As per other occasions when the topic of child maltreatment and autism has been discussed on this blog (see here), this is a subject that is never going to make for great dinner party conversation. It's important however that, minus any sweeping generalisations, such issues are not just swept under the research or clinical carpet...
So it is then that the paper by Christina McDonnell and colleagues [1] is offered up for discussion, and once again minus any sweeping generalisations, how a diagnosis of autism spectrum disorder (ASD) with or without accompanying intellectual (learning) disability (ID) seems to increase the risk of maltreatment compared with not-autistic, not learning disabled population controls.
McDonnell et al discuss their cross-analysis of the records held at "the Department of Social Services (DSS) and the Autism and Developmental Disabilities Monitoring (ADDM) network" in parts of the United States (US). The ADDM has appeared before on this blog as part of those very important discussions about the (estimated) prevalence rate of autism in the US alongside related matters (see here). Researchers included quite a decent sized participant number - "ASD-only (n = 316), ASD and comorbid ID (ASD+ID; n = 291), ID-only (n = 1,280), and controls (n = 3,101)" - and set to work looking at the prevalence of maltreatment based on reported and substantiated cases.
So: "Controlling for demographic factors, this study found significantly higher odds of reported and substantiated maltreatment among children with ASD-only (odds ratio = 1.86 for reported, 1.51 for substantiated), ASD+ID (odds ratio = 2.35 for reported, 1.97 for substantiated), and ID-only (odds ratio = 2.45 for reported, 2.49 for substantiated) relative to a population control group." Specific maltreatment falling into the category 'physical neglect' was notable among the groups, but various other forms of abuse were also detailed as appearing. Researchers also observed that: "Maltreatment was associated with higher likelihood of aggression, hyperactivity, and tantrums for children with ASD."
In light of other independent evidence in this area [2] I don't think anyone should be too surprised by the McDonnell findings. I don't say that in a blasé manner; maltreatment is not something that any child should have to tolerate. I merely point out that the evidence is accumulating suggesting that a diagnosis of autism or learning disability does seem to increase the risk of such an issue occurring.
On the previous blogging occasion where this topic was discussed (see here) I went through some of the possible hows-and-whys of such behaviour(s). I'm not going to repeat myself here, aside from stressing that maltreatment probably has many different 'causes' or routes towards it and the more successful ways to tackle such issues are probably going to be multi-factorial.
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[1] McDonnell CG. et al. Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample. J Child Psychol Psychiatry. 2018 Oct 19.
[2] Duan G. et al. Physical maltreatment of children with autism in Henan province in China: A cross-sectional study. Child Abuse Negl. 2015 Oct;48:140-7.
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While it is obvious that a more challenging child is driving parents more easily over the edge, I would like to point to 3 other risk factors: 1. the parents of autistic children tend to have emotional regulation problems and mental health issues themselves, because often they are more neurodiverse, too (the same goes for the parents with regard to their own parents) 2. due to their issues, they have the more too much more stressful lives, in particular in low-welfare- countries 3. parents with a child on the autism spectrum tend to have more than just one child that is neurodiverse, which raises the stress level further, plus most families with many children tend to be very neurodiverse; although they are often under the surveillance of the CPS, they hardly get adequate help, on the contrary: CPS and family courts might wrongly blame too much of the behavioral issues of the children to educational failures of their parents and make things worse instead of making them better.
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