Zero Tolerance Initiative > Common Signs and SymptomsPerhaps the most difficult aspect of recognizing the signs and symptoms of abuse and neglect is that individuals with developmental disabilities may exhibit certain physical and/or behavioral traits due to the nature of their disability. Therefore, it is very important to recognize changes in behavior or health (particularly those not typically associated with the individual's disability) as potential abuse indicators. It is also important to note that there is no universal response to abuse or neglect. Show
Above all else, be mindful that any sudden change in the physical, behavioral, or financial status of someone with a developmental disability may be the result of past or ongoing incidences of abuse, neglect or exploitation. While each victim of abuse, neglect, or exploitation will respond differently, the available research data reveals that the presence of certain physical and behavioral indicators (described in greater detail below) are highly correlated with abusive situations and environments. "The indicators or warning signs of abuse are clues that something is happening in the life of the person that should be looked into. Some indicators are obvious signs of abuse. Other indicators are subtle, requiring careful observation. In some situations abuse may not be occurring at all. It is important to think about the person and any health or behavioral issues they have. Some people may get injured more easily due to health reasons or aging. For example, some medications and some health problems like hemophilia (where the blood clots slowly) can cause easy bruising. Some people may engage in self-injurious behaviors that cause injuries that look like abuse. Even if you discover that a person has a health or behavioral issue that might be the cause of the injury, it is still important to investigate to rule out abuse as the cause. It is important to put aside any biases that you might have that care providers would not abuse a person with a disability that they support.¹" As you interact with someone with a developmental disability, you should pay close attention to any changes in how that person looks or acts. A sudden or gradual change in appearance or behavior can be an indicator that abuse or neglect has occurred (or may still be happening.) Physical Signs of Abuse
Physical Signs of Neglect (in both the person and their home)
Behavioral Signs
Behaviors of Caregivers who may be Abusers As you interact with caregivers, you should always be on the lookout for certain behaviors that may be indicators that this person is an abuser. Caregiver behaviors to look for include:
Profiles of Abusive Caregivers Caregivers who abuse, neglect, or exploit people with developmental disabilities are either UNABLE or UNWILLING to provide care to these individuals in an appropriate way. It is very important to understand what is going on with these types of caregivers because that will help us develop and implement prevention strategies (which we will talk about later on in this training). Caregivers who UNABLE to provide care appropriately may include individuals who are not properly trained or have the necessary experience to perform their caregiving duties. They may have mental retardation or mental illness themselves. Perhaps they are physically unable to provide care to a person with the developmental disability due to their own medical or health condition. Caregivers who are UNABLE to provide appropriate care may also be overly stressed or overly tired. They may also be working under the influence of drugs or alcohol which limits their abilities. Caregivers who are UNWILLING to provide care appropriately are more likely to know what they are doing is wrong yet continue to act in that way. Research shows that these individuals will abuse, neglect, or exploit individuals with developmental disabilities over and over again as long as they are given the opportunity to do so. Some of these caregivers may not view their victims as actual people (with feelings and emotions). In other cases, caregivers who are UNWILLING to provide appropriate care see people with developmental disabilities as the perfect victims who may not be able to defend themselves or tell anyone what has happened. Abusive caregivers may also have:
Types of Emotional Abuse and Neglect Emotional abuse is the most difficult form of abuse to identify. Even though emotional abuse often happens along with other forms of abuse, it can also occur by itself. Caregivers who have power and influence over others' lives can use that power to harm or exploit, rather than to support and nurture. This can be especially devastating for children in their developmental years, but it can be harmful for anyone. Emotional abuse can take the form of threats, insults harassment, and less noticeable forms that are difficult to detect. These can be perpetrated by individuals or by representatives of caregiving systems. Here are some of the most common types of emotional abuse and neglect:
Physical Abuse in Caregiving Sometimes abuse of persons with developmental disabilities takes the form of acts that could be thought of as well-intentioned but unsuccessful attempts by the caregiver to ensure the person's well-being. In other cases, the abuse is deliberate, and is disguised as caregiving. Here are a few examples of that type of abuse:
Frightening Physical Actions Using frightening physical actions that stop short of causing serious physical harm is another form of physical abuse that is too often used by abusive caregivers of people with developmental disabilities. Consider how these actions might affect a person with developmental disabilities:
Physical Signs of Abuse: Questionable Bruises Bruises are among the most common injuries found in children and adults with developmental disabilities who have been abused. It is important to remember that occasional bruising is also common in people who are not abused, and that people with some disabilities may be prone to bruising for other reasons. Here are some of the more common bruises that may indicate signs of abuse:
Other Physical Indicators The following are some other physical indicators of abuse or neglect of persons with developmental disabilities. In each case, other indicators such as behavior and circumstances must be considered. Questionable cuts and scrapes
Burns or scalds
Bites
Ligature marks and welts (which could have come from being tied up or gagged)
Eye and ear injuries
Dental and mouth injuries
Dislocations of joints
Fractures:
Coma:
Distinguishing Abuse from Accidental Injury Accidents happen with everyone, including people with developmental disabilities. The following is a guide to help you tell the difference between accidental and non-accidental injuries. When observing an injury that might be the result of abuse, consider these factors: Location of the injury:
Number and frequency of injuries:
Size and shape of the injury:
Description of how the injury occurred:
Consistency of injury with the person's developmental capability:
Behavioral Signs of Abuse Behavioral signs can be extremely important in detecting abuse and neglect, especially in people who have communication challenges and are unable to tell anyone about what happened to them. In many cases, physical signs of abuse may not yet be present or noticed so behavioral signs are often the first indicators. Usually it is a combination of physical and behavioral changes that are seen in people that have been abused. Here are some of the behavioral signs of possible abuse: Aggressive behavior
Atypical attachment
Disclosure
Fearfulness
Learning Disabilities Difficulty learning can be a result of abuse for complex reasons. Much of the child's energy is directed toward surviving the abuse and coping with stress. This leaves little energy for learning or other typical childhood activities. Psychotherapy, or other appropriate treatments, can lead to improvement for those whose learning disabilities resulted from their psychological response to abuse. Noncompliance
Regression
Sleepdisturbance
Withdrawal
Signs and Symptoms of Exploitation Taking advantage of individuals with a developmental disability can rob them of their independence and the ability to afford the basic necessities of life, such as food, rent payments and medicine. It's also a crime and should be reported right away to the Florida Abuse Hotline. In particular, financial exploitation often goes unreported or is reported long after the damage is done. When that happens, the suspect is far more likely to get away with the crime and move on to other victims. Here are a few signs to watch for:
If you notice any of these signs or suspect that a person with a developmental disability might be a victim of exploitation, please contact the Florida Abuse Hotline immediately. Factors That Make it Hard to Recognize Abuse, Neglect, and Exploitation A number of factors can make it difficult to identify abuse, neglect, and exploitation of persons with developmental disabilities. Person does not recognize abuse, neglect, or exploitation. In order to let someone know they are being maltreated, victims of abuse must:
"I wasn't able to say, "knock it off" to my family who was doing my personal care. I thought it was normal to be tossed around in my chair. To have a comb dragged through my hair so it comes out. To be left on a toilet for an hour. It took me about five years of hiring people, when I realized that I didn't have to accept those things."5 Many people with developmental disabilities have grown accustomed to being treated without respect, and are used to routine treatment that most other people would not tolerate. People with developmental disabilities may view only the most severe acts against them to be worthy of attention and possible reporting. The victim may consider an incident "unimportant" unless it involves serious physical harm. Greater personal assistance needs Fear of not
having needs met Communication challenges Self-abusive behaviors Signs of abuse may be interpreted as behavioral problems
The Problem with "Subtle" Abuse "If they're (personal assistants are) feeling angry for some reason…at you or whatever, they might set you down in your chair a little harder than normal. Or…position you in a little rougher way. And you sit there thinking, 'Now did he mean to do that?' It's really hard to distinguish. It makes you question yourself a lot."6 While some actions (such as punching) are easy to identify as abuse, other forms of mistreatment by caregivers are harder to spot (although they still represent acts of abuse). Below are examples of what can be termed "subtle" abuse:
Conditions of People with Developmental Disabilities That Can Sometimes Look Like Abuse or Neglect There are a number of conditions that may lead you to incorrectly think that someone with a developmental disability has been abused or neglected. Here are some of the most common: Spotting the Red Flags: An Activity Directions:
What might you suspect? What might you suspect? What might you suspect? What might you suspect? What might you suspect? What might you suspect? Answers:
Which behavior would the nurse suspect is contributing to a toddler's malnourishment and dental caries?What does the nurse suspect is causing malnourishment and dental caries in a child? Six ounces of fruit juice per day is sufficient for a toddler. Excessive consumption of fruit juice can result in diarrhea, overnutrition or undernutrition, and dental caries.
Which statement characterizes the eating behavior of toddlers quizlet?Terms in this set (26) Which description characterizes toddlers' eating behavior? They are fussy eaters.
Which response would the nurse provide to the parent of a toddler who reports coating the child's pacifier with honey?A parent of an 18-month-old toddler asks the nurse if the baby's pacifier can be coated with honey, because it is good for the immune health. What should the nurse tell the parent? Honey should not be given to infants.
Which cause of anemia would the nurse recognize as the most common cause of anemia in 1 year olds?The most common cause of anemia is not getting enough iron. A child who's anemic doesn't have enough red blood cells or enough hemoglobin. Hemoglobin is a protein that lets red blood cells carry oxygen to other cells in the body.
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