Academic journal article International Journal of Child Health and Human Development

Epidemiology, Disability, Child Abuse, and Neglect

Academic journal article International Journal of Child Health and Human Development

Epidemiology, Disability, Child Abuse, and Neglect

Article excerpt

Introduction

Child maltreatment (CM) continues to affect large numbers of children every year. In 2014, 700,000 children younger than 18 years were found to be victims after investigation by United States (US) child protective services (CPS) agencies (1). Despite being extant since the beginning of human civilization, it is only relatively recently that we have come to understand the profound effects of abuse and neglect on persons with disability. At the time of the classic description of the battered child by C Henry Kempe in 1962, physical abuse and neglect were not a stranger to children with disabilities, and people with intellectual and developmental disabilities (IDD) faced almost complete exclusion from schools, communities, and sometimes even homes. Families were regularly counseled to place children with IDD in state-run facilities and were assured that their children would be cared for and protected, but the facilities were often riddled with systemic neglect and abuse.

It was within this context that the Federal Government began providing funds to enhance institutions, and parents and others provided private special-education classes and sheltered workshops for children and adults who were living with their families (2). The United States Child Abuse Prevention and Treatment Act was passed in 1974 and reauthorized in 2010 to further develop state-based child abuse reporting and response systems, including foster care and home-based services (3). As a result, a number of agencies have been put in place at different levels (e.g., local, state, federal) to improve our response to abuse and neglect, and information has been collected about developmental and intellectual disabilities in the child welfare system. If a child discloses information or behaves in such a way that leads to a suspicion of abuse or neglect, a variety of professionals and agency staffmembers can be legally mandated (each state/country according to their laws) to make a report to the governmental entity designed to receive such reports. This entity determines if there is enough evidence to prompt an investigation and/or begins an investigation which includes assessing the safety of the home, interviewing family members and others known to the patient, and obtaining medical and other records. This investigation can involve law enforcement and child or adult protective services. If abuse occurs in an institution or in foster care, the agencies involved may also conduct their own investigation. This has been further codified and expanded throughout the world with the adoption of the United Nations Convention on the Rights of the Child in 1989 (4) and the Convention on the Rights of Persons with Disabilities in 2006 (5). The known and suspected causes of child maltreatment among children with disabilities are multifactorial, ranging from genetics, epigenetics, environment, and ecology to family demography, behavior, and social and societal norms.

Despite the existence of reporting, it is difficult to precisely determine the incidence and prevalence of child maltreatment in the US and across the world due to variations in the application of definitions in law and practice, different numbers of cases generated with voluntary versus mandated reports, large numbers of cases that are never known to CPS agencies, parenting and cultural practices, acceptability of corporal punishment and other family violence, and resources available for systematic epidemiologic case ascertainment. Some jurisdictions have little or no information about child maltreatment, while data systems have been in place in many countries such as the US for more than 20 years (1). Several models have been developed in various countries to capture the number of children coming to the attention of social services or legal authorities or the prevalence of behaviors that place children at risk for child maltreatment (6). In addition, population-based surveys using variations of the parent-child Conflict Tactics Scale, the Adverse Childhood Experiences questionnaire, the Lifetime Victimization Screening Questionnaire, and the International Society for the Prevention of Child Abuse and Neglect screening tools have all been used to assess child maltreatment worldwide (7). …

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