Maltreatment and disabilities: a population-based epidemiological study☆
Introduction
The hypothesized Association between disabilities and child maltreatment has been controversial for over a decade (c.f. Ammerman 1991, Starr et al 1984). Not only has there been a paucity of research on the maltreatment of children with disabilities, state agencies charged with the responsibility of investigating or responding to maltreatment have long been unlikely to even note the presence of disabilities in their records. Indeed, Bonner, Crow, and Hensley (1997) indicated that only seven states currently record disability status in their abuse records, a decline from 1982 when Camblin reported fewer than half the states recorded disability status of maltreated children. Thus, although the Child Abuse Prevention, Adoption, and Family Services Act of 1988 (1988, April) (PL100-294) in the US mandated the study of maltreatment among children with disabilities, relatively little scholarly and practical attention has focused on the hypothesized association between disabilities and child maltreatment.
One recent attempt to explore the relation between maltreatment and disabilities used the methodology of the Second National Incidence Study (NIS-2; Office of Human Development Services, 1988) to determine the incidence of abuse among children with disabilities (Westat, Inc., 1993). Data were collected from 35 Child Protective Service (CPS) agencies selected to be nationally representative of US counties. The study concluded that the incidence of maltreatment among children with disabilities was estimated to be 1.7 times the incidence of children without disabilities. Additionally, based on the opinions of CPS workers, it was estimated that the disability either led to or contributed to the abuse in 47% of the cases, whereas in 37% of cases the abuse contributed to or resulted in a disability. Importantly, like Camblin (1982) and Bonner and colleagues (1997), the Westat, Inc. (1993) study reported that CPS agencies rarely recorded disability status in a systematic fashion.
Although the Westat, Inc. (1993) study provided support for the hypothesis that there is an association between disabilities and maltreatment, methodological limitations precluded strong inferences from that work. Most importantly, the Westat, Inc. (1993) study relied on the opinions of CPS workers to determine the presence or absence of disabilities, whether the disability played a role in the maltreatment, or whether the maltreatment caused a disability. Thus, analyses regarding disability were based on opinion rather than disability diagnosis established by physicians or other appropriate professionals trained to diagnose those disabilities. Finally, because of the reliance on CPS records, the study was largely limited to cases of intrafamilial abuse. That is, extrafamilial maltreatment is typically recorded in law enforcement records and law enforcement records are rarely represented in state CPS records (Flango et al., 1988). Consequently, extrafamilial maltreatment may not be accurately represented in the Westat, Inc. (1993) study.
Recently Sullivan and Knutson (1998) completed an epidemiological study designed to evaluate the hypothesized association between disabilities and maltreatment using a hospital-based sample that permitted diagnoses of disabilities from medical records. Additionally, because Sullivan and Knutson (1998) used CPS records, foster care records, and law enforcement records to obtain evidence of maltreatment, the study was not limited to intrafamilial maltreatment. Based on a sample of 3001 maltreated children and 880 comparison children, Sullivan and Knutson (1998) provided considerable evidence that disabilities were risk factors for maltreatment, as well as evidence that maltreatment could be important in the development of some disabilities, especially those related to conduct-disordered behavior.
Although the Sullivan and Knutson (1998) study provided strong support for the hypothesized link between disabilities and maltreatment, the use of a hospital-based sample could limit the generalizability of that research. That is, Coon, Beck, and Coon (1980) have argued that studies of maltreatment in hospital populations may over sample subjects with disabilities. As a result, the present study was designed to be a replication and extension of the Sullivan and Knutson (1998) research. By using an entire school-based population drawn from the same geographical region as the Sullivan and Knutson (1998) study, the present study avoided any subject selection bias. Additionally, by using a school-based disability criterion (i.e. educationally mandated disabilities), the study assured full inclusion of disabilities.
Section snippets
Subjects
The subjects for this study were all 50,278 children enrolled in the Public (OPS) and Archdiocese schools of Omaha, Nebraska during the 1994–95 school year. In addition to the kindergarten through 12th grade pupils, the population included children who were eligible to participate in various special education programs in OPS (e.g., Zero to Three, Early Intervention Preschool). Thus, the population ranged in age from 0 to 21. The population was 51.4% male and 48.6% female. The ethnic composition
Results
Table 1 shows the overall prevalence of disabilities among the maltreated and nonmaltreated children enrolled in the Omaha Public Schools. Although there was an overall rate of maltreatment of approximately 11% in the population, the overall rate of maltreatment among children who had an identified disability for which they were receiving special education services was 31%, a rate more than three times that of children without an educationally relevant disability. Stated another way, among the
Discussion
The findings of the present research provide unequivocal evidence that there is a strong association between childhood disabilities and child maltreatment. The 31% maltreatment rate among children with disabilities, in contrast to the 9% rate for nondisabled children, provides further support for the notion that children with disabilities are at increased risk for having been maltreated. Indeed, disabled children were 3.4 times more likely to be the victim of some type of maltreatment than
Acknowledgements
The authors gratefully acknowledge the cooperation of the Omaha Public Schools, the Omaha Archdiocese Schools, the Nebraska Department of Social Services, the Foster Care Review Board, the Omaha Police Department, and Hang Pham-Bowman, Clare Burton, Richard Swayze, and David Van Dyke for their assistance in the completion of this research.
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This work was supported by a research grant (90-CA-1562) funded by the National Center on Child Abuse and Neglect.