Children with a disability are at greater risk of death at the hands of someone else – through homicide or the effects of maltreatment – than children without a disability.
John Frederick* has led a systematic review looking at the theories that explain why this is the case. Here is John:
There is growing recognition of the increased vulnerability to abuse of children who are disabled. Specifically, within the literature on homicides and maltreatment-related deaths of children, disabled children have been identified as likely to experience a greater risk.
We systematically reviewed the empirical literature to better understand the risk factors involved and assess support for the theories that have been proposed to explain this greater risk.
To start with the latter, what are the theories to explain disabled children’s higher risk? They respectively focus on:
- The stress of caregiving;
- Altruistic intent;
- Lack of bonding with the child;
- The challenging behaviours of the child;
- Cultural beliefs about disabled children; and
- Evolutionary imperatives.
Reviewing the literature from 1990 until 2018 via six different databases, we identified 25 empirical articles that met our criteria.
Two of the six theoretical explanations were found to be more commonly used and supported:
- the theory relating to the stress of caregiving, whereby parents experience more physical, economic and emotional demands when their child is disabled which can increase the sense of being overwhelmed, stressed and isolated; and,
- the theory relating to altruistic intent, involving two forms of altruistic filicide. The first is ‘filicide associated with suicide,’ committed by parents who claim that they ‘could not abandon their children’ when they sought to die by suicide. The second is ‘filicide to relieve suffering,’ where the parent’s aim is to alleviate the child’s suffering, which may have been real or imagined.
There also appeared to be some support for the theory relating to lack of bonding with the child, and for the theory regarding the challenging behaviours of the child as well, but not for theories around cultural beliefs about disabled children nor evolutionary imperatives.
All these theories should not necessarily be considered discrete and disconnected, however. Several theories, operating in combination, may provide a fuller explanation for the deaths of these children.
Some of the reviewed articles highlighted that while some disabled children died as a result of violence directed at them, others died either as a result of general neglect of their care and health needs, or neglect with the deliberate intention of causing death. The issue of ‘deliberate or malicious failure to supply the needs of a child’, termed as ‘deprivational abuse’, may be a specific form of harm directed at and experienced by disabled children.
A range of potential risk factors were found in the reviewed articles, relating to the child, the perpetrator and the environment, with the pathway to harming the child involving an interactive process between each of these. Type of disability, such as autism, family factors, such as stress and mental illness, and risks associated with the environment, such as a lack of services, were evident.
The overarching message is that we still have limited evidence regarding the specific risks involved in the homicides and maltreatment-related deaths of disabled children. Greater international cooperation about how we record such information would assist us as we move forward.
In practical terms, going forward, there appears to be a need for:
- Coordination of clear care pathways for families with disabled children, including the provision of support and counselling.
- Improved professional awareness of the needs of disabled children and understanding that these needs may not coincide with those of their parents or carers.
- Provision of opportunities for respite to enable parents of disabled children to continue their task of caring.
- Consistent data on disabled children to be collected through existing child death review processes and the criminal justice system.
* John is a visiting scholar at the University of Edinburgh, though based in Australia. He is also a member of our project to better understand the needs of children and young people bereaved by domestic homicide (more on that later! We’ll be doing interviews with young people, caregivers and professionals from early 2021).