Child abuse and neglect was identified as a "national epidemic" in the 1991 report of the U.S. Advisory Board on Child Abuse and Neglect. In 1993, the National Committee to Prevent Child Abuse (NCPCA) determined that approximately 2.9 million children were identified and/or reported as victims of child abuse and neglect throughout the United States. Until recently, however, the number of children with disabilities who have been abused and neglect has not been well documented.

In November, 1993, the National Center on Child Abuse and Neglect (NCCAN) released a study regarding the abuse of children with disabilities. This first national effort to determine the incidence of abuse among this population found that children with disabilities are abused at approximately twice the rate of children without disabilities (WESTAT, 1993). Other studies document an increased risk of abuse for children with disabilities between four to ten times that of the generic population (Baladerian, 1990).

All forms of abuse, including multiple types of abuse with the same child, multiple perpetrators of abuse, and multiple victims within a grouping of children, are found within the population of children with disabilities. The vast majority of the perpetrators are well known to the abuse victim. Perpetrators may include family members and service providers such as teachers, doctors, administrators, direct care providers, therapists, and transportation providers.

A young man at thirteen years old, had mild mental retardation and cerebral palsy. In counseling he revealed that he was thinking about his future, including marriage and parenthood. Afraid that his children would "be retarded like me," he was asked the cause of his disability. "I was born normal. My Dad used to come home drunk and get real mad. I remember he would throw me against the wall. My head hurt a lot. This happened all the time, when I was little. Now I'm retarded." Although this young man understood the origin of his disability, he did not understand genetics or heredity. When told that his children would probably be born just like he had been, he was happy. He said, "I would never hurt my kids like my Dad [did] (sic)."

In addition to the fact that children with disabilities are at increased risk of abuse is the fact that child abuse can cause disabilities. The exact number of abuse-caused disabilities is unknown, but it is estimated to represent 25% of all developmental disabilities (Baladerian, 1992). In addition, more than 50% of the child victims of severe neglect sustain permanent disabilities, including mental retardation and other forms of learning and cognitive disabilities.

According to a 1990 study, 53% of child abuse related fatalities were children under one year of age, and 90% of the children were under five years of age (April 1994 Carnegie Report). Head trauma is the leading cause of death for children who die from child abuse (Michael Durfee, 1994). It is unknown how many more children suffer "near misses" and retain serious permanent disabilities due to head and neck trauma. Specific causes of brain and other central nervous system injuries may result from the "shaken baby syndrome," blows to the head (e.g., slapping, hitting, child tossing), as well as asphyxiation (due to suffocation or strangling).

The signs of abuse characteristic of children in the general population are pertinent to children with disabilities.
These signs include the following:

• physical injuries including unexplained bruises, welts, broken bones, burns
• frequent unexplained injuries
• aggressive or withdrawn behavior
• unusual fears
• craving for attention
• wary of physical contact
• afraid to go home
• destructive to self and others
• poor social relations
• fatigue
• lack of concentration
• unusual knowledge of sex

Unfortunately, for children with severe disabilities, discovery of their abuse is usually dependent upon the emergency of incontrovertible physical signs (e.g., death, pregnancy, venereal disease, physical injury) and/or obvious behavioral signs (e.g., sudden changes in behavior that re-enact the abuse). Less obvious behavioral signs do not necessarily alert the untrained caregivers to possible abuse. Even more problematic is that professionals providing services to children with disabilities have too often attributed clear signs of abuse to a disability. This oversight has left children in abusive situations, in some cases for several years.

In addition, many people have difficulty believing that children with disabilities can be victims of abuse and neglect. This misperception creates an exaggerated level of vulnerability, as children with disabilities, and their families, are not prepared psychologically, intellectually, or physically to resist or respond to abuse. One woman, who has a severe disability, recently stated that, "until as an adult I was sexually abused, I never thought that persons with disabilities were rape victims. I'd never heard of it. Of course I know about sexual abuse, but it never occurred to me that people with disabilities were abused. I was so naive."

Parents of children with disabilities often receive a lot of information about disabilities, child care, child development, and community resources, but are rarely prepared or trained on the subject of physical or sexual abuse or neglect. While abuse prevention programs exist in various forms throughout the country, these are rarely offered to children with disabilities and their families. When programs are offered, they are not always age appropriate, as when programs designed for younger children are presented to older children with disabilities.

Programs that are designed with the "No-Go-Tell" concept as their base are not, in general, useful for the child with a disability. These programs teach children to tell the potentially abusive adult, "No!" then to go to someone they trust, and tell them about the other adult's behavior. Telling an adult, "no," is difficult for any child; children with disabilities, however, may have even greater difficulty as they are usually taught to strongly respect the authority of almost any adult or person who is "in charge." In addition, most persons who abuse children with disabilities are in positions of trust, authority, and relationship with the children (e.g., parents, professionals, paraprofessionals, or other family friends). Thus the ability to socially resist an abuse is diminished.

So, what does work? First, the parents and family members of children with disabilities should be informed that their children, like other children, are at risk. Frequently parents, and the children themselves, believe that due to the disability they cannot become abuse victims. Second, parents should talk directly to their children about abuse awareness, and develop a communication cue that will alert the parent that something has happened. Parents need to be empowered to take firm action to apprehend the identified perpetrator.

Many children with disabilities can benefit from self defense programs with individually tailored defense and response techniques, depending on the child's disability. Programs are in effect all across the country, and in Europe, teaching self defense techniques to children with intellectual, communication, mobility, and sensory disabilities. Practicing communication cues and self defense techniques is important. Equally important is teaching and implementing assertion and personal empowerment skills. If a child is only encouraged to be assertive when and if an assault is in progress, success is unlikely. Only when the child is assertive in all areas of life can it be expected to be successful in the face of assault.

Unfortunately, in many cases a child cannot stop or avoid the abuse. In these cases, the child and parents must be encouraged to "do everything possible," which may include identifying the event as abuse and reporting it immediately. Such a response can be empowering for both the child and the family, ameliorating the effects of the abuse itself.

Recently the fields of child abuse protection and disabilities have begun to recognize their common interest in working to prevent abuse of children with disabilities. Both fields have much to learn to become competent to deal with the specific issues of abuse for this population. This collaboration is thought by many to be the key to successful intervention and amelioration of maltreatment of children with disabilities.

In reducing the risk of abuse for children with disabilities, and in providing effective and sensitive intervention services, professionals will need to develop working relationships in a structure that allows for cross referral, cross training, consultation across a variety of agency lines, and increased accessibility and understanding for the disabled community. This will require changes for both abuse protection and disability service agencies.

Increasingly child abuse response professionals, program administrators, and the law enforcement community are seeking skills to help in the identification, reporting, interviewing, and adjudication of suspected child abuse for children with disabilities. With this interest and a matching commitment on the part of funding sources, the specialized training they seek can be provided. Additionally, disability specialists and service providers are seeking the expertise of those in the child abuse community to learn how to recognize and respond effectively and appropriately to the epidemic of child abuse.

Intervention includes a myriad of services, ranging from the initial observation and report taking to assessment and interviewing, placement, court, treatment, and monitoring. As therapists skilled in providing treatment for severely disabled abuse victims become more available, CPS workers will more easily make referrals for the children they serve.

These changes will take time, but with increasing interest in this population, and the availability of good training programs as well as models for inter-agency collaboration, it is likely that these changes can be in place in the near future.

States may want to follow the leadership of Florida, Washington, and California, where some legislation and activities are in place to address the issue of abuse of children with disabilities. For example, in California the state chapter of the National Committee to Prevent Child Abuse (NCPCA) has attempted to develop liaisons at the local, state, and national levels by writing to all NCPCA chapters alerting them to the problems of child abuse and neglect for children with developmental disabilities. They have encouraged the chapters to contact their State Councils on Developmental Disabilities to establish working relationships. A similar letter was sent to each of the State Councils.

In the past five years, awareness of the problem of abuse and neglect of children with disabilities has begun to increase. It is important to foster greater awareness of this issue. This can be done through comprehensive public awareness campaigns by adding a few critical facts to the generic child abuse awareness campaigns.

• Child abuse happens to children with disabilities.
• Child abuse and neglect can cause disabilities.
• Children with disabilities can resist abuse attempts when given information and skills development training.
• Parents of children with disabilities can learn to distinguish signs of abuse and disability related problems.
• Children with disabilities are competent to communicate their abuse experience.
• Children with disabilities can be acknowledged as credible witnesses to their own experience.

The problem of abuse of children with disabilities is a serious issue, but is still not largely recognized by service agencies. Prevention and abuse awareness programs need to include information about the heightened risk of abuse of children with disabilities, and the onset of a permanent disability as a consequence of abuse. The utilization of training programs for children, parents, families, and child abuse response and disability services providers, will play a unique and critical part in the reduction of risk for children with disabilities.

** The above fact sheet was produced by the ARCH National Resource Center **

Child abuse can mean a lot of different things such as neglect, physical, emotional or sexual abuse - it's not always easy to know if you or someone you know is being abused. But the important thing to remember is that no-one has the right to hurt you or make you do anything that feels wrong.

Defined as non-accidental trauma or physical injury caused by otherwise harming a child, physical abuse is the most visible form of child maltreatment. That could be hurting you with their hands, their feet, or an object. The parent or caretaker may not have intended to hurt the child; the injury is not an accident. It may, however, have been the result of over-discipline or physical punishment that is inappropriate to the child's age. If someone makes you swallow something that hurts, or makes you ill, including giving you medicine when you are not ill or do not need it, including of harmful substances, such as drugs, alcohol or poison. If a parent or carer reports non-existent symptoms of illness in a child, or deliberately causes illness in a child, this is also a form of physical abuse.

• Physical indicators of abuse include: bruises which look like hand or finger marks, black eyes, lacerations, swollen areas, and marks on the child?s face, head, back, chest, abdomen, genital area, buttocks or thighs. Wounds like human bite marks, that of the child cannot explain or explains unconvincingly, cigarette burns, scalds or burns, broken bones, puncture marks or missing hair, beating, hitting, shaking, choking, or any other harmful or dangerous use or force.

The effects on children:
Physical abuse can have long-term effects on a child's health and development. It can cause physical injury, brain damage or disability and may lead to children developing emotional, behavioral or educational problems. For some children, these difficulties can continue in adulthood. For example, people who were physically abused as children may have problems with personal relationships and they may be more likely to treat their own children abusively. The child's age, the frequency of the abuse and how long it has been happening, all influence how much they will be affected by it.

Emotional abuse is when someone tries to make you feel bad. Also known as: verbal abuse, mental abuse, and psychological maltreatment.

• Verbally assaulting; belittling, insulting, ridiculing, embarrassing, humiliating, when a child is constantly put-down, called names, or criticized so that they lose confidence in self, using derogatory terms to describe the child, continual severe criticism or blaming.
• If someone is always telling you that you're ugly, or fat, or stupid, or worthless, or that they wish you'd never been born, phrases like "you never do anything right", "you're stupid" or "you're lazy", can damage a child's self esteem.
• The use of extreme and/or bizarre forms of punishment, such as confinement in a closet or dark room or being tied to a chair for long periods of time, ways of verbally "terrorizing" a child or threatening.
• Constant rejection and denial of affection, socially isolating the child; making unreasonable demands on a child.

Children's emotional needs:
It's not always easy to identify when a child is being emotionally abused. But the effects are damaging and long lasting. They can lead to serious behavioral, learning, emotional or mental disorders. All of which affect the child's chances of developing into a healthy, well-adjusted adult. All children need acceptance, love, encouragement, discipline, consistency and positive attention from their parents. Children who are denied these things often grow up thinking they are deficient in some way and that they somehow deserved to be treated badly. Sadly, when they become parents themselves they may emotionally deprive their own children because they don't have a positive model of parenting to draw on.

Domestic violence can affect anyone. It usually happens between two people who are in a relationship now or have been in the past. It is usually men being abusive to women, and sometimes there are other family members involved. But men can experience it too, and it can also happen in same-sex relationships. Domestic violence can include physical, sexual and emotional abuse.

The signs of domestic violence
If you are experiencing domestic violence, you might feel:

• Isolated
• Frightened of the person who is hurting you
• Angry or upset that someone you may love is treating you this way
• Confused because sometimes this person is loving or charming
• Powerless or lacking in confidence
• Tired and depressed
• Ashamed
• Guilty
• Unable to show your children all the care and attention you would like to give them.

Children who have witnessed domestic violence are often:

• Afraid
• Withdrawn
• Angry
• Lacking in confidence
• Suffering from health or sleeping problems
• Struggling at school
• Ashamed to bring friends home
• Violent or showing other behavior problems
• Physically hurt or abused

Child sexual abuse is the deliberate exposure of minor children to sexual activity. This means a child is forced or talked into sex or sexual activities by another person. Such abuse includes touching (fondling), pornography, and other sexual activity.

Warning Signs of Child Molestation
Below are some of the most common signs of child molestation:

• Changes in behavior such as withdrawal, fearfulness, crying without provocation.
• Change in eating habits.
• Disrupted sleep patterns, fear of the dark or nightmares.
• Regression to more infantile behavior such as bedwetting, sucking their thumbs, or abnormal and excessive crying.
• Bruises, rashes, cuts, limping, or poorly explained injuries.
• Vaginal or rectal bleeding, pain, itching, swollen genitals, vaginal discharge, or sexually transmitted diseases.
• Stained or torn underwear.
• Unusual interest in or knowledge of sexually related matters or expression of affection in ways inappropriate for a child of that age.
• Fear of a person or an intense dislike at being left somewhere or with someone (relatives, babysitters, etc)
• Other behavioral signals such as aggressive or disruptive behavior, running away, failing in school.

If a child tells you that they have been sexually abused in any way, believe them. Children rarely lie about sexual abuse. 80% of all child molestation cases involve someone the child knows. Additionally, it's especially important to be supportive of the child. Children have an enormous fear that they are the one to blame in this situation and it's important that they realize it is not their fault. Alleviating this self-blame is extremely important.

Please Remember - if you or someone you know is being abused in any way, then the most important thing to do is talk to someone about it. The most important thing to remember is that if you have a gut feeling that something is not right, trust your judgment and take action.