Family patterns and child abuse in a nationally representative American sample

Data on 1, 146 families with a child age 3 through 17 at home are presented. Child abuse information was obtained for a randomly selected child in each family. Child abuse was defined as an attack by a parent involving punching, kicking, biting, hitting with an object, “beating up,” or using a knife or gun. Over 14 out of every 100 American children 3–17 are subjected to abusive violence each year. These figures are at least 26 times greater than those of the National Center For Child Abuse and Neglect. Even so, for reasons outlined in the paper, they are underestimates. Families in which child abuse occurred are compared with other families. The results suggest that child abuse is brought about by the very nature of the society and its family system. This has profound implications for the prevention and treatment of child abuse. Although psychotherapy may be appropriate in some cases, a more fundamental approach lies in such things as a more equal sharing of the burdens of child care, replacement of physical punishment with non-violent methods of child care and training, eliminating the stresses and insecurity which now characterize our economic system, and strengthening the ties of individual families to the extended family and the community.     

Empathy and narcissism in a sample of child abuse perpetrators and a comparison sample of foster parents

OBJECTIVE: The purpose of this research was to study the personality variables of empathy and narcissism in a sample of child abuse perpetrators and a comparison sample of foster parents, conceptualized as nonabusive parents, in order to gain further understanding of perpetrators and to provide clues for intervention. METHOD: The sample consisted of two groups: physically and emotionally abusive parents (n=52) and foster parents (n=101). Participants responded to three instruments: the Interpersonal Reactivity Index (IRI), an instrument measuring individual differences in empathy, and two instruments measuring narcissism: the Narcissistic Personality Inventory (NPI) and the Hypersensitivity Narcissism Scale (HSNS). RESULTS: Statistically significant differences were found between the two groups on three of the four subscales of the IRI: perspective-taking, empathic concern, and personal distress. Based on the definition of these subscales, the abusive parents as compared to the foster parents were not able to take the perspective of another or see things from another's viewpoint, showed less warmth, compassion and concern for others, and experienced difficulty in tense interpersonal situations. Statistically significant differences were found for the two groups on three of the six subscales of the NPI: authority, exhibitionism, and superiority, and on the HSNS. The abusive parents demonstrated less self-confidence, a greater lack of impulse control and were more narcissistic than their foster parent counterparts. CONCLUSIONS: The results suggest that it is how the perpetrators experience aversive behavior in their children that may provoke them to physically and emotionally abuse their children. Their self-centeredness in addition to their deficiencies in empathy may cause them to experience their children's misbehavior as an affront to their authority. Implications for treatment are made from this conceptualization of parental abuse.     

The relationship between child sexual abuse and academic achievement in a sample of adolescent psychiatric inpatients

OBJECTIVES: To examine the relationship between sexual abuse and academic achievement in an adolescent inpatient psychiatric population. Individual factors expected to influence this relationship were measured to explore the way they each interacted with sexual abuse and its relationship to academic achievement. METHOD: Eighty-one adolescent psychiatric inpatients participated in the study (aged 12--18 years: M=16.0). Participants were administered tests of academic achievement (dependent variable) and intelligence, and completed a number of self-report measures of their experience of different types of maltreatment, their perception of the parenting they received, socio-economic status, substance abuse, and psychopathology. RESULTS: Hierarchical regression analysis revealed that intelligence was the main predictor of academic achievement (uniquely explaining 26% of the variance). A number of interaction effects were also significant indicating that intelligence, substance abuse, internalizing behavior problems, externalizing behavior problems all influenced the relationship between sexual abuse and academic achievement. DISCUSSION: Examining the impact of sexual abuse is complex because it is typically an experience embedded in a range of other risk factors, such as poverty, family dysfunction, and other types of maltreatment. This study demonstrated coexistence between sexual abuse and a number of other variables, including other maltreatment types and parental overprotection, underscoring the requirement for complex models of research that more accurately reflect the experience of abused children.     

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.     

Prevalence of child sexual abuse reported by a cross-sectional sample of New Zealand women

OBJECTIVE: The objective is to describe the prevalence of child sexual abuse (CSA) among women in New Zealand, document ethnic specific rates, and outline the frequency of abuse experienced and the most commonly identified perpetrators. Associations between CSA and later adverse consequences were also explored. METHODS: Retrospective report from a random sample of 2,855 women aged 18-64 years old in two regions in New Zealand. Face-to-face interviews with one randomly selected woman from each household were conducted. RESULTS: The overall prevalence rates for CSA were 23.5% for women from the urban region and 28.2% from the rural region. In both urban and rural regions, Māori women more frequently reported experiences of CSA than women from European and other ethnic groups (urban: 30.5% vs. 17.0% and rural: 35.1% vs. 20.7%). The median age of onset of the abuse was 9 years, and the median estimated age of the abuser was 30 years. Half of those who experienced CSA reported that it occurred once or twice, 27% "a few times," and 23% "multiple times." Sole perpetrators were involved in 83% of cases. The majority of cases were perpetrated by a family member, most frequently male. Compared with non-victims, victims of CSA were twice as likely to experience later intimate partner violence and violence by others. CONCLUSIONS: This study reports on a large, population-based sample in an ethnically diverse population in New Zealand, providing the first ethnic-specific rates of CSA available. Findings suggest important priorities for prevention and intervention activities.     

Incidence and impact of sexual abuse in a child outpatient sample: The role of direct inquiry

From the child psychiatry outpatient department of a university medical center, 64 charts were reviewed in two phases: 29 were randomly selected from outpatient files, and 35 were examined after clinicians were asked to directly query sexual abuse. Although the reported sexual abuse rate for randomly selected charts was quite low (6.9%), reference to sexual abuse history in charts of children who were asked about molestation was 4.5 times more frequent (31.4%; 11.5% of all boys, 50% of all girls). Children with an identified sexual abuse history reported more psychological symptoms, had made more suicide attempts in the past, and were more likely than nonabused children to receive a diagnosis of major depression.     

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.     

Development and initial validation of the institutional child abuse processes and coping inventory among a sample of Irish adult survivors of institutional abuse

ObjectiveTo develop a psychometric instrument to evaluate psychological processes associated with institutional abuse and coping strategies used to deal with such abuse.MethodsAs part of a comprehensive assessment protocol, an inventory containing theoretically derived multi-item rational scales which assessed institutional abuse-related psychological processes and coping strategies were administered to 247 Irish adult survivors of institutional child abuse. Exploratory and confirmatory factor analyses were used to derive 6-factor scales, the reliability and validity of which were assessed.ResultsFactor scales to assess the following constructs were developed (1) traumatization, (2) re-enactment, (3) spiritual disengagement, (4) positive coping, (5) coping by complying, and (6) avoidant coping. There were varying degrees of support for the validity of the scales with most support for the traumatization and re-enactment scales.ConclusionsThe Institutional Child Abuse Processes and Coping Inventory (ICAPCI), particularly its traumatization and re-enactment scales, may be used in future research on adult survivors of institutional child abuse because they are currently the only scales that have been developed with this population to provide reliable and valid assessments of these constructs.Practice implicationsThe ICAPCI may be used, cautiously, to assess adult survivors of institutional child abuse.     

The prevalence of child sexual abuse victimization in an adult sample of Texas residents

Attempts to identify characteristics of children who have been sexually abused have generally been based on cases reported to clinics, hospitals, law enforcement and social service agencies. In this study a questionnaire was mailed to a representative sample of the adult population in Texas. Child sexual abuse was defined as sexual interaction between a child and an adult or between two minors when the perpetrator is significantly older than the victim or is in a position of power over the victim. A return rate of 53% was obtained. The surveys returned varied from previous studies of the same population in that the respondents were slightly older, more often married and from a slightly higher socioeconomic level. They were, however, closely matched on the variables of sex, race and educational level. Childhood sexual victimization was reported by 7.4% of the respondents. Female victims comprised 82% of this group. The racial/ethnic distribution of victims paralleled that of the Texas census with 77% white, 5% black, and 16% Hispanic. Victimization rates were highest for Hispanic females followed by black and white females in that order. Hispanic and black males reported the lowest victimization rates. Based on these findings, it was estimated that 821,359 adult Texas residents were sexually abused as children. These results were compared with those of other studies along with their implications for policy-making.     

Identified spouse abuse as a risk factor for child abuse

CONTEXT: There are limited data on the extent to which spouse abuse in a family is a risk factor for child abuse. OBJECTIVE: To estimate the subsequent relative risk of child abuse in families with a report of spouse abuse compared with other families. DESIGN: Cohort study. SETTING: Analysis of a centralized US Army database PARTICIPANTS: Married couples with children with at least one spouse on active duty in the US Army during 1989-95. MAIN OUTCOME MEASURES: The US Army Family Advocacy Program's Central Database was used to identify child and spouse abuse. The exposure was an episode of identified spouse abuse and the main outcome was a substantiated episode of subsequent child abuse.RESULTS: During the study period of an estimated 2,019,949 person years, 14,270 incident child abuse cases were substantiated. Families with an incident case of spouse abuse identified during the study period were twice as likely to have a substantiated report of child abuse compaired with other military families, rate ratio, 2.0, (95% confidence interval [CI] 1.9-2.1). Young parental age had the highest rate ratio, 4.9 (95% CI 4.5-5.3) in the subgroup analysis controlling for rank. Identified spouse abuse was associated with physical abuse of a child, rate ratio 2.4 (95% CI 2.2-2.5), and with sexual abuse of a child, rate ratio 1.5 (95% CI 1.3-1.7). Identified spouse abuse was not associated with child neglect or maltreatment, rate ratio, 1.0 95% CI 0.9-1.1) CONCLUSION: An identified episode of spouse abuse in a family appears to be associated with an increased risk of subsequent child abuse and serves as an independent risk factor. Therefore. care providers should consider the potential risk to children when dealing with spouse abuse.     

Dissociation as a mediator between child abuse history and adult abuse potential

OBJECTIVE: It has commonly been found that abused children are at risk for later becoming abusive parents (Kaufman & Zigler. 1987; Oliver, 1993) and observational learning has been discussed as a mechanism that perpetuates this intergenerational cycle of abuse. However, two thirds of abused children do not become abusive (Kaufman & Zigler, 1987). Thus, the goal of the current study was to examine whether dissociation functions as an additional mechanism mediating the relation between a history of child abuse and abusiveness as an adult. METHOD: A cross-sectional design was used to examine physical abuse history, dissociation, and physical abuse potential in a sample of 190 college students. Questionnaires were utilized to assess the three constructs. RESULTS: Findings indicated that the three constructs were intercorrelated. In particular, a newly established association was found between dissociation and physical abuse potential (r = .54, p < .0001). The primary finding was that the relation between physical abuse history and physical abuse potential was significantly mediated (z = 2.19, p < .05) by level of dissociation, with dissociation accounting for approximately half of the observed relation between history of abuse and abuse potential. CONCLUSION: Results suggested that dissociation may be one mechanism that helps to perpetuate the intergenerational cycle of abuse. Although dissociation promotes psychological survival during children's abuse experiences, it may result in the development of abusive tendencies in later life. Reducing parental dissociation may assist clinicians in preventing or terminating physical child abuse.     

The relationship between child abuse,parental divorce,and lifetime mental disorders and suicidality in a nationally representative adult sample

ObjectivesTo determine how the experiences of child abuse and parental divorce are related to long-term mental health outcomes using a nationally representative adult sample after adjusting for sociodemographic variables and parental psychopathology.MethodsData were drawn from the National Comorbidity Survey (NCS, n = 5,877; age 15–54 years; response rate 82.4%). Logistic regression models were used to determine the odds of experiencing lifetime psychiatric disorders and suicidal ideation and attempts.ResultsParental divorce alone was associated with some psychiatric disorders after adjusting for sociodemographic variables (AOR ranging from 1.30 to 2.37), while child abuse alone was associated with psychiatric disorders (AOR ranging from 1.39 to 6.07) and suicidal ideation (AOR = 2.08; 95% CI = 1.57–2.77) and attempts (AOR = 1.54; 95% CI = 1.02–2.31) after adjusting for sociodemographic variables. However, having experienced both parental divorce and child abuse together resulted in significantly increased odds for lifetime PTSD (AOR = 9.87; 95% CI = 6.69–14.55), conduct disorder (AOR = 4.01; 95% CI = 2.92–5.51) and suicide attempts (AOR = 2.74; 95% CI = 1.84–4.08) compared to having experienced either parental divorce or child abuse alone. These results were attenuated when further adjusting for parental psychopathology.ConclusionsWhen the experience of parental divorce is accompanied with child abuse, the associations with some poor mental health outcomes are significantly greater compared to the impact of either parental divorce or child abuse on its own. Therefore, parental divorce is an additional childhood adversity that significantly contributes to poor mental health outcomes especially when in combination with child abuse. Parental psychopathology attenuated these relationships suggesting that it may be one possible mechanism to explain the relationships between child abuse, parental divorce, and psychiatric disorders and suicide attempts.     

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.     

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.