Lecture 25
Childhood Psychopathology:
Child Abuse and Neglect
Lecture Outline
I. Introduction
II. Definitions and Disbelief
A. Definitions
B. Disbelief
III.Numbers
IV. Course
A. Infancy and Childhood
B. Adolescence and Adulthood
V. Etiology
A. Child factors
B. Parent factors
C. Cross-Generational factors
D. Societal factors
VI. Conclusion
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I. Introduction
In today's lecture we will examine child abuse and neglect, two
closely related problems that have recently gained a lot of attention
from professionals and the public alike. These are not new problems,
however. There is evidence of child abuse and child neglect as far back
as our history goes (Oates, 1982). What is new is the realization that
these behaviors are terribly serious, and that they occur with alarming
frequency. Public awareness of the problem was spurred in the 1960's by
the landmark work of Kempe, who identified what he termed the "battered-
child syndrome". Since then, public and professional interest has
grown. In 1976 the International Society for the Prevention of Child
Abuse and Neglect was formed. In 1979, we saw the International Year of
the Child, with its special emphasis on the rights of children. The
media has taken an active role in educating the public about the problem
(Cohn, 1982) (for example, see Handout 25-1). Professional journals
have been formed, e.g: Child Abuse and Neglect. A new field has grown
up, with many investigators actively searching for an understanding of
and effective interventions for the problem. Nonetheless, most experts
would agree that we have a long way to go before we adequately address
the problem of child abuse and neglect.
II. Definitions and Disbelief
The study of child abuse and neglect is complicated by a number of
related issues. We begin with perhaps the most basic problem: What is
it that we mean by child abuse and child neglect?
A. Definitions
On the face of it, the definition of abuse and of neglect is
fairly straight forward.
1. Child Abuse: Acts of commission - the active use of force
aimed at hurting, injuring, or destroying the child. Includes
sexual and psychological abuse, in addition to physical abuse
(McRae & Longstaffe, 1982). Psychological abuse (demeaning,
denigrating, ridiculing, and condemning the child, placing
him/her in intolerable situations such as double binds, etc)
frequently accompanies actual physical abuse (Wilbur, 1985).
2. Child Neglect: Acts of omission - non-nurturing,
deprivation, understimulation (McRae & Longstaffe, 1982):
neglect of the legitimate needs of the developing child,
whether by intention, unavailability, or some form of deficit
or incapacity in the caretaker. Eg: the child is not held,
comforted, bathed, kept warm, diapered, or fed adequately
(Wilbur, 1985).
However, these definitions are often overly broad and vague.
There are many situations where it is difficult to decide: is this
abuse or not. What is abuse to one person may merely be proper
although strict parenting to someone else. It's sometimes very
difficult to draw the line between punishment and abuse (McRae &
Longstaffe, 1982). In particular, work by historians and
anthropologists have clearly demonstrated vast differences, from
one period to another and from one culture to another, regarding
acts considered to constitute child maltreatment (Cantwell, 1982).
Thus, there is wide discretion left to the courts, professionals
etc to impose their own idiosyncratic definitions. The result:
frequency of abuse and neglect is difficult to determine
identifying children at risk is difficult
identifying victims difficult
devising and assessing interventions is difficult
It is sometimes very difficult to balance out the rights of parents
and the protection of children. For example, how do we determine
where to draw the line in terms of a parent's right to discipline a
child versus the right of the child not to be abused - how do we
distinguish physical punishment from abuse?
The complexities involved in studying abuse and neglect are
compounded by a particularly insidious problem, to which we now
turn.
B. Disbelief
Child abuse has a long history of inspiring incredulity in
mental health professionals (Goodwin, 1985). The reports made by
the child are often dismissed as immature fantasies, or at least as
over-exaggerations. [There are certainly many skilled
professionals, devoted to the rights of children. I am not
suggesting here that all professionals are turning their backs on
these children. However, given the horrendous nature of the crime,
disbelief can occur even in the most devoted professional].
1. Professional Incredulity: Iwan Bloch, a contemporary of
Freud, stated:
Children's declarations before the law are, for the truly
experienced knower of children...absolutely worthless and
without significance; all the more insignificant and all
the more hollow the more often the child repeats the
declaration and the more determined he is to stick to his
statements (quoted in Goodwin, 1985, p.4).
Freud originally believed that many of his patients had
suffered from abuse (esp. sexual abuse) in their early
childhood, but he later reversed his belief and came to see
his patients memories as actually representing early fantasies
and conflicts that were still not resolved - fantasies and
conflicts unconsciously disguised as sexual abuse. These are
but examples of the suspicion people (including scientists
such as Freud) have held regarding the existence of abuse.
Such disbelief is still prevalent today. Children who die
because of abuse have usually been referred for child
protective services, but their cases are frequently closed
because no serious problem was believed to exist (Goodwin,
1985; Scott, 1973).
Why such widespread disbelief? Some have argued (Goodwin,
1985) that this disbelief is rooted in our defenses against
our fear, guilt and anger that are associated with child
abuse. Denial and disbelief are effective ways of distancing
oneself from terrifying realities. By placing limits on what
we believe, we maintain for ourselves a more sane and
manageable world (Wilbur, 1985)...
Incredulity protects both the physician and the family
from unpleasant realities, such as investigating the
physical and psychological consequences to the child,
inquiring about other victims, going to Court to protect
the child, or making a commitment to the hundreds of
hours of treatment that may be necessary (Goodwin, 1985,
p.8).
The key credibility issue is this: To what extent can we
believe the child who says abuse has occurred?
2. The Credibility of Children: There is much debate in the
field as to whether what children say should be believed.
[See the entire issue of Journal of Social Issues, 20 (2),
1984 for a look at the competence of children to testify in a
Court]. The fact is, children do tend to be unreliable
sources of information - concerning both themselves and what
is occurring in the world around them.
Children's reports are questioned on a number of grounds:
(i) Developmental Issues - The child has limited
cognitive abilities. In particular, the young child will
often mix fantasy and accounts of actual events. S/he
has limited understanding and vocabulary to express
events.
(ii) Traumatization - It is well known that trauma can
induce distortions into any one's memory for an event.
For children, this seems especially true. Example: In
1976, 23 grade school children were involved in a school
bus kidnapping in California. Three masked men blocked
the road, took over the bus at gunpoint, drove the
children around for 11 hours and then buried the children
in a truck trailer were they stayed for 16 hours before
two of the older boys dug them out. Months after this
event, 14 of the children had major memory distortions of
the event: belief in a forth kidnapper at large, mistakes
about the appearance of the kidnappers, the timing of
events; three of the children even hallucinated entire
scenes (Goodwin, 1985). Child abuse is also a traumatic
experience for a child. The distortions seen in
children's reports have been used, however, to question
the child's credibility.
(iii) Family Context - The credibility of children is
made even more problematic when it is a family member who
has traumatized the child. The child may still have
feelings of love, loyalty, etc toward the abuser. As a
result, there is often a "conspiracy of silence"
(Goodwin, 1985) - the victim denies the abuse, both to
others and to him/ herself. When s/he does admit to the
abuse, guilt often follows, leading to changing ones
story. In addition, children may be coerced and
threatened by family members to remain silent.
3. The Child's Denial: In the face of their own confused
feelings, the family coercion, the disbelief from
professionals and other adults, it is not surprising that as
many as 1/3 of abused children deny the abuse (Goodwin, 1985).
For many children of abuse, they are not so much denying
anything as they are unaware that the parent's behavior is
abnormal - they have nothing to compare their parents to.
Thus, victims of abuse (especially sexual abuse) may not even
mention it to anyone for years.
III. Numbers
Each year, thousands of children are abused, and thousands
more are neglected. Death is not an infrequent consequence (Schwartz &
Johnson, 1985).
1 to 1.9 million children in the U.S. (3.6%) between the ages
3 and 17 are bitten, kicked, or punched by their parents each
year (Oates, 1982).
3% of the parents have threatened or actually used a gun or
knife on their children (Schwartz & Johnson, 1985).
Overall, abuse/neglect victims are young: mean age = 7.4 years
(Wolfe, 1987).
Neglect is more common during infancy and toddlerhood; abuse
becomes more common in older children. The highest rate of
actual physical injury is with children aged 12-17 years.
However, even the most violent abuse does occur with very
young children (Wolfe, 1987).
There is no significant sex difference for abuse and neglect,
except for sexual abuse (where females comprise 85% of the
victims) (Wolfe, 1987).
It is generally agreed that such numbers are probably underestimates -
obscured by denial, secrecy, underreporting, etc...
IV. Course
Let us now turn to the characteristics of the child currently being
abused, as well as the effects of that abuse on the child when s/he
grows up. The characteristics given here are not to imply a single
profile exists for all abused children. However, there is evidence that
suggests that children who face chronic abuse or neglect will suffer
some problems as a result (Farber & Egeland, in press). The following
characteristics have been found to significantly correlate with abuse
and neglect (Martin, 1982; McRae & Longstaffe, 1982):
A. Infancy and Childhood
1. Wounds/Injuries: tissue damage, burns, fractures, brain
injuries, internal organ damage, intracranial bleeding (from
excessive shaking)
2. Health Problems: Largely because of the under-nutrition and
lack of stimulation that these children suffer, numerous
physical problems arise: anemia, infections, dental problems,
vision and hearing deficits, failure to thrive (ie: stunted
physical growth), and in some cases, death.
3. Neuro-developmental disabilities: There is considerable
data that mistreated children are at considerable risk for
mental retardation, brain damage, motor & language delays, and
learning disabilities. It has been found that over 4 times as
many abused and neglected children are in special education
classes than are found in regular classrooms (Martin, 1982).
4. Behavioral and Emotional Problems: Most reports of abused
children identify them as aggressive, hyperactive, poor
impulse control, lacking self-esteem or a positive self-
concept, distrustful, anxious, depressed, possibly suicidal
(reported even in children as young as 8). In some cases,
rather than aggressive and hyperactive, the child may strive
to be overcompliant and passive. In general, the child may
have difficulties in his/her relationships: shy, rejected,
unable to relate to others.
B. Adolescence and Adulthood
Few studies have attempted to follow the abused child into
adulthood. What evidence we do have about the long-term effects of
abuse and neglect indicate that adolescents and adults (although
not all) continue to suffer from various problems (Browne &
Finkelhor, 1986; Martin, 1982; Wilbur, 1985):
delinquency
criminal behavior
drop-outs
teenage pregnancy
social immaturity
low self-esteem
substance abuse
the learning disabilities, etc., of childhood do not
spontaneously disappear, so there are now repeated failures
in work, school, and relationships
psychological disorders (eg: anxiety, depression, dissociative)
V. Etiology
A Problem: Many of the factors that have been identified as
etiologically significant in the development of child abuse and neglect
also occur in families where child abuse/neglect does not occur (Oates,
1982). The picture is far from clear. It is unlikely that there will
be a simple, common-to-all-families explanation of child abuse. There
will be a potentially complex interaction of child, parent, family, and
community variables. In addition, variables suggested as etiologically
significant are actually just correlates of abuse - there is no clear
indication how these variables could actually cause abuse.
A. Child factors
1. Prematurity is associated with abuse/neglect in 12 to 30%
of cases (Oates, 1982; Wolfe, 1987). Why this may lead to
maltreatment may be that prematurity is associated with a higher
degree of birth defects and medical problems. The child stays in
the hospital for extended periods of time (certainly the first
months), and so bonding between the mother and her child is
impaired. The warm attachment that might reduce the likelihood of
abuse is never formed.
2. Physical & mental handicaps in the child are also
associated with up to 70% of the cases (Oates, 1982). Again, such
handicaps may interfere with bonding - the parents may feel guilty,
angry, resentful, etc. Nevertheless, it is difficult to determine
in many of these cases which came first - the handicaps or the
abuse/ neglect. The handicaps may actually be simply the result of
the abuse.
3. Temperament: No longer are infants seen as the proverbial
"blank slate" - shaped solely by the environment. Infants come
into the world with their own unique temperament. Some babies are
simply more difficult to manage: they fuss and scream and cry more
than other babies (McRae & Longstaffe, 1982).
B. Parent factors
1. Behavioral factors: The parents tend to be socially
isolated -few contacts with the extended family or with friends
(Oates, 1982; Wolfe, 1987). There is thus, limited social supports
in times of crisis - no place to get help, feedback, etc.
Other factors include: less communication with the child, a
high rate of negative interactions within the family in general,
marital problems, and inadequate parenting skills (eg: overly
intrusive, inconsistent or chaotic) (Wolfe, 1987).
2. Psychological factors: Parents tend to be unhappy, rigid,
distressed; there is more expressed anger, a low frustration
tolerance (ie: easily upset by the child). They have been
described as immature and dependent, or apathetic and passive. In
particular, the parents often have inappropriate expectations of
the child's needs and abilities (Oates, 1982; Wolfe, 1987).
Examples:
the belief that the infant is intentionally annoying the parent.
the belief that the infant burping and looking away means she
doesn't love the parent.
parents expect the child to meet their own unmet needs (for
love, affection, companionship, friendship)
Combined with the lack of outside supports and thus "reality
testing", such misperceptions and misbeliefs are likely to
continue.
Life stress has also been associated with higher rates of
abuse and neglect. Stresses such as financial problems,
employment, health problems, marital dissatisfaction, etc.
However, what actually seems to be the key is not the amount of
stress (the majority of families who are under stress do not abuse
their children), but rather the parents' perception of greater life
stress (Wolfe, 1987).
C. Cross-generational factors
Parents who grew up in families that were abusive tend to
repeat the abuse with their children - there is a cycle of violence
(Davis & Leitenberg, 1987; Oates, 1982; Wolfe, 1987). A history of
neglect and abuse seems to stand out as a key factor in the
etiology of child abuse (McRae & Longstaffe, 1982). There is at
least an increased predisposition to use abusive methods with ones
own children: an increase of approximately three to five times over
the typical rate of child abuse in the population (Wolfe, 1987).
In particular, the parents perceive their childhood as lacking
affection, having a high degree of rejection and deprivation. One
explanation is that the parents learned what was appropriate
behavior in a family from their own family of origin, and this
includes the use of force.
D. Societal factors
One final factor that may play a role is society's attitudes
toward violence in general. It has been argued that violence is
increasingly accepted as normal in our society (as seen in the
increasingly violent flavor of art, music, films, television, etc)
(Deveson, 1982), and such acceptance serves to legitimize or at
least desensitize us to the use of force with our children. Some
telling numbers: 81% of mothers with infants become sympathetic to
"baby batterers"; of mothers with children 1-4 years 57% have lost
their tempers and hit their child "very hard", and 40% feared one
day they would lose control and truly damage their child; and it's
been estimated that 97% of children are subject to some form of
physical punishment (McRae & Longstaffe, 1987).
VI. Conclusion
Again, it must be emphasized that the majority of parents facing
stress, isolation, or what have you, do not abuse their children.
Indeed, it is undoubtedly normal for a parent to become angry at their
child, especially during times of stress, or if the child is
particularly difficult. In one study, 76% of parents interviewed said
they have stopped themselves from losing their tempers with their
children (by counting to ten, deep breathing, leaving the room, etc)
(Wolfe, 1987). So why do some parents go on to abuse or neglect their
children? It is perhaps the case that abusive parents have no way
(skills, past experiences, social support, etc) to deal with these
normal feelings of frustration and anger.