The dark side of social support: Understanding the role of social support,drinking behaviors and alcohol outlets for child physical abuse

The purpose of this study is to examine how parental drinking behavior, drinking locations, alcohol outlet density, and types of social support (tangible, emotional, and social companionship) may place children at greater risk for physical abuse. Data on use of physical abuse, drinking behaviors, types of social support, social networks, and demographic information were collected via telephone interviews with 3,023 parent respondents in 50 cities in California. Data on alcohol outlet density were obtained by the California Department of Alcoholic Beverage Control. Multilevel Poisson models were used to analyze data for the drinking levels in the entire sample and dose-response drinking models for drinkers. Social companionship support was related to more frequent use of physical abuse. Having a higher percentage of social companionship support network living within the neighborhood was related to more frequent physical abuse in the full sample. This relationship was moderated by on-premise alcohol outlet density. With regards to drinking behaviors, drinking behaviors from ex-drinkers to frequent heavy drinkers used physically abusive parenting practices more often than lifetime abstainers. The dose-response models show that each additional drinking event at a bar or home/party was related to more frequent use of physical abuse. Practitioners working with parents who abuse their children should be aware that not all social support is beneficial. Findings build evidence that child maltreatment is influenced by the interaction between individual and ecological factors.     

The sexually mistreated child: Diagnostic evaluation

Ten children, ages five through eleven, who had been sexually abused, were seen for diagnostic evaluations. The children represented a wide spectrum of sexual abuse. Nine of the children had numerous behavioral symptoms, the most frequent of which were sleep disturbances and school problems. Nine of the families were viewed as dysfunctional. The children displayed similar psychodynamic themes and were preoccupied in obtaining adequate parental care and affection of which they were deprived. The presence of unmet affectional needs in the child cut across all types of sexual abuse giving rise to the conclusion that a child with unmet affectional needs is at high risk for sexual abuse.Evaluations of sexually mistreated children should focus on family dynamics. The Kinetic Family Drawing test and the Conger Sentence Completion test are effective diagnostic tools. All children who have been sexually abused should be carefully evaluated and provided with appropriate treatment in their own right.     

The incidence of severe physical child abuse in Wales

OBJECTIVES: The purposes of this study were: (1) to ascertain the incidence and nature of severe physical child abuse in Wales; (2) to ascertain the incidence of all physical abuse in babies under 1 year of age; and (3) to determine whether child protection registers (CPR) accurately reflect the numbers of children who are physically abused. METHODS: This is a population-based incidence study based in Wales, UK, for 2 years from April 1996 through March 1998. Children studied were under the age of 14 with severe physical abuse consistent with the criminal law level of Grievous Bodily Harm. This included seven categories of injury (death; head injury including subdural hemorrhage; internal abdominal injury; physical injury in Munchausen Syndrome by Proxy including suffocation; fracture; burn or scald; adult bite). Cases were ascertained by a pediatrician surveillance reporting system (WPSU). A criterion for inclusion was multidisciplinary agreement that physical abuse had occurred (at case conference, strategy meeting, or Part 8 Review). The incidence of all babies under 1 year of age with physical abuse was also studied. Ascertainment of babies under the age of 1 year was undertaken from CPR as well as the WPSU. RESULTS: Severe abuse is six times more common in babies [54/100,000/year (95% CI +/- 17.2)] than in children from 1 year to 4 years of age [9.2/100,000 (95% CI +/- 3.6)]. It is 120 times more common than in 5- to 13-year-olds [0.47/100,000 (95% CI +/- 0.47)]. This is mainly because two types of serious abuse (brain injury including subdural hemorrhage and fractures) are more common in babies under the age of 1 year than older children. Using data from two sources (the WPSU and CPRs), the incidence of physical abuse in babies is 114/100,000 (CI 114 +/- 11.8) per year. This equates to 1 baby in 880 being abused in the first year of life. The largely rural Health Authority area in Wales had incidence figures for abuse in babies that were 50% of the three other predominantly urban Health Authority areas. Boys throughout the series were more at risk of being severely abused than girls (p < .025). Only 29% of the babies under 1 year of age on the CPR had actually been injured. Thirty percent of abused babies under the age of 1 year and 73% of severely abused children over the age of 1 year had caused previous concern to health professionals regarding abuse or neglect. Conclusions: Physical abuse is a significant problem in babies under the age of 1 year. Very young babies (under 6 months old) have the highest risk of suffering damage or death as a result of physical abuse. Severe abuse, in particular subdural hematoma and fracture, is much more common in babies than in older children. There is evidence of failure of secondary prevention of child abuse by health professionals, with a greater need to act on concerns regarding abuse and neglect. Interagency child protection work in partnership with parents should focus more on protecting babies under age 1 year from further abuse than on maintenance of the infant within an abusive home. The CPR is not intended as an accurate measure of children suffering abuse. It is a record of children requiring a child protection plan and must not be used as a measure of numbers of abused children.     

Scarring for life: abuse with electric cords

The authors studied 78 cases of child abuse in which electric cords were used to discipline children. Abuse was usually chronic, and body scars and/or lacerations, usually linear or looped in shape, were found on 95% of these children. Black children over age 5 years were most often the victims. The most commonly injured and/or scarred body sites were the arms, thighs, and back. The majority of perpetrators were single female heads of household raising more than one child, who did not perceive their use of electric cords to discipline children as inappropriate.     

Accuracy of a screening instrument to identify potential child abuse in emergency departments

Although screening for child abuse at emergency departments (EDs) increases the detection rate of potential child abuse, an accurate instrument is lacking. This study was designed to measure the accuracy of a screening instrument for detection of potential child abuse used in EDs. In a prospective cohort study at three Dutch EDs, a 6-item screening instrument for child abuse, Escape, was completed for each child visiting the ED. The data from the completed Escape instrument was used to calculate sensitivity, specificity, and the positive/negative predictive value per item. The clinical notes and conclusions of the screen instruments of all potentially abused children reported to the hospitals’ Child Abuse Teams were collected and reviewed by an expert panel. A logistic regression model was used to evaluate the predictors of potential abuse. Completed Escape instruments were available for 18,275 ED visits. Forty-four of the 420 children with a positive screening result, and 11 of the 17,855 children with a negative result were identified as potentially abused. Sensitivity of the Escape instrument was 0.80 and specificity was 0.98. Univariate logistic regression showed that potentially abused children were significantly more likely to have had an aberrant answer to at least one of the items, OR = 189.8, 95% CI [97.3, 370.4]. Most of the children at high risk for child abuse were detected through screening. The Escape instrument is a useful tool for ED staff to support the identification of those at high risk for child abuse.     

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.     

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.     

Physical child abuse and social change. Judicial intervention in families in The Netherlands, 1960-1995

OBJECTIVE: To show changes in the way juvenile judges and judicial child protection workers deal with physical child abuse in the period 1960-1995 in the Netherlands. METHOD: The study is based on an analysis of files on adolescent and younger children placed by juvenile judges in the Dutch judicial child protection system during the 1960s, 1970s, 1980s, and 1990s. RESULTS: The prevalence of very severe physical violence against children was lower in the recent files than in the older files. Spanking and other minor violence acts were noted more often than in the older files. In the 1960s files, the parents talked still rather openly about the physical punishments they used in child rearing. In spite of the growing attention for and increasing concern about child abuse among professionals, judicial child protection workers intervened less harshly in recent cases of physical child abuse than in the 1960s. CONCLUSION: The decrease in severe physical child abuse may indicate that physical child abuse is actually becoming a less serious problem in the Dutch judicial child protection system. But that may not be the case because of the increased reluctance of parents to report and changes in intervention practices. Other than expected, the growing sensibility for child abuse did not mean more effective control by judicial child protection workers. Possible reasons for these changes are discussed, including the strengthening of the position of perpetrators in law proceedings and the emancipation of children and women in society.     

A socioclinical overview of 28 sex-abused children

A retrospective overview of 28 sexually-abused children evaluated at a university-based child guidance clinic is reported. These 28 cases are scrutinized and empirical data are culled on the following sociodemographic and clinical variables: age, gender, race, family composition, referral source, presenting complaints, type of referral, psychiatric history of the child and family, diagnosis, disposition, type and duration of treatment, and a severity rating (done by parents) of the child's behavioral maladjustment. Historical information about the sexual abuse is presented: molester, type of abuse, duration of abuse and recency of sex abuse. The sociodemographic findings reveal the sex-abused child prototype to be a white girl, 9 years old, from a working class family headed by both parents or by mother alone. She was abused by an adult male relative. If a boy, abuse was by a male age-mate. Genital abuse was the most frequent type with sexual intercourse of very high frequency for children of all ages. Many psychiatric difficulties were reported in the families of these children. Some children had more than one molester. The clinical findings show psychic suffering among all studied children—most of moderate levels, behavior reactions. All but 3 children had therapy recommended to them. Presenting difficulties were for sexual abuse per se and/or for a wide-ranging variety of symptom complaints. The socioclinical overview of sexually molested children compells researchers to look closer at broader, extra-familial, cultural and socio-economic issues in the lives of these children and not just at psychopathologies of individual molesters and family units.     

Intervening in severe physical child abuse cases: mental health, legal, and social services.

OBJECTIVE: To examine the child protection process in cases of severe physical abuse, to compare characteristics of the families with risk factors previously reported in the published literature, and to develop recommendations about the use of mental health professionals in such cases. METHOD: Reviewers examined 30 case records of severely physically abused children under age 5, nominated by child protection workers and mental health providers. The reviewers recorded demographic, clinical, and case process information such as mental health and other referrals, reunification status, and frequency of criminal prosecution. A case study was described. RESULTS: The parents displayed a range of psychological characteristics (e.g., depression, anxiety, personality disorders) and life problems (e.g., domestic violence, substance abuse, abused as child). The majority of parents denied the abuse. The children were very young (more than half under 6 months old) and many had difficult births or medical problems prior to the abuse. The most common services offered were individual psychotherapy and parenting classes. More than half of the children reunified with at least one parent within I year. Forty percent of the cases involved criminal prosecution. CONCLUSIONS: Reunification occurred more quickly and more often than expected based on the severity of the injuries. The system often relies on psychotherapy to correct the abusive behavior, even when the perpetrator remains unknown and specific risks such as substance abuse or domestic violence are present. The authors advise utilizing multidisciplinary teams for recommendations regarding reunification.     

The role of parental stress in physically abusive families

This study examines the role of several components of parental stress in physically abusive and nonabusive families with conduct-disordered children. The 123 families studied were seen in a parenting clinic aimed at improving parent-child interactions in families with a highly oppositional child. Data were collected over a several-week period and included both mother and father self-report measures and independent observations by trained researchers. Parental stress was found to play an important role in abusive families. Physically abusive families were significantly more often low income, had younger mothers with less education, more frequently reported a family history of child abuse, and were more likely to be abusing alcohol or drugs. Abusive mothers reported more stress due to frequent life events, and had a more negative perception of these events. Further, these mothers had higher rates of both depression and state anxiety. Abusive fathers spanked their children significantly more often than the nonabusive fathers, and abusive mothers had the highest frequency of critical statements directed at their children. Children from abusive households had significantly more behavior problems. Finally, abusive mothers reported more marital dissatisfaction and social isolation than their nonabusive counterparts.     

Differences in child sexual abuse cases involving child versus adolescent complainants

While adolescents report the highest rates of sexual abuse victimization, few studies have investigated how child sexual abuse (CSA) cases involving adolescent complainants may differ from cases involving child complainants. The current study draws on 3,430 allegations of CSA in Canada to compare abuse characteristics and judicial outcomes in cases involving adolescent complainants to cases involving child complainants. Adolescent complainants were more likely than child complainants to be abused by a stranger or a person with a community connection to the complainant, while children were more likely than adolescents to be abused by a parent or other relative. Furthermore, compared to child complainants, adolescent complainants were more frequently involved in the most intrusive offenses and their cases were more likely to involve violence. Both groups were most likely to disclose the abuse to a parent, though a greater proportion of children disclosed the abuse to a parent. There were no differences in the delay to disclosure. Accused were equally likely to plead “guilty” and to be convicted in cases involving child and adolescent complainants. However, offenders convicted of the most intrusive offenses received longer probation sentences when the complainant was a child than when the complainant was an adolescent. These findings have implications for ensuring appropriate support and services to adolescent victims of CSA.     

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.     

Removing the child--prosecuting the offender in cases of sexual abuse: evidence from the national reporting system for child abuse and neglect

Sexual abuse has come to public attention so rapidly and is such a difficult problem to deal with that many observers are concerned that the quality of child protective intervention in these cases has been haphazard and indiscriminate. This article analyzes data on all 6,096 cases of child sexual abuse which were "officially reported" in 1978 to see what kinds of intervention were made. The data show that foster placement occurred in more cases of sexual abuse than physical abuse, and was concentrated among cases of older children who reported their own victimization. Criminal action was taken almost five times more often in cases of sexual abuse than in cases of physical abuse, and occurred more often among cases which were directly reported to police and involved offenders with prior criminal records. Black families and poorer families did not seem to be the objects of obvious discrimination in the disposition of these cases.     

International perspectives on child abuse

This paper reviews an extensive sampling of the international literature on child abuse. The paper focuses on: (1) where the international research on child abuse is being conducted; (2) similarities and differences in definitions of abuse and violence; (3) the types of research methods and theoretical models used to study abuse; and (4) what we currently know about child abuse in other countries. The paper concludes with a discussion of how we can advance our understanding of child abuse by pursuing cross-cultural research. Awareness of child abuse, internationally, varies a great deal, often depending on the political, social, economic, and cultural milieu of the country. Also, despite noticeable trends within countries, the research techniques and theoretical models used to guide scientific investigations vary considerably from one country to the next. For these reasons, one must draw conclusions about the patterns, causes, and extent of child abuse around the world very tentatively. There is much variation as to the likelihood of children being abused, although western, industrialized nations report the highest rates of abuse. Explanations for the variation of child abuse from one country to the next emphasize cultural differences in attitudes towards, and values placed on children, and the cultural appropriateness of using violence as a means of social control.     

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.     

Sexual abuse in young children: its clinical presentation and characteristic patterns

A retrospective record survey was performed using all child clients aged less than 7 years seen at a community mental health center during the period 1982-1984. The total number of 202 children fell into three groups: sexually abused (n = 37), physically abused (n = 35), and nonabused clinical children (n = 130). These groups were compared in order to learn more about sexual abuse in young children. Family background of both abused groups were similar to each other but differed from the nonabused group in having more factors related to family stress than the nonabused group. Clinical presentations of all the children overlapped a great deal symptomatically; however, the sexually abused children had a statistically significant higher frequency of inappropriate sexual behavior than the other two groups. Several characteristics of the abusive patterns suffered by the two abuse groups differed at or near statistical significance: sexually abused children were more often victimized in single acts by nonrelated child perpetrators than were physically 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.     

The prevalence and context of family violence against children in Finland

The prevalence and context of violence against children in their families was surveyed as part of a study on the sexual abuse of children. A random sample of 409 comprehensive school classes with approximately 9,000 15-year-olds was asked to anonymously fill out questionnaires. The majority filled out the questionnaires in the privacy of the school nurse's office, the rest in their classrooms. Of the selected classes, 88.8% participated in the survey, and the response rate of the students in those classes was 96%. Mild violence (slapping, pushing, etc.) was reported by 72% of the respondents, and severe violence (hitting with a fist, kicking, use of weapons) was reported by 8%. Violence was committed by the parents sometime before the children reached age 14. Incidents of violence during the year preceding the survey were reported by 19% and 5%, mild and severe, respectively. Mild violence was committed slightly more often by mothers than fathers. Severe violence was perpetrated more frequently by fathers. Girls reported mild abuse more often than boys. Severe violence was experienced equally often by both sexes. Children living with single mothers reported less-than-average mild violence, but more frequent severe violence. The highest incidence of severe violence was found among youth living in families with a stepfather. Unemployment in a family tended to increase both mild and severe violence. Violence was reported least often by children living in farming families or Swedish speaking families (which make up about 6% of Finnish population). Overall the frequency of violence toward children in Finland is significantly lower than in the U.S. Comparison to Sweden seems to show an identical level of child abuse, although different study methods make comparisons difficult.