Sexual victimization and intellectual disabilities among child welfare involved youth
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:
- 1
Higher levels of intellectual ability, social support, and community environment will be associated with lower odds of experiencing sexual victimization.
- 2
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.
Section snippets
Social support
For the purposes of this study, social support involves relationships with people who offer emotional caring and assistance with problem-solving (Broadhead, Gehlbach, DeGruy, & Kaplan, 1988). Social support has been found to be protective against negative outcomes related to child sexual abuse, adult sexual assault, and the likelihood of revictimization. Higher levels of social support in the lives of low-income Black women were found to mediate the relationship between childhood maltreatment
Community environment
Although research on community-level factors associated with experiencing child maltreatment is limited, some studies suggest that cohesive and safe neighborhoods provide some protection. Abner (2014) found that families in environments with low social cohesion and low social capital were at greater risk for child maltreatment than were families with high social cohesion and medium social capital. Similarly, Obasaju, Palin, Jacobs, Anderson, and Kaslow (2009) found that higher levels of
Sexual victimization and children and youth with disabilities
Children and youth with disabilities face poorer outcomes and higher rates of all types of abuse. Studies that examined the relationships between children with disabilities and abuse found high rates of multiple instances of sexual, emotional, and physical victimization over time. In a U.S. population–based epidemiological study of merged school, foster care, and police records, children with disabilities experienced maltreatment at 3.4 times the rate of nondisabled children (Sullivan &
Early experiences of sexual victimization lead to revictimization
The transition into young adulthood can be particularly difficult for youth with disabilities and can be a time of vulnerability to sexual victimization and revictimization. In a review of the literature concerning sexual revictimization, Classen, Palesh, and Aggarwal (2005) found that two of every three individuals who have been sexually victimized would be revictimized and that childhood sexual abuse and assault are significant risk factors for revictimization as an adult. Almost one-third of
Early sexual victimization leads to commercial sex work, survival sex, and sex trafficking
Commercial sex work, survival sex, and sex trafficking are considered forms of transactional sex, defined as the exchange of sexual acts for money, drugs, food, shelter, or other goods (Stoltz et al., 2007; Surratt & Kurtz, 2012; Williams & Frederick, 2009). Commercial sex is considered the voluntary exchange of sex for money or goods by consenting adults age 18 years or older (Institute of Medicine & National Research Center, 2013; Surratt & Kurtz, 2012). Survival sex includes the consensual
Current study
Studies have documented the high prevalence of sexual victimization among youth involved in child welfare service systems and among children and adults who have intellectual disabilities; yet research that considers the relationship between intellectual disability, child welfare involvement, and sexual victimization and engaging in transactional sex is limited. The aim of this study is to examine the relationship of intellectual disability, social support, and community environment to sexual
Sample and procedure
This study uses a secondary analysis of a subset of data from the National Survey on Child and Adolescent Well-Being II (NSCAW II), which compiled a stratified random sample based on 83 counties in nine geographic areas in the United States served by the designated state child welfare protection agency. The sample includes 5,872 children and youth ages 0–17.5 years at baseline who lived at home or in another living arrangement, regardless of whether they received services. NSCAW II data were
Data analysis
Data screening and analysis were conducted using Mplus Version 8 because of its ability to perform maximum likelihood estimation to address missing data that has a complex survey design (Muthén & Muthén, 1998–2017Muthén and Muthén, 1998Muthén & Muthén, 1998–2017). All analyses were conducted using the weighting, cluster, and stratification variables with the subpopulation feature (Muthén & Muthén, 1998–2017Muthén and Muthén, 1998Muthén & Muthén, 1998–2017). These adjustments are made to the
Bivariate correlation
Bivariate correlations were calculated for all the independent and dependent variables. The correlations for the independent variables were examined for multi-collinearity, with modest correlations found between the independent variables. All correlations were well below recommended multi-collinearity guidelines, with the highest correlation being r = .26 (Field, 2013).
Logistic regression analyses
Two multivariate logistic regression models were calculated, one for each dependent variable (i.e. sexual victimization and
Discussion
As has been found in other studies, female gender was associated with greater sexual victimization (Casanueva et al., 2012; Finkelhor et al., 2014). A new finding from this study is the association between intellectual ability and transactional sex among older youth transitioning from child welfare services involvement. Forty percent of the youth of this study had intellectual disability scores one standard deviation below the norm, compared with 16.65 % of the general population (Kaufman &
Limitations and directions for future research
This study involved a secondary analysis and was therefore constrained by the variables available. Although the K-BIT is a widely used measure of intellectual ability and disability, it is limited to two narrow domains: verbal and non-verbal (Kaufman & Kaufman, 1990). Our understanding of disability and ability within this population would be enhanced in future research efforts by use of adaptive behavior scales that measure daily living, social, and communication skills. Another limitation for
Conclusion
The transition from child welfare services involvement presents a time of risk and opportunity for older youth as they navigate their way to adulthood. This study reconfirmed that gender is a risk factor for sexual victimization among young women transitioning to independence and found that higher intellectual ability is associated with decreased risk of exploitation through engaging in transactional sex. Additional research is needed to identify protective factors that will reduce sexual
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors report no declarations of interest.
References (86)
- et al.
Association between childhood sexual abuse and transactional sex in youth aging out of foster care
Child Abuse & Neglect
(2012) - et al.
The lifetime prevalence of child sexual abuse and sexual assault assessed in late adolescence
Journal of Adolescent Health
(2014) - et al.
Child human trafficking victims: Challenges for the child welfare system
Evaluation and Program Planning
(2010) - et al.
Evaluation of a tool to identify child sex trafficking victims in multiple healthcare settings
Journal of Adolescent Health
(2018) - et al.
Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: A cumulative stressors model
Child Abuse & Neglect
(2007) - et al.
Prevalence and risk of violence against children with disabilities: A systematic review and meta-analysis of observational studies
Lancet
(2012) - et al.
Rasch calibration of physical activity self-efficacy and social support scale for persons with intellectual disabilities
Research in Developmental Disabilities
(2010) - et al.
Prevalence of children with disabilities in the child welfare system and out-of-home placement: An examination of administrative records
Children and Youth Services Review
(2011) - et al.
Toward a cumulative ecological risk model for the etiology of child maltreatment
Children and Youth Services Review
(2011) - et al.
Sexual violence victimization against men with disabilities
American Journal of Preventative Medicine
(2011)
Adverse childhood experiences and sexual victimization in adulthood
Child Abuse & Neglect
Associations between childhood maltreatment and sex work in a cohort of drug-using youth
Social Science & Medicine
Maltreatment and disabilities: A population-based epidemiological study
Child Abuse & Neglect
Family structure, victimization, and child mental health in a nationally representative sample
Social Science & Medicine
Characteristics of child commercial sexual exploitation and sex trafficking victims presenting for medical care in the United States
Child Abuse & Neglect
Dimensions of structural disadvantage: A latent class analysis of a neighborhood measure in child welfare data
Journal of Social Service Research
Social support as a mediator of revictimization of low-income African American women
Violence and Victims
The DUKE-UNC functional social support questionnaire: Measurement of social support in family medicine patients
Medical Care
Toward an experimental ecology of human development
The American Psychologist
The ecology of human development: Experiments by nature and design
Involvement of youths with autism spectrum disorders or intellectual disabilities in multiple public service systems
Journal of Mental Health Research in Intellectual Disabilities
The span of collective efficacy: Extending social disorganization theory to partner violence
Journal of Marriage and the Family
Construct validity of the Kaufman Brief Intelligence Test, Wechsler Intelligence Scale for children-third edition, and adjustment scales for children and adolescents
Journal of Psychoeducational Assessment
NSCAW child well-being spotlight: Teen-age girls in the child welfare system report high rates of risky sexual activity and pregnancy. OPRE Report #2014-07
NSCAW II wave 2 report: Children’s services. OPRE report #2012-59
Misdiagnosis and missed diagnoses in foster and adopted children with prenatal alcohol exposure
Pediatrics
Sexual crime against schoolchildren with disabilities: A nationwide prospective birth cohort study
Journal of Interpersonal Violence
Sexual revictimization: A review of the empirical literature
Trauma, Violence & Abuse
Lifetime victimization and poly-victimization in a sample of adults with intellectual disabilities
Journal of Interpersonal Violence
Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 26
Midwest evaluation of the adult functioning of former foster youth: Outcomes at age 21
Cognitive functioning in children prenatally exposed to alcohol and psychotropic drugs
Neuropediatrics
Intelligence and fetal alcohol spectrum disorders: A review
Journal of Population Therapeutics and Clinical Pharmacology
Childhood victimization and subsequent adult revictimization assessed in a nationally representative sample of women and men
Violence and Victims
Relation between adaptive function and IQ among youth with histories of heavy prenatal alcohol exposure
Birth Defects Research
Focusing on prevention: The social and economic rights of children vulnerable to sex trafficking
Health and Human Rights
Reconciling race and class differences in self-reported and official estimates of delinquency
American Sociological Review
The prevalence of child sexual abuse in out-of-home care: Increased risk for children with a mild intellectual disability
Journal of Applied Research in Intellectual Disabilities
42 U.S.C. § 1397g(c)(1)
Discovering statistics using IBM SPSS statistics
Philadelphia family management study: Parent interview schedule
An ecological approach to understanding sexual revictimization: Linking personal, interpersonal, and sociocultural factors and processes
Child Maltreatment
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