Child welfare system (CWS) involvement is extremely stressful for families, particularly those with autistic children. Research has shown that substantially higher numbers of children with autism are reported to and investigated by child protective services. Some evidence suggests that autistic children are more likely to experience maltreatment by their caregivers as compared to typically developing peers. However, there is little published data on the lived experiences and long-term impact of CWS involvement on autistic children and their families. This article highlights concerns for autistic children and offers guidance for caregivers and professionals.
Are Autistic Children Overrepresented in the Child Welfare System?
Research shows that autistic children have higher rates of involvement with Child Welfare Services (CWS). A large population-based study in Tennessee found that autistic children were significantly more likely to be referred to the Child Abuse Hotline than those without autism (17.3% vs 7.4%). However, autistic children were less likely to have referrals screened in for further action (62% vs 91.6%, respectively). In this study, substantiated maltreatment rates were similar in children with and without autism. However, within the autism group, autistic girls were more likely to have substantiated maltreatment (13.6% vs 1.9%). The high percentage of referrals, the differential pattern of screening for further action, and the high levels of substantiated maltreatment in autistic girls are notable findings (Fisher, 2019). These results highlight the need for specialized training for child welfare professionals, particularly in recognizing and addressing the unique challenges faced by autistic girls and their families. Additionally, targeted research into effective intervention strategies is crucial to help child welfare systems better support this vulnerable population
McDonnell and colleagues found that autistic children do, in fact, face higher rates of caregiver maltreatment than typically developing peers. A study of nearly 5,000 children identified as autistic, having an intellectual disability (ID) or both found that autistic children were more likely to be victims of reported and substantiated cases of maltreatment compared with a control group. Children with a sole diagnosis of autism were nearly twice as likely to be reported and 1.5 times more likely to have maltreatment substantiated. Children with both ASD and ID and ID-only were more likely to experience reported sexual, physical, and emotional abuse. In this study, children with only ASD were uniquely at risk for reported physical abuse (McDonnell, 2019).
It is worth noting that children with disabilities in general are referred to Child Protective Services (CPS) at higher rates than those without disabilities, are more likely to experience substantiated maltreatment, and undergo placement in foster care (Alwash, 2022). Autistic children may be referred to CPS more often due to factors like increased interactions with mandated reporters and their own communication and social challenges. These difficulties can make them more vulnerable to abuse, as they may struggle to express concerns or recognize harmful intentions, making it harder for them to report or describe abuse (Palm, 2017). Families of children with autism may experience heightened social isolation and diminished family and community support. Consequently, their access to external support systems that facilitate the identification or resolution of abuse cases is often limited (Fisher, 2019).
These findings raise important questions about the intersection of autism and the child welfare system, and the need for nuanced approaches in both policy and practice. Factors such as communication differences, behavioral challenges, and the increased likelihood of misunderstandings may contribute to the higher rates of investigation and reporting among autistic children. At the same time, these children and their families often encounter systems that are ill-equipped to recognize or adequately address the complexities of neurodevelopmental conditions within the context of child protection.
Moreover, the process of navigating the child welfare system can be daunting for parents and professionals alike. For families with autistic children, the stakes are particularly high, as the consequences of misinterpretation or lack of support can result in harmful outcomes. It is important to view these factors as risks and not causes of maltreatment, as there are ascertainment and methodological limitations both in research and CPS data collection (Fisher, 2019). The intricate relationship between autism, family stress, and child welfare involvement underscores the urgency of expanding research and resources dedicated to this population.
What Happens When a Report is Made?
When a report of suspected child abuse or neglect is filed with CPS, the process generally unfolds in stages, although specific details and timelines vary by jurisdiction. When the initial report is received, it is screened to determine if it meets criteria for abuse or neglect. If a report is credible, it is “screened in,” triggering further CPS action, while others may be “screened out” and no further response is warranted.
For screened-in reports, CPS initiates either a formal investigation or a family assessment. During a formal investigation, CPS gathers evidence, assesses the child’s safety, and determines whether maltreatment has occurred. This process generally includes interviews with the child, parents, caregivers, and other household members. The evaluation involves reviewing the home environment for safety and living conditions, observing the child’s physical and emotional well-being, examining pertinent medical and school records, and consulting individuals familiar with the child. If criminal activity is suspected, law enforcement agencies conduct a separate investigation.
Some states use an alternative or family assessment response (FAR) for lower-risk reports, which assesses family needs and strengths without formally determining maltreatment. According to NCANDS data, alternative responses vary by state but result in more families receiving services, with no increased risk of later reports compared to traditional investigations (O’Grady, 2005).
After investigating, CPS determines if allegations are substantiated, unsubstantiated, or inconclusive. Depending on the outcome, CPS may close the case, offer services, develop a safety plan, remove the child for their protection, or start legal action. If removal occurs, efforts shift toward reunification, with regular court hearings to monitor placement and parental progress. In rare cases where reunification is not possible, CPS may seek termination of parental rights and adoption (Child Welfare Information Gateway, 2002).
Special Considerations for Autistic Children
CWS involvement can cause significant stress for children and parents, due to investigations, loss of control, community judgment, and fear of separation. Initial visits by CPS workers, regardless of the outcome of the case, can create lasting fear and trauma within the family (Newport, 2023). This stress is magnified in parents of autistic children, who must convey and advocate for their children’s unique communication, emotional, behavioral, and educational needs.
Studies indicate that autistic children with ID are 2 to 5 times more likely to be placed in foster care than U.S. children in the general population (Shea, 2024). The long-term impact of foster care on autistic children can be significant and challenging. Changes in placement can disrupt routines and relationships, which disproportionately affects children with autism who rely on structure and predictability. This instability can lead to increased behavioral problems, social and emotional difficulties, and a higher risk of mental health challenges (Cruz, 2019). These issues may impair the formation of healthy attachments with foster parents. Autistic children also have significant placement instability, with higher rates of disruption and longer length of stay compared to their neurotypical peers. This instability can lead to poor outcomes in mental health and overall well-being (Platt, 2022).
Guidance for Caregivers and Professionals
Autistic children involved in the child welfare system require approaches that are trauma-informed, neurodiversity-affirming, and culturally competent. Effective support should prioritize education, advocacy, improved access to services, and the prevention of unnecessary family separation. The table below outlines key areas where caregivers and professionals can take proactive steps to support autistic children and reinforce family stability:
Parents and Caregivers:
- Seek advocates and legal counsel experienced in disability law
- Utilize community resources, especially if directed by family assessment response (FAR)
Caseworkers
- Obtain specific training in ASD, recognizing the difference between neglect and difficulties due to disability
- Assist family with Medicaid waivers and accessing community supports
Educators
- Encourage enrollment in schools with strong special education services
- Utilize trauma-informed educational and behavioral support for autistic children
Despite the significant disparities in CWS involvement for the autistic population, this group is relatively understudied, and there is little consistent data on outcomes for autistic children. Child welfare databases should monitor autism diagnoses and services. Long-term outcomes, including placement stability, access to services, and educational attainment should be monitored. In addition, neurodevelopmental disorders should be consistently identified as special needs during placement determinations. Enhanced professional training and improved interagency collaboration among child welfare, developmental disability services, educational institutions, and mental health providers are recommended.
Judith A. Lucas, MD, MJ, is a board-certified developmental-behavioral pediatrician at the Albany Medical Center in Albany, New York. She holds a Masters in Jurisprudence in Children’s Law and Policy. For more information, email lucasJA@amc.edu.
References
Alwash NM, Palusci VJ. Factors related to medical neglect recurrence and foster care and adoption services. Child Abuse and Neglect. 2022 Jan;123(105378). https://doi.org/10.1016/j.chiabu.2021.105378
Child Welfare Information Gateway. (2022). Understanding child welfare and the courts. U.S. Department of Health and Human Services, Administration for Children and Families, Children’s Bureau. https://www.childwelfare.gov/pubs/factsheets/cwandcourts/
Cruz N. How foster care fails children with autism. Children’s Rights. https://www.childrensrights.org/news-voices/how-foster-care-fails-children-with-autism#:~:text=The%20foster%20care%20system%20is,in%20a%20state%20of%20limbo
Fisher MH, Epstein RA, Urbano RC, Vehorn A, Cull MJ, Warren Z. A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder. Autism. 2019 Jul;23(5):1335-1340. doi: 10.1177/1362361318813998. Epub 2018 Dec 7. PMID: 30523699; PMCID: PMC6555697.
Fisher MH, Epstein RA, Urbano RC, Vehorn A, Cull MJ, Warren Z. A population-based examination of maltreatment referrals and substantiation for children with autism spectrum disorder. Autism. 2019 Jul;23(5):1335-1340. doi: 10.1177/1362361318813998. Epub 2018 Dec 7. PMID: 30523699; PMCID: PMC6555697.
McDonnell CG, Boan AD, Bradley CC, Seay KD, Charles JM, Carpenter LA. Child maltreatment in autism spectrum disorder and intellectual disability: results from a population-based sample. J Child Psychol Psychiatry. 2019 May;60(5):576-584. doi: 10.1111/jcpp.12993. Epub 2018 Oct 19. PMID: 30368827; PMCID: PMC6458088.
Newport AB. Civil Miranda Warnings: The fight for parents to know their rights during a child protective services investigation, Columbia Human Rights Law Review. 2023 (54.2) 854-903.
O’Grady MJ, Broman BB. Alternative responses to child maltreatment: findings from NCANDS research summary. ASPE Office of the Assistant Secretary for Planning and Evaluation (ASPE), US Department of Health and Human Services, August 2005. https://aspe.hhs.gov/sites/default/files/migrated_legacy_files//67156/rs_3.pdf
Palm C, McDonald A. Dynamics of abuse and disclosure for children with special needs. Society for Child and Family Policy and Practice. Section on Child Maltreatment Newsletter, September 2017.
Platt C, Gephart SM. Placement disruption of children with disabilities in foster care. J Pediatr Nurs. 2022 Sep-Oct;66:30-35. doi: 10.1016/j.pedn.2022.05.004. Epub 2022 May 20. PMID: 35605440.
Shea L, Villodas ML, Ventimiglia J, Wilson AB, Cooper D. Foster Care Involvement Among Youth With Intellectual and Developmental Disabilities. JAMA Pediatr. 2024;178(4):384–390. doi:10.1001/jamapediatrics.2023.6580
