Maltreatment and Autism: The Most Vulnerable of the Vulnerable?

Background: Compared to children without disabilities, children with autism spectrum disorder (ASD) may be at increased risk of experiencing child abuse or neglect. Despite this potential increased risk, few well-controlled population-based studies have examined the prevalence of child maltreatment for clearly defined subtypes of disability, such as ASD. Given growing numbers of children with ASD and the need for systems of care that can adequately serve them, it is important to understand the nature and scale of maltreatment of children with ASD.

Objectives: We examined the prevalence of maltreatment among a large, population-level sample of children meeting well-defined and established criteria for ASD to answer two research questions: 1) Are children with ASD more likely to be referred for a maltreatment assessment or investigation from the TNDCS hotline than comparison children? and, 2) Are children with ASD more likely than those without ASD to be classified as maltreatment?

Methods: Data were obtained from the Tennessee Autism and Developmental Disabilities Monitoring (TN-ADDM) Network, Tennessee Department of Children’s Services (TNDCS) between 2006 and 2014, and the 2006 Tennessee Department of Health (TDH) birth vital records. Using deterministic linkage of common identifiers (e.g., name, address, birthday, gender), a single population-based dataset was created with information on ASD diagnosis, allegations of maltreatment (referrals to the hotline), processing of the allegations by TNDCS (triaged out or further action for either assessment or investigation), and the TNDCS determined maltreatments status. The final sample consisted all children from the 11 county TN-ADDM catchment area born in 2006, and included 387 children with ASD (cases) and 23,921 children without ASD (controls). These records were linked to all cases in the TNDCS database of children born in 2006 (N=4,385).

Results: At the time of submission, initial results indicate that twice as many children with ASD compared to control children (14.47% vs. 6.0%, X² = 45.9, p < .001) required ‘further action’ after their referral to the TNDCS hotline. Among those children referred for ‘further action’, slightly more children with ASD referred for Assessments had a decision of maltreatment (3.62% vs. 2.24%, X² =2.69, p = .101). In contrast, there were no significant differences in findings of maltreatment between the ASD and Control groups for those children referred for Investigation (2.07% vs. 2.56%) or those with combined Assessments-Investigations (3.88% vs. 4.09%).

Conclusions: In summary, children with ASD, compared to children without ASD, are more likely to be referred for ‘further action’ from the TNDCS hotline. When examining the processing of referrals, the results are mixed. Children with ASD are slightly more likely than controls to have a disposition of maltreatment after receiving an Assessment. In contrast, children with ASD are equally as likely to have a disposition of maltreatment after receiving an Investigation or Assessment-Investigation. These findings highlight the complexity of examining child maltreatment rates and additional analyses will examine the differences in the number of referrals children receive, the age at which maltreatment occurs, and the difference in rates of substantiated maltreatment for those who received further assessments-investigations.