Although we know that children with developmental disabilities are at higher risk for child maltreatment, the frequency and severity of developmental disabilities among children in the child welfare system is less well known. A new study published in the Journal of Developmental and Behavioral Pediatrics sought to explore this question by identifying subtypes of disability among children in families investigated by child protective services.
After a review of information on more than 2,600 children >3 years of age from the National Survey of Child and Adolescent Well-Being II from February 2008 to April 2009, authors reported a higher percentage of children with intellectual delays or emotional/behavioral impairment, compared to previous studies. In particular, the percentage of children with intellectual disabilities (8 to 9 percent) was much higher than in previous studies (2 to 3 percent in other studies).
My takeaway is that clinicians and staff within the child welfare system need to understand the unique challenges of working with children with cognitive delays and may have implications on the design of child abuse prevention programs and respite care, as well as child abuse assessment. Daily living skills and social skills were reduced in both children with cognitive delays and emotional/behavioral difficulties, further underscoring the need for educational and social services to provide support in these areas.
What They Found
- Compared with those remaining in home, children who were placed in out-of-home care after an investigation had significantly lower social skills (78.1 vs 86.1; p = 0.04).
- Nearly half of the children in the study belonged to either an "intellectual disability" or "emotional or behavioral impairments" subgroup:
- A greater proportion of children residing in home belonged to the "intellectual disability" subgroup (defined by scores on intellegience testing 3 SD below the population mean), compared with children placed out of home. Children in the intellectual disability subgroup represented around 13 percent of children remaining in home and 8 percent of children placed out of home.
- Children categorized in the "emotional or behavioral impairments" subgroup (defined by ratings on the emotional/behavioral scale of 1.5 SD beyond the mean) represented around 37 percent of children remaining in home and 39 percent of children placed out of home. Children in this category tended to also have delays in social and daily living skills.
- "Typically developing" children represented 53 percent of children remaining in their home and 52 percent of children placed out of the home.Their scores on all testing were all within one standard deviation of the mean.
- Among children who remained in home, the presence of an Individualized Education Plan (IEP) was associated with an increased odds of being categorized in the intellectual disability group and behavior impairment group [odds ratio (OR) = 21.11, p < 0.01]. Being an "other" race lowered the odds of being in the intellectual disability category.
- Among children in out of home care, the presence of an IEP was associated with an increased odds of being in the intellectual disability group (OR = 6.59, p = 0.01). Having substantiated maltreatment increased the odds of being in the emotional or behavioral impairment group (OR = 1.96, p = 0.02)
Study Methods and Data
Data included information about more than 2,600 children >3 years of age from the National Survey of Child and Adolescent Well-Being II (NSCAW II, a national study of children who were subjects of child abuse and neglect investigations) from February 2008 to April 2009. Intelligence, social skills, functional dependence (how ably a child functions in his or her environment), and emotional/behavioral profile (including withdrawn episodes, somatic complaints, anxiety depression, attention problems, and aggressive behaviors) were assessed as part of the NSCAW II.
Other variables included in the analysis included age, race/ethnicity, gender, overall health, presence of an Individualized Education Plan at school, and status of abuse/neglect claim (substantiated, indicated [used in some states to reflect that evidence of abuse/neglect exists but not at "a sufficient level to warrant substantiating the allegations"], or neither substantiated nor indicated). Children who remained in home after an investigation were analyzed separately from children who were placed in out-of-home care after an investigation.
This study did not include analysis of children with physical or sensory impairments, which historically has represented a very small percentage of children in the child welfare system. This survey relied on reports from both biological as well as foster parents, who may have variable length of experience with the child.
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