DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY
EDITORIAL
‘The Other Side’: abuse and maltreatment of children and young people with disabilities As a practitioner in the field of childhood disability, I am confronted nearly every week with a new case of abuse of a child with disabilities. Most of these children have been treated in our institution. Sometimes they already have a motor or language problem; sometimes they are just crying ‘too much’; sometimes they suffer from multiple difficulties. Often our discussions question whether the symptoms and signs of the child are in fact signs of their impairment or reactions to maltreatment. While there are numerous scientific studies and books on assessing, treating, and preventing child abuse and maltreatment, it is often overlooked when discussing children with disabilities. Only a few studies address the importance of assessment, early recognition, and treatment in these children.1 Abuse is about three times as frequent in children with disabilities as in their non-disabled peers. This is really striking, as maltreatment will be seen more often by most of us than many of the rare diseases.2 Diagnosing physical abuse is easier than recognizing its emotional response. Emotional abuse3 leads the child to develop a negative body image and to believe that he/she is deficient and valueless. Children with disabilities are in fact classified as ‘deficient’ – even within the frame of the International Classification of Functioning, Disability and Health – and experience that every day. In general there are reasonable concerns about the overdiagnosis of emotional and behavioural disorders in children4 and its consequences. But child abuse, especially of children with disabilities, and its consequences seem more often to remain undiagnosed and thus underreported. Maltreatment in childhood can lead to various symptoms and disorders. One of these disorders following abuse can be post-traumatic stress disorder. However, it is difficult to diagnose in early childhood and even more difficult in children with disabilities because their reactions to maltreatment might differ from the given assessment criteria.
Failure in diagnosis and reporting is also likely to occur in sexual abuse. Children with communication difficulties, intellectual disability, and those who are physically dependent (especially those living in institutions) are particularly endangered. Studies of prevention and treatment of (sexually) abused children with disabilities are not yet evidencebased. Abuse of disabled children and its detection and management is one of the topics to be covered at the 26th Annual Meeting of the European Academy of Childhood Disability (http://www.eacd2014.org). A parent session will address the negative experiences of young people with disabilities. The title of the meeting, ‘The Other Side’, reflects our intention to include topics that are not usually covered in annual meetings (e.g. neuropsychoanalysis, the effects of music on our brain, and prevention of disability), as well as more usual topics such as early diagnosis and intervention in cerebral palsy. ‘The Other Side’ was chosen as a title in tribute to the book by the Austrian artist and poet Alfred Kubin. It reminds us that each object, each action, or type of behaviour one observes can also be seen from another perspective, or can be attributed to another cause. It has another side. This is also true for symptoms which point to both impairment and abuse. In my opinion, the recognition of abuse and appropriate management are most important for the future life of children and young people with disabilities. I would consider it a great success if the EACD meeting would encourage more scientists to focus on the importance of studies on abuse and maltreatment of children with disabilities and its consequences.
FRIEDRICH BRANDSTETTER Centre for Promoting Development, Vienna, Austria. doi: 10.1111/dmcn.12487
REFERENCES 1. Hibbard RA, Desch LW, American Academy of Pediat-
2. Jones L, Bellis MA, Wood S, et al. Prevalence and risk of
4. Batstra L, Hadders-Algra M, Nieweg E, Van Tol D, Pijl
rics Committee on Child Abuse and Neglect; American
violence against children with disabilities: a systematic
SJ, Frances A. Childhood emotional and behavioral
Academy of Pediatrics Council on Children with Disabili-
review and meta-analysis of observational studies. Lancet
problems: reducing overdiagnosis without risking under-
ties. Maltreatment of children with disabilities. Pediatrics
2012; 380: 899–907.
treatment. Dev Med Child Neurol 2012; 54: 492–4.
2007; 119: 1018–25.
3. Garbarino J, Guttmann E, Seeley JW. The Psychologically Battered Child. San Francisco: Jossey-Bass, 1986.
508
© 2014 Mac Keith Press
EDITORIAL
‘The Other Side’: abuse and maltreatment of children and young people with disabilities As a practitioner in the field of childhood disability, I am confronted nearly every week with a new case of abuse of a child with disabilities. Most of these children have been treated in our institution. Sometimes they already have a motor or language problem; sometimes they are just crying ‘too much’; sometimes they suffer from multiple difficulties. Often our discussions question whether the symptoms and signs of the child are in fact signs of their impairment or reactions to maltreatment. While there are numerous scientific studies and books on assessing, treating, and preventing child abuse and maltreatment, it is often overlooked when discussing children with disabilities. Only a few studies address the importance of assessment, early recognition, and treatment in these children.1 Abuse is about three times as frequent in children with disabilities as in their non-disabled peers. This is really striking, as maltreatment will be seen more often by most of us than many of the rare diseases.2 Diagnosing physical abuse is easier than recognizing its emotional response. Emotional abuse3 leads the child to develop a negative body image and to believe that he/she is deficient and valueless. Children with disabilities are in fact classified as ‘deficient’ – even within the frame of the International Classification of Functioning, Disability and Health – and experience that every day. In general there are reasonable concerns about the overdiagnosis of emotional and behavioural disorders in children4 and its consequences. But child abuse, especially of children with disabilities, and its consequences seem more often to remain undiagnosed and thus underreported. Maltreatment in childhood can lead to various symptoms and disorders. One of these disorders following abuse can be post-traumatic stress disorder. However, it is difficult to diagnose in early childhood and even more difficult in children with disabilities because their reactions to maltreatment might differ from the given assessment criteria.
Failure in diagnosis and reporting is also likely to occur in sexual abuse. Children with communication difficulties, intellectual disability, and those who are physically dependent (especially those living in institutions) are particularly endangered. Studies of prevention and treatment of (sexually) abused children with disabilities are not yet evidencebased. Abuse of disabled children and its detection and management is one of the topics to be covered at the 26th Annual Meeting of the European Academy of Childhood Disability (http://www.eacd2014.org). A parent session will address the negative experiences of young people with disabilities. The title of the meeting, ‘The Other Side’, reflects our intention to include topics that are not usually covered in annual meetings (e.g. neuropsychoanalysis, the effects of music on our brain, and prevention of disability), as well as more usual topics such as early diagnosis and intervention in cerebral palsy. ‘The Other Side’ was chosen as a title in tribute to the book by the Austrian artist and poet Alfred Kubin. It reminds us that each object, each action, or type of behaviour one observes can also be seen from another perspective, or can be attributed to another cause. It has another side. This is also true for symptoms which point to both impairment and abuse. In my opinion, the recognition of abuse and appropriate management are most important for the future life of children and young people with disabilities. I would consider it a great success if the EACD meeting would encourage more scientists to focus on the importance of studies on abuse and maltreatment of children with disabilities and its consequences.
FRIEDRICH BRANDSTETTER Centre for Promoting Development, Vienna, Austria. doi: 10.1111/dmcn.12487
REFERENCES 1. Hibbard RA, Desch LW, American Academy of Pediat-
2. Jones L, Bellis MA, Wood S, et al. Prevalence and risk of
4. Batstra L, Hadders-Algra M, Nieweg E, Van Tol D, Pijl
rics Committee on Child Abuse and Neglect; American
violence against children with disabilities: a systematic
SJ, Frances A. Childhood emotional and behavioral
Academy of Pediatrics Council on Children with Disabili-
review and meta-analysis of observational studies. Lancet
problems: reducing overdiagnosis without risking under-
ties. Maltreatment of children with disabilities. Pediatrics
2012; 380: 899–907.
treatment. Dev Med Child Neurol 2012; 54: 492–4.
2007; 119: 1018–25.
3. Garbarino J, Guttmann E, Seeley JW. The Psychologically Battered Child. San Francisco: Jossey-Bass, 1986.
508
© 2014 Mac Keith Press
