Chapter 14 Child Abuse and Neglect

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Chapter 14Child Abuse and Neglect
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Terminology

• Risk factor - A characteristic of a situation or
  person that makes a certain negative outcome MORE
  likely. Without this particular trait, the
  individuals risk for the outcome is decreased.
• Protective factor - A characteristic of a
  situation or person that makes a certain negative
  outcome LESS likely. Without this particular
  trait, the individuals risk for the outcome is
  increased.
• Lifetime prevalence - At some point in the
  individuals life, he or she exhibits the outcome
  of interest.

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Healthy Child-Rearing and Families

• Children need a balance of control and
  responsiveness
• Healthy parenting includes knowledge of child
  development and expectations, adequate coping
  skills, healthy parent-child attachment and
  communication, home management skills, shared
  parental responsibilities, and provision of
  social services
• Healthy parenting involves a gradual shift of
  control from parents to child and community

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Child-Rearing and Maltreatment

• Maltreatment represents major failures of the
  childs expectable environment
• for infants, an expectable environment includes
  protective and nurturing adults, and
  opportunities for socialization
• older children require a supportive family,
  contact with peers, and plenty of opportunities
  to explore and master the environment

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Classification of Maltreatment

• Boundaries between appropriate and inappropriate
  child rearing are not always clear or
  well-established, and may vary according to
  cultural values, community standards, and
  personal experiences.
• Example caning punishment in Singapore
• Example what is an appropriate medical
  intervention?
• Medications versus cupping/coining for flu
• Or, when disciplining a child, how much
  physical contact is okay? In our culture, none
  but in other cultures, lots.

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Classification of Maltreatment

• For DSM-IV, maltreatment could be noted on Axis I
  (Other conditions that may be the focus of
  clinical attention) or Axis IV (psychosocial
  and environmental problems)
• Important to note, however, that abusing a child
  does not automatically qualify the abuser for any
  diagnostic label.
• There is no child abuser disorder. In
  fact, we are more likely to consider the
  child/victim the sick one.

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Types of Maltreatment

• Physical abuse A non-accidental injury to a
  child by a parent or caretaker.
• Examples
• physically harmful acts including punching,
  beating, kicking,biting, burning, shaking.
• Telltale signs
• Frequent bruises especially on face, neck,
  forearms.
• The child may be overly afraid of the parents
  reaction to misbehavior.

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Types of Maltreatment

• Neglect failure to provide for a childs basic
  physical, educational, or emotional needs. The
  child does not receive food, appropriate
  clothing, hygenic care, medical care,
  supervision.
• Telltale signs
• A very young child routinely left alone at
  home. A severe or recurring illness is not being
  adequately treated. A child might appear
  frequently at the homes of neighbors saying that
  their parent told them to stay away,
  inappropriate dress for the weather or time of
  day.
• Rule out poverty.

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Types of Maltreatment

• Sexual abuse acts ranging from sexual touching
  to exhibitionism, intercourse, and sexual
  exploitation
• Telltale signs
• Sexual behavior way beyond what is expected
  for the childs age, sexual slang, trying to
  fondle other children.
• Toileting difficulties, blood in underwear,
  walks funny.
• Itching, burning, bleeding in genital area.

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Types of Maltreatment

• Emotional abuse acts or omissions that could
  cause serious behavioral, cognitive, emotional,
  or mental disorders.
• Telltale signs
• Parent verbally terrorizes or humiliates
  child, especially in the presence of others.
• Parent fails to express any affection toward
  child.

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Incidence of Maltreatment

• 3 million suspected cases of maltreatment in the
  U.S. each year, far fewer are actually
  corroborated.
• Neglect accounts for 60 of all documented
  incidents, 25 of cases involve physical abuse,
  12 involve sexual abuse (25 involve more than
  one type)
• Lifetime prevalence estimates
• Sexual abuse 4.3 of males, 12.8 of females
• Physical abuse 31.2 of males, 21.1 of females

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Incidence of Maltreatment (cont.)

• Figure 14.1
• Percentages of types of maltreatment. Source
  U.S. Department of Health and Human Services
  (USDHHS, 2000.)

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Characteristics of Victimized Children

• Effects of age
• Younger children more at risk for physical
  neglect
• Toddlers, preschoolers, and young adolescents at
  risk for physical and emotional abuse
• Sexual abuse relatively constant after age 3
• Effects of sex
• 80 of sexual abuse victims female
• Boys more likely to be sexually abused by male
  non-family members, girls by male family members
• Racial and ethnic background is not related to
  risk

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Characteristics of Family Perpetrator

• More common among poor and disadvantaged
• Single-parent (especially father-only) homes and
  large families at risk
• Childs parent is perpetrator 80 of time, except
  in cases of sexual abuse (50 of time) mother is
  perpetrator of neglect 90 of time
• Males are offenders in majority of sexual (90),
  emotional (63), and physical (58) abuse

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Cross-Cultural Comparisons

• Physical and sexual abuse are found in all
  societies
• Estimated that 40 million children under the age
  of 15 are victims of maltreatment each year
  worldwide

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Resilience and Adaptation to Maltreatment

• Maltreatment does not affect each child in a
  predictable or consistent way
• Resilience factors include positive self-esteem
  and sense of self, and a positive relationship
  with at least one important and consistent person

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Developmental Consequences

• Problems with early attachment and affect
  regulation
• Insecure-disorganized attachment, characterized
  by a mixture of approach and avoidance,
  helplessness, apprehension, and general
  disorientation
• Difficulty understanding, labeling, and
  regulating internal emotional states
• Poor emotion regulation, which may lead to
  internalizing and externalizing problems

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Developmental Consequences (cont.)

• Disturbances in emerging views of self and others
• Negative representational models of self and
  others
• Feelings of betrayal and powerlessness, which may
  become part of the childs self-identify
• Sometimes internal attributions of blame for the
  maltreatment

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Developmental Consequences (cont.)

• Problems with Peers and school adjustment
• Easily distracted by aggressive stimuli and
  tendency to make hostile attributions for the
  actions of others
• Physically abused and neglected children show
  little skill at recognizing distress in others,
  and respond to others distress with fear,
  attack, or anger
• Maltreated children (especially those physically
  abused) more physically and verbally aggressive
  with peers, and are more likely to be unpopular
  and rejected
• Maltreated children (especially those neglected)
  often withdraw from and avoid peer interaction

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Developmental Consequences (cont.)

• Problems with peers and school adjustment cont
• Neglected children have the most severe and
  wide-ranging problems in school and interpersonal
  adjustment
• Sexually abused children described as more
  anxious, inattentive, and unpopular, and having
  less autonomy and self-guidance in completing
  school work

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Psychopathology and Adult Outcomes

• Physically abused children at risk for later
  interpersonal problems involving aggressive
  behavior (cycle of violence)
• Sexually abused children may develop chronic
  impairments in self-esteem, self-concept, and
  emotional and behavioral self-regulation,
  including PTSD, depression, dissociative states,
  and sexual maladjustment
• Teens with a history of maltreatment are at much
  greater risk of substance abuse

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Psychopathology and Adult Outcomes (cont.)

• History of maltreatment and criminal behavior
• Most abused children do not go on to commit
  crimes
• However, there is a significant connection
  between maltreatment and subsequent arrests and
  sexual and physical violence
• A history of maltreatment is associated with an
  earlier mean age at first offense, a higher
  frequency of offenses, and a greater chronicity
  of offending

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Causes of Maltreatment

• Physical abuse and neglect
• Many abusive and neglectful parents have had
  little exposure to positive parental models and
  supports
• Often a greater degree of stress in the family
  environment
• Information-processing disturbances may cause
  maltreating parents to misperceive or mislabel
  their childs behavior, leading to inappropriate
  responses
• Often a lack of awareness or understanding of
  developmentally appropriate expectations

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Causes of Maltreatment (cont.)

• Physical abuse and neglect (cont.)
• Neglectful parents have more striking personality
  disorders, inadequate knowledge of childrens
  needs, and chronic social isolation than abusive
  parents
• With abuse, may see a conditioning of negative
  arousal and emotions with certain events
• Conflict and marital violence may be implicated
• No child characteristic has been linked to the
  risk of maltreatment, once environmental and
  adult factors are controlled (with the exception
  of gender for sexual abuse)

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Causes of Maltreatment (cont.)

• Figure 14.3
• An integrated model of physical child abuse. (D.
  A. Wolfe, 1999)

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Causes of Maltreatment (cont.)

• Causes of sexual abuse
• Most offenders are males who meet the DSM-IV
  criteria for pedophilia
• Victims are gradually indoctrinated into sexual
  activity, force is seldom used
• A sense of entitlement and privilege may be
  involved
• Offenders often have their own histories of abuse
• Incestuous families characterized by factors that
  protect the family secret and maintain control
  and domination by the abuser, such as social
  isolation, restrictive personal autonomy,
  deference to strict morality and religiosity

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Causes of Maltreatment (cont.)

• Causes of Sexual Abuse cont
• Certain situational factors increase childrens
  vulnerability to being sexually abused, which
  offenders exploit to their advantage, including
  having family problems, being unsupervised and
  spending a lot of time alone, and being unsure of
  themselves

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Causes of Maltreatment (cont.)

• Social and Cultural Dimensions
• Our society condones and glorifies violence
• Poverty, social isolation, and acceptance of
  corporal punishment contribute to maltreatment
• Inequality is the major sociocultural factor
  contributing to abuse and neglect
• Social and cultural disadvantage may result in an
  extra burden of stress and confusion, and limited
  alternatives
• Maltreatment is often associated with limited
  opportunities to learn appropriate child-rearing
  and to receive needed supports

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Prevention and Treatment

• Physical abuse and neglect
• Enhancing positive experiences early in the
  development of the parent-child relationship may
  help to prevent maltreatment
• Treatment for physical abuse aims to change how
  parents teach, discipline, and attend to their
  children
• Cognitive-behavioral methods target anger
  patterns and distorted beliefs
• Treatment for neglect focuses on parenting skills
  and expectations, and may include training in
  social competence and management of daily demands

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Prevention and Treatment (cont.)

• Sexual abuse
• Childrens treatment programs are few and
  difficult to devise as sexual abuse affects each
  child differently
• Treatment try to restore childs sense of trust,
  safety, guiltlessness through educational and
  cognitive-behavioral methods, as well as group
  therapy
• Child needs to express feelings about the abuse,
  and may need specialized treatment if suffering
  from PTSD

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Other Important Facts About Abused Boys

• New research on boys suggests that 10-20 of all
  boys are sexually abused in some way. However,
  widely differing definitions of abuse in studies
  and differences in who was being studied make it
  difficult to accurately gauge the prevalence of
  sexual abuse.

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Other Important Facts About Abused Boys

• Suicide rate among abused boys is 12-14 times
  higher than nonabused boys substance abuse among
  boys in 6th grade was 40 times greater than
  nonabused boys.

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Other Important Facts About Abused Boys

• 33 of juvenile delinquents, 40 of sex
  offenders, and 75 of serial rapists report that
  they were sexually abused as youngsters.

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However,

• This may only be true if the abuser was also
  maleboys who have sexual experiences with older
  females at a young age often appear to be
  unimpaired by the experience.

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However,

• Girls respond with fear, unpleasant confusion,
  embarrassment
• Boys indifference tinged with mild anxiety,
  positive pleasure

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Treating the Abuser

• We are in need of effective treatments for
  abusers increase remorse and empathy, help them
  confront their own abuse, realize their distorted
  attitudes toward children, target the need for
  control.
• New drug therapy Depo Provera, which is a type
  of birth control, is also used to reduce
  testosterone and reduce the desire to molest
  children.

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The Internet

• The internet may eventually be censored or
  targeted as a means of decreasing child abuse.
  The internet provides a convenient way to conduct
  illegal activities involving children.