Child Abuse & Neglect, Vol. 24, No. 8, pp.

1073–1084, 2000
Copyright © 2000 Elsevier Science Ltd.
Pergamon Printed in the USA. All rights reserved
0145-2134/00/$–see front matter

PII S0145-2134(00)00159-9

IS SEXUAL ABUSE OF CHILDREN WITH DISABILITIES

DISCLOSED? A RETROSPECTIVE ANALYSIS OF CHILD
DISABILITY AND THE LIKELIHOOD OF SEXUAL
ABUSE AMONG THOSE ATTENDING NORWEGIAN
HOSPITALS

MARIT HOEM KVAM

SINTEF Unimed, Oslo, Norway

ABSTRACT

Objective: According to North American studies disabled children are at 2–3 times greater risk of being sexually abused
than non-disabled. If the risk ratio for disabled children in Norway is similar, and the disclosure of sexual abuse is the same
for disabled as for non-disabled, one should expect disabled children to constitute 2–3 times the 11% they constitute in the
general population. This research aimed to investigate if this is the case for Norwegian children, and to find characteristics
within in the handicapped group suspected of being sexually assaulted.
Method: A questionnaire was addressed to all Norwegian pediatric hospitals. Of interest were numbers of children having
a medical examination for possible sexual assault in the years 1994 –1996, the number with a smaller or severe disability,
a description of the disability, age and gender, and the conclusion of the examination as to the likelihood of sexual abuse.
Results: The severely disabled children constituted only 1.7% of the examined 1293 children. Altogether, 6.4% of the
children had a smaller or severe disability. These children were more often assessed as “probably assaulted” than the
non-disabled. The disabled group had a larger part of boys than the non-disabled group.
Conclusions: Children with disabilities make up a smaller part of children coming to pediatric hospitals with the suspicion
of being sexually abused than expected. The results indicate that when a child has a severe disability, the caretakers do not
seem to recognize it as sexual abuse before it is quite obvious. © 2000 Elsevier Science Ltd.

Key Words—Sexual abuse, Children, Disabled children, Medical examinations.

INTRODUCTION

Are Children with Disabilities at Risk of Abuse?

MYTHS LEAD MANY people to believe that handicapped children are not subject to sexual
assault: the myth that no one will harm a handicapped child, or that no one will find a disabled child
attractive. Today we know that many disabled children are sexually assaulted, and that their
reaction to the assault may be even more negative than other children’s (Cruz, Price-Williams, &
Andron, 1988). However, the proliferation of myths may have hindered the disclosure of ongoing
assaults. This study intended to assess the degree to which Norwegian children with disabilities
who may have been assaulted receive medical attention. Furthermore it elucidates some of the
characteristics in the group of disabled children, as age, gender, type of disability, conclusion as to
the likelihood of sexual abuse, and to compare the disabled children with the non-disabled children.

Submitted for publication August 24, 1999; final revision received December 7, 1999; accepted December 13, 1999.
Requests for reprints should be sent to Marit Hoem Kvam, PhD, SINTEF Unimed, PB 124, Blindern, N-0314 Oslo, Norway.
1073
1074 M. H. Kvam

Child Sexual Abuse as a General Problem

Child sexual abuse was not a theme among researchers until the last part of last century. In the
1950s the American researcher Weinberg (1955) conducted a prevalence study concluding that
incest was a minor problem; only one child in a million would be exposed. During the course of
the last decades we have realized too well that this conclusion is wrong. Children all over the world
are at risk of being sexually abused by family members or other adults.
In most countries, laws provide a gradient of the seriousness of sexual abuse against children.
The least serious abuse excludes physical contact, for instance showing pornography and witness-
ing masturbation. More serious is kissing, fondling, or being made to touch the perpetrator and
other forms of physical contact without intercourse. The most serious level of abuse includes sexual
intercourse with penetration. Compounding the seriousness of the assault, a child’s long- and
short-term reaction will vary in accordance with, for instance, age at onset, whether the abuse is
often repeated, the child’s relationship to the abuser, the use of violence and threats, and the child’s
own personality. The family situation and the adults’ reactions if the abuse is disclosed are also of
importance.
The American researcher Finkelhor (1979) has been a pioneer in the prevalence studies on child
sexual abuse in the USA. Others have followed in different countries (Finkelhor, 1994; Gorey &
Leslie, 1997). Prevalence estimates, however, vary widely, due in part to the differences in the
operational definition of child sexual abuse, the method of collecting data, sampling bias, and study
response rate.
Gorey and Leslie (1997) made an integrative review synthesizing the findings of 16 cross-
sectional surveys on the prevalence of child sexual abuse among non-clinical North American
samples. After adjustments for response rates and definitions (excluding the non-contact category)
they estimated the prevalence to be 12–17% for females and 5– 8% for males. These results
correspond well with a large Norwegian study, where Tambs (1994) found 13% and 7%,
respectively.

Research Among Children with Disabilities

The last 10 –20 years some studies have been undertaken with the aim of disclosing the
prevalence of sexual abuse among disabled children, especially in North America (for instance,
Baladerian, 1990; Chamberlain, Rauh, Passer, McGrah, & Burket, 1984; Crosse, 1993; Jaudes &
Diamond, 1983; Knutson & Sullivan, 1993; Ryerson, 1984; Sobsey & Mansell, 1994; Sullivan,
Knutson, & Scanlan, 1996). To estimate the relative risk, it is first necessary to estimate the number
of disabled children within a population. In the USA it is often estimated to be 9 –12% (Baladerian,
1990; Crosse, 1993; Garbarino, Brookhauser, & Authier, 1987). This is in accordance with the
estimate of 11% of Norwegian children having a smaller or more severe disability (Barth, 1987;
Kvam, 1995).
Generally, one of two ways is chosen to determine the prevalence:
1. To use a group of disabled persons as informants, and then to investigate to which extent they
have been exposed to sexual abuse during childhood.
2. To use a group of abused people as informants, and then determine the number having a
disability in the group.
A modified version of the latter approach is used in the Norwegian research, which will be
described in this article. No standards exist with respect to the prevalence or risk rate of sexual
abuse among disabled children. However, since most of the current research in this area has taken
place in North America, results from some American studies are presented here to illustrate the
breadth results that have so far been achieved.
The Seattle Rape Relief Developmental Disabilities Project defined sexual abuse as rape,
 Is sexual abuse of children with disabilities disclosed? 1075

attempted rape, incest, and exhibition. Ryerson (1984) found through this project that during
1977– 83 more than 700 mentally disabled children and adults in Seattle were sexually abused. The
initial abuse often started when the child was 2– 4 years old, and continued through a period of 5–15
years. When these findings were compared with the general information about sexual abuse in
California during the same period, it was found that the rate among the mentally disabled in the
Seattle Project was more than four times that seen in the general population.
Chamberlain and colleagues (1984) reviewed the situation of 87 mentally retarded girls attending
a multiservice adolescent clinic, aged 11–23 years. They found that 25% had been exposed to
attempted or successful coerced intercourse. That is about twice as much as one could expect from
the previous mentioned data in the general population, which included different forms for sexual
abuse with physical contact (Gorey & Leslie, 1997).
Sullivan, Vernon, and Scanlan (1987) studied four research articles about deaf people. They
conclude:

These four pioneering studies yield certain trends. First, there appears to be more sexual abuse of deaf children than
hearing children. Whereas 10% of hearing boys and 25% of hearing girls report sexual abuse, the rates are 54 and 50%
respectively for deaf boys and girls. (p. 257)

Crosse (1993) found through a large study involving 36 nationally representative Child Protec-
tive Service agencies (CPS) that the risk ratio for abuse was 1.7 for disabled children compared to
children in the general population. He estimated the number of disabled children in the general
population to be 9%, based on data from the US Department of Education. The study only implied
children in care of CPS, and children in institutions are probably under-represented.
Sobsey and Mansell (1994) administered a questionnaire to different organizations taking care
of abused people. They found that the risk of abuse was more than doubled when the child had a
disability.
As a conclusion from the above-mentioned studies, it seems that they all regard the risk of being
sexually assaulted to be higher when the child has a disability. Most studies indicate that the risk
may be 2–3 times higher. The studies are, however, often subject to sampling bias.
This study represents the total population of children in Norway suspected of being sexually
abused during a 3-year period, and therefore avoids the problem of sampling bias. Furthermore it
deals with children, both disabled and non-disabled, who are currently exposed to the possibility
of sexual abuse.

Purpose of Study

As there has been no research about sexual abuse of handicapped children in the Nordic
countries, a project was carried through in co-operation with the Norwegian Save the Children
(Kvam, 1998). As mentioned earlier, in Norway, the prevalence of both child sexual abuse in the
general population, and the prevalence of disability among children are similar to that in America.
Hence it is likely that the American results can be compared to the results from this Norwegian
project.
This research is concerned with two main questions:

● What is the proportion of disabled children among those receiving medical attention for
suspected sexual abuse?
● What are the characteristics in the handicapped group concerning type and degree of disability,
age, gender, and conclusion as to abused or not, compared to the non-disabled?
1076 M. H. Kvam

METHODS

Subjects
If there is suspicion of serious abuse and possible intercourse, a Norwegian child will generally
be referred to a hospital to undergo a medical examination. In Norway there are 26 hospitals with
separate pediatric departments. A pediatric doctor will examine the sex organs, the anus, and the
mouth of the child. Furthermore, a psychologist will examine the child to disclose if his or her
behavior indicates abuse. Children who go through such examinations are suspected of serious
abuse, intercourse and penetration being the most common forms.
All children visiting the hospitals because of suspected sexual assault during a period of 3 years
were the subjects of the investigation. The case sheets from the hospitals that conduct such
examinations provide the information necessary for the project.

Questionnaire
Since strict rules restrict the accessibility to the medical records of patients, the use of a
questionnaire was deemed to be the optimal method to collect information. The questionnaire was
designed to be comprehensive, but simple enough so that the majority of hospitals would respond.
The questionnaires were posted in the beginning of 1997, and addressed to the chief pediatric
doctor of each of the 26 relevant hospitals. The addressee was asked to be responsible for the reply
and the quality of the answers.
There were three color-coded sheets. On one (white) the doctor was asked to fill in the number
and gender of all children attending the hospital with reference to possible sexual abuse during the
years 1994 –1996 inclusive. The second (yellow) and the third sheet (blue) were designed for
children with a “smaller” or a “severe” disability, respectively. One reason for this distinction is the
often-mentioned extra risk factors constituted by frequent contact with different adults providing
services for handicapped children (Sobsey & Mansell, 1994). Generally, more seriously disabled
children receive extra service in the form of special schools or classes, camps, or relief homes, by
drivers, nurses, special teachers, and different caretakers at home or at an institution. Another
reason for the distinction was that smaller disabilities might be the result of an assault, and not
necessarily the risk factor.
The degree and type of disability, age, gender, and the hospital’s conclusion as to abuse was
registered for each disabled child. To ensure that the answers were as valid as possible, the
questionnaire had definitions and descriptions of what a “smaller” or a “severe” disability should
include. The following disabilities are categorized as smaller: MBD/ADHD, serious concentration
difficulties, moderate degree of hearing or sight impairment, anomalies, and speech handicap.
Severe disabilities include children with severe hearing loss (⬎ 70 dB best ear), severe visual
handicap (visual equity ⬍ 6/60 best eye or visual field ⬍ 20 degrees), mental retardation (IQ ⬍ 80),
severe orthopedic disability (using wheelchair or two crutches to move), or multiple disabled
(having more than one impairment).
Social maladjustment was not classified as a handicap, as practically all sexually assaulted
children will show some maladjustment (Bryer, Nelson, Miller, & Kroll, 1987; Hobbs, 1990;
Jacobsen & Richardson, 1987; Kvam, 1998; Sobsey & Mansell, 1994).

RESULTS

Disabled Children Compared to Children Without Disabilities

All 26 hospitals responded to the questionnaire. In all but one instance the pediatrician was the
signing officer, the chief nurse being the single exception at one hospital. Most of the information
 Is sexual abuse of children with disabilities disclosed? 1077

Table 1. Gender and Disability Distribution among the 1293 Children Examined in Norwegian
Hospitals for Suspected Sexual Abuse 1994 –96
Girls Boys Total

Status N % N % N %

Disabled 54 5.4 29 10.2 83 6.4

Nondisabled 954 94.6 256 89.8 1210 93.6

Total 1008 78 285 22 1293 100

Yates’ corrected chi-square ⫽ 7.8, df ⫽ 1, p ⫽ 0.005.

was gathered through the medical records. Only a few hospitals with 3– 4 children examined with
suspicion of sexual assault had answered from memory.
A total number of 1293 children aged 0 –16 years were medically examined in Norwegian
hospitals for suspected sexual abuse during the period 1994 –96. Four of the hospitals had not
conducted any examinations of children suspected of sexual abuse during the period in question.
Among the remaining 22 hospitals the number of examinations varied from 2 to 401 children
(median 40, mean 59). Only four hospitals, all with a reputation for expertise in the field, had more
than mean. One hospital had in their material 55 children with disabilities, while 14 hospitals had
examined only non-disabled children. The distribution of disability by gender is illustrated in
Table 1.
Among the 1293 examined children we found 54 girls and 29 boys with a disability. Girls
constitute 79% of the non-disabled group and 65% of the disabled group. For boys the corre-
sponding numbers were 21% and 35% (Yates’ corrected ␹2 ⫽ 7.8, p ⫽ .005).
In addition to the above mentioned disabled children, 64 had long-lasting or chronic diseases, as
allergy/asthma (41), epilepsy (8), and undiagnosed pains (15).

Type of Disability

The hospitals had registered disabilities in accordance with definitions outlined in the question-
naire. Responses from the hospitals made it possible to register each child into one of seven
different diagnosis groups. In Table 2 the children are registered according to the main diagnosis.
Even though approximately 1/3 of the children had more than one disability, only one, a
12-year-old girl, was classified as multiple disabled. Apart from her, children with MBD or

Table 2. Main Diagnosis and Mean Age by Degree of Disability

Severe Disability Smaller Disability Total

Diagnosis N Mean Age N Mean Age N Mean Age

MBD/Concentration Problem – – 28 8.8 28 8.8

Mental Retardation 11 9.5
CP/Physical Disability 7 8.6
Sight/Hearing Disability 2 10.0
Communication Disability – –
Syndrome – –
Psychotic 1 8.0
Multiple Disabled 1 12.0
9 7.6
10 4.7
5 5.8
7 6.0
2 5.5
– –
– –
20 8.6
17 7.0
7 8.7
7 6.0
2 5.5
1 6.0
1 12.0

Total 22 9.3 61 7.3 83 7.8

1078 M. H. Kvam

Table 3. Main Diagnosis and Mean Age for 22 Children with a Severe Disability by Gender
Girls Boys Total

Diagnosis N Mean Age N Mean Age N Mean Age

Mental Retardation 9 9.2 2 11.0 11 9.5

CP/Physical Disability 6 8.0 1 12.0 7 8.6
Deaf – – 2 10.0 2 10.0
Insane 1 8.0 – – 1 8.0
Multiple Disabled 1 12.0 – – 1 12.0

Total 17 8.9 5 10.8 22 9.3

concentration difficulties had the highest mean age (8.8 years), followed by mental retardation (8.6
years). The children classified as having a syndrome were youngest (mean age 5.5 years).
The children with a smaller disability were younger when visiting the hospital than were children
with a severe disability.

Children with a Severe Disability

As stated above, severely disabled children constitute the real risk group in connection with
sexual abuse. Hence a special interest lies in the group of 22 children classified as severely
disabled.
Of the 54 disabled girls, 17 had a severe disability (31%), compared to 5 of the 31 disabled boys
(16%). The different hospitals had from 0 –2.7% children with a “severe disability” in their
material.
Some of the children were given two diagnoses. In addition to the main one in Table 3, they had
“language/speech problems,” “MBD/concentration problems,” and “autism.” Despite the two
diagnoses, only one child was labeled “multiple-disabled.”
Mental retardation was the largest group (50%). Even though the questionnaire defined all
children with mental retardation as being “severely disabled,” nine children with mental retardation
were classified as having a smaller disability by their hospital. In the tables the hospitals’ choice
of coding has been respected.
Fifteen of the severely disabled children (68%) were 7–10 years at the time of examination. The
mean age for girls and boys was 8.9 and 10.8 years, respectively. The youngest girl was 4.1 years,
and the youngest boy 8.1 years. The oldest girl and the oldest boy were both 14 years.

Probability as to Assault
The hospitals could code the probability of assault on a 3-point scale: Probably no assault/ abuse,
Uncertain, Probably assaulted/abused. Reported results for 747 non-disabled children, 61 children
with “smaller” and 22 children with “severe” disability with respect to probability of assault are
show in Table 4.
Since the original questionnaire did not ask for a conclusion regarding likelihood of assault at the
time of medical examination for the non-disabled group, this information was collected retrospec-
tively for 60% of the non-disabled group, mainly from annual reports.
Table 4 shows that for 21 children in the “severe” group—all except one girl—the possibility of
a sexual assault was not excluded. The percentage of “probably assaulted” was seen to increase
with the severity of the disability, though the overall Pearson chi-square was not significant. An
analysis of linear trends for proportions, where those “probably assaulted” are compared to the
combined categories “probably not assaulted” and those classified as “uncertain,” reveals the same
 Is sexual abuse of children with disabilities disclosed? 1079

Table 4. The Number and Percentage of Children Classified by Disability and Probability of Assault
Prob. Not Uncertain Prob. Assault
Degree of Total
Disability N % N % N % O.R. N

No Disability 179 24 321 43 247 33 1.0 747

Smaller 11 18 25 41 25 41 1.35 61
Severe 1 5 11 50 10 45 1.62 22

Total 191 23 357 43 282 34 – 830

Pearson’s chi-square ⫽ 6.44, df ⫽ 4, p ⫽ 0.17.

Probably assaulted: Chi-square for linear trend ⫽ 2.3, df ⫽ 1, p ⫽ 0.13.

trend. The increasing odd ratio (risk ratio) with increasing degree of disability can be viewed as an
estimate of relative risk. The chi-square for linear trend, however, was not significant.
Table 5 shows that the likelihood of assault differs within and between the different diagnosis
groups. About half of the children with mental retardation, reduced sight/hearing, and MBD-like
problems, were classified as “probably assaulted.”
Table 6 reveals that more disabled boys than girls were thought to have been assaulted (p ⫽ .09),
though not significantly.

DISCUSSION

This study is built on the responses from all Norwegian hospitals that had carried through
medical examinations on children suspected of being sexually abused during the years 1994 –1996.
Some areas of uncertainty need to be addressed:
● the uncertainty connected to the term disability,
● uncertainty pertaining to the international research which have been the bases for this study,
● uncertainty with respect to the estimate of children with a smaller or severe disability in the
population, and
● uncertainty regarding the conclusions of the examinations as to the likelihood of sexual assault.
It is difficult to discern the borders between “no disability,” “smaller disability,” and “severe
disability.” Some minor disabilities are not visible, and some will not become obvious until the
child gets older. While some physicians may neglect a minor disability, others may emphasize a
minor disability that under different circumstances would have been neglected. Furthermore, a

Table 5. Probability of Assault and Diagnosis among the 83 Disabled Children

Diagnosis Prob. Not Uncertain Prob. Assault Total

MBD/Concentration Problems 3 12 14 29
Mental Retardation – 10 10 20
CP/Physical Disability 5 6 5 16
Sight/hearing Disability 1 2 4 7
Communication Disorder 1 5 1 7
Syndrome 2 – – 2
Psychotic – – 1 1
Multiple Disabled – 1 – 1

Total 12 36 35 83
1080 M. H. Kvam

Table 6. The Number and Percentage of Disabled Children Classified by Gender and Probability of Assault
Prob. Not Uncertain Prob. Assault Total

Gender N % N % N % N %

Girls 11 20.4 23 42.6 20 37.0 54 65.1

Boys 1 3.4 13 44.8 15 51.8 29 34.9

Total 12 14.5 36 43.4 35 42.1 83 100

Pearson’s chi-square ⫽ 4.72, df ⫽ 2, p ⫽ 0.09.

smaller disability may in some cases be the result of assault rather than the cause (Jaudes &
Diamond, 1983). Some would include children with allergy/asthma and epilepsy in the sample,
conditions that are excluded in this analysis. There is a large degree of uncertainty as to causal
relation connected to MBD-like problems, as such conditions often are diagnosed through the
child’s behavior.
Less uncertainty is connected to the term “severe disability,” as such disabilities often are evident
from early childhood.
International studies on sexual assault of disabled children form the premises for some of the
conclusions. The validity of those studies has, however, not been assessed. Conclusions drawn
from these studies vary widely and are often based on small samples without the benefit of a control
group.
There are different opinions as to the proportion of children having a disability. In Norway about
10% of children will have reading disabilities, and 6 –7% MBD/ADHD-symptoms (Kvam, 1998).
However, these are not always of a serious character. Our finding that 11% of Norwegian children
have a smaller or more severe disability is based on statistical data from official sources (Barth,
1987) and corresponds with American data (Baladerian, 1990; Crosse, 1993; Garbarino et al.,
1987). However, the sited American studies generally include more serious types of disabilities.
These children often reside in full-care facilities, away from home for extended periods and receive
help from different caretakers, among who may be a person with pedophilia tendencies. Disabled
children may have communication problems and be less able to refer the circumstances of what
transpired, they are often less able to defend themselves, have less knowledge about their own
bodies and what may be considered as normal sexuality, and finally, they may be dependent upon
the abuser. These are circumstances that an adult may misuse, and thus the severely disabled
children constitute the real risk group.
Different opinions exist as to the number of children in a population who have a “severe”
disability. The group mainly consists of mentally retarded children. The border between “normal”
and “mentally retarded” is sometimes set at 70 IQ-point (The American Psychiatric Association,
1987), others use 80 IQ-points as a limit (Carmody, 1991; Sobsey, 1994). As people with mild
mental retardation seem to be very vulnerable to sexual assault (Chamberlain et al., 1984), the
border between “mild retardation” and “normal” in this study is 79/80 IQ-points. Together with
children with moderate, severe and profound mental retardation, they will include about 3% of the
population. Children with severe sight or hearing disabilities, cerebral palsy (CP), myelomenin-
gocele (MMC), or handicapping effect of illness or accident are presumed to include 1% of the
child population, and hence the group “severely disabled children” is calculated to constitute 4%
of the population (Kvam, 1998).
The conclusion arrived by the pediatrician regarding the probability of sexual assault is also
subject to a degree of uncertainty. However, any error in this estimate will be the same for both the
disabled and non-disabled groups, since the doctor and the psychologist do not build their
conclusion on verbal communication.
 Is sexual abuse of children with disabilities disclosed? 1081

As mentioned previously, conclusions as to the likelihood of sexual assault among children in

the non-disabled group was collected afterwards for 60% of the material. Little difference was
found between the responding hospitals, also in comparison with group of children with disabil-
ities, which give reason to believe that the numbers and percentages are representative.

Discrepancy Between Expected and Observed Number of Children with a Disability

From international research it is expected that the risk of abuse is 2–3 times higher when a child
has a disability. This risk rate includes all types of sexual abuse. It is likely that the risk of serious
abuse, like those expected when a medical examination is necessary, is at least at the same high
level. Sobsey (1994) writes:

Furthermore, individuals with a disability who have been victimized typically experience more prolonged and severe
abuse. (p. XIV)

If 11% of the general child population are disabled, one would expect the sexually abused
disabled children to constitute 2–3 times the 11% they are supposed to constitute in the general
population. In this research children with a disability constituted 6.4% of the informant group. The
extra risk is not mirrored in the study.
The 4% children in the population with severe disabilities probably constitute the real risk group.
Hence one should expect them to constitute 8 –12% of the informant group, that is 103–155
children. However, only 22 children, or 1.7%, were diagnosed as severely handicapped. If all the
mentally disabled children are grouped “severely disabled,” as the questionnaire described, the
group increases to 2.4%.
The explanation for the discrepancy between expected and observed number of children with a
severe disability is probably that sexual abuse is less likely to be disclosed among children with a
severe disability than among non-disabled children. Ryerson (1984) and Crosse (1993) have found
support for this in their studies. Tharinger and colleagues (1989) writes:

Some estimates suggest that only 1 in 30 cases of sexual abuse/assault of persons with disabilities is reported, compared
to 1 in 5 cases with the non-disabled. (p. 301)

Apart from the false myths mentioned at the beginning, the lack of disclosure may have several
additional reasons. The first is connected to the difficulties in understanding the child’s verbal
communication. Like all children, however, the disabled child will give non-verbal signals when
abused: loss of appetite, sleeping problems, crying, nightmares, rage, or introverted behavior and
apathy. When such behavior arise, the caretakers of disabled children generally link these to
bullying, failures, wrong medication, fear of future hospitalization and so forth. Those involved in
the care of the disabled children seem to find explanations for the changed behavior in the disability
itself. Sexual assault is not disclosed until it is much more evident.
This explanation is supported by the fact that children with a disability more often get the
conclusion “uncertain” or “probably assaulted” than do non-disabled children. The tendency
towards more certainty increased with the degree of disability.
Furthermore, it is supported by the age of the children. While the non-disabled group had an
average age of less than 7 years, the children with a smaller disability corresponding had more than
7, and the severely disabled group more than 9 years.
A second possible explanation for dark alleys is that assault against a disabled child may be
regarded as less severe for the child and therefore ignored. Crosse (1993) found in the CPS-study
that in many cases the closest family/guardian knew what was going on, but neglected to
acknowledge the sexual abuse if the child had a disability. This was the case with 43% of the
disabled children, compared to only 11% of the non-disabled.
1082 M. H. Kvam

A third explanation may be the schools’ fear of acquiring a negative reputation, leading them not
to report possible assaults. Sullivan and colleagues (1987) claims that several institutions have tried
to act on their own:

For example, the abuser may be asked to resign and promised a good recommendation if he complies. As a result, the
molester goes recommended to another school to sexually abuse more deaf youth. (p. 258)

A fourth reason for lack of disclosure may be the parents’ or caretakers’ lack of faith in the
existing judicial system. If a sexual assault is suspected, they choose not to trouble the handicapped
child with a medical examination, believing that a trial would probably not lead to conviction.
Sobsey (1994) writes about disabled children:

All the studies discussed above agree that convictions of offenders were rare in spite of the chronic and severe nature of
abuse. . . .Ironically, many who failed to report abuse indicated that they lacked the faith in the justice system to secure
convictions. This appeared to become a self-fulfilling prophecy, as crimes that go unreported cannot be punished. (p. 79)

None of these four explanations is acceptable. For all children, regardless of disability, it is
crucial that sexual abuse is prevented or immediately stopped. It is even more important to the child
who already has difficulties coping with every-day-life.

Gender and Age Differences

Finkelhor (1994) reviewed studies from 19 different countries. He concluded that girls were
abused 1.5–3 times more often than were boys in the general population. Dobash, Carnie, and
Waterhouse (1993) found 74% girls among the abused in the UK; in Norway this was 65% (Tambs,
1994).
We reported 78% girls and 22% boys among the non-disabled, slightly more girls than in the
above mentioned studies. The disabled group, however, included 65% girls and 35% boys. The
difference in gender distribution between disabled and non-disabled is significant (Yates’ corrected
␹2 7.8; df ⫽ 1, p ⫽ .005). Sobsey, Randall, and Parrila (1997) found the same tendency in the
mentioned CPS-material, where boys were over-represented among the disabled sexually abused
children compared to the non-disabled.
Disabled boys were more classified as “probably assaulted” than disabled girls (Pearson’s ␹2
4.72, df ⫽ 2, p ⫽ .09). The average age of disabled boys was about 2 years higher than that of
disabled girls, which may indicate either that boys are older when assaulted, or that, for a boy, it
is even more difficult to discover an assault.
Two of the children were deaf. Both were 10-year-old boys, and both were classified as
“probably assaulted.” Despite the small numbers, this finding is in agreement with Sullivan and
colleagues (1987), who found more boys than girls in their “deaf” material.
It is difficult to give a valid explanation to the increasing risk for boys with a disability compared
to non-disabled boys. However, one cannot ignore the possibility of the disabling effects of sexual
abuse on boys. Research has shown that a boy being assaulted by a man can get strong harmful
effect by loss of masculine identity and uncertainty about sexual preference (Saetre, 1999).
Apart from the single multiple disabled child who was 12 years old when attending the hospital,
the children with “MBD/concentration problems” were oldest (mean age 8.8 years) among the 83
disabled ones, followed by “mentally retarded” (mean age 8.6 years). This seems to be natural, as
such problems often will be evident after some years at school. Children with CP/physical
disabilities were as a group youngest (4.6 years). Their visible disability has probably been evident
since they were babies.
 Is sexual abuse of children with disabilities disclosed? 1083

CONCLUSIONS

From American research it is expected that the risk of sexual abuse is 2–3 higher for disabled
children compared to non-disabled. This is probably true also when serious sexual abuse is
concerned. Hence one should expect that disabled children constitute a larger proportion among the
children attending Norwegian hospitals because of suspected serious sexual abuse than in the
general population. This could not be supported by our research. As contrast to 11% in the general
population, children with different disabilities constituted 6.4% of the total informant group. The
discrepancy between the expected and observed numbers was especially evident for children with
severe disabilities. Instead of constituting 8 –12% of the sample, they constituted 1.7%. This group
was older when they came to the hospital, and were more often classified as “probably assaulted”
than other disabled children. The reason for this is probably that sexually assaulted children with
severe disabilities are not referred to medical examination to the same degree as other children.
However, there may be uncertainties as to whether disabled children in Norway are assaulted to
the same degree as disabled children in North America. It is, therefore, important that this research
be continued in order that the extent of sexual abuse against disabled children is fully disclosed. A
further study is planned to obtain information about childhood sexual abuse among Norwegian deaf
adults.
It is of great importance that people working with disabled children are aware of the incumbent
risks and take steps to put a stop to any offending sexual behavior between a child and an adult.
Upon disclosure, therapy adapted to the specific needs of the sexually abused disabled child must
be offered. It is a paradox that disabled children, who are totally dependent upon qualified help,
very seldom receive therapy specifically adapted to their needs. Normally, those who are knowl-
edgeable with regards to the handicap know little about therapy, and vice versa. Adapted therapy
has, however, proven to be of great value (Cruz et al., 1988; Tharinger et al., 1989; Westcott, 1993;
Sullivan et al., 1996).

Acknowledgments—The author wishes to thank Mitchell Loeb, Researcher at SINTEF Unimed, Oslo, Save the Children,
Norway, The Norwegian State Council on Disability, and all Norwegian pediatric hospitals.

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