Quality of Life, Children with Intellectual and Developmental Disabilities, and Maltreatment

IntroductionQuality of life is typically considered to be a concept that supports a positive approach to human life, and child maltreatment is a concept that describes an unwanted and often abhorrent aspect of some children's lives. Applying quality of life to child maltreatment might seem, at first glance, to be an unlikely undertaking. But the initial link made between the two (1) argued that negative aspects of life - especially those such as child maltreatment that are both preventable and treatable - need to be addressed first in a quality of life approach. This argument built on a proposal by Brown (2) that improving quality of life needs to first attend to the basic necessities of life (food, water, shelter, safety, etc.), followed by ensuring satisfactory life activities and environments, and achieving higher level life fulfillment.The link between child maltreatment and 10ointellectual and developmental disabilities (IDD) has been clearly delineated in the academic literature, especially by Fudge Schormans and her colleagues (3- 6). Citing the basic human right to live free from fear and want (7) as a beginning point, these authors have set out strong evidence that child maltreatment continues to be a serious social issue throughout the world, that children with IDD face a higher risk for maltreatment because of their disability, and that disability can be a consequence of maltreatment. Although this body of work does not explicitly address quality of life, an underlying assumption contained in it is that child maltreatment detracts markedly from positive life experience. In this sense, it supports Brown's (8) view that child maltreatment is one of the negative basic necessities of life that need to be attended to first in a quality of life approach.The purpose of this paper is to explore further the link between child maltreatment and quality of life for children with IDD. The nature of child maltreatment and its relationship to IDD is expanded upon, taking into consideration important historical and theoretical influences. On the whole, this paper aims to explore how a quality of life approach can be useful to addressing issues and concerns that are commonly associated with child maltreatment.What is child maltreatment?Child maltreatment is variously understood and defined throughout the world today. One of the best articulated understandings comes from the Canadian Incidence Study of Reported Child Abuse and Neglect (CIS-2008) (9), which examines the incidence of reported child maltreatment and the characteristics of children and families coming into contact with child protection services. The CIS-2008 identifies five categories of child maltreatment: physical abuse, sexual abuse, neglect, emotional maltreatment, and to intimate partner violence. Thirty-two forms of child maltreatment are captured within these five categories (9). Reflecting how definitions of maltreatment change over time, the inclusion of exposure to intimate partner violence is relatively new - it was not, for example, used in the preceding study, the CIS-2003.Child maltreatment is a socially constructed concept that is variably understood across both space and time (10,11). Its definition is contingent upon such factors as geography, culture, class, gender, ability, and generation. It reflects and is influenced by the lack of consensus regarding the definition of child, a construct that similarly varies in accordance with the laws and customs that determine both the status of children and the ages at which individuals are considered to be adults. This social, political, and economic variability and the resultant multiplicity of meanings of child maltreatment confound attempts at a universal understanding. A common understanding of child maltreatment in many western countries - and the one that guides this chapter - is as follows (12, pl094):Childhood maltreatment can be defined as any act or series of acts of commission or omission by a parent or other caregiver, in the context of a relationship of responsibility, trust, or power, that results in harm, potential for harm, or threat of harm to a child's health, survival, development, or dignity. …

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