Cruelty begins at home

The abuse of children is presumed by most mental health professionals to occur at the hands of parents who were themselves harshly traumatized by abuse or neglect. A 14-month-old child is presented who was well treated by his family and developed well until 6.5 months of age, after which, due to traumatization of his mother, the child became neglected and physically abused. In a therapeutic-observational environment, as the child recovered from his massive depression, much explosive destructive behavior not seen in him before was observed. From his past studies and those of other psychoanalysts, the author presents the collectively advanced hypothesis that excessive unpleasure mobilizes hostility in humans and suggests that this hypothesis may be fruitfully applied to explain why the abused become abusers. The hypothesis may also serve to guide the treatment of abused children so as to prevent their becoming tomorrow's abusers. Furthermore, the hypothesis suggests that strategies can be proposed toward preventing child abuse.     

The assessment of risk in child abuse and neglect case investigations

Estimates vary, but statistics indicate that anywhere between one and six million children will be abused and/or neglected this year in the United States. In the process of investigating reports of abuse and neglect, child protective service workers are called upon to make numerous case decisions. Critical to much of this decision making is the assessment by the worker of the potential risk of harm that exists to the child regarding further abuse or neglect. This paper, based on two separate research studies, identifies the criteria child protective service workers use to assess this potential risk of harm to the child. The research also shows that the criteria are not used as individual factors that indicate the presence or absence of risk. Instead the criteria form a constellation of factors that function for the worker in assessing the degree of potential risk to the child. The article concludes with a discussion of the implications of research findings for child welfare practice.     

The intellectual profile of abused and neglected children in the Philippines: An analysis of SB5 IQ scores of sexually abused,physically abused and neglected children

Child abuse and neglect have been associated with cognitive deficits, among other effects on child development. This study explores the prediction that child abuse and neglect has an impact on Stanford-Binet Intelligence Scales 5th Edition (SB5) IQ scores, in relation to gender, age and type of abuse experienced. 300 children with experiences of abuse and neglect were included in the study, comprising 100 sexually abused, 100 physically abused and 100 neglected children. Overall, all scores on the SB5 were found to be significantly lower than the minimum average scores on the test. Verbal IQ (VIQ) scores were likewise found to be significantly lower than Nonverbal IQ (NVIQ) scores. Full Scale IQ (FSIQ) scores did not reveal heterogeneity when gender was factored in. Age and type of abuse (with a moderate effect size) on the other hand, showed significant differences among groups. Statistical analyses of SB5 Factor Index Scores revealed that abused children, in general, have significantly higher Visual-Spatial Processing (VS) and Quantitative Reasoning (QR) scores and lower scores in Knowledge (KN). There was a large effect size found in such an analysis. Age (with a large effect size), gender and type of abuse (with moderate effect sizes) give significant variations to this obtained profile.     

The effects of child maltreatment on language development

The separate effects of child neglect, abuse, and their interaction upon language development as measured by the Preschool Language Scale were examined in four groups of children (n = 79) in a quasi-experimental design. There were three groups of maltreated subjects, all drawn from a treatment center: an abused only group (n = 13), a neglected only group (n = 7), and an abused and neglected group (n = 31); a non-maltreated group (n = 28) was drawn from a day care center. Abuse, neglect, and their interaction were used to predict both auditory comprehension and verbal ability as separate criteria in two stepwise multiple regression equations, where the variance attributable to gender and mother's status on Aid to Dependent Children had been removed. Child neglect was found to predict significantly both auditory comprehension and verbal ability. Neither child abuse nor the interaction between abuse and neglect significantly predicted either dependent variable. These findings suggest that child neglect may be the critical type of maltreatment associated with language delay.     

Does childhood victimization increase the risk of early death? A 25-year prospective study

BACKGROUND: Abuse and neglect have been shown to influence the mental and physical health of children; however, few studies have examined whether childhood victimization leads to an increased risk of early death. PURPOSE: This paper compares mortality data and examines cause of death for a sample of 908 abused and/or neglected individuals and 667 matched controls who were followed up into young adulthood. METHODS: Using data from a prospective cohort design study, a large group of children with substantiated cases of abuse (physical and sexual) and/or neglect approximately 25 years ago were matched with a control group of children and both groups were followed up into adulthood. The National Death Index was searched twice and official death certificates were collected for most individuals who had died. RESULTS: Surprisingly, there were no significant differences in rates of mortality for the two groups (abuse and neglect = 3.5%, controls = 3.0%). Furthermore, victims of child abuse and neglect were not more likely to experience a violent death. CONCLUSIONS: Our results do not provide support for a heightened rate of early death in abused and neglected children followed up into young adulthood. Limitations of the study are discussed as well as potential reasons for these unexpected findings.     

Children neglected: Where cumulative risk theory fails

Neglected children, by far the majority of children maltreated, experience an environment most deficient in cognitive stimulation and language exchange. When physical abuse co-occurs with neglect, there is more stimulation through negative parent–child interaction, which may lead to better cognitive outcomes, contrary to Cumulative Risk Theory. The purpose of the current study was to assess whether children only neglected perform worse on cognitive tasks than children neglected and physically abused. Utilizing LONGSCAN archived data, 271 children only neglected and 101 children neglected and physically abused in the first four years of life were compared. The two groups were assessed at age 6 on the WPPSI-R vocabulary and block design subtests, correlates of cognitive intelligence. Regression analyses were performed, controlling for additional predictors of poor cognitive outcome, including socioeconomic variables and caregiver depression. Children only neglected scored significantly worse than children neglected and abused on the WPPSI-R vocabulary subtest (p = 0.03). The groups did not differ on the block design subtest (p = 0.4). This study shows that for neglected children, additional abuse may not additively accumulate risk when considering intelligence outcomes. Children experiencing only neglect may need to be referred for services that address cognitive development, with emphasis on the linguistic environment, in order to best support the developmental challenges of neglected children     

The handicapped child and child abuse

For a group of children with handicaps, growth and development are also affected by abuse or neglect. Our understanding of the problems of the abused, handicapped child emerges from experience with 37 children with cerebral palsy who have been maltreated, coupled with a review of the literature in related areas. We identify the following four problems as crucial to the study of abuse and neglect to the child with handicaps: (1) abuse that causes handicaps, (2) abuse that occurs to the handicapped child, (3) compromises in care that can occur when the handicapped child becomes involved with the medical and legal systems, and (4) arrangements for foster care or other out-of-home placement for the child with handicaps. We conclude that the very systems designed to protect and care for the child often fail, leaving the handicapped child without opportunity to reach developmental potential. In light of our observations, we recommend that the pediatrician not only be aware of the existence of abuse and neglect in the population of handicapped children, but also serve in the dual role of coordinator of services and advocate for these children.     

Dissociation in maltreated versus nonmaltreated preschool-aged children.

OBJECTIVE: Dissociation is linked to the experience of child maltreatment for adults and for school-aged children. The goals of the current paper were: First, to extend existing research and examine the link between child maltreatment and preschool-aged children; and second, to examine which subgroups of maltreated preschoolers are most likely to evidence dissociation. METHOD: A well-validated measure of dissociation in children, The Child Dissociative Checklist (CDC; Putnam, Helmers, & Trickett, 1993), was utilized in a sample of low SES maltreated and nonmaltreated preschoolers (N = 198). A measure of internalizing and externalizing symptoms was also utilized. The maltreated children were assessed for sexual abuse, physical abuse, neglect, and also for severity, chronicity, and multiple subtypes of maltreatment. RESULTS: The sexually abused, physically abused, and neglected groups each demonstrated more dissociation than did the nonmaltreated group. Dissociation in the clinical (psychopathological) range was associated with physical abuse. Moreover, maltreatment severity, chronicity, multiple subtypes, and internalizing and externalizing symptomatology were each related to dissociation. CONCLUSIONS: Child maltreatment is a factor in dissociation in preschool-aged children as it is in older children and in adults. Sexual abuse, physical abuse, neglect, severity, and chronicity are all implicated. Developmentally sensitive interventions that look beyond comorbidity with behavioral symptoms for dissociative preschool-aged children are needed.     

Louisiana's statewide interdisciplinary approach to diagnostic, protective and treatment services to abused and neglected children and their families

The provision of the most comprehensive funded statewide delivery of diagnostic, protective and treatment services to abused and neglected children and their families in the country has been made possible by the State of Louisiana and its concerned citizenry. The importance of obtaining a legislative mandate establishing and funding the statewide child protection concept by the Louisiana legislature was illustrated.We described how the medical and protective services components cooperate and coordinate at the state and local levels to provide the abused and neglected child and his family with the best possible services available. Throughout our presentation the use of the interdisciplinary team concept was emphasized as the best system known to enhance the reporting, investigation and diagnosis of child abuse and/or neglect cases as well as providing protective and treatment services to the child and his family.The Child Protection Center is the community agency serving as the “core” for the interdisciplinary approach to be successful. The role of each discipline employed by the center was reviewed and how interagency coordination is accomplished through their efforts.The interdisciplinary dispositional conference prior to a child's discharge from the hospital was considered as an excellent method to insure that several disciplines share in the definitive protective and treatment plans for the abused child.Several treatment modalities and their success rates for the child and his family were discussed. The accomplishments of the center were listed.Finally, a review of how the citizenry from the Baton Rouge Community responded overwhelmly by their involvement and commitments in an all out effort to combat a serious social symptom and disease — child abuse and neglect.     

Child victims of sexual abuse: Teachers' evaluation of emotion regulation and social adaptation in school

This study assessed the social adaptation of sexually abused children and tested whether children's emotion regulation competencies mediated the association between child sexual abuse (CSA) and two outcomes of the social domain (i.e. withdrawal and social difficulties). A group of 283 child victims of sexual abuse and a comparison group composed of 60 nonabused children was recruited. Teachers completed questionnaires assessing the children's emotion regulation competencies, withdrawal, and social difficulties exhibited in the school context. Results showed that sexually abused children displayed poorer emotion regulation skills and higher levels of both withdrawal and social difficulties relative to nonabused children. CSA was associated with social difficulties and withdrawn behavior through the mediation of emotion regulation competencies. Teachers and school psychologists should be assisted in identifying children at risk of social difficulties and emotional dysregulation and schools be encouraged to adopt a trauma‐informed approach.     

A multimodal assessment of behavioral and cognitive deficits in abused and neglected preschoolers

42 preschool children who had a previous history of physical abuse, serious neglect, or no prior history of child maltreatment participated in a multimodal assessment of cognitive and behavioral functioning. In addition to standardized tests of cognitive ability and behavioral observations in the classrooms, both the parents and teachers rated the children on several measures. Results show that the abused and neglected children had lower scores on all the measures of cognitive functioning when compared to the matched comparison children. The behavioral observation data from the classrooms, however, were more complex. That is, differences among groups depended on the type of behavior observed. Neglected children engaged in the least number of interactions with other children, and the abused children demonstrated the most aggression. Both parents and teachers rated the maltreated children as more aggressive, less mature, and less ready to learn. In summary, differences between abused, neglected, and comparison children were present on a number of measures, indicating that maltreated children display significant cognitive and social deficits.     

Childhood abuse and neglect and adult intimate relationships: a prospective study

OBJECTIVE: The present study extends prior research on childhood maltreatment and social functioning by examining the impact of early childhood physical abuse, sexual abuse, and neglect on rates of involvement in adult intimate relationships and relationship functioning. METHOD: Substantiated cases of child abuse and neglect from 1967 to 1971 were matched on gender, age, race, and approximate family class with non-abused and non-neglected children and followed prospectively into adulthood. Between 1989 and 1995, 1,196 participants (676 abused and neglected and 520 controls) were administered a 2-hour in-person interview, including a psychiatric assessment and a variety of standardized rating scales. RESULTS: Male and female abuse and neglect victims reported higher rates of cohabitation, walking out, and divorce than controls. Abused and neglected females were also less likely than female controls to have positive perceptions of current romantic partners and to be sexually faithful. CONCLUSIONS: Although previous research on childhood maltreatment and adult intimate relationships has emphasized outcomes for female victims of childhood sexual abuse, present findings suggest that other forms of early maltreatment (physical abuse and neglect) also have a negative effect on both males' and females' ability to establish and maintain healthy intimate relationships in adulthood.     

Child abuse: A study of the child''s perspective

This study ascertained the child's response to various types of abuse and neglect. With interviews and questionnaires for the staff of a child psychiatric unit, the mothers and the children involved, we assessed the severity, frequency and duration of physical abuse, verbal abuse, physical neglect, emotional neglect or sexual abuse of children. The physically abused children accepted blame for mild but not severe mistreatment. Verbally and sexually abused children did not believe it was their fault if the mistreatment was moderately extensive but did if it was mild or severe. The relationship between extent of abuse and blame was less clear for neglect, but children usually though it was their fault. Verbal and sexual abuse appeared to have a greater impact on the children's perception of themselves and the world. Verbally abused children were more angry and more pessimistic about their future. Although physical abuse appeared to make some children feel they were unwanted at birth, how much the mother wanted her children was not related to the extent of any type of abuse. Both the type and extent of mistreatment appear to have different effects on the child's subjective experience. The use of the visual analogue scale in this study made it possible to differentiate a continuum of severity and frequency of five types of mistreatment without the need for definition.     

Child neglect: developmental issues and outcomes

OBJECTIVE: This article highlights the manner in which child neglect, the most common form of maltreatment, affects children's development. METHOD: The review is organized according to three developmental periods (i.e., infancy/preschool, school-aged and younger adolescents, and older adolescents and adults) and major developmental processes (cognitive, social-emotional, and behavioral). Although the focus is on specific and unique effects of various forms of child neglect, particular attention is paid to studies that allow comparisons of neglect and abuse that clarify their similarities and differences. RESULTS: Past as well as very recent findings converge on the conclusion that child neglect can have severe, deleterious short- and long-term effects on children's cognitive, socio-emotional, and behavioral development. Consistent with attachment and related theories, neglect occurring early in life is particularly detrimental to subsequent development. Moreover, neglect is associated with effects that are, in many areas, unique from physical abuse, especially throughout childhood and early adolescence. Relative to physically abused children, neglected children have more severe cognitive and academic deficits, social withdrawal and limited peer interactions, and internalizing (as opposed to externalizing) problems. CONCLUSIONS: The current review offers further support for the long-standing conclusion that child neglect poses a significant challenge to children's development and well-being. Limitations with regard to the state of the knowledge are discussed and directions for future research are outlined.     

Profile of abused and neglected American Indian children in the Southwest

From both knowledge gained working in Indian communities and a major data collection program, this article examines child abuse and neglect among the Indian tribes in a southwestern state. The period of study covers 1982 through 1985. The study sample consists of 53 children targeted by the local Indian Health Service Hospital Child Protection Team as being abused and/or neglected. In addition, information on the parents, grandparents and, in a number of cases, great-grandparents are examined. The study is a secondary data analysis of clinic and hospital records and interviews with local community health care providers and tribal officials. The results indicate that alcohol abuse was present in 85% of the neglect cases and in 63% of the abuse cases. In addition, child abuse and neglect occurred simultaneously in 65% of the sample. Child abuse and neglect are found to be part of a larger phenomenon of multiproblem families which raises the issue of intergenerational perpetuation of these problems. The results underscore the importance of interagency cooperation in surveillance, treatment, and prevention, as well as more careful and thorough documentation of record maintenance.     

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.     

National call to action: Working toward the elimination of child maltreatment. The economics

No reliable estimates exist of the overall costs to society of child maltreatment that will withstand serious examination. Arguably some of the most important human costs of maltreatment are unquantifiable. Moreover, in many cases it is difficult if not impossible to separate the economics of child abuse and neglect from the economics of a host of other problems facing families. Still, even conservative estimates of government spending on behalf of abused and neglected children and their families illustrate that child maltreatment costs society a great deal, with much of that expense going for deep-end intervention rather than family support and prevention. Government expenditures directed at this social problem have grown rapidly since the rediscovery of child abuse in the 1960s and now exceed spending for a number of essential supports for children and families. Moreover, the new era of continuing commitment to child protection in the context of a revised social contract with the nation's poor raises serious questions about the economics of child maltreatment in the future.     

Analysis of sexual abuse hotline reports

As concern about physical child abuse and neglect has increased, so too has the realization that children are also sexually exploited and abused. Yet, many protective service workers are often ill prepared to perform the difficult task of treating the abused child and his/her family. Through the analysis of sexual abuse hotline reports, the central aim of this study was to generate findings that would increase the knowledge base of protective service workers and private therapists engaged in treating sexually abused children and their families. To accomplish this task, and using seven classes of variables, analysis was performed on 205 substantiated cases of childhood sexual abuse. A number of important conclusions were discovered including: One-third of the cases had been reported to the agency previously; less than one-half (48%) of the victimized children were living with their natural fathers; natural fathers were identified as the perpetrator in 39% of the cases; and in contrast to other studies, a great number of cases (43%) involved vaginal intercourse between the victim and the perpetrator. Implications for treatment are also discussed, particularly in relation to improving resources and specialized training for workers involved in this highly sensitive area of practice.