Involvement of Children With Autism Spectrum Disorder (ASD) in the Child Protection System

Abstract

The present study provides information about children with autism spectrum disorder (ASD) who are involved in the child protection system in a large, Midwestern state. Findings revealed that children with ASD (and children with other disabilities) were more likely to receive services from the child protection system (CPS) than children without disabilities. Children with ASD in CPS were more likely to be elementary school-age (6–10 years) and Caucasian than other children involved in CPS. Children diagnosed with ASD and other disabilities were significantly overrepresented for physical abuse as the primary reason for involvement in CPS. Parental mental health issues were more evident than was expected for families of children with ASD (17%) as compared with children diagnosed with other disabilities (10%) and children not diagnosed with any disability (10%). The implications of these findings as they relate to interventions for children with ASD in CPS are discussed.

Keywords

autism spectrum disorders child maltreatment disabilities

Autism spectrum disorders (ASD) are among the fastest growing developmental disability diagnosis in the United States. State educational data on number of children with an ASD diagnosis suggest a 10% to 17% annual growth in nationwide prevalence estimates (U.S. Department of Education, Office of Special Education Programs, 2003). Most recent estimates from the Centers for Disease Control and Prevention (CDC) indicate that 1 in 68 children are currently diagnosed with ASD (CDC, 2014). The average age for a diagnosis of an ASD is approximately 5 years; however, general behavioral symptoms are often noted much earlier (Shattuck, Durkin, et al., 2009). Research also supports significant disparities in the diagnosis of ASDs across racial, cultural, and socioeconomic groups (Liptak et al., 2008). For children of color, the median age of ASD diagnosis is approximately 8.2 years, approximately 3 years later than diagnosis in White children (Shattuck, Constantino, & Fitzgerald, 2009). Overall, children in poverty receive a diagnosis almost 1 full year later than children with family incomes above the poverty level (Mandell, Novak, & Zubritsky, 2005).

Due to this increase in ASD prevalence, it is logical to question the implications of the increase in ASD diagnosis on other large service support systems such as the child protection system, education, and other social service agencies. These agencies receive thousands of cases every year (U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, 2010). An increasing number of these cases will likely involve children with developmental disabilities such as ASD. The increase in ASD prevalence highlights the need for well-developed decision making processes within agencies to address the specific needs of children with ASD and their families. The development of effective interventions in the lives of children with ASD and their families is not the unique responsibility of any one of these agencies but rather is a shared responsibility across multiple agencies and the broader community (Crosson-Tower, 2003).

While agencies such as Child Protection Services have significant expertise in areas of child welfare and protection, knowledge around disability is often secondary and sometimes limited to non-existent in child protection records (Hibbard & Desch, 2007; Lightfoot & LaLiberte, 2006; Sullivan & Knutson, 2000). Furthermore, there are many challenges to collecting accurate data around children with disabilities and their experience with CPS. One significant challenge is in the consistent documentation of both child maltreatment and disability status. Child protection agencies did not include information about the child’s disability status in their records until the reauthorization of the Child Abuse Prevention and Treatment Act (CAPTA) in 2010 (see Section 602, 2024 U.S.C. 1401; 202 U.S.C. 1432; Lightfoot & LaLiberte, 2013; Shannon & Tappan, 2011; Stalker & McArthur, 2012; Sullivan & Knutson, 2000). The issue is further compounded by a general lack of education and training around identifying children with disabilities (Kendall-Tackett, Lyon, Taliaferro, & Little, 2005).

This article provides an overview of a general population of children identified with ASD who are involved in the child protection system. Specifically, this study is to examine how the characteristics of children and families within CPS vary for children with ASD compared with children with other disability diagnoses and children without disability diagnoses. This article utilizes a comparative framework between children with ASD, children with other disabilities, and children with no identified disability, and their involvement in the child protection system (CPS). An examination of specific characteristics and risk factors for children with ASD and their families and how these variables influence rates of child maltreatment is also presented.

Children With Disabilities and the Child Protection System

The maltreatment of children with disabilities is a critical issue that affects our country’s public health, education, and social service systems. According to the U.S. Census Bureau (2010) data, it is estimated that 8.4% of children in the United States have a diagnosed disability. Research from the U.S. Department of Health and Human Services Children’s Bureau (2012) indicates that approximately 686,000 children in the United States were substantiated victims of abuse or neglect. However, more than 3.8 million children were alleged victims of maltreatment reports during this same period. Of the states in the United States that documented disability status within their CPS departments, children with disabilities accounted for approximately 11% of all victims (U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, 2010). Previous studies provide consistent support of a significant relationship between childhood disabilities and the risk of maltreatment (Mandell, Walrath, Manteuffel, & Pinto-Martin, 2005; Sullivan & Knutson, 2000).

Children with disabilities are more likely to be maltreated than their peers without disabilities (Embry, 2001; Lightfoot & LaLiberte, 2013; Sullivan & Knutson, 2000). Research from the Second National Incidence Study of Child Maltreatment reported the risk of maltreatment among children with disabilities as 1.6 to 2.2 times more likely than children without disabilities (Crosse, Kaye, & Ratnofsky, 1993; U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, 2010). A large, population-based research study completed by Sullivan and Knutson (2000) found a 31% maltreatment rate among children with disabilities, in the contrast to the 9% rate for children without disabilities. Children with disabilities were 3.4 times more likely to experience maltreatment than children without disabilities (Sullivan & Knutson, 2000).

Demographic Trends for Maltreatment of Children With Disabilities

There are also several established demographic trends for children with disabilities and maltreatment. When compared with children without disabilities, children with disabilities tend to be victims of maltreatment at younger ages. The pre-school ages tend to be a time in which children with disabilities experience more issues of neglect and abuse than children with disabilities at all other ages (e.g., elementary, middle, and high school; Lightfoot, Hill, & LaLiberte, 2011; Lightfoot & LaLiberte, 2013; Sullivan & Knutson, 1998). Gender is also a relevant factor in maltreatment. In populations of students without disabilities, more girls are victims of abuse. In contrast to the general population, male children with disabilities appear to have higher rates of abuse than girls with disabilities (Lightfoot & LaLiberte, 2013; Sobsey, Randall, & Parrila, 1997; Sullivan & Knutson, 2000).

The data also reveal that children with some types of disabilities appear to have a significantly greater risk of maltreatment. Previous research reveals that children with developmental disabilities have approximately three to four times greater risk of maltreatment when compared with peers without disabilities (Johnson-Reid, Drake, Kim, Porterfield, & Han, 2004; Sullivan & Knutson, 2000; Westat Inc., 1993). Children with communication disorders have approximately five times the risk of physical abuse and neglect and approximately three times the risk of sexual abuse (Sullivan & Knutson, 1998). Of all disability groups, children with behavioral disorders appear to have the greatest risk of maltreatment (Govindshenoy & Spencer, 2006; Helton & Cross, 2011; Jaudes & Mackey-Bilaver, 2008; Sullivan & Knutson, 2000). The risk of maltreatment such as physical abuse, emotional abuse, and neglect for children with behavioral disorders was approximately seven times higher than the rates for children without any diagnosed disabilities (Sullivan & Knutson, 2000).

Another consistent finding in the literature is that perpetrators of maltreatment of children with disabilities are typically immediate family members (Sullivan & Knutson, 1998, 2000; Westat Inc., 1993). Neglect is the most common form of maltreatment of children with disabilities (as it is for children without disabilities as well), followed in order by physical, emotional, and sexual abuse. However, it is important to note that most children experience more than one type of maltreatment (Sullivan & Knutson, 2000). Furthermore, previous research also confirms a consistent relationship between economic disadvantage and overall increased risk of neglect (Sullivan & Knutson, 1998, 2000).

Children With ASD and Maltreatment

Despite the growing interest and focus on children with ASD, a dearth of specific research exists around the prevalence of children with ASD in CPS. The current literature base provides some general data on children with disabilities and maltreatment with some brief data on children with ASD as a subset of the broader population of children with disabilities. Furthermore, much of the previous research was conducted using clinical or institution based population samples, whereas most children with ASD are served in community- and school-based settings (Jacobson & Mulick, 2000; Järbrink & Knapp, 2001). The small body of research that exists on children with ASD and maltreatment reveals mixed results. A study by Mandell, Walrath, et al. (2005) revealed that among a group of students with ASD, who were receiving treatment in community mental health settings, approximately one in five had encountered physical abuse and one in six had experienced sexual abuse. In another study, caregivers reported that approximately 19% of children with ASD had been victims of physical abuse and an estimated 17% had experienced sexual abuse. In contrast, findings from a study conducted by Sullivan and Knutson (2000) revealed rates of abuse for children with ASD similar to those in the general population.

Children with special needs often place an increased physical, emotional, social, and financial demand on families and caregivers (Brehaut et al., 2004; Mbugua, Kuria, & Ndetei, 2011). In the case of children with ASD, the child’s behavioral characteristics such as communication difficulties, social issues, and atypical behaviors may cause increased levels of stress for the parents and caregivers. Due to their limited communication abilities and social isolation, it has been suggested that children with ASD may be at heightened risk of abuse (Howlin & Clements, 1995). Furthermore, children with ASD may not respond to typical means of behavioral intervention, which can be challenging for parents. Caregivers of children with communication problems and behavioral issues may resort to more physical methods of discipline due to both frustration and lack of ability to communicate in other ways (Ammerman, Hersen, Van Hesselt, Lubetsky, & Sieck, 1994; Mandell, Walrath, et al., 2005).

Overall, there appears to be a significant lack of research regarding the relationship between children with ASD and their involvement in CPS. Given the increasing prevalence rates of children diagnosed with ASD, it becomes important to understand the association between ASD and the risks of maltreatment. Furthermore, data on these risks need to be provided from more natural contexts for serving children with ASD such as school and community settings. The purpose of this study is to explore and describe child and family characteristics of children involved in CPS who have been diagnosed with ASD and other disabilities. Children involved in CPS but who do not have a disability diagnosis serve as a reference group for this study. This article addresses the following questions for children with CPS involvement:

What is the demographic profile of children with ASD in the child protection system compared with other groups (e.g., children with other disabilities, children without disabilities)?

What types of maltreatment allegations are most commonly reported for children with ASD compared with other groups (e.g., children with other disabilities, students without disabilities)?

Which family conditions are most commonly occurring for children with ASD as compared with children with other disabilities or no disabilities?

Method

Data

This study was conducted using secondary data from the Minnesota Linking Information for Kids (Minn-LInK) project at the Center for Advanced Studies in Child Welfare (CASCW), University of Minnesota. The Minn-LInK project utilizes statewide administrative data from multiple agencies to answer questions about the impacts of policies, programs, and practice on the well-being of children in Minnesota. For this study, Minnesota Department of Human Services’ (DHS) Social Service Information System (SSIS) 2000 to 2009 data, and Minnesota Department of Education’s (MDE) Minnesota Automated Reporting Student System (MARSS) 2004 to 2005 school year data, were used in accordance with data-sharing agreements between the Minn-LInK project at the University of Minnesota and these State agencies. The rationale for these specific years involved the availability of integrated data for the variables of interest for this study. Furthermore, the years of 2004 and 2005 were chosen due to statewide trends and political focus around identification of ASD. Data-sharing agreements allowed for the use of identified data for the purpose of conducting research on families and children. The University’s Institutional Review Board approved the use of these secondary data for these purposes, and all identifiers were removed from the data file once cross-system matching was achieved (de-identification).

Sample

The sample consisted of school-aged children who attended public school in the 2004–2005 school year, and were also involved in an accepted case of alleged child maltreatment in Minnesota between the years of 2000 and 2009. Through Minn-LInK, MDE-MARSS (2004–2005) administrative data consisting of educational records of 882,638 children were matched with the records of children in the DHS-SSIS (2000–2009) data. Matching was done through a reiterative process using a combination of first name, middle name, last name, and birth date. Of the 882,638 children, records of 35,390 children were found in the SSIS database. Of 35,390 children, 9,536 had an accepted case of alleged maltreatment in Minnesota between 2000 and 2009. The final data set was composed of those 9,536 children with an accepted case of alleged maltreatment. Sample selection allowed for an understanding of the disability diagnoses of all the children involved in CPS in the state of Minnesota in a single academic year.

Variables

Primary disability

Children with primary disability (or lack thereof) were identified using the MDE records for the 2004–2005 academic year. The primary disability indicator is used in federal civil rights reports and other federal statistical reports, including children exiting from special education and Child Count Reports. Primary disability is noted in MDE if the student had a disability and had an Individualized Education Program (IEP)/Individualized Family Service Plan (IFSP)/Individual Interagency Intervention Plan (IIIP) anytime during the school year. For the present study, primary disability was coded 01 (any report of ASD during the school year), 02 (any report of other disabilities—speech language impairment, development cognitive disabilities, physical or visual impairment, specific learning disabilities, emotional behavior disorders, development delay, and all other disabilities), and 03 (no disability reported).

Demographic profile

Information about demographics of children was obtained using MDE records for 2004–2005 school year. Data are entered by local school districts according to state and federal statute; data are cleaned by the school district as well as by MDE prior to analysis. Variables included eligibility for free/reduced meal and race/ethnicity. Eligibility for free/reduced meal serves as a proxy for economic indicator. A child is eligible for free meal if the family income is at or below 130% of Federal poverty guidelines, for reduced price meal, if the family income is between 130% and 185% of the guidelines (U.S. Department of Agriculture, Food and Nutrition Service, Office of Research and Analysis, Direct Certification in the National School Lunch Program: State Implementation Progress, 2008). Although recent legislation has allowed for all children in out-of-home placement to receive free meals, during the time of this study, this policy was not in place in Minnesota. Meal eligibility was coded 0 (if the child was ineligible for a free or reduced meal in 2004–2005 school year), 1 (if the child was eligible for reduced price meal during 2004–2005 school year), and 2 (if the child was eligible for free meal during 2004–2005 school year). For race/ethnicity, the following coding schemes were used: 01 (American Indian or Alaskan Native), 02 (Asian or Pacific Islander), 03 (Hispanic), 04 (Black, not of Hispanic origin), and 05 (White, not of Hispanic origin).

Types of maltreatment and alleged offender

Allegations of maltreatment experienced by children and alleged offender(s) are entered into the SSIS database primarily by screeners, who are social workers. However, if new allegations arise during the investigation, those allegations may be entered into the SSIS system by the front-line social worker who has specialized training in the identification/substantiation of maltreatment as well as the identification of family conditions and characteristics associated with child maltreatment. The presence of each type of maltreatment was coded 0 (no) or 1 (yes) for the following alleged maltreatment types: Neglect, Physical Abuse, Sexual Abuse, Mental Injury and Emotional Harm, and Medical Neglect. Relationship of offenders to the children was also dichotomously coded 0 (no) or 1 (yes) for each potential offender, including Biological Parents, Adoptive Parents, Stepparent, Foster Parent, Group Home or Residential Facility Staff, Child Day Care Provider, Unmarried Partner of Parent, Legal Guardian, and Other including friends, neighbors, and other relatives. Children may have experienced multiple incidents and/or types of maltreatment by one or more alleged offenders during the study period. Therefore, analyses based on allegation/maltreatment type or alleged offender report sample sizes based on the total number of allegations or alleged offenders rather than the total number of children in the sample.

Family conditions

To identify family conditions associated with CPS involvement across the three groups (ASD, Other disability, and No disability), SSIS records were used. Family conditions refer to the families’ circumstances at the time of the allegation that led to the child protection intervention or were identified during the assessment/investigation by child welfare workers trained to identify and document the presence of a number of family conditions. Guidance for indication of seven of the eight family conditions comes from the National Child Abuse and Neglect Data System (NCANDS; National Data Archive on Child Abuse and Neglect, 2009). Those seven family conditions are reported to NCANDS by states annually. Parenting Issues, the eighth family condition, is an indicator defined and utilized at the state and local level. The presence of each family condition was dichotomously coded 0 (no) or 1 (yes) for the following conditions: Domestic Violence, Inadequate Housing, Financial Problems, Public Assistance, Alcohol Abuse, Drug Abuse, Mental Health, and Parenting Issues. Multiple family conditions may exist for each child depending on family circumstances. Definitions for family conditions can be found in Table 1.

Table 1.

Family Condition Definitions.

Family condition	Definition
Domestic violence^a	An incidence of interspousal physical or emotional abuse perpetrated by one of the spouses or parent figures on the other spouse or parent figure in the child victim’s home environment.
Inadequate housing^a	Substandard, overcrowded, unsafe, or otherwise inadequate housing conditions, including homelessness.
Financial problems^a	The family’s inability to provide sufficient financial resources to meet minimum needs.
Public assistance^a	Anyone or combination of the following welfare or social services programs: AFDC, General Assistance, Medicaid, SSI, Food Stamps, etc.
Alcohol abuse^a	The principal caretaker(s)’ compulsive use of alcohol; not of temporary nature.
Drug abuse^a	The principal caretaker(s)’ compulsive use of drugs; not of temporary nature.
Mental health/emotionally disturbed^a	A condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree: an inability to build or maintain satisfactory interpersonal relationships; inappropriate types of behavior or feelings under normal circumstances; a general pervasive mood of unhappiness or depression; or a tendency to develop physical symptoms or fears associated with personal problems. The term includes persons who are schizophrenic or autistic. The term does not include persons who are socially maladjusted, unless it is determined that they are also seriously emotionally disturbed. This condition must be clinically diagnosed. The diagnosis is based on the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders.
Parenting issues^b	The caregiver lacks understanding of the physical, developmental, or emotional needs of the child. Parenting issues do not include problems that arise or persist solely due to a lack of resources. Parenting issues related to physical need include a demonstrated lack of knowledge of appropriate food, shelter, clothing, sleep, hygiene, or medical needs. Parenting issues related to developmental needs include failing to provide appropriate supervision; having unrealistic expectations of the child; using inappropriate, excessive, or inadequate discipline; failing to facilitate the child’s education; or interfering with educational services. Parenting issues related to emotional needs include failing to provide the child with strong attachment to positive adults, a sense of safety and security, affection, positive feedback, and appropriate boundaries.

Note. AFDC = Aid to Families with Dependent Children; SSI = Supplemental Security Income.

National Data Archive on Child Abuse and Neglect, 2009. ^bSocial Service Information System, 2009.

Results

The data analysis for this study included several steps. As a first step in the data analysis, descriptive analysis was conducted to understand the basic features of the data. This analysis consisted of summaries of the overall participant sample. Participant data were then categorized into three distinct groups: Children with ASD, Children with Other Disabilities, and Children with No Disability. Chi-square analysis was used to describe child and family characteristics of children involved in CPS who have been diagnosed with ASD or other disabilities as compared with children involved in CPS but who do not have a disability. Standardized residuals (z scores) were computed within each cross tabulation to determine over- or underrepre-sentation of children and were compared with a standard cutoff of 1.96 (corresponding to p = .05).

Findings demonstrate that children who were diagnosed with ASD were represented at higher rates in the child protection system as were children diagnosed with other disabilities (χ² = 6994.792, p = .00). In the population of children who attended public school in the academic year 2004–2005, children with ASD accounted for approximately 1%, while children with other disabilities accounted for approximately 16%. The records of these children were then matched to the state social service system, which revealed that 2% of children with ASD were known through the formal social service system network, 30% of children with other disabilities were known through that same network, and 68% of children without any disability diagnosis were found in this data system. Approximately 27% of children present within the social service system were involved in an accepted case of alleged maltreatment (served by CPS). Children diagnosed with ASD accounted for approximately 2% of the children reported to CPS while children diagnosed with other disabilities accounted for approximately 32% of those children reported.

Demographics

Demographic data are presented in Table 2. Chi-square tests were conducted to compare demographic characteristics of children involved in CPS who were diagnosed with ASD, diagnosed with other disabilities, or not diagnosed with a disability.

Table 2.

Demographics of Children Involved in Child Protection Diagnosed With ASD, Other Disability, and No Disability (in Percentage).

		Groups
Demographics of children in CPS	Total	ASD	Other disability	No disability
Age (years)	N = 9,536	n = 162	n = 3,025	n = 6,349
1–5	12	13.0	12.3	11.8
6–10	40.3	45.1	36.0*	42.3*
11–15	38.8	37.0	41.2*	37.7
16–20	8.9	4.9	10.4*	8.2
21–25	0.0	0.0	0.0	0.0
Race/ethnicity	N = 9,536	n = 162	n = 3,025	n = 6,349
American Indian or Alaskan Native	6.6	1.9*	7.2	6.4
Asian or Pacific Islander	2.2	1.2	1.1*	2.8*
Hispanic	4.4	1.9	4.4	4.5
Black, not of Hispanic origin	17.5	6.8*	18.6	17.3
White, not of Hispanic origin	69.2	88.3*	68.7	69.0
Lunch eligibility	N = 9,334	n = 160	n = 2,917	n = 6,257
Ineligible	29.9	45.0*	25.6*	31.5*
Reduced meal	11.8	11.3	12.3	11.5
Free meal	58.3	43.7*	62.1*	57.0
Missing	202	2	108	92

Note. ASD = autism spectrum disorder.

p < .05.

Age

Across the three groups, the most common ages of first involvement with CPS included 6- to 10-year-olds for those diagnosed with ASD or no disability whereas 11 to 15 years of age was the most common first involvement age for those children diagnosed with other disabilities (see Table 2). Chi-square analysis suggested significant association among disability group and age (χ² = 44.126, p = .00). Children with ASD were neither over nor underrepresented across age groups. However, within the other disability group elementary-aged children (6–10) were significantly underrepresented (z = −3.7) whereas older youth (11–15 and 16–20) were significantly overrepresented (z = 2.1 and 2.9, respectively). Elementary-aged children were significantly overrepresented among children without disability diagnoses (z = 2.4).

Race/ethnicity

Across the three groups, the most common race/ethnicity was White, not of Hispanic origin (see Table 2). Chi-square analysis suggested significant association between disability group and race/ethnicity (χ² = 58.003, p = .00). There was a significant underrepresentation of American Indian or Alaskan Native and African American children within the ASD group (z = −2.3 and −3.3, respectively). However, White children were overrepresented in this category (z = 2.9). Within the other disability group, Asian or Pacific Islander children were significantly underrepresented (z = −4.1). In contrast, Asian or Pacific Islander children were significantly overrepresented among children without a disability (z = 3.0).

Socioeconomic status (SES)

Three categories of lunch eligibility were examined (ineligible, reduced price meal, and free meal) as a proxy for SES. Most children across the three groups were positioned in the ineligible or free meal categories; few children were eligible for reduced price meal (see Table 2). Chi-square analysis suggested significant association among disability group and race/ethnicity (χ² = 96.856, p = .00). Within the ASD category, there was a significant underrepresentation of children qualifying for free meals (z = −2.3) with an overrepresentation of those ineligible for free or reduced price meals (z = 3.6). For children with other types of disabilities, those who were ineligible for free or reduced price meals were significantly underrepresented (z = −4.7), but those who were eligible for free meals were overrepresented (z = 2.1). For children without a disability diagnosis, those who were ineligible for free or reduced price meals were significantly overrepresented (z = 2.7).

Types of Maltreatment Allegations

Type of maltreatment

Data on types of maltreatment allegations are presented in Table 3. Across the three groups, the most common allegation was neglect (ranging from 55% to 67% of all allegations across groups). Chi-square analysis suggested significant association among disability group and maltreatment allegation (χ² = 106.190, p = .00). Within ASD, neglect allegations were significantly underrepresented (z = −2.2) while physical abuse was overrepresented (z = 3.6). For children diagnosed with other disabilities, neglect allegations were significantly underrepresented (z = −3.1) while physical abuse and medical neglect were overrepresented (z = 3.6 and 5.2, respectively). For children without a disability diagnosis, neglect allegations were significantly overrepresented (z = 2.7) while physical abuse and medical neglect were underrepresented (z = −3.2 and −3.7, respectively).

Table 3.

Percentage of Children Diagnosed With ASD, Other Disability, and No Disability by Types of Allegations (in Percentage).

	Total	Groups
Allegation	N = 18,165	ASD, n = 314	Other disabilities, n = 6,310	No disability, n = 11,541
Neglect	64.8	54.8*	61.6*	66.8*
Physical abuse	25.0	35.0*	27.3*	23.5*
Sexual abuse	8.6	8.3	8.9	8.4
Mental injury and emotional harm	0.5	1.3	0.4	0.5
Medical neglect	1.2	0.6	1.9*	0.8*

Note. ASD = autism spectrum disorder.

p < .05.

Relationship of offender

Table 4 presents data on the relationship of the child to the alleged offender of maltreatment. Across the three groups, the alleged offender for most is either unknown or their biological parent. Chi-square analysis suggested significant association among disability group and maltreatment allegation (χ² = 193.572, p = .00). For children with ASD, alleged offenders of maltreatment were significantly overrepresented by group home/residential facility staff (z = 9.9). For children diagnosed with other disabilities, foster parents and unknown alleged offenders were significantly overrepresented (z = 4.3 and 3.3, respectively) while biological parents were significantly underrepresented as alleged offenders (z = −3.4). For children without a disability, biological parents were significantly overrepresented as alleged offenders (z = 2.6) while foster parents, group home or residential facility staff, and unknown alleged perpetrators were significantly underrepresented (z = −3.0, −2.9, and −2.2, respectively).

Table 4.

Relationship of Offender to Children Involved in Child Protection Diagnosed With ASD, Other Disability, and No Disability (in Percentage).

	Total	Groups
Offender relation	N = 11,049	ASD, n = 190	Other disabilities, n = 3,802	No disability, n = 7,057
Biological parent	44.0	42.1	40.4*	46.1*
Adoptive parent	1.0	2.1	1.1	0.9
Stepparent	4.0	5.2	3.8	4.1
Foster parent	0.5	0.0	1.0*	0.3*
Group home or residential facility staff	0.2	3.2*	0.3	0.0*
Child day care provider	0.3	0.0	0.3	0.3
Unmarried partner of parent	4.4	2.1	4.2	4.6
Legal guardian	0.6	0.0	0.8	0.5
Other	6.8	7.9	6.9	6.6
Unknown	38.2	37.4	41.2*	36.6*

Note. Other refers to friends, neighbors, and other relatives. ASD = autism spectrum disorder.

p < .05.

Family Conditions

Data on family conditions are presented in Table 5. Across the three groups, most children came from families who either had parenting issues or none of the presenting family conditions present. Chi-square analysis suggested significant association among disability group and maltreatment allegation (χ² = 54.849, p = .00). Within ASD, children whose parents abused drugs were significantly underrepresented (z = −2.0) while children whose parents had mental health issues were overrepresented (z = 2.7). For children diagnosed with other disabilities, domestic violence and alcohol abuse conditions were significantly underrepresented (z = −2.0 and −2.4, respectively) while receipt of public assistance was overrepresented (z = 3.5). For children without a disability diagnosis, receipt of public assistance was significantly underrepresented (z = −2.5) while alcohol abuse was overrepresented (z = 2.0).

Table 5.

Family Conditions of Children Involved in Child Protection Diagnosed With ASD, Other Disability, and No Disability (in Percentage).

	Total	Groups
Family condition	N = 9,536	ASD, n = 162	Other disabilities, n = 3,025	No disability, n = 6,549
None	24.7	27.2	24.9	24.5
Domestic violence	8.0	6.8	6.9*	8.5
Inadequate housing	2.1	1.9	2.1	2.2
Financial problems	6.4	6.8	6.7	6.3
Public assistance	8.7	10.5	10.6*	7.8*
Alcohol abuse	5.4	1.9	4.4*	6.0*
Drug abuse	5.7	1.9*	5.2	6.0
Mental health	10.1	16.7*	10.4	9.7
Parenting issues	28.9	26.5	28.8	29.0

Note. ASD = autism spectrum disorder.

p < .05.

Discussion

The results of the current study provide new findings as well as consistent findings with previous research in the area of disability and maltreatment. The focus of this study was to examine child and family characteristics of children involved in CPS who have been diagnosed with ASD and other disabilities. Overall, there appears to be an overrepresentation of children diagnosed with ASD in the Minnesota Department of Human Services (DHS) data system, which suggests that it is more likely that the families of children diagnosed with ASD are receiving formal services and supports available through the broader social service system, as well as through CPS. In fact, the proportion of children with ASD and other disabilities doubles (compared with those in public education) in the DHS data system and maintains that heightened level when looking specifically at CPS involvement. This finding is consistent with previous research that reveals that families of children with ASD seek out formal support services from larger social service agencies (Bebbington & Beecham, 2007; Boyd, 2002; Twoy, Connolly, & Novak, 2007). This finding also supports the broader research literature that indicates that children with disabilities are at a greater risk of maltreatment than children without disabilities (Johnson-Reid et al., 2004; Lightfoot & LaLiberte, 2013; Sullivan & Knutson, 2000).

A closer look at the population of children with ASD in the child protection system reveals some interesting demographic trends. For the population of children with ASD who are involved in the child protection system (CPS), the ages of elementary years (ages 6–10) appeared to be the developmental time when first reported to CPS, although not statistically significant. This finding is consistent with previous work highlighting the fact early elementary ages tend to be one of the common times in which children with disabilities experience more issues of maltreatment (Sullivan & Knutson, 2000). It is also interesting to consider that this grouping encompasses the age for entrance into the public school system and hence greater access to mandated reporters such as classroom teachers, school social workers, and counselors. However, most of the children with other disabilities in this study were first involved in CPS between the ages of 6 and 15 years. Of this group, there are statistically more older children (11–15 years and 16–20 years) involved for the first time in CPS than would be expected.

Significantly fewer children who were diagnosed with ASD in CPS were eligible for free/reduced lunch when compared with children diagnosed with other disabilities and without any diagnosis of disability. In addition, it was interesting to note that children with ASD in this sample were also significantly underrepresented in the neglect categories. Because poverty is an established risk factor for neglect (Drake & Pandey, 1996; Sullivan & Knutson, 2000), the lower reported levels of neglect for families with ASD may be more of a reflection of socioeconomics within this specific study sample than specific factors related to ASD. In terms of race and ethnicity of children in CPS, Caucasian children were statistically overrepresented among the children diagnosed with ASD, but American Indian or Alaskan Native and Black children with ASD were underrepresented. This finding is not surprising and is likely a broader reflection of the overrepresentation of Caucasian children within the general population of children with ASD. However, the rates of ASD are growing in children of color, as reflected by the recent CDC estimates reporting an increase in prevalence for students of color with ASD (CDC, 2012). As the population of individuals with ASD continues to grow and change, it will be important to explore how this demographic shift influences other support systems such as Developmental Disabilities (DD), which serve children with ASD and their families.

Several interesting trends emerged when the types of allegation and disability were compared. Children diagnosed with ASD and children with other disabilities were overrepresented for physical abuse. This finding is highly consistent with the previous literature indicating that children with disabilities encounter significantly higher rates of maltreatment, including physical abuse (Lightfoot et al., 2011; Sullivan & Knutson, 2000). Yet, this finding also presents a question around the unique contribution of the specific characteristics of a child’s disability and risk of maltreatment. Previous research reveals nuances around the type of maltreatment a child experiences in relation to both the type and severity of the child’s disability (Helton & Cross, 2011). For example, children with disabilities that include behavioral challenges experience significantly higher rates of physical abuse (Govindshenoy & Spencer, 2006; Helton & Cross, 2011; Jaudes & Mackey-Bilaver, 2008; Sullivan & Knutson, 2000). The current analysis compared children with ASD with a broad category of children with other disabilities. As a result, some of the nuance around a child’s disability characteristics and subsequent risk of type of maltreatment may have been overlooked. A more focused comparative analysis of ASD around the specific types of disability and subsequent implications for physical abuse would be a valuable focus of future study.

As this finding around increased rates of physical abuse pertains to children with ASD, there are a variety of possible hypotheses. Previous research indicates that ASD may be one of the most stressful disabilities for families to accommodate and manage effectively (Higgins, Bailey, & Pearce, 2005; Sanders & Morgan, 1997). First, it may be the case that the high stress levels reported by families of children with ASD also contribute to the higher rates of physical abuse. Another possible reason for this finding could be attributed to the challenges around the use of effective disciplining techniques with children with ASD. Standard behavioral management techniques may not be consistently effective for children with ASD, and many individuals with ASD may need specialized behavioral interventions with highly trained behavioral support staff (Hastings & Brown, 2002; Mandell, Walrath, et al., 2005; Twoy et al., 2007). It may be the case that parents and caregivers of children with ASD may attempt to manage behavioral issues using physical methods that may escalate and result in abuse.

In terms of the relationship of the offender to victims, biological parents and unknown offenders were most commonly identified to be perpetrators of maltreatment for all three groups of children. The lack of accessible, high quality home supports and respite services may further compound the parental stress in families and contribute to parents being alleged offenders. For children with ASD, staff at group homes and/or residential facilities were more likely to be alleged perpetrators of maltreatment as compared with children with other disabilities and no diagnosis of a disability. While it would be interesting to explore this finding further, this may also be a function of an overall increased number of children with ASD in alternative settings such as group homes or other residential placements.

One of the most interesting findings was the relationship between family condition(s) and disability diagnosis in CPS. Parent mental health issues were significantly overrepresented in families of children with ASD as compared with children diagnosed with other disabilities and children not diagnosed with any disability. This finding is consistent with previous research that reveals increased levels of mental health issues in parents of children with ASD (Bromley, Hare, Davison, & Emerson, 2004; Fombonne, Simmons, & Ford, 2001; Hastings & Brown, 2002). Numerous studies have revealed that mothers of children with ASD have higher rates of depression and anxiety than mothers of children with other disabilities such as Down syndrome (Pisula, 2003; Sanders & Morgan, 1997). These findings appear to suggest that the mental health outcomes for parents of children with ASD cannot be exclusively attributed to the challenges of raising a child with a developmental disability. Using the previous research base as a guide, these mental health outcomes may be attributed to a variety of additional variables such as level of behavioral issues (Fombonne et al., 2001), number of family stressors (Sullivan & Knutson, 2000), and levels of family and social support (Bromley et al., 2004). Future studies should look more closely at the association between risk of maltreatment for children with ASD, specific family stressors, and the influence of support systems and interventions.

Practical Implications

The findings of the present study reveal that children with ASD as well as children diagnosed with other disabilities are at an increased risk of involvement in CPS. One potential risk factor for this increased involvement in CPS may be the challenging behaviors that can be associated with disabilities such as ASD. In addition, the increased rates of mental health issues in families with children with ASD may further highlight the stress these behavioral challenges create within the family system. Families with children with ASD may need targeted mental health supports and interventions that address the specific challenges and needs associated with raising a child with a complex disability such as ASD. Parents of children with ASD (as well as parents with children diagnosed with other disabilities) may need focused interventions around mental health promotion, stress management, and effective positive behavioral support strategies. Research supports that for parents with a child with ASD, parent training and parent support groups result in improved parental mental health outcomes (Salt et al., 2002; Schreibman & Anderson, 2001; Tonge et al., 2006). The current data further highlight the need for family-based supports and positive behavioral interventions targeting the child’s challenging behavioral issues. Structured support systems such as additional special education programming options and respite care may also be beneficial to supporting parental emotional health and positive family functioning. These supports may help to ameliorate some of the risks and challenges related to parenting a child with ASD as well as children with other disabilities.

Educational systems can also play a key prevention and intervention role. School professionals such as special education teachers and support staff develop close relationships and have regular contact with children with disabilities and their families. Therefore, educators are well positioned to play a key role in helping to prevent, recognize, and respond to issues of child abuse and neglect in children with disabilities such as ASD (Crosson-Tower, 2003). Education-based programs such Early Childhood Family Education (ECFE), Early Intervention, and Special Education should include screenings of overall family functioning and parental mental health as a function of preventive services. Furthermore, these programs can help to identify at-risk families and to mobilize additional support systems.

Child protection systems are also well positioned to provide the training, structured support, and behavioral interventions within the family case planning process. Child protection systems must consider an evaluation of their current service array to determine the availability of services needed by families and their children with disabilities such ASD, including preventive services and supports. In addition, the evaluation of service array should focus on the availability of case planning interventions such as Family Group Decision Making (FGDM). FGDM is a key example of an intervention that is able to support the inclusion of disability/ASD experts in the case planning process. Including these experts, along with the family, creates an opportunity to tailor the case plan to the unique needs of the children and their family and moves beyond a compliance model of completing a service to a more integrated model of behavioral and need based intervention. In addition to attending to the service array in child protection agencies, the field of child protection would be well served to review its current provision of disability related training including a specific component dedicated to ASD. While many agencies provide foundation training to staff, rarely if ever is disability or ASD training included among the topics considered essential training. Attention within training curriculum, beyond “normative development” is warranted based on the findings in this study that more than one third of the allegedly maltreated children in this study had some type of disability with a disproportionate number of these children having ASD. General disability knowledge is lacking, and the cry for inclusion in child welfare training has gone unanswered for nearly two decades (Drake, 1994).

Limitations

In reviewing these results, it is also important to consider some of the limitations. First, the data used for this study are cross-sectional; therefore, causation cannot be inferred from these results. Based on this analysis, the results of this study can only present associations and the direction of the effect; causality cannot be determined. The methodology used in this study introduced two additional limitations. First, the use of multiple chi squares within the same sample of data may have increased Type 1 error rates. In addition, because the sample was based on a single academic year, the results may be affected by cohort effects. Furthermore, this was a post hoc analysis using pre-existing administrative data. A study that more closely and specifically examines this relationship between ASD and risk of CPS involvement might reveal more illuminating results and offer more targeted opportunities for intervention. The inclusion of data collected from additional methodologies, such as caregiver, teacher, and provider interviews or surveys would add to the empirical knowledge base. These data would be able to speak directly to whether stress was a factor that contributed to maltreatment. In addition, the definition of ASD was limited to those students who received an educational diagnosis of ASD through the special education assessment process. This likely presents a narrower representation of students with ASD and may underestimate the overall number of children with ASD. Finally, the allegations for maltreatment were limited to CPS records. This also may represent a limited number of maltreatment allegations as there is no documentation of abuse that goes unreported.

Strengths

This study also offers several unique strengths and valuable contributions to the field of both ASDs and the child welfare research literature. To our knowledge, this is the first research study to explore the associations between ASD and risk of CPS involvement across administrative data sets (the state department of education and a state department of human services systems). Another strength of the study is the use of a large school-based sample. While many previous studies on children with ASD have focused on clinically based samples, the current study utilized a population-based sample of children enrolled within the public school system where the majority of students with ASD are served (Jacobson & Mulick, 2000; Järbrink & Knapp, 2001). Thus, the population of the current study may be more representative of the broader sample of children with disabilities including ASD. Findings from clinical settings may oversample students with more severe behavioral challenges, potentially skewing results toward more negative outcomes. Hence, the findings of the current study are likely more generalizable to the broader population of children with disabilities such as ASD.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This article was supported in part by Grant H133B080005 from the National Institute on Disability and Rehabilitation Research, by the U.S. Department of Education to the Research and Training Center on Community Living at the University of Minnesota, and by Grant #2-T73MC12835-03-00 from the Maternal Child Health Bureau (MCHB) of the U.S. Department of Health and Human Services awarded to the University of Minnesota. Support was also provided by the Center for Advanced Studies in Child Welfare in the School of Social Work at the University of Minnesota.

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