Recognizing & Interpreting Abuse of Individuals with Disabilities (Non-State Specific)

Objectives:

  • Discuss risk factors associated with abuse
  • Discuss individuals with disabilities being at increased risk for abuse
  • Define the different types of abuse
  • Discuss possible signs of abuse and neglect
  • Discuss legal responsibilities of professionals
  • Discuss reporting guidelines

Recognizing & Interpreting Abuse

Abuse and neglect can affect…

  • Any socioeconomic level
  • People across ethnic and cultural lines
  • Within all religions
  • At all levels of education

A report of child abuse is made every 10 seconds!

Individuals with disabilities are at increased risk for abuse compared to non-disabled individuals.

Risk Factors

Variances may exist in the type of abuse experienced in relation to the type of disability and the severity

  • Children with emotional or behavioral disorders may be at increased risk for abuse
  • Children with mild impairments may be at a greater risk than those with more severe impairments
  • Children who exhibit challenging behaviors may be at a greater risk for use of physical punishment
  • Adults with disabilities may be at a greater risk for physical and sexual abuse

Risk factors for abuse can be considered across the following categories:

  • Perpetrator Risk Factors: factors related to a person being more likely to abuse another
    • Parents who have a general lack of knowledge of their child’s needs and developmental age appropriateness, overall parenting skills, training and support
    • History of abuse. About 30% of abused and neglected children will later become abusers themselves
    • Substance abuse: children whose caregivers abuse alcohol and drugs are 3x more likely to be abused and 4x more likely to be neglected
    • Personal characteristics: often young in age, little to no social support, low levels of education, low income, large number of children to care for
    • Social isolation
    • Domestic violence
    • Parental stress
  • Victim Risk Factors: factors increasing the likelihood a person will be abused by another
    • Under the age of 4
    • Special needs that increase caregiver burden (to include physical or developmental disability, mental health issues, and chronic physical illness)
    • Elders or dependent adults
  • Specific Risk Factors related to Individuals with Disabilities: Additional risks associated with having a disability
    • Perpetrator considerations:
      • Financial impact/income: high costs related to treatment / low pay for aides or assistants
      • Increased caregiver stress and burden: more challenging behaviors and fewer adaptive skills
      • Social isolation: few non-caregiver activities
      • Limited understanding from other family members
      • Limited training and support for direct providers working alone with the child
      • Lack of understanding: that the individual’s needs are more intensive and unique, or of a typical child ‘s development and variances, and additional strategies available to teach the child
      • Non-biological, transient caregivers in home
    • Victim considerations:
      • Limited safety awareness: over compliant, stranger awareness, appropriate vs. inappropriate requests
      • Communication: impaired communication skills, impossible or difficult to report abuse,
      • Sleep difficulties: can result in chronic and longstanding sleep deprivation for caregivers,
      • Elopement/Wandering: difficult to provide adequate supervision
      • Difficulty understanding social cues and intentions: intentional versus unintentional injury
      • Limited understanding of personal safety and sexual abuse: what is okay and not okay

What exactly is considered abuse?

Legal definitions vary from state to state

The federal definition of abuse and neglect: Is an act or failure to act that results in death, serious harm or imminent risk of serious harm

Anyone who comes into contact with the victim can be responsible for the abuse.

Types of Abuse

Physical:

Non accidental physical injury

  • Includes the threat of physical injury
  • Includes the risk of physical injury

Emotional

Injury to the psychological capacity or emotional stability, evidenced by observable or substantial change in behavior, emotional response and cognition

  • Includes rejection and ignoring
  • Includes shame and humiliation
  • Includes terrorizing
  • Isolation

Sexual

Is the sexual contact or activity with another person without their consent

  • Includes sexual intercourse and activity
  • Includes sexual contact with a minor
    • Includes touching, encouraging to touch, requesting to touch
    • Directly or through clothing
    • Particular parts of the body
  • Includes specific sexual acts with a minor
  • Includes sexual exploitation: Allowing a minor child to engage in:
    • Prostitution
    • Production of pornography

Neglect

The failure to provide the basic necessities: food, clothing, shelter, medical care and adequate supervision and this threatens the individual’s health, safety or well-being.

***Some states may include specific exceptions within the definition of abuse & neglect***

Some exceptions include:

  • The financial inability to care for a child
  • Physical discipline that is reasonable and does not cause bodily injury
  • Failure to provide medical treatment due to religious beliefs

Common Signs of Abuse and Neglect

Common Signs of Abuse

  • Each type of abuse can result in physical and behavioral changes in the child
  • These changes can provide reasonable cause to believe or suspect abuse or neglect
  • Some signs of abuse are quite subtle and easily missed
  • Other signs may be obvious
  • The following signs can be present regardless of an individual having a disability or not:
    • Unexplained injuries
    • Peculiar Bruising – Shape of objects
    • Unconvincing or inconsistent explanation of injuries https://schweizer-apotheke.de/
    • Changes in behavior (scared, anxious, withdrawn, depressed, aggression
    • Returning to Earlier behaviors: regression, thumb sucking, bedwetting, fear of strangers, fear of the dark, loss of acquired language, etc.
    • Fear of Going to a Particular Location: home, school, community setting and it could be a sign of where the abuse is occurring.
    • Fear of going to a place with a person: because that is the person abusing them
    • Changes in eating behavior: eating more or eating less; weight gain or loss (significant)
    • Changes in sleeping behavior: night terrors, insomnia, fear of going to sleep
    • Lack of personal hygiene: consistently dirty, severe body odor, lack sufficient clothing for the weather
    • Risk-taking behavior: drugs, alcohol, carrying a weapon (not present previously)
    • Inappropriate sexual behavior: overly sexualized behavior, public masturbation, coercing other children into sexual activity
    • Explicit sexual language

Signs of Abuse for Individuals with Disabilities

  • Symptoms of disability can make the signs of abuse more difficult to identify or interpret (essentially masking them or mimicking them)
    • Unexplained Injuries: In ASD or others with disabilities self-injury is common, and can include bites, bruises, scratches, hair pulling. And this could mask actual instances of abuse. Additionally, non-compliance with medical treatment may look like abuse: often those with disabilities have difficulties in complying with or going through medical treatment and pulling stitches or scratching at scabs resembles unexplained injuries. Injuries may appear worse than they are resulting in suspicion and these injuries may have longer healing times, result in scarring and even re-injury.
      • In addition, individuals with a disability or ASD may have a higher tolerance for pain, which means that their reaction is more mild even when the injury is more severe. Leaving the injury not addressed properly. Further, because of this threshold, others may not be aware of the injury until much later.
      • Communication skills can contribute to non-reporting, or an inability to explain how something happened.
    • Changes in Behavior: This is difficult as for many behavioral difficulties are already present, anxiety, withdrawal and aggression all of which can either mask or mimic abuse signs. An increase in symptom is often more difficult to identify than an onset of symptoms.
    • Regression: Not uncommon in those with disabilities or ASD, even the re-emergence of problem behavior
    • Fear of Locations/People: Again, not uncommon in people with disabilities or ASD due to inherent difficulties with transition and change.

Other situations that might look like abuse but are necessary for that individual’s safety

  • Barren bedroom
  • Locked bedroom, bathroom, windows and/or cabinets

All of this can lead to false reports or underreporting!! So complicated! Be observant and be careful!

Mandated Reporters

Individuals that, in the ordinary course of their work, come into contact with children, individuals with disabilities, dependent adults or senior citizens are legally required to report abuse.

  • Abuse may be observed or just suspected
  • Individuals may be paid or unpaid volunteers
  • Under Federal Law we are required to report ANY instance of abuse or neglect
  • Individual states may vary in who they designate as mandated reporters, however nearly all states include educators and medical professionals

It can be very difficult to make the decision to report. You may worry or feel guilty about reporting. However, it is important to view such reports as a way to protect a child, and help a family and NOT as a punishment. When abuse is suspected a mandated reporter must immediately report the abuse to authorities.

When to Report:

  • When abuse is suspected
  • When abuse is observed
  • When abuse is reported to you | Verbal disclosure
    • When an individual self-discloses it is important to listen and document exactly what they say. Be supportive and non-judgemental. Remain neutral and calm. Tell the individual that it was not their fault. Only ask 4 questions:
      • What happened?
      • Who did this to you?
      • Where were you when this happened?
      • When did this happen?

Who to Report to?

  • Local Child Protective Services
  • Local Law Enforcement
  • Supervisor

How to Make a Report

  • Name, age, gender of the child
  • Description of the suspected/observed abuse
  • Curent condition of the child
  • Diagnosis can also aid in the investigation

Failure to Follow Reporting Laws

  • Failure to report, impede, inhibit reporting adult or child abuse
    • Misdemeanor
    • Punishable by time in county jail
    • Punishable by fine
    • Or both jail and fine

For further information visit:

Child Welfare Information Gateway

Childhelp

Learn More…

Understanding the Therapist’s Role in the ABA Treatment  Process

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