Monday, 1 June 2015

The physical maltreatment of children with autism

As dramatic as the title of this post might seem, it is taken from the title of the paper by Guiqin Duan and colleagues [1] who reported that: "CPM [child physical maltreatment] is widespread in families of children with autism in Central China and more knowledge should be provided to parents of children with autism."

Given the subject matter of the Duan paper I will at this point affirm that this is a blog about science (peer-reviewed science in the most part) and my discussions on this topic are directed at the science. I am not trying to stigmatise, generalise or any other -ise the quite uncomfortable and potentially emotive topic of child maltreatment with autism in mind.

Based on an analysis of 180 reports from parents of children with autism, including assessment of the severity of offspring autism (based on CARS scores) and data on "parental CPM during the past 3 months", researchers built up a picture of how prevalent CPM might be and how age and severity of autism in offspring might 'intersect' with such practices. By saying that last sentence I am in no way trying to excuse CPM on the basis of autism presentation.

Results: "CPM was self-reported by 88% of the parents of children with autism." Most of these reports were described as minor although about a third of such reports fell into the 'severe' categorisation but were "unlikely to have caused injury." An analysis of CARS scores and age suggested that there may be more to see when it came to these correlates and the use of severe CPM is perhaps in line with the findings reported by Andrea Roberts and colleagues [2] following on from the idea that those with "high levels of autistic traits may be targeted for abuse."

As I initially indicated, the issue of maltreatment is generally an uncomfortable topic to discuss particularly when linked to the word 'child'. Add also the label of autism into the mix and this turns into a potentially very emotive issue especially in light of some of the extreme examples of where child maltreatment and autism have been reported with the most saddest of outcomes (see here). An additional side to this issue is also the strong requirement not to further stigmatise parents of children with autism with findings such as those from Duan et al accepting that no asymptomatic control group was included in their study. As per other discussions on intimate partner abuse and risk of offspring autism (see here) based on other research from Roberts et al [3], there is a balance to be struck between recognition of an issue whilst at the same time not over-generalising said issue to an entire group or population of people.

Insofar as what could be potentially done to minimise CPM and it's impact I don't want to adopt the 'holier than thou' position on this. Parenting, whilst rewarding, is a difficult business. Without making light of the topic, have a look at comedian Michael McIntyre's routine: 'parents with no kids don't know' on just how stressful parenting can become. The evidence on parenting a child with autism suggests that there are additional stress and strains that can accompany those of parenting in general (see here) that might also need to be considered.

Help, support and education are perhaps some of the most important tools that can be utilised. Within those concepts I'm talking about the rise and rise of parent education (without being condescending) on the ways and means that strategies could be adopted in times when the risk of CPM is high. I'd also like to think that important services such as respite care can be utilised as and when required so that parenting can go back to being parenting and not just coping / getting by as a scenario that can build up over time. All of these concepts are set against a backdrop of differing national policies on what is and is not socially acceptable when it comes to the use of smacking (spanking) for example as one facet of CPM.

The bottom line is that no child should be exposed to physical maltreatment. Over and above however just finger pointing, the provision of help, support and services where and when required to aid the parenting journey need to be more fully incorporated into action plans to reduce the likelihood of CPM occurring when autism is diagnosed.


[1] Duan G. et al. Physical maltreatment of children with autism in Henan province in China: A cross-sectional study. Child Abuse Negl. 2015 May 6. pii: S0145-2134(15)00116-7.

[2] Roberts AL. et al. Association of autistic traits in adulthood with childhood abuse, interpersonal victimization, and posttraumatic stress. Child Abuse Negl. 2015 May 5. pii: S0145-2134(15)00128-3.

[3] Roberts AL. et al. Maternal exposure to intimate partner abuse before birth is associated with autism spectrum disorder in offspring. Autism. 2015 Feb 6. pii: 1362361314566049.

---------- Duan, G., Chen, J., Zhang, W., Yu, B., Jin, Y., Wang, Y., & Yao, M. (2015). Physical maltreatment of children with autism in Henan province in China: A cross-sectional study Child Abuse & Neglect DOI: 10.1016/j.chiabu.2015.03.018