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.     

Neighborhood views on the definition and etiology of child maltreatment

OBJECTIVE: The purpose of this study, as part of a larger study on neighborhoods and child maltreatment, was to determine how parents residing in neighborhoods with differing profiles of risk for child maltreatment reports defined child abuse and neglect and viewed its etiology. METHOD: Parents (n = 400) were systematically selected from neighborhoods (n=20) with different profiles of risk for child maltreatment report rates. As part of a larger interview, parents were asked to generate lists of behaviors that they would define as child abuse and neglect and to rate 13 etiological factors on a 10 point scale as to their contribution to the occurrence of child maltreatment. RESULTS: While there were differences in definitional emphases, with African-American parents including behaviors of neglect and European-American parents including behaviors of physical abuse, there was marked congruence on the catalogue of behaviors that parents would define as child abuse and neglect. Four factors were identified that explained almost two-thirds of the variance in parents' etiological explanations: poverty and family disruption, substance abuse and stress; lack of moral and family values; and individual pathology. These factors were related to neighborhood conditions, individual perceptions of neighborhood and individual characteristics. CONCLUSIONS: Community-based programs aimed at preventing or ameliorating child maltreatment must have at their very core an understanding of how populations being served define child maltreatment and why they believe that it occurs.     

Culture-specific views of child maltreatment and parenting styles in a Pacific-Island community

OBJECTIVE: Providing culturally sensitive definitions of child abuse is difficult as perceptions of what constitutes abuse can vary around the world. This study was undertaken to assess how teachers in the Republic of Palau perceived the severity of potentially abusive incidents and what types of recommendations, if any, they would have for situations judged as severely abusive. Attitudes about child rearing practices were also evaluated. METHODS: Teachers (n = 141 ) were given: (1) a questionnaire consisting of 25 vignettes describing parent/child interactions that were potentially abusive and asked to rate the severity of abuse and recommended interventions for each vignette; and (2) a 40-item parenting styles questionnaires to evaluate attitudes about child-rearing practices. RESULTS: Teachers identified and recommended interventions for more severe forms of abuse at rates similar to other international samples. For less severe parental misconduct, teachers were reluctant to involve nonfamily and outside agencies. Sexual abuse was rated as the most serious type of abuse and when identified, intervention was highly recommended. Some traditional Palauan parenting practices that might be considered maltreatment by other cultures were not considered abusive. For parenting styles, older individuals were more likely to use guilt induction and less likely to use methods of acceptance. Aggressive parenting styles were negatively correlated with all forms of abuse, suggesting that teachers who used aggressive disciplinary styles were less likely to perceive abusive situations as harmful. CONCLUSIONS: These results indicate that cultural values and practices play important roles in shaping the definition and interpretation of child maltreatment.     

Abusive parents' reports of child behavior problems: relationship to observed parent-child interactions

PURPOSE: We evaluated the hypothesis that abusive parents' reports may exaggerate rates of child behavior problems in a clinical sample. METHOD: The association between parental ratings of behavior problems and independent observations of child behaviors was examined in a sample of 205 clinic-referred families, 58 of which had a reported history of physical abuse. RESULTS: Relative to the comparison group, parents in the abuse group reported more externalizing problems in their children after controlling for parental psychopathology, and displayed more emotionally controlling and less supportive behavior during parent-child interactions. However, there was no association between abuse history and observed child behaviors during the interaction tasks. Abuse status significantly moderated the association between parent-reported externalizing behaviors and observed demanding behavior by the child; the association was significant among comparison families, but not in the abuse group families. CONCLUSIONS: Results indicate that abusive parents may over-report externalizing behavior problems in their children.     

Intergenerational transmission of abuse: a two-generational prospective study of an at-risk sample.

OBJECTIVE: A model was examined in which the association between a parent's history of abuse and the parent's own abusive behavior toward his or her children was hypothesized to be mediated by parental psychopathology, early childbearing, and consistency of discipline. Additionally, the effect of severity of abuse on the likelihood of becoming abusive was examined. METHOD: Participants were 109 parents (G1) and their male children (G2) who were involved in a longitudinal study. The G1 parents reported on their own experiences of abuse when they were children. Ten years later, the G2 youths reported on the G1 parents' abusive behavior toward them. A number of other factors, including parental socioeconomic status (SES), antisocial behavior, depression and Post-traumatic Stress Disorder (PTSD), consistency of discipline, and the perceived early difficulty of the G2 children were measured. RESULTS: As reported by their own children, parents who reported having been abused in childhood were significantly more likely to engage in abusive behaviors toward the next generation. Findings indicated that abuse experienced by the parents, as well as consistency of discipline and depression plus PTSD, were predictive of parental abuse of the child. Contrary to hypotheses, the effects were not fully mediated. However, there were significant interactions between parental history of abuse and consistency of discipline, as well as abuse history and depression and PTSD. Parents who had experienced multiple acts of abuse and at least one physical impact were more likely to become abusive than were the other parents. CONCLUSIONS: The implications of these findings for preventive interventions are discussed.     

Attributions and discipline history as predictors of child abuse potential and future discipline practices

OBJECTIVES: We attempted to identify factors that can be applied in primary and secondary prevention programs and expand the understanding of why those who were not abused may engage in abusive behavior. The purpose of this research was to explore how young adults' attributions of whether they deserved their childhood discipline, as well as their abuse history, relate to physical child abuse potential and their discipline plans for their future children. METHOD: A sample of 140 non-parent college students were asked to report on their discipline history, perceptions of that discipline, child abuse potential, and expected discipline practices. An age range of 18-20 was targeted for multiple reasons, including the suitability of these young adults for primary and secondary prevention programs. RESULTS: Analyses revealed that both physical child abuse potential and future discipline practices were independently predicted by respondents' belief that they deserved their discipline in conjunction with the harshness of their childhood discipline. DISCUSSION: These results suggest that the attributions of self-blame held by young adults about their discipline experiences are significant for increasing physical abuse potential regardless of whether the individual reports a history of abuse.     

Childhood sexual experiences among substance-using non-gay identified Black men who have sex with men and women

This study explored potential variations in childhood sexual abuse (CSA) by examining qualitative accounts of first sexual experiences among non-disclosing, non-gay identified Black men who have sex with men and women (MSMW). We analyzed data from semi-structured qualitative interviews with 33 MSMW who described first sexual experiences with male and female partners. Thematic analysis revealed four patterns of first sexual experiences including: unwanted sexual experiences with a male or female consistent with definitions of childhood sexual abuse; consensual sex with an older male or female; bodily exploration with another male or female child; and consensual sex with a peer-age female. Most of the experiences described by participants as consensual with an older male or female, however, met criteria for childhood sexual abuse found in the extant literature. Several men discussed childhood sexual experiences (CSE) relative to their experiences with alcohol, drugs, and same-sex behavior as adults. Findings suggest that the relationship between CSE and risk-taking behavior may be shaped by whether men perceive their experiences as abusive or consensual, and have implications for researchers, treatment providers and counselors.     

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.     

Child abuse,dissociation, and core beliefs in bulimic disorders

OBJECTIVE: This study of bulimic women examined the relationship between the severity of four forms of reported child abuse (emotional abuse, neglect, physical abuse, sexual abuse) and bulimic pathology. ln addition, it investigated the relationship of abuse with dissociation and core beliefs. METHOD: A sample of 23 women with bulimic disorders completed standardized self-report measures of child abuse, dissociation, core beliefs, and bulimic symptomatology. They also completed diary records of bulimic behaviors. RESULTS: No dimensional relationship was found between any form of child abuse and bulimic pathology. However, within this group of bulimics, neglect and sexual abuse were correlated with dissociation. In addition, a subset of core beliefs was associated with child abuse, with different cognitive profiles associated with each form of trauma. CONCLUSIONS: The findings need to be interpreted with caution because of the small, heterogeneous sample involved. Further research involving larger, homogenous samples is needed to investigate the generalizability of these findings, in order to determine if particular abusive experiences and core beliefs need to be addressed therapeutically in such cases. In addition, future research should consider the relationships between abuse, core beliefs and other impulsive behaviors.     

Emotional abuse and neglect (psychological maltreatment): a conceptual framework

OBJECTIVE: Emotional abuse and neglect is an under-recognized, but actually common, form of child abuse. Professionals in the field continue to find difficulty in recognizing and operationally defining it, and experience uncertainty about proving it legally. There are also questions about intervention and therapy to protect the child in the least detrimental manner. These difficulties have led to delays in recognition and protective intervention. Emotional abuse and neglect are defined as a carer-child relationship that is characterized by patterns of harmful interactions, requiring no physical contact with the child. Motivation to harm the child is not necessary for the definition. Unlike sexual abuse that is a secret activity, these forms of ill treatment are easily observable. The child's development is impaired in all domains of functioning but, not being specific to emotional abuse and neglect, cannot be regarded as diagnostic. METHOD: Research, clinical experience and theoretical considerations have led to a conceptual framework and operational definitions of five categories of harmful interactions between parent and child. This framework is contrasted with the APSAC categories. RESULTS: It is postulated that the different categories of ill treatment respectively require different therapeutic interventions. CONCLUSION: Concerns about the presence of emotional abuse need to trigger an assessment process that includes identifying the nature of the abusive or neglectful interactions and a time-limited trial of specific interventions. The family's response to this process and its outcome will determine the need for statutory involvement, as well as providing a basis for litigation if this is required.     

Childhood sexual abuse among university students in Tanzania

OBJECTIVES: There are no prevalence data for childhood sexual abuse among Tanzanian university students. This investigation addressed this paucity. The nature of sexual abuse was also investigated. METHOD: Participants (N=487) from a university in Tanzania completed a questionnaire which assessed abusive childhood sexual experiences, gathering information about age of victim, duration of abuse, perpetrators, amount of force or persuasion involved, and potential causes of child sexual abuse. A number of individuals were also interviewed about their experiences. RESULTS: The overall prevalence rate for child sexual abuse was 27.7%, with rates being higher for females than for males. The average age of the victim when abuse occurred was 13.8 years. Perpetrators were generally unidentified by respondents; nonetheless, a surprisingly high proportion of female perpetrators was noted. There was a considerable amount of force or persuasion involved in the abusive behavior: betrayal of trust, bribes and physical force were cited frequently. Poverty and superstition were the primary explanations given for child sexual abuse. CONCLUSION: The study provides evidence for the existence of child sexual abuse in Tanzania. Poverty feeds the "sugar daddy/mammy" phenomenon and combined with various forms of superstition is an important factor in child sexual abuse in Tanzania.     

Men's self-definitions of abusive childhood sexual experiences, and potentially related risky behavioral and psychiatric outcomes

OBJECTIVES: To estimate how many heterosexual and gay/bisexual men self-define abusive childhood sexual experiences (CSEs) to be childhood sexual abuse (CSA) and to assess whether CSA self-definition is associated with risky behavioral and psychiatric outcomes in adulthood. METHODS: In Philadelphia County, 197 (66%) of 298 recruited men participated in a telephone survey. They were screened for CSEs and then asked if they self-defined abusive CSEs to be CSA; they also were asked about risk behavior histories and post-traumatic stress disorder (PTSD) and depression symptoms. RESULTS: Of 43 (22%) participants with abusive CSEs, 35% did not and 65% did self-define abusive CSEs to be CSA ("Non-Definers" and "Definers," respectively). Heterosexual and gay/bisexual subgroups' CSA self-definition rates did not significantly differ. When self-definition subgroups were compared to those without CSEs ("No-CSEs"), Non-Definers had lower perceived parental care (p=.007) and fewer siblings (p=.03), Definers had more Hispanics and fewer African Americans (p=.04), and No-CSEs had fewer gay/bisexual men (p=.002) and fewer reports of physical abuse histories (p=.02) than comparison groups. Non-Definers reported more sex under the influence (p=.001) and a higher mean number of all lifetime sex partners (p=.004) as well as (only) female sex partners (p=.05). More Non-Definers than Definers reported having experienced penetrative sex as part of their CSA (83% vs. 35%, p=.006). Different explanations about self-definition were provided by subgroups. CONCLUSIONS: Many men with abusive CSEs do not self-define these CSEs to be CSA, though not in a way that differs by sexual identity. The process by which men self-define their abusive CSEs to be CSA or not appears to be associated not only with self-explanations that differ by self-definition subgroup, but also with behavioral outcomes that impart risk to Non-Definers.     

Child and partner abuse: self-reported prevalence and attitudes in the north of Portugal

OBJECTIVES: To determine the self-reported prevalence of child and partner physical and emotional abuse in the north of Portugal and to investigate attitudes about these forms of family violence. METHODS: Data were collected by questionnaire from a representative sample of parents in two-parent families with children under the age of 18 years. A total of 2,391 parents participated (1,057 males), aged 20-67 years. Four questionnaires were used, one behavioral and one attitudinal, for each of the forms of abuse: child and partner. RESULTS: At least one act of emotional or physical abuse towards a child during the previous year was reported by 25.9% of participants (12.3% reported physically abusive and 22.4% emotionally abusive acts). Abuse of a partner was reported by 26.2% of participants; at least one act of physical abuse during the previous year was reported by 12% and of emotional abuse by 23.7%. The attitudinal data, however, showed general disapproval of the use of violence, both for disciplining children and within marital relationships. The degree of self-reported support for physical punishment was higher in participants who reported using abusive behavior. Females more commonly reported acts of child abuse, and males reported acts of partner abuse. Both forms of self-reported abuse showed an association with low educational and socio-economic status. CONCLUSIONS: This is the first study in Portugal to analyze family violence through self-report using a representative sample. The findings indicate that child and partner abuse constitute a significant problem in the region of northern Portugal. The discrepancy between the self-reported behavioral and attitudinal data may reflect conflicts in Portuguese society, which is undergoing substantial cultural changes.     

The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings

OBJECTIVE: To determine the demographic and psychosocial correlates of physical and sexual abuse among children with autism. METHODS: Data collected from 1997 to 2000 through the national evaluation of the Comprehensive Community Mental Health Services for Children and their Families Program on 156 children with autism were used. Data included a baseline assessment of child and family psychosocial experiences and presenting problems associated with referral into system-of-care service, demographic information, and a clinical record review to obtain psychiatric diagnosis. Binary and multinomial logistic regression was used to determine the association of different characteristics of children who were abused compared with those who were not abused. RESULTS: Caregivers reported that 18.5% of children with autism had been physically abused and 16.6% had been sexually abused. Physically abused children more likely had engaged in sexual acting out or abusive behavior, had made a suicide attempt, or had conduct-related or academic problems. Sexually abused children more likely had engaged in sexual acting out or abusive behavior, suicidal or other self-injurious behavior, had run away from home, or had a psychiatric hospitalization. In adjusted multivariate models, the relationship between sexual abuse and sexual acting out, running away from home and suicidal attempts persisted. CONCLUSION: Based on the prevalence of abuse and its association with various behaviors, clinicians should be as attuned to the psychosocial histories of children with autism as they are for other children, and consider the potential of abuse when these behaviors are observed.     

Stability of retrospective self-reports of child abuse and neglect before and after therapy for child abuse issues

OBJECTIVE: This study is a follow-up to a previously reported outcome study evaluating the efficacy of an emotionally focused therapy for adult survivors of childhood abuse. The present purpose was to evaluate the stability of self-reports of child maltreatment in the context of reduced psychopathology after therapy. The Childhood Trauma Questionnaire (CTQ; Bernstein et al., 1994) was used to measure the extent of child abuse and neglect. METHOD: The CTQ and measures of symptomatology, abuse resolution, and self-esteem were administered at pretreatment to 44 clients and after 6 months of therapy to 33 therapy completers. Post-treatment interviews also assessed changes in clients' perceptions of self and abusive and neglectful others. Analyses examined change on dependent measures, in interviews, and on the CTQ, as well as the test-retest and alpha reliabilities of CTQ factor scales, and the relationship of CTQ factor scales with pretreatment measures of distress. RESULTS: Analyses revealed significant reductions in psychopathology on all dependent measures and reduced self-blame, negatively biased memories, avoidance, and minimization of the abuse after therapy. Reports of abuse and physical neglect on the CTQ remained stable from pre- to post-therapy. All CTQ dimensions demonstrated good internal consistency and convergent validity with trauma-specific measures of distress. CONCLUSIONS: The stability of the CTQ in the context of significantly reduced psychopathology contributes to evidence supporting the accuracy of retrospective self-reports of childhood abuse.     

Female survivors’ perceptions of lifelong impact on their education of child abuse suffered in orphanages

Many children raised in orphanages suffered ongoing child abuse and neglect including sexual abuse, and nearly all were denied an adequate education. This paper explores adult females’ perceptions of the impacts on their education of child sexual abuse they suffered while living in orphanages in Australia. In-depth qualitative and anonymous one-on-one interviews were undertaken with 10 female volunteers. Their narrative quotes emanate from questions asked about their experiences and perceptions of child sexual abuse, and its impacts on their educational achievement, educational development and educational opportunity. Of these volunteer females, only two had completed primary school, none had completed more than two years of secondary school, and none had undertaken any tertiary education. All had perceived child sexual abuse, in particular, to have had overwhelmingly negative impacts on their lifelong, educational achievement, educational development and educational opportunity. These impacts have had detrimental inter-generational consequences upon their own children. These adult females perceived child sexual abuse to be a major factor in their very poor, life-long educational development, achievement and opportunities, with intergenerational consequences for their self-esteem, wellbeing and success. Implications for practice are that children at risk should receive specialised teaching, educational support and counselling; adults with deficient education need help with learning processes such as dynamic learning, to help achieve active and inclusive citizenship.     

Childhood emotional maltreatment and mental disorders: Results from a nationally representative adult sample from the United States

Child maltreatment is a public health concern with well-established sequelae. However, compared to research on physical and sexual abuse, far less is known about the long-term impact of emotional maltreatment on mental health. The overall purpose of this study was to examine the association of emotional abuse, emotional neglect, and both emotional abuse and neglect with other types of child maltreatment, a family history of dysfunction, and lifetime diagnoses of several Axis I and Axis II mental disorders. Data were from the National Epidemiological Survey on Alcohol and Related Conditions collected in 2004 and 2005 (n = 34,653). The most prevalent form of emotional maltreatment was emotional neglect only (6.2%), followed by emotional abuse only (4.8%), and then both emotional abuse and neglect (3.1%). All categories of emotional maltreatment were strongly related to other forms of child maltreatment (odds ratios [ORs] ranged from 2.1 to 68.0) and a history of family dysfunction (ORs ranged from 2.2 to 8.3). In models adjusting for sociodemographic characteristics, all categories of emotional maltreatment were associated with increased odds of almost every mental disorder assessed in this study (adjusted ORs ranged from 1.2 to 7.4). Many relationships remained significant independent of experiencing other forms of child maltreatment and a family history of dysfunction (adjusted ORs ranged from 1.2 to 3.0). The effects appeared to be greater for active (i.e., emotional abuse) relative to passive (i.e., emotional neglect) forms of emotional maltreatment. Childhood emotional maltreatment, particularly emotionally abusive acts, is associated with increased odds of lifetime diagnoses of several Axis I and Axis II mental disorders.     

Childhood history of abuse and child abuse screening.

Although a childhood history of abuse is related to parental child abuse, many parents with a history of abuse are not abusive. To determine the effects of a childhood history of abuse on adult child abuse potential, a modified Conflict Tactics Scale (CTS) and the Child Abuse Potential (CAP) Inventory were administered to matched groups of physically abusive mothers with a childhood history of abuse, nonabusive comparison mothers with a childhood history of abuse, and nonabusive comparison mothers without a childhood history of abuse. The modified CTS asked about childhood events and was used to confirm a childhood history of abuse. As expected, the CTS verbal and violence scales were higher for the abusive and nonabusive mothers with a childhood history of abuse. None of the CTS scores were different for the abusive and nonabusive mothers with a childhood history of abuse. In contrast, the CAP abuse scores distinguished between all three study groups. However, on the CAP factor scales, only the rigidity and unhappiness factors discriminated between abusive and nonabusive mothers with a childhood history of abuse. Nonabusive mothers with a childhood history of abuse were less rigid in their child expectations and were happier in their interpersonal relationships than abusive mothers with a childhood history of abuse.