The Safety Net

Assessing Physical Abuse in Children and Adults with Limited Communication Skills


When called upon to assess for the possibility of physical abuse of either a child or an adult with limited communication skills, the clinical professional faces some unique challenges.  Persons with developmental disabilities are sometimes unable to easily communicate the fact that they have been physically abused. The person may not give verbal information so you may have to get a picture from the written assessments and nonverbal information. The following information is offered to assist those who may be required to perform such an assessment.  

  • Some physical indicators of abuse are: bite marks, burns (care should be taken to note the shape of the burn mark), lacerations, unexplained injuries to protected parts of the body such as the buttocks, thighs, torso, ears and neck and bruises in the shape of a hand, cord loop, buckle or of a circular shape. Repeated accident s and injuries may also be an indicator that the person is being physically abused.  
  • Behavioral indicators may also point toward abuse.  Some signs are: excessive fearfulness of the caregiver, wearing clothing to cover bruises or other injuries, inconsistent stories from the injured person about the circumstances, fear of physical contact, crying, indicators of pain when moving or upon contact, reluctance to leave with certain people and the new onset of incontinence.
  • An injury that is inconsistent with the consumerís history is a red flag. A person who does not walk but has a broken arm is an example of a situation that warrants further inquiry. Consideration must be given to the developmental skills of the individual.  Does he/she have an unsteady gait and do the injuries appear where one would expect a fall to cause trauma such as shins, knees elbows or forehead or are they in areas of the body where a fall is not a reasonable explanation?  Is the person frequently lifted or transferred?  What medications are being taken and what are the side effects of those medications? Some medications may lead to easy bruising but a physician needs to make that judgment. 
  • When abuse is suspected, a full body medical examination is recommended.  Emergency room physicians or the individualís personal physician should be alerted to the possibility of abuse at the time of the exam. When the medical examination yields a picture different from the one that is provided by the caregiver or informant, then abuse must be suspected.
  • Indicators from caregivers that abuse may be a factor are: frequently changing physicians, history of drug or alcohol abuse, inappropriate reaction to the consumerís pain or injury, low frustration tolerance, many personal problems and other unexplained incidents from the same home or at a time of day when certain staff are on duty.  
  • When physical abuse is suspected, what is found upon examination must be paired with the history provided and with your knowledge of other circumstances relating to the suspected abuse.  Persons with limited verbal ability have many ways of communicating without the skilled use of language.  Observation will yield a great deal of information.
  • California law states that: "Any person who has assumed full or intermittent responsibility for care or custody of an elder or dependent adult, whether or not that person receives compensation, including administrators, supervisors and any licensed staff of a public or private facility that provides care or services for elder or dependent adults, or any elder or dependent adult care custodian, health practitioner, or employee of a county adult protective services agency or local law enforcement agency is a mandated reporter.Ē To put it simply, all employees who work for providers of services to persons with developmental disabilities are required by law to report and instance of suspected   abuse, neglect, abandonment, isolation and financial abuse.  Children with developmental disabilities have similar protections and those providing services must report suspicions of the same things but to Children's Protective Services.  This includes schoolteachers, nurses and any other providers of service.


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