The handicapped child and child abuse

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.     

Abuse in the investigation and treatment of intrafamilial child sexual abuse

This paper examines the effects of current practice in the investigation and treatment of documented incest abusers on the offenders and families involved. Fifteen offenders attending the Utah Parents United group completed a questionnaire on the sequence of events in the investigation and prosecution of their cases and the concomitant results of the investigation on their job status, living and financial situations, family and social relationships, and media reporting of the abuse. Results indicate that there is great variability in the investigation and prosecution of incest cases and the public announcement of abuse convictions. The consequences of the abuse investigation are devastating for offender and his family in terms of job loss; need for public assistance; family disbandonment through removal of the offender, victim, or both from the family, marital separation, and foster care for nonabused siblings; changes of residence, and the public announcement of the abuse in the media. Results also show that offenders receive little, if any, social support from family or friends. Changes in the current approach to the investigation and prosecution of incest offenders are proposed and include the following: (1) banning the publication of convictions for child abuse; (2) streamlining the legal process so that it is consistent from case to case; and (3) developing diversion programs as alternatives to prison for offenders. Suggested are self-help, court-ordered therapeutic programs, such as Parents United, that are designed for the treatment of families involved in child sexual abuse and incest. The desired outcomes of such a diversion program are low offender recidivism, avoidance of the offender's family being placed on welfare, less reliance on foster care placement for the offender's children, involvement of the offender's family in moving toward reunion when feasible, and the use of existing half-way houses in lieu of incarceration when necessary.     

Prediction of child abuse: A prospective study of feasibility

Feasibility of identifying risk for child abuse prospectively was determined by interviewing 1400 expectant mothers and predicting that 273 were high risk. Nonaccidental child injuries were subsequently reported to authorities for 6% of these versus 1% of the remaining 1127 families. Prediction was only effective for 24 months following interview. Thus prenatal prediction was feasible although the rate of false positive high risk assignment would limit practical application of the interview we used. As a first step to improve prediction accuracy, a group of the 20 strongest predictors was selected from the interview by regression analysis. The correlation of these with abuse was .44 compared to .15 for the original interview. Important predictors included subjective impressions of interviewers, residency transience, untruthfulness, disturbed childhood nurture, unwanted pregnancy, and perhaps conditions that increased parent-child exposure.     

The child sexual abuse accommodation syndrome

Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment.     

Characteristics of child physical and sexual abuse as predictors of psychopathology

Childhood physical and sexual abuse victims are at increased risk for developing depression, anxiety, and post-traumatic stress disorder (PTSD) in adulthood. Prior findings suggest abuse onset, duration, and severity moderate relationships between victimization and psychopathology. However, because these abuse characteristics are highly intercorrelated, their unique, individual effects on mental health outcomes remain unclear. To address this gap, the present study examined relationships between physical and sexual abuse characteristics and mental health outcomes and whether these relationships differed by sex. A diverse community sample of late adolescents and emerging adults (N = 1270; mean age = 19.68; 51% female) self-reported the onset, duration, and severity of physical and sexual abuse, as well as their depressive, anxiety, and PTSD symptoms. Results of a multivariate regression model (simultaneously evaluating all physical and sexual abuse characteristics) indicated that physical abuse onset in middle childhood and sexual abuse onset in middle childhood or adolescence were associated with all forms of psychopathology; and physical abuse onset at any time was uniquely linked with PTSD. Duration and severity of physical or sexual abuse did not predict psychopathology after accounting for time of onset. Multigroup analyses indicated that adolescence-onset and duration of sexual abuse respectively predicted anxiety and PTSD in females but not males, whereas sexual abuse severity predicted fewer PTSD symptoms in males but not females. Overall, results suggested that abuse occurring after age 5 may have the most deleterious impact on mental health.     

A retrospective study with ICAST-R (ispcan child abuse screening tools-retrospective) questionnaire for determination of child abuse in first year medical students in Turkish population

Child Abuse and Neglect (CAN) is an important problem both in Turkey and worldwide. Unfortunately, we still don’t have enough and reliable data on this important subject. In this study, we aimed to investigate the prevalence of childhood maltreatment in a population of first year medical students in a Turkish university using the retrospective version of the ISPCAN Child Abuse Screening Tool (ICAST-R). One hundred seventy three first year medical students, aged between 18 and 24 years, who agreed to complete the ICAST-R questionnaire, were recruited in our study. Of 173 students who completed the survey, 51.4% are found to be subjected to at least one type of child abuse (physical, emotional or sexual). The prevalence is higher in male gender and the difference is statistically significant. Physical, emotional and sexual abuse exposure rates are found to be 23.1%, 40.5% and 11% respectively. Physical and emotional abuse rates are higher in male gender and the difference is statistically significant. We did not find any statistically significant association between gender and sexual abuse. Efforts to prevent child abuse and neglect are growing in our country, as they are worldwide. However, child abuse is still common and a problematic issue. It is important to determine the prevalence of child abuse in order to raise awareness. We need further studies investigating not only prevalence but also risk factors to have reliable data for our country.     

The battered child: A study of the role of services in 25 cases of child abuse in The Netherlands

With the help of a questionnaire and the study of 25 cases of child abuse from 1973 to 1976, the course of assistance given by various services and social workers involved was followed and the extent of the coordination between them was assessed. The starting point was the fact that when child abuse has reached the crisis stage many different bodies give immediate assistance to both the child and his parents. Later on, however, as help continues, it is not clear which of the persons or bodies concerned is really in charge of the case. The following conclusions were drawn: Abused children came from multiproblem families who often already have had contact with care or welfare services though no steps had been taken to intervene before ill-treatment was verified. Many parents confessed to illtreatment of their child and desired help. Abused children were subjected to longer than usual hospital stays due to lack of reception facilities outside the hospital. Most ill-treated children abused enough to be hospitalized, were placed away from home although half of the parents did not agree with that decision. Of those later returned to their parents, over half had to be removed later for renewed ill-treatment and neglect. The need for one body to coordinate and be responsible for execution of plans for treatment was stressed.     

Getting evidence into action to tackle institutional child abuse

The Australian Royal Commission into Institutional Responses to Child Sexual Abuse is an example of a government response to survivors’ demands to address the harm they suffered. It is also a major response by a national government to improve child safety in the future. Facing up to child abuse is difficult and in other countries similar inquiries have suffered delays and derailing. This commentary uses an evidence-to-action lens to explore why clear evidence of child sexual abuse may be ignored and side-lined. It argues that where evidence challenges the powerful, is surprising and shocking, or undercuts current institutional and policy arrangements, then that evidence is likely to be ignored, undermined or refuted – all factors which are present in the case of historical institutional child sexual abuse.     

County-level socioeconomic and crime risk factors for substantiated child abuse and neglect

Rates of substantiated child abuse and neglect vary significantly across counties. Despite strong cross-sectional support for links between social-contextual characteristics and abuse and neglect, few longitudinal studies have tested relations between these risk factors and substantiated rates of abuse/neglect. The goal of this study was to identify county-level socioeconomic and crime factors associated with substantiated abuse/neglect rates over 13 years (2004–2016). Annual county-level data for Tennessee, obtained from the KIDS COUNT Data Center, included rates of substantiated child abuse and neglect, children’s race and ethnicity, births to unmarried women, teen birth rate, children in families receiving Supplemental Nutrition Assistance Program (SNAP) benefits, and children in families receiving Temporary Assistance for Needy Families. Annual county-level crime report data, obtained from the Tennessee Incident Based Reporting System, included sexual offenses, non-sexual assaults, stalking incidents, thefts, property damage, and drug-related offenses. Bayesian spatio-temporal models indicated that substantiated child abuse and neglect rates were independently and positively associated with teen birth rates, percentages of births to unmarried mothers, drug-related offenses, and percentages of children receiving SNAP benefits. In contrast, substantiated child abuse and neglect rates were negatively associated with percentages of African-American youth. The findings highlighted distinct demographic, socioeconomic, and crime factors associated with substantiated child abuse and neglect rates and have the potential to enhance identification of high-risk counties that could benefit from targeted abuse and neglect prevention efforts.     

The effects of abuse history on sexually intrusive behavior by children: An analysis of child justice records

Objectives

A commonly cited risk factor for sexually intrusive behavior (SIB) among children and adolescents is a history of abuse. Based on a large and non-clinical nationwide sample of children who were investigated as abuse victims and suspects of SIBs in Israel over a decade, the present study examines the rate of abuse history among child suspects who have admitted SIBs. In addition, this study compares some personal and family characteristics as well as selected aspects of SIBs reported by children with and without a history of abuse. Abuse history is then used to predict the nature of SIBs after controlling for other predictors.

Methods

National data files of the investigation of alleged child victims and child suspects aged 14 or under were electronically merged, allowing the identification of a sub-group of suspects, out of all suspects, who had a record of child abuse. Using only confirmed cases of boys with SIBs, child suspects with a record of abuse were compared to the larger group of child suspects with no record of abuse.

Results

Of 3,554 child suspects of SIBs, 345 or 9.7% had a formal record of abuse. Boys with a record of abuse engaged in SIBs at a younger age; were more likely to display mental disabilities; more often belonged to large size, single-parent, low SES, and immigrant families and were more likely to be removed from home to alternative care than boys with no record of abuse. The nature of SIBs varied across the groups, with victim-suspects more likely than their counterparts to act repeatedly, and to do so alone rather than in the presence of others. Victim-suspects were more likely to involve in SIBs with younger children, with siblings, and with unrelated children. Most aspects of SIBs were predicted by abuse history after controlling for other predictors, with some differences between age groups being evident.

Conclusions

Although abuse history is uncommon among children displaying SIBs in this sample, it seems to affect the involvement of children at a younger age in more severe SIBs, posing a higher risk to other children.

Practical implications

The low rate of abuse history among boys with SIBs suggests that clinical assessors of SIBs in children should not assume that these children have been victims of abuse or that abuse is a necessary component in the development of SIBs. This implies that the exploration of past abuse in the assessment of children with SIBs is not always relevant and that trauma-related components in the treatment of these children should be selective. As past-abuse is less related to SIB's for older children, the clinical focus on abuse is even less relevant for older children. However, when boys with SIBs have been past-victims, they seem to be in greater need for treatment than other boys with SIBs. Moreover, the dynamics of SIBs by past victims should raise more concern for older than for younger children.     

A meta-analysis of the prevalence of child sexual abuse disclosure in forensic settings

BackgroundIdentification, substantiation, prosecution, and treatment of child sexual abuse often rely heavily on a disclosure from the victim in the absence of corroborating evidence. For some, disclosure can be impeded by developmental or motivational barriers, thus compromising child safety and wellbeing. The literature on disclosure prevalence and mitigating influences does not yield a coherent picture. A more accurate estimate will help to inform investigation strategies to facilitate disclosure.ObjectiveThis study provides a meta-analysis of available research examining the prevalence of sexual abuse disclosure in forensic interviews with children under 18 years, and examines a range of factors that may influence the likelihood of disclosure.MethodDatabases were searched for published and unpublished studies up to May 2017. In total, 2393 abstracts were assessed for eligibility, 216 full-text articles were reviewed, and 45 samples (with 31,225 participants) provided estimates of effect sizes.ResultsThe mean prevalence of child sexual abuse disclosure in forensic settings was 64.1% (95% CI: 60.0–68.1). Between-study variability was explained by: (1) child age and gender, with higher prevalence in older children and females; (2) prior disclosure, with higher prevalence when present; and (3) study year, with higher prevalence in more recent studies.ConclusionsThis meta-analysis confirms an upward trend in child sexual abuse disclosure prevalence. However, more than a third of children do not disclose when interviewed, with those who are younger, male, and without a prior disclosure at greatest risk. Important implications for forensic interviewing protocols and future research are discussed.     

Prevalence of child abuse in school environment in Kerala,India: An ICAST-CI based survey

Very few studies focus on childhood abuse in developing countries and only a small fraction of such studies explicitly deal with abuse in a school environment. The purpose of this study was to estimate the prevalence of sexual, physical, and emotional abuse in a school environment in a developing country. Abuse history was collected using the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool – Children’s Institutional Version (ICAST-CI). Demographic variables were also collected. Student supportive measures were provided both during and after the survey. 6682 school attending adolescents in Thrissur, Kerala participated in this cross sectional self report study. One year and lifetime prevalence of physical (75.5%, 78.5%), emotional (84.5%, 85.7%) and sexual (21.0%, 23.8%) abuse was high. Abuse was considered to be present even if an individual item from these three categories was reported. Most abuse was reported as occurring ‘sometimes’ rather than ‘many times’. More males than females reported being victims of abuse; figures for one-year prevalence were: physical abuse (83.4% vs. 61.7%), emotional abuse (89.5% vs. 75.7%), and sexual abuse (29.5% vs. 6.2%). Various factors significantly increase the likelihood of abuse—male gender, low socioeconomic status, regular use of alcohol and drugs by family member at home, and having other difficulties at school. Children tended to report abuse less frequently if they liked attending school and if they always felt safe at school. The results highlight the urgent need to address the issue of abuse in the school environment and minimize its impact.     

A systematic review of randomized controlled trials of interventions designed to decrease child abuse in high-risk families

Child abuse is a global problem, and parents with histories of childhood abuse are at increased risk of abusing their offspring. The objective of this systematic review is to provide a clear overview of the existing literature of randomized controlled trials evaluating the effectiveness of interventions to prevent child abuse. PubMed, PsychINFO, Web of Science, Sociological Abstracts, and CINAHL were systematically searched and expanded by hand search. This review includes all randomized controlled trials (RCTs) of interventions designed to prevent abuse among mothers identified as high-risk. Of the eight studies identified, only three found statistically significant reductions in abuse by any measure, and only two found reductions in incidents reported to child protective services. While much has been written about child abuse in high-risk families, few RCTs have been performed. Only home visitation has a significant evidence base for reducing child abuse, and the findings vary considerably. Also, data from low- and middle-income countries are limited.     

Use of a home-based microcomputer to analyze community data from reported cases of child abuse and neglect

A personal microcomputer data base program was used to study 184 substantiated 1981 child abuse and neglect cases in the city of Lansing, Michigan. Data on 18 variables were entered directly into the microcomputer from the agency case closing forms in 7$\text{1}\text{2}$ hours. The microcomputer can sort by one or more variables. In analyzing the data, the following questions were addressed: Who reports the child abuse cases? In what types of families does abuse occur? Who are the perpetrators in relation to the child? Who are the victims by age and race? What types of abuse are substantiated? How many of the cases are repeats? Where are substantiated cases located? This study was both simple and inexpensive, requiring minimal staff time, a microcomputer with a data base program, and data already available in agency files. This study could be duplicated in any area by noncomputer persons to help professionals, community organizers, and others to better understand their community and help the abusive family.     

Child abuse among the Zulus: A people in cultural transition

Due to industrialization and Westernization the life-style of the Zulu people has undergone a rapid and radical change. This has led to a breakdown of the traditional culture and has not been replaced by an adequate social support structure. Consequently, the social ills of the First World abound and are compounded by persistent beliefs in witchcraft and the power of the ancestral spirits. The Zulu child has thus been exposed to a wide variety of abuses including sheer brutality, ongoing “minor” trauma, neglect, sexual and alcohol abuse. The extended family of yesteryear no longer exists to absorb the stresses and the nuclear family is frequently incomplete. Some contributions towards a solution are seen in (1) Appropriate education at every possible level; (2) Promoting formal and informal community support groups; (3) Screening mothers perinatally; (4) Developing and promoting an adoption service; and (5) Improving primary health care facilities.     

Fatal child abuse in Georgia: the epidemiology of severe physical child abuse

Decisions about the occurrence of child abuse are increasingly difficult to make because concepts of what qualifies as reportable child abuse may be broadening. We examined this question by comparing 51 fatal child abuse cases occurring in Georgia between July 1975 and December 1979 to non-fatal cases and to the Georgia population. Overall rates of fatal child abuse were higher for male perpetrators compared with female and black perpetrators compared with white. However, the latter finding varied with economic and geographic status. The highest child abuse fatality rates were found in poor, rural, white families (3.3/100,000 children) and in poor, urban, black families (2.4/100,000 children). Risk factors for fatal abuse included early childhood (RR 6:1), parental teenage childbearing (RR 4:1), and low socioeconomic status. These characteristics were similar to those of the severe child abuse cases noted in the early child abuse literature. Non-fatal cases did not clearly share these risk factors. Severe abuse, here represented by fatal cases, is a distinct subset of reported child abuse, but characteristics associated with it are frequently attributed to all reportable child abuse. Medical personnel should be aware that they cannot rely on the presence or absence of these characteristics in screening for risk of reportable child abuse. Child abuse research should use restricted, stated case definitions. When intervention and prevention programs are being organized, they should not generalize research findings to all forms of child abuse.     

Teachers who abuse: the impact on school communities

This paper addresses issues that may arise of a teacher or school employee is abusing pupils within the school community. Interviews were conducted with a number of respondents who had experienced situations of abuse within the school context. The incidents used, as case examples, all concern sexual abuse, although the framework developed could be used to examine different types of abuse. The paper concludes that changes in legislation and guidelines can improve practice, but that less tangible issues will continue to be involved when dealing with abuse, and that raising awareness of the issues is a key factor.     

Injury variables in child abuse

The child abuse reporting records of 616 children seen by the child abuse team in a metropolitan children's hospital were analyzed. Boys were referred for abuse more often than girls, and black children were reported disproportionately more often than were white children. Mothers were the most frequent perpetrators of abuse, although males constituted more than half of the abusers. Bruises were the most frequent manifestation of abuse. The types of injury, injury site and types of instruments used varied with the age and race, but not the sex of the child. The wide variety of instruments used to perpetrate child abuse resulted in a broad spectrum of injury types. If professionals are to recognize common and early manifestations of child abuse, they must be aware of the influence of regional socioeconomic and cultural factors on the spectrum of child abuse.     

The incidence of depressive symptomatology in juvenile sex offenders with a history of abuse

Depressive symptomatology was assessed in a sample of 246 male juvenile sex offenders using the Beck Depression Inventory. Of these participants, the racial composition was black = 147, Hispanic = 62, Caucasian = 34. Three adolescents elected not to identify their racial origin. Subjects were divided according to their self-reports of having been sexually or physically abused. The mean Beck score across all subjects was 14.3, a value markedly higher than published norms and indicative of mild depression. Forty-two percent of subjects attained scores indicative of appreciable depressive symptomatology. A history of sexual or physical abuse was significantly related to high Beck scores; abused subjects had a mean Beck score of 16.4, as contrasted to 12.3 for nonabused subjects (Wilcoxon test: z = 2.82; p less than .005). This relationship was apparent across all racial groups. While Hispanic subjects tended to have higher Beck scores and Caucasians lower scores, racial differences were not statistically significant. Results indicate that juveniles who have committed sexual crimes, particularly those with a history of abuse, should be evaluated for depression.