that studies have found between certain disabilities and abuse: Children with mild cognitive impairment may be at an increased risk for physical abuse, while children with psychological or speech disorders might be at greater risk of emotional abuse. Nonverbal children and children with hearing loss may be at a greater risk for sexual abuse.
Eileen Costello, chief of ambulatory pediatrics at Boston Medical Center, said the report offers helpful context for her practice, particularly since she sees a number of patients with hearing loss.
“I’m very happy to know that I should have my radar up even more to make sure that they’re being cared for adequately and that their needs are being met,” said Costello, who was not involved in the report.
The report set out seven guidelines for pediatricians like Costello who might care for children with disabilities to help prevent and recognize abuse. The recommendations emphasize being alert for signs of maltreatment, working to address issues of family stress, establishing reasonable expectations that a parent or caretaker should have of a child’s abilities, and providing access to community resources. They also emphasize that pediatricians know the procedure for reporting child abuse, which varies by state.
“It’s shocking how states are so different,” said Shelly Flais, a primary care pediatrician in Naperville, Ill., and a spokesperson for the AAP.
An inherent problem in identifying abuse is that due to communication difficulties, some children with disabilities who experience abuse might be unable to report it, said Heather Forkey, the division director of the child protection program at UMass Memorial Medical Center who helped review the AAP paper as a liaison from its council on foster and adoptive care.
“There could be a huge amount of neglect going on for a child who’s nonverbal that we would never know about,” she said.
Pam Nourse, the executive director of the Federation for Children with Special Needs, an organization that provides information and support to those who care for children with disabilities, said she thinks it is especially important for pediatricians to be “considering the family system as a whole.” She said that families of disabled children can be under a lot of stress, including navigating the complex systems necessary for their child’s care. That stress combined with a lack of resources can increase the risk of abuse.
Flais said she fears the Covid-19 pandemic has exacerbated many of these stresses.
“Then you’re all in a home together,” she said. “So there’s unfortunately lots of situations that can lead to the maltreatment of children.”
If pediatricians find any evidence that abuse has occurred, they are required to immediately report it to Child Protective Services. But Costello said she tries to support families with disabled children by having conversations about appropriate expectations, parenting, and discipline so that it never gets to that point.
“Nobody starts out thinking that they’re going to be abusing their children,” she said. “We have a lot of opportunities to talk about this before it becomes an issue.”