Recognizing Child Abuse
It's not always easy to recognize when a child has been abused.
Children who have been mistreated are often afraid to tell anyone because they think they will be blamed or that no one will
believe them. Parents also tend to overlook symptoms because they don't want to face the truth. This is a serious mistake.
A child who has been abused needs special support and treatment as early as possible. The longer he continues to be abused
or is left to deal with the situation on his own, the less likely he is to make a full recovery.
The best way to check for signs of abuse is to be alert to any
unexplainable changes in your child's body or behavior. Don't conduct a formal "examination" unless you have reason for suspicion,
as this may make the child fearful, but do look further if you notice any of the following:
Signs of Physical Abuse
- Any injury (bruise, burn, fracture, abdominal or head injury) that cannot be explained
Signs of Sexual Abuse
of Emotional Abuse
- Fearful behavior (nightmares,
depression, unusual fears, attempts to run away)
- Abdominal pain, bedwetting,
urinary tract infection, genital pain or bleeding, sexually transmitted disease
- Extreme sexual behavior that seems inappropriate for the child's
- Sudden change in self-confidence
- Headaches or stomachaches with no medical cause
- Abnormal fears, increased
- Attempts to run away
Signs of Emotional Neglect
- Failure to gain weight (especially
- Desperately affectionate behavior
- Voracious appetite and stealing of food
of Abuse and Neglect
In most cases, children who are abused or neglected suffer greater
emotional than physical damage. A child who is severely mistreated may become depressed or develop suicidal, withdrawn or
violent behavior. As he gets older, he may use drugs or alcohol, try to run away, refuse discipline or abuse others. As an
adult, he may develop marital and sexual difficulties, depression or suicidal behavior.
Not all abuse victims have severe reactions. Usually, the younger
the child, the longer the abuse continues, and the closer the child's relationship with the abuser, the more serious the emotional
damage will be.
When to Call the Pediatrician
If you suspect your child has been abused, get help immediately
through your pediatrician or a local child protective agency. Physicians are legally obligated to report all suspected cases
of abuse or neglect to state authorities. Your pediatrician also will detect and treat any medical injuries or ailments, recommend
a therapist and provide necessary information to investigators. The doctor also may testify in court if necessary to obtain
legal protection for the child or criminal prosecution of a sexual abuse suspect. Criminal prosecution is rarely sought in
mild physical abuse cases but is likely in those involving sexual abuse.
Your child will benefit from the services of a qualified mental
health professional if he has been abused. You and other members of the family may be advised to seek counseling so that you'll
be able to provide the support and comfort your child needs. If someone in your family is responsible for the abuse, a mental
health professional may be able to successfully treat that person as well.
If your child has been abused, you may be the only person who
can help him. There is no good reason to delay reporting your suspicions of abuse. Denying the problem will only make the
situation worse, allowing the abuse to continue unchecked and decreasing your child's chance for a full recovery.
Excerpted from Caring for Baby and Young Child: Birth to Age 5, Bantam 1999
of Child Abuse and Neglect
State Statutes Series
|Author(s): Child Welfare Information Gateway|
|Year Published: 2005|
Current through January 2005
You may wish to review this introductory text to better understand
the information contained in your State's statute. To see how your State addresses this issue, visit the State Statutes Search.
Child abuse and neglect are defined by both Federal and State
law. The Child Abuse Prevention and Treatment Act (CAPTA) is the Federal legislation that provides minimum standards for the
definition of child abuse and neglect that States must incorporate in their statutory definitions. Under CAPTA, child abuse
and neglect means, at a 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.1
The term sexual abuse includes:
- 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 interfamilial relationships,
statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.2
Types of Abuse
Each State, U.S. territory, and the District of Columbia provides
its own definitions of child abuse and neglect. As applied to reporting statutes, these definitions determine the grounds
for State intervention in the protection of a child's3 well-being. Definitions vary among States. For example, some States
define child abuse and neglect as a single concept, while others provide separate definitions for physical abuse, neglect,
sexual abuse, and/or emotional 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 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 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.
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.
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
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
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.
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
CAPTA defines the "withholding of medically indicated treatment"
"[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.
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:
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.
Generally, physical abuse is characterized by physical injury,
such as bruises and fractures that result from:
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:
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
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;
Inadequate or inappropriate supervision of a child's voluntary
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, 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.
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.
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.
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
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.
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
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—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
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.
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.
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.
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.
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
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.
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
What is Child Abuse & Neglect?
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
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
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
- 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:
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
Personality Characteristics and Psychological
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
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
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.
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
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.
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
||87 percent greater risk of being harmed by
||165 percent greater risk of experiencing notable
||74 percent greater risk of suffering from emotional
||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
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 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
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
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.
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
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 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
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
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
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
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
Other Health-related Problems
Maltreatment may affect an individual's health in
a number of direct and indirect ways. Victims of sexual abuse, for example, may become infected with sexually transmitted
diseases including syphilis and human immunodeficiency virus (HIV). Studies have found that women who had experienced sexual
abuse were more likely to experience ongoing health problems such as chronic pelvic pain and other gynecologic problems, gastrointestinal
problems, headaches, and obesity.93 Recent research suggests that adults who were maltreated as children show higher levels of many health problems not
typically associated with abuse and neglect—heart disease, cancer, chronic lung disease, and liver disease.94 The link between maltreatment and these diseases may be depression, which can influence the immune system and may lead
to higher risk behaviors such as smoking, alcohol and drug use, and overeating.95
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:
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
Violence, Substance Abuse, and Other Problem
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
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
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.