The document addresses the increased risk of abuse among children with developmental disabilities, highlighting both personal and environmental factors contributing to this vulnerability. It presents a group therapy program, 'Making Friends and Staying Safe', designed to teach social skills and abuse prevention strategies over 16 weeks, targeting both children and their caregivers. The program aims to reduce social isolation, enhance self-esteem, and promote communication about sensitive topics related to safety and sexual education.

1. Abuse Risk Reduction Skills for Children
with Developmental Disabilities: Making
Friends and Staying Safe
Karen C. Rogers, Ph.D.
Project HEAL Trauma Program
USC University Center for Excellence in Developmental Disabilities
Children’s Hospital Los Angeles, USA

2. OBJECTIVES
 Briefly review abuse risk factors among children with
developmental disabilities and their caregivers
 Introduce an abuse risk reduction program, Making
Friends and Staying Safe group program

3. How often are persons with
developmental disabilities
abused?
 Individuals with developmental disabilities are at
increased risk for abuse as compared to the general
population (Gil, 1970; Mahoney & Carrillo, 1998; Ryan, 1994).
 80% of mentally handicapped persons living in the
community are physically and sexually abused, cheated,
and robbed (Melberg, 1984).
 Nearly a quarter of a million Californians are victims of
elder and dependent adult abuse very year (National Aging
Resource Center on Elder Abuse, 1999)
 Some estimates suggest as many as 1/3 of children in
foster care have a developmental disability (American
Academy of Pediatrics, 2002)

4. How often are children with
developmental disabilities
sexually abused?
 1.8 times higher risk among those with
disabilities (Crosse, Kaye & Ratnofsky, 1993).
 Girls are at greater risk for being sexually
abused than boys (Sobsey, 1994).
 39%-83% of girls and 16%-32% of boys by age 18
vs. 20-30% & 10-15% (Badgley, 1984 & Hard, 1986 in
Baladerian, 1991 vs. Finkelhor et al, 1989).
 Most children identified as victims of abuse are
simultaneously subjected to more than one
type of maltreatment (Verdugo, 1995).

5. Characteristics of Abuse
 Abuse often chronic and severe, with
revictimization by the same person.
 Abuse may occur over many years with multiple
perpetrators.
 In 44% of the cases the offenders had a
relationship with the victim related to the
victim’s disability.
 Children who were less obviously disabled were
at greater risk.
 However children with severe language
problems are easy targets for abuse possibly
because they can’t “tell”

6. RISK FACTORS FOR ABUSE IN CHILDREN
WITH DD (Sobesy, 2002)
 Factors associated with the child
 Factors associated with the
perpetrator
 Environmental/familial factors

7. RISK FACTORS ASSOCIATED
WITH THE CHILD
 Impaired communication
 Cognitive impairments
 Lack of body knowledge
 Limited mobility
 Social isolation, distancing
 Low self-esteem
 Increased dependence
 Reinforced to be compliant

8. RISK FACTORS ASSOCIATED
WITH THE PERPETRATOR
 Large number of caregivers
 Scarce training
 Seeking employment in disability
related services
 Trusted by family members and
other caregivers

9. FAMILIAL & ENVIRONMENTAL
FACTORS
 Social isolation
 Myths about people with developmental disabilities
 Increased caregiver stress
 More likely to be in out-of-home placement
 Cultural attitudes & beliefs
• “No one would abuse a person with a disability”
• “Children with a disability are safe because they are
always with trusted people”
• “People with a disability don’t understand what is
happening, so they don’t suffer the way other youth do”
• “Keeping children at home or in a sheltered group facility
will lessen the risk of abuse”

10. A GROUP THERAPY APPROACH:
“Making Friends & Staying Safe”

11. MAKING FRIENDS & STAYING SAFE
A Social Skills Development
and Abuse Prevention Group
 Housed under the Project Heal Trauma Program
 Children’s Hospital Los Angeles/University of Southern
California /University Center for Excellence in
Developmental Disabilities
 16 weeks
 60 minutes sessions
 Co-concurring children and caregiver(s)
groups
 Caregiver group offered in English or Spanish

12. BENEFITS OF GROUP INTERVENTION
 Reduces social isolation among children and caregivers
 Provides opportunity for children to practice new skills
 Desensitizes participants to talking about sexual
education topics
 Normalizes content within
developmental context
 Cost effective

13. KEY GROUP ADAPTATIONS
 Shorter length of sessions
 Low client to therapist ratio (3:1)
 Visual alternatives for all verbal materials
 Directive teaching approach
 Structured format
 Use of developmentally appropriate language
 Slower pace/comprehension checks
 Repetition, Rehearsal and Reminder phrases
 Behavioral management/positive reinforcement system

14. MFSS STRATEGIES FOR CHILDREN
 Identification & expression of feelings
 Enhancing self-esteem & social skills
 Personal boundaries and body rights
 Sexual development/sexual education
 Abuse prevention skills

15. MFSS STRATEGIES FOR PARENTS
 Empathy and respect
 Education
 Peer support
 Linkage to community resources
 Skill building strategies
 Attention to personal experiences

16. CULTURAL CONSIDERATIONS
 Culture is an important variable in determining how
individuals see/interpret the world and make decisions
(traditions, ways of living, coping behaviors, values,
norms, and beliefs).
 Value of sexual education
 Stigma towards disability
 Beliefs regarding cause of
developmental disability
 Access to appropriate services

17. REFERENCES
 Batshaw, M., Pellegrino, L., & Roizen, N. (2009). Children with
Disabilities (6th ed.).Baltimore: Paul H. Brooks.
 California State Council on Developmental Disabilities.
http://www.scdd.ca.gov/Developmental_Disabilities.htm
 California Child Abuse Training and Technical Assistance Centers
(n.d.). Children with Disabilities & Sexual Abuse Fact Sheet.
Retrieved March 2012 from http://cirinc.org/catta/wp-
content/plugins/downloads-manager/upload/FactSheet.pdf
 Child Welfare Information Gateway (2009). The Risk and Prevention
of Maltreatment of Children with Disabilities. Washington, DC:U.S.
Department of Health and Human Services. Retrieved March 2012
from http://www.childwelfare.gov/pubs/prevenres
/focus/focusa.cfm

18.  Child Welfare Information Gateway (2009). Understanding the
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 Comisión Nacional de los Derechos Humanos (2011). Niños, Niñas y
Adolescentes Victimas de la Violencia y del Delito. Mexico, D.F.
Retrieved November 2012 from http://www.cndh.org.mx/sites/all/
fuentes/documentos/Programas/Provictima/5%20PUBLICACIONES/2J
ORNADAS/DECIMAS_JORNADAS.pdf
 Cook, A., Blaustein, M., Spinazolla, J., van der Kolk, B. (2003)
Complex trauma in children and adolescents. White paper from the
national child traumatic stress network complex trauma task force.
Los Angeles, CA: National Center for Child Traumatic Stress.

19.  Cook, A., Spinazzola, J., Ford, J., Lanktree, C., et. al. (2005)
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 LeDoux J.E. (1993). Emotional memory systems in the brain. Behav.
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 Secretaria de Salud (2006). Informed Nacional sobre Violencia y
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 Sobsey, D. (2002). Exceptionality, education and maltreatment.
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 Turner, H., Vanderminden, J., Finkelhor, D., Hamby, S., & Shattuck,
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20.  U.S. Department of Health and Human Services, Administration for
Children and Families, Administration on Children, Youth and
Families, Children’s Bureau(2011). Child Maltreatment 2010.
Retrieved March 2012 from http://www.acf.hhs.gov/programs/
cb/pubs/cm10/cm10.pdf#page=63
 World Health Organization (1999)Report of the Consultation on Child
Abuse Prevention, Social Change and Mental Health, Violence and
Injury Prevention. Retrieved October 2012 from www.who.int/mip
2001/files/2017/childabuse.pdf
 World Health Organization (2012) Early Childhood Development and
Disability: A discussion paper. Retrieved October 2012 from
http://apps.who.int/iris/bitstream/10665/75355/1/9789241504065_
eng.pdf

21. QUESTIONS/COMMENTS?
THANK YOU
For further information:
Karen Rogers, Ph.D.
krogers@chla.usc.edu