Physical abuse of abandoned children in India

Child abuse and neglect, though existing in India, has not come to light because of underlying social constraints like poverty, malnutrition and infection. With an intention to study the problem of physical abuse in neglected children, patients admitted to the pediatric wards of our institution, predominantly with some form of physical abuse were specifically looked for from January 1976 onwards. Over a period of 4$\text{1}\text{2}$ years, 18 such cases were encountered. Most of the babies were less than four weeks of age, were predominantly females, were quite often premature or malnourished, and rarely had a physical deformity. These babies were deserted and later were found by police or social workers in gutters, dustbins, garbage tins, railway platforms, etc. The spectrum of abuse and injuries included newborn babies with intact placenta, at times lacerated, strangling marks on the throat, multiple bruises, bleeding from the umbilicus, avulsion of the scalp with severe bleeding, shock as a result of environmental stress (i.e., hypothermia), evidence of infection, rat bite marks, and fractures. The morbidity was very high, ultimately resulting in 88.9% mortality over varying periods of time, maximum survival being 22 days. The motive behind this abuse always was an unwanted baby.     

Physical and mental health of children with substantiated sexual abuse: Gender comparisons from a matched-control cohort study

When compared to children from the general population, sexually abused children receive more medical services, both for physical and mental health problems. However, possible differences between sexually abused boys and girls remain unknown. The lack of control group in studies that find gender differences also prevents from determining if the differences are specific to sexual abuse or to gender. The objective of the study was to assess differences in physical and mental health between sexually abused boys and girls in comparison to those from the general population. Administrative databases were used to document physical and mental health problems of 222 males and 660 females with a substantiated report of sexual abuse between 2001 and 2010. A comparison group individually matched to those from the sexually abused group on gender, age and geographic area was also used to document gender differences in the general population. Yearly incidence rates of diagnoses resulting from medical consultations and hospitalizations of males and females were compared over five years after a first substantiated sexual abuse report using the mixed general linear model. Sexually abused girls were up to 2.2 times more likely to consult a physician than sexually abused boys for physical health problems. Similar findings are observed in the general population. Conversely, results revealed that sexually abused boys were up to 2.3 times more likely than females to consult a physician for mental health problems. This gender difference was not apparent in the general population group.     

Physical and sexual abuse among school children: Prevalence and prevention

Prevalence of physical and sexual abuse, with emphasis on data provided by the 1986 National Incidence Study sponsored by the U.S. Department of Health and Human Services, is discussed within certain data collection constraints. Incidence results are reported by subcategory of abuse, child's sex, child's age, child's race/ethnicity, family income, and family size. Effects of physical and sexual abuse and characteristics of abusers are presented to establish the context in which primary, secondary, and tertiary prevention programs are developed and delivered. Research on abuse prevention programs is discussed, with attention drawn to problems associated with the lack of a research base for school-based abuse prevention programs.     

Childhood abuse and later parenting outcomes in two American Indian tribes

OBJECTIVES: To examine the relationship of childhood physical and sexual abuse with reported parenting satisfaction and parenting role impairment later in life among American Indians (AIs). METHODS: AIs from Southwest and Northern Plains tribes who participated in a large-scale community-based study (n=3,084) were asked about traumatic events and family history; those with children were asked questions about their parenting experiences. Regression models estimated the relationships between childhood abuse and parenting satisfaction or parenting role impairment, and tested for mediation by depression or substance use disorders. RESULTS: Lifetime substance use disorder fully mediated the relationship between childhood physical abuse and both parenting satisfaction and parenting role impairment in the Northern Plains tribe. There was only partial mediation between childhood sexual abuse and parenting role impairment in the Southwest. In both tribes, lifetime depression did not meet the criteria for mediation of the relationship between childhood abuse and the two parenting outcomes. Instrumental and perceived social support significantly enhanced parenting satisfaction; negative social support reduced satisfaction and increased the likelihood of parenting role impairment. Exposure to parental violence while growing up had deleterious effects on parenting outcomes. Mothers and fathers did not differ significantly in the relation of childhood abuse experience and later parenting outcomes. CONCLUSIONS: Strong effects of social support and mediation of substance abuse disorders in the Northern Plains offer direct ways in which childhood victims of abuse could be helped to avoid negative attributes of parenting that could put their own children at risk. PRACTICE IMPLICATIONS: Mothers were not significantly different from fathers in the relation of abusive childhood experiences and later parenting outcomes, indicating both are candidates for interventions. Strong effects of social support offer avenues for interventions to parents. The prevalence of substance use disorders and their role as a mediator of two parenting outcomes in the Northern Plains should focus special attention on substance use treatment, especially among those who experienced childhood victimization. These factors offer direct ways in which childhood victims of abuse can be helped to avoid negative attributes of parenting that could put their own children at risk of violence.     

Sexual abuse of children under 12 years of age: a review of 511 cases

In a retrospective study of 511 cases of alleged sexual abuse in children 12 years of age and under, data were analyzed with respect to the victim's age, sex, and the type of sexual abuse (intra- or extrafamilial). A total of 85.5% of the victims were female and 14.5% were male with ages ranging from 2 months to 12 years. The mean age of female victims was 6.8 years and that of male victims, 7.4 years. Most victims (68%) presented with histories of single assault by a known perpetrator (78%). Characteristics of abuse were found to be associated with the victim's age, sex, and relationship to the assailant. School-age victims were more likely to be abused by an individual outside the family or by a complete stranger. Older victims were also more likely to be involved in severe forms of sexual abuse (penetration, attempted penetration or oral-genital contact), associated with acts of abduction and with reports to the police. Male victims were more likely to be assaulted by a stranger, outside the home environment, and to suffer a more severe form of sexual abuse than female victims. Finally, extrafamilial sexual abuse was distinguished from intrafamilial sexual abuse insofar as it was more often a single episode, occurring outside the home environment, involving an act of abduction and physical force, and being reported to the police.     

The impact of a management protocol on the outcomes of child abuse in hospitalized children in Hong Kong

OBJECTIVE: To study the outcomes of children hospitalized for suspected child abuse before and after the implementation of a management protocol in a hospital in Hong Kong. STUDY PERIOD: Two 2-year periods before (1994-1995) and after (2002-2003) the implementation of the protocol in 1998. METHODS: This is a retrospective hospital chart review in which the patients' characteristics, the use of laboratory and radiological examination, abuse substantiation and official registrations are compared between the two study periods. RESULTS: There were 109 and 320 patients admitted for evaluation of child abuse for the periods 1994-1995 and 2002-2003, respectively. Children in both periods were similar in sex ratio, proportion of severe forms of child abuse, rates of abuse substantiation and inclusion in the Child Protection Registry. After the implementation of a management protocol, there has been a significant drop in the proportion of children subjected to investigations such as blood counts (86% vs. 16%, p<.001), clotting study (75% vs. 9%, p<.001), and skeletal survey (78% vs. 6%, p<.001). The average length of hospital stay also dropped from 15.3 days to 6.1 days (p<.001). CONCLUSIONS: There has been an almost threefold rise in the number of child abuse cases handled at the hospital during the 10-year interval. With the implementation of a management protocol, only a small proportion of children need laboratory investigations or skeletal survey without any drop in abuse substantiation and official registration. The length of hospital stay has also been significantly reduced.     

Parents,teachers and children’s school outcomes: a Taiwanese study

The study examined relationships among family social status, perceptions of family and school learning environments, and measures of children’s academic achievement, educational aspirations and self‐concept. Data were collected from 261 (128 boys, 133 girls) 11‐year‐old Taiwanese children. The findings from structural equation modelling suggest that: (a) family social status continues to have an unmediated association with children’s academic achievement, but its relationship to educational aspirations and self‐concept is mediated by children’s perceptions of their more immediate learning environments, and (b) after taking into account differences in parents’ aspirations and parental involvement, children’s perceptions of teachers have strong associations with self‐concept but are not related to differences in academic achievement and educational aspirations.     

Navajo child abuse and neglect study: A comparison group examination of abuse and neglect of navajo children

The presence of vastly different cultural influences on child rearing and family life in Native Americans than are found in the general population offers an opportunity to examine the issue of child abuse and neglect in a different cultural context. A study was conducted to obtain baseline data and to isolate types and circumstances associated with maltreatment of Navajo children under 9 years of age. Records from tribal and state courts, the Bureau of Indian Affairs (BIA), state social services and a sample of ambulatory pediatric cases were reviewed to elicit abuse or neglect status data for calendar year 1975. Data on 365 abuse or neglect cases were compared with 867 nonabused or nonneglected children (comparison group). A double blind case numbering system was employed to ensure confidentiality of data obtained. Abuse cases were dichotomized according to litigation status (e.g., adjudicated versus documented by clinical findings). Neglect cases were categorized by perceived parental control over circumstances leading to the neglect (e.g., voluntary versus involuntary neglect). Reliability sub-studies were conducted by study staff and Navajo volunteers to assess the degree of agreement in the classification of study case status. Tribal census data for 1975 provided baseline information from which the incidence of abuse or neglect involving Navajo children was established. Extrapolated study data suggests up to 8.6% of the reservation resident Navajo children under age 9 to have been abused or neglected. Various sociode-mographic characteristics differentiating the abusive and neglectful families from those of the nonabused or nonneglected children in the comparison group are reported.     

Developmental outcomes of children in classes for special educational needs: results from a longitudinal study

This longitudinal study investigates the differences in cognitive and socio‐emotional development and academic achievement between children educated in special education classes (N = 37) and regular classes (N = 37). The study is retrospective. The first measurement point was while children were attending play‐oriented kindergarten and no decision about their education had yet been made. The second measurement point followed after 2 years of schooling. Comparing carefully matched groups, no differences in executive functions (EFs) were found before beginning school. Children assigned to special education had poorer language, fine motor skills and a lower pre‐academic self‐concept, self‐regulatory skills and social integration. Notably, every fourth child in special education was an immigrant, 9% of whom later attended regular classes. After 2 years of schooling in either setting, the groups differed significantly in academic achievement, EFs, fine motor skills and cognitive self‐regulatory skills. However, it was not – as school officials had intended – that children in special education classes had caught up, except in regard to their academic self‐concept and social integration.     

Childhood history of abuse and child abuse potential in adolescent mothers: a longitudinal study

OBJECTIVES: The purpose of this research was to determine whether adolescent mothers of newborns are at higher risk for child abuse than adult mothers of newborns and to examine whether adolescent mothers with memories of child maltreatment have a higher risk for child abuse. METHOD: Two groups (adolescents and adults) of pregnant mothers were followed for 20 months beginning between the 5th and the 7th month of pregnancy until the child was 18 months old. Adolescent (N = 24) and adult (N = 24) mothers were matched on sociodemographic variables. During pregnancy, memories of child maltreatment were evaluated. When child was 1, 6, 12, and 18 months old, risk for child abuse was evaluated. RESULTS: Adolescent and adult mothers showed no differences in memories of childhood physical or emotional abuse. Nevertheless, adolescent mothers showed higher child abuse potential and depression scores than adult mothers. Mothers with memories of severe physical punishment showed higher child abuse potential scores and mothers with memories of physical punishment producing physical damage showed higher child abuse potential and depression scores. A statistically significant age of the mother by physical punishment producing physical damage interaction was found for depression. CONCLUSIONS: The results of this longitudinal study indicated that the potential for abuse was significantly greater in adolescent mothers than in adult mothers, and in mothers who had been victims of physical abuse than in those who had not. It also appeared that, among adolescent mothers, those who had been victims of childhood physical abuse constitute a higher risk group for child physical 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.     

Child sexual abuse: a case study in community collaboration

OBJECTIVE: This is an exploratory study that describes the process and outcomes of a Midwestern US community's approach to case management of child sexual abuse. METHOD: Data were abstracted from 323 criminal court files. Specific information gathered included child and suspect demographic data, law enforcement and CPS involvement, child disclosure patterns and caretaker responses, offender confession, offender plea, trial and child testimony information, and sentences received by offenders. Both case process and outcome variables were examined. RESULTS: In this community, criminal court records reflect a sex offense confession rate of 64% and a sex offense plea rate of 70%. Only 15 cases went to trial and in six the offender was convicted. CONCLUSION: Communities can achieve successful outcomes when criminal prosecution of sexual abuse is sought, but the child's testimony is not necessarily the centerpiece of a successful case. In this study, desired outcomes were a consequence of the collaborative efforts of law enforcement, CPS, and the prosecutor's office, which resulted in a high confession and plea rate.     

Why children tell: a model of children's disclosure of sexual abuse

OBJECTIVE: The present study investigated variables associated with delay of disclosure of child sexual abuse and tested a model of time to disclosure. METHOD: Data were obtained for 218 alleged child sexual abuse victims whose cases had been referred to District Attorneys' Offices. Five variables were posited to influence the delay between an abusive event and children's disclosure of that event to a reporting adult: child's age, gender, type of abuse experienced (intrafamilial or extrafamilial), perceived responsibility for the abuse, and fear of negative consequences of disclosure. These variables were used to create a model of factors influencing children's disclosure of sexual abuse. RESULTS: Results indicated that age, type of abuse, fear of negative consequences, and perceived responsibility all contributed to predicting time to disclosure. There was significant support for the model, suggesting that children who were older, came from incestuous families, felt greater responsibility for the abuse, and feared negative consequences of disclosure took longer to disclose. CONCLUSIONS: Children's cognitive appraisal of others' tolerance of disclosure of child sexual abuse, and their own perceptions of responsibility for the abuse, are crucial to the decision to disclose. When evaluating children for possible sexual abuse, developmental, cognitive, and socio-emotional factors need to be taken into consideration.