Child abuse includes assaults in any of several domains (physical, sexual, or emotional) and may be acts of commission (abuse) or omission (neglect). Congress broadly defines child abuse in Public Law 93-247 as the "physical or mental injury, sexual abuse, negligent treatment, or maltreatment of a child under the age of eighteen by a person who is responsible for the child's welfare under circumstances which indicate that the child's health or welfare is threatened thereby." Many researchers and clinicians view child abuse as a broad collection and range of acts.
Physical abuse
Physical abuse is injury to the child inflicted by a caregiver. It is sometimes evidenced by multiple bruises or abrasions, by injuries in soft tissue areas (e.g., upper arm, thigh, buttocks) or by bruises, burns, or other marks in the shape of fingers, hands, or other objects. Unexplained multiple fractures are sometimes detectable on χ rays. Trauma to the head or eye is sometimes the result of "the shaken baby syndrome." For more information about this type of abuse, see Child Abuse, Physical. The remainder of this essay will discuss sexual and emotional abuse.
Sexual abuse
Children are said to be sexually abused when they experience sexual contact with an adult or older child through coercion or deceptive manipulation at an age and stage of development at which they do not possess sufficient maturity to understand the nature of the acts and therefore to provide informed consent. Often physical force is not necessary since the perpetrator is likely to be someone with whom the child has a trusting relationship and who is in a position of authority over the child.
The type of sexual contact may involve intercourse, touching or fondling the genitals or secondary sex organs with hands, mouth, or objects, or being forced to perform sexual acts with another person. Contact may not involve any actual touching. Children can be coerced into disrobing and exposing themselves, or watching adults disrobe or engage in sexual activity. In some cases, children can be involved in ritualistic sexual abuse as part of cult or other belief-driven practice.
Perpetrators go to great lengths to conceal sexual abuse. Children who have been sexually abused may not report the behavior due to threats or to a lack of understanding of what has happened. In addition, they may be confused by the simultaneous physical arousal they may feel and the clearly covert, possibly threatening nature of the event. Evidence of abuse may show in physical symptoms, such as rashes or injuries to the genital area and blood or discharge in bedding or underwear; advanced sexual knowledge for the child's age; provocative or seductive behavior toward others; bedwetting after the child has established the ability to stay dry through the night; declining peer relationships; fear of a person, place, or object associated with the abuse; or changes in school behavior or performance. In addition, older children or adolescents may begin to act out or to withdraw, use drugs or alcohol, or begin to harm themselves or become preoccupied with thoughts of death.
Emotional abuse
Abuse of children is not limited to the physical body. Children who are repeatedly called names, insulted, belittled, intimidated, rejected, criticized, terrorized, or corrupted by those upon whom they are dependent for nurturance have little opportunity to develop any sense of self-worth.
Emotional abuse may also be the result of actions not directed specifically at the child. The prevalence of domestic and community violence exposes children to intimidating and frightening scenes every day. A study at Boston City Hospital found that one in ten children living
in an inner city neighborhood had observed a shooting or a knifing by the age of six; half of these incidents occurred in the home and half in the streets. Studies have shown that when children live in homes in which domestic violence is a problem, 75-87% of them witness the violence and 40-60% of them experience abuse themselves, often as a result of being "caught in the middle" of a parental altercation. Children who observe violence react with many of the same psychological symptoms as children who have experienced it directly.
Neglect
Children who are not provided with basic food, shelter, and clothing to the best of their parent's ability are considered neglected. Not surprisingly, neglect is more prevalent in areas of extreme poverty than in other socioeconomic strata. Neglect may be evidenced in undernourishment or failure to thrive. Children may not be able to attend or learn in school because of lack of food or sleep. They may develop rashes or infections that go untreated. Failure to send children to school or otherwise provide for their education may also be considered neglect.
What are the outcomes of child abuse?
It is important to remember that there are often multiple factors to consider when discussing the results of child abuse. Abuse seldom occurs in isolation; there may be other problems in the family such as alcoholism or the stress of unemployment. Children may also experience multiple forms of abuse. Children may or may not have a supportive relationship with another adult to whom they can turn for support. Children may be abused for an acute period before there is some intervention, or they may experience the trauma chronically and for many years. The child's age and resources, the kind of relationship between the child and the perpetrator, the length and chronicity of the abuse, and the availability of therapy or other intervention services are all factors that contribute to the wide range of long- and short-term outcomes associated with child abuse.
Nonetheless, most children who have been abused experience some symptoms of Post Traumatic Stress Disorder (PTSD). PTSD in children and adolescents may be acute or delayed, that is, the child may experience symptoms immediately or after a period of time has passed, perhaps when the child feels safe. Symptoms may include re-experiencing the abusive episodes at some level, feeling emotionally numb, or becoming physiologically aroused (elevated heart rate, respiration, and so forth). Children may experience disassociation and appear to "space out" when reminded of the abuse or perpetrator. They may have physical symptoms. They may become enraged or feel guilt at having provoked the episodes or survived them. They may have invasive memories, repeated behaviors, or fears related to the abusive situations. They may act out some of their issues in play—punishing the bad guy or victimizing another character while playing with dolls or action figures. In severe cases of chronic trauma, the child may develop serious or prolonged disassociation or depression. Severe and chronic abuse has also been implicated in cases of multiple personality disorder.
Once the abuse has stopped, most of these symptoms can be treated with some form of counseling or therapy. Some have argued that full recovery is a lifelong task. Adults who have been abused as children may have to face issues long after the abuse has stopped, when they enter into their own sexual relationships, or when they raise their own children.
Do abused children become abusing adults? The de facto intergenerational transmission of child abuse is not supported by the facts. It appears that the cycle of abuse can be broken, and often is. Social workers David Gil found that only 11% of the abusing parents he studied reported having been abused themselves as children. More importantly, prospective studies of parents who have been abused as children or who were at high risk for abusing their own children found that about 70-80% of parents were able to break the cycle.
Who abuses?
No single causal factor explains who abuses children and who does not. The contributing factors are multifaceted and may be best understood from an ecological point of view, that is, identifying factors that operate in the person, the immediate social environment, and in the culture as a whole. Child abuse is most likely the product of environmental Stressors acting upon a person with psychological vulnerabilities in a culture in which violent behavior is an acceptable form of venting the resultant frustrations.
Abusing adults tend to be socially isolated, although it is not clear whether this isolation is due to poor social skills or to circumstance. Some have been abused themselves as children. Abusive incidents are often associated with alcohol consumption and the subsequent blurred judgment and decreased inhibitory control. Parents who abuse their children often overestimate the child's developmental capabilities and interpret behaviors as intentionally directed toward them, even the crying or soiling of young infants.
Although child abuse exists across socioeconomic, racial, and ethnic groups, it is more prevalent in lower-income groups in which the stresses of everyday life are often greater. Job loss and dissatisfaction are often associated with child abuse. Higher rates of abuse exist in military compared to non-military families. It is generally felt that the link between these environmental Stressors
and abuse is strengthened by the absence of social support networks that might otherwise buffer the family against adversity.
History of social policy
Despite the fact that children have long suffered from intentionally inflicted injuries or death, there have been few organized, comprehensive programs addressing the problem of child abuse. Although certain religions have long prohibited infanticide, and the establishment of asylums and orphanages to rear children whose lives were endangered by family violence or neglect is a practice centuries old, efforts to advocate for the children's basic right to health and safety have been meager and scattered.
Current social policy regarding child abuse in the United States began to take shape with the social work movements in large cities during the latter portion of the nineteenth century. One particular case, that of an 8-year-old girl who was discovered chained, starved, and beaten by her parents in New York City, was brought to the attention of Henry Berg, founder of the Society for the Prevention of Cruelty to Animals. Because no laws existed prohibiting the abuse of children by their parents, the police did not intervene. However, as a result of Berg's efforts, the mother was tried and incarcerated, and the child was removed to an orphanage. The publicity surrounding this case lead to the founding of the Society for the Prevention of Cruelty to Children in 1875.
Until the mid-twentieth century, child abuse was considered a social and legal, but not a medical, issue. Social standards and definitions were used to protect children and intervene as necessary to ensure their welfare. Legal definitions, though often vague, were designed to delineate which perpetrators could be prosecuted and under what conditions children could be made dependents of the state through the removal of parental rights and awarding of custody to the state's child welfare system. Medical definitions were not developed until advances in radiology made the detection of unreported or long-standing injuries possible. When old bone fractures became detectable on χ ray, physicians began to apply medical diagnoses to cases of child abuse. In 1961, C. Henry Kempe and his colleagues presented a symposium on child abuse to members of the American Academy of Pediatrics, and the following year introduced the term "the battered child" in an influential paper.
Current status
The National Center on Child Abuse Prevention Research reported 2.69 million cases of child abuse nationally in 1991. Of these, 25% were physical abuse cases, 15% were sexual abuse, and many involved more than one type of abuse or neglect. In 1992, the number had increased to 2.9 million with 87% of the victims under the age of five years, and 46% under the age of one. Fatalities related to child abuse and neglect were estimated at over 1200 cases, or between three and four children each day.
Is the incidence of child abuse increasing? Since Kempe's influential paper in 1962, the detection and reporting of child abuse has improved. This heightened awareness makes trends difficult to interpret. For example, the U.S. Department of Health and Human Services 1986 national incidence survey found the sexual abuse rate to be 2.8 per 1,000 children, an increase of 300% from 1980, but we cannot be certain whether that increase reflected more abuse, more reporting, or both.
Barriers to dealing with the problem
Why did it take centuries for the medical, social, and legal professions to address this devastating problem? Why is child abuse still prevalent in today's society? There are several possibilities. First, children have long been viewed as the property of their parents. Acceptance of this premise makes it difficult to legislate how one should treat one's own "property" in a culture that values individual rights. Second, certain beliefs about the nature of the child, including many with religious origins, view the child inherently wicked and willful. These views promote the idea that it is for the child's own good that he or she be "disciplined." The related premise, "Spare the rod and spoil the child," equates discipline with physical action and provides justification for some parents to use corporal punishment. David Gil has found that 60% of child abuse is a direct result of corporal punishment. Parents who intend only to spank their child may get carried away with their own anger, may not know their own strength, or may simply hurt their child by accident.
When the line is crossed and punishment turns to what we agree is abuse, our tolerance implodes and our reactions are extremely emotional. Yale University psychologist and child advocate Edward Zigler has suggested three reasons why our general reactions to the subject of child abuse are so emotionally laden. First, our own insecurities are threatened by the notion of a small, helpless child being maltreated by one in whose care he or she is entrusted. Second, the occurrence of abuse stands in direct opposition to the everyday experiences of the majority of parents who are engaged in secure, loving relationships with their children. Finally, the occurrence of abuse threatens the premise of many who hold that a fundamental nurturant, parental instinct exists within the human species. These reasons may also evoke a defensive reaction in people and may contribute to our historical and continued inability to confront the issue.
Books
Garbarino, D., E. Guttman, and J.W. Seeley. The Psychologically Battered Child: Strategies for Identification, Assessment, and Intervention. San Francisco: Jossey-Bass, 1988.
Gill, D. Violence Against Children: Physical Child Abuse in the United States. Cambridge, MA: Harvard, 1970.
Groves, B.M. "Children Who Witness Violence." In S. Parker & B. Zuckerman (Eds.) Behavioral and Developmental Pediatrics: A Handbook for Primary Care. Boston: Little-Brown, 1994.
Periodicals
Hunter, R. S. and N. Kilstrom. "Breaking the Cycle in Abusive Families." American Journal of Psychiatry 136, 1979, pp. 1,320-1,322.
Kempe, C., F. Silverman, B. Steele, W. Droegmeuller, and H. Silver. "The Battered Child Syndrome." Journal of the American Medical Association 181, 1962, pp. 17-24.
Rodham, H. "Children Under the Law." Harvard Educational Review 43, 1973, pp. 487-514.
Zigler, E. "Controlling Child Abuse: Do We Have the Knowledge and/or the Will?" In G. Gerbner, S. L. Kagan, and E. Zigler (Eds.). Child Abuse: An Agenda for Action. New York: Oxford, 1980, pp. 3-34.
Zigler, E. and N. W. Hall. "Child Abuse in America." In D. Cicchetti and V. Carlson (Eds.). Child Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect. New York: Cambridge, 1989, pp. 38-75.
Organizations
The National Adoption Information Clearinghouse Address: 1400 Eye Street, NW, Suite 600
Washington, D.C. 20005 Telephone: (202) 842-1919
(Maintains resources on adopting children who have been abused.)
The National Clearinghouse on Child Abuse and Neglect Address: P.O. Box 1182
Washington, D.C. 20013 Telephone: (703) 821-2086
(Collects and disseminates information; provides general publications; and conducts individual research on a particular topic at low cost.)
The National Resource Center on Child Sexual Abuse Address: 1141 Georgia Avenue
Wheaton, MD 20902 Telephone: (800) 543-7006
(Provides information and resources regarding child sexual abuse; publishes Round Table Magazine, and maintains a list of treatment programs in the nation.)
—Doreen Arcus, Ph.D.
University of Massachusetts Lowell
