Children with intellectual and developmental disabilities (IDD) are at a significantly higher risk of experiencing maltreatment compared to their typically developing peers. Studies consistently show that these children are more vulnerable to neglect, physical, sexual, and emotional abuse (Legano et al., 2021). In general, many factors leading to abuse among children with intellectual and developmental disabilities are the same as those found in the general population, i.e., single parents, teen parents, financial difficulties, lack of support, and various levels of stress.

Children with certain disabilities are more prone to maltreatment than others. For example, children born with congenital anomalies such as spina bifida or Down syndrome have an increased likelihood of maltreatment during the first month of life. Children with disabilities that affect conduct, such as attention deficit/hyperactivity disorder, may be vulnerable to physical abuse by parents or caregivers who may become frustrated by their behavior. Children who rely on adults for their care, as well as children who are nonverbal or hearing impaired, may be more likely than others to experience neglect or sexual abuse (CWIG, 2018).

Children with intellectual and developmental disabilities often have poor health outcomes due to lack of access to sufficient medical care and exclusion from public health and preventive care. A lack of training for care of patients with IDD has been reported across healthcare professions in medicine, dentistry, occupational and physical therapy, psychology, and nursing (Vi et al., 2023). Knowing the characteristics of a child’s disability can help you understand the barriers that these children face and better recognize and respond to those challenges.

9.1 Causes of IDD

Low birthweight, premature birth, multiple birth, and infections during pregnancy are associated with an increased risk for many developmental disabilities. Children who have a sibling with autism spectrum disorder are at a higher risk of also having autism spectrum disorder (CDC, 2025).

Untreated newborn jaundice (high levels of bilirubin in the blood during the first few days after birth) can cause a type of brain damage known as kernicterus. Children with kernicterus are more likely to have cerebral palsy, hearing and vision problems, and problems with their teeth. Early detection and treatment of newborn jaundice can prevent kernicterus (CDC, 2025).

Metabolic disorders affect how the body uses food and other materials for energy and growth. Problems with these processes can upset the balance of materials available for the body to function properly. Too much of one thing, or too little of another can disrupt overall body and brain functions. Phenylketonuria (PKU) and congenital hypothyroidism are examples of metabolic conditions that can lead to IDDs (NICHD, 2021).

Individuals with degenerative disorders may seem or be typical at birth and may meet usual developmental milestones for a time, but begin to experience disruptions in skills, abilities, and functions as the disorder progresses. In some cases, the disorder may not be detected until the child is an adolescent or adult and starts to show symptoms or lose abilities. Some degenerative disorders result from other conditions, such as untreated problems of metabolism (NICHD, 2021).

Other examples include:

• Epilepsy
• Prader-Willi syndrome
• Familial dysautonomia
• Neurological impairment

9.2 Defining Intellectual and Developmental Disability IDD

According to the Individuals With Disabilities Education Act (IDEA), the term “child with a disability” means a child (1) with intellectual disabilities, hearing impairments (including deafness), speech or language impairments, visual impairments (including blindness), serious emotional disturbance, orthopedic impairments, autism, traumatic brain injury, other health impairments, or specific learning disabilities and (2) who, by reason thereof, needs special education and related services (CWIG, 2018).

Intellectual and developmental disabilities are usually present at birth and can affect the trajectory of an person’s physical, intellectual, and/or emotional development. Many of these conditions affect multiple body parts or systems (NICHD, 2021). At least 25% of hearing loss among babies is due to maternal infections during pregnancy, such as cytomegalovirus (CMV) infection, complications after birth, and head trauma.

9.2.1 Intellectual Disability (ID)

Intellectual disability (ID) is characterized by both intellectual and adaptive functioning deficits in conceptual, social, and practical skills. Onset typically occurs during the developmental period (childhood and adolescence). The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5), classifies the severity of ID by the level of support required (Morinaga et al., 2024):

• mild if a person can live independently with minimal levels of support,
• moderate if a person can live independently with moderate levels of support,
• severe if a person needs daily assistance for self-care activities and safety supervision, and
• profound if a person needs 24-hour care.

Globally, ID ranks as the third leading cause of Disability-Adjusted Life Years for mental disorders among children aged 0 to 14 years and the seventh leading cause among all ages (Morinaga et al., 2024).

Some of the most common known causes of intellectual disability include fetal alcohol spectrum disorders; genetic and chromosomal conditions, such as Down syndrome and fragile X syndrome; and certain infections during pregnancy (CDC, 2025).

People with intellectual disabilities often experience communication difficulties, societal stigma, discrimination, and a lack of social support. These factors may be associated with greater risk for victimization by strangers, direct support staff, or family members (Brendli, Broda, and Brown, 2022).

9.2.2 Developmental Disability

The term “developmental disability” is a broader category of often lifelong challenges that can be intellectual, physical, or both. Developmental disabilities are a group of conditions due to an impairment in physical, learning, language, or behavior areas. These conditions begin during the child’s developmental period, may impact day-to-day functioning, and usually last throughout a person's lifetime. Most developmental disabilities begin before a baby is born, but some can happen after birth because of injury, infection, or other factors (CDC, 2025).

Most developmental disabilities are thought to be caused by a mix of factors. These factors include genetics:

• parental health and behaviors (such as smoking and drinking) during pregnancy;
• complications during birth;
• infections the mother might have during pregnancy or the baby might have very early in life; and
• exposure of the mother or child to high levels of environmental toxins, such as lead (CDC, 2025).

9.3 Physical Indicators of Child Maltreatment and Abuse in Children with IDD

Physical indicators  of child maltreatment and abuse in children with IDD can include:

• Unexplained bruises, scratches, marks or burns
• Bruising or bleeding in the genital area
• Poor hygiene
• Malnutrition or dehydration
• Medical neglect
• Physical restraint marks
• Difficulty walking or sitting

9.4 Behavioral Indicators of Child Maltreatment and Abuse in Children with IDD

Behavioral signs of abuse may be more obvious than physical signs of abuse in children with I/DD. Sudden or gradual changes in behavior, including increased aggression, withdrawal, fear, or changes in eating or sleeping habits are common behavioral indicators of maltreatment or abuse.

Some individuals with I/DD may engage in self-abusive behaviors or be prone to accidental injuries, making it more challenging to distinguish between self-harm and abuse. Additional behavioral signs can include:

• Regression in previously acquired skills
• Agitation, anxiety or stress around particular caregivers
• Inappropriate sexual behavior
• Atypical attachment
• Noncompliance

9.5 Communication Changes in Children with I/DD

A child who has difficulty communicating their wants and needs may become a target for physical abuse and neglect. The disabled child also can develop more extensive relationships of trust with greater numbers of people, and be unable to distinguish when boundaries are being crossed, resulting in potential sexual abuse.

Children with I/DD are often unable to report an abusive incident, making behavioral and circumstantial indicators important for identification. Communication challenges may also make it difficult for children with intellectual or developmental disabilities to seek help for maltreatment.

• Difficulty communicating
• Changes in vocalization
• Non-verbal cues

9.6 Behavioral Indicators of Caregivers to Children with IDD

Families with children with disabilities may feel unprepared to handle the care of a disabled child, including accepting that the child has a disability. It is important for professionals to understand the effects that raising a child with disabilities can have on family dynamics. Such knowledge can help medical professionals and service providers assess risk factors, family support systems, family functioning, and the additional risks associated with poverty (CWIG, 2018).

Family and parental risk factors include:

• stress and physical health
• lack of support
• family functioning
• poverty
• teen parenthood
• single parenthood

Pay attention to caregiver behaviors, such as refusal to follow directions, controlling attitudes, or attempts to isolate the child. Also note inconsistent explanations, a dismissive attitude toward the child or other people involved in the child’s care, anger, frustration, and isolation.