Introduction

Child abuse in the United States continues to be a serious and ever-increasing problem. Although the media report extreme and tragic examples of abuse, many children are living in less newsworthy, but alarming circumstances. The statistics are shocking. An incident of child abuse is reported—on average—every 10 seconds. The most recent government national study reported that more than 2.9 million reports of possible maltreatment involving children were made to child protective services in 2003. The actual incidence of abuse and neglect, however, is estimated to be three times greater than the number reported to authorities. Every day more than 4 children die as a result of child abuse in the home. The types of reported maltreatment included: Neglect (61%), Physical Abuse (19%), Sexual Abuse (10%), Psychological Maltreatment (5%), Medical Maltreatment (2%), Other (17%). The consequences to the children and families involved and to society are incalculable.

Child abuse and neglect can take different forms

Following is a summary of the types of child abuse and neglect, but definitions may vary according to state, legal, medical, mental health, economic, and child welfare systems. The types of child abuse and neglect are usually found in combination rather than alone.

  • Child physical abuse (CPA)–an injury to a child or adolescent by a parent or other caregiver after intentional physical contact. It is defined not by the act, but by the results of the act (e.g., bruises, burns, broken bones). The physical injury may result from different acts, including hitting, kicking, slapping, shaking, burning, choking, throwing, whipping, and/or paddling.

  • Child sexual abuse (CSA)–any form of sexual activity with a child or adolescent in which consent is not or cannot be provided (e.g., significant disparity in age, development or size). The sexual activity often includes physical contact (e.g., penetration, touching) and may also reflect non-contact sexual acts (e.g., exposure to pornography). Examples of sexual abuse include: fondling, penetration, pornography, exhibitionism, child prostitution, and forced observation of sexual acts.

  • Emotional or psychological abuse is assumed to be present in all other forms of abuse. It consists of any attitude or behavior which interferes with a child's mental health or social development, such as yelling, screaming, name calling, shaming, negative comparisons to others, telling children they are "bad" or "no good." Another aspect of emotional abuse is the failure to provide the affection and support necessary for the development a child's well being, such as ignoring, withdrawal of attention, lack of praise, and lack of positive reinforcement.

  • Neglect, is defined by the absence of specific events. Five types of neglect are identified:
    1. Physical neglect–the failure to provide for a child's physical needs, including adequate food, clothing, and shelter.
    2. Emotional neglect–failure to provide for a child's emotional needs which, in extreme cases, can lead to non-organic failure to thrive and physical illness/abnormalities.
    3. Medical neglect–failure to provide or comply with prescribed medical treatment, such as immunization, surgery, medication.
    4. Mental health neglect–failure to provide or comply with recommended corrections or therapeutic procedures in cases of serious emotional or behavioral disorders. This is not widely accepted and investigated as a form of neglect.
    5. Educational neglect–failure to comply with state requirements for school attendance.

Child abuse and neglect occur for many reasons

Although specific causes are not known, a significant body of research has identified several risk and protective factors. Multiple risk factors are more likely to increase the probability of abuse. For example, lack of preparation or knowledge of the demands of parenting can lead to abusive or neglectful parenting. Parents may lack understanding of their children's developmental stages and hold unreasonable expectations for their abilities and behavior; they may be unaware of effective discipline or alternatives to corporal punishment and may also lack knowledge of the health, hygiene and nutritional needs of their children. Individuals who have difficulty in single parenting, in controlling anger in relationships, who have mental health or substance abuse problems, financial stress or housing problems can appear uninterested in the care of their children and are also at risk for abusive behavior.

Warning signs of abuse and neglect–abuse leaves a mark

Early identification and treatment make a difference. Children who have been abused may show:

  • sexual acting out
  • poor self image
  • inability to trust or love others
  • aggressive, disruptive and sometimes illegal behavior
  • anger and rage
  • self destructive or self abusive behavior, suicidal thoughts
  • passive, withdrawn or clingy behavior
  • fear of entering into new relationships or activities
  • anxiety and fears
  • school problems or failure
  • feelings of sadness or other symptoms of depression
  • flashbacks, nightmares
  • drug or alcohol abuse
  • inability to stay awake or to concentrate for extended periods

Some children are more at-risk than others for negative effects

Children are more vulnerable to psychological problems if the child:

  • is abused severely, chronically, physically injurious, and by multiple abusers
  • is younger when the abuse/neglect begins
  • had a close relationship to the abuser
  • was not functioning well before the abuse
  • blames him/herself for the abuse and its consequences
  • views the world as a dangerous place

Some children may deal more adaptively than others. Protective factors include the child's individual characteristics such as optimism, good self-esteem, intelligence, creativity, humor and independence. Factors such as the availability of social support and a relationship with a caring adult are important. Community well-being, neighborhood stability, and access to health care are also critical.

Child abuse and neglect can seriously affect the lives of children and adolescents

Abuse and neglect affect a child's growth in establishing relationships with others, developing self-esteem, physical activity, academic performance and psychological functioning.

The following consequences of child abuse and neglect are listed by the National Clearinghouse on Child Abuse and Neglect:

  1. Physical health consequences
    Immediate physical effects can be relatively minor, (bruises or cuts), or severe, (broken bones, hemorrhage, or even death). Although the physical effects may be short-lived, the psychological effects may be more long-lasting. Other outcomes identified by researchers are:

    Shaken baby syndrome can cause vomiting, concussion, respiratory distress, seizures and death.

    Impaired brain development can cause important regions of the brain to fail to form properly.

    Poor physical health can persist throughout life.

  2. Psychological consequences—Emotional effects can persist and contribute to:

    Poor mental and emotional health, including vulnerability to depression, anxiety, eating disorders and suicide attempts. Panic disorder, dissociative disorders, attention-deficit/hyperactivity disorder and posttraumatic stress disorder, and reactive attachment disorders have also been associated with abuse. In adulthood, abused children may have trouble with physical closeness, touching, intimacy and trust.

    Cognitive difficulties found to be associated with abuse are cognitive impairment, language development, and academic achievement.

    Social difficulties of abused and neglected children are shown in difficulty in forming secure attachments, which may lead to later difficulties in relationships with peers and adults.

  3. Behavioral consequences—may occur in some victims of child abuse and neglect

    Difficulties during adolescence. Abused and neglected children have been found to be at 25 percent more likely to experience problems such as delinquency, teen pregnancy, low academic achievement, drug use, and mental health problems.

    Juvenile delinquency and adult criminality. Abuse and neglect increased the likelihood of adult criminal behavior by 28 percent and violent crime by 30 percent.

    Alcohol and drug abuse. Abused and neglected children are likely to smoke cigarettes, abuse alcohol, or take illicit drugs. As many as two-thirds of people in drug treatment programs reported being abused as children.

    Abusive behavior. Abusive parents often have experienced abuse during their own childhoods. It is estimated that approximately one-third of abused and neglected children will eventually victimize their own children.

  4. Societal consequences—society as a whole is impacted, directly and indirectly, by child abuse and neglect. Direct costs include those associated with maintaining a child welfare system to investigate and provide interventions for abused and neglected children. Indirect costs include long-term economic consequences such as juvenile and adult criminal activity, mental illness, substance abuse and domestic violence. Also included are losses of productivity, the cost of special education services and use of the health care system, and most importantly, the loss of the unrealized potential of the victims of child abuse and neglect

Prevention

Prevention efforts build on identifying family strengths by means of parent education, home visitation and support groups, helping parents develop parenting skills and understanding non-violent methods of discipline and other techniques of meeting their children's emotional, physical and developmental needs.

Treatment

The most effective interventions are those that are comprehensive, relatively long-term and individualized according to the family's specific needs. Factors to be considered are the child's age, gender, and race, family composition, and characteristics of the parents (need for parent training, substance abuse treatment, etc.) One treatment approach that has proven helpful is Cognitive Behavioral Therapy (CBT). CBT involves both the abused child and caregiver, provides a model for them to understand their reactions to abuse, normalize their experiences and symptoms, and teaches coping skills for upsetting thoughts, feelings, and behavior. Support groups, access to community resources, parent training and anger management are also helpful strategies.

Summary

Child abuse and neglect represent a problem of alarming proportions, with tremendous psychological and economic costs to both the individuals involved and to society. Early identification and treatment is important to avoid or minimize the long term consequences of abuse. Through treatment the abused child is helped to regain a sense of self-esteem and trust, and the family learns new ways of support and communication. It is critical to support ongoing and new research to point the way to effective strategies of prevention and intervention to change the course of the lives of victimized children.

Note: If an individual suspects abuse or neglect, it is his/her responsibility to report the incident. The National Child Abuse Hotline, 1-800-4-A-CHILD is staffed with professional counselors 24 hours a day.

References

Prevent Child Abuse America
www.preventchildabuse.org

ChildhelpUSA
www.childhelpusa.org

National Clearinghouse of Child Abuse and Neglect Information
e-mail nccanch@caliber.com
http://nccanch.acf.hhs.gov

MEDLINEplus: a service of the U. S. National Library of Medicine and the National Institutes of Health
http://medlineplus.gov