Disabling conditions and registration for child abuse and neglect: a population-based study

Effectiveness of school-based interventions on child sexual abuse knowledge in children with disabilities: Systematic review and meta-analysis

BACKGROUND

Children with disabilities (CWDs) constitute a substantial segment of the population who encounter abuse, emphasizing the need to comprehend the influence of school-based interventions on this susceptible group.

AIM

This systematic review and meta-analysis aimed to identify and evaluate the effectiveness of school-based interventions in enhancing child sexual abuse (CSA) knowledge among CWDs.

PARTICIPANTS

This meta-analysis incorporated seven published studies, encompassing 387 CWDs.

METHODS

Our study synthesizes findings from seven experimental and quasi-experimental studies, adhering to the PRISMA guidelines. The study was registered in PROSPERO. The literature search, conducted between September 25, 2023, and October 2, 2023, employed various databases and keywords relevant to the study's scope. The research question and articles' eligibility were assessed using the Population, Intervention, Comparison, Outcomes, and Study type (PICOs). The meta-analysis was conducted using the Comprehensive Meta-Analysis (CMA) software.

RESULTS

The school-based intervention greatly impacted CWDs' CSA knowledge scores (Hedges's g = 1.026 [95% CI: 0.845; 1.208], z = 11.074, p = 0.000). The findings of this meta-analysis demonstrate that Questionnaire/scale-based knowledge measurement (Hedges's g = 2.586 [95% CI: 0.920; 4.252], z = 3.043, P = 0.002) and Vignette-based knowledge measurement (Hedges's g = 1.065 [95% CI: 0.655; 1.474], z = 5.100, p = 0.000) are effective in assessing CWDs' knowledge of CSA.

CONCLUSION

This systematic review and meta-analysis of seven randomized controlled studies and quasi-experimental studies provide robust evidence supporting the effectiveness of school-based interventions in significantly enhancing CSA knowledge among CWDs.

IMPLICATIONS TO PRACTICE

These findings are potentially significant evidence for education professionals, including educators and school health nurses.

Adverse Childhood Experiences and Autism: A Meta-Analysis

Evidence suggests that autistic children have a higher probability of experiencing adverse childhood experiences (ACEs) compared to their non-autistic peers. This meta-analysis (PROSPERO: CRD42022262635) aimed to quantify the association of autism and ACEs. Eight databases and Google Scholar were searched for studies that reported dichotomous outcomes regarding the associations between ACEs and autistic individuals, compared to non-autistic individuals. A random-effects model was used to calculate the average Odds Ratio (OR) of the relationship between a diagnosis of autism and ACEs. A total of 40 studies with 5,619,584 participants were included, generating an overall average OR 2.11 (CI 1.61, 2.77). Significant differences in the magnitude of association were found across studies with regards to the type of ACEs studied, comparison groups, and population type. Overall, moderate certainty evidence (downgraded for bias) indicates that autistic individuals are at greater risk of experiencing ACEs, compared to non-autistic individuals. Appropriate support for autistic individuals and their families are required to prevent ACEs and treat the impact of ACEs.

Sexual Abuse of Children With Disabilities: Key Lessons and Future Directions Based on a Scoping Review

In recent years there has been a growing public and professional interest in situations of risk, abuse, and exploitation of children with disabilities (CWDs). Despite the increasing awareness of CWDs experiencing child sexual abuse (CSA) at high rates, research in this area is still in its infancy. The current study seeks to identify, map, and thoroughly analyze the existing knowledge to better inform future research, policy, and practice. A scoping review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identifying 35 articles addressing CSA among CWDs based on self-report surveys, official report data, and qualitative interviews. The findings addressed the phenomenon's epidemiology, disclosure, identification patterns, and consequences. Studies showed that CWDs experience CSA two to four times more often than children without disabilities and that they suffer longer and harsher abuse due to factors that complicate the identification of CSA of CWDs. This review highlights the diverse methodologies, producing a high variance in phenomenon rates, as well as unique methodological strategies for addressing challenges in CSA and disability research. Future research should focus on qualitative-retrospective studies of the perceptions of survivors and significant others in their lives (e.g., parents). Moreover, an intersectionality paradigm must be adopted in future studies to address the diverse contexts that construct the phenomenon (including sociocultural contexts). There is also a need to develop integrative interventions to allow higher accessibility of services, adaptive identification mechanisms, and more effective collaboration between professionals and CWDs.

An Autopsy Case of Abdominal Aortic Aneurysm in a Pediatric Decedent With Tuberous Sclerosis Complex

ABSTRACT

Vascular involvement in tuberous sclerosis complex (TSC) is uncommon and even more so in pediatric patients. When asymptomatic, these vascular abnormalities carry increased risk of rupture with increased morbidity and mortality. Here, we describe a case of a ruptured unrecognized abdominal aortic aneurysm in an 11-month-old patient with a history of TSC. The abdominal aortic aneurysm was discovered at autopsy and highlights the rarity of abdominal aortic aneurysm in pediatric patients diagnosed with TSC and the importance of screening for associated aneurysmal disease in the pediatric population with TSC. Furthermore, the extensive retroperitoneal hemorrhage seen in this case also highlights a rare but potential mimic of abuse in the pediatric population.

Physical violence against children with disabilities: A Danish national birth cohort prospective study

Background: Children with disabilities are at heightened risk of violence compared to their non-disabled peers. However, extant research suffers from several limitations, focusing on child abuse and one or few types of disability, ignoring conventional violent crimes.Objective: The aim was to assess 10 disabilities and to examine whether different disabilities vary in their risk of criminal victimization.Method: Using the Danish Psychiatric Case Register, the Criminal Register, and other population-based registers, we included nine birth cohorts (n = 570,351) and followed them until 18 years of age. We compared children exposed to violence with non-exposed children. We estimated odds ratios (ORs) for the disabilities and adjusted the ORs for several risk factors.Results: We identified 12,830 cases of reported violence (2.25% of the population) towards children and adolescents. Children with disabilities were overrepresented, as were boys and ethnic minorities. After controlling for risk factors, four disabilities had heightened risk for criminal violence: attention-deficit hyperactivity disorder (ADHD), brain injury, speech, and physical disabilities. When we compared risk factors controlling for the various disabilities, parental history of violence, family break-up, out-of-home placement, and parental unemployment contributed especially to the violence, while parental alcohol/drug abuse was no longer a predictor. Having several disabilities increased the risk of violence.Conclusions: Criminal victimization of children and adolescents with specific disabilities was common. However, compared to the previous decade, a considerable reduction of one-third has taken place. Four risk factors contributed particularly to the risk of violence; therefore, precautions should be taken to further reduce the violence.

Victimization and abuse among children with disabilities: Age adjusted rates in a US national sample

BACKGROUND

Research has indicated that children with disabilities are at higher risk for victimization although the literature on this topic is limited.

OBJECTIVE

We examined rates of assault, sexual victimization, peer-sibling victimization, property crime, maltreatment, and poly-victimization among youth in the United States with and without disabilities. We examined these rates for three age groups (children ages 0-4 years, ages 5-11 years, and ages 12-17 years).

PARTICIPANTS AND SETTING

We use data from the National Survey of Children's Exposure to Violence (NatSCEV), waves I (2008), II (2011), and III (2014). These are cross-sectional nationally representative samples of children and youth ages one month to 17 years (N = 12,634).

RESULTS

Considering children of all ages together, children in all disability categories, except for physical disability, were at higher risk for poly-victimization. Victimization exposure overall is higher among older children (except for assault among very young children with developmental or learning disabilities), though the disparity between children with and without disabilities generally narrows as children get older. Age of the child impacted the relationships between disability and victimization. Very young children with physical disabilities were at heightened risk for most types of victimization while children with internalizing disabilities were at heightened risk for assault, property crime, and maltreatment in middle childhood and adolescence. Children with externalizing disabilities were at heightened risk for most types of victimization across all ages while developmental disabilities appeared to be risk factor for very young children and a potentially protective factor at later ages though these varied by type of victimization.

CONCLUSION

Victimization risk varied by victimization and disability types. This study demonstrates the importance of controlling for demographic characteristics, especially age of the child in estimating the prevalence of victimization among children with disabilities and establishes the importance of type-specific analyses by victimization type, disability type, and age of the child.

Revisiting medical neglect concerns in children with life-threatening complex chronic conditions

BACKGROUND/OBJECTIVES

Life-Threatening Complex Chronic Conditions (LT-CCCs) increase the complexity of medical neglect concerns. Clinicians' perspectives are central in concerns for medical neglect, yet little is currently known regarding clinicians' understanding of and approach to these situations. We explored how clinicians who care for children with LT-CCCs understand medical neglect.

METHODS

We conducted a semi-structured qualitative interview study with 20 clinicians of varying disciplines from critical, palliative, and complex care services about medical neglect in children with LT-CCCs. We used inductive thematic analysis to generate themes.

RESULTS

Three primary themes emerged: Relationship between family and medical community, family overwhelmed with medical demands, and insufficient support. Taken together these themes suggest that concerns for medical neglect are directly related to clinician perception of family inability to meet medical needs.

CONCLUSION

Clinicians report that concerns for medical neglect in children with LT-CCCs often arise from a mismatch of medical expectations and the perception of familial ability to provide said medical care. Given the complex and delicate medical and psychosocial environments of care for children with LT-CCCs, these medical neglect concerns are more accurately described as Medical Insufficiency, a new term. By reframing this entity, we can reframe the dialogue surrounding this issue, and reconsider approaches to studying, preventing, and resolving it.

Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy

Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.

Pathways to inclusive and equitable quality early childhood education for achieving SDG4 goal—a scoping review

According to Sustainable Development Goal 4.2 (SDG 4.2), Equal Access to Quality Pre-primary Education, governments throughout the world are working to ensure that all children have access to high-quality early childhood development, care, and pre-primary education by 2030. In order to organize available evidence into a coherent framework, the current scoping review represents an exploratory synthesis addressing the broad question of what qualitative and inclusive Early Childhood Education and Care strategies are currently being established globally to achieve SDG4 targets. The goal of this scoping review in this respect, was to map the available research and offer an overview of micro-, meso-, and macro-level perspectives on evidence-based interventions and strategies, for the promotion of SDG4 globally. A layered model of early childhood education that is both inclusive and egalitarian education emerged, starting with the micro level: child, family and community, mezo level: nursery, and kindergarten and macro level: national policies and SDG 4.2 Agenda for 2030. The mezzo level connects the micro and macro levels, being the most solicited level of implementing inclusive and qualitative ECEC strategies. Thus, starting with putting a real emphasis on children rights, creating a qualitative and inclusive culture with a holistic understanding of child development, then investing in teacher preparation and instilling a strong belief and positive attitudes toward equity in early childhood services, developing inclusive educational policies with an authentic community support offered by all stakeholders, then adapting curriculum and assessment methods to all early childhood educational contexts and lastly piloting and up-scaling good practices, and investing in infrastructure, facilities and innovative educational services, SDG4.2 targets could transparently and efficiently be attained by 2030, with all the setbacks arisen from the pandemic context. The data provide light on a vast topic range, including human rights and values, policy actions, and ideologies. The micro-level themes emphasized the importance of fostering equitable and inclusive environments for children., as well as instructional approaches that encourage positive attitudes toward diversity and instructors' levels of experience in dealing with diversity. We also discovered the significance of creating chances that promote socialization, connection development, and a sense of belonging. Meso-level principles emphasized the relevance of schooling in a child's holistic development and skill acquisition. Mainstream availability for all children, national curriculum regulations, teacher preparation for inclusive early childhood education, excellent funding and governance, evaluation and monitoring, and research on inclusive early childhood education comprise the macro level. As a concept and an approach, inclusive and qualitative education necessitates the preparedness of all relevant educational components to participate. Providing inclusive education in the early years requires setting the foundation for subsequent levels of schooling. The active engagement of a young kid should be directed by developmentally and individually suitable curricula. Access to and participation in age-appropriate general curricula becomes critical in identifying and providing specialized support services. Inclusive programming does not imply that the educational programs will necessarily be of good quality. Efficiency and wellbeing are synonymous with equity. Equitable education investment benefits everyone in society, not just the most marginalized. Investing in education will help communities achieve all of the Sustainable Development Goals related to education.

Persons With Intellectual and Developmental Disabilities in the Mental Health System: Part 1. Clinical Considerations

Individuals with intellectual and developmental disabilities (IDD) are at high risk of co-occurring mental health conditions, including major depressive disorder, bipolar disorder, anxiety disorders, psychotic illnesses, impulse control disorders, and others. Because of symptoms associated with these illnesses and with the disabilities themselves, these individuals are often served in a mental health service system framework. However, treatment for them in these settings has typically not been sufficiently nimble, knowledgeable, or adept. Most mental health professionals receive little training about the needs of this population, and system structures typically bifurcate care, when, in reality, conditions can be complex and overlapping. In this first of two articles on care for persons with IDD in the mental health system, the authors provide a clinical overview of these neurodevelopmental disorders and of mental health and other conditions that co-occur with IDD. Considerations and challenges for treating this population in the mental health system include early recognition of mental health conditions, which often requires caregiver and family input, as well as information from a variety of additional collateral sources; the importance of trauma-informed and person-centered care; the promotion of self-determination through use of decision supports; use of approaches such as applied behavior analysis to develop a frame to address challenging behaviors; and the need to properly assess and provide thoughtful pharmacologic intervention when appropriate. The ability of individuals with IDD to thrive in a wide range of community integration opportunities depends on many factors, and clinicians must understand and use the available approaches for treating them.

Fifteen-minute consultation: Fractures in non-ambulant children with cerebral palsy

OBJECTIVE

To describe a safeguarding decision pathway for the assessment of osteopenic fractures in non-ambulant children with cerebral palsy.

METHOD

Literature review and consensus practice of a child safeguarding team, including clinicians and social workers.

CONCLUSION

Low-energy fractures of the lower limb in non-ambulant children with cerebral palsy are relatively common and explained by the presence of reduced bone strength, in the absence of any other unexplained injuries or safeguarding concerns.

Childhood Abuse and Cognitive Function in a Large Cohort of Middle-Aged Women

Cognitive function at middle age is of particular public health interest, as it strongly predicts later dementia. Children who have experienced abuse subsequently have worse cognitive function than those who have not. However, it remains unclear whether the association of abuse with cognitive function persists into middle age. In 2014-2016, 14,151 women ages 49-69 years who had previously responded to a childhood abuse questionnaire completed a cognitive battery. In models adjusted for childhood socioeconomic status and head trauma, combined physical, emotional, and sexual abuse was associated with lower scores on both Learning/Working Memory (severe abuse, lower scores similar to that observed in women 4.8 years older in our data) and Psychomotor Speed/Attention (severe abuse, lower scores similar to that observed in women to 2.9 years older in our data). Adjustment for adulthood socioeconomic status and health factors (e.g., smoking, hypertension) slightly attenuated associations. In exploratory analyses further adjusted for psychological distress, associations were attenuated. Women exposed versus unexposed to childhood abuse had poorer cognitive function at mid-life. Associations were particularly strong for learning and working memory and were not accounted for by adulthood health factors. Childhood abuse should be investigated as a potential risk factor for cognitive decline and dementia in old age.

Sexual Crime Against Schoolchildren With Disabilities: A Nationwide Prospective Birth Cohort Study

Numerous studies have shown that the rate of sexual victimization against children with disabilities is higher than the rate for children without disabilities. The study focuses on examining sexual crime against children with disabilities and explaining differences in victimization to elucidate to what extent types of disability, family disadvantages, gender, high-risk behavior, and location influence adolescents' risk of sexual victimization. Data are based on a national study of reported sexual crime against children in Denmark aged between 7 and 18 years using total birth cohorts (N = 679,683). The statistical analysis is a discrete-time Cox model. An extended list of potential risk factors was included in the analysis to adjust for confounding. The potentially confounding risk factors were collected independently from various population-based registers, for example, employment statistics, housing statistics, education statistics, income compensation benefits, and population statistics (e.g., gender, age, location). Hospital records with information on types of disability based on the national inpatient register and national psychiatric register were collected independently of the collection of law enforcement records about reported sexual offenses under the Danish Central Crime Register. Among total birth cohorts, 8,039 persons or 1.18%. were victims of a reported sexual crime once or several times. Children with intellectual disabilities were more likely to be victimized of a reported sexual crime than non-disabled children were: attention-deficit/hyperactivity disorder (ADHD), odds ratio: 3.7 (3.5-3.9); mental retardation, odds ratio: 3.8 (3.6-4.0); and autism, odds ratio: 3.8 (3.6-4.0). This contrasts with children with speech disability, stuttering, and dyslexia who were less likely to be victimized when adjusted for family vulnerability and other confounding risk factors. Intellectual disability and family vulnerability, for example, parental substance abuse, parental violence, family separation, the child in care, and parental unemployment, indicate an increased risk of being a victim of a sexual crime, while speech disability seems to be ensuring protection.

Multimorbidity and polyvictimization in children - An analysis on the association of children's disabilities and long-term illnesses with mental violence and physical violence

BACKGROUND

Children's disabilities and long-term illnesses (DLTIs) are a significant risk factor in the development of maltreatment.

OBJECTIVE

The study is focused on the association of children's DLTIs with child maltreatment and poly-victimization perpetrated by parents.

PARTICIPANTS AND SETTING

The study is based on a 2013 Child Victim Survey (N = 11,364), which is a cross-sectional survey. This nationally representative survey focused on the life situation of Finnish children aged 12-17 years, as well as on experiences of violence, crime, and bullying.

METHODS

Multinomial logistic regression analysis was used to examine the association of children's DLTIs and child maltreatment.

RESULTS

Poly-victimization played a significant role in child maltreatment. Children's hearing impairment (OR 5.68, 95% Cl 2.25-14.35), physical disability (OR 3.32, 95% Cl 1.61-6.88), and mental health problems (OR 4.37, 95% Cl 1.63-11.72) increased the odds of poly-victimization more than other forms of abuse. The situation was similar with both somatic diseases (OR 1.59, 95% Cl 1.14-2.21) and psychiatric illnesses (OR 2.12, 95% Cl 1.36-2.47) in children. Further, somatic and psychiatric multimorbidity in children increased the odds of poly-victimization (OR 4.17, 95% Cl 2.25-7.75) slightly more than risk of physical abuse (OR 3.57, 95% 1.11-11.49). As control variables, child's gender and age, the family financial situation, and the parent's intimate partner violence were adjusted in all of the analyses.

CONCLUSION

Clinical professionals should consider children's multimorbidity as a potential risk factor of maltreatment. The results of the study can be used to support families and children with DLTIs.

Are Children With a Number of Disabilities and Long-Term Illnesses at Increased Risk of Mental Violence, Disciplinary Violence, and Serious Violence?

The focus of this study was on the question of whether or not children with a number of disabilities and long-term illnesses are at increased risk of child maltreatment (mental violence, disciplinary violence, and serious violence). This study was based on the Child Victim Survey of 2013 (FSD2943). The data consist of a nationally representative sample of pupils in Finland in sixth grade (12-13 years of age) and ninth grade (15-16 years of age). The sampling was undertaken as a stratified cluster by province, municipality type, and school size. The total number of respondents was 11,364. According to the logistic regression analyses, the children with at least three disabilities or long-term illnesses had an increased risk of violence compared with children with no disability: The risk of mental violence increased by 2.96 times, the risk of disciplinary violence by 4.30 times, and the risk of serious violence by 3.53 times. The effect of the category of at least three disabilities and illnesses remained statistically significant, although the analysis also accounted for several confounding factors. Thus, a child's multiple morbidity (in the case of three or more disabilities and illnesses) can be categorized as one of the major risk factors for child maltreatment. The study complements the results of previous studies concerning the effect of children's disabilities and long-term illnesses and their impact on child maltreatment. The results underline the importance of employees of health and social care having knowledge of multiple morbidity and its importance as a key factor regarding child maltreatment.

Serious Life Events in People with Visual Impairment Versus the General Population

The present study aimed to examine the lifetime exposure to serious life events in people with visual impairment compared with the general population. Data were derived from a telephone survey including a probability sample of 736 adults with visual impairment (response rate: 61%). The lifetime prevalence of direct experiences with seventeen different categories of serious life events (Life Events Checklist for DSM-5 (LEC-5)) were compared to that obtained from the general Norwegian population (N = 1792, 36% response rate). Altogether, 68% of people with visual impairment had been directly exposed to at least one serious life event, with equal rates among males and females (p = 0.59). The prevalence of serious life events was higher than for the general population (60%, p < 0.001), especially for fire or explosions, serious accidents, sexual assaults, life-threatening illness or injury, and severe human suffering. In conclusion, our results indicate that people with visual impairment are more prone to experiencing serious life events. This highlights the need for preventive strategies that reduce the risk of serious life events in this population.

Children at the Intersection of Pediatric Palliative Care and Child Maltreatment: A Vulnerable and Understudied Population

CONTEXT

Concerns for child maltreatment can complicate the provision of pediatric palliative care (PPC). Little is known about the vulnerable population of children with life-threatening conditions involved with PPC and state Child Protective Services (CPS) or hospital Child Protection Teams (CPTs). More information is needed to inform and optimize collaborative care.

OBJECTIVES

Define and describe the population of children with PPC involvement for whom there was concern for maltreatment.

METHODS

Single-center retrospective chart review of children with PPC involvement for whom there was concern for maltreatment, defined as involvement of CPS/CPT between 2005 and 2017. Medical and demographic variables were abstracted and analyzed. Analyses include descriptive tabulation and measurements of association between PPC and CPS/CPT variables.

RESULTS

Among 1804 children followed by PPC, 189 (10.4%) had documented CPS/CPT involvement. Among those, 113 (60%) had CPT involvement, 88 (47%) had concerns of medical neglect, and 100 (53%) had simultaneous CPS/CPT and PPC involvement. Goals of PPC consultation varied by clinical characteristics and concerns for medical neglect. Frequency of CPT involvement and physical abuse concerns also varied by child clinical characteristics.

CONCLUSION

PPC practitioners regularly encounter children with CPS/CPT involvement. PPC practitioners should be aware of the risk of maltreatment in their patients. Although rare in the general pediatric population, medical neglect is a relatively frequent maltreatment concern in children cared for by PPC. PPC practitioners have an opportunity to aid in proper evaluation of medical neglect in children they care for. Closer PPC collaboration with CPS/CPT may further optimize care.

Maltreatment of Children With Disabilities

Over the past decade, there have been widespread efforts to raise awareness about maltreatment of children. Pediatric providers have received education about factors that make a child more vulnerable to being abused and neglected. The purpose of this clinical report is to ensure that children with disabilities are recognized as a population at increased risk for maltreatment. This report updates the 2007 American Academy of Pediatrics clinical report "Maltreatment of Children With Disabilities." Since 2007, new information has expanded our understanding of the incidence of abuse in this vulnerable population. There is now information about which children with disabilities are at greatest risk for maltreatment because not all disabling conditions confer the same risks of abuse or neglect. This updated report will serve as a resource for pediatricians and others who care for children with disabilities and offers guidance on risks for subpopulations of children with disabilities who are at particularly high risk of abuse and neglect. The report will also discuss ways in which the medical home can aid in early identification and intervene when abuse and neglect are suspected. It will also describe community resources and preventive strategies that may reduce the risk of abuse and neglect.

Working alongside people with intellectual disabilities who have had difficult experiences: Reflections on trauma-informed care within a service context

People with intellectual disabilities are more likely to experience adverse childhood experiences than those in the general population. Additionally, the conceptualization of 'trauma' is far broader than traditionally understood in order to encompass the far reaching relational nature of people with intellectual disabilities traumatic experiences. This reflective account details the first steps one service took to embrace trauma-informed care as a whole systems approach. The paper is a response to calls following conference presentations about our work, to share the process of the beginning of this journey, it also aims to provide key learning points, practical considerations and questions for reflection in order to support other services to begin their own relationships with trauma-informed care.

Healthcare providers' role in providing sexual and reproductive health information to people with intellectual and developmental disabilities: A qualitative study

BACKGROUND

Individuals with intellectual and developmental disabilities demonstrate disparities in sexual and reproductive health (SRH) compared to individuals without disabilities (e.g., lack of sexual education and knowledge, increased rates of abuse, unplanned pregnancies and sexually transmitted infections). Therefore, the purpose of this study was to identify topics healthcare providers address and perceived barriers and supports to SRH education.

METHODS

We conducted semi-structured interviews with healthcare providers (N = 12).

RESULTS

Providers address relationships, safety, protection and appropriate sexual behaviours with clients with intellectual and developmental disabilities. Parent education and client-centred care were identified as supports, while the patient's level of understanding, the provider's lack of knowledge or access to resources and to appropriate referrals were identified as barriers to SRH education.

CONCLUSION

Future studies are needed to link providers to resources they can use to provide comprehensive, accessible SRH education for clients with intellectual and developmental disabilities.

Increased risk for child maltreatment in those with developmental disability: A primary health care perspective from Israel

BACKGROUND

Child Maltreatment (CM) is a worldwide phenomenon. Literature suggests that children with disabilities are at increased risk for CM. However, limited information exists regarding if such increased risk is noted in community primary care clinics.

AIM

To report on the incidence of CM in children with and without disabilities attending community primary care clinics.

METHOD

This was a cohort study of children belonging to a Health Maintenance Organization (HMO) in Israel. The study group consisted of children with disabilities and the control group consisted of children without disabilities. Formal reports to child protection services, medical and sociodemographic data were extracted from designated documentation and medical records.

RESULTS

The odds to be identified as suspected CM, after adjusting for sociodemographic variables, was 6.2 times higher among children with disabilities compared to children without disabilities and 5.0 times higher among children with severe vs. mild disability.

CONCLUSIONS

Developmental disability is a risk factor for CM, and is noted even more seriously in community primary care clinics. CM positively correlated with the severity of disability. The presented data marks higher figures than previously reported, enhancing understanding of the scope of the problem and its relation to the type of organization being examined.

Predictors of Trauma Exposure and Trauma Diagnoses for Children with Autism and Developmental Disorders Served in a Community Mental Health Clinic

Exposure to potentially traumatic events (PTEs), and trauma related diagnoses are poorly understood in autism spectrum disorders (ASD) and developmental disabilities (DD). The current study examined N = 7695 cases seen by a community mental health provider to compare exposure to PTEs and trauma-related diagnoses between children with ASD, children with DD, and children with other mental health diagnoses (e.g., depression). Predictors included demographics, exposure to negative life events, living situations, and subscales of the strengths and difficulties questionnaire (SDQ). Logistic regressions showed that diagnostic group, number and type of negative life events and locations lived, and SDQ subscale scores predicted trauma reports and trauma diagnoses. The findings suggest screener questions that may be useful across diagnostic groups.

Neurodisability among Children at the Nexus of the Child Welfare and Youth Justice System

Although neurodisability features significantly across child welfare and youth justice cohorts, little research investigates neurodisability among crossover children with dual systems involvement. This study examined differences in childhood adversity, child protection involvement, and offending among crossover children by neurodisability status. Data were from a sample of 300 children (68% male, 31% female, 1% transgender; mean age = 16.2 years, range 10–21) who were charged and appeared in three Australian children’s courts, and who also had statutory child protection involvement in the study jurisdiction. The results indicated that nearly one-half of crossover children had a neurodisability (48%) and this group experienced greater cumulative maltreatment and adversity, earlier out-of-home care entry and offending onset, more caregiver relinquishment and residential care placement, and a greater volume of charges. While substantial differences between specific neurodisabilities were evident, crossover children with any neurodisability had greater odds of having charges related to criminal damage and motor vehicle theft, however they were no more likely to have violent charges relative to other crossover children. The study’s findings demonstrated that the prevalence of neurodisability, and child welfare system responses to this phenomenon, contributes to several offending-related trends observed among crossover children.

Developmental Stage of Onset, Poly-Victimization, and Persistence of Childhood Victimization: Impact on Adult Well-Being in a Rural Community-Based Study

The current study examines the persistence of victimization and poly-victimization (i.e., count of multiple types of victimization) across various stages of development (ages 0-5, 6-12, and 13-18) and the related impact on adult well-being. Participants were 2,098 adults from the Appalachian region of three Southern states. Eighty-two percent of participants reported at least one type of victimization during childhood. Among adult victims, 22.6% reported one victimization in one developmental stage (i.e., one stage, but no poly-victimization), 45.8% reported one victimization in more than one stage (i.e., persistent victimization, but no poly-victimization), 20.5% reported multiple types of victimization in one stage (i.e., poly-victimization), and 11.2% reported multiple types of victimization at more than one stage (i.e., persistent poly-victimization). Results indicated a linear decline in subjective well-being, mental health, and number of healthy days as victimization becomes more persistent across childhood and more diverse in types (i.e., poly-victimization). Study findings provide support for models of victimization that take both developmental trajectories and poly-victimization into account.

Association of Borderline Intellectual Functioning and Adverse Childhood Experience with adult psychiatric morbidity. Findings from a British birth cohort

BACKGROUND

To examine whether Borderline Intellectual Functioning (BIF) and Adverse Childhood Experiences independently predict adult psychiatric morbidity.

METHODS

We performed a secondary analysis of longitudinal data derived from the 1970 British Birth Cohort Study to examine whether BIF and Adverse Childhood Experiences independently predict adult mental distress as measured by the Malaise Inventory. Factor analysis was used to derive a proxy measure of IQ from cognitive testing at age 10 or 5. Variables that could be indicators of exposure to Adverse Childhood Experiences were identified and grouped into health related and socio-economic related adversity.

RESULTS

Children with BIF were significantly more likely than their peers to have been exposed to Adverse Childhood Experiences (BIF mean 5.90, non-BIF mean 3.19; Mann-Whitney z = 31.74, p < 0.001). As adults, participants with BIF were significantly more likely to score above the cut-off on the Malaise Inventory. We found statistically significant relationships between the number of socio-economic Adverse Childhood Experiences and poorer adult psychiatric morbidity (r range 0.104-0.141, all p < 001). At all ages the indirect mediating effects of Adverse Childhood Experiences were significantly related to adult psychiatric morbidity.

CONCLUSIONS

The relationship between BIF and adult psychiatric morbidity appears to be partially mediated by exposure to Adverse Childhood Experiences. Where possible, targeting Adverse Childhood Experiences through early detection, prevention and interventions may improve psychiatric morbidity in this population group.

Violent crime against children with disabilities: A nationwide prospective birth cohort-study

BACKGROUND

The rate of violent victimization against children with disabilities is thought to be lower than the rate for children without disabilities but several studies shows otherwise.

OBJECTIVE

The study focuses on examining violent crime against children with disabilities and explaining differences in victimization, in order to elucidate to what extent types of disability, family disadvantages, gender, high-risk behavior, location and indicator of ethnic minority (e.g. non-Danish citizens) influence adolescents' risk of violent victimization. Previous population studies in this area lack scientifically sound research methodology and results are weak or inconclusive.

METHOD

Data is based on a national study of reported violent crime against children in Denmark aged between 7 and 18 years, using total birth cohorts (N = 678,000). Data on types of disability were collected from the Danish national inpatient register. Violent-crime data were extracted from Danish police records. Within the birth cohorts studied, 3.5% of children had experienced a violent crime. A discrete-time Cox model was used for the statistical analysis, which included an extended list of potential risk factors to adjust for confounding.

RESULTS

Children with disabilities are more likely to be victims of a reported violent crime than non-disabled children - ADHD odds ratio: 2.7 (2.6-2.8), mental retardation: 2.7 (2.6-2.7), autism 2.6 (2.5-2.7), loss of hearing 1.4 (1.2-1.5), brain injury: 1.8 (1.7-1.9), physical disabilities 1.4 (1.2-1.5), and blindness 2.0 (1.4-2.8). Speech disability, epilepsy, stuttering, and dyslexia were not associated with increased risk of violent victimization, when adjusted for confounding risk factors and age.

CONCLUSIONS

The results of our study provide empirical insight into the first-time prevalence of victimization among children with disability, and into the predicative association between family disadvantages and victimization.

Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample

BACKGROUND

Children with developmental disabilities are at heightened risk for maltreatment. However, little is known regarding the prevalence of maltreatment among specific groups, such as autism spectrum disorder (ASD) and/or intellectual disability (ID). Information about maltreatment in these groups can aid in the development of supports and prevention strategies for vulnerable children and their families.

METHODS

Using record linkage between the Department of Social Services (DSS) and the Autism and Developmental Disabilities Monitoring (ADDM) network, this study compares the prevalence and characteristics of maltreatment among children with ASD-only (n = 316), ASD and comorbid ID (ASD+ID; n = 291), ID-only (n = 1,280), and controls (n = 3,101). Behavioral correlates of maltreatment are examined.

RESULTS

Controlling for demographic factors, this study found significantly higher odds of reported and substantiated maltreatment among children with ASD-only (odds ratio = 1.86 for reported, 1.51 for substantiated), ASD+ID (odds ratio = 2.35 for reported, 1.97 for substantiated), and ID-only (odds ratio = 2.45 for reported, 2.49 for substantiated) relative to a population control group, with large effects. In particular, children with ASD+ID and ID-only were between two and three times more likely to experience maltreatment. All groups were more likely to experience physical neglect, and children in the ASD+ID and ID-only groups were more likely to experience all forms of abuse. Children in the ASD-only group were more likely to experience physical abuse. Maltreated children in the ASD-only and ID-only groups experienced more cases of physical abuse and neglect, and were victimized by more perpetrators compared to other maltreated youth. Maltreatment was associated with higher likelihood of aggression, hyperactivity, and tantrums for children with ASD.

CONCLUSIONS

Children with ASD and/or ID are at heightened risk for maltreatment. Empirically-supported assessment and intervention approaches for identifying and addressing traumatic stress related to maltreatment in ASD are urgently needed.

Prevalence and Severity of Child Impairment in a US Sample of Child Maltreatment Investigations

OBJECTIVES

Although there is agreement that childhood disability is both a risk and result of maltreatment, the extent of disability in the child welfare system remains unclear. Our objective is to determine the prevalence and severity of child impairment in a national sample of child abuse and neglect investigations in the United States.

METHODS

We used data from the National Survey of Child and Adolescent Well-Being II, a study of 2644 children older than 3 years who were subjects of child abuse and neglect investigations. Groups of children were identified by latent profile analysis using continuous standardized measures of intelligence, emotional or behavioral impairments, adaptive behaviors, and social skills.

RESULTS

Whether the child remained in home or was removed to foster care after an investigation, 3 classes of children were identified: (1) slightly over one-tenth were in an intellectual disability subgroup characterized by marked intellectual impairments alongside delays in daily living functioning, (2) over one-third were in an emotional or behavioral impairment subgroup characterized by both frequent and severe internalizing and externalizing behaviors, and (3) slightly over half were in a typically developing subgroup.

CONCLUSION

When using standardized measures of disability, nearly half of the children investigated by child protection in the United States are not typically developing. These findings suggest that those working for the child welfare system need to be attentive to the complex needs of children with intellectual disabilities and emotional or behavioral impairments and their families, many of whom are under significant stress.

Perspectives of Young Child Abuse Survivors on Confidentiality: An Exploratory Literature Review

The current systematic narrative literature review sought to discover the views of young child sexual abuse (CSA) survivors, unknown to child protection services, on confidentiality. Due to the paucity of research on young CSA survivors, the review was widened to include users of sexual health services. Seventeen databases were searched, and results were refined by reading titles and abstracts, followed by full text. Analysis involved an exploratory interpretist approach to identify conceptual themes and research methodologies. Fifteen published papers were identified. Research methods were narrow and included surveys, interviews, and focus groups, with limited youth participation. In addition to the theme of confidentiality essential to this study, themes identified included - needing accurate information about services, the importance of someone non-judgemental to talk to, control over decisions affecting their lives, and better access to services. Studies indicated young people were fearful of child protection involvement. In conclusion, studies suggest young survivors unknown to child protection services need a higher level of confidential services and more control of their information. Further research involving young survivors in participatory methods is needed to explore issues of confidentiality, survivor participation, and fear of child protection agencies.

Foster Care Involvement Among Medicaid-Enrolled Children with Autism

The prevalence and risk of foster care involvement among children with autism spectrum disorder (ASD) relative to children with intellectual disability (ID), children with ASD and ID, and typically developing children were examined using 2001-2007 Medicaid data. Children were followed up to the first foster care placement or until the end of 2007; a discrete time logistic regression analysis was conducted. Both the prevalence and risk of foster care involvement were greatest for children with ASD, and the prevalence increased substantially over the study period among children with ASD. Continued examination of the factors contributing to the higher risk of foster placement is warranted to unravel the complex circumstances facing these vulnerable children and their families.

A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder

Children with disabilities experience elevated rates of maltreatment, but little is known about the interaction of children with autism spectrum disorder with child protection systems. A population-based dataset of 24,306 children born in 2008 in Tennessee, which included 387 children with autism spectrum disorder identified through the Autism and Developmental Disabilities Monitoring network, was linked with state child protection records. Rates of maltreatment referrals, screening for further action, and substantiated maltreatment were examined for children with versus without autism spectrum disorder. Significantly more children with autism spectrum disorder (17.3%) than without (7.4%) were referred to the Child Abuse Hotline. Children with autism spectrum disorder were less likely than children without autism spectrum disorder to have referrals screened in for further action (62% vs 91.6%, respectively), but substantiated maltreatment rates were similar across groups (3.9% vs 3.4%, respectively). Girls versus boys with autism spectrum disorder were more likely to have substantiated maltreatment (13.6% vs 1.9%, respectively). The high percentage of children with autism spectrum disorder referred for allegations of maltreatment, the differential pattern of screening referrals in for further action, and the high levels of substantiated maltreatment of girls with autism spectrum disorder highlights the need for enhanced training and knowledge of the complex issues faced by children with autism spectrum disorder, their families, and state welfare agencies.

Social history: A qualitative analysis of child abuse pediatricians' consultation notes

BACKGROUND

Child abuse pediatricians (CAPs) are often consulted for injuries when child physical abuse is suspected or when the etiology of a serious injury is unclear. CAPs carefully evaluate the reported mechanism of the child's injury and the medical findings in the context of the child's family and social setting to identify possible risk and protective factors for child abuse and the need for social services. It is unknown what population risk indicators along with other social cues CAPs record in the social history of the consultation notes when assessing families who are being evaluated for child physical abuse.

PARTICIPANTS AND SETTING

Thirty-two CAPs representing 28 US child abuse programs.

METHODS

Participants submitted 730 completed cases of inpatient medical consultation notes for three injury types: traumatic brain injury, long bone fracture, and skull fracture in hospitalized children 4 years of age and younger. We defined a priori 12 social cues using known population risk indicators (e.g., single mother) and identified de novo 13 negative (e.g., legal engagement) and ten positive social cues (e.g., competent parenting). Using content analysis, we systematically coded the social history for the social cues.

RESULTS

We coded 3,543 cues resulting in a median of 7 coded cues per case. One quarter of the cues were population indicators while half of the cues were negative and one quarter positive.

CONCLUSIONS

CAPs choose a wide variety of information, not always related to known population risk indicators, to include in their social histories.

First-time maltreatment in children ages 2-10 with and without specific birth defects: A population-based study

Children with disabilities are at an increased risk for maltreatment. However, little is known about the risk of maltreatment in children with specific types of birth defects. This study was conducted to determine whether the risk and predictors of maltreatment in children 2 to 10 years of age differ between those without and with specific birth defects: Down syndrome, cleft lip with/without cleft palate, and spina bifida. State administrative and United States Census data were linked to identify study groups, variables of interest, and outcome measures. Kaplan-Meier and multivariate Cox proportional hazard analyses were used to identify study groups and variables associated with an increased risk for maltreatment. The prevalence of substantiated maltreatment was consistently highest among children with cleft lip with/without cleft palate. After adjusting for birth-level factors, children with Down syndrome and cleft lip with/without cleft palate were 34% and 26% more likely to have been maltreated than those without birth defects, respectively. In all three birth defect groups, the risk of medical neglect was higher (relative risks ranged from 3 to 11) than in the unaffected group. The factors associated with increased risk for maltreatment were similar across all groups. Of note, parity, maternal education, and maternal Medicaid use at birth were all associated with greater than 2-fold increased risk for maltreatment. Our findings suggest that the families of children with birth defects may need support services throughout early childhood to help families cope with the needs of their children and reduce the risk of maltreatment.

Psychological and physical violence towards children with disabilities in Finland and Sweden

This article describes psychological aggression and physical violence by Swedish and Finnish mothers ( N = 3420) towards their 0- to 12-year-old children with disabilities ( N = 286) by comparing such behaviour with the mothers of children without disabilities ( N = 3134). The survey data are based on representative samples from Finland and Sweden of mothers' reports of their behaviour towards their child in conflict situations. Mothers of children with disabilities reported more psychological aggression towards their child than did mothers of children without disabilities. Mothers used psychological aggression, especially towards children with neurological/psychological disabilities. However, the only significant difference regarding physical violence was repetitive use of mild physical violence. Overall, the analysis suggests that children with neurological/psychological disabilities are more exposed to both psychological and physical violence than children without disabilities or children with somatic/developmental disabilities.

Prevalence and psychological sequelae of sexual abuse among individuals with an intellectual disability: A review of the recent literature

The impact of sexual abuse among those with an intellectual disability is an area in need of further research. The current article provides an in-depth narrative review of the sexual abuse literature relevant to individuals with an intellectual disability. The 29 articles included in this study focused on (a) the prevalence of sexual abuse, (b) the risk factors associated with this population, and (c) the psychological impact of abuse. The findings confirmed that children and adults with an intellectual disability are at a higher risk of sexual abuse than nondisabled peers. Research regarding risk factors is equivocal, with a range of possible factors indicated. Similarly, evidence suggests that there is no single diagnostic trajectory when dealing with the sequelae of sexual abuse among those with an intellectual disability. The article concludes by discussing recommendations for future research and development of policy around this area.

Sexual assaults in individuals with visual impairment: a cross-sectional study of a Norwegian sample

OBJECTIVE

To examine the prevalence of sexual assaults among individuals with visual impairment (VI) compared with the general population and to investigate the association between sexual assault and outcomes of self-efficacy and life satisfaction.

DESIGN

Cross-sectional interview-based study conducted between February and May 2017.

PARTICIPANTS

A probability sample of adults with VI (≥18 years) who were members of the Norwegian Association of the Blind and Partially Sighted. A total of 736 (61%) members participated, of whom 55% were of female gender. We obtained norm data for sexual assaults from a representative survey of the general Norwegian population.

OUTCOME MEASURES

Sexual assaults (Life Event Checklist for DSM-5), self-efficacy (General Self-Efficacy Scale) and life satisfaction (Cantril's Ladder of Life Satisfaction).

RESULTS

The prevalence of sexual assaults (rape, attempted rape and forced into sexual acts) in the VI population was 17.4% (95% CI 14.0 to 21.4) among women and 2.4% (95% CI 1.2 to 4.7) among men. For women, the VI population had higher rates of sexual assaults across age strata than the general population. For men, no significant differences were found. In the population of people with VI, the risk of sexual assault was greater for those having other impairments in addition to the vision loss. Individuals with VI who experienced sexual assaults had lower levels of self-efficacy (adjusted relative risk (ARR): 0.18, 95% CI 0.05 to 0.61) and life satisfaction (ARR: 0.31, 95% CI 0.19 to 0.50) than others.

CONCLUSIONS

The risk of experiencing sexual assault appears to be higher in individuals with VI than in the general population. Preventive measures as well as psychosocial care for those who have been exposed are needed.

Clinical characteristics of children presenting with a suspicion or allegation of historic sexual abuse

INTRODUCTION

Police-recorded sexual offences against children and young people (CYP) increased 85% in the UK between 2010/2011 and 2014/2015. Many children delay disclosure, but little data are available regarding characteristics of CYP presenting with historic child sexual abuse (CSA).

AIM

To identify the clinical and CSA-related characteristics of CYP presenting with a suspicion or allegation of historic CSA.

METHOD

Data were collected on all CYP<17 years presenting with suspected or alleged historic CSA (ie, >3 days since last sexual assault in prepubertal children, >7 days pubertal girls) between October 2009 and November 2014.

DATA COLLECTED

source and indication for referral, alleged perpetrator, physical findings. Findings supportive of CSA were peer reviewed for consensus agreement.

ANALYSIS

χ² test, Fisher's exact test and logistic regression.

RESULTS

Among 249 CYP, presentation with physical/behavioural symptoms was associated with age <13 years (p<0.01), and alleged penetration with ages 13-17 years (p<0.01). Where known, time since alleged CSA ranged from 1 week to 13 months. Anogenital findings supportive of CSA were present in 7% of examined children (16/233), significantly associated with alleged penetration (p<0.01) and more likely with increasing age (OR 1.46, 95% CI 1.23 to 1.72). Additionally, where tested, sexually transmitted infections (STI) were detected in 2.6% CYP (3/116). Alleged perpetrators were intrafamilial in 66% (126/190). No associations were identified between perpetrator type and gender (p=1.0), age (p=0.7) or indication for referral (p=0.35).

CONCLUSIONS

Despite significant time delay since the alleged CSA, this study highlights the persistence of anogenital findings supportive of CSA in 7% and STIs in 2.6% of CYP.

Mapping staff perspectives towards the delivery of hospital care for children and young people with and without learning disabilities in England: a mixed methods national study

Background

Children and young people (CYP) with learning disabilities (LD) are a vulnerable population with increased risk of abuse and accidental injury and whose parents have reported concerns about the quality, safety and accessibility of their hospital care. The Care Quality Commission’s (CQC) view of best practice for this group of patients includes: access to senior LD nurse provision; a clearly visible flagging system for identifying them; the use of hospital passports; and defined communication strategies (Glasper, Comp Child Adolesc Nurs 40:63-67, 2017). What remains unclear is whether these recommendations are being applied and if so, what difference they are making. Furthermore, what we do not know is whether parental concerns of CYP with LD differ from parents of other children with long-term conditions. The aims of this study were to 1) describe the organisational context for healthcare delivery to CYP with LD and their families and 2) compare staff perceptions of their ability to identify the needs of CYP with and without LD and their families and provide high quality care to effectively meet these needs.

Methods

Individual interviews (n = 65) and anonymised online survey (n = 2261) were conducted with hospital staff working with CYP in 15 children’s and 9 non-children’s hospitals in England. The majority of interviews were conducted over the telephone and recorded and transcribed verbatim. Health Research Authority was obtained and verbal or written consent for data collection was obtained from all interview participants.

Results

The nature and extent of organisational policies, systems and practices in place within hospitals to support the care of CYP with LD differs across England and some uncertainty exists within and across hospitals as to what is currently available and accessed. Staff perceived that those with LD were included less, valued less, and less safe than CYP without LD. They also reported having less confidence, capability and capacity to meet the needs of this population compared to those without LD.

Conclusion

Findings indicate inequality with regards the provision of high quality hospital care to children and young people with LD that meets their needs.

There is a pressing need to understand the impact this has on them and their families.

Trial registration

The study has been registered on the NIHR CRN portfolio 20461 (Phase 1), 31336 (Phases 2-4).

Electronic supplementary material

The online version of this article (10.1186/s12913-018-2970-8) contains supplementary material, which is available to authorized users.

Maternal Exposure to Childhood Abuse is Associated with Mate Selection: Implications for Autism in Offspring

Maternal experience of childhood abuse has been associated with offspring autism. To explore whether familial tendency towards autistic traits-presumably related to genetic predisposition-accounts for this association, we examined whether women who experienced childhood abuse were more likely to select mates with high levels of autistic traits, and whether parental autistic traits accounted for the association of maternal abuse and offspring autism in 209 autism cases and 833 controls. Maternal childhood abuse was strongly associated with high paternal autistic traits (severe abuse, OR = 3.98, 95% CI = 1.26, 8.31). Maternal and paternal autistic traits accounted for 21% of the association between maternal abuse and offspring autism. These results provide evidence that childhood abuse affects mate selection, with implications for offspring health.

ADHD in Tunisian Adolescents: Prevalence and Associated Factors

OBJECTIVE

The aims of the study were to determine the prevalence of ADHD in a population of high school students and to explore the factors associated with this disorder.

METHOD

This was a cross-sectional study that had included 447 high school students. The diagnosis of ADHD was made by the Adult ADHD Self-Report Scale translated in Arabic language. The sociodemographic and clinical characteristics were evaluated by a preestablished questionnaire. The self-esteem was assessed by the Rosenberg Self-Esteem Scale.

RESULTS

The prevalence of ADHD was 18.1%. The logistic regression analysis showed an association between the diagnosis of ADHD and the bad relationships with parents (odds ratio [OR] = 16.43; p < 10-3), the presence of personal psychiatric antecedents (OR = 12.16; p < 10-3), internet misuse (OR = 2.39; p = .014), and maltreatment antecedents (OR = 3.16; p = .009).

CONCLUSION

The prevalence of ADHD in this study was one of the highest prevalence reported. The factors associated with ADHD may have diagnostic and therapeutic implications.

Perceived social risk in medical decision-making for physical child abuse: a mixed-methods study

Background

The medical literature reports differential decision-making for children with suspected physical abuse based on race and socioeconomic status. Differential evaluation may be related to differences of risk indicators in these populations or differences in physicians’ perceptions of abuse risk. Our objective was to understand the contribution of the child’s social ecology to child abuse pediatricians’ perception of abuse risk and to test whether risk perception influences diagnostic decision-making.

Methods

Thirty-two child abuse pediatrician participants prospectively contributed 746 consultations from for children referred for physical abuse evaluation (2009–2013). Participants entered consultations to a web-based interface. Participants noted their perception of child race, family SES, abuse diagnosis. Participants rated their perception of social risk for abuse and diagnostic certainty on a 1–100 scale. Consultations (n = 730) meeting inclusion criteria were qualitatively analyzed for social risk indicators, social and non-social cues. Using a linear mixed-effects model, we examined the associations of social risk indicators with participant social risk perception. We reversed social risk indicators in 102 cases whilst leaving all injury mechanism and medical information unchanged. Participants reviewed these reversed cases and recorded their social risk perception, diagnosis and diagnostic certainty.

Results

After adjustment for physician characteristics and social risk indicators, social risk perception was highest in the poorest non-minority families (24.9 points, 95%CI: 19.2, 30.6) and minority families (17.9 points, 95%CI, 12.8, 23.0). Diagnostic certainty and perceived social risk were associated: certainty increased as social risk perception increased (Spearman correlation 0.21, p < 0.001) in probable abuse cases; certainty decreased as risk perception increased (Spearman correlation (−)0.19, p = 0.003) in probable not abuse cases. Diagnostic decisions changed in 40% of cases when social risk indicators were reversed.

Conclusions

CAP risk perception that poverty is associated with higher abuse risk may explain documented race and class disparities in the medical evaluation and diagnosis of suspected child physical abuse. Social risk perception may act by influencing CAP certainty in their diagnosis.

The mental health of adolescents with and without mild/moderate intellectual disabilities in England: Secondary analysis of a longitudinal cohort study

BACKGROUND

Children with mild/moderate intellectual disabilities are at greater risk for mental health problems, with socio-economic factors and adversity partly accounting for this. Fewer data are available for adolescents.

METHODS

Secondary analysis was undertaken of the Next Steps annual panel study following a cohort through adolescence into adulthood containing self-report mental health data up to age 16/17. Participants with mild/moderate intellectual disabilities were identified through data linkage with educational records.

RESULTS

Adolescents with mild/moderate intellectual disabilities were more likely than non-disabled peers to experience socio-economic disadvantage and bullying. Incidence rates of mental health problems were generally not significantly different between adolescents with and without intellectual disabilities.

CONCLUSIONS

These findings are consistent with higher rates of persistent mental health problems beginning earlier among children with intellectual disabilities. Greater attention needs to be paid to the timecourse of mental health problems, and the impact of socio-economic factors, family and peers on mental health.

Language disorder and retrospectively reported sexual abuse of girls: severity and disclosure

BACKGROUND

Despite emerging evidence for an association between communication disorders and maltreatment, little research has examined sexual abuse characteristics or disclosure experiences among individuals with language disorder (LD). Given that communication difficulties may constitute a barrier to disclosure, the disclosure experiences among individuals with and without communication difficulties may also differ.

METHODS

Five-year-old children identified with a language and/or speech disorder from a nonclinical community sample and a control group were followed to adulthood in a prospective longitudinal study. At age 31, participants completed a behaviorally specific questionnaire on experiences of sexual abuse and questionnaires on disclosure experiences and social reactions to disclosure. Due to low endorsement of sexual victimization among male participants and low sample size, results are reported for women only and exclude nine participants with speech disorder without LD. Participation rates were 28 of 40 in the LD cohort and 45 of 51 controls. Sexual victimization severity was defined using an index combining five indicators (duration, invasiveness, relationship to perpetrator, coercive tactics used, and number of perpetrators). Subthreshold sexual victimization was defined as a single, noncontact incident with a perpetrator unknown to the child; experiences with greater severity were classified as child sexual abuse.

RESULTS

Among women who reported sexual victimization by age 18, invasiveness and overall severity were greater in the LD cohort than in the control cohort. Women in the LD cohort (43%) were more likely than controls (16%) to report child sexual abuse, excluding subthreshold experiences. There were no differences between cohorts in probability of disclosure, latency to disclosure, or social reactions.

CONCLUSIONS

Women with a history of child LD in a nonclinical sample reported substantial child sexual abuse experiences. Implications for understanding associations between LD and mental health and for prevention and early intervention are discussed.