(Ebook) The Encyclopedia of Child Abuse by Robin E. Clark, Judith Freeman Clark, Christine A. Adamec ISBN 9780816066773, 0816066779
(Ebook) The Encyclopedia of Child Abuse by Robin E. Clark, Judith Freeman Clark, Christine A. Adamec ISBN 9780816066773, 0816066779
CHILD ABUSE
THIRD EDITION
Introduction by
Richard J. Gelles, Ph.D.
The Encyclopedia of Child Abuse, Third Edition
Copyright © 2007, 2001, 1998 by Robin E. Clark and Judith Freeman Clark
All rights reserved. No part of this book may be reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying, recording, or by any information storage or retrieval
systems, without permission in writing from the publisher. For information contact:
Clark, Robin F.
The encyclopedia of child abuse / Robin E. Clark and Judith Freeman Clark with Christine Adamec;
introduction by Richard J. Gelles.—3rd ed.
p. cm.
Includes bibliographical references and index.
ISBN 0-8160-6677-9 (hardcover: alk. paper)
1. Child abuse—United States—Dictionaries. 2. Child abuse—Dictionaries. I. Clark, Judith Freeman.
II. Adamec, Christine A. 1949— III. Title.
HV6626.5.C57 2000
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VB Hermitage 10 9 8 7 6 5 4 3 2 1
Preface v
Acknowledgments vii
Introduction: Child Abuse—An Overview ix
Entries A to Z 1
Appendixes 287
Bibliography 362
Index 369
PREFACE
C hild abuse and neglect have many different
dimensions. Though we often think of child
abuse only in terms of physical violence, various
Space and time considerations forced us to be
selective in choosing the topics we discussed. In
attempting to present an overall view of child
forms of psychological threats, coercion, sexual abuse and neglect, we chose topics that we felt
exploitation and even folk medicine practices can would give the reader a grasp of the central issues.
also produce serious and long-lasting damage. The Information presented in this book comes from
range of actions classified as child abuse or neglect the most up-to-date sources available at the time
is constantly changing as a result of social and eco- of writing. We have attempted to present material
nomic conditions, political ideology, advances in in clear language that does not require specialized
medicine, improvements in communication and knowledge of medicine, law or other disciplines.
melding of cultures. Absence of a single, explicit Our use of “simple” language should not be con-
and universally accepted definition of abuse makes strued as simplistic. We believe professionals and
studies of it difficult. Yet, child abuse and neglect general readers alike will find the book contains a
are not simply cultural inventions. As international wealth of useful information.
concern for the plight of children grows, those Though we have attempted to present child
concerned with preventing abuse and neglect are abuse and neglect from an international perspec-
beginning to find more and more common ground tive, readers will notice that most statistical infor-
for collaboration. mation comes from the United States. This is a
The Encyclopedia of Child Abuse reflects the reflection of the availability of such information
struggle to define, prevent and treat this problem. rather than a statement of relative importance.
Entries reflect the range of disciplines (including In selecting entries, we chose not to include
law, medicine, psychology, sociology, economics, biographies of individuals who have contributed to
history, education and others) that contribute to the understanding and/or prevention of child abuse
our understanding of child maltreatment as well and neglect. The list of these individuals is long,
as the scope of debate within and among disci- and new names are constantly being added. Such
plines. Where there is disagreement on a particu- a listing, though important, is beyond the scope
lar point, we have tried to identify the different of this book. Biographical information is included
arguments. Obviously, it is not possible to present only when it is relevant for the understanding of a
an exhaustive discussion of each of the hundreds particular case, concept or contribution.
of topics included in this book. For those who wish In this third edition of The Encyclopedia of Child
to explore a topic in depth, we make suggestions Abuse, we have both updated older entries and
for further reading at the end of selected entries. included new entries. For example, we offer a
An extensive bibliography is also included at the new entry on abusers, with an analysis of those
back of the book. individuals who neglect or physically or sexu-
v
vi The Encyclopedia of Child Abuse
ally maltreat children. We also offer a new entry well as other churches which discovered incidents
on adults abused as children, because numerous of sexual abuse.
studies have documented that child abuse often Other new entries include bullying, central
has a lifelong effect; for example, adults abused as registries of abuse, guilt and shame, pediatricians
children have a greater risk of substance abuse in and statutory rape. We have also heavily rewrit-
adulthood, as well as risks for psychiatric problems ten many entries, such as burns, civil commitment
such as depression and anxiety disorders. laws, family preservation, fetal alcohol syndrome,
Adults abused as children also have a greater foster care, Munchausen syndrome by proxy,
risk for suicide than individuals who were not parental substance abuse, sexual trafficking and
abused in childhood. Childhood abuse has a long shaken infant syndrome, to name just a few.
reach in its effects, and adults abused as children This third edition includes two new appendixes,
are more likely to be victimized in adulthood with including an appendix on state-by-state laws on
sexual and physical abuse. Not all adults abused as the involuntary termination of parental rights
children grow up to abuse their own children, but and an appendix with state-by-state definitions of
the risk is elevated, and as many as 40% will be abuse, physical abuse, neglect, sexual abuse and
abusive to their children. Without intervention the emotional abuse.
cycle may continue when their children grow up. We hope users of this book will be stimulated
We also offer a new entry on sexual abuse of to learn more about child abuse and neglect. Only
children and adolescents that was perpetrated by through a better understanding of the complex
members of the clergy, peaking in the 1970s to and often misunderstood phenomenon of child
1980s. This discovery shocked millions of people abuse can we hope to prevent it.
worldwide and rocked the Catholic Church, as
ACKNOWLEDGMENTS
O ver the months that the third edition of this
book was researched and written, we con-
tacted dozens of organizations to ask for informa-
Kate Kelly, our former editor, was unfailingly
cheerful throughout all stages of the original proj-
ect; her suggestions were thoughtful and her edito-
tion about child abuse and neglect. In particular, rial comments helpful. Elizabeth Frost Knappmann
staff at the Clearinghouse on Child Abuse and of New England Publishing Associates deserves
Neglect Information; the House of Representatives mention for her efforts on our behalf.
Subcommittee on Children, Youth and Families; Friends and colleagues have been generous with
staff of the American Association for Protect- support and encouragement during the time that
ing Children; and staff of the Incest Survivors we researched and wrote this book. Janet Logan
Resource Network deserve special acknowledg- and Susan Carter Sawyer are among those who
ment. Countless individuals at other public- and were especially helpful to us.
private-sector agencies answered our mail and Members of our family have been patient as
telephone inquiries and sent us statistics and facts we completed our work. We are grateful for their
on hundreds of topics. Although it is impossible to understanding and, in particular, would like to
mention each person by name, a sincere thank- acknowledge the support of our mothers, Martha
you goes to these people for their cooperation and Clark and Elizabeth Bartlett. Finally, a very special
assistance. thanks to Tim and Stephanie.
vii
INTRODUCTION
CHILD ABUSE—AN OVERVIEW
ix
x The Encyclopedia of Child Abuse
comments that “Child abuse thrives in the shad- cal care but also was a center of the moral reform
ows of privacy and secrecy. It lives by inattention” movement on behalf of children (Robin, 1982).
(Bakan, 1971). In the United States, the case of Mary Ellen
Wilson is usually considered the turning point in
concern for children’s welfare. In 1874, the then
The Discovery of Childhood, eight-year-old Mary Ellen lived in the home of
Children and Abuse and Neglect Francis and Mary Connolly but was not the blood
Although abuse and neglect of children was some- relative of either. Mary Ellen was the illegitimate
times condoned, and most of the time occurred daughter of Mary Connolly’s first husband. A
within the intimacy and privacy of the home, social neighbor noticed the plight of Mary Ellen, who
concern for children, their plight and their rights was beaten with a leather thong and allowed to go
coexisted with the occurrence of maltreatment. ill-clothed in bad weather. The neighbor reported
Concern for the rights and welfare of children has the case to Etta Wheeler—a “friendly visitor” who
waxed and waned over the centuries, but there has worked for St. Luke’s Methodist Mission. (In the
always been some attempt to protect children from mid-1800s, child welfare was church-based rather
mistreatment. than government-based.) Wheeler turned to
Six thousand years ago, children in Mesopota- the police and the New York City Department of
mia had a patron goddess to look after them. The Charities for help for Mary Ellen Wilson and was
Greeks and Romans had orphan homes. A variety turned down—first by the police, who said there
of historical accounts mention some form of “fos- was no proof of a crime, and second by the charity
tering” for dependent children. The absolute rights agency, which said they did not have custody of
of parents were limited by legislation. Samuel Rad- Mary Ellen. The legend goes on to note that Henry
bill (1980) reports that child protection laws were Bergh, founder of the Society for the Preven-
enacted as long ago as 450 B.C.E. Attempts were tion of Cruelty to Animals, intervened on behalf
made to modify and restrict fathers’ complete con- of Mary Ellen and the courts accepted the case
trol over their children. Anthropologists note that because Mary Ellen was a member of the animal
virtually all societies have had mores, laws or cus- kingdom. In reality, the court reviewed the case
toms that regulate sexual access to children. because the child needed protection. The case was
The Renaissance marked a new morality regard- argued, not by Henry Bergh, but by his colleague,
ing children. Children were seen as a dependent Elbridge Gerry. Mary Ellen Wilson was removed
class in need of the protection of society. At the same from her foster home and initially placed in an
time, however, the family was expected to teach orphanage. Her foster mother was imprisoned for a
children the proper rules of behavior. Moreover, year, and the case received detailed press coverage
this was a historical period in which the power of for months. In December 1874, the New York Soci-
the father increased dramatically. This dialectic— ety for the Prevention of Cruelty to Children was
concern for children and increased demands and founded (Nelson, 1984; Robin, 1982). This was the
power of parents to control children—has been a first organization that focused on child maltreat-
consistent theme throughout history. ment in the United States.
Defining childhood as a separate stage and chil- Protective societies appeared and disappeared
dren as in need of protection did not reduce the during the next 80 years. The political scientist
likelihood of maltreatment. In Colonial America, Barbara Nelson (1984) notes that by the 1950s
Puritan parents were instructed by leaders, such public interest in child maltreatment was practi-
as Cotton Mather, that strict discipline of children cally nonexistent in the United States (and much
could not begin too early (Greven, 1991). of the world, for that matter). Technology paved
The enlightenment of the 18th century brought the way for the rediscovery of physical child abuse.
children increased attention, services and protec- In 1946, the radiologist John Caffey reported on
tion. The London Foundling Hospital, established six cases of children who had multiple long bone
during the 18th century, not only provided medi- fractures and subdural hematomas (Caffey, 1946).
Introduction xi
It would take nine more years before the medical Child Abuse Prevention and Treatment Act and
profession would begin to accept that such inju- created the National Center on Child Abuse and
ries were the result of actions by children’s care- Neglect (Nelson, 1984). Today, the Office of Child
takers. In 1955, P. V. Wooley and W. A. Evans not Abuse and Neglect remains within the Children’s
only concluded that the X-rays revealed a pattern Bureau and continues to coordinate the federal
of injuries but that the injuries were committed effort to prevent and treat the abuse and neglect of
willfully (Wooley and Evans, 1955). Wooley and children in the United States.
Evans went on to criticize the medical profession
for its reluctance to accept the accumulating evi-
dence that long-bone fractures seen on X-rays were The Definitional Dilemma
indeed inflicted willfully. One of the most enduring problems in the field
In 1958, C. Henry Kempe and his colleagues of child abuse and neglect has been the develop-
formed the first hospital-based child protective ment of a useful, clear, acceptable and accepted
team at Colorado General Hospital in Denver. definition of “abuse” and “neglect.” Defining what
Kempe and his colleagues would publish their is and is not abuse and neglect is at the core of
landmark article, “The Battered Child Syndrome,” research, intervention, prevention and social pol-
in the Journal of the American Medical Association in icy. Researchers must have a definition of abuse
July 1962. Kempe’s and his multidisciplinary col- and neglect in order to engage in the most basic
leagues’ article was accompanied by a strong edi- studies of extent, risk factors and causes. Those
torial on the battered child. The article and the who are required to report child maltreatment
editorial were the beginning of the modern con- need a benchmark or standard to determine what
cern for child abuse and neglect, a concern that should be reported and what should not. And yet,
has grown and expanded both nationally and there still is not a widely accepted definition of
internationally in the past four decades. abuse and neglect. There is considerable variation
across the 50 state definitions that are included in
laws mandating reporting.
Prevention and Treatment Efforts At the core of the definition problem is deciding
The United States Children’s Bureau was founded what constitutes appropriate and inappropriate
in 1912 as an agency in the Department of Labor. parent and caretaker behavior. Is a spanking an
(The bureau was later moved to the newly created appropriate and even necessary method of disci-
Department of Health, Education, and Welfare, plining children, or is it physical abuse? Most peo-
which was subsequently renamed the Department ple agree that an adult having sexual intercourse
of Health and Human Services.) The Children’s with a minor child is sexual abuse. But what if
Bureau was founded by an act of Congress with a the child is 13, 14 or even 17 years of age? Legally
mandate to disseminate information on child devel- a 17-year-old is a child, but if the sex is consen-
opment; it also acquired the budget and mandate to sual, is it abuse? Most people agree that appropri-
conduct research on issues concerning child devel- ate parent behavior includes providing food and
opment. The Children’s Bureau has engaged in a shelter for children. But what if poverty limits a
variety of activities regarding child maltreatment parent’s ability to provide—is this neglect? There
and participated in the earliest national meetings is an infinite set of questions and dilemmas about
on child abuse, sponsored by the Children’s Divi- where to draw the line between appropriate and
sion of the American Humane Association. After acceptable behavior versus inappropriate and
the publication of Kempe and his colleagues’ 1962 unacceptable behavior. There is general agreement
article, the Bureau convened a meeting in 1963 at the extremes as to what is appropriate and inap-
that drafted a model child abuse reporting law. propriate, but the middle area is subject to intense
By 1967, all 50 states and the District of Columbia debate. The debate deepens when we consider cul-
had enacted mandatory reporting laws based on tural variations, both within our own society and
the Bureau’s model. In 1974, Congress enacted the across societies. In some cultures, female genital
xii The Encyclopedia of Child Abuse
cutting (or what is called female circumcision or The most recent authorization of the Child
genital mutilation) is acceptable and even man- Abuse Prevention and Treatment Act, signed into
dated. In the United States, cutting the genitals of law in 2003, defined child abuse and neglect as
females is considered abusive. Male circumcision
is accepted in the United States and many other the term “child abuse and neglect” means, at
nations. a minimum, any recent act or failure to act on
What is defined as abuse and neglect varies the part of a parent or caretaker, which results in
across societies, cultural groups and even across death, serious physical or emotional harm, sex-
historical time. Kempe and his colleagues’ first ual abuse or exploitation, or an act or failure to
focus was restricted to physical abuse, or what act which presents an imminent risk of serious
they called “the battered child.” In the subse- harm;
quent 50 years, as concern for children’s well-
being expanded, so, too, did the definition of the term “sexual abuse” includes
child abuse and neglect. The expansion of the
definition can be seen in changes in how child (A) the employment, use, persuasion, induce-
abuse and neglect have been defined in the Fed- ment, enticement, or coercion of any child to
eral Child Abuse Prevention and Treatment Act. engage in, or assist any other person to engage
In the 1974 version of the law, abuse and neglect in, any sexually explicit conduct or simulation
were defined as: of such conduct for the purpose of producing a
visual depiction of such conduct; or
The physical or mental injury, sexual abuse, neg- (B) the rape, and in cases of caretaker or inter-
ligent treatment, or maltreatment of a child under familial relationships, statutory rape, moles-
the age of eighteen by a person who is responsible tation, prostitution, or other form of sexual
for the child’s welfare under circumstances which exploitation of children, or incest with children;
indicate that a child’s health and welfare is harmed
or threatened thereby (Public Law 93-237). the term “withholding of medically indicated
treatment” means the failure to respond to the
The Child Abuse Prevention and Treatment Act infant’s life-threatening conditions by provid-
of 1984 defined child abuse and neglect as: ing treatment (including appropriate nutrition,
hydration, and medication) which, in the treat-
The physical or mental injury, sexual abuse or ing physician’s or physicians’ reasonable medi-
exploitation, negligent treatment, or maltreat- cal judgment, will be most likely to be effective
ment of a child under the age of eighteen or the age in ameliorating or correcting all such conditions,
specified by the child protection law of the state except that the term does not include the fail-
in question, by a person (including an employee ure to provide treatment (other than appropriate
of a residential facility or any staff person provid- nutrition, hydration, or medication) to an infant
ing out-of-home care) who is responsible for the when, in the treating physician’s or physicians’
child’s welfare under circumstances which indi- reasonable medical judgment —
cate that the child’s health or welfare is harmed or
threatened thereby, as determined in regulations the infant is chronically and irreversibly coma-
prescribed by the Secretary. tose; the provision of such treatment would —
the provision of such treatment would be vir- harm does not meet this definition), and prevent-
tually futile in terms of the survival of the able (the action could have been prevented).”
infant and the treatment itself under such
circumstances would be inhumane
The Extent of Child Abuse and
Source: (U.S.C. Title 42, Chapter 67, Subchapter Neglect
I, § 5106g) As explained in the previous section, child abuse
and neglect is a general term that covers a wide
That the federal government has a legal defini- range of acts of commission and omission, either
tion of child abuse and neglect still does not set- carried out by a child’s caretaker or allowed to hap-
tle the matter. First, each state has its own legal pen, that result in a range of injuries ranging from
definition of child maltreatment and those defini- death, to serious disabling injury, to emotional dis-
tions do vary. Second, child welfare caseworkers tress, to malnutrition and illness.
and family and juvenile court judges vary in how Child abuse and neglect can take many and var-
they apply the state definitions during the course ied forms. The Office on Child Abuse and Neglect
of child abuse and neglect investigations and court classifies the various forms of maltreatment into
actions. Thirdly, researchers must “operational- six major types (see National Center on Child
ize” the definitions; that is, they must determine Abuse and Neglect [NCCAN], 1988):
how they will actually measure child abuse and
neglect. Here too, there is considerable variation 1. Physical Abuse: Acts of commission that result in
in how the concept “child abuse and neglect” is physical harm, including death, to a child.
operationally defined. Finally, legal definitions 2. Sexual Abuse: Acts of commission including
and research operationalizations do not result in intrusion or penetration, molestation with
definitions that can be applied across cultures and genital contact or other forms of sexual acts in
subcultures. which children are used to provide sexual grat-
All of the above problems actually arise out of ification for a perpetrator.
the fact that there is no universal standard for what 3. Emotional Abuse: Acts of commission that include
constitutes optimal child rearing. Thus, there is no confinement, verbal or emotional abuse or other
universal standard for what constitutes child abuse types of abuse such as withholding sleep, food
and neglect (Korbin, 1981). David Finkelhor and or shelter.
Jill Korbin (1988) propose that a definition of child 4. Physical Neglect: Acts of omission that involve
abuse and neglect that could be applied across sub- refusal to provide health care, delay in provid-
cultures and cultures should have two objectives: ing health care, abandonment, expulsion of a
(1) it should distinguish child abuse clearly from child from a home, inadequate supervision,
other social, economic and health problems; and failure to meet food and clothing needs, and
(2) it should be sufficiently flexible to apply to a conspicuous failure to protect a child from haz-
range of situations in a variety of social and cul- ards or danger.
tural contexts. The later recommendation is a cau- 5. Educational Neglect: Acts of omission and com-
tion that some of what is considered child abuse in mission that include permitting chronic tru-
Western societies has very little meaning in other ancy, failure to enroll a child in school and
societies and vice versa. inattention to specific education needs.
Finkelhor and Korbin (1988) propose the fol- 6. Emotional Neglect: Acts of omission that involve
lowing definition of child abuse and neglect for failing to meet the nurturing and affection
cross-cultural research and study: “Child abuse is needs of a child, exposing a child to chronic or
the portion of harm to children that results from severe spouse abuse, allowing or permitting a
human action that is proscribed (negatively val- child to use alcohol or controlled substances,
ued), proximate (the action is close to the actual encouraging the child to engage in maladap-
harm—thus deforesting land that results in child tive behavior, refusal to provide psychological
xiv The Encyclopedia of Child Abuse
care, delays in providing psychological care and ESTIMATES OF THE TOTAL NUMBER OF MALTREATED
CHILDREN, 1993
other inattention to the child’s developmental
needs. Maltreatment Type Total Number of Cases
conducted by Murray Straus and his colleagues, Finkelhor and his colleagues conducted a
interviewed two nationally representative samples national survey of child victimization in 2002–03
of families: 2,146 family members in 1976 (Straus, (Finkelhor, Ormrod, Turner and Hamby, 2005).
Gelles and Steinmetz, 1980) and 6,002 family The survey collected data on children from two to
members in 1985 (Gelles and Straus, 1988). The 17 years of age. Interviews were conducted with
surveys measured violence and abuse by asking parents and youth. Slightly more than one in
respondents to report their behaviors toward their seven children (138 per 1,000) experienced child
children during the previous 12 months. “Mild” maltreatment. Emotional abuse was the most fre-
forms of violence, such as that thought of as “phys- quent type of maltreatment. The rate of physical
ical punishment” by most people, was the type abuse (meaning that children experienced physical
reported most commonly. More than 80% of the harm) was 15 per 1,000, while the rate of neglect
parents/caregivers of children three years to nine was 11 per 1,000. The overall projected extent of
years of age reported hitting their children at least maltreatment was 8,755,00 child victims (Finkel-
once during the previous year. Among older chil- hor, Ormrod, Turner and Hamby, 2005).
dren, the reported rates were lower: 67% of the An examination of NCANDS’s data on reports
parents/caregivers of preteens and young adoles- of child maltreatment reveals that the number
cents reported hitting their youngsters during the of sustantiated reports of sexual abuse cases has
previous year and slightly more than 33% of care- declined 40% from 1992 to 2000—from 150,000
givers/parents of teenagers 15 years to 17 years of cases to 89,500 cases (Finkelhor and Jones, 2004).
age reported hitting their adolescents during the There are a number of plausible explanations for
prior year. this drop, and, in fact, there are probably many
Even with the most severe forms of violence, factors that led to the decline. However, Finkelhor
the reported rates were surprisingly high. Slightly and Jones conclude that at least part of the decline
more than 20 parents in 1,000 admitted to engag- is due to a true overall decline in the occurrence of
ing in an act of “abusive violence” during the year child sexual abuse.
prior to the 1985 survey. Abusive violence, which Child Homicide. NCANDS estimated that
was defined as an act that had a high probabil- 1,500 children were killed by parents or caregivers
ity of injuring the child, included kicking, biting, in 2004 (U.S. Department of Health and Human
punching, beating, hitting or trying to hit a child Services, 2006). Expressed in rates, 2.03 children
with an object, burning or scalding, and threaten- per 100,000 children under 18 years of age are vic-
ing to use or using a gun or a knife. Seven chil- tims of fatal child abuse and neglect. This rate is
dren in 1,000 were hurt as the result of an act of slightly higher than the rate of 1.84 in 2000. Forty-
violence directed at them by a parent or caregiver five percent of child maltreatment fatalities were
during the previous year. Based on these find- children under the age of one, while 38% of the
ings, it is projected that 1.5 million children in victims were between one and three years of age.
the United States under the age of 18 years who Nearly 78% of the perpetrators were either one or
live with one or both parents are victims of acts of both parents.
abusive physical violence each year, and 450,000 The varied estimates of the prevalence of child
children are injured annually as a result of paren- abuse and neglect most likely underestimate the
tal violence. true extent of child maltreatment. Given that care-
In a more recent telephone survey of 900 par- takers carry out most maltreatment in the privacy
ents regarding children’s experiences with violence of the home, much abuse and neglect goes unde-
in the home, more than 28% of parents of two- to tected. Moreover, the lack of a cultural consensus
eight-year-old children reported using an object about which acts constitute abuse and neglect and
to spank their child’s bottom (Straus and Stewart, which acts are designated appropriate discipline
1999). Nearly three-quarters (74%) of children techniques makes it difficult to assess the true
under the age of five years had been hit or slapped level of the mistreatment of children. The above
by their parent(s) (Straus and Stewart, 1999). estimates of maltreatment, including the estimate
xvi The Encyclopedia of Child Abuse
of child homicide, should be considered a lower Income. Although most poor parents do not
boundary of the full extent of abuse and neglect in abuse or neglect their children, self-report sur-
the United States. veys and official report data find that the rates of
child maltreatment, with the exception of sexual
abuse, are higher for those whose family incomes
Risk and Protective Factors are below the poverty line than for those whose
The first research articles on child abuse and income is above the poverty line. (Pelton, 1994;
neglect characterized offenders as suffering from Waldfogel, 1998)
various forms of psychopathology (see for example, However, the impact of poverty varies by the
Bennie and Sclare, 1969; Galdston, 1965; Steele age of the child victim and the type of abuse. Child
and Pollock, 1974). Thus, the initial approach to abuse rates are higher for infants who live in high-
explaining, understanding and treating maltreat- poverty counties compared to infants growing up
ment was to identify the personality or character in low-poverty counties (Wulczyn, Barth, Yuan,
disorders that were thought to be associated with Harden and Landsverk, 2005). The county poverty
abuse and neglect. There were many methodologi- rate made less of a difference in terms of maltreat-
cal problems that limited studies that attempted ment for children older than one year of age. Liv-
to develop psychological profiles of caretakers ing in a high-poverty county increased the risk
who maltreated their children. Most early studies of physical abuse for all children, irrespective of
had small samples and no, or inappropriate, com- age; however, only one-year-olds had significantly
parison groups. Collectively, the studies failed to higher rates of neglect in high-poverty versus low-
develop a consistent profile of abusers. poverty counties. For children older than one, the
Current theoretical approaches tend to recog- poverty rate of a county did not make a large dif-
nize the multidimensional nature of abuse and ference in terms of the risk of child neglect.
neglect and locate the roots of child maltreatment Race. Both official report data and self-report
in psychological, social, family, community and survey data often report that child abuse is over-
societal factors. represented among minorities. However, both the
Researchers have identified both risk and pro- second and the third study of the National Inci-
tective factors for abuse and neglect. The following dence and Prevalence of Child Abuse and Neglect
are the major risk and protective factors: (National Center on Child Abuse and Neglect,
Age. One of the most consistent risk factors 1988; 1996) found no significant relationship
is the age of the offender. According to NCANDS between the incidence of maltreatment and the
data on reported and investigated child maltreat- child’s race/ethnicity. There was no significant
ment, the modal age of perpetrators is 30 to 39. relationship for any of the subcategories of mal-
However, the modal age for female perpetrators— treatment. NCANDS data and the two National
mostly mothers—is 20 to 29 (U.S. Department of Family Violence Surveys, however, found stronger
Health and Human Services, 2006). relationships between race/ethnicity and violence
Sex. Mothers are the most likely offenders toward children. According to the most recent
in acts of child homicide, accounting for 31.3% NCANDS data, African-American children expe-
of all child homicide perpetrators in 2004 (U.S. rienced the highest rates of maltreatment (19.9
Department of Health and Human Services, per 1,000), followed by Pacific Island (17.6), and
2006). Women were the perpetrators in 57.8% of Native American children (15.5). The lowest rates
child maltreatment homicides (U.S. Department were for whites (10.7), Hispanic (10.4), and Asian
of Health and Human Services, 2006). Of course, children (2.9) (U.S. Department of Health and
women’s higher rate of fatal and nonfatal abuse Human Services, 2006).
and neglect is not surprising, given that women Wulczyn and his colleague’s (Wulczyn, Barth,
spend more time caring for children and are del- Yuan, Harden and Landsverk, 2005) found a much
egated far more responsibility for raising children more nuanced relationship between multiple vari-
than men. ables in their examination of NCANDS data. Here
Introduction xvii
again, age was a major factor in differentiating the The intergenerational transmission of
risk of child maltreatment. The rate of maltreat- violence. The notion that abused children grow up
ment for African-American children, one year of to be abusing parents and violent adults has been
ago and living in high-poverty counties, was signif- widely expressed in the child abuse and family
icantly higher than the rate for white or Hispanic violence literature (Gelles, 1980). Kaufman and
children. However, for older children, the race of a Zigler (1987) reviewed the literature that tested
child was not a major risk predictor (although the the hypothesis of intergenerational transmission
rate of victimization was still highest for African- of violence toward children and concluded that the
American children). The same age-specific pattern best estimate of the rate of intergenerational trans-
was found in the low-poverty counties; however, mission appears to be 30% (plus or minus 5%).
here the rate for older African-American chil- Although a rate of 30% is substantially less than
dren was higher than for older white or Hispanic the majority of abused children, the rate is consid-
children. erably more than the 2–4% rate of abuse found in
the general population (Straus and Gelles, 1986;
Widom 1989). Egeland and his colleagues (Ege-
Situational and Environmental land, Jacobvitz and Papatola, 1987) examined con-
Factors tinuity and discontinuity of abuse in a longitudinal
Stress. Unemployment, financial problems, study of high-risk mothers and their children. They
being a single parent, being a teenage mother and found that mothers who had been abused as chil-
sexual difficulties are all factors that are related to dren were less likely to abuse their own children if
child maltreatment, as are a host of other stressor they had emotionally supportive parents, partners
events (Burrell, Thompson and Sexton, 1994; Gelles or friends. In addition, the abused mothers who did
and Straus, 1988; Gelles, 1989; Parke and Collmer, not abuse their children were described as “middle
1975; Straus et al., 1980). class” and “upwardly mobile,” suggesting that they
Social isolation and social support. The data on were able to draw on economic resources that may
social isolation are somewhat less consistent than not have been available to the abused mothers who
are the data for the previously listed risk factors. did abuse their children.
First, because so much of the research on child Evidence from studies of parental violence indi-
abuse and neglect is cross-sectional, it is not clear cates that although experiencing violence in one’s
whether social isolation precedes maltreatment or family of origin is often correlated with later violent
is a consequence of it. Second, social isolation has behavior, such experience is not the sole determin-
been crudely measured and the purported cor- ing factor. When the intergenerational transmis-
relation may be more anecdotal than statistical. sion of violence occurs, it is likely the result of a
Nevertheless, researchers often agree that parents complex set of social and psychological process.
who are socially isolated from important sources
of social support are more likely to maltreat their
children. (Wolfe and St. Pierre, 1989) Part of the Research on Victims
explanation for the correlation between social iso- Compared to research on offenders, there has been
lation and child maltreatment may be the poor somewhat less research on victims of child abuse
social skills of the caregivers (Azar, Povilaitis, and neglect that focuses on factors that increase or
Lauretti and Pouquette, 1998). reduce the risk of victimization. Most research on
Social support appears to be an important pro- victims examines the consequences of victimiza-
tective factor. One major source of social support is tion (e.g., depression, psychological distress, sui-
the availability of friends and family for help, aid cide attempts, symptoms of post-traumatic stress
and assistance. The more a family is integrated into syndrome, etc.) or the effectiveness of various
the community and the more groups and associa- intervention efforts.
tions they belong to, the less likely they are to be The very youngest children are at the greatest
violent (Straus et al., 1980). risk of being abused, especially by lethal forms of
xviii The Encyclopedia of Child Abuse
violence (U.S. Department of Health and Human ual victimization and age is also associated with
Services, 2006; Wulczyn, Barth, Yuan, Harden family structure and race.
and Landsverk, 2005). However, older children are
at the greatest risk of nonlethal physical abuse and
the youngest children (one to three years of age) Explaining the Abuse and Neglect of Children
have the highest rate of being reported for child Risk and protective factors do not, in and of them-
neglect (U.S. Department of Health and Human selves, explain why parents and caretakers abuse
Services, 2006). and neglect their children. The earliest explanatory
Early research suggested that there were a num- theories and models focused on intra-individual fac-
ber of factors that raise the risk of a child being tors to explain maltreatment. These models included
abused. Low birth weight babies (Parke and Coll- a psychopathological explanation that explained
mer, 1975), premature children (Elmer, 1967; New- abuse and neglect as a function of individual psy-
berger et al., 1977; Parke and Collmer, 1975; Steele chopathology. Other models proposed that maltreat-
and Pollock, 1974) and handicapped, retarded or ment arose out of mental illness or the use and abuse
developmentally disabled children (Friedrich and of alcohol and illicit drugs.
Boriskin, 1976; Gil, 1970; Steinmetz, 1978) were Later theories added social, cultural and envi-
all described as being at greater risk of being abused ronmental factors to the models. The major multi-
by their parents or caretakers. However, a review dimensional models include:
of studies that examines the child’s role in abuse Social learning theory. Social learning theory
calls into question many of these findings (Starr, proposes that individuals who experienced abuse
1988). One major problem is that few investigators and neglect as children are more likely to maltreat
used matched comparison groups. Secondly, newer their own children than individuals who experi-
studies fail to find premature or handicapped chil- enced no abuse or neglect. Children who either
dren at higher risk for abuse (Egeland and Vaughan, experience abuse themselves or who witness vio-
1981; Starr et al., 1984). lence between their parents are more likely to use
violence when they grow up. This finding has been
interpreted to support the idea that family violence
Factors Associated with Sexual and caretaking is learned. The family is the institu-
Abuse of Children tion and social group where people learn the roles
There has been a great deal of research on the of husband and wife, parent and child. The home
characteristics of sexual abusers, but current is the prime location where people learn how to
research has failed to isolate characteristics, espe- deal with various stresses, crises and frustrations.
cially demographic, social or psychological charac- In many instances, the home is also the site where
teristics, that discriminate between sexual abusers a person first experiences violence and abuse. Not
and nonabusers (Black, Heyman and Slep, 2001; only do people learn violent behavior, but also they
Quinsey, 1984). learn how to justify being violent. For example,
One of the key questions raised in discussions hearing father say “this will hurt me more than it
about sexual abuse is whether all children are at will hurt you,” or mother say, “you have been bad,
risk for sexual abuse or whether some children, so you deserve to be spanked,” contributes to how
because of some specific characteristic (e.g., age children learn to justify violent behavior.
or poverty status), are at greater risk than others Social situational/stress and coping theory. So-
are. Current research is unclear as to definitive cial Situational/Stress and Coping Theory explains
factors that can predict future sexual abuse. Fin- why maltreatment occurs in some situations and
kelhor, Moore, Hamby and Straus (1997) found not others. The theory proposes that abuse and
that a child’s sex does not necessarily predict later neglect occur because of two main factors. The
victimization. However, Sedlak (1997) asserts that first is structural stress and the lack of coping
female children are at an increased risk for sexual resources in a family. For instance, the association
abuse, and the relationship between a child’s sex- between low income and child abuse indicates that
Introduction xix
an important contributor to the risk of abuse is tion is that natural selection is the process of dif-
inadequate financial resources. The second factor ferential reproduction and reproductive success
is the cultural norm concerning the use of force (Daly and Wilson, 1980). Males can be expected
and violence. In contemporary American society, to invest in offspring when there is some degree
as well as many societies, violence in general, and of parental certainty (how confident the parent is
violence toward children in particular is norma- that the child is their own genetic offspring), while
tive (Straus, 1994). Thus, individuals learn to use females are also inclined to invest under condi-
violence both expressively and instrumentally as a tions of parental certainty. Parents recognize their
means of coping with a pileup of stressor events. offspring and avoid squandering valuable repro-
Ecological theory. Garbarino (1977) and Bel- ductive effort on someone else’s offspring. Thus,
sky (1980; 1993) propose an ecological model to Daly and Wilson (1985) conclude that parental
explain the complex nature of child maltreatment. feelings are more readily and more profoundly
The ecological model proposes that violence and established with one’s own offspring than in cases
abuse arise out of a mismatch of parent to child where the parent-offspring relationship is artifi-
or family to neighborhood and community. For cial. Children not genetically related to the par-
example, parents who are under a great deal of ent (e.g., stepchildren, adopted or foster children)
social stress and have poor coping skills may have or children with low reproductive potential (e.g.,
a difficult time meeting the needs of a child who handicapped or retarded children) are at the high-
is hyperactive. The risk of abuse and violence est risk for infanticide and abuse (Burgess and
increases when the functioning of the children Garbarino, 1983; Daly and Wilson, 1980; Hrdy,
and parents is limited and constrained by devel- 1979). Large families can dilute parental energy
opmental problems such as children with learn- and lower attachment to children, thus increas-
ing disabilities and social or emotional handicaps, ing the risk of child abuse and neglect. (Burgess &
and when parents are under considerable stress Drais-Parrillo, 2004).
or have personality problems, such as immaturity Attachment Theory. Attachment theory des-
or impulsiveness. Finally, if there are few institu- cribes the propensity of individuals to form a
tions and agencies in the community to support strong emotional bond with a primary caregiver
troubled families, then the risk of abuse is further who functions as a source of security and safety
increased. (Bowlby, 1973). The theory proposes that there is a
Exchange theory. Exchange theory proposes clear association between early attachment expe-
that child rearing and child abuse is governed by riences and the pattern of affectionate bonds one
the principle of costs and benefits. Abuse is used makes throughout one’s lifetime. If an individual
when the rewards are perceived as greater than has formed strong and secure attachments with
the costs (Gelles, 1983). The private nature of the early caregivers, later adult relationships will also
family, the reluctance of social institutions and have secure attachments. On the other hand, if an
agencies to intervene—in spite of mandatory child individual has formed insecure, anxious or ambiv-
abuse reporting laws—and the low risk of other alent attachments early on, later adult attachments
interventions reduce the costs of abuse and neglect. will be replicated similarly. Therefore, accord-
The cultural approval of violence as both expres- ing to the theory, attachment difficulties under-
sive and instrumental behavior raises the potential lie adulthood relational problems. Bowlby (1988)
rewards for violence. The most significant reward posits that anxiety and anger go hand-in-hand
is social control, or power. as responses to risk of loss and that anger is often
Sociobiology theory. A sociobiological, or evo- functional. For certain individuals with weak and
lutionary perspective of child maltreatment, sug- insecure attachments, the functional reaction to
gests that the abuse and neglect of human or anger becomes distorted and is manifested by vio-
nonhuman primate offspring is the result of the lent acts against one’s partner.
reproductive success potential of children and A model of sexual abuse. Finkelhor (1984)
parental investment. The theory’s central assump- reviewed research on the factors that have been
xx The Encyclopedia of Child Abuse
proposed as contributing to sexual abuse of children Ystgaard, Hestetun, Loeb and Mehlum (2004)
and developed what he calls the “Four Precondi- report that physical and sexual abuse are signifi-
tion Model of Sexual Abuse.” His review suggests cantly and independently associated with repeated
that all the factors relating to sexual abuse can be suicide attempts. In other words, physical and
grouped into one of four preconditions that must sexual abuse increase the risk of suicide attempts,
be met before sexual abuse can occur. The precon- even when controlling for other adverse events
ditions are: and situations children experience.
Research on the consequences of sexual abuse
1. A potential offender needs to have some moti- finds that inappropriate sexual behavior, such as
vation to abuse a child sexually. frequent and overt sexual stimulation and inap-
2. The potential offender has to overcome internal propriate sexual overtures to other children, are
inhibitions against acting on that motivation. commonly found among victims of sexual abuse
3. The potential offender has to overcome external (Kendall-Tackett et al., 1993). Roberts and his
impediments to committing sexual abuse. colleagues (Roberts, O’Connor, Dunn, Golding
4. The potential offender or some other factor has et. al., 2004) conducted a longitudinal study of
to undermine or overcome a child’s possible 8,292 families and found that sexual abuse expe-
resistance to sexual abuse. rienced before age 13 was associated with poorer
psychological well-being, teenage pregnancy and
Summary. The intra-individual models of child adjustment problems in the victim’s own children.
abuse and neglect dominated the first decade Widom (1995) has found that people who were
of research, practice and policy. Although some sexually abused during childhood are at higher risk
professions still subscribe to psychopathological of arrest for committing crimes as adults, includ-
explanations for child maltreatment, such narrow ing sex crimes, compared to people who did not
models eventually gave way to more multidimen- suffer sexual abuse. However, this risk is no greater
sional approaches that included psychopathology, than the risk of arrest for victims of other child-
but also considered social, environmental and cul- hood maltreatment, with one exception: Victims
tural factors. Current theoretical approaches tend of sexual abuse are more likely to be arrested for
to be based on the ecological model of child mal- prostitution than other victims of maltreatment.
treatment (National Research Council, 1993). As noted in the discussion of the extent of child
maltreatment, child neglect is by far the most
common form of maltreatment. While the more
The Consequences of Maltreatment dramatic forms of maltreatment—physical abuse
The consequences of child abuse and neglect differ and sexual abuse—receive considerable attention
by the age of the child. During childhood some of in terms of the impact on children, there is far
the major consequences of maltreatment include less research, and even concern, for the impact of
problematic school performance and lowered the chronic form of maltreatment: child neglect.
attention to social cues. Researchers have found Hildyard and Wolfe (2002) reviewed the research
that children whose parents are “psychologically on the impact of child neglect and find consider-
unavailable” function poorly across a wide range able support for the conclusion that child neglect
of psychological, cognitive and developmental produces significant developmental problems for
areas (Egeland and Sroufe, 1981). Physical aggres- child victims. Neglect has a deleterious effect on
sion, antisocial behavior and juvenile delinquency children’s cognitive, socioemotional and behav-
are among the most consistently documented con- ioral development. The earlier in life a child is
sequences of abuse in adolescence and adulthood neglected, the more comprised the child’s develop-
(Aber et al., 1990; Dodge et al., 1990; Widom, ment. The impact of neglect is somewhat unique,
1989a; 1989b; 1991). Evidence is more suggestive producing more severe cognitive and academic
that maltreatment increases the risk of alcohol and deficits, social withdrawal and limited peer inter-
drug problems (National Research Council, 1993). actions. Victims of neglect tend to internalize the
Introduction xxi
impact of that neglect as opposed to externalizing investigate to determine if the child is in need of
through aggressive and violent behavior (Hildyard protection and if the family is in need of help or
and Wolfe, 2002). assistance. Although a wide array of options are
As severe and significant as the consequences available to child protection workers, they typically
of child abuse and neglect are, it is also important have two basic ways to protect a victim of child
to point out that the majority of children who are abuse: (a) removing the child and placing him or
abused and neglected do not show signs of extreme her in a foster home or institution; or (b) providing
disturbance. Despite having been physically, psy- the family with social support, such as counseling,
chologically or sexually abused, many children food stamps, day care services, etc.
have effective coping abilities and thus are able to Neither solution is ideal, and there are risks in
deal with their problems better than other mal- both. For instance, a child may not understand
treated children. There are a number of protective why he or she is being removed from the home.
factors that insulate children from the effects of Children who are removed from abusive homes
maltreatment. These include: high intelligence and may be protected from physical damage, although
good scholastic attainment; temperament; cogni- some children are abused and killed in foster
tive appraisal of events—how the child views the homes and residential placements. Abused chil-
maltreatment; having a healthy relationship with dren frequently require special medical and/or
a significant person; and the type of interventions, psychological care and it is difficult to find a suit-
including placement outside of the home (National able placement for them. They could well become
Research Council, 1993). a burden for foster parents or institutions that
have to care for them. Therefore, the risk of abuse
might even be greater in a foster home or institu-
Witnessing Domestic Violence tion than in the home of the natural parents. In
Children who witness domestic violence are a addition, removal may cause emotional harm. The
unique population warranting research and clini- emotional harm arises from the fact that abused
cal attention (Rosenberg and Rossman, 1990). children still love and have strong feelings for
Witnessing is at the intersection of child abuse and their parents and do not understand why they
neglect and domestic violence. Researchers and have been removed from their parents and homes.
clinicians report that children who witness acts of Often, abused children feel that they are respon-
domestic violence experience negative behavioral sible for their own abuse.
and developmental outcomes, independent of any Leaving children in an abusive home and pro-
direct abuse or neglect that they may also experi- viding social services involves another type of risk.
ence from their caretakers (Jaffe, Wolfe and Wil- Most protective service workers are overworked,
son, 1990; Osofsky, 1995; Rosenberg and Rossman, undertrained and underpaid. Family services,
1990). Estimates from the two National Family such as substance abuse treatment, crisis day
Violence Surveys are that between 1.5 million and care, financial assistance and suitable housing
3.3 million children three to 17 years of age are and transportation services, are limited. This can
exposed to domestic violence each year (Gelles and lead to cases where children who were reported as
Straus, 1988; Straus, Gelles and Steinmetz, 1980). abused, investigated and supervised by state agen-
cies are killed during the period when the family
was supposedly being monitored. Half of all chil-
Prevention and Treatment dren who are killed by caretakers are killed after
As noted earlier, all 50 states had enacted man- they have been reported to child welfare agencies
datory reporting laws for child abuse and neglect (Gelles, 1996).
by the late 1960s. These laws require certain pro- Only a handful of evaluations have been made
fessionals (or in some states, all adults) to report of prevention and treatment programs for child
cases of suspected abuse or neglect. When a report maltreatment. In Elmira, New York, Olds and his
comes in, state or local protective service workers colleagues (1986) evaluated the effectiveness of
xxii The Encyclopedia of Child Abuse
a family support program during pregnancy and Council report did come to the following conclu-
for the first two years after birth for low-income, sion regarding social service interventions:
unmarried, teenage first-time mothers. Nineteen
percent of a sample of poor unmarried teenage Social service interventions designed to improve
girls who received no services during their preg- parenting practices and provide family support have
nancy period was reported for subsequent child not yet demonstrated that they have the capacity to
maltreatment. Of those children of poor, unmar- reduce or prevent abusive or neglectful behaviors
ried, teenage mothers who were provided with significantly over time for the majority of families
the full compliment of nurse home visits during who have been reported for child maltreatment
the mother’s pregnancy and for the first two years (National Research Council, 1998, p. 118).
after birth, 4% had confirmed cases of child abuse
and neglect reported to the state child protection Thus, while we have made great strides in iden-
agency. Subsequent follow-ups by the home health tifying child abuse and neglect as a social problem,
visiting intervention worker demonstrated the and we have developed numerous programs to
long-term effectiveness of this intervention. How- attempt to treat and prevent abuse and neglect, we
ever, the effectiveness varied depending on the still have much to learn about what causes parents
populations receiving the service, the community and caretakers to abuse their children and what
context and who made the visits (nurses or others) steps society must take to prevent the maltreat-
(Olds, Henderson, Kitzman, Eckenrode, Cole and ment of children.
Tatelbaum, 1999).
Daro and Cohn (1988) reviewed evaluations of —Richard J. Gelles, Ph. D.,
88 child maltreatment programs that were funded Dean
by the federal government between 1974 and 1982. Joanne and Raymond Welsh Chair of Child
They found that there was no noticeable correla- Welfare and Family Violence
tion between a given set of services and the likeli- Director, Center Research on Youth and Social Policy
hood of further maltreatment of children. In fact, Director, Ortner-Unity Program on Family Violence
the more services a family received, the worse the Codirector, Field Center for Children’s Policy,
family got and the more likely children were to be Practice, and Research, School of Social Policy
maltreated. Lay counseling, group counseling and & Practice
parent education classes resulted in more positive University of Pennsylvania, Philadelphia
treatment outcomes. The optimal treatment period
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National Research Council. Understanding Child Abuse and and M. Demorest. “The contribution of handicapping
Neglect. Washington, D.C.: National Academy Press, conditions to child abuse.” Topics in Early Childhood Spe-
1993. cial Education 4 (1984): 55–69.
———. Violence in families: Assessing prevention and treat- Starr, R. H., Jr. “Physical abuse of children.” In V. B. Van
ment programs. Washington, D.C.: National Academy Hasselt, R. L. Morrison, A. S. Bellack, and M. Hersen,
Press, 1998. eds. Handbook of Family Violence. New York: Plenum,
Nelson, B. J. Making an Issue of Child Abuse: Political Agenda 1988, pp. 119–155.
Setting for Social Problems. Chicago: University of Chi- Steele, B. F., and C. Pollock. “A psychiatric study of par-
cago Press, 1984. ents who abuse infants and small children.” In R. Heif-
Newberger, E., R. Reed, J. H. Daniel, J. Hyde, and M. Ko- er and C. H. Kempe, eds. The Battered Child. Chicago:
telchuck. “Pediatric social illness: Toward an etiologic University of Chicago Press, 1968, pp. 103–137.
classification.” Pediatrics 60 (1977): 178–185. Steele, B. F., and C. Pollock. “A psychiatric study of par-
Olds, D. L., C. R. Henderson Jr., R. Tatelbaum, and R. ents who abuse infants and small children.” In R.
Chamberlin. “Preventing child abuse and neglect: A Heifer and C. Kempe, eds. The Battered Child. 2nd ed.
randomized trial of nurse home visitation.” Pediatrics Chicago: University of Chicago Press, pp. 89–134.
77 (1986): 65–78. Steinmetz, S. K, “Violence between family members.”
Olds, D. L., C. R. Henderson, H. J. Kitzman, J. J. Ecken- Marriage and Family Review 1 (1978): 1–16.
rode, R. E. Cole, and R. C. Tatelbaum. “Prenatal and Straus, M. A. Beating the Devil out of Them: Corporal Punish-
infancy home visitation by nurses: Recent findings.” ment in American Families. New York: Lexington Books,
The Future of Children 9 (1999): 44–65. 1994.
Parke, R. D., and C. W. Collmer. “Child abuse: An inter- Straus, M. A., and R. J. Gelles. “Societal change and
disciplinary analysis.” In M. Hetherington, ed. Review change in family violence from 1975 to 1985 as re-
of Child Development Research. Vol. 5. Chicago: Univer- vealed in two national surveys.” Journal of Marriage
sity of Chicago Press, pp. 1–102. and the Family 48 (1986): 465–479.
Introduction xxv
Straus, M. A., R. J. Gelles, and S. K. Steinmetz. Behind ———. “Child abuse, neglect, and violent criminal be-
Closed Doors: Violence in the American Family. New York: havior.” Criminology 27 (1989b): 251–271.
Doubleday/Anchor, 1980. ———. Victims of Childhood Sexual Abuse—Later Criminal
Ten Bensel, R. L., M. Rheinberger, and S. X. Radbill. Consequences. National Institute of Justice research in
“Children in a world of violence: The roots of child brief. Washington, D.C.: U.S. Department of Justice
maltreatment.” In M. E. Heifer, R. S. Kempe, and R. Office of Justice Programs, 1995.
D. Krugman, eds. The Battered Child. 4th ed. Chicago: Wolfe, D. A., and St. Pierre, J. “Child abuse and neglect.”
University of Chicago Press, 1997, pp. 3–28. In T. H. Ollendick and M. Hersen, eds. Handbook of
U.S. Advisory Board on Child Abuse and Neglect. A Na- Child Psychotherapy. 2nd ed. New York: Plenum Press,
tion’s Shame: Fatal Child Abuse and Neglect in the United 1989, pp. 377–398.
States. Washington, D.C.: U.S. Department of Health Wooley, P., and W. Evans. “Significance of skeletal lesions
and Human Services, 1995. resembling those of traumatic origin.” Journal of the
U.S. Department of Health and Human Services, Admin- American Medical Association 158 (1955): 539–543.
istration on Children, Youth and Families. Child Mal- Wulczyn, F., R. P. Barth, Y. Y. Yuan, B. J. Harden, and
treatment 1996: Reports from the States to the National Child J. Landsverk. Beyond Common Sense: Child Welfare, Child
Abuse and Neglect Data System. Washington, D.C.: U.S. Well-being and the Evidence for Policy Reform. New Bruns-
Government Printing Office, 1998. wick, N.J.: Aldine/Transaction, 2005.
Waldfogel, J. The Future of Child Protection: How to Break Ystgaard, M., Hestetun, I., Loeb, M., and Mehlum, L. “Is
the Cycle of Abuse and Neglect. Cambridge, Mass: Harvard there a specific relationship between childhood sexual
University Press, 1998. and physical abuse and repeated suicide behavior?”
Widom, C. S. The Cycle of Violence. Science 244 (1989a): Child Abuse & Neglect 28 (2004): 863–875.
160–166.
ENTRIES A to Z
A
abandonment Leaving a minor child alone for children, and as a result, if a female child is born,
an extended period, depending on the definitions she may be abandoned. Children are also aban-
of the laws of the state or area. Criminal abandon- doned in other countries, such as in Latin America,
ment generally means that the caregiver, usually because the biological mother cannot care for her
a parent, made no provisions for another adult to child but is too ashamed, in large part because of
care for the child during an absence, particularly an social stigma against unmarried mothers, to come
infant or young child. Infants may be abandoned in forth and express her desire for the child to have
hospitals or, much worse, in Dumpsters or deserted another family. It may also be illegal or extremely
areas where they are likely to die. difficult for her to openly arrange an adoption,
In the United States and other Western coun- depending on the laws of the country. Thus, aban-
tries, parents who abandon the child can, in some donment may be seen as the only option.
cases, be charged with neglect. Each state has its
own, different statute with regard to the legal
definition of abandonment; these statutes apply abdominal injuries Abdominal trauma is a com-
not only to infants and small children but to ado- mon but often overlooked result of physical abuse.
lescents as well. There are legal precedents for Such trauma includes damage to kidneys, blood
abandonment charges to be brought against par- vessels, stomach, duodenum, small bowel, colon,
ents who lock their teenage children out of the pancreas, liver or spleen. Frequently more than one
house. organ is affected. Because there are few outward
Most states have statutes regarding criminal signs of abdominal injuries, they may go untreated
neglect and abandonment, although the laws and for extended periods of time, subjecting the child
the penalties for violating such laws vary greatly. to a great deal of pain and sometimes resulting in
Abandonment is a felony offense in some states death.
and a misdemeanor in others. The age of the child Injuries to the abdomen are usually caused
who was abandoned is also addressed in some stat- by one of three forces: compression, crushing or
utes; for example, it being a crime to abandon a acceleration. A blow to the midsection can com-
child under 10, 12 or some other age. The federal press organs filled with fluid or gas, causing them
ADOPTION AND SAFE FAMILIES ACT allows states to ter- to rupture. Compression injuries most often affect
minate the parental rights of parents of abandoned the stomach and colon. Crushing of internal organs
children after a hearing is held. can occur when a blow to the front of the abdo-
In non-Western countries, parents sometimes men presses the organ against a hard structure such
abandon their children (usually infants) at orphan- as the spinal column or rib cage. Rupture of the
ages or in hospitals or churches because they are kidneys, pancreas, spleen or liver may result from
unable to care for them. They may hope that such crushing. Rapid acceleration, such as when a
another family will adopt the child. child is thrown or struck so forcefully that he or
As of this writing, this practice is relatively com- she is knocked down, can tear connective tissue,
mon in China, where there is a state-imposed limit resulting in hemorrhage or perforation of the small
of one child per family. Most families want male intestines.
1
2 abduction
A thorough screening for abdominal trauma is abuse, sibling See SIBLING ABUSE.
recommended when children show evidence of
having been physically abused or when abuse is
suspected. abuse, situational See SITUATIONAL ABUSE AND
NEGLECT.
abuse, drug See SUBSTANCE ABUSE. abuse, verbal See VERBAL ABUSE.
TABLE I
PERPETRATORS BY RELATIONSHIP TO VICTIMS AND TYPES OF MALTREATMENT, UNITED STATES, 2003
Parent Other relative Foster parent
Maltreatment type Number % Number % Number %
treatment 2003, published in 2005 by the U.S. neglect only, the next greatest category is sexual
Department of Health and Human Services. In abuse only (29.9%).
contrast, observations about the psychological
mindset of abusers, patterns among abusers and Statistical Patterns among People
other issues related to child abuse are offered Who Maltreat Children
through research studies. There are many statistical generalizations about
Although most child abuse is committed by par- child abusers that can be made, such as that, in
ents or relatives, in some cases abusers come from most cases of child abuse (with the exception of
outside the family; for example, it is commonly SEXUAL ABUSE), the perpetrator is a parent (75%).
known that sometimes people in a position of trust, Both males and females abuse children, but females
such as teachers, members of the clergy and other (58.2%) are more likely to be abusive.
individuals in environments where children con- Sometimes siblings abuse each other, with the
gregate, sometimes abuse children. abuse going far beyond the normal teasing and
See CLERGY, SEXUAL ABUSE BY; TRUSTED PROFES- some minor pushing and shoving in which brothers
SIONALS, CHILD ABUSE BY. and sisters may engage; instead, it is actual physical
abuse or sexual abuse.
Types of Abuse See SIBLING ABUSE.
As can be seen from Table I, among the categories of
physical abuse only, neglect only, sexual abuse only Age of Perpetrators
and other categories, of the parents who abuse or The majority of known perpetrators of child maltreat-
neglect their children, the largest percentage (62%) ment (about 80%) are under age 40, and the largest
fits the category of “neglect only.” This category is single group of perpetrators, including both males
also the greatest percentage of all forms of abuse and females (about 42%) is 30–39 years old. Individ-
among foster parents who maltreat children (50%) uals who are age 19 or younger represent only about
as well as among other relatives (37.5%). The next 5% of the abusers. About 5% of child maltreatment
most prominent form of maltreatment for parents perpetrators are age 50 or older. (See Table II.)
is “multiple maltreatment” (15.2%), which is also
the next greatest form of maltreatment among fos- Male Perpetrators
ter parents (19.6%); however, among other rela- In 2005, the Department of Health and Human
tives who maltreat children, after the category of Services released a report on male perpetrators of
4 abusers
TABLE II
AGE AND SEX OF PERPETRATORS OF CHILD ABUSE IN THE UNITED STATES, 2003
Men Women Total
Age Number % Number % Number %
child maltreatment, based on data from 18 states. surrogate fathers alone or the 11% among biologi-
Of these male perpetrators, about half were biologi- cal fathers acting alone.
cal fathers (51%), and about 20% were men who In considering the category of multiple mal-
filled another parental role (stepfather, adoptive treatment, male perpetrators acting with the
father or mother’s boyfriend). child’s mother were most prominent; for exam-
The balance of the male perpetrators was indi- ple, nonparent males acting alone had a multiple
viduals in nonparental roles, such as relatives, foster maltreatment rate of 6%, compared to the rate for
parents, day-care providers or friends. Of the men abusive nonparents who were acting with moth-
who were not biological parents but were acting in ers, or 24%.
a parental role, boyfriends accounted for 10% of With the abuse category of neglect or medical
all perpetrators, followed by stepfathers (8%) and neglect only, biological fathers acting with moth-
adoptive fathers (1%). ers had the highest rates of abuse: biological fathers
Biological fathers were more likely than the other with mothers represented 70%, while father sur-
categories of males to maltreat young children and rogates and mothers accounted for 46% and non-
to be involved in neglect cases. They were, how- parents for 37%.
ever, much less likely to be sexual abusers. Instead, Live-in boyfriends Experts report that violence
nonparental male perpetrators were the most likely against children may be committed by the live-in
to be involved in sexual abuse. boyfriend or girlfriend of the parent. In one study
In considering recidivism (re-abuse) rates among in North Carolina of 220 child abuse homicides,
male perpetrators, the rates were highest among bio- 28% of the perpetrators were the mothers’ boy-
logical fathers, mother’s boyfriends and nonparents friends. Mothers’ boyfriends were the third most
and lowest among adoptive fathers and stepfathers. likely perpetrators, after the children’s fathers and
Table III delineates child maltreatment by males then their mothers.
that is either committed alone or in concert with Wilson and Daly used research from Canada and
the child’s mother. For example, in considering the United States; for example, they studied police
physical abuse only, males acting alone represented department homicide records in Chicago for 1965–
a greater percentage than males acting with the 90 and found that 115 children under age five were
child’s mother. In the category of physical abuse, killed by their fathers, “while 63 were killed by
both father surrogates (42%) and biological fathers stepfathers or (more or less co-resident) mothers’
(40%) acting alone had the highest rates of abuse. boyfriends. Most of these children were less than 2
In considering sexual abuse only, however, non- years old, and because very few babies reside with
parents acting alone had the highest rate of abuse substitute fathers, the numbers imply greatly ele-
(78%), much higher than the 35% found among vated risk to such children.”
abusers 5
TABLE III
ACTIONS AND CATEGORIES OF MALE PERPETRATORS BY TYPE OF MALTREATMENT
Acting alone Acting with mother
Type of Biological Father Non- Biological Father Non-
maltreatment father surrogate parent Total father surrogate parent Total Total
Physical 9,982 3,854 1,947 15,783 1,686 1,172 294 3,152 18,935
abuse only (40%) (42%) (12%) (31%) (9%) (18%) (11%) (11%) (24%)
Neglect or 8,587 1,079 1,027 10,693 13,201 2,944 1,032 17,177 27,870
medical (34%) (12%) (6%) (21%) (70%) (46%) (37%) (62%) (35%)
neglect only
Sexual 2,698 3,198 13,055 18,951 340 575 700 1,615 20,566
abuse only (11%) (35%) (78%) (37%) (2%) (9%) (25%) (6%) (26%)
Other or 2,001 484 234 2,718 874 297 64 1,235 3,953
emotional (8%) (5%) (1%) (5%) (5%) (5%) (2%) (4%) (5%)
abuse only
Multiple 1,913 583 535 3,031 2,626 1,383 666 4,675 7,706
maltreatment (8%) (6%) (3%) (6%) (14%) (22%) (24%) (17%) (10%)
Total 25,181 9,198 16,798 51,176 18,727 6,371 2,756 27,854 79,031
(100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
Source: Schusterman, G. R., J. D. Fluke, and Y. T. Yuan. Male Perpetrators of Child Maltreatment: Findings from NCANDS. U.S. Department of
Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, 2005, page 20.
Wilson and Daly found a much higher rate of abuse 100,000 for single mothers. Married parents were
among some categories of nonbiological fathers; for the least neglectful, at 7.9 per 1,000. In the cate-
example, stepfathers were 120 times more likely to gory of emotional abuse, single mothers showed a
beat a child to death than were their genetic fathers. lower rate than married parents or single fathers:
It is important to point out, however, that these the single mothers’ rate was only 2.1 per 100,000
researchers specifically studied homicide, and most single mothers versus 2.6 for married parents and
fathers and stepfathers are not child murderers. 5.7 for single fathers.
victims, and of these victims, 67.8% experienced when he or she becomes a parent. (As mentioned
neglect only. earlier, however, future abuse by an abused child is
With regard to sexual abuse, the greatest percent- not a certainty; it is only a higher probability than if
age of victims among their race were whites. There the person had not been abused.)
were 29,411 victims, and of these, 8.8% were sexu- One study compared formerly abused women
ally abused. (See Table IV for more information.) who were now mothers and a control group of
non-abused women who were mothers. In this
Family Size study, 25 mothers known to child protective ser-
Another impact on child maltreatment found in the vices (CPS) as abusers in 1987 (referred to as CPS
National Incidence Study was family size, and fami- mothers) and a control group of 25 non-abusive
lies with four or more children were at greatest risk. mothers were studied by researchers in 1994–95
Interestingly, families with two or three children and reported on in a 1999 issue of the Journal of
were at the lower risk in some categories of abuse Interpersonal Violence. The goal was to look for pre-
(sexual abuse, emotional abuse and neglect) than dictive patterns and also to determine if women
families with only one child. Perhaps when there who were abused as children were more likely to
are two or three children, there is some protective become abusive parents than were non-abused
factor. If so, this factor disappears when there are individuals.
four or more children in the household. Table V Case files revealed that about a third of the
illustrates the differences. CPS mothers had abused and neglected their chil-
dren. The researchers found that the key predictor
Childhood Abuse Experienced by Parents of abuse was whether or not the mothers’ social
Most experts agree that if a person is abused as a problems continued. Having been abusive in the
child, that person is more likely to become abusive past was an indicator of future abuse; however, it
TABLE IV
VICTIMS BY RACE AND MALTREATMENT TYPE, 2003
Psychological
maltreatment,
Number Physical Sexual other only Multiple
of victims abuse only Neglect only abuse only or unknown only maltreatment
Race Number % Number % Number % Number % Number %
African American 159,361 24,354 15.3 81,651 51.2 8,451 5.3 23,711 14.9 21,194 13.3
American Indian 7,469 728 9.7 5,061 67.8 296 4.0 398 5.3 986 13.2
or Alaska Native
Asian 3,933 653 16.6 1,873 47.6 210 5.3 548 13.9 649 16.5
Pacific Islander 1,390 119 8.6 329 23.7 69 5.0 580 41.7 293 21.1
White 334,965 40,956 12.2 161,703 48.3 29,411 8.8 49,586 14.8 53,309 15.9
Multiple races 10,133 1,124 11.1 5,669 55.9 440 4.3 1,223 12.1 1,677 16.5
Hispanic 78,207 10,383 13.3 39,740 50.8 5,792 7.4 10,318 13.2 11,974 15.3
Unknown 34,224 4,898 14.3 18,236 53.3 2,586 7.6 3,226 9.4 5,278 15.4
or missing
Total 629,682 83,215 314,262 47,255 89,590 95,360
Source: Adapted from Administration on Children, Youth and Families, Child Maltreatment 2003. Children’s Bureau, U.S. Department of Health
and Human Services, Washington, D.C., 2005, page 48.
abusers 7
of women whose children were born when the • When do you tend to want a drink? When alone
women were younger than age 18. The data were or with others? If you drink with others, with
drawn from the national Women Co-occurring Dis- whom? When bored or when you want to party?
orders and Violence Study (WCDVS). The research- When you are angry, frustrated or stressed?
ers considered current mental health symptoms, • What drugs have you tried?
alcohol and drug use severity and trauma and found
• How often do you use?
that the mothers’ current mental health symptoms
were the strongest predictors of child abuse. • How do/did you use/take it?
The women were recruited from residential treat- • How long have you been using? How long did
ment programs in Colorado and mental health and you use?
substance abuse treatment outpatient centers in cen- • How much do you smoke?
tral Florida. This is a high-risk population because
• When do you usually want a cigarette?
of the presence of both mental illness and substance
abuse issues, also known as a “dual diagnosis.” • When you were pregnant, what was your drink-
Six factors in the Child Abuse Potential Inven- ing/drug use like?
tory (CAP) were evaluated, including the women’s • How does your behavior change when you
distress, unhappiness, rigidity and problems with drink/use?
their children, themselves, their families and oth- • How do you feel when you drink/use?
ers. The researchers found that 65% of the women
• What impact has alcohol and/or any other drug
in Colorado and 66% of the woman in Florida had
use had on your own health?
elevated CAP scores. The authors concluded that
“The primary recommendation from this study is • What legal problems have you encountered as a
that mothers who are experiencing current men- result of your alcohol and/or drug use?
tal health symptoms should be further screened for • How has the use of alcohol and/or other drugs
potential to abuse their child and linked to parent- affected your employment?
ing support services when needed.” • How has your use of alcohol and/or other drugs
In another study of women who killed their affected your social relationships?
babies, discussed in a 2004 issue of the American
• Has the use of alcohol and/or other drugs resulted
Journal of Psychiatry, Dr. Spinelli argued that mental
in violence or abuse in the home?
illness, particularly postpartum psychosis, may play
a major role in the deaths of some infants. • What concerns do you have about your use of
See INFANTICIDE. alcohol and/or other drugs?
Assessing Abusers with Substance Abuse Issues In addition, it is also recommended that ques-
Many abusive and neglectful parents are also sub- tions be asked about the impact of substance abuse
stance abusers, and most states identify substance on other members of the family, including such
abuse as a key risk factor for child maltreatment. questions as
(See SUBSTANCE ABUSE.) According to the National
Center on Child Abuse and Neglect, in their manual • How do family members view alcohol and/or
on protecting children in substance-abusing fami- other drug use?
lies, protective service workers can gain important • Do family members deny use and/or its impact?
assessment information about substance abuse • Do family members express worry about the user?
from parents by asking the following questions:
• Do family members feel tense, anxious or overly
• How often do you drink beer, wine, liquor? responsible?
• How many drinks do you generally have when • Are family members angry with the user?
you are drinking? • Do children in the family exhibit adult behaviors
• How old were you when you had your first drink? or assume adult parenting roles?
abusers 9
Protective service workers should also evaluate • A parent shows signs of addiction (needle tracks,
the parents’ awareness of the relationship of their skin abscesses, burns on inside of lips).
substance abuse and their children’s care. Profes- • A parent shows or reports experiencing physical
sionals need to consider the following issues: effects of addiction or being under the influence,
including withdrawal (nausea, euphoria, slowed
• If the parents were under the influence when thinking, hallucinations or other symptoms).
the suspected child abuse or neglect occurred,
and this was a contributing factor, do the par- Cognitive Patterns
ents acknowledge this relationship, and are they
The way that people perceive a situation directly
willing to make the changes necessary to avoid
affects how they react to it. According to Howe in
repeated injury or neglect?
Child Abuse and Neglect: Attachment, Development and
• How have the parents provided for their chil- Intervention, there are four basic cognitive areas
dren’s needs in situations of relapse? It is help- that are problematic for most maltreating parents.
ful to determine whether parents have exercised First, in the area of perceptions, they may only see
the judgment to leave their children in the care the negative behaviors of their children; these par-
of responsible relatives or friends, or whether ents do not notice when the child behaves well.
the children have been left with strangers or In addition, they often entirely misinterpret their
brought along with the parents into dangerous children’s emotional expressions; for example, the
situations. child may express surprise, which the parent mis-
• In cases of prenatal substance abuse (that affects interprets as dissatisfaction. The parent then acts on
the child after birth), how do the parents view the his or her own distorted perception rather than on
infant’s symptoms? Initially, parents may deny the child’s actual behavior.
that symptoms or developmental problems exist. Second, parents at high risk for maltreatment
Although this initial denial can serve as a pro- are more likely to exaggerate their children’s nega-
tective coping mechanism for parents, continual tive behavior than are low-risk parents, often see-
denial may interfere with the parents’ obtaining ing these behaviors as deliberate and willful. Third,
needed services for their children. parents who maltreat their children are less likely
to consider the particular situation when interpret-
In the 2004 government manual Understanding ing the child’s behavior. If the dog knocks over a
Substance Abuse and Facilitating Recovery, it is suggested child’s drink, the maltreating parent is likely to crit-
that when substance abuse is suspected by protective icize the child, rather than accepting that the child
service workers performing a maltreatment investi- was not to blame.
gation, the following in-home signs of substance Last, maltreating parents are inflexible and rigid,
abuse should be considered by the worker: and they do not adapt to changes in the environ-
ment as readily as non-abusive parents. Says Howe,
• Paraphernalia is found in the home (syringe kit “An injured child, an ill child, and a tired child might
[and the parent is not a diabetic], or there are all be seen as conditions demanding a response, the
pipes, charred spoon, foils, large number of liquor effect of which is to annoy the parent. The distressed
or beer bottles. child is immediately told off and disciplined.”
• The home or the parent may smell of alcohol, Patterns of Family Violence and Child Abuse
marijuana or drugs.
In their landmark studies of family violence in 1975
• A child reports alcohol and/or other drug use by and 1985, Murray Straus and Richard Gelles found
parent(s) or other adults in the home. patterns between FAMILY VIOLENCE and child abuse.
• A parent appears to be actively under the influ- For example, they found that blue-collar workers
ence of alcohol or drugs (slurred speech, inability were about one-third more likely to abuse their
to mentally focus, physical balance is affected, children than were white-collar workers. In addi-
extremely lethargic or hyperactive). tion, wives of blue-collar workers were also more
10 abusers
TABLE VI
NONPARENT PERPETRATORS BY RELATIONSHIP TO VICTIMS AND TYPES OF ABUSE
Other
Day-care provider Legal guardian professionals Friends or neighbors
Maltreatment type Number % Number % Number % Number %
Physical abuse only 679 12.9 165 14.0 241 23.9 54 3.4
Neglect only 2,544 48.4 655 55.7 313 31.1 153 9.7
Sexual abuse only 1,209 23.0 49 4.2 270 26.8 1,192 75.9
Psychological maltreatment only, 130 2.5 69 5.9 73 7.2 42 2.7
other only, or unknown only
Multiple maltreatments 689 13.1 238 20.2 110 10.9 130 8.3
Total 5,251 1,176 1,007 1,571
Total % 100.0 100.0 100.0 100.0
Source: Adapted from Administration on Children, Youth and Families, Child Maltreatment 2003, Children’s Bureau, U.S. Department of Health
and Human Services, Washington, D.C., 2005, page 68.
See also ATTACHMENT DISORDER; INFANTICIDE; Howe, David. Child Abuse and Neglect: Attachment, Develop-
NEGLECT; PARENTAL SUBSTANCE ABUSE; PHYSICAL ABUSE; ment and Intervention. New York: Palgrave Macmillan,
SEX OFFENDERS, CONVICTED; SEXUAL ABUSE; SHAKEN 2005.
INFANT SYNDROME; SIBLING ABUSE; SUDDEN INFANT Kropenske, Vickie, and Judy Howard. Protecting Children in
DEATH SYNDROME. Substance-Abusing Families. U.S. Department of Health
and Human Services, Administration for Children and
Administration on Children, Youth, and Families. Child Families, National Center on Child Abuse and Neglect,
Maltreatment 2003. Children’s Bureau, U.S. Department 1994.
of Health and Human Services, Washington, D.C., National Center for Injury Prevention and Control.
2005. “Child Maltreatment Fact Sheet.” Available online.
Breshears, E. M., S. Yeh, and N. K. Young. Understand- URL: http://www.cdc.gov/ncipc/factsheets/cmfacts.
ing Substance Abuse and Facilitating Recovery: A Guide htm. Downloaded November 4, 2005.
for Child Welfare Workers. Rockville, Md.: U.S. Depart- Rinehart, Deborah J., et al. “The Relationship between
ment of Health and Human Services, Substance Mothers’ Child Abuse Potential and Current Mental
Abuse and Mental Health Services Administration, Health Symptoms.” Journal of Behavioral Health Services
2004. & Research 32, no. 2 (2005): 155–166.
Crosson-Tower, Cynthia. Understanding Child Abuse and Schusterman, G. R., J. D. Fluke, and Y. T. Yuan. Male Per-
Neglect. Boston: Allyn & Bacon, 2004. petrators of Child Maltreatment: Findings from NCANDS,
Daly, Martin, and Margo I. Wilson. “Some Differential U.S. Department of Health and Human Services, Office
Attributes of Lethal Assaults on Small Children by of the Assistant Secretary for Planning and Evaluation,
Stepfathers versus Genetic Fathers.” Ethnology and 2005.
Sociobiology 15 (1994): 207–217. Spinelli, Margaret G., M.D. “Maternal Infanticide Associ-
Gelles, Richard. “Treatment-Resistant Families.” In Treat- ated with Mental Illness: Prevention and the Promise
ment of Child Abuse: Common Ground for Mental Health, of Saved Lives.” American Journal of Psychiatry 161, no.
Medical, and Legal Practitioners. Baltimore: Johns Hop- 9 (September 2004): 1,548–1,557.
kins University Press, 2000, pp. 304–312. Straus, Murray A., and Richard E. Gelles. Physical Violence
Haapasalo, Jaana, and Terhi Aaltonen. “Child Abuse, in American Families: Risk Factors and Adaptation in 8,115
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lence 14, no. 6 (June 1999): 571–585. 1995.
addiction, infantile 13
acting out The term acting out is often used to refer behavior should be examined closely when it is
to aggressive or socially undesirable behavior dis- persistent and extreme.
played by children or adults. Some mental health
professionals see such behavior as an outward man-
ifestation of internal (intrapsychic) conflict. Accord- addiction, infantile Infants born to drug-addicted
ing to psychodynamic theory, individuals may act mothers are at great risk of being addicted at birth.
out feelings that, because of their highly sensitive
Withdrawal symptoms usually appear during the
emotional content, are difficult to discuss directly.
first 24 hours following birth. The severity of the
In some cases, these feelings may be unconscious.
infant’s symptoms is proportional to the quantity
Psychodynamic theorists and practitioners often
of any drug used on a daily or frequent basis by the
attribute the abusive behavior exhibited by parents
mother. Symptoms frequently observed in infants
to the expression of repressed or unconscious feel-
ings. Abusive behavior directed toward a child may experiencing narcotic withdrawal are listed in the
be traced to internal conflicts that have little direct following table.
connection with the child. Based on this theoretical While most acute symptoms of infantile addiction
model, treatment of abusers focuses on helping the disappear within 10 days of birth, follow-up studies
patient to become aware of internal conflicts and have shown that these infants continue to appear irri-
to address these problems in a more effective and table, restless and unresponsive for up to a year. They
socially acceptable manner. may need frequent feeding, tend to regurgitate often
Acting out may partially explain the behavior and require almost constant attention. These charac-
of abusers. When displayed by a child, however, it teristics would challenge even a non-addicted mother
may help to identify him or her as a possible victim and this may increase the likelihood that the infant
of abuse. Though antisocial behavior is a feature will be physically abused or neglected by the primary
of normal child development some behaviors are caretaker if or when she continues to use drugs.
associated with maltreatment. See “AT RISK” CHILDREN.
Sexually abused children may display sex-
ual knowledge and aggressiveness beyond that Laws on Drug-Exposed Infants
expected for their age. Conversely, some child vic- Some states have enacted laws that require physi-
tims may display fear and/or aggression toward all cians to report the presence of drugs in a newborn
males. Behaviors that have no apparent rational infant. (See Appendix V) Laws may also require the
basis may lead the trained child protection worker
to question the child further.
In adolescents, running away from home and NEONATAL WITHDRAWAL SYMPTOMS
sexual promiscuity are often connected to abuse. Tremors
Studies of runaways show a high incidence of incest Irritability
and other forms of abuse. Tachypnea (unusually rapid respiration)
Physically abused children sometimes display Muscular rigidity
extreme aggression toward other children. This Diarrhea
behavior may be seen as an attempt by the child to Watery stools
gain control over his or her life. A child, defenseless Vomiting
against physical attacks by an adult, may become Shrill crying
abusive toward other children as a way of acting Excessive perspiration
out aggressive feelings that cannot be expressed Sneezing
safely in the presence of the abuser. Yawning
Fever
Most child development experts agree that a cer-
Myoclonic jerks (erratic muscular spasms)
tain amount of acting out is to be expected of chil-
Convulsions
dren. These experts caution, however, that such
14 addiction, maternal
state social services department or another organi- Some abuse of adolescents is a continuation of
zation to monitor a drug-addicted infant and his or an abusive pattern that began in early childhood. In
her mother shortly after birth. other cases abuse of adolescents is a new phenom-
In some states, in the case of the child of a drug- enon brought on by a complex set of factors. Chil-
addicted mother or a child with FETAL ALCOHOL SYN- dren may outgrow methods of parental control that
DROME, the state may offer rehabilitative services relied heavily on use of physical force, indulgence
to the mother; if she declines this opportunity, she or intrusion. Abusive families may be less able to
may lose her parental rights to the child. adapt to these changes, thereby increasing the level
See also PARENTAL SUBSTANCE ABUSE. of conflict.
Adolescents at high risk of abuse often have
more poorly developed social skills and display
addiction, maternal See MATERNAL DRUG DEPEN- more negative behavior than their peers. The
DENCE. combination of an aggressive or defiant adolescent
with a parent who uses a harsh or inappropriate
parenting style greatly increases the likelihood of
adjudicatory hearing Once charges of abuse or abuse.
neglect have been filed, a court hearing is held to
determine the extent to which these charges are Abuse and Runaways
supported by admissible evidence. If insufficient A disproportionate number of adolescents who
evidence is presented, a judge may decide not to run away from home are victims of abuse. Stud-
proceed with a trial. A trial may be scheduled if, ies show that abused adolescents tend to run far-
in the judge’s opinion, there is sufficient evidence ther from home and stay away longer than those
to warrant further consideration of the charges. An with no history of maltreatment. Further, the act
adjudicatory hearing may also be called a “factfind- of running away greatly increases the likelihood of
ing” hearing. sexual abuse for both boys and girls. Runaways,
See also EVIDENCE. particularly those who have been sexually abused,
often fall into prostitution as a means of support-
ing themselves. One study found that 60% of run-
adolescent abuse Abuse of adolescents has attracted aways involved in prostitution had been sexually
less public attention than maltreatment of younger abused at home. Another study of adolescents
children. Many assume that the age of the child is housed in a Canadian runaway shelter found that
relatively unimportant or that adolescents are better 38% of boys and 73% of girls had been sexually
able to defend themselves and thus adolescent abuse molested.
is less serious. Yet, the abuse of adolescents can have Not all adolescent runaways leave home by
profound and lifelong impacts on the adolescents, choice. Statistics show that 10% to 25% of adoles-
their peers and others with whom they interact. cents housed in runaway programs had been put
Available data indicate that adolescent abuse is, out of their homes by their parents. These adoles-
in many ways, significantly different from abuse cents are considered victims of parental neglect,
of children under the age of 12. Psychological and just as infants are abandoned by their parents.
sexual abuse levels are higher among adolescents. See ABANDONMENT.
Adolescents receive less serious injuries as a result
of abuse, reflecting both fewer physical assaults and Sexual Abuse and Psychological Maltreatment
a greater ability to protect themselves. and Consequences
Boys are at greatest risk of abuse during early Adolescent sexual abuse is predictive of serious
childhood, becoming less susceptible as they grow problems among adolescents in middle school and
older. Conversely, girls are more likely to be abused high school. Many studies have demonstrated that
as they grow older, particularly in the case of SEX- sexually abused adolescents are at risk for depres-
UAL ABUSE. sive disorders as well as for the abuse of drugs
adolescent abuse 15
and/or alcohol. They also have an increased risk use and vulnerability to HIV infection among
for SUICIDE. those young injection drug users. Furthermore,
In one study of sexual victimization among we observed, as have other researchers, that
adolescent women, reported in a 2004 issue of sexual abuse is associated with higher rates of
Perspectives on Sexual and Reproductive Health, the trading sex for money or drugs. Whether or not
researchers studied adolescents in 1995 and again the relation between sexual abuse and the ini-
in 1996. They found that 7% of their sample (of tiation of injection drug use is causal, childhood
more than 7,000 adolescent women) was forced sexual abuse can be considered a valuable marker
into sexual intercourse. Some predictive factors of risk for behaviors that comprise the health of
for sexual victimization were alcohol use in the young adults. The integration of substance abuse
past year, marijuana use in the past 30 days and interventions with postvictimization and pro-
having been exposed to violence in the past year. tective services for children and adolescents is
Other risk factors for sexual victimization were warranted.
parental heavy drinking and/or drug use, living
away from both parents before age 16, the per- In another study reported in the Journal of
manent physical disability of the adolescent and American Academy of Child & Adolescent Psychiatry, the
living in poverty. researchers sampled students from 27 high schools
Of the sexually abused females, 8% were revic- in Australia. They found that sexual abuse was
timized within the next year. Some predictors of linked to the risk for suicide as a result of feelings of
revictimization were alcohol use, recent cocaine hopelessness and/or depressive symptoms. Feelings
use and increasing levels of emotional distress. of hopelessness correlated with a high suicide risk,
A study reported in the American Journal of Public while depression was associated with both a high
Health in 2005 studied adults who injected illegal suicide risk and suicide attempts.
drugs. These subjects had a higher rate of childhood The researchers found that hopelessness was
or adolescent sexual abuse (14.3%) than among more strongly associated with the sexual abuse
subjects in the general population (about 8%). The of boys than among girls, while depressive symp-
researchers found that childhood and adolescent toms were more prominent among sexually abused
sexual abuse was significantly associated with an girls. Said the researchers about childhood and
early initiation of injection drug use. adolescent sexual abuse (CSA), “CSA should be
The researchers found that among those sexu- considered a risk factor for suicidal behavior even
ally abused before age 13, the average age of start- in the apparent absence of other psychopathol-
ing injection drug use was 17.4 years. Of those who ogy, although depressive symptoms may further
were sexually abused between the ages of 13 and increase its likelihood.” In addition, they stated,
17 years, the average age of starting injection drug “Sexually abused adolescents may also be more
use was 18 years. (Of the subjects who injected likely to make more frequent and more severe [sui-
drugs but were not sexually abused, the average cide] attempts, requiring prompt interventions and
age when they started injecting illegal drugs was persistent follow-up.”
19.1 years.) A Canadian study reported in a 1997 issue of
The researchers also found that women were Development and Psychopathology looked at the impact
more likely to have been sexually abused before of perceived and actual abuse among adolescents
they began injecting illegal drugs. and the victims’ subsequent adjustment. Research-
Said the researchers, ers studied 160 children (70 boys and 90 girls) ages
11–17, with a mean age of about 14 years. Most
Although further investigation is needed to fully (96%) were white, with a small percentage of blacks
elucidate the association between sexual abuse and Native Canadians. Most of the children (68%)
and the initiation of substance use, we can con- came from families receiving public assistance and
clude that childhood sexual abuse is strongly most (about 69%) had been in child services cus-
associated with early initiation of injection drug tody more than once.
16 adolescent abuse
All the children had experienced abuse, as psychical experience such as sexual abuse is more
documented by child protective services. About difficult to deny or minimize, and that such denial
one-third had been sexually abused and about would result in more serious affective and behav-
two-thirds had experienced physical abuse. Most ioral distortion.”
(87%) had also experienced neglect or psycho- The researchers also found gender differences,
logical maltreatment (92%). The researchers inter- in that females were more likely to exhibit behav-
viewed and tested the children, reviewed the child ior problems than were males in response to psy-
protective service records and also interviewed and chological maltreatment, and they speculated that
tested caretakers. females might have a “developmentally greater
The researchers found that PSYCHOLOGICAL MAL- vulnerability to parental criticism and hostility.”
TREATMENT had the most significant impact on the
negative behavior of the adolescents studied, and Abuse and Antisocial Behavior
it also seemed to make the effects of physical or In another study of abuse and adolescents, research-
sexual abuse worse. ers used questionnaires on 4,790 public school
One interesting finding was that when there was children in grades 8, 10 and 12 in the state of Wash-
a discrepancy between the adolescent’s perception ington. The goal was to determine if abuse was
of sexual abuse and documented abuse in social ser- linked to antisocial and suicidal behavior.
vice records, greater maladjustment then occurred. Students were asked “Have you ever been abused
For example, the best adjustment occurred when or mistreated by an adult?” (which researchers
both the adolescent and the record reflected no sex- considered “abuse”) and “Has anyone ever touched
ual abuse. However, the next best level of adjust- you in a sexual place, or made you touch them,
ment occurred when the adolescent and the record when you did not want them to?” (which research-
reflected that sexual abuse did occur. In contrast, ers considered “molestation”).
the poorest levels of adjustment occurred when Antisocial behavior among students was deter-
sexual abuse was documented in the record but it mined by responses to questions on whether the
was denied by the adolescent OR when abuse was student had ever carried a handgun, sold illegal
not documented in the record but it was reported drugs, stolen a motor vehicle, been arrested or
by the adolescent. taken a handgun to school. Questions about sui-
Interestingly, these findings for sexual abuse did cidal behavior ranged from questions about having
not also hold in the case of psychological maltreat- suicidal thoughts to making a suicide plan through
ment. Instead, as the perception of actual psycho- taking an actual suicide attempt.
logical maltreatment increased, so did the stress and Most students (about 74%) did not report abuse.
maladjustment of the adolescent. Thus, learning With regard to antisocial behavior, about 18%
about and accepting psychological maltreatment reported one or more such acts. About 7% reported
caused greater maladjustment than learning about a suicide attempt.
and accepting sexual abuse. The researchers found a positive correlation
Said the researchers, “One might speculate that between mild and severe antisocial behavior and
as youths’ ‘eyes are opened’ to a harsh emotional abuse and molestation. They also found a signifi-
family climate, their attachment system comes cant correlation between abuse or molestation and
under new strain—the resulting conflict produces suicidal thoughts and behavior. They noted that
acute inner pain. If this finding is borne out in “[t]he associations were especially strong for the
future research, one implication is that clinicians more severe forms of the behaviors (such as injuri-
must tread carefully when helping youth recognize ous suicide attempts) and for the combination of
ongoing psychological maltreatment.” antisocial and suicidal behaviors,”
Why did stress and acting-out behavior decrease Although not all children who exhibit antisocial
with the acceptance of previous sexual abuse but or suicidal behavior are abuse victims, it is possible
increase with acceptance of psychological abuse? that abuse could be an underlying factor for some
The researchers said, “One might speculate that a children.
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