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Table of Contents
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 45-47

Prevalence, risk factors and consequences of sexual abuse among children with Intellectual Developmental Disorder (IDD)

Assistant Professor of Nursing, NIMHANS

Date of Web Publication9-Jul-2019

Correspondence Address:
G Radhakrishnan
Assistant Professor of Nursing, NIMHANS

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2231-1505.262424

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How to cite this article:
Radhakrishnan G. Prevalence, risk factors and consequences of sexual abuse among children with Intellectual Developmental Disorder (IDD). Indian J Psy Nsg 2017;14:45-7

How to cite this URL:
Radhakrishnan G. Prevalence, risk factors and consequences of sexual abuse among children with Intellectual Developmental Disorder (IDD). Indian J Psy Nsg [serial online] 2017 [cited 2023 Jun 1];14:45-7. Available from: https://www.ijpn.in/text.asp?2017/14/1/45/262424

Sexual abuse in children, especially among those with Intellectual Development Disorder (IDD) is a grave concern. Abuse among children gets unnoticed and unreported. The trauma that the children undergo is enormous and lifelong.

Prevalencein India

The National Crime Records Bureau(NCRB) reveals shocking report on child abuse in India in 2015:

  • 10854 children were raped
  • 8930 assaults on girls
  • 3350 cases of sexual harassment

Though both genders are subject to sexual abuse, the prevalence is more among girls/ women with IDD:

  • A study conducted by the Government of India in 2007 among 17,220, children and adolescents to estimate the burden of sexual abuse revealed shocking results and showed that every second child in the country was sexually abused; among them, 52.94 per cent were boys and 47.06 per cent were girls.
  • Highest sexual abuse was reported in Assam (57.27%) followed by Delhi (41%), Andhra Pradesh (33.87%) and Bihar (33.27%).

Children with IDD are more vulnerable to sexual abuse because of the nature of their illness and difficulty in expressing themselves and communication.

Risk Factors

  • Lack of understanding.
  • Lack of social awareness and training that would help identify and anticipate abusive situations
  • Ingrained reliance on the caregiver authority figure
  • Long-term dependence on services and personal care.
  • Emotional and social insecurities
  • Lack of capacity to consent to sexual activity
  • Lack of knowledge and training in sex education
  • Powerless position in society
  • Low self-esteem, contributing to powerlessness.
  • Not realizing that sexual abuse can cause harm.
  • Not being able to tell anyone about the abuse.
  • Learned behaviour not to question caregivers or others in authority.
  • Communication difficulties that hinder reporting abuse.
  • Fear of not being believed, leading to non-reporting of abuse.
  • Feelings of guilt or shame that prevent reporting of abuse.
  • Difficulty identifying an appropriate person to report the abuse to.
  • Low risk of prosecution for perpetrators
  • Routine prescription of contraceptives to women with intellectual disabilities, leading to reduced risk of detection for perpetrators.

People with moderate to severe intellectual disabilities, and those with additional physical disabilities, form the majority of learning disabled people experiencing sexual violence.


Research suggests that 97% to 99% of abusers are known and trusted by the victim who has the intellectual disability.

According to Sobsey and Doe’s 1991 analysis of 162 reports of sexual abuse against people with intellectual disabilities, the largest percentage of offenders (28%) were service providers (direct care staff members, personal care attendants, psychiatrists). In addition, 19% of sexual offenders were natural or step-family members, 15.2% were acquaintances (neighbours, family friends), 9.8% were informal paid service providers (babysitters), and 3.8% were dates.

Further, 81.7% of the victims were women, and 90.8% of the offenders were men.

Different Forms of Sexual Abuse among Children with IDD

According to the Ministry of Women and Child Development, India (2007), severe forms of Child Sexual Abuse include:

a. Assault, including rape and sodomy

b. Touching or fondling a childpExhibitionism- Forcing a child to exhibit his/her private body parts

c. Photographing a child in nude

Other forms of Child Sexual Abuse include:

a. Forcible kissing

b. Sexual advances towards a child during travel

c. Sexual advances towards a child during marriage situations

d. Exhibitionism- exhibiting before a child

e. Exposing a child to pornographic materials.

Consequences of sexual abuse among children with IDD ? Unwanted pregnancy

? Sexually Transmitted Diseases ? Physical injuries ? Psychological trauma ? Emotional change

? Changes in behavior especially for those with communication difficulties.

? Damage in relationship with care givers, friends and family members.

Behavioral and physical indicators of children facing abuse in general

Behavioral indicators

  • Regression in behaviour, and; in attaining developmental mile stones
  • Decreased school performance
  • Acute traumatic response such as clingy behaviour and irritability in young children
  • Sleep disturbance
  • Eating disorders
  • Depression
  • Withdrawn behaviour
  • Poor self esteem
  • In appropriate sexualised behaviour (masturbation, touching private parts of self or others,
  • Displays knowledge or interest in sexual acts inappropriate to his or her age
  • Makes strong efforts to avoid a specific person, without an obvious reason.
  • Doesn’t want to change clothes in front of others or participate in physical activities.
  • Runs away from home.
  • Nightmares
  • Becoming unusually secretive
  • Sudden unexplained personality changes, mood swings and seeming insecure
  • Unaccountable fear of particular places or people
  • Outburst of anger
  • New adult words for body parts and no obvious source
  • Talk of a new, older friend and unexplained money or gifts
  • Self-harm (cutting, burning or other harmful activities)
  • Not wanting to be alone with a particular child or young person
  • Complaints of bed wetting and faecal soiling beyond usual age

Physical indicators

  • Pain on urination
  • Anal complaints (pain, bleeding, fissures)
  • Trouble walking or sitting.
  • A sexually transmitted disease (STD) or pregnancy, especially under the age of fourteen.
  • Physical signs, such as, unexplained soreness or bruises around genitals or mouth,

As these children becomes silent victims of abuse, it’s important that the mental health nurses carefully assess and monitor them to avoid such risk. Nurses also have primary responsibility of educating the child, parents and special educators on these issues.

  References Top

Crosse, S., Elyse, K. & Ratnofsky, A. (1993). A report on the maltreatment of children with disabilities. Washington, DC: National Center on Child Abuse and Neglect, U.S. Department of Health and Human Services.  Back to cited text no. 1
Knutson, J. & Sullivan, P. (1993). Communicative disorders as a risk factor in abuse. Topics in Language Disorders, 13 (4), 1-14.  Back to cited text no. 2
National Research Council (2001). Crime victims with developmental disabilities: Report of a workshop. Committee on Law & Justice. Joan Petersilia, Joseph Foote, and Nancy A. Crowell, editors. Commission on Behavioral and Social Sciences and Education. Washington, D.C: National Academy Press.  Back to cited text no. 3
Sobsey, D. (1992). Violence and abuse in the lives of people with disabilities: The end of silent acceptance? Paul H. Brookes Publishing Co: Baltimore, MD.  Back to cited text no. 4
Sobsey, D., Wells, D., Lucardie, R. & Mansell, S. (1995). Violence & disability: An annotated bibliography. Baltimore: Brookes Publishing.  Back to cited text no. 5
Sullivan, P.M. (2003). Violence against children with disabilities: Prevention, public policy, and research implications. Conference Commissioned Paper for the National Conference on Preventing and Intervening in Violence Against Children and Adults with Disabilities (May 6-7, 2002), SUNY Upstate Medical University, NY  Back to cited text no. 6
Sullivan, P. & Knutson, J. (2000). Maltreatment and disabilities: A population-based epidemiological study. Child Abuse & Neglect, 24 (10), 1257-1273.  Back to cited text no. 7
Sullivan, P. & Knutson, J. (1998). The association between child maltreatment and disabilities in a hospital-based epidemiological study. Child Abuse & Neglect, 22 (4), 271-288.  Back to cited text no. 8


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