Abuse of Children and Dependent AdultsPage 4 of 10

2. Risk and Protective Factors in Abuse

In Child Abuse

A combination of individual, relational, community, and societal factors contribute to the risk of child maltreatment. Although children are not responsible for the harm inflicted upon them, certain characteristics have been found to increase their risk of being abused or neglected. Risk factors are those characteristics associated with child maltreatment—they may or may not be direct causes (CDC, 2019b).

Risk Factors for Victimization

Individual risk factors

  • Children younger than 4 years of age

Special needs that may increase caregiver burden (e.g., disabilities, mental health issues, chronic physical illnesses) (CDC, 2019b).

Additional child factors that can increase the risk of abuse include a baby that is sickly, colicky, unwanted, or a product of an abusive relationship; a lack of attachment between child and parent can also be a risk factor (Child Matters, n.d.).

Age can be a factor in the type of abuse children experience. Babies are small and in need of constant care, and are more likely to experience abuse such as shaking by a frustrated or overwhelmed caregiver, while teenagers are at greater risk for sexual abuse (APA, 2019).

Children with aggression, attention deficits, difficult temperaments, or behavior problems have an increased risk of maltreatment, especially if their parents are not well equipped to cope with the behavior. Abuse can then exacerbate the original problem, or a physically abused child may develop aggressive behaviors; in either case a vicious cycle ensues (APA, 2019).

Risk Factors for Perpetration

Individual risk factors

  • Parents’ lack of understanding of children’s needs, child development and parenting skills
  • Parents’ history of child maltreatment in family of origin
  • Substance abuse and/or mental health issues including depression in the family
  • Parental characteristics such as young age, low education, single parenthood, large number of dependent children, and low income
  • Non-biological, transient caregivers in the home (eg, mother’s male partner)
  • Parental thoughts and emotions that tend to support or justify maltreatment behaviors (CDC, 2019b).
  • Parent has already abused a child (Child Matters, n.d.).

Family risk factors

  • Social isolation
  • Family disorganization, dissolution, and violence, including intimate partner violence
  • Parenting stress, poor parent-child relationships, and negative interactions (CDC, 2019b).

Community risk factors

  • Community violence
  • Concentrated neighborhood disadvantage (eg, high poverty and residential instability, high unemployment rates, high density of alcohol outlets), and poor social connections (CDC, 2019b).

It is important to remember that the vast majority of parents and caregivers dealing with the stresses noted above do not abuse the children in their care. However, being aware of these factors and alert to a situation can allow a bystander, family member, or other adult to be supportive, offer assistance or, if necessary, take appropriate action to protect a child’s health and safety (APA, 2019; Child Matters, n.d.).

Protective Factors for Child Maltreatment

Protective factors may reduce the likelihood of children’s being abused or neglected. However, protective factors have not been studied as extensively or rigorously as risk factors and additional work to identify and understanding protective factors is just as important (CDC, 2019b).

Family protective factors

  • Supportive family environment and social networks
  • Concrete support for basic needs
  • Nurturing parenting skills
  • Stable family relationships
  • Household rules and child monitoring
  • Parental employment
  • Parental education
  • Adequate housing
  • Access to healthcare and social services
  • Caring adults outside the family who can serve as role models or mentors

Community protective factors

  • Communities that support parents and take responsibility for preventing abuse (CDC, 2019b).

Factors of a child’s personality and experience can also act as protective factors. These include:

  • Optimism, high self-esteem, intelligence, creativity, humor, and independence, which improve coping skills when dealing with adversity
  • Acceptance from peers
  • Experience of love, acceptance, positive guidance, and protection from a caring adult (APA, 2019).

Protective Factors for Children with Disabilities

Children with disabilities are more vulnerable to maltreatment, but different forms of disability carry different levels of risk and not all children diagnosed with the same type of disability will have the same experience with abuse or neglect. Children with conduct-related disabilities may face a higher risk of physical abuse because of the inability of parents/caregivers to deal with the frustration engendered by their behavior (CWIG, 2018).

Children whose disability makes them entirely dependent on a caregiver, who experience hearing impairment, or are non-verbal, are at increased risk of neglect or sexual abuse. Welfare and healthcare providers will be better able to assist a child and family if they understand the nuances of the disability and of the child’s personal, family, and social situations (CWIG, 2018).

Children with disabilities may feel isolated and powerless. They may have a limited ability to protect themselves or even to understand if they are being mistreated. The lack of independence and privacy that come with a need for total reliance on a caregiver may make it difficult for a child to identify inappropriate behavior (CWIG, 2018).

While most maltreatment is perpetrated by family members, children with disabilities face additional risks with other caregivers. In cases of substantiated abuse, they are more likely than children without disabilities to be placed in out-of-home care; also, they may face higher risks of sexual abuse with placements in isolating environments such as group homes or long-term care facilities, and it is important that foster care parents receive specific training in disability-related issues (CWIG, 2018).

Despite a common misperception that having a disability is a protective factor for a person, there are still some protective possibilities. One potential protective factor is willingness of parents to engage with a variety of service professionals regarding care for a disabled child. In addition, programs and services that are deliberately developed to emphasize a child’s strengths and/or the individual strengths of caregivers can improve confidence and self-esteem and help a child feel more supported (CWIG, 2018).

In Dependent Adult Abuse

As with child abuse, a combination of individual, relational, community, and societal factors contribute to the risk of dependent adult maltreatment. They are contributing factors and may or may not be direct causes, but understanding them may facilitate opportunities for prevention (CDC, 2019c).

Risk Factors for Perpetration

Individual Level

  • Current diagnosis of mental illness
  • Current abuse of alcohol
  • High levels of hostility
  • Poor or inadequate preparation or training for caregiving responsibilities
  • Assumption of caregiving responsibilities at an early age
  • Inadequate coping skills
  • Exposure to abuse as a child

Relationship Level

  • High financial and emotional dependence upon a vulnerable elder
  • Past experience of disruptive behavior
  • Lack of social support
  • Lack of formal support

Community Level

  • Formal services—such as respite care for those providing care to elders—are limited, inaccessible, or unavailable

Societal Level

A culture where:

  • There is high tolerance and acceptance of aggressive behavior
  • Healthcare personnel, guardians, and other agents are given greater freedom in routine care and decision making
  • Family members are expected to care for elders without seeking help from others
  • Persons are encouraged to endure suffering or remain silent regarding their pain
  • There are negative beliefs about aging and elders (CDC, 2019c).

In addition to the above factors, there are also specific characteristics of institutional settings that can increase the risk for perpetration of abuse of vulnerable elders, including:

  • Unsympathetic or negative attitudes toward residents
  • Chronic staffing problems
  • Lack of administrative oversight, staff burnout, and stressful working conditions (CDC, 2019c).

Protective Factors for Elder Abuse

As with child abuse, protective factors may help reduce risk for perpetrating abuse and neglect of vulnerable adults, but protective factors have not been studied as extensively or rigorously as risk factors. Identifying and understanding protective factors are important as a means to determine whether they are effective as buffers against abuse of elders and other vulnerable adults (CDC, 2019c).

Protective Factors for Perpetration

Relationship Level

  • Having numerous, strong relationships with people of varying social status

Community Level

  • Coordination of resources and services among community agencies and organizations that serve the elder population and their caregivers
  • Higher levels of community cohesion and a strong sense of community or community identity
  • Higher levels of community functionality and greater collective efficacy

Institutional settings

  • Effective monitoring systems
  • Solid institutional policies and procedures regarding patient care
  • Regular training on elder abuse and neglect for employees
  • Education and clear guidance on durable power of attorney and how it is to be used
  • Regular visits by family members, volunteers, and social workers (CDC, 2019c).

For Adults with Dementia

Elders with dementia are thought to be at greater risk of abuse and neglect than those of the general population of elders. Reasons for the added vulnerability include the fact that dementia can prevent a person from reporting or even recognizing that they are being maltreated, and they may be more easily taken advantage of by strangers (Alzheimer’s Association, 2019).

The elder population is growing and the number of people with dementias, especially Alzheimer’s disease, is also increasing, so this is a growing public health problem (NCEA, 2011; Alzheimer’s Association, 2019). While 1 in 10 elders is believed to have been subject to abuse or neglect, recent studies show that nearly 50% of those with dementia have been subject to maltreatment (NCOA, n.d.).

In one U.S. study, 20% of caregivers indicated concern that they might become violent with people in their care. Three studies done in other countries found overall rates of caregiver abuse of people with dementia in the range from 34% to 62%, while a U.S. study found abuse and neglect of people with dementia in 47.3% of the caregivers studied (NCEA, 2011).

In one study published in the Journal of the American Geriatrics Society, caregivers of those with dementia were surveyed about the types of abuse they had committed, and 60% reported verbal abuse, 5% to 10% physical abuse, and 14% neglect. Caregiver characteristics that are associated with mistreatment of people with dementia include anxiety, depressive symptoms, lack of social contacts, perceived burden, emotional status, and role limitations due to emotional problems. However, care recipients’ psychological aggression and physical assault behaviors were deemed to be the best indicators for elder mistreatment in this study (NCEA, 2011). This is one of many areas surrounding elders and elder abuse that are in critical need of additional research.

For Adults with Disabilities

Based on figures from the 2010 U.S. Census, approximately 14 million, or 1 in 3, adults age 65 or older had a disability (NCEA, 2012). In 2014 estimates indicate that just over 16 million (35.9%) of non-institutionalized adults 65 and older have a disability (NCEA, 2019). A growing elder population and increasing levels of certain diseases associated with disability pointed toward a continuing rise in numbers.

While much more research needs to be done, what is available points to a significant increase in the risk for abuse of dependent adults with disabilities when compared with the risk for those adults without disabilities. Both women and men, institutionalized and non-institutionalized, are subject to this increased risk. A recent meta-analysis of research concludes that “over the course of their lives, IPV [interpersonal violence] occurs at disproportionate and elevated rates among men and women with disabilities” (NCEA, 2019; Hughes et al, 2012; APA, 2019a; WHO, 2019).

Millions of American adults utilize Personal Assistance Service (PAS), which refers to aid in performing activities of well-being, comfort, safety, appearance, and community interaction. Most PAS users are community dwellers and are older than 65 years of age. The majority of them (79%) utilize PAS provided by volunteer/unpaid persons, often a family member or friend. About 11% use a combination of volunteer and paid services, while 10% use only paid (NCEA, 2012).

Thirty percent of adults with disabilities who use PAS for aid with activities of daily living reported one or more types of maltreatment by their primary provider. Adults with lower incomes were most likely to experience mistreatment. Available studies also show increased risk of abuse for institutionalized men and women with disabilities (NCEA, 2012).

Abuse can be particularly hard to recognize with dependent adults and also hard for them to report. Increased awareness and inquiry are critical to helping to reduce this form of abuse.