Epidemiology of Neglect and Maltreatment in Children with Autism Spectrum Disorders

Background:   Although researchers have speculated that youth with autism spectrum disorders (ASD) are at particular risk for maltreatment due to social and communication impairments, there has been little research examining this issue. One study reported ASD rates of 18.5% and 16.6% for physical and sexual abuse respectively; however this data was centered on caregiver report in a high-functioning sample.  Based on an increasing ASD prevalence, it is imperative that we determine the relationship between children with ASD and maltreatment.

Objectives:  This research aims to determine the prevalence of neglect and maltreatment among children with ASD, determine the number and type of outside placements, compare findings with a matched control group, and determine risk factors of neglect and maltreatment.

Methods:  Information was collected on 8-year old children in South Carolina between 2000 and 2008 as part of an ongoing CDC-sponsored population-based multiple source surveillance of ASD. Data collected included ASD case status, previous diagnosis, Intellectual Disability (ID), and presence of autism discriminators. These data were linked with data from the Department of Social Services (DSS), the lead agency for child protective services and foster care in the state.   DSS data included number of cases of maltreatment, number of outside placements, and maltreatment category for founded cases.   This data was provided for all children with ASD as well as on a comparison control group that was randomly selected and matched on age, sex, and race, at a rate of 3:1.   From the linked dataset, we calculated descriptive statistics for number of founded DSS cases and placements, with Chi-square tests or Wilcoxon rank sum tests used to determine differences between ASD-cases and ASD-non-cases.  Logistic regression was used to calculate risk factors of neglect and maltreatment among children with ASD. 

Results:  Of 873 children with ASD, 115 (13%) were identified in DSS.  ASD cases had a mean of 1.4 (SD±0.73) founded cases, compared to 1.9 (±1.3) for non-ASD controls (p=0.001).   Reasons for removal of children with ASD were similar to the control group, with the majority removed due to neglect.  As children aged and were in the system longer, those with ASD more often reported neglect as the maltreatment code, compared to controls (92% versus 71%, X²=4.3, p=0.04).  And although not significant, 12% of ASD cases reported medical neglect, compared to 8% of non-ASD controls.

ID, previous ASD diagnosis, and special education placement were determined to be significant risk factors predicting DSS services. OR was 4.0 for ID compared to non-ID children (95% CI 2.3-7.2), 1.9 for NO previous ASD diagnosis compared to children with prior diagnosis (95% CI 1.1-3.2) and 2.4 for children in an “Other Health Impairment” educational classroom compared to children in other classrooms (95% CI 1.1-5.1). 

Conclusions:  This research indicates that children with ASD are similar to controls with regards to percent in DSS and maltreatment type, however their need for social services does not decline with age.  ASD children with ID, no prior ASD diagnosis, and in a non-autism specific classroom are at highest risk of requiring DSS services.