Violence/Sexual Abuse

Jurors' perceptions of adolescent sexual assault victims who have intellectual disabilities.

Bottoms BL, Nysse-Carris KL, Harris T, Tyda K.
Department of Psychology (m/c 285), University of Illinois at Chicago, 1007 W. Harrison Street, Chicago, Illinois 60607-7137, USA. bbottoms@uic.edu
Law Hum Behav. 2003 Apr;27(2):205-27.

Children and adolescents with intellectual disabilities are especially likely to be sexually abused. Even so, their claims are not likely to be heard in court, possibly because people assume that jurors will not believe them. We tested this assumption in a mock-trial study in which 160 men and women watched videotaped excerpts from an actual trial. As predicted, when the 16-year-old sexual assault victim was portrayed as “mildly mentally retarded” instead of as “having average intelligence,” jurors were more likely to vote guilty and had more confidence in the defendant’s guilt; considered the victim to be more credible and the defendant to be less credible as witnesses; and rated the victim as more honest, less capable of fabricating the sexual abuse accusation, and less likely to have fabricated the sexual abuse accusation. Men and women were affected similarly by the disability manipulation, but women were generally more pro-prosecution in their case judgments and perceptions than were men. Finally, jurors who had more liberal views toward persons with disabilities were more likely than other jurors to make pro-prosecution judgments on measures of guilt. Implications for psychological theory and the law are discussed.

National survey of sexual behavior and sexual behavior policies in facilities for individuals with mental retardation/developmental disabilities.

DA, Wang SA, Grot J, Ransom R, Levine WC.
National Immunization Program, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Atlanta, GA 30333, USA. dgg6@cdc.gov
Ment Retard. 2003 Oct;41(5):365-73.

To obtain information regarding sexual behavior and related policies in state residential facilities for individuals with mental retardation/developmental disabilities, we sent surveys to 168 members listed in the Association of Public Developmental Disabilities Administrators 1998-1999 directory. Response rate was 68.5%. For the 46 facilities where 50% or fewer of clients had profound retardation, sexual relations between clients was reported to occur “sometimes” or “often” by 29 (63%). Six of 115 (5.2%) administrators reported at least one client with a sexually transmitted disease (STD) in the past year. Of 110 instances of sexual abuse reported, the perpetrator was another client in 63% of cases. Ninety-six percent of administrators (n = 110) reported their facility had written guidelines concerning sexual abuse. Careful monitoring of STDs and the effectiveness of sex education will be instrumental in preventing HIV/STDs and helping prevent sexual abuse in this vulnerable population.

Capacity to consent to sexual relationships in adults with learning disabilities.

Murphy GH.
Tizard Centre, University of Kent, Canterbury, UK. g.h.murphy@kent.ac.uk
J Fam Plann Reprod Health Care. 2003 Jul;29(3):148-9.

People with learning disabilities used to be seen as asexual or promiscuous and were discouraged from expressing their sexuality. However, with the growth of the rights movement, attention has turned to the dilemma of how to both empower and protect people with learning disabilities in relation to their sexuality. A recent research project showed that, on average, adults with learning disabilities knew much less about sex and understood much less about sexual abuse than non-disabled young people aged 16 years. Sex education made a significant difference to their knowledge and understanding however. The implications of the study for services for people with learning disabilities and for definitions of capacity to consent to sexual relationships are discussed.

Clinical effects of sexual abuse on people with learning disability: critical literature review.

Sequeira H, Hollins S.
Department of Psychiatry of Disability, St George’s Hospital Medical School, London, UK. heathersequeira@onetel.net.uk
Br J Psychiatry. 2003 Jan;182:13-9.

Background: There are few publications concerning the psychological reactions of people with learning disabilities to sexual abuse. Most significantly, there are no controlled studies and few which demonstrate a systematic approach to documenting the sequelae of trauma.

Aims: To critically review the published research in this field.

Methods: A literature search in peer-reviewed psychiatry, psychology, nursing and social care journals for the years 1974 to 2001 was conducted and 25 studies were reviewed.

Results: Several studies suggest that, following sexual abuse, people with learning disabilities may experience a range of psychopathology similar to that experienced by adults and children in the general population. However, because of methodological limitations, these results are not conclusive.

Conclusion: Whether people with learning disabilities experience reactions to sexual abuse similar to the general population has yet to be explored by systematic research.

Psychological disturbance associated with sexual abuse in people with learning disabilities. Case-control study.

Sequeira H, Howlin P, Hollins S.
St George’s Hospital Medical School, London, UK. heathersequeira@onetel.net.uk
Br J Psychiatry. 2003 Nov;183:451-6.

Background: The association between sexual abuse, mental health and behavioural problems in people with learning disabilities has not previously been examined in a controlled study.

Aims: To identify symptoms of psychological disturbance in adults with and without a confirmed history of sexual abuse.

Methods: The study used a matched (1:1) case-control design comparing 54 adults who had experienced sexual abuse with 54 adults with no reported history of abuse. The two groups were selected from a community population of adults with learning disabilities living in residential care, and compared for selected psychiatric diagnoses and for scores on measures of disturbed behaviour.

Results: Sexual abuse was associated with increased rates of mental illness and behavioural problems, and with symptoms of post-traumatic stress. Psychological reactions to abuse were similar to those observed in the general population, but with the addition of stereotypical behaviour. The more serious the abuse, the more severe the symptoms that were reported.

Conclusion: The study provides the first evidence from a controlled study that sexual abuse is associated with a higher incidence of psychiatric and behavioural disorder in people with learning disabilities.

Violent victimization of persons with co-occurring psychiatric and substance use disorders.

Sells DJ, Rowe M, Fisk D, Davidson L.
Department of Psychiatry, Program for Recovery and Community Health, Yale University School of Medicine, Suite 306, New Haven, CT 06511, USA. david.sells@yale.edu
Psychiatr Serv. 2003 Sep;54(9):1253-7.

Objective: This study examined the frequency with which persons in the community with psychiatric disorders, substance use disorders, and both types of disorders are victims of violence.

Methods: The relationship between diagnosis, gender, and victimization over a one-year period was examined in two cross-sectional data sets, one drawn from a study of adaptation to community life of persons with severe mental illness in Connecticut (N=109) and the other drawn from assessments made by caseworkers in a Connecticut outreach project for persons with psychiatric and substance use disorders (N=197). Analysis of variance was used to evaluate the frequency of victimization across diagnostic categories in each data set.

Results: People with co-occurring psychiatric and substance use disorders had significantly more episodes of victimization than those with either a psychiatric or a substance use disorder only. Gender was not associated with victimization. Qualitative data from focus groups indicated that social isolation and cognitive deficits leading to poor judgment about whom to trust may leave people with serious mental illness vulnerable to drug dealers.

Conclusion: Social environmental mechanisms, such as exploitation by drug dealers, may play an important role in maintaining victimization among persons with co-occurring disorders.

Abuse assessment screen-disability (AAS-D): measuring frequency, type, and perpetrator of abuse toward women with physical disabilities.

McFarlane J, Hughes RB, Nosek MA, Groff JY, Swedlend N, Dolan Mullen P.
Texas Woman’s University, 1130 M.D. Anderson Boulevard, Houston, TX 77030
J Womens Health Gend Based Med. 2001 Nov;10(9):861-6.

An interview questionnaire was presented to a multiethnic sample of 511 women, age 18-64 years, at public and private specialty clinics to determine the frequency, type, and perpetrator of abuse toward women with physical disabilities. The four-question Abuse Assessment Screen-Disability (AAS-D) instrument detected a 9.8% prevalence (50 of 511) of abuse during the previous 12 months. Using two standard physical and sexual assault questions, 7.8% of the women (40 of 511) reported abuse. The two disability-related questions detected an additional 2.0% of the women (10 of 511) as abused. Women defining themselves as other than black, white, or Hispanic (i.e., Asian, mixed ethnic background) were more likely to report physical or sexual abuse or both, whereas disability-related abuse was reported almost exclusively by white women. The perpetrator of physical or sexual abuse was most likely to be an intimate partner. Disability-related abuse was attributed equally to an intimate partner, a care provider, or a health professional. This study concludes that both traditional abuse-focused questions and disability-specific questions are required to detect abuse toward women with physical disabilities.

Helping women with disabilities and domestic violence: strategies, limitations, and challenges of domestic violence programs and services.

Chang JC, Martin SL, Moracco KE, Dulli L, Scandlin D, Loucks-Sorrel MB, Turner T, Starsoneck L, Dorian PN, Bou-Saada I.
Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. jchang@mail.magee.edu
J Womens Health (Larchmt). 2003 Sep;12(7):699-708.

Purpose: To describe the types of services provided to women with disabilities at community-based domestic violence programs in the state of North Carolina, the challenges faced, and strategies used to provide the services.

Methods: We conducted a statewide cross-sectional survey of community domestic violence programs and had a response rate of 85%.

Results: Of the participating programs, 99% provided services to at least one woman with a physical or mental disability in the preceding 12 months; 85% offered shelter services to women with physical or mental disabilities. Most respondents (94%-99%) reported that their programs were either somewhat able or very able to provide effective services and care to women with disabilities. The respondents also described challenges to serving women with disabilities, including lack of funding, lack of training, and structural limitations of service facilities. Strategies used by the programs to overcome these challenges were networking and coordinating care with organizations that specifically serve disabled populations.

Conclusion: Domestic violence programs in North Carolina provide services to women with disabilities but are faced with challenges stemming from limited funding, physical space, and training. Collaborations between domestic violence and disability service providers are necessary to improving the services and care delivered to women with disabilities who experience domestic violence.

Violence against women with physical disabilities.

Milberger S, Israel N, LeRoy B, Martin A, Potter L, Patchak-Schuster P.
Developmental Disabilities Institute, Wayne State University, Detroit, MI 48202, USA.
smilberg@math.wayne.edu
Violence Vict. 2003 Oct;18(5):581-91.

This study explored risk factors for violence among a sample of adult women with physical disabilities. Fifty-six percent (100) of the 177 women participating in the study indicated a positive history of abuse. Of the women who reported abuse, most reported multiple abuse situations and abusers who were typically their male partners. In addition, only a small proportion of women sought and received adequate help. Women who indicated that they did not seek help were asked why this was the case. Their responses included: feeling that they could handle it themselves, having other sources of support available, being unaware of where to go, feeling embarrassed, feeling guilty about being a burden or that it was their fault, fear that abuser would come after them, fear of not being believed, and, to a lesser extent, concern that the shelter would lack appropriate accommodations. These findings highlight the importance of intervention strategies including advocacy activities for women with disabilities, activities with schools, activities to deter and prevent partner and caregiver violence, community awareness activities, and dissemination activities.

Injury prevention for children with disabilities.

Gaebler-Spira D, Thornton LS. Northwestern University, Feinberg School of Medicine, Pediatric Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, IL, USA. dgaebler@rehabchicago.org Phys Med Rehabil Clin N Am 2002 Nov;13(4):891-906

Little injury data exists for children who have disabilities. There is an urgent need to address injury prevention and to improve safety standards for this group. Understanding the epidemiology of injuries will allow clinicians to accurately advise patients and their families on individual risks and counsel them in steps to take to reduce those risks. Safety information must be tailored to consider each child’s functional impairments. All children who have disabilities are at risk for maltreatment. Open discussion of this problem is warranted given the immensity of the problem. Identifying parental concerns and supporting parents in the use of respite resources are appropriate. For children who have problems in mobility, falls are the number one concern. Collaboration with reliable vendors and therapists that adhere to standards for safe seating is essential for reducing the risk of wheelchair tips and falls. In addition, therapists should be directed to provide mobility training for activities from safe transfers to street crossing in a community setting. Parents should be counseled to approach their child’s injury risk based on the child’s cognitive and behavioral level rather than their chronological level. Knowledge of the child’s developmental quotient or intelligence quotient will also allow the clinician to accurately formulate an injury prevention plan. Many children will always need supervision for tasks that put them in situations of injury risk (i.e., swimming, street crossing, bathing). Sensorineural deficits such as blindness or deafness create significant alterations in negotiating the environment and an increased risk of injury. Awareness of the special needs for fire risk reduction and street safety are critical in this population. The collection of injury data is critical to define the scope of the problem and to influence changes in policy and the development of technical standards. Educational efforts focused on safety should include pediatricians, rehabilitative therapists, social workers, teachers, parents, and—most importantly—the empowerment of children as they age injury-free into adults.

Suggested Strategies: A national injury surveillance system for children who have disabilities should be developed to identify injury risk factors for children with disabilities. Children with disabilities should be monitored as a separate risk group in data collection regarding injuries. Parents should be aware of the cognitive level of their child and its influence on their injury risk. Crash testing on passenger restraints should include crash dummies whose physical characteristics resemble those of children who have disabilities. Families should have an emergency evacuation plan with specific consideration of their disabled child in the event of an emergency. Risk of burns to insensate skin and risks of thermal and friction trauma should be discussed when appropriate. The fire department and the police department should be notified of the presence of a child who has a disability in the home. Parents must be aware of the risk of falls to children who are mobile but cognitively impaired and to those in wheelchairs regardless of cognitive ability. Hospitals must have Child Protective Services teams with specific training in abuse to children with disabilities. Discussion of maltreatment risk should be addressed during routine office visits and appropriate resources should be made available to provide support to families. Educational programs should be developed to alert providers to the risks of abuse of children who have disabilities.

Providing medical evaluations for possible child maltreatment to children with special health care needs.

Giardino AP, Hudson KM, Marsh J.
Children’s Seashore House of The Children’s Hospital of Philadelphia, Philadelphia, PA 19134, USA.
Child Abuse Negl. 2003 Oct;27(10):1179-86

Objective: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team’s experience providing medical evaluations for suspected child maltreatment to children with special health care needs.

Methods: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children with Disabilities were abstracted and analyzed. Mail and telephone follow-up contact was attempted after the medical evaluation to determine adherence with treatment recommendations. A subsample of cases for which complete financial information was available was reviewed to determine a reimbursement rate.

Results: During the study, 49 children received complete outpatient evaluations. Ages ranged from 3 to 16 years old, and 54% were males. Special needs spanned a wide range of physical, developmental/cognitive and behavioral conditions. The largest number of referrals came from child protective services (42%) followed by referrals from physicians (27%). After the team’s comprehensive evaluation, 18% of the children were found to have a history or physical examination that was diagnostic for child maltreatment, 13% were thought to be at high risk, 25% were thought to be at low risk and 44% were thought to have non-abusive etiologies. The collection rate was 14% for an average reimbursement of $38 per case. Only 29 caregivers could be found at follow-up and 22 remembered the recommendations made by the team. Of the 25 cases that were referred for outpatient mental health counseling, 12 (48%) complied.

Conclusion: Children with a wide range of special health care needs were evaluated in an outpatient special health care needs clinic that offered comprehensive medical evaluations for possible child maltreatment. Medical evaluation services for this group of children were poorly reimbursed. Mental health services were frequently recommended but often not accessed. Child maltreatment teams seeking to serve children with special health care needs will need to plan for service delivery to a potentially diverse group of children and families who may experience difficulty in carrying through on the team’s treatment recommendations.

Ten-year research update review: child sexual abuse.

Putnam FW.
Children’s Hospital Medical Center, Cincinnati, Ohio, 45229-3039, USA. Frank.Putnam@chmcc.org
J Am Acad Child Adolesc Psychiatry. 2003 Mar;42(3):269-78.

Objective: To provide clinicians with current information on prevalence, risk factors, outcomes, treatment, and prevention of child sexual abuse (CSA). To examine the best-documented examples of psychopathology attributable to CSA.

Methods: Computer literature searches of and for key words. All English-language articles published after 1989 containing empirical data pertaining to CSA were reviewed.

Results: CSA constitutes approximately 10% of officially substantiated child maltreatment cases, numbering approximately 88,000 in 2000. Adjusted prevalence rates are 16.8% and 7.9% for adult women and men, respectively. Risk factors include gender, age, disabilities, and parental dysfunction. A range of symptoms and disorders has been associated with CSA, but depression in adults and sexualized behaviors in children are the best-documented outcomes. To date, cognitive-behavioral therapy (CBT) of the child and a nonoffending parent is the most effective treatment. Prevention efforts have focused on child education to increase awareness and home visitation to decrease risk factors.

Conclusions: CSA is a significant risk factor for psychopathology, especially depression and substance abuse. Preliminary research indicates that CBT is effective for some symptoms, but longitudinal follow-up and large-scale “effectiveness” studies are needed. Prevention programs have promise, but evaluations to date are limited.

U.S. policy: keeping children with special needs safe in America.

Shelton D.
Catholic University of America, School of Nursing, Washington DC 20064, USA. sheltond@cua.edu
J Pediatr Nurs. 2003 Oct;18(5):344-6.

This paper reviews the major efforts being made to reform the child welfare system for children with special needs who are in protective placements. Barriers to finding permanent and loving homes result in putting these children at high risk of institutionalization, poor physical and emotional health, and abuse and neglect. Education for prospective parents, foster parents and the child service provider workforce is necessary to minimize these poor outcomes.