The relationship between parental substance abuse and child maltreatment: findings from the Ontario Health Supplement

OBJECTIVE: This study examined the relationship between reported exposure to child abuse and a history of parental substance abuse (alcohol and drugs) in a community sample in Ontario, Canada. METHOD: The sample consisted of 8472 respondents to the Ontario Mental Health Supplement (OHSUP), a comprehensive population survey of mental health. The association of self-reported retrospective childhood physical and sexual abuse and parental histories of drug or alcohol abuse was examined. RESULTS: Rates of physical and sexual abuse were significantly higher, with a more than twofold increased risk among those reporting parental substance abuse histories. The rates were not significantly different between type or severity of abuse. Successively increasing rates of abuse were found for those respondents who reported that their fathers, mothers or both parents had substance abuse problems; this risk was significantly elevated for both parents compared to father only with substance abuse problem. CONCLUSIONS: Parental substance abuse is associated with a more than twofold increase in the risk of exposure to both childhood physical and sexual abuse. While the mechanism for this association remains unclear, agencies involved in child protection or in treatment of parents with substance abuse problems must be cognizant of this relationship and focus on the development of interventions to serve these families.     

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.     

Screening homeless youth for histories of abuse: prevalence, enduring effects, and interest in treatment

Objectives

To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse.

Methods

Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in a structured assessment of histories of abuse, tobacco use and substance abuse.

Results

Sixty-four homeless youth in Salt Lake City, Utah completed the study, 43 males and 21 females. Eighty-four percent screened positive for childhood physical and/or sexual abuse occurring before the age of 18; 42% screened positive for both physical and sexual abuse; 72% reported still being affected by their abuse. Among all abuse victims, 44% were interested in treatment for their abuse history and 62% of homeless youth who reported still being affected by their abuse were interested in treatment. Individuals were more likely to be interested in treatment if they were female, had not completed high school or had been previously asked about family dysfunction. Many victims who declined treatment offered spontaneous insight into their decision. Interest in treatment was similar to interest in treatment for other behaviors such as smoking and substance abuse.

Conclusions

Histories of abuse are common among homeless youth. A majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse. Our finding that homeless youth continue to be impacted by their abuse and are interested in treatment should prompt more screening for histories of abuse.     

Physical and sexual abuse in orphaned compared to non-orphaned children in sub-Saharan Africa: A systematic review and meta-analysis

This systematic review assessed the quantitative literature to determine whether orphans are more likely to experience physical and/or sexual abuse compared to non-orphans in sub-Saharan Africa (SSA). It also evaluated the quality of evidence and identified research gaps. Our search identified 10 studies, all published after 2005, from Zimbabwe, South Africa, Kenya and Uganda. The studies consisted of a total 17,336 participants (51% female and 58% non-orphans). Of those classified as orphans (n = 7,315), 73% were single orphans, and 27% were double orphans. The majority of single orphans were paternal orphans (74%). Quality assessment revealed significant variability in the quality of the studies, although most scored higher for general design than dimensions specific to the domain of orphans and abuse. Combined estimates of data suggested that, compared to non-orphans, orphans are not more likely to experience physical abuse (combined OR = 0.96, 95% CI [0.79, 1.16]) or sexual abuse (combined OR = 1.25, 95% CI [0.88, 1.78]). These data suggest that orphans are not systematically at higher risk of experiencing physical or sexual abuse compared to non-orphans in sub-Saharan Africa. However, because of inconsistent quality of data and reporting, these findings should be interpreted with caution. Several recommendations are made for improving data quality and reporting consistency on this important issue.     

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.     

Relationship between child abuse exposure and reported contact with child protection organizations: Results from the Canadian Community Health Survey

Much of what is known about child abuse in Canada has come from reported cases of child abuse and at-risk samples, which likely represent the most severe cases of child abuse in the country. The objective of the current study is to examine the prevalence of a broad range of child abuse experiences (physical abuse, sexual abuse, and exposure to IPV) and investigate how such experiences and sociodemographic variables are related to contact with child protection organizations in Canada using a representative general population sample. Data were drawn from the 2012 Canadian Community Health Survey: Mental Health collected from the 10 provinces using a multistage stratified cluster design (n = 23,395; household response rate = 79.8%; aged 18 years and older). Physical abuse only (16.8%) was the most prevalent child abuse experience reported with the exposure to specific combinations of two or more types of child abuse ranging from 0.4% to 3.7%. Only 7.6% of the adult population with a history of child abuse reported having had contact with child protection organizations. Experiencing all three types of child abuse was associated with the greatest odds of contact with child protection organizations (AOR = 15.8; 95% CI = 10.1 to 24.6). Physical abuse only was associated with one of the lowest odds of contact with child protection organizations. Preventing child abuse is widely acknowledged as an important, but challenging public health goal. Strategies to increase reporting of child abuse may help to protect children and to connect families with necessary services. One obvious priority would be physical abuse.     

Association between child sexual abuse and infectious disease diagnoses

BackgroundThough many studies have linked child sexual abuse (CSA) to psychological health problems, little is known regarding the relationship between CSA and children and adolescents’ physical health.ObjectiveThe objective of this study was to assess the relationship between CSA and infectious disease diagnoses.ParticipantsOf the 955 eligible children and adolescents who had a substantiated report of sexual abuse between 2001 and 2010, medical data was retrieved for 882 individuals, who formed the sexually abused group. These 882 participants were matched to 882 participants on age, gender, and administrative healthcare region to form the general population group.Setting and methodsThis matched-cohort study, conducted in a large Canadian city, compared the number of infectious disease diagnoses between the date of the substantiated sexual abuse report and August 1, 2013, between the two groups.ResultsResults indicate that sexually abused participants had 1.27 times more (95% CI – 1.13 to 1.42) infectious diseases diagnoses than those from the general population. They received 1.83 times more genitourinary infection diagnoses (95% CI – 1.43 to 2.33), 1.31 times more diagnoses for other types of infections (95% CI – 1.11 to 1.55) and 1.21 times more respiratory and ear infection diagnoses (95% CI – 1.05 to 1.40). There was no statistically significant difference regarding skin infection diagnoses. These results indicate an association between CSA and more frequent infectious diseases diagnoses.     

Child maltreatment and problem gambling: A systematic review

This study systematically reviews research on child maltreatment and risk of gambling problems in adulthood. It also reviews adult problem gamblers’ risk of abusing or neglecting their own children. Multiple database searches were conducted using pre-defined search terms related to gambling and child abuse and neglect. We identified 601 unique references and excluded studies if they did not report original research, or did not specifically measure child maltreatment or gambling. Twelve studies that included multivariable analysis of childhood maltreatment exposure and problem gambling were identified. Six of seven studies examining childhood sexual abuse and four of five examining physical abuse showed a significant positive association between abuse and later gambling problems (odds ratios for sexual abuse 2.01–3.65; physical abuse 2.3–2.8). Both studies examining psychological maltreatment and two of three examining neglect identified positive associations with problem gambling. In most studies, risks were reduced or eliminated when controlling for other mental health disorders. The three studies measuring risk of child abuse and neglect among current problem gamblers suggest an increased risk for child physical abuse and medical conditions indicative of neglect although there is a considerable amount of variation among studies. Child abuse is associated with increased risk of gambling problems – gambling treatment providers should ask about maltreatment history as part of their clinical assessment. Problem gamblers may be more likely to physically abuse or neglect their children, but data here are more limited. Child welfare professionals should consider asking questions about parental gambling when assessing family risk.     

Sexual abuse in the national incidence study of child abuse and neglect: An appraisal

The National Incidence Study of Child Abuse and Neglect was a major, government sponsored effort to collect data on reported and unreported child abuse. It used a systematic representative sample methodology and very precisely developed definitions of child abuse. This paper reviews some of the main limitations of the study in regard to findings on sexual abuse. First, there is probably less “new” data in the study on sexual abuse than on other forms of abuse, since so many of the study cases of sexual abuse were “officially reported” cases. In addition, the study limited its definition of sexual abuse only to cases where a caretaker was the perpetrator, a definition that is much more restrictive than what is used in many treatment programs. Finally, the data on perpetrators has a number of problems that stem from the study's definitions of sexual abuse. The paper makes suggestions for future incidence type studies of sexual abuse.     

Law enforcement officers as investigators and therapists in child sexual abuse: A training model

Law enforcement officers, often the first professionals to come in contact with a victim of child sexual abuse, can either increase or decrease the traumatic impact on the child and the family at the time of disclosure. The model for a training program for police officers in handling cases of child sexual abuse outlined in this paper is divided into three sections. The first part is directed towards theoretical issues involved in this problem, including an explanation of the history and background of sexual abuse of children by adults and of the difference in the dynamics of extra- and intrafamilial sexual abuse. The second part consists of a detailed explanation of different types of sex offenses and of standard physical examinations of sexual abuse victims. Graded slides of physical trauma geared towards wound identification are paired with relaxation exercises. The third section focuses on special considerations when interviewing sexually abused children. The difference between interviewing and interrogation, specific questioning techniques, and the use of videotape is explained. Each part of this training procedure is followed by a question and answer period and small group discussions for the purpose of encouraging disclosure and better understanding of the officers' personal reactions to cases of child sexual abuse.     

Child maltreatment rates assessed in a national household survey of caregivers and youth

This paper reports on national estimates for past year child maltreatment from a national household survey conducted in 2011. It also discusses the validity of such estimates in light of other available epidemiology. The Second National Survey of Children Exposed to Violence obtained rates based on 4,503 children and youth from interviews with caregivers about the children ages 0–9 and with the youth themselves for ages 10–17. The past year rates for physical abuse by caregivers were 4.0% for all sample children, emotional abuse by caregivers 5.6%, sexual abuse by caregivers 0.1%, sexual abuse by caregivers and non-caregivers 2.2%, neglect 4.7% and custodial interference 1.2%. Overall, 12.1% of the sample experienced at least one of these forms of maltreatment. Twenty-three percent of the maltreated children or 2.8% of the full sample experienced 2 or more forms of maltreatment. Some authority (teacher, police, medical personnel or counselor) was aware of considerable portions of most maltreatment, which suggests the potential for intervention. Many of the study's estimates were reasonable in light of other child maltreatment epidemiological studies, but comparisons about emotional abuse and neglect were problematic because of ambiguity about definitions.     

Child extrafamilial sexual abuse: predicting parent and child functioning

Objective: This study evaluated the emotional and behavioral adjustment of parents and children within 3 months and 1 year after the discovery of child extrafamilial sexual abuse.Method: Ninety-two case parents (63 mothers, 29 fathers) and 56 children were compared to a nonclinical comparison group of 136 parents (74 mothers, 62 fathers) and 75 children. Parent adjustment was assessed using self-report measures while child functioning was assessed using a combination of child-, parent- and teacher-report measures.Results: Mothers, fathers and sexually abused children experienced clinically significant effects both initially and at 12 months post-disclosure. Children’s perceptions of self-blame and guilt for the abuse and the extent of traumatization predicted their self-reported symtomatology at 3 months and 1 year post-disclosure. Child age and gender also significantly contributed to the prediction of many of the child outcome measures. No abuse-related variable was related to any child self-report measure. Mothers’ satisfaction in the parenting role, perceived support and intrusive symptoms predicted their initial emotional functioning. Avoidant symptoms, child’s internalizing behavior and mothers’ initial emotional functioning were significant predictors of longer-term emotional functioning.Conclusions: Results emphasize the need to address children’s abuse-related attributions and underscore the need to expand our focus beyond the child victims to the traumatized families.     

Barriers and facilitators to disclosing sexual abuse in childhood and adolescence: A systematic review

Children and young people often choose not to disclose sexual abuse, thus preventing access to help and allowing perpetrators to continue undetected. A nuanced understanding of the barriers (and facilitators) to disclosure is therefore of great relevance to practitioners and researchers. The literature was systematically searched for studies related to child and adolescent disclosures of sexual abuse. Thirteen studies were reviewed and assessed for methodological quality. Results of the review illustrate the heterogeneous nature of these empirical studies. Findings demonstrate that young people face a number of different barriers such as limited support, perceived negative consequences and feelings of self-blame, shame and guilt, when choosing to disclose. Being asked or prompted, through provision of developmentally appropriate information, about sexual abuse facilitates disclosure. The review highlights the need for robust, longitudinal studies with more sophisticated methodology to replicate findings. The review identifies the need for developmentally appropriate school-based intervention programmes that facilitate children’s disclosure by reducing feelings of responsibility, self-blame, guilt and shame. In addition, prevention programmes should encourage family members, friends and frontline professionals to identify clues of sexual abuse, to explicitly ask children about the possibility of sexual abuse and also to respond supportively should disclosures occur. Facilitating disclosure in this way is key to safeguarding victims and promoting better outcomes for child and adolescent survivors of sexual abuse.     

Type and severity of child abuse and college students'' lifetime suicidality

Objective: The present study compared reported histories and severity of child sexual abuse, child physical abuse, and both, in college men and women.Method: Four hundred and eighty-six consenting undergraduates completed measures of suicidality, sexual abuse (SA), and physical abuse (PA). Based on their responses, they were categorized into 12 mutually exclusive groups: no PA/no SA (n = 234), moderate PA/no SA (n = 78), severe PA/no SA (n = 34), no PA/mild SA (n = 21), moderate PA/mild SA (n = 12), severe PA/mild SA (n = 5), no PA/moderate SA (n = 20), moderate PA/moderate SA (n = 15), and severe PA/moderate SA (n = 10).Results: Participants who reported both severe sexual and severe physical abuse reported more lifetime suicidality than participants who reported either mild sexual and/or physical abuse. Those who reported sexual abuse involving invasive sexual acts such as rape, and physical abuse involving behaviors that resulted in physical injury to the child, were more suicidal than those who reported less severe abuse. In addition, although combined sexual and physical abuse correlated with increased suicidality, unexpectedly, there was no interaction. Finally, women students endorsed more reasons for living than men and about the same level of suicidal ideas and global suicidality, despite a greater likelihood of having been abused.Conclusions: The absence of an interaction between sexual and physical abuse suggests that this increased suicidality is additive rather than multiplicative. An implication is that college counseling personnel need to be aware of the suicidal risk of women and men students reporting either sexual or physical abuse.     

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.     

Child abuse and neglect and intimate partner violence victimization and perpetration: A prospective investigation

This paper describes the extent to which abused and neglected children report intimate partner violence (IPV) victimization and perpetration when followed up into middle adulthood. Using data from a prospective cohort design study, children (ages 0–11) with documented histories of physical and sexual abuse and/or neglect (n = 497) were matched with children without such histories (n = 395) and assessed in adulthood (M_age = 39.5). Prevalence, number, and variety of four types of IPV (psychological abuse, physical violence, sexual violence, and injury) were measured. Over 80% of both groups – childhood abuse and neglect (CAN) and controls – reported some form of IPV victimization during the past year (most commonly psychological abuse) and about 75% of both groups reported perpetration of IPV toward their partner. Controlling for age, sex, and race, overall CAN [adjusted odds ratio (AOR) = 1.60, 95% CI [1.03, 2.49]], physical abuse (AOR = 2.52, 95% CI [1.17, 5.40]), and neglect (AOR = 1.64, 95% CI [1.04, 2.59]) predicted increased risk for being victimized by a partner via physical injury. CAN and neglect also predicted being victimized by a greater number and variety of IPV acts. CAN and control groups did not differ in reports of perpetration of IPV, although neglect predicted greater likelihood of perpetrating physical injury to a partner, compared to controls. Abused/neglected females were more likely to report being injured by their partner, whereas maltreated males did not. This study found that child maltreatment increases risk for the most serious form of IPV involving physical injury. Increased attention should be paid to IPV (victimization and perpetration) in individuals with histories of neglect.     

Paternal support for child sexual abuse victims: A qualitative study

BackgroundThe current state of knowledge regarding the role of non-offending fathers in supporting their sexually abused children is very scarce.ObjectiveThe objective of this study is to further our understanding of fathers’ roles following disclosure of their children’s sexual abuse (SA) by evaluating fathers’ perceptions of the impact of disclosure on their involvement and support of their children.Participants and methodThis qualitative study relies on individual semi-structured interviews conducted with 17 fathers of allegedly abused children.ResultsInductive thematic analysis first highlighted that some reported a period of disengagement from the child during which they put into question their role and attitudes, followed by a period of re-involvement. This period of difficulties experienced by some fathers in regard to their involvement towards their children was due to either their own important psychological distress, their ambivalence towards their child or even because of feelings of uneasiness experienced during physical contact with them. Despite this, findings indicate the presence of thoughts and attitudes that suggest children are a source of concern for fathers. The four forms of abuse-specific support previously observed among mothers (believing the child, seeking out professional services, protecting him/her from the offender, supporting him/her emotionally) were also observed among fathers. In accordance with the activation theory, a form of support specific to fathers, namely, encouraging the child to open up to and explore the world outside the family, thereby, fostering the child’s self-esteem development, was observed and constitutes a relevant finding.ConclusionClinical and empirical implications are discussed.     

Genital examinations for alleged sexual abuse of prepubertal girls: findings by pediatric emergency medicine physicians compared with child abuse trained physicians

OBJECTIVE: This study compares abnormal genital examination findings made by pediatric emergency medicine (PEM) physicians to examinations by physicians with training in child sexual abuse in the evaluation of prepubertal girls for suspected sexual abuse. METHOD: A prospective study was performed following the genital examination by a PEM physician of prepubertal girls suspected of being sexually abused. A physician with training in child sexual abuse re-examined those girls whose examinations were interpreted as abnormal by the PEM physicians. The findings and interpretations of the PEM physician were then compared to those by the physicians with training in child abuse. RESULTS: Between October 1994 and October 1998, 46 patients diagnosed by PEM physicians with nonacute genital findings indicative of sexual abuse were re-examined by a physician with training in child abuse. The follow-up examinations were done 2 days-16 weeks (mean 2.1 weeks) after the emergency department visit. The physicians with training in child abuse concluded that only eight of these children (17%) showed clear evidence of abuse. Normal findings were noted in 32 children (70%), nonspecific changes were noted in 4 children (9%), and 2 children (4%) had findings that are more commonly seen in abused children than nonabused children but are not diagnostic for abuse (concerning for abuse). CONCLUSIONS: There was poor agreement between the pediatric emergency medicine physicians and the physicians with training in child sexual abuse. This study suggests that emergency medicine physicians should consider additional training in this area. In addition, all children with abnormal ED examinations should have follow-up examinations by a child abuse trained physician.     

An examination of trends in child sexual abuse investigations in Ontario over time

BackgroundChild sexual abuse (CSA) rates have been declining since the 1990s (Dunne et al., 2003; Finkelhor & Jones, 2004, 2012; Jones et al., 2001). Discrepancies in contexts and measures complicate comparing CSA rates across jurisdictions and studies, and there is limited literature about trends in CSA in Canada.ObjectiveUsing data from the Ontario Incidence Study of Reported Child Abuse and Neglect (OIS), the only source of provincially aggregated data in Ontario, Canada, that describes child welfare investigations, this paper provides information on reported and investigated CSA over the past 20 years.Participants and settingThe OIS uses a file review methodology; information is collected directly from investigating child welfare workers.MethodsA sample of child welfare agencies is selected for the study, and data are collected over a three-month period. Weights are applied to produce annual provincial estimates.ResultsThe rates of investigated CSA in Ontario decreased between 1993 and 2013, from 5.20 (95% CI [3.94, 6.47]) to 1.81 (95% CI [0.97, 2.66]) children per 1000. During this time, the rate of all child maltreatment-related investigations doubled, from 21.41 (95% CI [18.38, 24.42]) to 53.32 ([29.61, 77.03]) children per 1000.ConclusionsUnlike other forms of child maltreatment, the incidence of investigated CSA in Ontario declined since 1993. Substantiation rates for CSA investigations decreased more dramatically than the rate of all CSA investigations, which could indicate a true decline in rate or an inability to accurately identify cases of CSA.