Abuse of the disabled child: a systematic review of population-based studies

Objective To ascertain the strength of the association between childhood disability and abuse and neglect. Methods Systematic review of population- based studies published between 1966 and January 2006. Medline, Embase, Cinahl, Cochrane library, National Research Register, Social Sciences database and PsychInfo databases were searched for potentially relevant studies. Inclusion criteria: populationbased cohort, case - control or cross- sectional studies of children < 18 years of age that reported empirical data on the association of abuse with disability. Risk estimates were expressed as odds ratios with 95% confidence intervals ( CI) where possible. Meta- analysis was not undertaken because of heterogeneity of studies. Results Four studies met the inclusion criteria. Two were longitudinal studies, one was a retrospective birth cohort and the remaining study was a cross- sectional survey. Types of disability studied varied widely as did methods used to ascertain abuse and neglect. Two studies accounted for potential confounding. Three studies reported an association between psychological and emotional disabilities and abuse. Two studies reported an association of learning disability with abuse. Only one study examined the association of physical disability ( cerebral palsy) with abuse reporting an adjusted odds ratio for all forms of abuse of 1.79 ( 95% CI 0.96, 3.36) and for physical abuse of 3.00 ( 95% CI 1.29, 6.78). Conclusions The evidence base for an association of disability with abuse and neglect is weak. Psychological and emotional problems, and learning difficulties appear to be associated with abuse but this association might arise because these conditions share a common aetiological pathway with abuse. There is limited evidence that physical disability predisposes to abuse