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I.

Introduction

Child abuse

It is a physical, sexual, or emotional maltreatment or neglect of


children by parents, guardians, or others responsible for a child's welfare.
Physical abuse is characterized by physical injury, usually inflicted as a result
of a beating or inappropriately harsh discipline. Sexual abuse includes
molestation, incest, rape, prostitution, or use of a child for pornographic
purposes. Neglect can be physical in nature (abandonment, failure to seek
needed health care), educational (failure to see that a child is attending
school), or emotional (abuse of a spouse or another child in the child's
presence, allowing a child to witness adult substance abuse). Inappropriate
punishment, verbal abuse, and scapegoating are also forms of emotional or
psychological child abuse. Some authorities consider parental actions
abusive if they have negative future consequences, e.g., exposure of a child
to violence or harmful substances, extending in some views to the passive
inhalation of cigarette smoke.

Causes and Effects


There are many interacting causes of child abuse and neglect.
Characteristics or circumstances of the abuser, the child, and the family may
all contribute. In many cases the abuser was abused as a child. Substance
abuse has been identified as a key factor in a growing number of cases. In
some cases abusers do not have the education and skills needed to raise a
child, thus increasing the likelihood of abuse, and providing inadequate
parental role models for future generations. Children who are ill, disabled, or
otherwise perceived as different are more likely to be the targets of abuse.
In the family, marital discord, domestic violence, unemployment and
poverty, and social isolation are all factors that can precipitate abuse.
Patterns of abusive behavior may result in the physical or mental
impairment of the child or even death. Small children are especially
vulnerable to physical injury such as whiplash or shaken infant syndrome
resulting from battery. Abused children are more likely to experience
generalized anxiety, depression, truancy, shame and guilt, or suicidal and
homicidal thoughts or to engage in criminal activity, promiscuity, and
substance abuse.

For the survivors of child abuse, the effects include:

• long-term physical problems, including physical disabilities


• behavioral problems
• psychological problems
• difficulties in school and social relationships
• criminal behavior and a high risk of being arrested for a violent
crime as a juvenile or adult

Another big consequence of child abuse is the direct and indirect cost
associated with child abuse, which have been estimated to be about $94
billion each year, including child welfare, law enforcement and special
education.

Treatment
There are a number of treatments available to victims of child abuse.
Trauma-focused cognitive behavioral therapy, while developed to treat
sexually abused children, is now used for victims of any kind of trauma. It
targets trauma-related symptoms in children including Posttraumatic Stress
Disorder (PTSD), clinical depression, and anxiety. It also includes a
component for non-offending parents. Several studies have found that
sexually abused children undergoing TF-CBT improved more than children
undergoing certain other therapies. Data on the effects of TF-CBT for
children who experienced only non-sexual abuse was not available as of
2006.
Abuse-focused cognitive behavioral therapy was designed for children
who have experienced physical abuse. It targets externalizing behaviors and
strengthens prosocial behaviors. Offending parents are included in
treatment, to improve parenting skills/practices. It is supported by one
randomized study.
Child-parent psychotherapy was designed to improve the child-parent
relationship following the experience of domestic violence. It targets trauma-
related symptoms in infants, toddlers, and preschoolers, including PTSD,
aggression, defiance, and anxiety. It is supported by two studies of one
sample.

The Types of Abuse Reported

• Over 60 percent (62.8%) of child victims suffered neglect;


• 16.6% of the victims suffered physical abuse;
• About 10% of the victims suffered sexual abuse;
• Less than 10 percent of the victims suffered emotional abuse.

The Different Types of Abuse

PHYSICAL ABUSE
Physical abuse is the non-accidental infliction of physical injury
to a child. The abuser is usually a family member or other caretaker
and is more likely to be male. One fourth of the confirmed cases of
child abuse in the United States involve physical abuse. A rare form of
physical abuse is Munchausen syndrome by proxy, in which a caretaker
(most often the mother) seeks attention by making the child sick or
appears to be sick.
The usual physical abuse scenario involves a parent who loses
control and lashes out at a child. The trigger may be normal child
behavior such as crying or dirtying a diaper. Unlike non-abusive
parents, who may become angry at or upset with their children from
time to time but are genuinely loving, abusive parents tend to harbor
deep-rooted negative feelings toward their children. Unexplained or
suspicious bruises or other marks on the skin are typical signs of
physical abuse, as are burns. Skull and other bone fractures are often
seen in young abused children, and in fact, head injuries are the
leading cause of death from abuse. Children less than one year old are
particularly vulnerable to injury from shaken baby syndrome. Physical
abuse also causes a wide variety of behavioral changes in children.
EMOTIONAL ABUSE
Emotional abuse is the rejecting, ignoring, criticizing, isolating,
or terrorizing of children, all of which have the effect of eroding their
self-esteem. Emotional abuse usually expresses itself in verbal attacks
involving rejection, scape goting, belittlement, and so forth. Because it
often accompanies other types of abuse and is difficult to prove, it is
rarely reported and accounts for only about 6 percent of the confirmed
cases. Emotional abuse can happen in many settings: at home, at
school, on sports teams, and so on. Some of the possible symptoms
include loss of self-esteem, sleep disturbances, headaches or stomach
aches, school avoidance, and running away from home.

SEXUAL ABUSE
Psychologists define child sexual abuse as any activity with a
child, before the age of legal consent, that is for the sexual
gratification of an adult or a significantly older child. It includes,
among other things, sexual touching and penetration, persuading a
child to expose his or her sexual organs, and allowing a child to view
pornography. In most cases the child is related to or knows the abuser,
and about one in five abusers are themselves underage.
Sexual abuse accounts for 12 to 15 percent of confirmed abuse
cases. In multiple surveys, 20 to 25 percent of females and 10 to 15
percent of males report that they were sexually abused by age 18.
The two prerequisites for this form of maltreatment are sexual
arousal towards children and the willingness to act on this arousal.
Factors that may contribute to this willingness include alcohol or drug
abuse, poor impulse control, and a belief that the sexual behaviors are
acceptable and not harmful to the child. The chances of abuse are
higher if the child is developmentally handicapped or vulnerable in
some other way. Genital or anal injuries or abnormalities (including the
presence of sexually transmitted diseases) can be signs of sexual
abuse, but often there is no physical evidence for a doctor to find. In
fact, physical examinations of children in cases of suspected sexual
abuse supply grounds for further suspicion only 15 to 20 percent of the
time. Anxiety, poor academic performance, and suicidal conduct are
some of the behavioral signs of sexual abuse but are also found in
children suffering other kinds of stress. Excessive masturbation and
other unusually sexualized kinds of behavior are more closely
associated with sexual abuse itself.

NEGLECT
Neglect the failure to satisfy a child's basic needs, can assume
many forms. Physical neglect is the failure (beyond the constraints
imposed by poverty) to provide adequate food, clothing, shelter, or
supervision. Emotional neglect is the failure to satisfy a child's normal
emotional needs, or behavior that damages a child's normal emotional
and psychological development (such as permitting drug abuse in the
home). Failing to see that a child receives proper schooling or medical
care is also considered neglect. Slightly more than half of all reported
abuse cases involve neglect.
Many cases of neglect occur because the parent experiences
strong negative feelings toward the child. At other times, the parent
may truly care about the child but lacks the ability or strength to
adequately provide for the child's needs because handicapped by
depression, drug abuse, mental retardation, or some other problem.
Neglected children often do not receive adequate nourishment or
emotional and mental stimulation. As a result, their physical, social,
emotional, and mental development is hindered. They may, for
instance, be underweight, develop language skills less quickly than
other children, and seem emotionally needy.
Intervention in Child Abuse Cases

In the United States, New York became the first state to institute child
protection laws (1875) that made abuse against children a crime, and other
states soon followed with similar laws. In 1974 the U.S. Congress passed the
Child Abuse Prevention and Treatment Act, which encouraged remaining
states to pass child protection laws and created the National Center on Child
Abuse and Neglect. In addition, all states have their own reporting laws,
juvenile and family court laws, and criminal laws.
Cases of child abuse are handled by an multidisciplinary team including
medical personnel, law enforcement officers, the schools, social workers, and
the courts. School personnel may be the first to notice and report signs of
abuse. Child-abuse cases are often coordinated by a community's child
protective services unit, which sends case workers to the home for
evaluation and offers services to the child and family. Medical professionals
may report cases, provide treatment for injured children, provide testimony
in court, or help to educate parents. Law enforcement personnel may be
involved when cases are reported or when there is a question of a criminal
action. The courts provide emergency protective orders or decide whether
the child should be removed from the home. Child abuse may be punished
by incarceration of the perpetrator or by the denial of custody rights to
abusive parents or guardians.

Incidence

Despite efforts to reduce child abuse in America, more than a million


children are physically abused each year; about 2,000 die. Although the
magnitude of sexual abuse of children in the United States is unknown, it is
considered to be an escalating problem, and one that can result in serious
psychological damage among victims. There are no reliable statistics
available for emotional abuse and neglect, but these types of child abuse are
as potentially damaging to their victims as are various forms of physical
abuse. Child abuse extends across racial, ethnic, and socioeconomic lines,
but there are consistently more reports concerning children born into
poverty. The reporting of child abuse is complicated by the private nature of
the crime, the fearfulness of the child, and strong motivation for denial in
the abuser.
Child Abuse Prevention

One good way to prevent child abuse is to recognize risk factors that
are associated with child abuse, including:

• substance abuse
• domestic violence
• a personal history of child abuse
• poverty
• lack of parenting skills
• a small social support network

And then, in addition to supporting programs that target those high


risk groups to prevent child abuse, such as education programs, parent
support groups, and mentoring, some good child abuse prevention strategies
include learning the signs of child abuse and how to report suspected child
abuse.
What age child is abused?
All ages of children suffer from child abuse and neglect. Research has
shown, however, that risk factors exist making it more likely that certain
child may be abused. These risk factors include
1. age: 67% of abused children are less than 1 year old; 80% are less
than 3 years old;

2. past history of abuse: Repeated abuse has been shown to occur more
than 50% of the time; repeatedly abused children have a 10% chance
of sustaining a lethal event;

3. children with learning disabilities, speech/language disorders and


mental retardation,

4. children with congenital anomalies (malformations) and


chronic/recurrent conditions;

5. Adopted and foster children.

Bibliography
J. Goldstein, A. Freud, A. J. Solnit, and S. Goldstein, In the Best
Interests of the Child (1986);
J. Garbarino, E. Guttmann, and J. W. Seeley, The Psychologically
Battered Child (1987);

D. E. H. Russell, The Secret Trauma: Incest in the Lives of Girls and


Women (1986);

R. E. Helfer and R. S. Kempe, The Battered Child (4th ed. 1987);

D. J. Besharov, Recognizing Child Abuse: A Guide for the Concerned (1990);

Publications of the National Clearinghouse on Child Abuse and Neglect.

Browne, Kevin, et al. Early Prediction and Prevention of Child Abuse: A


Handbook. Hoboken, NJ: John Wiley & Sons, 2002.
Crosson-Tower, Cynthia. Understanding Child Abuse and Neglect, 6th
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Publishers, 2003.
Bechtel, Kirsten, et al. "Characteristics that Distinguish Accidental from
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