Important Notice
This Addendum is required for anyone who completed NY Child Abuse on our website between the dates of June 10, 2024 to August 31, 2025. If you did not take the NY Child Abuse course from our website during the dates indicated, we will not report the completion of this Addendum to NY State. If you’re not sure if you took the previous course from us, please email ([email protected]) or call (707 459-3475 Pacific time).
Children with disabilities are at an elevated risk of maltreatment, abuse, and neglect due to dependence on caregivers, social isolation, and challenges in expressing their needs. The type and severity of the disability can influence both the likelihood and nature of maltreatment.
Younger children may experience higher rates of neglect than older children, suggesting that age plays a role in vulnerability. Children with autism spectrum disorder alone appear particularly vulnerable to physical abuse, whereas those with comorbid autism spectrum disorder and intellectual disability face elevated risks of multiple forms of abuse, including emotional and sexual abuse (Makhoul Khoury et al., 2025).
Children with sensory impairments, such as those who are deaf or hard-of-hearing, have unique vulnerabilities. Studies show that more than 94% of deaf or hard-of-hearing children experience both physical and psychological maltreatment, and over half endure severe abuse (Makhoul Khoury et al., 2025).
Physical Abuse Indicators
Bruises and welts
Specific Signs
- Unexplained or recurring bruises in varying stages of healing;
- Found in atypical locations (torso, back, buttocks, neck, inner thighs, face);
- Forming patterned shapes (such as a belt buckle, cord, or handprint);
- Seen on both sides of the body (accidental injuries are usually on one side).
Special Considerations for Children with IDD
- A child with limited mobility may have no accidental bruises.
- Bruises in a non-walking child are highly suspicious.
Burns
Specific Signs
- Patterned burns (e.g., shaped like a cigarette, iron, or other implement);
- immersion burns (glove-like on hands, sock-like on feet, or doughnut-shaped on buttocks/genitalia), suggesting forced contact with hot liquid.
Special Considerations for Children with IDD
Any burn on a child with IDD must be thoroughly investigated, as they may have difficulty communicating the source of the pain.
Fractures
Specific Signs
- Multiple or repeated fractures in various stages of healing;
- Spiral fractures (from a twisting motion) in non-ambulatory children;
- Fractures that are inconsistent with the child's medical condition (e.g., not explained by a fragile bone disorder).
Special Considerations for Children with IDD
Children with some medical conditions may be prone to fractures, but a clear medical explanation must exist and must be consistent with the type of injury.
Injuries to the head or face
Specific Signs
- Missing teeth that are unexplained;
- Lacerations or abrasions to the mouth, lips, gums, or eyes;
- Spotty balding (from hair pulling).
Special Considerations for Children with IDD
A child with head-banging or self-injurious behavior may have head injuries, but the pattern should be consistent with the known behavior, not a caregiver's conflicting explanation.
Physical restraint marks
Specific Signs
Rope burns or ligature marks on the wrists, ankles, or neck from being tied up.
Special Considerations for Children with IDD
The use of restraints for behavioral control should only be done under strict, documented circumstances; unexplained marks are a sign of abuse.