Conceptualization, reporting and underreporting of child abuse in Hong Kong

OBJECTIVE: To understand the conceptualization of child abuse and attitudes on reporting behaviors of Hong Kong adults. METHODS: Cross-sectional telephone survey of 1,001 randomly selected subjects. MAIN RESULTS: There is a discrepancy between perceived prevalence and the ability to name different child abuse types without prompting: 79.9% named physical abuse, while 41.2% felt it was common: 21.0% named child neglect, while 76.9% felt it was common; 13.4% named psychological abuse, while 47.4% felt it was common; 6.8% named sexual abuse, while 23.5% felt it was common. Most respondents classified severe physical abuse situations as abusive (e.g., "severely injuring a child"). Other scenarios such as "mildly injuring a child" and neglect and psychological abuse scenarios (e.g., "leaving a young child alone at home" and "shouting at a child often") were often not classified as abusive. As regards case-reporting behavior, only about 40% would report abuse cases to authorities. Those who would not report abuse were less likely to classify abuse situations as abusive and more likely to think that seeking help is difficult, troublesome and unhelpful. CONCLUSIONS: The official reported prevalence figures for child abuse in Hong Kong should be interpreted with care, because underreporting is likely to be serious. Hong Kong people's conceptualization and awareness of what comprises child abuse is found to differ from official definitions. They are reluctant to report abuse cases, due to their perceived low efficacy of case reporting. Both the difference in conceptualization and the reluctance to report might partly be attributable to Chinese culture.     

Effects of witness characteristics on the perception and reportage of child abuse

Vignettes depicting the physical mistreatment, psychological mistreatment and neglect of children were used in an experimental design to test for bias in perception and reportage of child abuse. Subjects were 160 jurors and 176 child protective service (CPS) and police personnel. Jurors born before 1945 were less critical of such mistreatment than those born later. Female jurors pledged to report mistreatment more often than did male jurors, and they pledged to report the abuse of a female victim more often than a male victim. The other groups did not show this bias in reporting. Findings might explain discrepancies between studies of the incidence of child abuse and reportage of it.     

Substance abuse and serious child mistreatment: prevalence, risk, and outcome in a court sample

This study examined the prevalence and specific types of substance abuse in a sample of 206 cases of serious child abuse or neglect brought before a metropolitan juvenile court on care and protection petitions. In 43% of the cases, at least one of the parents had a documented problem with either alcohol or drugs, a figure which rose to 50% when alleged instances of substance abuse were included. Alcohol, cocaine, and heroin were the three most frequently mentioned abused substances. Parents with documented substance abuse were significantly more likely than nonsubstance-abusing parents to have been referred previously to child protective agencies, to be rated by court investigators as presenting high risk to their children, to reject court-ordered services, and to have their children permanently removed. When the two factors of court investigator high risk ratings and presence of parental substance abuse were combined, it was possible to obtain even higher levels of prediction of which parents would reject services and have their children permanently removed. Results suggest (1) the importance of increased screening, evaluation, and treatment of parental substance abuse in cases of serious child mistreatment; and (2) the possibility of adopting a predictive approach as to which families will be able to respond to court-ordered treatment requests and have their children returned.     

From maltreatment report to juvenile incarceration: the role of child welfare services

OBJECTIVE: This study examined whether children who received child welfare services (e.g., in-home or out-of-home placement) were more or less likely to become incarcerated as serious and violent youthful offenders than those children who were investigated as victims of abuse and neglect but received no further child welfare intervention. METHOD: Administrative data on child abuse reporting, foster care, birth records, and juvenile corrections (CYA) were linked to prospectively examine the risk of incarceration as an adolescent following an investigation of abuse or neglect after age 6. The 10 county California sample included 159,549 school-aged children reported for abuse and neglect after 1990. RESULTS: About 8 per 1,000 children in the sample were later incarcerated in CYA. African American and Hispanic children who received in-home or foster care services after the index investigation event had a lower risk of incarceration than those whose cases were closed after the investigation. Among females, the rate of incarceration was highest for those who experienced foster or group care placements. Children initially reported for neglect were more likely to be incarcerated than those reported for physical or sexual abuse. CONCLUSIONS: Public child welfare services have rarely been assessed in terms of future negative child outcomes. This study finds that one serious negative outcome, CYA involvement, can only be understood when a number of factors are considered. The importance of understanding the differences between how different subpopulations respond to services is highlighted. Specifically, our findings suggest that more attention should be focused on children who are now receiving no services after an investigated child abuse and neglect report, on females, and on victims of child neglect.     

Child abuse: A study of the child''s perspective

This study ascertained the child's response to various types of abuse and neglect. With interviews and questionnaires for the staff of a child psychiatric unit, the mothers and the children involved, we assessed the severity, frequency and duration of physical abuse, verbal abuse, physical neglect, emotional neglect or sexual abuse of children. The physically abused children accepted blame for mild but not severe mistreatment. Verbally and sexually abused children did not believe it was their fault if the mistreatment was moderately extensive but did if it was mild or severe. The relationship between extent of abuse and blame was less clear for neglect, but children usually though it was their fault. Verbal and sexual abuse appeared to have a greater impact on the children's perception of themselves and the world. Verbally abused children were more angry and more pessimistic about their future. Although physical abuse appeared to make some children feel they were unwanted at birth, how much the mother wanted her children was not related to the extent of any type of abuse. Both the type and extent of mistreatment appear to have different effects on the child's subjective experience. The use of the visual analogue scale in this study made it possible to differentiate a continuum of severity and frequency of five types of mistreatment without the need for definition.     

Relationships between childhood abuse and neglect experience and HIV risk behaviors among methadone treatment drop-outs

OBJECTIVE: The purpose of this study was to examine the relationships between childhood abuse/neglect experiences (sexual abuse, physical abuse, emotional abuse, and child neglect) and adult life functioning among Methadone Maintenance Treatment Program (MMTP) drop-outs. METHOD: 432 subjects who dropped out of MMTP were recruited in New York City in 1997-1999. Adult life functioning was measured by HIV drug and sex risk behaviors, Addiction Severity Index (ASI) composite scores, and depression. The chi(2) tests, t tests, correlation, and multiple logistic regressions were performed to examine the relationships between abuse experiences and adult life functioning. RESULTS: The prevalence of child abuse/neglect history was high among MMTP drop-outs: sexual abuse-36%; physical abuse-60%; emotional abuse-57%; child physical neglect-66%; all four experiences-25%. As assessed via ASI composite scores, those who had been abused in childhood had significantly more medical, legal, relationship, and psychological problems than those who had not. Overall, several significant associations were found between the abuse experiences and HIV risk behaviors. Those who had experienced child neglect were more likely to be HIV positive. In multivariate analyses, childhood physical abuse was a significant predictor of having multiple sex partners while depression was significantly related to injection drug use in adulthood (p<.05). There were trends for the relationships between childhood sexual abuse and HIV sex risk behavior (p<.10) and between gender and injection drug use (p<.10). CONCLUSIONS: The findings support a need for drug treatment programs that include specialized therapies for those who suffered childhood abuse and neglect experiences.     

Diagnosed intellectual and emotional impairment among parents who seriously mistreat their children: prevalence, type, and outcome in a court sample

A substantial body of research evidence over the past three decades has indicated that intellectual and emotional impairment among parents is a factor contributing to child abuse and neglect. This study examined the court records of 206 seriously abused or neglected children and their families in a large urban area and found that in over half the records a parent had been diagnosed as having an emotional disorder and/or low IQ, with a majority of these diagnoses indicating significant impairment. Although type of impairment (emotional, low IQ, and a subsample of substance abusers) did not predict type of mistreatment, higher predicted risk for continued mistreatment, or greater likelihood of permanent removal of the child by the court, low IQ parents revealed significantly less prior court involvement and greater acceptance of court-ordered services. Parents diagnosed with serious emotional disorders were significantly more likely than less disturbed parents to have their children permanently removed despite findings of no significant differences in risk or compliance factors.     

Child abuse in the eyes of the beholder: lay perceptions of child sexual and physical abuse

OBJECTIVE: The purpose was to explore the effects of victim and perpetrator gender, type of abuse, and victim-perpetrator relationship on university students' and non-students' perceptions of different kinds of child abuse. METHOD: One hundred and ninety-nine participants (including university students and non-student adults) evaluated each of 24 vignettes (within-subjects design) describing an abusive interaction between a child and an adult. The following four variables were manipulated: the victim's gender, the perpetrator's gender, the type of abuse (physical, relatively mild sexual, or relatively severe sexual), and the perpetrator's relationship to the victim (parent or babysitter). Participants rated each vignette on a number of dimensions: degree of trauma and severity, likelihood of general occurrence and reoccurrence, victim believability, and "repressibility" of the event. RESULTS: Significant interactions emerged on each dimension. For example, sexual abuse (whether mild or severe) was rated as being more traumatic and severe if perpetrated by a parent, but relationship type did not affect perceptions of physical abuse. In addition, significant perpetrator gender by victim gender interactions indicated that homosexual abuse was perceived as more traumatic and repressible than heterosexual abuse, but as less likely to occur; and male participants tended to be more affected by the gender of the perpetrator and abuse type than female participants. CONCLUSION: The results suggest that people have stereotypes about the circumstances and consequences of child abuse. These stereotypes are often, though not always, consistent with existing empirical findings.     

The maltreatment of adolescents

Official reports of maltreatment involving adolescent victims were compared to those involving younger children in a representative sample of protective services' reports drawn from New York State in 1985. Specific case characteristics, including age, gender, ethnicity of the victim, and source of report, are described and their relation to case substantiation is examined. Analyses revealed that adolescents represent a substantial proportion of all victims of official child maltreatment reports. The impact of age on substantiation varied as a function of the type of maltreatment, where for adolescents sexual abuse reports were more likely to be substantiated, while neglect and physical abuse reports were less likely to be substantiated. Reports involving adolescents were significantly more likely to involve a female victim. Significant gender differences in substantiation rate were found only for sexual abuse reports involving adolescents. White children were also found to be under-represented in this sample, while blacks were over-represented relative to their numbers in the population. The impact of minority status on substantiation was significant for neglect and physical abuse reports involving children. The majority of adolescent reports came from mandated sources, which had a significantly higher substantiation rate than reports from non-mandated sources.     

Behavioral/emotional indicators of sexual abuse in child psychiatric inpatients: A controlled comparison with physical abuse

Several behavioral and emotional indicators of child sexual abuse were compared for both sexually (n = 29) and physically abused (n = 52) children from a sample of 103 hospitalized psychiatric patients. The measures included (1) scores from a factor-analyzed sexual abuse symptom checklist covering home/community behavior that was rated by parents during a clinical interview and (2) frequency counts of psychological symptoms exhibited by the children during a 3-week period of hospitalization. Results of a 2 (sexual abuse status) X 2 (physical abuse status) X 2 (gender) Multivariate Analysis of Variance indicated that sexually abused children exhibited greater sexual behavior, fear/mistrust/anxiety, and withdrawal at home, and greater sexual behavior, fear/anxiety, and sadness in the hospital than nonabused children. In contrast, there were no significant differences between physically abused and nonabused children, and no significant interactions. Few significant correlations were found between symptoms exhibited at home and in the hospital.     

Child abuse reporting: teachers' perceived deterrents

OBJECTIVE: There are three general objectives: First, to determine the number of reports of abuse made by teachers, their knowledge of child abuse laws and reporting procedures, and their perceived deterrents in reporting abuse; second, to determine if there were gender or ethnic differences in reporting; and third, to evaluate teachers responses to case vignettes. METHOD: A survey of 197 teachers was conducted. They were given a questionnaire that included demographic information, knowledge of child abuse laws and procedures, and two scenarios of legally reportable child abuse. RESULTS: Seventy-three percent of this sample reported that they had never made a report of child abuse, while those who had made reports made an average of one report. Only 11% of teachers reported that there were instances in which they believed abuse may have occurred, but failed to report. Additionally, these teachers felt that their pre- and post-service training did not adequately prepare them for abuse reporting. The most common reasons cited for not reporting abuse were fear of making an inaccurate report, feeling as though child protective services do not help families, and no apparent physical signs of abuse. There were no gender differences in reporting. The teachers' responses to the case vignettes were not consistent with their previous reports. CONCLUSIONS: In general, most teachers reported having never made a child abuse report. Although only a small percentage of teachers reported failing to report abuse, when presented with legally reportable case vignettes, many failed to report. The majority of teachers report receiving inadequate training in child abuse signs, symptoms, and reporting procedure. There is an obvious need for more education for teachers that addresses their perceived deterrents and aids them in feeling more confident in making reports of child abuse.     

The cycle of victimization: The relationship between childhood maltreatment and adolescent peer victimization

Child maltreatment has been demonstrated to have many short- and long-term harmful consequences for victims, but whether or not child abuse is associated with an increased risk of peer victimization during adolescence is unclear. This study analyzed prospective data from 831 children and parents participating in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN) to investigate the relationships between child physical and sexual abuse and adolescent victimization by peers, as well as the potential for gender to moderate these relationships. Results from ordinal logit regression models indicated that children who were physically abused prior to age 12, based on official reports, parent reports, and child reports, had a greater risk of experiencing more intimidation and physical assault by peers at age 16. Having a history of sexual abuse predicted more physical assault but not intimidation. There was no evidence that gender moderated these relationships; in all cases, the relationship between abuse and revictimization was similar for boys and girls. The findings emphasize the need to provide victims of abuse with assistance to help prevent a cycle of victimization.     

Perceived neighborhood social disorder and residents' attitudes toward reporting child physical abuse

OBJECTIVE: This study aimed to explore the relationship between perceived neighborhood social disorder and attitudes toward reporting child physical abuse. METHOD: Data from a national probabilistic sample (N=9,759) were used. Responses about the perception of neighborhood social disorder, perceived frequency of child physical abuse in Spanish families, and willingness to report a case of child physical abuse to the police were collected through face-to-face interviews in respondents' homes. RESULTS: Multivariate logistic regression analysis showed that perceived neighborhood social disorder was negatively related to residents' attitudes toward reporting child physical abuse. These results take into account the potential confounding effects of gender, age, socio-economic status, educational level, size of city, and perceived frequency of child physical abuse on reporting attitudes. CONCLUSION: Results illustrate the important role that community characteristics may play in processes relevant to the prevention of child maltreatment such as residents' attitudes towards reporting child physical abuse, and suggest that especially disadvantaged communities characterized by high levels of social disorder need to be specifically targeted if the aim is to increase the capacity to prevent child maltreatment in the community.     

Patterns of child abuse and neglect associated with chronological age of children living in a midwestern county.

OBJECTIVE: The main objective of the study was to investigate the relationship between age of the very young victim and the type of abuse perpetrated against that victim. A secondary objective was to examine gender and racial differences in child abuse and neglect in children between the ages of birth and 7 years. METHOD: Archived data for all cases of substantiated abuse of children for the years of 1990-1996 inclusive were retrieved from a data bank at a county children services department (N = 876). Chi-square analyses were used to determine age, gender, and racial differences in child abuse and neglect in children 0 to 7 years of age. RESULTS: Neglect was the most common form of primary substantiated abuse recorded for this population of children under the age of 7 years, although the incidence of neglect decreased as chronological age of the child increased. Sexual abuse increased in occurrence as the children got older. Girls were more likely to be victims of sexual abuse than boys. No significant age differences were observed for physical abuse or for emotional abuse, and no racial differences were detected for any of the four types of abuse examined. CONCLUSIONS: Although the findings of this study are in agreement with those of previously published reports, there is some question as to whether archived data are an accurate reflection of actual patterns of maltreatment occurring in very young children or whether they represent the types of abuse that are subjectively identified and reported by authorities.     

Child abuse in South Africa: an examination of how child abuse and neglect are defined

OBJECTIVE: The purpose of this study was to explore which of 17 categories of child maltreatment South Africans evaluated as most serious and to determine if those working with abuse and neglect evaluated abuse and neglect differently from those who did not. METHOD: A revised version of Giovannoni and Becerra's [Giovannoni, J., & Becerra, R. (1979). Defining child abuse. New York: The Free Press] questionnaire exploring the definition of abuse and neglect was completed by 181 residents of Cape Town, South Africa. The new form had 17 categories of child maltreatment, including 4 categories of societal abuse. Respondents were social workers (n = 57), human service workers (n = 42), laypersons (n = 65), and members of the child protection unit of the South African Police (n = 18). ANOVA was used to compare the groups' responses. When significant differences among groups were found, a Bonferroni post hoc test was run to determine differences between groups. RESULTS: The respondents ranked sexual abuse and child prostitution as most serious and housing and child labor as least serious of the 17 categories. There was a significant difference (p < or = .01) between groups on nine categories. When post hoc tests were run, differences were found for eight categories with laypersons generally evaluating categories as significantly more serious than social workers. CONCLUSIONS: Reasons for the order of the rankings are discussed, but concern remains that differences in the evaluation of child maltreatment will lead to difficulty in implementing a protocol for identifying and responding to incidents of abuse and neglect.     

Does the gender of parent or child matter in child maltreatment in China?

Child maltreatment is a public health problem worldwide, and China is no exception. However, the pattern of child maltreatment remains unknown, including whether the gender of children and their parents has an impact on the occurrence of maltreatment. This study aims at examining the rates and frequency of child maltreatment, including physical abuse, psychological abuse and neglect perpetrated by mothers and fathers. We also test whether the interaction between parents’ gender and their child's gender affects the occurrence of child maltreatment in China. 997 children from the China Jintan Child Cohort Study participated in the present study and reported their maltreatment experience perpetrated by their mothers and fathers using the questionnaire, Parent–Child Conflict Tactics Scale (CTSPC_CA). Generalized linear model analyses show that boys were more likely than girls to report physical abuse, and, in particular, boys were more likely than girls to be physically abused by their fathers. On the other hand, mothers were more likely than fathers to exhibit psychological aggression and use corporal punishment for both boys and girls. There was no difference based on the child's or parent's gender in the occurrence of neglect. The findings present empirical evidence that enhances the understanding of the pattern of child maltreatment in China, provide implications for social workers and health professionals to identify children at risk of child maltreatment, and shed light on future research studies.     

Severity of maltreatment and personality pathology in adolescents of Jammu,India: A latent class approach

The aims of the present study were to identify discrete classes of adolescents based on their reporting of emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect of several levels of severity using a person-centered analytic approach (i.e., latent class analysis), and to compare the latent classes on 17 dimensions of personality pathology. It was hypothesized that based on types of maltreatment and severity levels within each type there would be discrete latent classes, and that classes of adolescents exposed to a larger number of maltreatment types with higher severity (i.e., moderate–severe) would report higher levels of personality pathology than adolescents in classes exposed to less types with less severity, after controlling for age and gender. Participants were 702 adolescents from Jammu, India (13–17 years, 41.5% females). The latent classes were based on three levels of severity for each type of maltreatment assessed via the Childhood Trauma Questionnaire (Bernstein et al., 2003). Four distinct classes of adolescents, namely, Moderate–severe abuse and physical neglect (Class 1), Low to moderate–severe abuse (Class 2), Moderate–severe neglect (Class 3), and Minimal abuse or neglect (Class 4) were found. Classes with higher percentages of adolescents reporting abuse and neglect with higher severity (Classes 1 and 2) reported higher levels of personality pathology than the other classes. There are distinct classes of adolescents’ identifiable based on levels of severity and types of abuse and neglect, which are differentially associated with specific dimensions of personality pathology. Implications for research and practice are discussed.     

Understanding child directed caregiver aggression: An examination of characteristics and predictors associated with perpetration

Child physical abuse presents a substantial public health concern with lasting negative consequences for victims. Understanding the variables associated with perpetration can help inform prevention and intervention efforts. The current study examined background and clinical variables in a sample of 195 help-seeking caregivers who were at risk for or had been identified as having engaged in child directed aggression or abuse. We found that caregivers who did (vs. did not) report severe child directed aggression had poorer parenting and reported more drug use. Having a recent allegation of child physical abuse (vs. no allegation) based on official child welfare records was unrelated to parenting, drug and alcohol use, negative affect, parenting stress, or neglect. Structural equation modeling was used to examine the influence of parenting stress on child directed aggression and its effects through negative affect and positive parenting. We found that parenting stress predicted higher negative affect, which was related to greater child directed aggression. Additionally, parenting stress predicted lower positive parenting, which in turn predicted lower child directed aggression. A model including drug and alcohol use did not add to the prediction of child directed aggression. Prediction of neglect using similar variables found that only positive parenting was of import and that parenting stress and negative affect did not contribute to neglect. Implications for future prevention and treatment development efforts with abusive/aggressive caregivers are discussed.