THE SEXUAL ABUSE OF CHILDREN WITH DISABILITIES

RATES OF SEXUAL ABUSE

There is a great deal of evidence that suggests that children with disabilities are at greatly increased risk of all forms of abuse and neglect, including sexual abuse.

• is estimated that 39-68% of all girls with disabilities and 16-30% of boys with disabilities will be sexually abused before age 18 (Senn, 1988).
• Findings from the largest national study on the issue found 70% of children who were sexually abused had some form of disability (Crosse, Kaye, and Ratnofsky, 1993).
• Cases of abuse of children with disabilities are less likely to be recognized, reported, and substantiated (Manders, 1996).
• When findings from multiple studies are considered, the sexual abuse of children with disabilities could be up to11 times higher than the rates of the sexual abuse of children without disabilities (Petersilia, 2000).

The abuse also tends to be more chronic and severe. The sexual abuse of children with disabilities:

DYNAMICS OF SEXUAL ABUSE OF CHILDREN WITH DISABILITIES

Why are children with disabilities at increased risk?

Children with disabilities are at increased risk for many reasons. Dr. Richard Sobsey (1994) organizes these multiple risk factors into categories associated with characteristics of the child, the perpetrator, the environment, and the culture.

Characteristics of Children with Disabilities

A number of risk factors are a direct result of disability. For example, some children with disabilities may simply be unable to physically escape from the abuse, and others with disabilities related to communication may be unable to report that abuse has occurred.

Some children may have been taught learned helplessness ("Nothing I do can stop this.") or learned compliance ("If I comply the pain will stop.") through aversive procedures developed specifically to address the disability. Many have undeveloped senses of personal space due to intrusive educational, behavioral, or medical interventions that teach children their bodies are not their own. For example, the use of "physical prompting," when used appropriately, assists the learner by physically guiding the child's hand or body response. When used excessively or incorrectly, however, this procedure can teach a child to comply with physical coercion.

Characteristics of Perpetrators

Most of the characteristics of the perpetrators of sexual abuse are the same, regardless of whether a child has a disability. A significant amount of the heightened risk, however, comes from increased contact with multiple caregivers and service providers. A child with a disability may have as many as 50-80 people providing some form of care or service before entering school, greatly increasing their chances of exposure to a sexual abuser. For example, children with disabilities may need assistance in eating, dressing, bathing, or using the restroom. Many receive medical care or physical therapy that requires close personal contact. Paid service providers account for 28% of the sexual abuse of people with disabilities, followed by family members (17%) (Sobsey, 1994.)

Characteristics of the Environment

In the past, services for children with disabilities were provided mainly in segregated programs or living environments such as "special" schools or classrooms, group homes, or large residential institutions. While these programs and facilities were designed to protect and meet the needs of children with disabilities, such segregation actually increases risk in a number of ways. Grouping children who are vulnerable into isolated environments actually attracts sexual predators who are drawn to the locations where potential victims are congregated, such as "special" classrooms, buses, clinics, or living facilities.

These environments are often isolated from others, making it less likely that abuse will be recognized or reported. A high rate of turnover among providers or care givers in these settings decreases the number of people who form long-term, caring relationships with the children and increases the likelihood of exposure to potential abusers.

The best protection children with disabilities can be given is full inclusion in their families, schools, and communities. Full inclusion means that children with disabilities live, learn, and play in the same places all other children do. Children who are fully included live with their families instead of in group homes or institutions. They attend classes with children without disabilities, with appropriate support. They play on the same playgrounds and participate in the same community activities.

Community inclusion protects children by increasing the number of people who know and care about the children, providing children with opportunities to have meaningful, safe relationships with a wide variety of others, and increasing child development. Inclusion also clearly communicates that children with disabilities are children first and foremost, with the same rights, dreams, strengths, and needs as all other children.

Characteristics of the Culture

Because children with disabilities have often been isolated from their families and communities, opportunities have been limited for many community members to develop comfortable, positive relationships with children and adults with disabilities. As a result, social attitudes have been based on perceptions of difference, weakness, and vulnerability rather than sameness, strength, and capacity.

Wescott (1993) maintains that increased vulnerability is often more a factor of society's response to disability rather than the disability itself, stating, "Children with disabilities are extra vulnerable as a result of being seen as 'different' and treated in ways not experienced by their non-disabled peers (p.43)." For example, there are a number of myths that often prevent children with disabilities from receiving equal protection and justice, such as:

• No one would sexually abuse a child with a disability.
• A child with a disability cannot understand or use personal safety information or sex education.
• A child with a disability does not understand or remember what happened to her or him.
• A child with a disability cannot be a credible witness.
• A child with a disability does not experience pain or trauma the way other children do.
• A child with a disability cannot benefit from post-trauma therapy.

Many service providers may feel unprepared to effectively serve children with disabilities. While a high level of comfort in interactions is critical to any successful investigation, Child Protective Service investigators and case workers have reported discomfort in interacting with children with all 17 types of disabilities listed on a Comfort Scale, with the highest levels of discomfort being with children who had emotional/behavioral disabilities, mental retardation, or were deaf (Manders, 1996).

Discomfort interacting with a child may cause us to:

• limit the time we spend with that child
• decrease the information we receive, or
• make a determination before we have all the needed information.

Abuse investigators must be given the support needed to feel effective and comfortable in working with children with disabilities and their families. The good news is that there are strategies and resources that can help.

SUCCESSFUL INVESTIGATIONS OF THE SEXUAL ABUSE OF CHILDREN WITH DISABILITIES

The investigation of the sexual abuse of any child is a challenging and complex effort. The presence of a disability can often compound these challenges. In some instances, characteristics of a child with a disability can be very similar to signs of abuse. For example, some children with disabilities engage in self-stimulating behaviors, such as frequent masturbation. Others may engage in self-injurious behaviors, such as biting or hitting themselves. It is very important not to assume that a child with these behaviors has been abused. It is equally important not to rule out abuse because the sign or behavior is assumed to be simply a characteristic of the disability. Investigators must be prepared for the extra time and consideration these investigations may require.

Children with the same type of disability, such as autism, are usually as different from each other as they are from their peers without disabilities. Therefore, we cannot make assumptions about what a child with a particular type of disability is "like" or needs based only on their labeled disability. Instead, we must treat each as a whole child, with abilities, needs, and life circumstances similar to those of all children. There are, however, some steps we can take to make investigations successful.

Communication with Children with Disabilities

Many children with disabilities have some form of communication challenge. It is important to understand that even when a child has difficulty communicating, he or she usually knows what happened to them and who did it. They may simply need assistance in communicating this to you.

Communication can be divided into three stages: input, processing, and output (VCPN, 2000). Input refers to the ability to receive information. For example, children who have hearing impairments or are deaf have difficulty receiving verbal information.

Processing involves the ability to understand language. Some children with cognitive disabilities may have difficulty understanding the information or questions you are asking.

Output refers to the ability to express thoughts. In general, most children are better able to understand language more easily than they express language. This may be particularly true for children with disabilities. For example, some children with physical disabilities, cerebral palsy, or speech disorders may understand language very well, but be unable to respond verbally. They may use symbols or communication devices to express their thoughts.

Talking with children with disabilities:

Preparing for the Interview:

• Be aware of your own comfort in interacting with children with disabilities. Many of us have not had opportunities to get to know people with disabilities and may not be sure of how to behave. We may get tense if we have a hard time understanding or communicating with a child. A child who doesn't speak, stay still, or is aggressive can be difficult to talk to. Recognize your own level of comfort and how this might affect your investigation.
• Avoid having any prior expectations regarding a child's abilities before meeting with the child and talking to others.
• Do not confuse difficulty communicating with a lack of awareness/knowledge of what occurred.
• Make no assumptions about what has happened to a child, what the child knows, or what the child can communicate to you. Be open.
• Be prepared to spend extra time with the child. Spend time with the child before formally starting the interview. Spending time with the child beforehand will help you feel more comfortable and give you ideas about how to best communicate during the interview.
• Find out as much as possible about the child's disability, particularly any communication challenge they might have.
• If a child uses a communication device, learn a little about how it works before talking with the child.
• If a sign language interpreter is needed, use a professional who is comfortable communicating sexually-explicit information. See the appended Resource List for qualified interpreters in your area.
• Plan for additional meetings to get all the information you need. Expect to get smaller amounts of information per meeting.

Conducting the Interview:

• Spend additional time helping the child to feel comfortable. Children with disabilities are more likely than others to assume they are in trouble. Reassure the child.
• Family members can be excellent sources of information about the how the child communicates and the words the child uses beforehand, but should not be asked to interpret the child's communication during the interview.
• Keep language simple. Use the child's own terms.
• Avoid yes/no questions.
• Break down complex questions (ask one question at a time).
• Pay extra attention to body language and non-verbal cues. Be prepared for non-verbal cues such as acting out a scene, yelling, biting, screaming, or removal of clothes.
• Use aids such as dolls, drawings, mood charts, and pictures.
• A "Who, What, Where, When" paper can often help direct the interview and keep the questioning simple.

Talking With Families

In approaching the families of children with disabilities, it is important to keep several points in mind:

• Be sensitive to other stresses the family may be under. Many families have been treated with either suspicion or pity simply because their child has a disability. It is sometimes assumed that the parents may have somehow caused the disability by their behavior, such as drug abuse, poor prenatal care, or child abuse or neglect. Others may look at the families with pity, assuming that having a child with a disability must cause constant stress or sadness.
• Be aware of family strengths. Current research tells us that the families of children with disabilities cope very well when provided the appropriate services and support. Constant grief, stress, or dysfunction are not inevitable. Most families provide very happy, safe, loving homes in which the children are valued members.
• Be aware that children with disabilities are at significantly increased risk of sexual abuse from perpetrators outside the family, primarily those who contact them through the disability-related service delivery system.
• Always find out what disability-related services the child or family is receiving. When possible, work with the family to gain access to trusted individuals providing or coordinating services who can assist you and give you information.

RESOURCES TO HELP: THE TEAM APPROACH

Clearly, the presence of a disability can bring an additional challenge to an investigation. Fortunately, it is not necessary to become an "expert" about issues related to disability in order to be comfortable and effective in your work. There are people in your community that can assist you.

Georgia CPS supports a team approach to the investigation and intervention in child maltreatment. The participation of disability-related professionals on these teams should be encouraged whenever possible. Participation can include phone consultations and referrals, meeting with investigators and case workers, or participating in family assessments and home visits. Their involvement throughout all stages of the case should be supported, including investigation, case planning and management, evaluation, and case closure.

Any infant or child with a diagnosed disability should be receiving disability-related services. Such services may include speech therapy, physical therapy, behavioral therapy, medical treatment, or special education, depending on the needs of the child and family. Many of these service providers or coordinators may have known the child and family over a period of time and will be able to provide very valuable information, such as the nature of the disability, how the child communicates, whether they have noticed indicators of abuse, or other relevant information. Some may be able to assist you in interviewing the child.

Signed parental consent or a court order will be needed in order for service providers or coordinators to release information or participate in investigations involving children or families they directly serve or have knowledge of. The extra effort required to get this permission will be well worth the time.

A disability-related service provider can serve as a resource on a team without a court order or parental permission if they are not directly involved in services to that specific child or family or have had previous knowledge or contact with that family.

Any investigator should attempt to determine:

• Is this child or family receiving disability-related services?
• If so, what services? Who provides those services? For how long?
• Will the family give permission to contact the service providers or coordinators? If not, is it possible to get a court order for the records?
• Who in your area could serve as a resource without parental permission or a court order? For example, is there a speech therapist in another county who doesn=t know the family or work for an organization that provides services to the family who could assist with the investigation?

Infants and young children with disabilities from birth through age 3 receive early intervention services from Babies Can't Wait (BCW). Each child has a service coordinator. There is a BCW office in each of the Public Health districts.

Preschool-aged children receive services through Pre-School Special Education programs in each school district. School-aged children receive special education services through the school system. For information, contact the Special Education Director in each of the school districts.

Parent to Parent of Georgia, Inc. also maintains a comprehensive resource and referral link to programs and services for children with disabilities of all ages in communities within the state.

The Abuse Prevention and Intervention Project at the Institute on Human Development and Disability, The University of Georgia, provides information, training, and referrals on issues related to the abuse of children and adults with disabilities.

LEGAL ISSUES

Credibility, Memory, and Suggestibility

The credibility of children and adults with disabilities is often doubted. It is frequently assumed that they have poor memories, inaccurate recall of events, and can easily be led by others to make false or inaccurate statements. Research on the issue does indicate that children with some forms of cognitive disabilities may remember fewer details of events, and may have difficulty with dates, times, and the order of events. They may not answer short answer questions as well, particularly those that are meant to confuse.

Children with disabilities can, however, provide important, accurate information when interviewed by someone familiar with the nature of the disability and methods of effective communication. It is critical to know that children and adults with disabilities:

• have not been shown to be more likely to create false memories or distort the information they do remember.
• can be very reliable witnesses in recalling what happened to them and who did it.

Preparing Witnesses for Court

There are a number of steps that can prepare children with disabilities to testify in court:

• Familiarize child with courtroom through visiting or pictures. Tell child who will be there.
• Familiarize child with words/terms that might be used in cross-examination.
• Let child know she/he can take time answering any question and it is fine to say if they don't know the answer.
• Role play the process.
• Use videotaped or transcribed testimony when possible.

Facilitated Communication

Facilitated communication is a method sometimes used to assist children who cannot communicate with words. This type of communication often involves a facilitator physically supporting a person's hand to type or identify words or symbols. This method of communication is extremely controversial, however, because of the possibility that the facilitator may influence or misinterpret what is communicated.

There have been a number of cases in which substantiated abuse has been identified in using this method. Any allegation of abuse disclosed through facilitated communication should be investigated. It is critical, however, that additional methods of corroboration be used in the investigation and prosecution of these cases (Sobsey, 1994).

TREATMENT

Children with disabilities suffer the same consequences of abuse as all other children (Sobsey, 1993). Despite this need, children with disabilities frequently do not receive treatment for a variety of reasons:

• It is a common but very unfortunate misconception that a child with a disability may not be as affected by the abuse because he or she does not remember or understand what occurred.
• It is sometimes assumed that a child with a cognitive disability cannot benefit from therapy.
• Therapists may be uncomfortable working with a child with a disability or doubt their capacity to do so effectively.

Children with disabilities are as much in need of, and as capable of benefiting from therapy as other children. Most therapies are designed to be highly individualized and can be easily adapted to meet the needs of children with disabilities (Sullivan, 1993).

In most cases, therapy for children with disabilities will not require specialized knowledge or training related to the disability. All that is required is that the therapist be open and comfortable with the child. In cases in which additional information or support is needed, therapists should work with professionals providing disability-related services to the child to determine appropriate courses of treatment and needed accommodations. These professionals can be tremendous resources to the therapist by providing very helpful information about the child's background, levels of ability, and communication style.

RESOURCES

Local and State Resources

Abuse Prevention and Intervention Project
Dr. Jenny Manders
Institute on Human Development and Disability
College of Family and Consumer Sciences
The University of Georgia
850 College Station Road
Athens, Georgia 30602-4806
Telephone: 706.542.2418
www.uap.uga.edu
conducts education, research, and community-based training and technical assistance on issues related to children and adults with disabilities

Babies Can't Wait
2 Peachtree Street NW, Room 11-212
Atlanta, Georgia 30303
Telephone: 404.657.2727
www.ph.dhr.state.ga.us/programs/bcw
provides and coordinates early intervention services across the state for infants and young children with disabilities birth through age 3

Georgia Advocacy Office
100 Crescent Centre Parkway, Suite 520
Tucker, Georgia 30084
Telephone: 1.800.537.2329
provides information, referrals, and legal advocacy for individuals with disabilities and their families

Georgia Integrated Interpreting Services Network
44 Broad Street, Suite 503
Atlanta, GA 30303
Telephone: 404.521.9100
http://georgiaenterprises.com
provides state-wide referrals to qualified sign language interpreters

Parent to Parent of Georgia
Telephone: 1.800.229.2038
www.parenttoparentofga.org
provides support and information to parents and professionals across the state, maintains comprehensive database of services for young children with disabilities

National and International Resources

Girls and Boys Town National Institute for Communication Disorders in Children
555 North 30th Street
Omaha, NE 68131
Telephone: 402.498.6511 (Mon. - Fri.)
provides assessment, treatment services, and consultation regarding the abuse of children with disabilities

International Coalition on Abuse and Disability
Abuse and Disability Project
6-102 Education North
University of Alberta Edmonton, AB T6G Canada
Telephone: 403.492.1142
maintains an electronic computer network of advocates and professionals

Journal of Sexuality and Disability
Human Services Press, Inc.
233 Spring Street
New York, New York 100-13-1578
publishes articles on sexuality and disability, including abuse

REFERENCES

Baladarian, N. (1992). Interviewing skills to use with victims who have developmental disabilities. National Aging Resource Center on Elder Abuse.

Manders, Jeanette. (1996). Children with disabilities in the child protective services system: The impact of disability on abuse investigation and case management.

Senn, C.Y. (1988). Vulnerable: Sexual abuse and people with an intellectual handicap. Downsview, Ontario, Canada: G. Allan Roeher Institute.

Sobsey, R. (1994). Violence and abuse in the lives of people with disabilities: The end of silent acceptance? Baltimore: Paul H. Brooks Publishing

Sobsey, R. (1993). Responding to the needs of sexually abused children with disabilities: Program criteria. Journal of Child Sexual Abuse, 2(2), 131-133.

Sobsey, R., and Doe, T. (1991). Patterns of sexual abuse and assault. Journal of Sexuality and Disability, 9(3), 243-259.

Sullivan, P.M. (1993). Sexual abuse therapy for special children. Journal of Child Sexual Abuse, 2(2), 117-125.

Virginia Child Protection Newsletter, Volume 59, Summer, 2000.

Wescott, H. (1993). The abuse of disabled children and adults with disabilities. London: National Society for the Prevention of Cruelty to Children.