Beyond disability status: Social determinants of maltreatment among children with disabilities in a national matched analysis.

BACKGROUND: Children with disabilities face elevated risk of maltreatment. However, limited evidence distinguishes the unique contribution of disability status from the social, familial, and contextual factors that frequently co-occur with disability and may independently increase vulnerability. OBJECTIVE: This study examined differences in exposure to high-intensity maltreatment between children with and without disabilities in Israel and identified individual-, family-, and community-level risk factors associated with maltreatment beyond disability status. METHODS: Data were drawn from the Israeli National Program for Children and Youth at Risk (2022-2023). Propensity score matching was used to create comparable groups of children with and without disabilities based on child, family, and community characteristics. The matched analytic sample included 4894 children (2447 with disabilities and 2447 without disabilities). High-intensity maltreatment across domains within and outside the family was examined using group comparisons and logistic regression analyses within the matched sample. RESULTS: After matching, most differences in high-intensity maltreatment between children with and without disabilities were not statistically significant. High-intensity abuse outside the family was the only outcome that differed significantly in the primary matched analysis (RR = 1.45); however, the absolute difference was small, and this finding was not consistently replicated in sensitivity analyses. Economic hardship, older age, parental disability, non-married parental status, and difficulties in identifying risky situations were consistently associated with increased odds of high-intensity maltreatment. Disability status showed only weak associations, alongside a higher prevalence of multiple risk factors among children with disabilities. CONCLUSION: Findings suggest that while disability per se contributes modestly to high-intensity maltreatment, children with disabilities are disproportionately exposed to clusters of socio-economic, familial, and personal vulnerabilities that collectively shape maltreatment risk, highlighting the role of social, familial, and contextual conditions in shaping patterns of maltreatment risk.