Prevalence of abuse of people with disabilities

Vulnerability to abuse

People with disabilities may be more vulnerable to abuse than are others.

A series of NDA expert seminars held in autumn 2006 explored explanations for this higher vulnerability to abuse.[4] People with disabilities in day or residential services may be exposed to higher risks if there are not appropriate safeguards in place. They may be more isolated from friends and family, which renders them more vulnerable to abuse. Their impairment may be targeted as a focus of abuse.

Vulnerability factors were also identified in the Sexual Violence and Abuse in Ireland Report's review of the literature relating to sexual abuse of people with intellectual disabilities

"..Factors that appear to increase the vulnerability of this population including deficiencies of sexual knowledge, physical and emotional dependence on caregivers, multiple care-giving, limited communication skills and behavioural difficulties "[5]

People with intellectual disabilities may also be more vulnerable to abuse because they may lack or have a reduced capacity to consent to sexual activity. Another factor can be poor exposure to sex education and sexual health programmes.[6]

Obstacles to disclosure

Disclosure of abuse may be particularly difficult. People with disabilities in a position of care dependency may find it difficult to disclose abuse, particularly if they do not see they have any realistic care alternatives. The NDA expert seminars noted that people with disabilities may feel disempowered from making complaints, may have little contact with the outside world, may find it more difficult to communicate, or to be taken seriously if they do complain. So people with disabilities may be easier for abusers to victimise.

The capacity of the criminal justice system to hear and respond to complaints from people with disabilities is another factor affecting disclosure.

The symptoms of abuse may be attributed to a person's disability, and thus overlooked, as noted by the Sexual abuse and violence in Ireland Report (2002).

Children First (1999) has guidelines on signs and symptoms of child abuse - development of equivalent guidance in relation to abuse of people with disabilities, alongside training to enable frontline staff recognise abuse symptoms, would be helpful.

Health professionals can play a key role in helping uncover abuse, particularly as physical and sexual abuse may result in a health consultation. It could be valuable to develop and implement protocols whereby health professionals would routinely check for the possibility of abuse when dealing with patients, particularly those with disabilities.

Research findings

Few research studies

There are very few national and international studies on the prevalence of abuse of people with disabilities, according to a review of the literature undertaken for the NDA.[7] This dearth of studies may partly reflect the obstacles to disclosure of such abuse. Most of the available studies focus on specific kinds of abuse, such as sexual abuse or domestic violence, and or particular sub-groups such as children or people with intellectual disabilities.

To summarise this literature, the limited national and international evidence available suggests that people with disabilities are more vulnerable to abuse than the population in general.

An exception to this trend is that Irish data on reported abuse to rape crisis centres shows people with disabilities are under-represented in those reporting such abuse. However, it is possible that problems around disclosure and around access to rape crisis services affect these figures. The true incidence of sexual abuse in Ireland against people with disabilities may not in fact be lower than for other citizens. Other Irish published research and investigations have documented significant incidence of alleged sexual abuse within services over long time periods.[8]

Gender abuse and domestic violence

In the case of domestic violence or abuse by an intimate partner, Irish data shows adults with severely hampering disabilities were 2.9 times more likely to have experienced such abuse than other adults. Twice as many adults with disabilities had experienced severe abuse compared with other adults.[9]

The prevalence of abuse among women with disabilities began to be studied internationally in the 1980s and 1990s. There is now a considerable body of evidence that violence/abuse are serious problems for persons with disabilities and they are at greater risk than non-disabled persons (Powers et al, 2004; Hassouneh-Phillips and Curry, 2002; Hughes et al, 2001; Powers et al 2002; Sobsey and Doe, 1991; Turk and Brown; 1993; Young et al 1997).

In a national survey in the USA, Young et al (1997) found similar levels of overall abuse among women with and without disabilities (62% of both groups of women had experienced some type of abuse at some points in their lives); however women with disabilities reported significantly longer durations of physical and sexual abuse when compared to non-disabled women and they were more likely to have been abused within the past year. Of women who had experienced abuse, half of each group had experienced physical or sexual abuse. Husbands or live-in partners were the most common perpetrators of emotional or physical abused for both groups. Male strangers were the most common perpetrators of sexual abuse. Women with physical disabilities were more likely to be abused by their attendants and by health care providers (Young et al, 1997).

Other surveys have found higher rates of abuse among women with disabilities. For example, a survey of 200 women with physical disabilities or a combination of physical and cognitive disabilities in the USA revealed that 67% had experienced physical abuse and 53% had experienced sexual abuse at some point in their lives (Powers et al., 2002). These rates of physical and sexual abuse are approximately double the national rates of women without disabilities (National Research Council, 1996).

The Disabled Women's Network of Canada (Ridington, 1989) surveyed 245 women with disabilities and found that 40% had experienced abuse. Perpetrators of the abuse were primarily spouses and ex-spouses (37%) and strangers (28%), followed by parents (15%), service providers (10%), and dates (7%). Less than half the victims reported this violence, due mostly to fear and dependency.

Another 2002 study on 177 women with physical disabilities over the age of 18 years in Michigan, USA reported a prevalence of domestic abuse was 56%. There was a positive relationship between abuse and being unemployed, divorced, having more than one disability, and having a hearing impairment (Milberger et al, 2002).

Abuse of children with disabilities

Some international evidence puts the risk of all types of abuse for children with disabilities at 1.7 times higher than that for children without disabilities,[10] while some US research has shown that children with disabilities are twice as likely to be physically, emotionally and sexually abused.[11] Canadian research suggests that risk of sexual violence was 2-4 times higher for those housed in institutional settings.[12]

A study of children with disabilities in Kansas found they were 3 times more likely to be sexually abused than non-disabled children.[13] Evidence from Norway suggests that deaf children are at greater risk than their hearing peers, with 40% of deaf women and 33% of deaf men in a Norwegian study stating they have experienced childhood sexual abuse, compared to 19% and 10% for hearing women and men respectively. Half of these reported cases were in respect of periods spent in boarding schools for deaf children.[14] American estimates show up to 1 in 3 adolescents with learning disabilities have been sexually abused, while UK estimates are 1 in 10.[15] An Israeli study of 50 adolescents with intellectual disabilities and 50 other adolescents found a higher incidence of abuse among the young people with disabilities.[16]

The inquiry into the Brothers of Charity services in Galway investigated allegations of abuse against children receiving residential services over the period 1965 to 1998. The inquiry investigated allegations of abuse made by 21 former residents against a total of 18 individual staff members.[17]

Ireland's rape crisis centre statistics for 2006 showed 4% of those reporting childhood sexual abuse had a disability, of whom over half reported abuse by a family member, typically before the age of 11.[18]

The Ombudsman for Children has expressed particular concern about inadequate protection in relation to children with disabilities in residential care.[19]

Sexual abuse

Ireland's rape crisis statistics show the proportion of people with disabilities who report sexual abuse to such services is lower than the share of people with disabilities in the general population. While about 10% of the population have a disability (as per Census 2006), people with disabilities accounted for just 5% of users of rape crisis services in 2006.[20] The main categories of disabled people using rape crisis services were those with intellectual and those with mobility impairments. As noted above, it is possible that the difficulties around disclosure of abuse by people with disabilities may mean these figures do not accurately portray the relative incidence of sexual abuse of people with disabilities and the general population.

An Irish study (McCormack et al) examined 118 episodes of confirmed sexual abuse recorded in the records of a large intellectual disability service, where either the perpetrator or victim had a learning disability.[21] Among a study population of 1,450 clients over a 15-year period, this study found there were 250 allegations of sexual abuse of which a total of 118 were confirmed following multi-disciplinary investigation. This amounted to an average of 17 allegations and eight confirmed cases per year over the period. In most episodes the victim had a learning disability, while in more than half of the episodes, the perpetrator had a learning disability. 14% of episodes involved child victims and 86% of victims were adults.

Internationally, Sobsey and Doe (1991) were among the first to report sexual abuse and assault among institutionalised children and adults with intellectual disabilities in the USA. In their review of 162 reported cases of sexual abuse, the majority of victims were under 20 and female. The majority of offenders were male. Most of the victims had a relationship with their perpetrator, including family members, acquaintances, paid service providers, or a relationship that was specifically related to their disability, such as personal care assistants, psychiatrists and residential care staff.

Brown, Stein and Turk (1995) reported a large-scale study carried out across the south east of England of sexual abuse of people with learning disabilities. About a sixth of these cases were perpetrated by family members, a sixth by service workers or volunteers and the other sixth by known and trusted people within the community, often occupying "pillar of the community" roles. Very few cases of abuse by strangers were reported. The remaining cases were perpetrated by other service users.[22]

Elder abuse

International evidence shows that between three and five percent of older people in the community are the victims of abuse at any one time[23], and this is likely to underestimate the problem since there are no statistics on the prevalence of abuse in institutions (Working Group on Elder Abuse 2002). The HSE's elder abuse service received 927 allegations of abuse in 2007.[24]

Future data collection

Potential sources of information include:

  • Records of alleged abuse reported in specific services (e.g. HSE child protection and elder abuse statistics)
  • Statistics of victim support services (e.g. Rape Crisis Centres)
  • One-off studies
  • National crime statistics

Agreement has been reached for the Garda Public Attitudes survey to record disability status, which will give information for the future on the relative incidence of crimes against people with disabilities and others. This information is not currently available.

It would also be valuable if Cosc were to ensure that disability status would be recorded as standard in any research it conducts or commissions. Cosc could also encourage the recording of information on disability status as standard by abuse support agencies receiving state funds. This would help build a more accurate picture of the incidence of domestic, sexual or gender-based abuse of people with disabilities.

NDA's 2007 - 2009 strategic plan sets out NDA's intention to conduct research in this area to improve the evidence base for service planning and provision. To this end NDA has recently established an Expert Advisory Committee to advise on the design and implementation of a national study to identify the prevalence of abuse of people with disabilities and areas for improvements within systems for protection and redress.

[4] More detail on the 2006 expert seminar findings are given in Appendix

[5] McGee et al. (2002) Sexual abuse and violence in Ireland (SAVI Report) Dublin: Liffey Press – p 244

[6] Allen and Seery (2007) The current status of relationships and sexuality education practice for people with an intellectual disability in Ireland. Dublin: Irish Sex Education Network

[7]Brown (2006) A review of the literature on abuse of people with disabilities. NDA, unpublished. The author of the literature review argues that obstacles to disclosure may be a factor in the lack of evidence (Brown 2006: 44)

[8] McCormack et al (2005) study of 250 documented allegations of abuse (118 confirmed) reported in St. Michael’s House over a 15-year period; McCoy investigation (2007) into allegations of abuse 1965-1998, Brothers of Charity Services, Galway

[9] Watson et al. (2005) Domestic Abuse of Women and Men in Ireland. ESRI/ National Crime Council

[10] National Center on Child Abuse and Neglect, cited in Brown 2006: 54

[11] Westcott and Cross, 1996, quoted in McGee (2002) Sexual Abuse and Violence in Ireland (SAVI Report), Dublin: Liffey Press, p. 244

[12] Sobsey and Mansell (1990) “Prevalence of sexual abuse of people with developmental disabilities”, Developmental Disabilities Bulletin 18 51-66, quoted in McGee et al.(2002) Sexual Abuse and Violence in Ireland, p. 250

[13] Sullivan and Knutson 2000, quoted in Bob McCormack, Denise Kavanagh, Shay Caffrey, Anne Power (2005) Investigating Sexual Abuse: Findings of a 15-Year Longitudinal Study. Journal of Applied Research in Intellectual Disabilities 18 (3), 217–227

[14] Kvam (2004) “Sexual abuse of deaf children. A retrospective analysis of the prevalence and characteristics of childhood sexual abuse among deaf adults in Norway”Child Abuse and Neglect Volume 28, Issue 3, March 2004, Pages 241-251, quoted in Brown 2006: 54

[15] Allington-Smith et al.(2002) “Management of sexually-abused children with learning disabilities” Advances in Psychiatric treatment 8: 66-72

[16] Reiter S., Bryen D. Schachar I. (2007) “Adolescents with intellectual disabilities as
victims of abuse” Journal of Intellectual Disability pp. 371-385

[17] McCoy, D (2007) Report on Western Health Board Inquiry into Brothers of Charity Services in Galway. HSE

[18] National Rape Crisis Statistics (2006) p. 23

[19] Ombudsman for Children 2006 Annual Report

[20] National Rape Crisis Statistics (2006) pages 51, 12

[21] Bob McCormack, Denise Kavanagh, Shay Caffrey, Anne Power (2005) Investigating Sexual Abuse: Findings of a 15-Year Longitudinal Study. Journal of Applied Research in Intellectual Disabilities 18 (3), 217–227

[22] Brown H, Stein J and Turk V (1995) “The sexual abuse of adults with learning disabilities: report of a two-year incidence survey. Mental handicap research 8(1) pp. 3-24

[23] O’Loughlin, Ann and Duggan, J (1998) Abuse, Neglect and Mistreatment of Older People. Dublin: NCAOP

[24]As reported in Irish Times 29 January 2008

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