Child abuse is the physical, sexual or emotional maltreatment or neglect of a child or children.
[1]
In the
United States, the Centers for Disease Control and Prevention (CDC) and the Department for Children
And Families (DCF) define child maltreatment as any act or series of acts of commission or omission by a
parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.
[2]
Child
abuse can occur in a child's home, or in the organizations, schools or communities the child interacts
with. There are four major categories of child abuse: neglect, physical abuse, psychological or emotional
abuse, and sexual abuse.
In Western countries, preventing child abuse is considered a high priority, and detailed laws and policies
exist to address this issue. Different jurisdictions have developed their own definitions of what constitutes
child abuse for the purposes of removing a child from his/her family and/or prosecuting a criminal charge.
According to the Journal of Child Abuse and Neglect, child abuse is "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, an act or failure to act which presents an imminent risk of serious harm".
[3]
However, Douglas J. Besharov, the first Director of the U.S. Center on Child Abuse and Neglect, states
"the existing laws are often vague and overly broad"
[4]
and there is a "lack of consensus among
professionals and Child Protective Services (CPS) personnel about what the terms abuse and neglect
mean".
[5]
Susan Orr, former head of the United States Childrens Bureau U.S. Department of Health and
Services- Administration for Children and Families, 2001-2007, states that "much that is now defined as
child abuse and neglect does not merit governmental interference".
[6]
Types[edit]
Child abuse can take several forms:
[9]
The four main types are physical, sexual, psychological, and
neglect.
[10]
According to the 2010 Child Maltreatment Report (NCANDS), a yearly Federal report based on
submission by state Child Protective Services (CPS) Agencies, as in prior years, neglect was the most
common form of maltreatment. The cases were substantiated as follows: neglect 78.3%, physical abuse
17.6%, sexual abuse 9.2%, and psychological maltreatment 8.1%.,
[11]
According to Richard Wexler, the
Director of National Coalition of Child Protection Reform, of those labeled substantiated or indicated
by protective workers, relatively few are the kind that leap to mind when we hear the words child abuse.
By far the largest category was neglect. Often, these are cases in which the primary problem is family
poverty.
[12]
Physical abuse[edit]
Physical abuse involves physical aggression directed at a child by an adult. Most nations with child-abuse
laws consider the deliberate infliction of serious injuries, or actions that place the child at obvious risk of
serious injury or death, to be illegal. Bruises, scratches, burns, broken bones, lacerations, as well as
repeated "mishaps," and rough treatment that could cause physical injury, can be physical
abuse.
[13]
Multiple injuries or fractures at different stages of healing can raise suspicion of abuse. Physical
abuse can come in many forms, although the distinction between child discipline and abuse is often
poorly defined. However, the Human Rights Committee of the United Nations has stated that the
prohibition of degrading treatment or punishment extends to corporal punishment of children.
[14]
Since
1979, 34 countries around the world (at 2013) have outlawed domesticcorporal punishment of
children.
[15]
In Europe, 22 countries have banned the practice. Cultural norms about what constitutes
abuse vary widely: among professionals as well as the wider public, people do not agree on what
behaviors constitute abuse.
[16]
Some professionals claim that cultural norms that sanction physical
punishment are one of the causes of child abuse, and have undertaken campaigns to redefine such
norms.
[17][18][19]
Psychologist Alice Miller, noted for her books on child abuse, took the view that
humiliations, spankings and beatings, slaps in the face, etc. are all forms of abuse, because they injure
the integrity and dignity of a child, even if their consequences are not visible right away.
[20]
Sexual abuse[edit]
Main articles: Child sexual abuse and child-on-child sexual abuse
Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a child for
sexual stimulation.
[21]
Sexual abuse refers to the participation of a child in a sexual act aimed toward the
physical gratification or the financial profit of the person committing the act.
[13][22]
Forms of CSA include
asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent
exposure of the genitals to a child, displaying pornography to a child, actual sexual contact with a child,
physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using
a child to produce child pornography.
[21][23][24]
Selling the sexual services of children may be viewed and
treated as child abuse with services offered to the child rather than simple incarceration.
[25]
Effects of child sexual abuse include guilt and self-blame, flashbacks, nightmares, insomnia, fear of things
associated with the abuse (including objects, smells, places, doctor's visits, etc.), self-
esteem issues, sexual dysfunction, chronic pain, addiction, self-injury, suicidal ideation, somatic
complaints, depression,
[26]
post-traumatic stress disorder,
[27]
anxiety,
[28]
other mental
illnesses including borderline personality disorder
[29]
and dissociative identity disorder,
[29]
propensity to re-
victimization in adulthood,
[30]
bulimia nervosa,
[31]
and physical injury to the child, among other problems.
[32]
In the United States, approximately 15% to 25% of women and 5% to 15% of men were sexually abused
when they were children.
[33][34][35][36][37]
Most sexual abuse offenders are acquainted with their victims;
approximately 30% are relatives of the child, most often brothers, fathers, mothers, uncles or cousins;
around 60% are other acquaintances such as friends of the family, babysitters, or neighbours; strangers
are the offenders in approximately 10% of child sexual abuse cases.
[33]
In over one-third of cases, the
perpetrator is also a minor.
[38]
In a 1999 news story, BBC reported, "Close-knit family life in India masks an alarming amount of sexual
abuse of children and teenage girls by family members, a new report suggests. Delhi
organisation RAHI said 76% of respondents to its survey had been abused when they were children -
40% of those by a family member."
[39]
Psychological/emotional abuse[edit]
Main article: Emotional abuse
Emotional abuse is defined as the production of psychological and social deficits in the growth of a child
as a result of behavior such as loud yelling, coarse and rude attitude, inattention, harsh criticism, and
denigration of the child's personality.
[13]
Other examples include name-calling, ridicule, degradation,
destruction of personal belongings, [torture] or killing of a pet, excessive criticism, inappropriate or
excessive demands, withholding communication, and routine labeling or humiliation.
[40]
Victims of emotional abuse may react by distancing themselves from the abuser, internalizing the abusive
words, or fighting back by insulting the abuser. Emotional abuse can result in abnormal or
disrupted attachment development, a tendency for victims to blame themselves (self-blame) for the
abuse, learned helplessness, and overly passive behavior.
[40]
Neglect
Child neglect is the failure of a parent or other person with responsibility for the child to provide needed
food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety, and well-
being are threatened with harm. Neglect is also a lack of attention from the people surrounding a child,
and the non-provision of the relevant and adequate necessities for the child's survival, which would be a
lacking in attention, love, and nurture.
[41]
Some of the observable signs in a neglected child include: the
child is frequently absent from school, begs or steals food or money, lacks needed medical and dental
care, is consistently dirty, or lacks sufficient clothing for the weather.
[42]
Neglected children may experience delays in physical and psychosocial development, possibly resulting
in psychopathology and impaired neuropsychological functions including executive
function, attention, processing speed, language, memory and social skills.
[43]
Researchers investigating
maltreated children have repeatedly found that neglected children in foster and adoptive populations
manifest different emotional and behavioral reactions to regain lost or secure relationships and are
frequently reported to have disorganized attachments and a need to control their environment. Such
children are not likely to view caregivers as being a source of safety, and instead typically show an
increase in aggressive and hyperactive behaviors which may disrupt healthy or secure attachment with
their adopted parents. These children have apparently learned to adapt to an abusive and inconsistent
caregiver by becoming cautiously self-reliant, and are often described as glib, manipulative and
disingenuous in their interactions with others as they move through childhood.
[44]
Children who are victims
of neglect have a more difficult time forming and maintaining relationships, such as romantic or friendship,
later in life due to the lack of attachment they had in their earlier stages of life.
Effects[edit]
There are strong associations between exposure to child abuse in all its forms and higher rates of many
chronic conditions. In the United States, the strongest evidence comes from the Adverse Childhood
Experiences (ACE's) series of studies which show correlations between exposure to abuse or neglect and
higher rates in adulthood of chronic conditions, high-risk health behaviors and shortened lifespan.
[119]
A
recent publication, Hidden Costs in Health Care: The Economic Impact of Violence and Abuse,
[120]
makes
the case that such exposure represents a serious and costly public-health issue that should be addressed
by the healthcare system. A big concern with researchers is the degree to which maltreated children grow
up to be maltreating adults or if they exhibit social signs of abuse or neglect. Studies show that 90 percent
of maltreating adults were maltreated as children in their life. When children were two, studies show that
16 percent of 267 high-risk mothers mistreated their own children, to different effects.
[121]
The first two
years of a child's life is when parents invest the least in their children. Almost 7 million American infants
go to child care services, like day care, and a majority of that care is poor. Serious consequences occur
when young children are maltreated, including developmental issues.
[122]
16 percent of those 267 high
risk mothers mistreat their two year old children in different ways. 55 percent of the children experienced
physical abuse, 55 percent experienced neglect, 43 percent experienced hostile and rejecting parenting,
and 43 percent experienced unavailable parenting.
[121]
Psychological effects[edit]
Children who have a history of neglect or physical abuse are at risk of
developing psychiatric problems,
[123][124]
or a disorganized attachment style.
[125][126][127]
Disorganized
attachment is associated with a number of developmental problems,
including dissociative symptoms,
[128]
as well as anxiety, depressive, and acting out symptoms.
[129][130]
A
study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited symptoms
of disorganized attachment.
[131][132]
When some of these children become parents, especially if they suffer
from posttraumatic stress disorder (PTSD), dissociative symptoms, and other sequelae of child abuse,
they may encounter difficulty when faced with their infant and young children's needs and normative
distress, which may in turn lead to adverse consequences for their child's social-emotional
development.
[133][134]
Despite these potential difficulties, psychosocial intervention can be effective, at
least in some cases, in changing the ways maltreated parents think about their young children.
[135]
Victims of childhood abuse, it is claimed, also suffer from different types of physical health problems later
in life. Some reportedly suffer from some type of chronic head, abdominal, pelvic, or muscular pain with
no identifiable reason.
[136]
Even though the majority of childhood abuse victims know or believe that their
abuse is, or can be, the cause of different health problems in their adult life, for the great majority their
abuse was not directly associated with those problems, indicating that sufferers were most likely
diagnosed with other possible causes for their health problems, instead of their childhood abuse.
[136]
One
long-term study found that up to 80% of abused people had at least one psychiatric disorder at age 21,
with problems including depression, anxiety, eating disorders, and suicide attempts.
[137]
One Canadian
hospital found that between 36% and 76% of women mental health outpatients had been abused, as had
58% of women and 23% of men schizophrenic inpatients.
[138]
In the case of 23 of the 27 illnesses listed in the questionnaire of a French INSEE survey, some
statistically significant correlations were found between repeated illness and family traumas encountered
by the child before the age of 18 years. According to Georges Menahem, the French sociologist who
found out these correlations by studying health inequalities, these relationships show that inequalities in
illness and suffering are not only social. Health inequality also has its origins in the family, where it is
associated with the degrees of lasting affective problems (lack of affection, parental discord, the
prolonged absence of a parent, or a serious illness affecting either the mother or father) that individuals
report having experienced in childhood.
[139]
Physical effects
Children who are physically abused are likely to receive bone fractures, particularly rib fractures,
[140]
and
may have a higher risk of developing cancer.
[141]
Children who experience child abuse & neglect are 59%
more likely to be arrested as juveniles, 28% more likely to be arrested as adults, and 30% more likely to
commit violent crime.
[142]
The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or severe
(broken bones, hemorrhage, or even death). In some cases the physical effects are temporary; however,
the pain and suffering they cause a child should not be discounted. Meanwhile, the long-term impact of
child abuse and neglect on physical health is just beginning to be explored. The long-term effects can be:
Shaken baby syndrome. Shaking a baby is a common form of child abuse that often results in
permanent neurological damage (80% of cases) or death (30% of cases).
[143]
Damage results from
intracranial hypertension (increased pressure in the skull) after bleeding in the brain, damage to the
spinal cord and neck, and rib or bone fractures (Institute of Neurological Disorders and Stroke, 2007).
Impaired brain development. Child abuse and neglect have been shown, in some cases, to cause
important regions of the brain to fail to form or grow properly, resulting in impaired development (De
Bellis & Thomas, 2003). These alterations in brain maturation have long-term consequences for
cognitive, language, and academic abilities (Watts-English, Fortson, Gibler, Hooper, & De Bellis,
2006). NSCAW found more than three-quarters of foster children between 1 and 2 years of age to be
at medium to high risk for problems with brain development, as opposed to less than half of children
in a control sample (ACF/OPRE, 2004a).
Poor physical health. Several studies have shown a relationship between various forms of household
dysfunction (including childhood abuse) and poor health (Flaherty et al., 2006; Felitti, 2002). Adults
who experienced abuse or neglect during childhood are more likely to suffer from physical ailments
such as allergies, arthritis, asthma, bronchitis, high blood pressure, and ulcers (Springer, Sheridan,
Kuo, & Carnes, 2007).
[144]
On the other hand, there are some children who are raised in child abuse, but who manage to do
unexpectedly well later in life regarding the preconditions. Such children have been termed dandelion
children, as inspired from the way that dandelions seem to prosper irrespective of soil, sun, drought, or
rain.
[145]
Such children (or currently grown-ups) are of high interest in finding factors that mitigate the
effects of child abuse.
Prevention[edit]
A support-group structure is needed to reinforce parenting skills and closely monitor the child's well-being.
Visiting home nurse or social-worker visits are also required to observe and evaluate the progress of the
child and his/her caretaking situation. The support-group structure and visiting home nurse or social-
worker visits are not mutually exclusive. Many studies have demonstrated that the two measures must be
coupled together for the best possible outcome.
[146]
Children's school programs regarding "good
touch...bad touch" can provide children with a forum in which to role-play and learn to avoid potentially
harmful scenarios. Pediatricians can also help identify children at risk of maltreatment and intervene with
the aid of a social worker or provide access to treatment that addresses potential risk factors such as
maternal depression.
[147]
Unintended conception increases the risk of subsequent child abuse, and large
family size increases the risk of child neglect.
[97]
Thus a comprehensive study for the National Academy of
Sciences concluded that affordablecontraceptive services should form the basis for child abuse
prevention.
[97][148]
"The starting point for effective child abuse programming is pregnancy planning,"
according to an analysis for US Surgeon General C. Everett Koop.
[97][149]
April has been designated Child Abuse Prevention Month in the United States since 1983.
[150]
U.S.
President Barack Obama continued that tradition by declaring April 2009 Child Abuse Prevention
Month.
[151]
One way the Federal government of the United States provides funding for child-abuse
prevention is through Community-Based Grants for the Prevention of Child Abuse and Neglect
(CBCAP).
[152]
Each year during Child Abuse Prevention Month, often media and commentators take the
number of reports to be synonymous with the number of cases of actual child maltreatment; this is
obviously not the case.
[153]
From the 3.3 million hotline calls (2010), there were less than 475,000
substantiated cases (2010 NCANDS: 436,321 substantiated+24,976 indicated=461,297 total), resulting in
about 15% of hotline calls substantiated/indicated, of which 78.3% were for neglect.
[11][88]
Some argue
that even many substantiated reports involve only minor or insignificant matters, which most reasonable
people would not truly consider abuse or neglect..
[89]
The 3.3 million annual (hotline) referrals effects on
average 1 out of 10 U.S. families with children (There are 32,200,000 U.S. families with children under 18
according to the 2010 U.S. Census) .
[87]
Unsubstantiated rates of the current magnitude go beyond
anything reasonably needed; a high rate of unsubstantiated reports should concern everyone, according
to Besharov. He further states each report results in what can be an intrusive and traumatic investigation
that is inherently a breach of parental and family privacy. The emotionally charged desire to do
something about child abuse, fanned by repeated and often sensational media coverage has led to an
understandable, but counterproductive over reaction on the part of the professionals and citizens who
report child abuse according to Besharov.
[154]
Resources for child-protection services are sometimes limited. According to Hosin (2007), "a considerable
number of traumatized abused children do not gain access to protective child-protection
strategies."
[155]
Briere (1992) argues that only when "lower-level violence" of children
[clarification needed]
ceases
to be culturally tolerated will there be changes in thevictimization and police protection of children.
[156]
Treatment[edit]
A number of treatments are available to victims of child abuse.
[157]
Trauma-focused cognitive behavioral
therapy, first developed to treat sexually abused children, is now used for victims of any kind of trauma. It
targets trauma-related symptoms in children including post-traumatic stress disorder (PTSD), clinical
depression and anxiety. It also includes a component for non-offending parents. Several studies have
found that sexually abused children undergoing TF-CBT improved more than children undergoing certain
other therapies. Data on the effects of TF-CBT for children who experienced only non-sexual abuse was
not available as of 2006.
[157]
The purpose of dealing with the thoughts and feelings associated with the
trauma is to deal with nightmares, flashbacks and other intrusive experiences that might be
spontaneously brought on by any number of discriminative stimuli in the environment or in the individuals
brain. This would aid the individual in becoming less fearful of specific stimuli that would arouse
debilitating fear, anger, sadness or other negative emotion.In other words, the individual would have
some control or mastery over those emotions.
[44]
Abuse-focused cognitive behavioral therapy was designed for children who have experienced physical
abuse. It targets externalizing behaviors and strengthens prosocial behaviors. Offending parents are
included in the treatment, to improve parenting skills/practices. It is supported by one randomized
study.
[157]
Rational Cognitive Emotive Behavior Therapy consists of ten distinct but interdependent steps. These
steps fall into one of three theoretical orientations (i.e., rational or solution focused, cognitive emotive, and
behavioral) and are intended to provide abused children and their adoptive parents with positive behavior
change, corrective interpersonal skills, and greater control over themselves and their relationships. They
are: 1) determining and normalizing thinking and behaving, 2) evaluating language, 3) shifting attention
away from problem talk 4) describing times when the attachment problem isnt happening, 5) focusing on
how family members successfully solve problematic attachment behavior; 6) acknowledging unpleasant
emotions (i.e., angry, sad, scared) underlying negative interactional patterns, 7) identifying antecedents
(controlling conditions) and associated negative cognitive emotive connections in behavior (reciprocal role
of thought and emotion in behavioral causation), 8) encouraging previously abused children to experience
or own negative thoughts and associated aversive emotional feelings, 9) modeling and rewarding
positive behavior change (with themselves and in relationships), and 10) encouraging and rewarding
thinking and behaving differently. This type of therapy shifts victims thoughts away from the bad and
changes their behavior.
[44]
Child-parent psychotherapy was designed to improve the child-parent relationship following the
experience of domestic violence. It targets trauma-related symptoms in infants, toddlers, and
preschoolers, including PTSD, aggression, defiance, and anxiety. It is supported by two studies of one
sample.
[157]
Other forms of treatment include group therapy, play therapy, and art therapy. Each of these types of
treatment can be used to better assist the client, depending on the form of abuse they have experienced.
Play therapy and art therapy are ways to get children more comfortable with therapy by working on
something that they enjoy (coloring, drawing, painting, etc.). The design of a child's artwork can be a
symbolic representation of what they are feeling, relationships with friends or family, and more. Being
able to discuss and analyze a child's artwork can allow a professional to get a better insight of the child
