What is child abuse?

Introduction

It is difficult to imagine anything more frightening to a child than being
neglected, threatened, beaten, or molested by an adult who is supposed to be his
or her primary source of care and protection. Yet throughout human history,
children have been abandoned, incarcerated, battered, mutilated, exploited, and
even murdered by their caregivers. Although the problem of child maltreatment is
an old one, both the systematic study of child abuse and the legally sanctioned
mechanisms for child protection are relatively new and have gained momentum in the
last half of the twentieth century.

In the United States, child abuse and neglect are defined in both federal and
state legislation. The federal legislation provides a foundation for states by
identifying a minimum set of acts or behaviors that characterize maltreatment. The
Child Abuse Prevention and Treatment Act (CAPTA), passed in 1974 and amended in 2003 by the Keeping Children and
Families Safe Act, defines child abuse and neglect as "any recent act or failure
on the part of a parent or caretaker, which results in death, serious physical or
emotional harm, sexual abuse or exploitation, or an act or failure to act which
presents an imminent risk of serious harm."

When applied by legal and mental health professionals in real-world situations,
however, the definition of abuse may vary according to the developmental age of
the child victim, the frequency or intensity of the behaviors regarded as abusive, the degree of
intentionality, and a consideration of extenuating circumstances. In general,
however, child abuse includes any act or omission on the part of a parental figure
that damages a child’s physical or psychological well-being or development that is
nonaccidental or the result of a habitual behavioral pattern. A broad spectrum of
behaviors is considered to be abusive, ranging from the more easily recognizable
physical abuse to more subtle forms of maltreatment, including neglect and
emotional abuse.

Types of Abuse

Physical abuse is characterized by the nonaccidental infliction of physical
injury as a result of punching, pushing, striking, kicking, biting, burning,
shaking, or otherwise harming a child. The parent or caretaker may not have
intended to badly hurt the child; rather, the injury may have resulted from
overdiscipline or physical punishment. Child neglect is characterized by failure
to provide for the child’s basic needs. Neglect can be physical, educational, or
emotional. Physical neglect includes refusal of, or delay in, seeking health care,
food, clothing, or shelter; abandonment; expulsion from the home or refusal to
allow a runaway to return home; and inadequate supervision. Educational neglect
includes the allowance of chronic truancy, failure to enroll a child of mandatory
school age in school, and failure to attend to a special educational needs.
Emotional neglect includes such actions as marked inattention to the child’s needs
for affection; refusal of or failure to provide needed psychological care; spouse
abuse in the child’s presence; and permission of drug or alcohol use by the child.
The assessment of child neglect requires consideration of cultural values and
standards of care, as well as recognition that the failure to provide the
necessities of life may be related to poverty.

Sexual abuse includes fondling a child’s genitals, intercourse, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials. Many experts believe that sexual abuse is the most underreported form of child maltreatment because of the secrecy or “conspiracy of silence” that so often characterizes these cases.

Emotional abuse (psychological or verbal abuse, or mental injury) includes acts
or omissions by the parents or other caregivers that have caused behavioral,
cognitive, emotional, or mental injury. In some cases of emotional abuse, the acts
of parents or other caregivers alone, without any harm evident in the child’s
behavior or condition, are sufficient to warrant intervention and investigation by
the Child Protective Services (CPS). For example, the parents or caregivers may
use extreme or bizarre forms of punishment, such as confinement of a child in a
dark closet. Less severe acts, such as habitual scapegoating, belittling, or
rejecting treatment, are often difficult to prove. Therefore, CPS may not be able
to intervene without evidence of harm to the child.

Extent of Abuse

According to data from the National Child Abuse and Neglect Data System of the
Department of Health and Human Services, there were approximately 686,000 reports
of child abuse or neglect in the United States in 2012, representing a 3.3
decrease in the number of reports from 2008 (716,000). Of these reports,
approximately 78 percent indicated child neglect, 18 percent indicated physical
abuse, 9 percent reported sexual abuse, and 8.5 percent reported psychological or
emotional abuse. It is estimated that more than four children die every day in the
United States as a result of child abuse, with 70 percent of these children being
under the age of four years. It is important, when considering the actual
magnitude of the problem of child maltreatment, to remember that the estimates
given most likely underestimate the true incidence of child abuse, both because of
the large number of cases that go unreported and because of the lack of agreement
as to precisely which behaviors constitute “abuse” or “neglect.” In addition,
abusive treatment of children is rarely limited to a single episode, and it
frequently occurs within the context of other forms of family violence.

Certain forms of maltreatment seem to appear with greater regularity within
certain age groups. Neglect is most often reported for infants and toddlers, with
incidence declining with age. Reports of sexual abuse and emotional maltreatment
are most common among older school-aged children and adolescents. Physical abuse
seems to be reported equally among all age groups; however, children less than
five years old and adolescents have the highest rates of actual physical injury.
Boys and girls are equally as likely to be victims of child abuse and neglect, but
the rate of abuse-related fatality is slightly higher for boys.

Although research studies generally conclude that there is no “typical” child
abuse case consisting of a typical abused child and a typical abusive parent or
family type, certain characteristics occur with greater regularity than others.
For example, there is considerable evidence that premature infants,
low-birth-weight infants, and children with problems such as attention-deficit hyperactivity
disorders, physical disabilities, and intellectual
disabilities are at particularly high risk for being abused by their caregivers.
Physical abuse and neglect are reported with approximately equal frequency for
girls and boys, while sexual abuse against girls is reported four times more
frequently than sexual abuse against boys.

Although female caregivers are the perpetrators in approximately 60 percent of
all reported cases of child maltreatment, male caregivers are more likely to
inflict serious physical injury, and men are the primary perpetrators in cases of
sexual abuse of both male and female children. Although no single abusive
personality type has been identified, research has revealed a number of areas of
psychological functioning in which abusive parents often differ from nonabusive
parents. Abusive parents tend to exhibit low frustration tolerance, have poor impulse
control, and express negative emotions (for example, anger or disappointment)
inappropriately. They are more socially isolated and are more likely to abuse
alcohol or drugs than nonabusive parents. Abusive parents also tend to have
unrealistic expectations of their children, to misinterpret their children’s
motivations for misbehaving, to utilize inconsistent and inflexible parenting
skills, and to view themselves as inadequate or incompetent as parents.

Research also indicates that marital conflict, unemployment, large and closely
spaced families, overcrowded living conditions, and extreme household
disorientation are common in abusive homes. Statistics regarding race, education
level, and socioeconomic status of abusive families are somewhat controversial in
that there exists the possibility of an underreporting bias favoring white,
middle- to upper-class families. However, like several other negative outcomes in
childhood (for example, academic underachievement, criminality, teen pregnancy),
child abuse is associated with family poverty, underemployment, insufficient
education, and the increased experience of stress and social isolation that
coexists with these sociodemographic variables.

Consequences of Abuse

Children who have experienced abuse are believed to be at much greater risk of
developing some form of pathology in childhood or in later life, most commonly depression,
anxiety, eating disorders such as anorexia and
bulimia, or suicide ideation. When considered as a group and
compared to nonabused youngsters, abused children are at a higher risk of
exhibiting a variety of psychological difficulties and behavioral problems. Yet no
single emotional or behavioral reaction is consistently found in all abused
children. It is important, when investigating the impact of child abuse, to view
the abuse within a developmental perspective. Given a child’s different
developmental needs and capabilities over the course of a child's development, one
might expect that both the psychological experience and the impact of the abuse
would be quite different for an infant than if the same maltreatment involved an
eight-year-old child or an adolescent. One should also note that, in some cases,
the experience of the abuse per se may not be the singular, most powerful
predictor of the psychological difficulties found in abused children. Rather, the
child’s daily exposure to other, more pervasive aspects of the psychological
environment associated with an abusive family situation (for example, general
environmental deprivation, impoverished parent-child interactions, or chronic
family disruption and disorganization) may prove to be more psychologically
damaging. Finally, it is important not to view the range of symptoms associated
with abused children solely as deficits or pathology. These “symptoms” represent
an abused child’s best attempt at coping with an extremely stressful family
environment given the limited psychological resources and skills he or she has
available at that particular time in his or her development.

From the home environment, and from parents in particular, children learn their earliest and perhaps most influential lessons about how to evaluate themselves as valuable, lovable, and competent human beings. They learn about controlling their own actions and about successfully mastering their environment. They learn something about the goodness of their world and how to relate to the people in it. Growing up in an abusive home distorts these early lessons, often resulting in serious interference with the most important dimensions of a child’s development: the development of a healthy sense of self, the development of self-control and a sense of mastery, the capacity to form satisfying relationships, and the ability to utilize one’s cognitive capacities to solve problems.

In general, research has shown that abused children often suffer from low
self-esteem, poor impulse control, aggressive and antisocial
behaviors, fearfulness and anxiety, depression, poor relationships with peers and adults, difficulties with
school adjustment, delays in cognitive development, lowered academic achievement,
and deficits in social and moral judgment. The way in which these difficulties are
expressed will vary according to a child’s stage of development.

Signs of Abuse

In infancy, the earliest sign of abuse or neglect is an infant’s failure to
thrive. These infants show growth retardation (weight loss can be so severe as to
be life-threatening) with no obvious physical explanation. To the observer, these
infants appear to have “given up” on interacting with the outside world. They
become passive, socially apathetic, and exhibit little smiling, vocalization, and
curiosity. Other abused infants appear to be quite irritable, exhibiting frequent
crying, feeding difficulties, and irregular sleep patterns. In either case, the
resulting parent-child attachment bond is often inadequate and
mutually unsatisfying.

Abused toddlers and preschoolers seem to lack the infectious love of life, fantasy, and play that is characteristic of that stage of development. They are typically anxious, fearful, and hypervigilant. Their emotions are blunted, lacking the range, the spontaneity, and the vivacity typical of a child that age. Abused toddlers’ and preschoolers’ ability to play, particularly their ability to engage in imaginative play, may be impaired; it is either deficient or preoccupied with themes of aggression. Abused children at this age can either be passive and overcompliant or oppositional, aggressive, and hyperactive.

School-aged children and adolescents exhibit the more recognizable signs of low self-esteem and depression in the form of a self-deprecating attitude and
self-destructive behaviors. They may be lonely, withdrawn, and joyless.
Behaviorally, some act in a compulsive, overcompliant, or pseudomature manner,
while others are overly impulsive, oppositional, and aggressive. Problems with school adjustment and achievement are common. With the school-aged
child’s increased exposure to the larger social environment, deficits in social
competence and interpersonal relationships become more apparent. Progressing
through adolescence,
the manifestations of low self-esteem, depression, and aggressive, acting-out
behaviors may become more pronounced in the form of suicide attempts, delinquency,
running away, promiscuity, and drug use.

These distortions in self-esteem, impulse control, and interpersonal
relationships often persist into adulthood. There has been much concern expressed
regarding the possibility of an intergenerational transmission of abuse—of the
experience of abuse as a child predisposing a person to becoming an abusive
parent. Research indicates that abused children are six times more likely to abuse
their own children than are members of the general population. Approximately 30
percent of abuse and neglected children will abuse their own children in the
future; however, the vast majority of people who experienced abuse and neglect as
children will never neglect or abuse their own children.

Explanations

Child maltreatment is a complex phenomenon that does not have a simple,
discrete cause, nor does it affect each victim in a predictable or consistent
manner. Perhaps the most comprehensive and widely accepted explanation of child
abuse is the ecological model, which examines both the risk factors for and
protective factors against child abuse and neglect. This model views abuse as the final product of a set of interacting
factors, including child-mediated stressors (for example, temperamental
difficulties or intellectual or physical disabilities), parental predispositions
(for example, the parent's history of abuse as a child, emotional immaturity, or
substance abuse), and situational stresses (for example, marital conflict,
insufficient social
support, or financial stress) occurring within a cultural context that
inadvertently supports the mistreatment of children by its acceptance of corporal
punishment and tolerance for violence and its reluctance to interfere with family
autonomy. Utilizing this ecological framework, one can imagine how an abusive
situation can develop when, for example, an irritable, emotionally unresponsive
infant is cared for by an inexperienced, socially isolated mother in a
conflict-filled and financially strained household embedded within a larger
cultural context in which the rights and privileges of childhood do not
necessarily include freedom from violence.

Knowledge regarding the impact of child abuse has also changed over the years,
from a view of maltreated children as almost doomed to develop some form of
psychopathology to an acknowledgment that child abuse, like other major childhood
stressors, can result in a broad spectrum of adaptive consequences, ranging from
psychological resilience to severe psychiatric disorder. Some children actually do
well in their development despite their experience with extreme stress and
adversity. For example, while adults who were abused as children are more likely
than nonabused individuals to become child abusers, nearly two-thirds of all
abused children do not become abusive parents. The important questions to be
answered are why and how this is so. Research on “stress-resistant” individuals
such as these nonabusers has shifted the focus away from pathology to the
identification of factors within the individual (for example, coping strategies) and
within the environment (for example, social support) that appear to serve a
protective function.

Finally, while the treatment of abused children and their abusive caregivers
remains an important goal in the mental health field, a focus on the prevention of
child abuse has also gained momentum. Many abused children and their families can
be helped with proper treatment; however, the existing need for services far
exceeds the mental health resources available. An increased understanding of the
factors that protect families against engaging in abusive behaviors has resulted
in the creation of successful preventive interventions. These prevention programs
seek to reduce the incidence of new cases of child abuse by encouraging the
identification and development of competencies, resources, and coping strategies
that promote psychological well-being and positive change in parents, children,
and families.

The problem of child abuse does not occur in isolation. It coexists with other
abhorrent problems facing families such as poverty, lack of access to adequate
medical care, insufficient quality child care, and unequal educational resources.
Child abuse, like these other problems, can be prevented and eradicated.

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