Child Abuse
Childhood abuse, like partner abuse, is a significant health issue across the globe.
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Childhood abuse, like partner abuse, is a significant health issue across the globe. Childhood abuse may be physical, sexual, or psychological in nature, or may involve psychological or physical neglect. Definitions of childhood abuse and maltreatment vary widely. Legal definitions of childhood abuse, for example, differ from state to state. While all state statutes acknowledge that physical abuse includes non-accidental physical injury that results in harm or substantial risk of harm, some statutes specify the types of acts (e.g., striking with an object) or overt consequences (e.g., visible bruises) that constitute physical abuse (Barnett et al., 1997). Considerable disagreement exists both among the public and child development professionals as to what separates "normal" corporal punishment (e.g., spanking) from abuse. Spanking, paddling, and slapping children as a form of discipline is a common practice in the United States and such behaviors are typically not labeled as abusive by most adults. On the other hand, some experts have argued that spanking is always harmful because it legitimizes violence and may engender other forms of interpersonal aggression (e.g., sibling abuse, violence outside the home) (Straus, 1994). As Kolko (1996) argued, "The task of determining when parental behaviors are excessive, unwarranted, dangerous, and ultimately abuse remains a complex one" (p. 22).
Definitions of childhood sexual abuse are dependent upon historical, cultural, and social contexts and vary widely. Emotional abuse and child neglect are perhaps the most prevalent forms of childhood maltreatment, and the most difficult to define. Bernstein and Fink (1998) have identified some common definitions of child abuse and neglect found in the childhood trauma literature:
Emotional abuse refers to verbal assaults on a child’s sense of worth or well-being, or any humiliating, demeaning, or threatening behavior directed toward a child by an older person. Physical abuse refers to bodily assaults on a child by an older person that pose a risk of, or result in, injury. Sexual abuse refers to sexual contact or conduct between a child and older person; explicit coercion is a frequent but not essential feature of these experiences. Emotional neglect refers to the failure of caretakers to provide a child’s basic psychological and emotional needs, such as love, encouragement, belonging, and support. Physical neglect refers to failure of caregivers to provide a child’s basic needs, including food, shelter, safety, and supervision. (p. 2)
Scope
The Third National Incidence Study of Child Abuse and Neglect (NIS-3), conducted by the National Center on Child Abuse and Neglect, was mandated by Congress to provide official estimates of these phenomenon in the United States. The NIS-3 follows the NIS-1, published in 1981, and the NIS-2, published in 1986. The findings of the NIS-3 are based on a nationally representative sample of over 5,600 professionals in 842 agencies in 42 counties, and reflect the number of abuse and neglect cases investigated by child protective services or served by community agencies. Data were collected in 1993 and compared to data collected in the NIS-2 survey. The NIS-3 used two standards. Children who had already experienced harm from abuse or neglect were considered abused by the Harm Standard; children who experienced abuse or neglect that put them at risk for harm were considered abused by Endangerment Standard. Using the Harm Standard, survey findings suggest that in 1993, 1,553,800 children were abused or neglected; this estimate raises to 2,815,600 under the Endangerment Standard. Outlined in Table 1 are the number of children estimated to have been sexually or physically abused and physically or emotionally neglected. The authors of the survey concluded, "The findings of the Third National Incidence Study of Child Abuse and Neglect (NIS-3) show a sharp increase in the scope of the problem, whether maltreatment is defined using the Harm Standard or the Endangerment Standard" (Sedlak & Broadhurst, 1996, p. 7).
Table 1
Estimated incidence of child abuse in the US in 1993 from the Third National
Incidence Study of Child Abuse and Neglect (Sedlak & Broadhurst, 1996)
| Harm Standard |
Endangerment Standard |
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Sexually abused
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217,700
|
83%*
|
|
300,200
|
125%*
|
|
Physically neglected
|
338,900
|
102%*
|
|
1,335,100
|
163%*
|
|
Emotionally neglected
|
212,800
|
333%*
|
|
585,100
|
188%*
|
|
Physically abused
|
381,700
|
42%*
|
|
614,100
|
97%*
|
|
Total abused or neglected
|
1,553,800
|
67%*
|
|
2,815, 600
|
98%*
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*Increase over NIS-2 estimates in 1986
Official estimates such as those derived from the NIS-3 survey are based on only those children who come to the attention of authorities or helping professionals. The actual incidence of abuse and neglect of children in the U.S. is likely to be much higher. Participants in the National Violence Against Women Survey, for example, were asked a series of behaviorally specific questions about a range of physical assaults committed by adult caretakers. More than half of the respondents had experienced at least one physical assault by a caretaker (Tjaden & Thoennes, 2000a). In a national U. S. telephone survey of 2,626 adults, 27 % of the women and 16 % of the men reported experiencing sexual abuse during their childhood (Finkelhor, Hotaling, Lewis, & Smith, 1990).
Throughout history, parents and other caretakers have maltreated children.
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History
Throughout history, parents and other caretakers have maltreated children. Many societies practice infanticide and the abandonment of unwanted children. Industrialized societies have used children for dangerous and exhausting work (Barnett et al., 1997). Girls around the world are especially at risk for sexual abuse, child marriage, child prostitution and pornography, and female genital mutilation (Kendall-Tackett, 2001).
In the U. S., children have historically been considered property of their parents and without legal rights. In 1874, the first U.S. child abuse case was tried in New York; it resulted in a conviction of a woman for assault and battery on her 8 year-old stepdaughter, Mary Ellen (Barnett et al., 1997). Mary Ellen had been beaten daily, starved, and prohibited from leaving the house. This case attracted considerable public attention and led to the founding of the Society for the Prevention of Cruelty to Children (SPCC).
In the early 1900s, state legislatures began to enact statutes criminalizing the abuse and neglect of children and providing protective measures for mistreated children. Between 1899 and 1920, almost all states in the United States instituted statewide juvenile court systems (Bulkley, Feller, Stern, & Roe, 1996). In the 1900s, several child protective organizations were founded, including the National Committee to Prevent Child Abuse, the Family Resource Coalition, the Children’s Defense Fund, the National Center for Missing and Exploited Children, and the Child Welfare League of America (Barnett et al., 1997).
In 1962, C. Henry Kempe, a pediatrician at the University of Colorado, and his colleagues identified the "battered child syndrome" - a constellation of physical and psychological symptoms resulting from physical child abuse (Kempe, Silverman, & Stele, 1962). Kempe’s work resulted in increased recognition and reporting of childhood physical abuse by health professionals and mobilized advocacy for greater government intervention for child welfare. In 1974, Congress enacted the Child Abuse Prevention and Treatment Act (CAPTA), providing federal funds for states that passed legislation requiring the reporting of child abuse by certain professionals (e.g., teachers, health care professionals). It also established the National Center for Child Abuse and Neglect (Barnett et al., 1997). The 1980s and 1990s saw a proliferation of health-system and community-based interventions for the prevention and treatment of physical child abuse (Barnett et al., 1997).
The third "discovery" of childhood sexual abuse occurred during the 1970s with the advent of the women’s movement. Along with issues of rape and wife battering, activists and survivors brought childhood sexual abuse into public awareness.
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Historically, professionals and the public did not consider sexual abuse to be a prevalent or traumatic experience in the lives of children. Herman (1981) identified three "discoveries" of incest. In the first "discovery," Freud initially reported that female patients in psychoanalysis frequently described incestuous childhood experiences, and that these experiences were the root cause of adult hysteria. He later repudiated this claim in the service of protecting the culture of the patriarchal family and suggested instead that the women’s claims were incestuous fantasies rather than actual childhood events. Following this repudiation, the reality and prevalence of childhood sexual abuse were again denied. In the 1940s, incest was "discovered" again by social scientists conducting large scale surveys of sexual practices, such as the early Kinsey studies. Despite the fact that the prevalence of childhood sexual abuse was substantiated in these studies, Herman suggested that the reality of the experience was minimized. Because the researchers were attempting to encourage enlightenment and tolerance of sexual attitudes, they failed to highlight the victimizing nature of the experiences. The third "discovery" of childhood sexual abuse occurred during the 1970s with the advent of the women’s movement. Along with issues of rape and wife battering, activists and survivors brought childhood sexual abuse into public awareness. In the 1980s and 1990s, there was a proliferation of scholarly, clinical, and self-help literature on the topic.
The sexual abuse of children also began to receive legislative attention in the U. S. in the 1970s. In 1978, the Protection of Children Against Sexual Exploitation Act was passed. In 1986, the Child Sexual Abuse and Pornography Act made it a federal crime to sexually exploit children or to permit a child to engage in pornography (Barnett et al., 1997).
Health Consequences
Child abuse can have significant psychological and physical consequences for children, as well as long-term effects that may extend into adulthood. Barnett and colleagues (1997) identified the most frequently reported effects of physical abuse on children. Physical consequences may include bruises; head, chest, and abdominal injuries; burns and fractures. Abused children often exhibit a number of cognitive difficulties, including deficits in verbal, reading, math, and perceptual-motor skills; poor school achievement; and impaired memory. Behavioral problems, such as aggression, noncompliance, and antisocial behaviors, have also been associated with abuse, as have a variety of emotional difficulties, including depression, low self-esteem, and increased daily stress. Long-term effects in adults may include criminal/violent behavior (for adult males), substance abuse, and a variety of social and emotional problems, including suicidality, anxiety, hostility, dissociation, and interpersonal difficulties. Experts stress, however, that physical child abuse does not affect individuals in consistent and predictable ways. The negative effects, in fact, can be mitigated by a number of factors, especially by the presence of supportive adults in the child’s life (Barnett et al., 1997).
Barnett and colleagues (1997) have summarized the most frequented substantiated effects of child sexual abuse as well. Physical consequences of child sexual abuse often include genital bruising, bleeding, pain, and itching; enuresis; encopresis; and a variety of stress-related symptoms, including sleep and eating disturbances, stomachaches, and headaches. Short-term effects of child sexual abuse include emotional problems, such as anxiety, depression, aggression, and low self-esteem, as well as a variety of behavioral and learning difficulties. Long-term effects exhibited by adult survivors of child sexual abuse include emotional difficulties, such as depression, anxiety, and posttraumatic stress symptoms; interpersonal and sexual problems; and certain behavior problems, such as eating and substance abuse disorders. As with physical abuse, individual responses to child sexual abuse are highly individualized and can be mediated by a number of factors, including the victim’s subjective perception of the events and available social support (Barnett et al., 1997).
A myriad of effects have also been associated with childhood neglect. Childhood neglect may result in social difficulties, including impairment of parent-child interactions and problematic peer interactions; intellectual deficits; and a variety of emotional and behavior problems, including low self-esteem, ineffective coping, aggression, and negative affect. The physical consequences of child neglect include failure to thrive and death. The effects of psychological maltreatment have not been studied extensively, but seem to include a variety of negative effects, including difficulties in interpersonal adjustment, intellectual deficits, and affective-behavioral problems(Barnett et al., 1997).
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