CHAMPAIGN, Ill. - Researchers have long known that children with disabilities are at increased risk of being abused by their caregivers. But a groundbreaking new study by Jesse Helton, a faculty member in the Children and Family Research Center in the School of Social Work at the University of Illinois, indicates that the risk and degree of physical abuse varies according to the child's type and level of disability - and those at greatest risk of maltreatment may be those with average functioning or only mild impairments.
Earlier studies indicated that children with behavioral, developmental, mental and physical disabilities are 3 to 11 percent more likely to be harmed by caregivers - and the abuse also is likely to be of longer duration - than children without disabilities. However, prior research did not examine how victims' types and degrees of functional disabilities correlated with the abuse.
"We found that a lot of times kids with disabilities get lumped into one category - kids either have a disability or they don't," Helton said. "That isn't a great way of looking at it because the World Health Organization and the medical community don't consider a kid disabled versus not disabled - they consider all of us as being somewhere on a continuum of health. If you have a kid with cerebral palsy who can't move or speak very well, a kid with high-functioning autism, and one with high-functioning Down syndrome, they present different individual vulnerabilities to maltreatment."
Helton, who co-wrote the study with Ted Cross, also a professor in the Children and Family Research Center, obtained the data from the National Survey of Child and Adolescent Well-Being, a national probability study comprising 5,500 children ages 3 to 10 in 36 states. The families in the study were the subjects of abuse-and-neglect investigations between October 1999 and December 2000.
From those data, the researchers selected 1,678 children living with their biological parents, who had completed self-reports about the frequency and severity of discipline and maltreatment used against the child during the prior year. Maltreatment ranged from minor assaults, such as shaking, pinching or slapping the child, to severe assault, such as hitting the child with a closed fist, intentionally burning or scalding them or threatening them with a weapon.
The sample included children who had no disabilities as well as children with behavioral problems or social, daily-living skills or language acquisition disabilities.
Helton and Cross found a significant linear relationship between behavioral problems and minor and severe assault - the more intense and frequent a child's emotional and physical outbursts were, the higher their risk of being physically assaulted by their caregiver.
However, children with average daily living skills functioning were at the highest risk of severe assault, as were older children, boys and Hispanic and African American children.
Likewise, children with language acquisition problems who were of average or slightly below average functioning were at greater risk of minor abuse, while their peers at the ends of the spectrum - those with severe impairments or superior functioning - were at the lowest risk.
The reasons for the correlations between functionality and parental assault are unknown, Helton said. Perhaps parental expectations were higher for children with average or slightly below average language abilities, for example, increasing the probability that parents would become frustrated and resort to corporal punishment when children failed to comply with their instructions.
Likewise, children with average or slightly below average verbal skills may have been able to talk back or challenge their parents more than their peers with severe limitations. And children with advanced verbal skills, who were at the lowest risk of assault, may have been more responsive to verbal methods of discipline, better able to communicate in ways that reduced the risk of assault or less likely to behave in ways that angered or frustrated the parents.
Another theory is that some parents may have failed to comprehend how their child's disability prevented them from consistently performing tasks or behaving well, thus triggering the parents to lash out at the children when their initial disciplinary methods failed.
"A kid with autism, a learning disability or attention-deficit hyperactivity disorder may have some really good days where they're doing well in school and at home and are able to connect with their parents," Helton said. "And then they have really bad days where nothing seems to get through to them. And on those bad days, they may be more at risk of experiencing physical abuse."
Parents may be better able to comprehend the effects of severe impairments on children's behavior and capabilities than mild disabilities, which might explain why children with average or slightly below average functioning were at greater risk of assault than their peers, the researchers hypothesized.
Better understanding of children's capabilities and that there may be day-to-day and context-specific variances in them could "also influence whether a parent interprets noncompliance as willful disobedience or as a function of the child's limitations," the researchers wrote.
"In terms of decreasing rates of child abuse, we may need to focus on educating parents that their child's limitations may not allow them to act a certain way all of the time, thus the adults' expectations need to be flexible," Helton said.
The study appears in the journal Child Maltreatment, which was published online March 25.