Sexual victimization and intellectual disabilities among child welfare involved youth

Abstract

Background and objective

Youth with intellectual disabilities involved in child welfare systems are at greater risk of sexual victimization than youth who have not been investigated for child maltreatment. This study addresses a gap in the literature regarding older youth with intellectual disabilities who are sexually victimized and pushed to engage in transactional sex while they are transitioning from child welfare systems involvement. It does so by examining risk and protective factors at the individual, micro, exo, and macro systems levels.

Participants and setting

This study included 334 youth ages 18–19.5 from a nationally representative sample of 5,872 child welfare–involved youth.

Methods

Multivariate logistic regression models were used to conduct a secondary analysis of the National Survey of Child and Adolescent Well-Being II to examine relationships between intellectual ability, social support, and community environment and sexual victimization and engaging in transactional sex.

Results

Results indicate that 2.5 % of the youth experienced sexual victimization in the past 12 months, and 3.9 % had engaged in transactional sex in the past 6 months. The mean intelligence score for these youth was one standard deviation below average (M = 84.62, SD = 19.60). Being female was associated with experiencing sexual victimization (Odds Ratio = 17.29, p = .025). Higher intellectual ability scores were associated with lower odds of engaging in paid sexual activity (Odds Ratio = 0.92, p = .002).

Conclusions

This study highlights the need for early identification of intellectual disabilities among child welfare–involved youth, provision of informed social supports and services, and building community connections during transition to prevent sexual victimization.

Introduction

Children who have experienced childhood sexual abuse are at greater risk of future sexual victimization in adolescence and adulthood than their peers who were not abused (Papalia, Mann, & Ogloff, 2020; Pittenger, Pogue, & Hansen, 2018; Walker, Freud, Ellis, Fraine, & Wilson, 2019). Children involved in child welfare systems have significantly more learning, emotional, and developmental disabilities than children in the general population (Casanueva, Stambaugh, Tueller, Dolan, & Smith, 2012; Lightfoot, Hill, & LaLiberte, 2011). Children and youth with disabilities are particularly vulnerable to sexual victimization and revictimization (Christoffersen, 2020; Codina, Pereda, & Guilera, 2020; Sullivan & Knutson, 2000). A growing body of research suggests that youth who have been sexually abused are at increased risk for engaging in transactional sex, which includes commercial sex work, survival sex, and being sex trafficked (Ahrens, Katon, McCarty, Richardson, & Courtney, 2012; Surratt & Kurtz, 2012; Varma, Gillespie, McCracken, & Greenbaum, 2015; Wolfe, Greeson, Wasch, & Treglia, 2018). There is a lack of research that examines the risk and protective factors for older youth with intellectual disabilities associated with sexual victimization as they transition from child welfare system involvement to adulthood.

This study is grounded in the ecological framework outlined by Bronfenbrenner (1977, 1979), which suggests that a child’s development occurs within nesting relationships that start with the individual in the center and include the micro, meso, exo, and macro systems. Ecological frameworks have been applied to child maltreatment in efforts to explain its multidimensional causes (MacKenzie, Kotch, & Lee, 2011). For purposes of this study, the ecological theoretical framework enables us to examine the risk and protective factors found within multiple systems that surround youth involved in child welfare services. This study aims to assess risk and protective factors in the context of multiple systems by examining the effects of intellectual ability, social supports, and community environment associated with sexual victimization and engaging in transactional sex.

Risk and protective factors include individual attributes (intellectual ability); microsystem level factors concerned with interpersonal relationships (social supports, living arrangement); and exosytem level factors, which are “the settings and systems beyond the immediate situation containing the developing person”—in other words, the community environment (Bronfenbrenner, 1977, p. 527). Family income, race, and gender are macrosystem level factors expressed by social and cultural ideology through economic, social, educational, legal, and political institutions (Bronfenbrenner, 1977). This study explores the risk and protective factors associated with experiencing sexual victimization and engagement in transactional sex by youth with intellectual disabilities who are transitioning out of child welfare services. Two hypotheses are proposed:

• Higher levels of intellectual ability, social support, and community environment will be associated with lower odds of experiencing sexual victimization.

• Higher levels of intellectual ability, social support, and community environment will be associated with lower odds of being paid to have sex.

Although no precise data identify the prevalence and type of disabilities found in children involved in child welfare systems, evidence suggests that children and youth are at elevated risk for problems with cognitive development, academic achievement, and socio-emotional well-being (Shannon & Tappan, 2011). Data from the Institute of Education Science (2018) show that 6.4 % of youth in the general school-age population have intellectual disabilities. Analysis of a statewide administrative data set in Minnesota found that 27.9 % of the children over age 5 involved in substantiated maltreatment investigations had disabilities, with the most common being emotional impairments, developmental disabilities, and learning disabilities (Lightfoot et al., 2011). A study using a stratified sample of 1,715 children and youth ages 6–17 years involved in public service systems in San Diego County found that 13 % of youth involved in child welfare systems had autism or an intellectual disability (Brookman-Frazee et al., 2009). The National Survey on Child and Adolescent Well-Being II (NSCAW II) includes children and youth who have been involved in substantiated and unsubstantiated child welfare investigations (National Data Archive on Child Abuse and Neglect [NDACAN], 2014a). Almost 25 % of school age children from NSCAW II meet federal eligibility standards for enhanced education services because of having a disability that interferes substantially with learning (Casanueva et al., 2012). This rate is almost twice that of the U.S. school population which is 13.4 % (U.S. Department of Education, 2019). The NSCAW II data also revealed that 64 % of children and youth with clinically elevated scores—indicating cognitive impairments—who needed a referral for special education services did not have a current individualized education plan (Casanueva et al., 2012). A large proportion of child welfare–involved children and youth are missing out on needed education and specialized services.

The leading preventable cause of intellectual and neurodevelopmental disabilities is prenatal exposure to alcohol (Williams & Smith, 2015). Between 6 % and 16.9 % of children and youth involved in child welfare systems were found to have a Fetal Alcohol Spectrum Disorder (FASD), according to a meta-analysis of international, active ascertainment studies that pooled prevalence rates (Lange, Shield, Rehm, & Popova, 2013). In comparison, the rate of the U.S. general elementary school population is between 1 % and 5 % (May et al., 2018). Although children and youth who are involved in child welfare systems are known to be at high risk for FASD, they are rarely evaluated. Chasnoff, Wells, and King (2015) found in a group of 156 foster and adopted children that 80.1 % who had a FASD had not been diagnosed, and 6.4 % had received a misdiagnosis. Children and youth who have FASD are often undiagnosed or receive other diagnoses because of a lack of information and attention to this spectrum disorder.

A review of the neurobehavioral conditions associated with prenatal alcohol exposure showed a reduction in intellectual ability to be one of the most commonly found disabilities (Mattson, Bernes, & Doyle, 2019). Fetal Alcohol Syndrome (FAS) is the most well-known condition of FASD, because it results in distinct facial features. However, one comparison showed that children who were exposed to alcohol prenatally but who did not have distinctive facial features had significantly lower intellectual ability scores than children who had been exposed to psychotropic drugs (Dalen, Bruarøy, Wentzel-Larsen, & Laegreid, 2009). An integrated systematic review of the literature conducted from 2006 to 2016 examined articles related to FASD and intellectual ability; it found significantly lower scores in the alcohol-exposed groups, although no significant differences were found between verbal and nonverbal IQ scores (de L. Ferreira & Cruz, 2017). A study from the Collaborative Initiative on FASD found that higher IQ scores were not significantly associated with adaptive skills for youth who had prenatal alcohol exposure but were so associated for youth who had no prenatal alcohol exposure (Doyle et al., 2019). This finding indicates that overall intellectual ability may not account for the level of adaptive behavior, meaning children and youth with FASD may not be appropriately recognized as having intellectual and learning disabilities.