![](media/image1.png){width="5.96875in" height="0.41944444444444445in"}

Top of Form

## Complete Summary

#### GUIDELINE TITLE

Maltreatment of children with disabilities.

#### BIBLIOGRAPHIC SOURCE(S)

Hibbard RA, Desch LW, American Academy of Pediatrics Committee on Child
Abuse and Neglect, American Academy of Pediatrics Council on Children
With Disabilities. Maltreatment of children with disabilities.
Pediatrics 2007 May;119(5):1018-25. \[39 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17473105)

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: American Academy of
Pediatrics: Committee on Child Abuse and Neglect and Committee on
Children With Disabilities. Assessment of maltreatment of children with
disabilities. Pediatrics 2001 Aug;108(2):508-12.

All clinical reports and policy statements from the American Academy of
Pediatrics automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or before that time.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Maltreatment of children, including those with disabilities

**Note**: For purposes of this report, the terms \"disability\" and
\"special health care needs\" include the full spectrum of physical,
mental, and emotional impairment.

#### GUIDELINE CATEGORY

Evaluation\
Prevention\
Risk Assessment\
Screening\
Treatment

#### CLINICAL SPECIALTY

Family Practice\
Pediatrics\
Preventive Medicine\
Psychology

#### INTENDED USERS

Advanced Practice Nurses\
Allied Health Personnel\
Nurses\
Physician Assistants\
Physicians\
Social Workers

#### GUIDELINE OBJECTIVE(S)

-   To increase awareness and provide education to pediatricians
    regarding risk factors of child abuse and neglect

-   To ensure that children with disabilities are recognized as a
    population that is also at risk of maltreatment

-   To present recommendations for early recognition, intervention,
    early detection and prevention of child abuse and neglect in this
    population

#### TARGET POPULATION

Children and adolescents with disabilities, including physical, mental,
and emotional impairment

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Screening**

1.  Assessment of:

    -   Signs and symptoms of child maltreatment

    -   Disabling conditions that can mimic child abuse

    -   Family\'s strengths and need for resources

2.  Evaluation of maltreated child for disabilities

**Prevention**

1.  Provision of:

    -   Emotional support

    -   Needed equipment and resources to children and families

2.  Treatment plans and collaborative team approach

3.  Advocacy for:

    -   Children with disabilities or special health care needs

    -   Changes in state and local policies

    -   Positive behavioral supports and elimination of aversive
        techniques

    -   Better health care coverage

#### MAJOR OUTCOMES CONSIDERED

-   Causal factors related to child maltreatment

-   Incidence of maltreatment in children with disabilities

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

Not stated

#### NUMBER OF SOURCE DOCUMENTS

Not stated

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Not stated

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

1.  Be capable of recognizing signs and symptoms of child maltreatment
    in all children and adolescents, including those with disabilities.

2.  Be familiar with disabling conditions that can mimic abuse or pose
    an increased risk of accidental injury that can be confused with
    abuse.

3.  Because children with disabilities are at increased risk of
    maltreatment, remain vigilant not only in assessment for indications
    of abuse but also in offerings of emotional support and provision of
    equipment and resources to meet the needs of children and families.

4.  Ensure that any child in whom maltreatment has been identified is
    evaluated thoroughly for disabilities.

5.  Advocate for all children, especially those who have disabilities or
    special health care needs, to have a medical home. (Medical Homes
    Initiatives for Children with Special Needs Advisory Committee &
    American Academy of Pediatrics, 2002) If a child is hospitalized and
    does not have a medical home, the inpatient attending physician can
    help the family secure one before discharge, preferably as early as
    possible in the hospital course. (Percelay & American Academy of
    Pediatrics, 2003)

6.  Be actively involved with treatment plans developed for children
    with disabilities and participate in collaborative team approaches.

7.  Use health supervision visits as a time to assess a family\'s
    strengths and need for resources to counterbalance family stressors
    and parenting demands.

8.  Advocate for changes in state and local policies in which system
    failures seem to occur regarding the identification, treatment, and
    prevention of maltreatment of children with disabilities.

9.  Advocate for the implementation of positive behavioral supports and
    elimination of aversive techniques and unnecessary physical
    restraints in homes, schools, and other educational and therapeutic
    programs (both public and private), institutions, and settings for
    children who have disabilities.

10. Advocate for better health care coverage by both private insurers
    and governmental funding.

#### CLINICAL ALGORITHM(S)

None provided

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=11059)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting each recommendation is not specifically
stated.

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

Appropriate assessment of maltreatment of children with disabilities may
lead to early recognition and intervention of child abuse and neglect,
as well as prevention of child maltreatment

#### POTENTIAL HARMS

Not stated

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

The guidance in this report does not indicate an exclusive course of
treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

An implementation strategy was not provided.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Staying Healthy

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Hibbard RA, Desch LW, American Academy of Pediatrics Committee on Child
Abuse and Neglect, American Academy of Pediatrics Council on Children
With Disabilities. Maltreatment of children with disabilities.
Pediatrics 2007 May;119(5):1018-25. \[39 references\]
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17473105)

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

2001 Aug (revised 2007 May)

#### GUIDELINE DEVELOPER(S)

American Academy of Pediatrics - Medical Specialty Society

#### SOURCE(S) OF FUNDING

American Academy of Pediatrics (AAP)

#### GUIDELINE COMMITTEE

Committee on Child Abuse and Neglect\
Committee on Children with Disabilities

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

*Committee on Child Abuse and Neglect, 2006-2007*: Carole Jenny, MD,
MBA, *Chairperson*; Cindy W. Christian, MD; \*Roberta A. Hibbard, MD;
Nancy D. Kellogg, MD; Betty S. Spivack, MD; John Stirling, Jr, MD

*Liaisons*: David L. Corwin, MD, American Academy of Child and
Adolescent Psychiatry; James A. Mercy, PhD, Centers for Disease Control
and Prevention

*Staff*: Tammy Hurley

*Committee on Children with Disabilities, 2006-2007*: Paul H. Lipkin,
MD, *Chairperson*; J. Daniel Cartwright, MD; \*Larry W. Desch, MD; John
C. Duby, MD; Ellen Roy Elias, MD; Chris Plauché Johnson, MD, Med; Eric
B. Levey, MD; Nancy A. Murphy, MD; Scott M. Myers, MD; Ann Henderson
Tilton, MD

*Liaisons*: Beverly Crider, Family Voices; Donald Lollar, EdD, Centers
for Disease Control and Prevention; Merle McPherson, MD, MPH, Maternal
and Child Health Bureau

*Staff*: Stephanie Mucha Skipper, MPH

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: American Academy of
Pediatrics: Committee on Child Abuse and Neglect and Committee on
Children With Disabilities. Assessment of maltreatment of children with
disabilities. Pediatrics 2001 Aug;108(2):508-12.

All clinical reports and policy statements from the American Academy of
Pediatrics automatically expire 5 years after publication unless
reaffirmed, revised, or retired at or before that time.

#### GUIDELINE AVAILABILITY

Electronic copies: Available from the [American Academy of Pediatrics
(AAP) Policy Web
site](http://aappolicy.aappublications.org/cgi/content/full/pediatrics;119/5/1018).

Print copies: Available from the American Academy of Pediatrics, 141
Northwest Point Blvd., P.O. Box 927, Elk Grove Village, IL 60009-0927.

#### AVAILABILITY OF COMPANION DOCUMENTS

None available

#### PATIENT RESOURCES

None available

#### NGC STATUS

This summary was completed by ECRI on May 7, 2002. The information was
verified by the guideline developer on June 11, 2002. This NGC summary
was updated by ECRI Institute on September 4, 2007. The updated
information was verified by the guideline developer on September 18,
2007.

#### COPYRIGHT STATEMENT

This National Guideline Clearinghouse summary is based on the original
guideline, which is subject to the guideline developer\'s copyright
restrictions. Please contact the Permissions Editor, American Academy of
Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.

### DISCLAIMER

#### NGC DISCLAIMER

The National Guideline Clearinghouse™ (NGC) does not develop, produce,
approve, or endorse the guidelines represented on this site.

All guidelines summarized by NGC and hosted on our site are produced
under the auspices of medical specialty societies, relevant professional
associations, public or private organizations, other government
agencies, health care organizations or plans, and similar entities.

Guidelines represented on the NGC Web site are submitted by guideline
developers, and are screened solely to determine that they meet the NGC
Inclusion Criteria which may be found at
<http://www.guideline.gov/about/inclusion.aspx> .

NGC, AHRQ, and its contractor ECRI Institute make no warranties
concerning the content or clinical efficacy or effectiveness of the
clinical practice guidelines and related materials represented on this
site. Moreover, the views and opinions of developers or authors of
guidelines represented on this site do not necessarily state or reflect
those of NGC, AHRQ, or its contractor ECRI Institute, and inclusion or
hosting of guidelines in NGC may not be used for advertising or
commercial endorsement purposes.

Readers with questions regarding guideline content are directed to
contact the guideline developer.

Bottom of Form

© 1998-2008 National Guideline Clearinghouse

Date Modified: 11/3/2008