Child Abuse & Neglect

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Child Abuse & Neglect

The news is so full of reports about child mistreatment that you can't help but wonder how safe your child really is. While it's a mistake to become overprotective & make your child fearful, it's important to recognize the actual risks & familiarize yourself w/the signs of abuse.

More than 2.5 million cases of child abuse & neglect are reported each year. Of these, 35% involve physical abuse, 15% involve sexual abuse & 50% involve neglect.

Child abuse is common. Studies show that 1 in 4 girls & 1 in 8 boys will be sexually abused before they're 18 years old. About 1 in 20 children is physically abused each year.

Sexual abuse includes inappropriate touching of a child's breasts or genitalia, as well as someone's exposing their genitalia to a child.

Physical abuse involves injuring a child's body by burning them, beating them or breaking their bones. Because a bruise indicates that body tissue has been damaged & blood vessels have broken, any discipline method that leaves bruises isn't appropriate.

Child neglect can include physical neglect (withholding food, clothing, shelter or other physical necessities), emotional neglect (withholding love, comfort or affection) or medical neglect (withholding needed medical care).

children 101 divider

Physical Abuse

All States and territories provide definitions for physical abuse. The term is generally defined as any nonaccidental physical injury to the child, and can include striking, kicking, burning, or biting the child, or any action that results in a physical impairment of the child.

Substance Abuse

Substance abuse is an element of the definition of child abuse or neglect in some States.⁴ Circumstances that can be considered abuse or neglect include:

Manufacture of a controlled substance in the presence of child or on the premises occupied by a child⁵
Allowing a child to be present where the chemicals or equipment for the manufacture of controlled substances are used or stored⁶
Selling, distributing, or giving drugs or alcohol to a child⁷
Use of a controlled substance by a caregiver that impairs the caregiver's ability to adequately care for the child⁸
Exposure of the child to drug paraphernalia,⁹ the criminal sale or distribution of drugs,¹⁰ or drug-related activity¹¹

Neglect

Neglect is also addressed in the statutes of all States and territories, either in a separate definition, or as a type of abuse. Neglect is frequently defined in terms of deprivation of adequate food, clothing, shelter, or medical care. Several States distinguish between failure to provide based on the financial inability to do so and the failure to provide for no apparent financial reason. The latter constitutes neglect.

Sexual Abuse/Exploitation

All States include sexual abuse in their definitions. Some States refer in general terms to sexual abuse, while others specify various acts as sexual abuse. Sexual exploitation is an element of the definition of sexual abuse in most jurisdictions. Sexual exploitation includes allowing the child to engage in prostitution or in the production of child pornography.

Emotional Abuse

All States and territories except Georgia and Washington include emotional maltreatment as part of their definitions of abuse or neglect. Approximately¹² 22 States,¹³ the District of Columbia, the Northern Mariana Islands, and Puerto Rico provide specific definitions of emotional abuse or mental injury to a child. Typical language used in these definitions is "injury to the psychological capacity or emotional stability of the child as evidenced by an observable or substantial change in behavior, emotional response, or cognition," or as evidenced by "anxiety, depression, withdrawal, or aggressive behavior."

Abandonment

Many States and territories now provide definitions for child abandonment in their reporting laws. Approximately 18 States¹⁴ and the District of Columbia include abandonment in their definition of neglect, while 13 States,¹⁵ American Samoa, Guam, Puerto Rico, and the Virgin Islands provide separate definitions for establishing abandonment. In general, it is considered abandonment of the child when the parent's identity or whereabouts are unknown, the child has been left by the parent in circumstances where the child suffers serious harm, or the parent has failed to maintain contact with the child or to provide reasonable support for a specified period of time.

Standards for Reporting

The standard for what constitutes an abusive act varies among the States. Many States define abuse in terms of harm or threatened harm to a child's health or welfare. Other standards commonly seen include acts or omissions, recklessly fails or refuses to act, willfully causes or permits, and failure to provide. These standards guide mandatory reporters in their decision on whether to make a report to child protective services.

Persons Responsible for the Child

In addition to defining the acts or omissions that constitute child abuse or neglect, several statutes provide specific definitions of the persons who are reportable under the civil child abuse reporting laws to child protective services as perpetrators of abuse and neglect. These are persons who have some relationship or regular responsibility for the child. This generally includes parents, guardians, foster parents, relatives, or other caretakers responsible for the child's welfare.

Exceptions

A number of States provide exceptions in their reporting laws, which exempt certain acts or omissions from their statutory definitions of child abuse and neglect. For instance, in six States¹⁶ and the District of Columbia, financial inability to provide for a child is exempted from the definition of neglect. In 14 States,¹⁷ the District of Columbia, American Samoa, and the Northern Mariana Islands, physical discipline of a child, as long as it is reasonable and causes no bodily injury to the child, is an exception to the definition of abuse.

The Child Abuse Prevention and Treatment Act Amendments of 1996 added new provisions specifying that nothing in the Act be construed as establishing a Federal requirement that a parent or legal guardian provide any medical service or treatment that is against the religious beliefs of the parent or legal guardian (42 U.S.C. § 5106i). At the State level, civil child abuse reporting laws may provide an exception to the definition of child abuse and neglect for parents who choose not to seek medical care for their children due to religious beliefs.

Approximately 30 States,¹⁸ the District of Columbia, and Guam provide an exemption from the definition of neglect for parents who choose not to seek medical care for their children due to religious beliefs, while 3 States¹⁹ specifically provide an exception for Christian Science treatment. However, 17 of these States²⁰ authorize the court to order medical treatment for the child when the child's condition warrants intervention, and 4 States²¹ require mandated reporters to report instances when a child is not receiving medical care so that an investigation can be made.

Chapter Three: What Is Child Maltreatment?

To prevent and respond to child abuse and neglect effectively, there needs to be a common understanding of the definitions of those actions and omissions that constitute child maltreatment. Unfortunately, there is no single, universally applied definition of child abuse and neglect. Over the past several decades, different stakeholders—including State and Federal legislative bodies, agency officials, and researchers—have developed definitions of maltreatment for different purposes. Definitions vary across these groups and within them. For example, legal definitions describing the different forms of child maltreatment for reporting and criminal prosecution purposes are found mainly in State statutes, and definitions vary from State to State. Similarly, agency guidelines for accepting reports, conducting investigations, and providing interventions vary from State to State and sometimes from county to county. In addition, researchers use varying methods to measure and define abuse and neglect, making it difficult to compare findings across studies. Despite the differences, there are commonalities across definitions. This chapter describes sources of definitions in Federal and State laws and summarizes those elements commonly recognized as child maltreatment.

Definitions in Federal Law

The Child Abuse Prevention and Treatment Act (CAPTA) provides minimum standards for defining physical child abuse, child neglect, and sexual abuse that States must incorporate in their statutory definitions to receive Federal funds. Under CAPTA, child abuse and neglect means:

Any recent act or failure to act on the part of a parent or caretaker that results in death, serious physical or emotional harm, sexual abuse, or exploitation;
An act or failure to act that presents an imminent risk of serious harm.

The definition of child abuse and neglect refers specifically to parents and other caregivers. A "child" under this definition generally means a person who is under the age of 18 or who is not an emancipated minor. In cases of child sexual abuse, a "child" is one who has not attained the age of 18 or the age specified by the child protection law of the State in which the child resides, whichever is younger.

While CAPTA provides definitions for sexual abuse and the special cases related to withholding or failing to provide medically indicated treatment, it does not provide specific definitions for other types of maltreatment—physical abuse, neglect, or psychological maltreatment.

CAPTA Definition of Sexual Abuse

CAPTA defines "sexual abuse" as:

"[T]he employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct;"

"[T]he rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children."

CAPTA Definition of
Withholding of Medically Indicated Treatment

CAPTA defines the "withholding of medically indicated treatment" as:

"[T]he failure to respond to the infant's life-threatening conditions by providing treatment…which, in the treating physician's reasonable medical judgment, will be most likely to be effective in ameliorating or correcting all such conditions."

The term "withholding of medically indicated treatment" does not include the failure to provide treatment (other than appropriate nutrition, hydration, and medication) to an infant when, in the treating physician's reasonable medical judgment:

The infant is chronically and irreversibly comatose;
The provision of such treatment would merely prolong dying;
The provision of such treatment would not be effective in ameliorating or correcting all of the infant's life-threatening conditions;
The provision of such treatment would otherwise be futile in terms of the survival of the infant;
The provision of such treatment would be virtually futile in terms of the survival of the infant, and the treatment itself under such circumstances would be inhumane.²

Sources of Definitions in State Law

While the Federal legislation sets minimum definitional standards, each State is responsible for providing its own definition of maltreatment within civil and criminal contexts. The problem of child maltreatment is generally subject to State laws (both statutes and case law) and administrative regulations. Definitions of child abuse and neglect are located primarily in three places within each State's statutory code:

Mandatory child maltreatment reporting statutes (civil laws) provide definitions of child maltreatment to guide those individuals mandated to identify and report suspected child abuse. These reports activate the child protection process. (See Chapter 9, "What Does the Child Protection Process Look Like?," for more information on mandated reporters and reporting procedures.)
Criminal statutes define those forms of child maltreatment that are criminally punishable. In most jurisdictions, child maltreatment is criminally punishable when one or more of the following statutory crimes have been committed: homicide, murder, manslaughter, false imprisonment, assault, battery, criminal neglect and abandonment, emotional and physical abuse, child pornography, child prostitution, computer crimes, rape, deviant sexual assault, indecent exposure, child endangerment, and reckless endangerment.
Juvenile court jurisdiction statutes provide definitions of the circumstances necessary for the court to have jurisdiction over a child alleged to have been abused or neglected. When the child's safety cannot be ensured in the home, these statutes allow the court to take custody of a child and to order specific treatment services for the parents and child.

Together, these legal definitions of child abuse and neglect determine the minimum standards of care and protection for children and serve as important guidelines for professionals regarding those acts and omissions that constitute child maltreatment.

Child protective services (CPS) workers use statutory definitions of child maltreatment to determine whether maltreatment has occurred and when intervention into family life is necessary. For particular localities within a State, local CPS policies and procedures, based on statutes and regulations, further define different types of maltreatment and the conditions under which intervention and services are warranted.

State Statutes

To review a summary of reporting laws, visit the State Statutes section of Child Welfare Information Gateway website at www.childwelfare.gov/systemwide/laws_policies/index.cfm.

General Definitions by Type of Maltreatment

There are four commonly recognized forms of child abuse or maltreatment:

Physical
Sexual
Neglect
Psychological

There is great variation from State to State regarding the details and specificity of child abuse definitions, but it is still possible to identify commonalities among each different type of child maltreatment. These commonalities, in part, reflect societal views of parental actions that are seen as improper or unacceptable because they place children at a risk of physical and emotional harm.

Physical Abuse

Generally, physical abuse is characterized by physical injury, such as bruises and fractures that result from:

Punching
Beating
Kicking
Biting
Shaking
Throwing
Stabbing
Choking
Hitting with a hand, stick, strap, or other object
Burning

Although an injury resulting from physical abuse is not accidental, the parent or caregiver may not have intended to hurt the child. The injury may have resulted from severe discipline, including injurious spanking, or physical punishment that is inappropriate to the child's age or condition. The injury may be the result of a single episode or of repeated episodes and can range in severity from minor marks and bruising to death.

Some cultural practices are generally not defined as physical abuse, but may result in physically hurting children. For example:

"Coining" or cao gio—a practice to treat illness by rubbing the body forcefully with a coin or other hard object.
Moxabustion—an Asian folkloric remedy that burns the skin.

As Howard Dubowitz, a leading researcher in the field, explains: "While cultural practices are generally respected, if the injury or harm is significant, professionals typically work with parents to discourage harmful behavior and suggest preferable alternatives."³

Sexual Abuse

Child sexual abuse generally refers to sexual acts, sexually motivated behaviors involving children, or sexual exploitation of children.⁴ Child sexual abuse includes a wide range of behaviors, such as:

Oral, anal, or genital penile penetration;
Anal or genital digital or other penetration;
Genital contact with no intrusion;
Fondling of a child's breasts or buttocks;
Indecent exposure;
Inadequate or inappropriate supervision of a child's voluntary sexual activities;
Use of a child in prostitution, pornography, Internet crimes, or other sexually exploitative activities.

Sexual abuse includes both touching offenses (fondling or sexual intercourse) and nontouching offenses (exposing a child to pornographic materials) and can involve varying degrees of violence and emotional trauma. The most commonly reported cases involve incest—sexual abuse occurring among family members, including those in biological families, adoptive families, and step-families.⁵ Incest most often occurs within a father-daughter relationship; however, mother-son, father-son, and sibling-sibling incest also occurs. Sexual abuse is also sometimes committed by other relatives or caretakers, such as aunts, uncles, grandparents, cousins, or the boyfriend or girlfriend of a parent.

Child Neglect

Child neglect, the most common form of child maltreatment, is generally characterized by omissions in care resulting in significant harm or risk of significant harm. Neglect is frequently defined in terms of a failure to provide for the child's basic needs—deprivation of adequate food, clothing, shelter, supervision, or medical care. Neglect laws often exclude circumstances in which a child's needs are not met because of poverty or an inability to provide. In addition, many States establish religious exemptions for parents who choose not to seek medical care for their children due to religious beliefs that may prohibit medical intervention.

The Department of Health and Human Services' Third National Incidence Study of Child Abuse and Neglect (NIS-3)⁶ is the single most comprehensive source of information about the current incidence of child maltreatment in the United States. NIS-3 worked with researchers and practitioners to define physical, educational, and emotional neglect in a succinct and clear manner, as described below.

Physical Neglect

Refusal of health care—the failure to provide or allow needed care in accordance with recommendations of a competent health care professional for a physical injury, illness, medical condition, or impairment.
Delay in health care—the failure to seek timely and appropriate medical care for a serious health problem that any reasonable layman would have recognized as needing professional medical attention.
Abandonment—the desertion of a child without arranging for reasonable care and supervision.
Expulsion—other blatant refusals of custody, such as permanent or indefinite expulsion of a child from the home without adequate arrangement for care by others or refusal to accept custody of a returned runaway.
Inadequate supervision—leaving a child unsupervised or inadequately supervised for extended periods of time or allowing the child to remain away from home overnight without the parent or caretaker knowing or attempting to determine the child's whereabouts.
Other physical neglect—includes inadequate nutrition, clothing, or hygiene; conspicuous inattention to avoidable hazards in the home; and other forms of reckless disregard of the child's safety and welfare (e.g., driving with the child while intoxicated, leaving a young child in a car unattended).

Educational Neglect

Permitted chronic truancy—habitual absenteeism from school averaging at least 5 days a month if the parent or guardian is informed of the problem and does not attempt to intervene.
Failure to enroll or other truancy—failure to register or enroll a child of mandatory school age, causing the child to miss at least 1 month of school; or a pattern of keeping a school-aged child home without valid reasons.
Inattention to special education need—refusal to allow or failure to obtain recommended remedial education services or neglect in obtaining or following through with treatment for a child's diagnosed learning disorder or other special education need without reasonable cause.

Emotional Neglect

Inadequate nurturing or affection—marked inattention to the child's needs for affection, emotional support, or attention.
Chronic or extreme spouse abuse—exposure to chronic or extreme spouse abuse or other domestic violence in the child's presence.
Permitted drug or alcohol abuse—encouragement or permitting of drug or alcohol use by the child.
Permitted other maladaptive behavior—encouragement or permitting of other maladaptive behavior (e.g., chronic delinquency, severe assault) under circumstances where the parent or caregiver has reason to be aware of the existence and seriousness of the problem but does not intervene.
Refusal of psychological care—refusal to allow needed and available treatment for a child's emotional or behavioral impairment or problem in accordance with a competent professional recommendation.
Delay in psychological care—failure to seek or provide needed treatment for a child's emotional or behavioral impairment or problem that any reasonable layman would have recognized as needing professional, psychological attention (e.g., suicide attempt).

Spotlight on Chronic Neglect

One issue in defining child neglect involves consideration of "incidents" of neglect versus a pattern of behavior that indicates neglect. Susan J. Zuravin, from the University of Maryland at Baltimore School of Social Work, recommends that if some behaviors occur in a "chronic pattern," they should be considered neglectful.⁷ Examples include lack of supervision, inadequate hygiene, and failure to meet a child's educational needs. This suggests that rather than focusing on individual incidents that may or may not be classified as "neglectful," one should look at an accumulation of incidents that may together constitute neglect. "If CPS focuses only on the immediate allegation before them and not the pattern reflected in multiple referrals, then many neglected children will continue to be inappropriately excluded from the CPS system."⁸ For example, a family exhibiting a pattern of behavior that may constitute neglect might include frequent reports of not having enough food in the home or keeping older children home from school to watch younger children. In most CPS systems, however, the criteria for identifying neglect focuses on recent, discrete, verifiable incidents.

One study found that many children who had been referred to CPS for neglect did not receive services because their cases did not meet the criteria for "incidents" of neglect. It also found, however, that all of these children had, in fact, suffered severe developmental consequences . In recognition of this issue, the Missouri Division of Family Services (n.d.) has assigned one of its CPS staff as a "Chronic Neglect Specialist." This office defines chronic neglect as "…a persistent pattern of family functioning in which the caregiver has not sustained and/or met the basic needs of the children which results in harm to the child." The focus here is on the "accumulation of harm." CPS and community agencies across the country are recognizing the importance of early intervention and service provision to support families so that neglect does not become chronic or lead to other negative consequences.⁹

Psychological Maltreatment

Psychological maltreatment—also known as emotional abuse and neglect—refers to "a repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another's needs."¹⁰ Summarizing research and expert opinion, Stuart N. Hart, Ph.D., and Marla R. Brassard, Ph.D., present six categories of psychological maltreatment:

Spurning (e.g., belittling, hostile rejecting, ridiculing);
Terrorizing (e.g., threatening violence against a child, placing a child in a recognizably dangerous situation);
Isolating (e.g., confining the child, placing unreasonable limitations on the child's freedom of movement, restricting the child from social interactions);
Exploiting or corrupting (e.g., modeling antisocial behavior such as criminal activities, encouraging prostitution, permitting substance abuse);
Denying emotional responsiveness (e.g., ignoring the child's attempts to interact, failing to express affection);
Mental health, medical, and educational neglect (e.g., refusing to allow or failing to provide treatment for serious mental health or medical problems, ignoring the need for services for serious educational needs).¹¹

To warrant intervention, psychological maltreatment must be sustained and repetitive. For less severe acts, such as habitual scapegoating or belittling, demonstrable harm to the child is often required for CPS to intervene.

Psychological maltreatment is the most difficult form of child maltreatment to identify. In part, the difficulty in detection occurs because the effects of psychological maltreatment, such as lags in development, learning problems, and speech disorders, are often evident in both children who have experienced and those who have not experienced maltreatment. Additionally, the effects of psychological maltreatment may only become evident in later developmental stages of the child's life.

Although any of the forms of child maltreatment may be found alone, they often occur in combination. Psychological maltreatment is almost always present when other forms are identified.

Case Examples Of Maltreatment

Physical Abuse
During a violent fight between her mother and her mother's boyfriend, 8-year-old Kerry called 911. She told the operator that her mother's boyfriend always hit her mommy when he came home drunk. In addition, Kerry said she was worried about her 5-year-old brother, Aaron, because he tried to help their mom and the boyfriend punched him in the face. As a result, Aaron fell, hit his head on the coffee table, and had not moved since. The operator heard yelling in the background and the mother screaming, "Get off the phone!" When the police and paramedics arrived, Aaron was unconscious and the mother had numerous bruises on her face.

Child Neglect
Robert and Carlotta are the parents of a 9-month-old son named Ruiz. Robert and Carlotta used various drugs together until Robert was arrested and sent to prison for distributing cocaine. Since Robert's arrest, Carlotta has been living with different relatives and friends. Recently, she left her son with her sister who also has a history of drug use. Her sister then went to a local bar and left Ruiz unattended. After hearing the baby boy cry for over an hour, the neighbors called the police. When Carlotta arrived to pick up Ruiz, the police and the CPS worker were also there. It appeared that she had been using drugs.

Sexual Abuse
Jody, age 11, said that she was asleep in her bedroom and that her father came in and took off his robe and underwear. She stated that he got into bed with her and pulled up her nightgown and put his private part on her private part. She stated that he pushed hard and it hurt. Jody said that the same thing had happened before while her mother was at work. Jody stated that she told her mother, but her father insisted that she was telling a lie.

Psychological Abuse
Jackie is a 7-year-old girl who lives with her mother. Jackie's mother often screams at her, calls her degrading names, and threatens to kill her when Jackie misbehaves. Jackie doesn't talk in class anymore, doesn't have any friends in her neighborhood, and has lost a lot of weight.

Verbal Abuse In Childhood Triggers Adult Anxiety, Depression

Main Category: Psychology / Psychiatry
Also Included In: Anxiety / Stress; Depression
Article Date: 24 May 2006 - 6:00 PDT

A new study by Florida State University researchers has found that people who were verbally abused as children grow up to be self-critical adults prone to depression and anxiety.

People who were verbally abused had 1.6 times as many symptoms of depression and anxiety as those who had not been verbally abused and were twice as likely to have suffered a mood or anxiety disorder over their lifetime, according to psychology Professor Natalie Sachs-Ericsson, the study's lead author.

"We must try to educate parents about the long-term effects of verbal abuse on their children," Sachs-Ericsson said. "The old saying about sticks and stones was wrong. Names will forever hurt you."

Sachs-Ericsson co-authored the study, published in the Journal of Affective Disorders, with FSU psychology Professor Thomas Joiner and researchers from the University of Illinois at Urbana-Champaign and the University of North Carolina at Chapel Hill. The researchers studied data from 5,614 people ages 15 to 54 - a subset of the National Comorbidity Survey. The average age of the multiethnic sample was 33.

The findings are significant because of the clear implications for clinical treatment. Research has shown self-critical people can benefit from cognitive-behavioral therapy, an approach that helps people identify their irrational thought patterns and replace them with more rational thoughts, Sachs-Ericsson said. In addition, they are taught new behaviors to deal with uncomfortable situations.

The high percentage of study participants who reported that they were sometimes or often verbally abused by a parent - nearly 30 percent - surprised the researchers, Sachs-Ericsson said. Verbal abuse included insults, swearing, threats of physical abuse and spiteful comments or behavior.

Parents may have learned this style of parenting from their own parents, or they simply may be unaware of positive ways to motivate or discipline their children, Sachs-Ericsson said. They may also have a psychiatric or personality disorder that interferes with their parenting abilities.

Over time, children believe the negative things they hear, and they begin to use those negative statements as explanations for anything that goes wrong. For instance, a child who does not get invited to a party or does poorly on a test will think the reason is because he or she is no good if that is the message conveyed by a parent. This pattern of self-criticism continues into adulthood and has been shown to make an individual more prone to depression and anxiety.

To assess self-criticism, researchers asked participants to respond to statements such as, "I dwell on my mistakes more than I should," and "There is a considerable difference between how I am now and how I would like to be." Those who had been verbally abused were more likely to be self-critical than those who were not.

Those who suffered parental physical abuse (6.6 percent) or sexual abuse by a relative or stepparent (4.5 percent) also were more self-critical, but the researchers determined that self-criticism may not have been as important a factor in the development of depression and anxiety for physically and sexually abused participants as it was for those who experienced verbal abuse.

"Childhood abuse of any type has the potential to influence self-critical tendencies," she said. "Although sexual and physical abuse don't directly supply the critical words like 'you're worthless,' the overall message conveyed by these kinds of abuse clearly does."

By Jill Elish

Natalie Sachs-Ericsson
sachs@psy.fsu.edu
Florida State University
http://www.fsu.edu

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What is Child Abuse & Neglect?

Year Published: 2006

Each State provides its own definitions of child abuse and neglect based on minimum standards set by Federal law.

How Is Child Abuse and Neglect Defined in Federal Law?

Federal legislation provides a foundation for States by identifying a minimum set of acts or behaviors that define child abuse and neglect. The Federal Child Abuse Prevention and Treatment Act (CAPTA), (42 U.S.C.A. §5106g), as amended by the Keeping Children and Families Safe Act of 2003, defines child abuse and neglect as, at minimum:

Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or
An act or failure to act which presents an imminent risk of serious harm.

What Are the Major Types of Child Abuse and Neglect?

Within the minimum standards set by CAPTA, each State is responsible for providing its own definitions of child abuse and neglect.¹ Most States recognize four major types of maltreatment: neglect, physical abuse, sexual abuse, and emotional abuse. Although any of the forms of child maltreatment may be found separately, they often occur in combination.

The examples provided below are for general informational purposes only. Not all States' definitions will include all of the examples listed below, and individual States' definitions may cover additional situations not mentioned here.

Neglect is failure to provide for a child's basic needs. Neglect may be:

Physical (e.g., failure to provide necessary food or shelter, or lack of appropriate supervision)
Medical (e.g., failure to provide necessary medical or mental health treatment)²
Educational (e.g., failure to educate a child or attend to special education needs)
Emotional (e.g., inattention to a child's emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs)

These situations do not always mean a child is neglected. Sometimes cultural values, the standards of care in the community, and poverty may be contributing factors, indicating the family is in need of information or assistance. When a family fails to use information and resources, and the child's health or safety is at risk, then child welfare intervention may be required.

Physical abuse is physical injury (ranging from minor bruises to severe fractures or death) as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or otherwise harming a child. Such injury is considered abuse regardless of whether the caretaker intended to hurt the child.

Sexual abuse includes activities by a parent or caretaker such as fondling a child's genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials.

Sexual abuse is defined by CAPTA as "the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases of caretaker or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children."

Emotional abuse is a pattern of behavior that impairs a child's emotional development or sense of self-worth. This may include constant criticism, threats, or rejection, as well as withholding love, support, or guidance. Emotional abuse is often difficult to prove and, therefore, CPS may not be able to intervene without evidence of harm to the child. Emotional abuse is almost always present when other forms are identified.

Chapter Five: What Factors Contribute to Child Abuse and Neglect?

There is no single known cause of child maltreatment. Nor is there any single description that captures all families in which children are victims of abuse and neglect. Child maltreatment occurs across socio-economic, religious, cultural, racial, and ethnic groups. While no specific causes definitively have been identified that lead a parent or other caregiver to abuse or neglect a child, research has recognized a number of risk factors or attributes commonly associated with maltreatment. Children within families and environments in which these factors exist have a higher probability of experiencing maltreatment. It must be emphasized, however, that while certain factors often are present among families where maltreatment occurs, this does not mean that the presence of these factors will always result in child abuse and neglect. The factors that may contribute to maltreatment in one family may not result in child abuse and neglect in another family. For example, several researchers note the relation between poverty and maltreatment, yet it must be noted that most people living in poverty do not harm their children. Professionals who intervene in cases of child maltreatment must recognize the multiple, complex causes of the problem and must tailor their assessment and treatment of children and families to meet the specific needs and circumstances of the family.

Risk factors associated with child maltreatment can be grouped in four domains:

Parent or caregiver factors
Family factors
Child factors
Environmental factors

It is increasingly recognized that child maltreatment arises from the interaction of multiple factors across these four domains.²⁰ The sections that follow examine risk factors in each category. Available research suggests that different factors may play varying roles in accounting for different forms of child maltreatment (physical abuse, sexual abuse, neglect, and psychological or emotional abuse). Some of these differences are highlighted throughout the chapter.

A greater understanding of risk factors can help professionals working with children and families both to identify maltreatment and high-risk situations and to intervene appropriately. Assessment of the specific risk factors that affect a family may influence the prioritization of intervention services for that family (e.g., substance abuse treatment). Moreover, addressing risk and protective factors can help to prevent child abuse and neglect. For example, prevention programs may focus on increasing social supports for families (thereby reducing the risk of social isolation) or providing parent education to improve parent's age-appropriate expectations for their children. Prevention activities and their link to risk factors are discussed further in Chapter 7, "What Can Be Done to Prevent Child Abuse and Neglect?"

Parent or Caregiver Factors

Parent or caregiver factors potentially contributing to maltreatment relate to:

Personality characteristics and psychological well-being
History of maltreatment
Substance abuse
Attitudes and knowledge
Age

Personality Characteristics and Psychological Well-Being

No consistent set of characteristics or personality traits has been associated with maltreating parents or caregivers. Some characteristics frequently identified in those who are physically abusive or neglectful include low self-esteem, an external locus of control (i.e., belief that events are determined by chance or outside forces beyond one's personal control), poor impulse control, depression, anxiety, and antisocial behavior.²¹ While some maltreating parents or caregivers experience behavioral and emotional difficulties, severe mental disorders are not common.²²

Parental Histories and the Cycle of Abuse

A parent's childhood history plays a large part in how he or she may behave as a parent. Individuals with poor parental role models or those who did not have their own needs met may find it very difficult to meet the needs of their children.

While the estimated number varies, child maltreatment literature commonly supports the finding that some maltreating parents or caregivers were victims of abuse and neglect themselves as children.²³ One review of the relevant research suggested that about one-third of all individuals who were maltreated will subject their children to maltreatment.²⁴ Children who either experienced maltreatment or witnessed violence between their parents or caregivers may learn violent behavior and may also learn to justify violent behavior as appropriate.²⁵

An incorrect conclusion from this finding, however, is that a maltreated child will always grow up to become a maltreating parent. There are individuals who have not been abused as children who become abusive, as well as individuals who have been abused as children and do not subsequently abuse their own children. In the research review noted above, approximately two-thirds of all individuals who were maltreated did not subject their children to abuse or neglect.²⁶

It is not known why some parents or caregivers who were maltreated as children abuse or neglect their own children and others with a similar history do not.²⁷ While every individual is responsible for his or her actions, research suggests the presence of emotionally supportive relationships may help lessen the risk of the intergenerational cycle of abuse.²⁸

Substance Abuse

Parental substance abuse is reported to be a contributing factor for between one- and two-thirds of maltreated children in the child welfare system.²⁹ Research supports the association between substance abuse and child maltreatment.³⁰ For example:

A retrospective study of maltreatment experience in Chicago found children whose parents abused alcohol and other drugs were almost three times likelier to be abused and more than four times likelier to be neglected than children of parents who were not substance abusers.³¹
A Department of Health and Human Services study found all types of maltreatment, and particularly neglect, to be more likely in alcohol-abusing families than in nonalcohol-abusing families.³²

Substance abuse can interfere with a parent's mental functioning, judgment, inhibitions, and protective capacity. Parents significantly affected by the use of drugs and alcohol may neglect the needs of their children, spend money on drugs instead of household expenses, or get involved in criminal activities that jeopardize their children's health or safety.³³ Also, studies suggest that substance abuse can influence parental discipline choices and child-rearing styles.³⁴

Over the past decade, prenatal exposure of children to drugs and alcohol during their mother's pregnancy and its potentially negative, developmental consequences has been an issue of particular concern. The number of children born each year exposed to drugs or alcohol is estimated to be between 550,000 and 750,000.³⁵ While this issue has received much attention, children who are exposed prenatally represent only a small proportion of children negatively affected by parental substance abuse.³⁶

The number and complexity of co-occurring family problems often makes it difficult to understand the full impact of substance abuse on child maltreatment.³⁷ Substance abuse and child maltreatment often co-occur with other problems, including mental illness, HIV/AIDS or other health problems, domestic violence, poverty, and prior child maltreatment. These co-occurring problems produce extremely complex situations that can be difficult to resolve.³⁸ Because many of the problems may be important and urgent, it can be difficult to prioritize what services to provide. Additionally, identifying and obtaining appropriate resources to address these needs is a challenge in many communities.

Attitudes and Knowledge

Negative attitudes and attributions about a child's behavior and inaccurate knowledge about child development may play a contributing role in child maltreatment.³⁹ For example, some studies have found that mothers who physically abuse their children have both more negative and higher than normal expectations of their children, as well as less understanding of appropriate developmental norms.⁴⁰ Not all research, however, has found differences in parental expectations.⁴¹

A parent's lack of knowledge about normal child development may result in unrealistic expectations. Unmet expectations can culminate in inappropriate punishment (e.g., a parent hitting a one-year-old for soiling his pants). Other parents may become frustrated with not knowing how to manage a child's behavior and may lash out at the child. Still others may have attitudes that devalue children or view them as property.

Age

Caretaker age may be a risk factor for some forms of maltreatment, although research findings are inconsistent.⁴² Some studies of physical abuse, in particular, have found that mothers who were younger at the birth of their child exhibited higher rates of child abuse than did older mothers.⁴³ Other contributing factors, such as lower economic status, lack of social support, and high stress levels may influence the link between younger childbirth—particularly teenage parenthood—and child abuse.⁴⁴

Family Factors

Specific life situations of some families—such as marital conflict, domestic violence, single parenthood, unemployment, financial stress, and social isolation—may increase the likelihood of maltreatment. While these factors by themselves may not cause maltreatment, they frequently contribute to negative patterns of family functioning.

Family Structure

Children living with single parents may be at higher risk of experiencing physical and sexual abuse and neglect than children living with two biological parents.⁴⁵ Single parent households are substantially more likely to have incomes below the poverty line. Lower income, the increased stress associated with the sole burden of family responsibilities, and fewer supports are thought to contribute to the risk of single parents maltreating their children. In 1998, 23 percent of children lived in households with a single mother, and 4 percent lived in households with a single father.⁴⁶ A strong, positive relationship between the child and the father, whether he resides in the home or not, contributes to the child's development and may lessen the risk of abuse.

In addition, studies have found that compared to similar non-neglecting families, neglectful families tend to have more children or greater numbers of people living in the household.⁴⁷ Chronically neglecting families often are characterized by a chaotic household with changing constellations of adult and child figures (e.g., a mother and her children who live on and off with various others, such as the mother's mother, the mother's sister, or a boyfriend).⁴⁸

The Child Abuse and Father Absence Connection

The rate of child abuse in single parent households is 27.3 children per 1,000, which is nearly twice the rate of child abuse in two parent households (15.5 children per 1,000).

An analysis of child abuse cases in a nationally representative sample of 42 counties found that children from single parent families are more likely to be victims of physical and sexual abuse than children who live with both biological parents. Compared to their peers living with both parents, children in single parent homes had:

-	77 percent greater risk of being physically abused
-	87 percent greater risk of being harmed by physical neglect
-	165 percent greater risk of experiencing notable physical neglect
-	74 percent greater risk of suffering from emotional neglect
-	80 percent greater risk of suffering serious injury as a result of abuse
-	120 percent greater risk of experiencing some type of maltreatment overall.

A national survey of nearly 1,000 parents found that 7.4 percent of children who lived with one parent had been sexually abused, compared to only 4.2 percent of children who lived with both biological parents.
Using data from 1,000 students tracked from seventh or eighth grade in 1988 through high school in 1992, researchers determined that only 3.2 percent of the boys and girls who were raised with both biological parents had a history of maltreatment. However, a full 18.6 percent of those in other family situations had been maltreated.
A study of 156 victims of child sexual abuse found that the majority of the children came from disrupted or single-parent homes; only 31 percent of the children lived with both biological parents. Although stepfamilies make up only about 10 percent of all families, 27 percent of the abused children in this study lived with either a stepfather or the mother's boyfriend.⁴⁹

Marital Conflict and Domestic Violence

According to published studies, in 30 to 60 percent of families where spouse abuse takes place, child maltreatment also occurs.⁵⁰ Children in violent homes may witness parental violence, may be victims of physical abuse themselves, and may be neglected by parents who are focused on their partners or unresponsive to their children due to their own fears.⁵¹ A child who witnesses parental violence is at risk for also being maltreated, but, even if the child is not maltreated, he or she may experience harmful emotional consequences from witnessing the parental violence.⁵²

Stress

Stress is also thought to play a significant role in family functioning, although its exact relationship with maltreatment is not fully understood.⁵³ Physical abuse has been associated with stressful life events, parenting stress, and emotional distress in various studies.⁵⁴ Similarly, some studies have found that neglectful families report more day-to-day stress than non-neglectful families.⁵⁵ It is not clear, however, whether maltreating parents actually experience more life stress or, rather, perceive more events and life experiences as being stressful.⁵⁶ In addition, specific stressful situations (e.g., losing a job, physical illness, marital problems, or the death of a family member) may exacerbate certain characteristics of the family members affected, such as hostility, anxiety, or depression, and that may also aggravate the level of family conflict and maltreatment.⁵⁷

Parent-Child Interaction

Families involved in child maltreatment seldom recognize or reward their child's positive behaviors, while having strong responses to their child's negative behaviors.⁵⁸ Maltreating parents have been found to be less supportive, affectionate, playful, and responsive with their children than parents who do not abuse their children.⁵⁹ Research on maltreating parents, particularly physically abusive mothers, found that these parents were more likely to use harsh discipline strategies (e.g., hitting, prolonged isolation) and verbal aggression and less likely to use positive parenting strategies (e.g., using time outs, reasoning, and recognizing and encouraging the child's successes).⁶⁰

Child Factors

Children are not responsible for being victims of maltreatment. Certain factors, however, can make some children more vulnerable to maltreating behavior. The child's age and development—physical, mental, emotional, and social—may increase the child's vulnerability to maltreatment, depending on the interactions of these characteristics with the parental factors previously discussed.

Age

The relationship between a child's age and maltreatment is not clear cut and may differ by type of maltreatment. In 2000, for example, the rate of documented maltreatment was highest for children between birth and 3 years of age (15.7 victims per 1,000 children of this age in the population) and declined as age increased.⁶¹ The inverse relationship between age and maltreatment is particularly strong for neglect, but not as evident for other types of maltreatment (physical, emotional, or sexual abuse).

Infants and young children, due to their small physical size, early developmental status, and need for constant care, can be particularly vulnerable to child maltreatment. Very young children are more likely to experience certain forms of maltreatment, such as shaken baby syndrome and nonorganic failure to thrive. Teenagers, on the other hand, are at greater risk for sexual abuse.⁶²

Disabilities

Children with physical, cognitive, and emotional disabilities appear to experience higher rates of maltreatment than do other children.⁶³ A national study, completed in 1993, found that children with disabilities were 1.7 times more likely to be maltreated than children without disabilities.⁶⁴ To date, the full degree to which disabilities precede or are a result of maltreatment is unclear.

In general, children who are perceived by their parents as "different" or who have special needs—including children with disabilities, as well as children with chronic illnesses or children with difficult temperaments—may be at greater risk of maltreatment.⁶⁵ The demands of caring for these children may overwhelm their parents. Disruptions may occur in the bonding or attachment processes, particularly if children are unresponsive to affection or if children are separated by frequent hospitalizations.⁶⁶ Children with disabilities also may be vulnerable to repeated maltreatment because they may not understand that the abusive behaviors are inappropriate, and they may be unable to escape or defend themselves in abusive situations.⁶⁷ Some researchers and advocates have suggested that some societal attitudes, practices, and beliefs that devalue and depersonalize children with disabilities sanction abusive behavior and contribute to their higher risk of maltreatment.⁶⁸ For instance, there may be greater tolerance of a caregiver verbally berating or physically responding to a disabled child's inability to accomplish a task or act in an expected way than there would be if similar behavior was directed at a normally abled child.

Other Child Characteristics

While some studies suggest that infants born prematurely or with low birth-weight may be at increased risk for maltreatment, other studies do not.⁶⁹ The relationship between low birth-weight and maltreatment may be attributable to higher maternal stress heightened by high caregiver demands, but it also may be related to poor parental education about low birth-weight, lack of accessible prenatal care, and other factors, such as substance abuse or domestic violence.⁷⁰

Child factors such as aggression, attention deficits, difficult temperaments, and behavior problems—or the parental perceptions of such problems—have been associated with increased risk for all types of child maltreatment.⁷¹ These factors may contribute indirectly to child maltreatment when interacting with certain parental characteristics, such as poor coping skills, poor ability to empathize with the child, or difficulty controlling emotions. In addition, these same child characteristics may be reinforced by the maltreatment (e.g., a physically abused child may develop aggressive behaviors that elicit harsh reactions from others) and create conditions that can lead to recurring maltreatment.⁷²

Environmental Factors

Environmental factors are often found in combination with parent, family, and child factors, as highlighted in previous sections of this chapter. Environmental factors include poverty and unemployment, social isolation, and community characteristics. It is important to reiterate that most parents or caregivers who live in these types of environments are not abusive.

Poverty and Unemployment

Poverty and unemployment show strong associations with child maltreatment, particularly neglect.⁷³ The NIS-3 study, for example, found that children from families with annual incomes below $15,000 in 1993 were more than 22 times more likely to be harmed by child abuse and neglect as compared to children from families with annual incomes above $30,000.⁷⁴ It is important to underscore that most poor people do not maltreat their children. However, poverty—particularly when interacting with other risk factors such as depression, substance abuse, and social isolation—can increase the likelihood of maltreatment. In 1999, 85 percent of States identified poverty and substance abuse as the top two problems challenging families reported to child protective service (CPS) agencies.⁷⁵

Rod Plotnik, emeritus professor, Department of Psychology, San Diego State University, describes several theories related to the association between poverty and maltreatment, all of which may hold some truth. One theory is that low income creates greater family stress, which, in turn, leads to higher chances of maltreatment. A second theory is that parents with low incomes, despite good intentions, may be unable to provide adequate care while raising children in high-risk neighborhoods with unsafe or crowded housing and inadequate daycare. A third theory is that some other characteristics may make parents more likely to be both poor and abusive. For example, a parent may have a substance abuse problem that impedes the parent's ability to obtain and maintain a job, which also may contribute to abusive behavior. A final theory is that poor families may experience maltreatment at rates similar to other families, but that maltreatment in poor families is reported to CPS more frequently, in part because they have more contact with and are under greater scrutiny from individuals who are legally mandated to report suspected child maltreatment.⁷⁶

Social Isolation and Social Support

Some studies indicate that compared to other parents, parents who maltreat their children report experiencing greater isolation, more loneliness, and less social support.⁷⁷ Social isolation may contribute to maltreatment because parents have less material and emotional support, do not have positive parenting role models, and feel less pressure to conform to conventional standards of parenting behaviors.⁷⁸ It is not clear, however, whether social isolation in some cases precedes and serves as a contributing factor to maltreatment or whether it is a consequence of the behavioral dynamics of maltreatment.⁷⁹

Violent Communities

Children living in dangerous neighborhoods have been found to be at higher risk than children from safer neighborhoods for severe neglect and physical abuse, as well as child sexual victimization.⁸⁰ Some risk may be associated with the poverty found in dangerous neighborhoods, however, concerns remain that violence may seem an acceptable response or behavior to individuals who witness it more frequently.

Societal attitudes and the promotion of violence in cultural norms and the media have been suggested as risk factors for physical abuse.⁸¹ In addition, while the research is controversial, some studies show a positive relationship between televised violence and aggressive behaviors, particularly for individuals who watch substantial amounts of television.⁸²

Protective Factors

Just as there are factors that place families at risk for maltreating their children, there are other factors that may protect them from vulnerabilities—factors that promote resilience. In general, research has found that supportive, emotionally satisfying relationships with a network of relatives or friends can help minimize the risk of parents maltreating children, especially during stressful life events.⁸³ For example, parents who were abused as children are less likely to abuse their own children if they have resolved internal conflicts and pain related to their history of abuse and if they have an intact, stable, supportive, and nonabusive relationship with their partner.⁸⁴ Additionally, programs on marriage education and enhancement may provide a roadmap of expected challenges such as the birth of the first child, parenting adolescents, and common gender differences which may act as a protective factor by strengthening families.⁸⁵

Chapter Six: What Are the Consequences of Child Abuse and Neglect?

The consequences of child maltreatment can be profound and may endure long after the abuse or neglect occurs. The effects can appear in childhood, adolescence, or adulthood, and may affect various aspects of an individual's development (e.g., physical, cognitive, psychological, and behavioral). These effects range in consequence from minor physical injuries, low self-esteem, attention disorders, and poor peer relations to severe brain damage, extremely violent behavior, and death.⁸⁶

While substantial evidence exists for the negative consequences of maltreatment, practitioners should be aware of the limitations of current research. First, many research efforts have studied the effects of child maltreatment among individuals from lower socio-economic backgrounds, prison populations, mental health patients, or other clinical populations who may exhibit the most serious behavior problems and whose families often have had many other problems (e.g., poverty, parental substance abuse, domestic violence). Further, many early studies examining consequences did not compare outcomes among maltreated individuals with outcomes among individuals who had not experienced maltreatment. In addition, studies often rely on official records or self-reporting of current or past child maltreatment, both of which may undercount the true prevalence of maltreatment. Finally, the nature and extent of maltreatment are different for each child and family, and these differences may influence the consequences.

Despite the above challenges, it is still possible to identify effects that have been more commonly associated with individuals who have experienced abuse and neglect. These effects are discussed in the sections that follow as they relate to three overlapping areas:

Health and physical effects
Intellectual and cognitive development
Emotional, psychological, and behavioral consequences

While maltreated children have a higher risk of certain problems, it cannot be concluded that any given consequence will always occur. Not all children who have been maltreated will suffer severe consequences. A number of factors may influence the effects of maltreatment, including the child's age and developmental status at the time of the maltreatment, as well as the type, the frequency, the duration, and the severity of the maltreatment and co-occurring problems.⁸⁷ In addition, research has identified certain protective factors that mediate the effects of maltreatment. These protective factors and a child's resilience to negative consequences are addressed in the final section of this chapter.

Health and Physical Effects

Health and physical effects can include the immediate effects of bruises, burns, lacerations, and broken bones and also longer-term effects of brain damage, hemorrhages, and permanent disabilities. Negative effects on physical development can result from physical trauma (e.g., blows to the head or body, violent shaking, scalding with hot water, or asphyxiation) and from neglect (e.g., inadequate nutrition, lack of adequate motor stimulation, or withholding medical treatments). Specific physical effects as they relate to the early brain development of infants are highlighted in the following sections, along with some general health problems associated with maltreatment. The issue of child fatalities, the most tragic consequence of child maltreatment, is discussed in Chapter 4, "What is the Scope of the Problem?"

Physical Effects on Infants

Infants and young children are particularly vulnerable to the physical effects of maltreatment. Shaking an infant may result in bruising, bleeding, and swelling in the brain. The health consequences of "shaken baby syndrome" can range from vomiting or irritability to more severe effects, such as concussions, respiratory distress, seizures, and death.⁸⁸ Other possible consequences include partial loss of vision or blindness, learning disabilities, mental retardation, cerebral palsy, or paralysis.⁸⁹

Infants who have been neglected and malnourished may experience a condition known as "nonorganic failure to thrive." With this condition, the child's weight, height, and motor development fall significantly below age-appropriate ranges with no medical or organic cause. The death of the child is the end result in extreme cases. Nonorganic failure to thrive can result in continued growth retardation as well as cognitive and psychological problems. ⁹⁰ Even with treatment, the long-term consequences can include continued growth problems, diminished cognitive abilities, retardation, and socio-emotional deficits such as poor impulse control.

Effects on Brain Development

Over the last decade, researchers have enhanced the field's understanding of the adverse effects of maltreatment on early brain development. Recent brain research has established a foundation for the neurobiological explanations for many of the physical, cognitive, social, and emotional difficulties exhibited by children who experienced maltreatment in their early years.

One explanation begins with the link between chronic physical abuse, sexual abuse, or neglect and the chronic stress it typically causes in a young child. In reaction to this persistent stress associated with ongoing maltreatment, the child's brain may strengthen the pathways among neurons that are involved in the fear response. As a result, the brain may become "wired" to experience the world as hostile and uncaring. This negative perspective may influence the child's later interactions, prompting the child to become anxious and overly aggressive or withdrawn.⁹¹

Research shows that maltreatment also may inhibit the appropriate development of certain regions of the brain. A neglected infant or young child, for example, may not be exposed to stimuli that would activate important regions of the brain and strengthen cognitive pathways. Consequently, the connections among neurons in these inactivated regions can literally whither away, hampering the individual's later functioning. If the regions responsible for emotional regulation are not activated, the child may have trouble controlling his or her emotions and behaving or interacting appropriately (e.g., impulsive behavior, difficulties in social interactions, or a lack of empathy).⁹²

Cognitive Development and Academic Achievement

Current research differs on findings related to the consequences of maltreatment on cognitive development, verbal abilities, and problem-solving skills. Some studies find evidence of lowered intellectual and cognitive functioning in abused children as compared to children who had not been abused,⁹⁶ and other studies find no differences.⁹⁷

Research has consistently found that maltreatment increases the risk of lower academic achievement and problematic school performance.⁹⁸ Abused and neglected children in these studies received lower grades and test scores than did nonmaltreated children.

Emotional, Psychosocial, and Behavioral Development

All types of maltreatment—physical abuse, sexual abuse, neglect, and psychological or emotional maltreatment—can affect a child's emotional and psychological well-being and lead to behavioral problems. These consequences may appear immediately after the maltreatment or years later.

Emotional and Psychological Consequences

While there is no single set of behaviors that is characteristic of all children who have been abused and neglected, the presence of emotional and psychological problems among many maltreated children is well documented. Clinicians and researchers report behaviors that range from passive and withdrawn to active and aggressive.⁹⁹ Physically and sexually abused children often exhibit both internalizing and externalizing problems.¹⁰⁰ Emotional and psychosocial problems identified among individuals who were maltreated as children include:

Low self-esteem
Depression and anxiety
Post-traumatic stress disorder (PTSD)
Attachment difficulties
Eating disorders
Poor peer relations
Self-injurious behavior (e.g., suicide attempts)¹⁰¹

Maltreated children who developed insecure attachments to caregivers may become more mistrustful of others and less ready to learn from adults. They also may experience difficulties in understanding the emotions of others, regulating their own emotions, and in forming and maintaining relationships with peers.¹⁰²

Violence, Substance Abuse, and Other Problem Behaviors

Individuals victimized by child maltreatment are more likely than people who were not maltreated to engage in juvenile delinquency, adult criminality, and violent behavior.¹⁰³ A study sponsored by the National Institute of Justice followed cases from childhood through adulthood and compared arrest records of a group of substantiated cases of maltreatment with a comparison group composed of individuals who were not officially recorded as maltreated. While most members of both groups had no juvenile or adult criminal records, being abused or neglected as a child increased the likelihood of arrest as a juvenile by 53 percent and as a young adult by 38 percent.¹⁰⁴ Physically abused children were the most likely of maltreated children to be arrested later for violent crime, followed closely by neglected children.

Other studies also have found maltreated children to be at increased risk (at least 25 percent more likely) for a variety of adolescent problem behaviors, including delinquency, teen pregnancy, drug use, low academic achievement, and mental health problems.¹⁰⁵ It must be underscored, however, that while the risk is higher, most abused and neglected children will not become delinquent, experience adolescent problem behaviors, or become involved in violent crime.

Research also suggests a relationship between child maltreatment and later substance abuse.¹⁰⁶ In addition to being a risk factor, child maltreatment, particularly sexual abuse, may be a precursor of substance abuse.¹⁰⁷

Resilience

Not every child who is maltreated will experience the negative consequences discussed above. "Protective factors" that appear to mediate or serve as a "buffer" against the effects of the negative experiences may include:

Personal characteristics, such as optimism, high self-esteem, high intelligence, or a sense of hopefulness.¹⁰⁸
Social support and relationships with a supportive adult(s).¹⁰⁹

The finding that the seriousness of negative effects experienced by victims can be influenced by the availability of support from parents, relatives, professionals, and others has important implications for prevention and early intervention, discussed later in this manual.

Studies have documented the link between abuse and neglect of children and a range of physical, emotional, psychological, and behavioral problems. In addition to the tragic consequences endured by the children who have been maltreated, society pays a high monetary cost for child maltreatment. The costs for child maltreatment include both direct costs (i.e., those associated with the immediate needs of abused and neglected children) and indirect costs (i.e., those associated with the longer term and secondary effects of child maltreatment). Since some maltreatment goes unrecognized and it is difficult to link costs to specific incidents, it is not possible to determine the actual cost of child abuse and neglect. As estimated by Prevent Child Abuse America, the total annual cost of child abuse and neglect in the United States may be as high as $94 billion, as shown in Exhibit 6-1.

the following web links are provided for your convenience in visiting the source sites of the information displayed on this page:

Many Abused Kids Don't Get Mental Health Services

medline.com / same article link below En Espanol!

El llanto de un bebé podría desencadenar abusos por parte de algunos padres

medline.com

Child Abuse & Neglect

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