It was the third time this month that Billy1 came to school with a bruise on his face or neck. Mrs. Jones didn't know what to do; she was worried about Billy, but every time she asked about what happened, Billy would always have a story to describe what had happened to him. Mrs. Jones didn't always think the story Billy gave sounded credible, but she didn't know what else to do. Mrs. Jones decided to seek guidance from a colleague, who suggested she call Child Protective Services (or CPS) in their area. Mrs. Jones was concerned she didn't have enough information to make a hotline call; in fact, she had heard of hotlines before, but never made a call to one. Mrs. Jones didn't know if something really was happening to hurt Billy or who was hurting Billy and Mrs. Jones's colleague explained that an investigation would help find these things out—she didn't have to have any proof, just reasonable concern. Mrs. Jones decided to make the hotline call during her lunch break.
Billy grabbed his coat to take to lunch and then recess and Mrs. Jones noticed several bruises on Billy's arms. She asked Billy what happened and he angrily said, “Nothing, I just fell, okay?” Mrs. Jones didn't have a good feeling about this and decided to make the hotline call about her concerns. The hotline was taken from the central call center and routed to the local county office for further investigation.
Billy's stepfather, Jay, had been physically abusing Billy for several months. Jay was typically pretty good at covering up any evidence of marks or bruises, but had gotten sloppy over the last several weeks. He threatened Billy and explained that if Billy told anyone about the hitting, he would kill Billy's whole family. Plus, his mom had seen Jay hit him before and never stopped it or said anything. Fortunately, Mrs. Jones contacted local authorities and Billy and his siblings were able to be protected. Because Billy's mom needed help for domestic violence concerns as well, which Billy often witnessed, Billy and his siblings were taken into foster care and placed with a nice family just outside of their hometown. Billy's mom plans to leave Jay and to work hard to get her children back, but it will take significant effort on her part and the state needs to see it before the boys can be returned home. A very detailed treatment plan was written so all parties know what their responsibilities are in the situation. The children's safety comes first and the state will ensure all decisions made for the boys are in their best interest. Billy was very thankful Mrs. Jones had stepped in and gotten him the help he couldn't ask for himself.
Regrettably, the scenario depicted earlier is not uncommon; children are abused and neglected every day. Child abuse is an unfortunate occurrence that impacts hundreds of thousands of children in the United States each year. According to the U.S. Department of Health and Human Services (2011), 676,569 victims of child abuse and neglect were reported in fiscal year (FY) 2011. Some of these victims may have been subject to more than one report and when examining those numbers, more than 3.7 million children were subject to at least one report in the same fiscal year. These numbers suggest there are approximately 9 reported victims for every 1,000 children in the United States, which is a devastating number considering the data suggesting many child abuse incidents are never reported to authorities (DHHS, 2011).
When examining child abuse victim characteristics further, children under the age of 1 were the most represented age group in the statistics reported above. Typically, victimization in this age group is most closely associated with neglect versus abuse (Children's Bureau, 2011). Neglect is an act of omission (not giving the children something they need like food, water, shelter, or medical care), whereas abuse is an act of commission (doing something to a child that is in excess of what is appropriate). Neglect is actually the most common form of reported abuse, although it is not discussed as frequently as other types of abuse.
Gender is equally distributed in the statistics in this report and in general, the rate of abuse and/or neglect decreased with age. It is possible that older children may come to the attention of authorities sooner (remember Billy's scenario) because they are more visible (in school, etc.) and more verbal and able to communicate concerns more easily than older children.
As you will learn in Chapter 12, a big responsibility of professionals is mandated reporting. Mandated reporting laws vary by state, but in general, they require certain individuals or professionals to report concerns of child abuse and neglect. If these professionals do not appropriately follow these laws, criminal charges are possible. Through mandated reporting, many concerns of child abuse are brought to light. People do not have to be required by law to contact their state's child abuse and neglect hotline or local authorities. Essentially, making a report, or calling a hotline, begins an investigative process when concerns, like the ones you learn about in this chapter, are present. People do not have to have proof of their concerns to make a hotline call, as you learn in Chapter 12; in fact, a reasonable suspicion is all that is required and the investigation of the concerns should be left to the professionals. As you read through this chapter and the various scenarios presented, consider if you believe the situation warrants additional investigation.
As was mentioned earlier, neglect is an act of omission, where people, typically caregivers, fail to provide adequate care to another person dependent on them. There are various forms of neglect including physical, medical, emotional, and educational. According to Gaudin (1993), defining neglect includes analysis of the following items:
Like other forms of abuse, each state defines and delivers consequences for neglect differently. In general, the definitions for each state follow Gaudin's criteria when considering whether neglect, an act, or failure to act causes harm, exploitation, or death or a risk of such consequences. In general, the four most common forms of neglect are defined as follows, according to American Humane Society (n.d.).
Physical neglect accounts for the majority of cases of neglect that are reported. Physical neglect generally involves the parent(s) or caregiver(s) not providing the child with basic provisions needed for survival such as adequate food, clothing, supervision, and/or shelter. Because these are important to our survival, failure to provide these necessities can have long-term consequences including developmental concerns, cognitive deficits, and/or mental health issues. For example, a father who eats all of the food in the household and does not provide food for his children may be neglecting a need related to physical neglect.
Medical neglect is the failure to provide suitable health care for a child when the means exist to provide such care. Said another way, financially, a person is able to provide access to health care services and does not do so. This is an important distinction because the law may view a lack of medical care due to poverty in a different way than a lack of medical care due to a motivation issue. If a child breaks his arm and his parents refuse to take him to the doctor because of inconvenience, this would be viewed differently than a family who does not seek medical services due to financial concerns and lack of access. Lower-income families may have difficulty gaining access to the medical services they need—some families may be placed on significant waiting lists to see physicians, including psychiatrists, due to the type of insurance they have. They may not be able to seek alternate care because the psychiatrist contacted is the only person in their region who accepts their insurance. Authorities would not necessarily look at this delay in care as neglect, but a lack of available resources. The delay in care may have deleterious effects, however, as waiting many months to address a problem that is currently an issue is unacceptable.
A lack of access to appropriate health care can have serious consequences, including lifelong medical concerns or death. For example, a mother who does not provide medical care when her child complains of chronic pain after a fall may be neglecting a medical need. Getting more information in situations like this is crucial, because the lack of medical care may be due to an inability to take off work, financial barriers, and so on.
Educational neglect involves the failure to provide adequate educational resources to a child of school age. If enrolling in private or public schools is not desired, participation in a home-schooling program is required. Additionally, not requiring school attendance of a child who is school age may be considered educational neglect. Because so many skills are developed and acquired at school, a lack of attendance can have serious social, emotional, psychological, and educational consequences. A father who allows his teenage daughter to skip school for weeks at a time may be neglecting an educational need of his daughter.
Emotional neglect is more difficult to define and prove in a court of law. How can we prove that an action may hurt a child's psyche? How do some children experience emotional neglect and maltreatment and appear unscathed while others crumble and have significant issues? Some of these differences may be due to protective factors. Protective factors are characteristics that mitigate, or lessen, the impact of negative experiences. Access to support systems, access to resources, coping skills, and close, healthy relationships are some examples of protective factors. These, along with other individual characteristics may help explain the differences we see in the presentation of victims of emotional neglect and maltreatment.
Emotional, or psychological, neglect may include engaging in unstable interactions in front of the child (domestic violence), refusing access to mental health care, withholding affection, name-calling, ignoring, rejecting, isolating the child, threatening/terrorizing, or exploiting. Poor emotional development can lead to severe psychological consequences, including social skill concerns, substance abuse, poor self-esteem, and/or destructive decision making For example, a mother who calls her son names multiple times a day and withholds affection and praise may be neglecting his emotional needs.
Perpetrators of neglect may lack understanding of child development (which may lead to unnecessary frustration or a lack of necessary care), may be single parents, may be in financial distress, may report greater mental health concerns, may have a history of substance abuse, may have been previously victimized, and may be younger in age (Children's Bureau, 2011).
The primary goal in dealing with neglectful families is safety and prevention of additional harm. Fortunately, neglectful families are often able to remain united and can improve functioning with access to services and some mental health assistance. Parent Child Interaction Therapy, or PCIT, may be a useful treatment method for families in distress. It aims to improve the skills of parents, decrease negative interactions between children and parents, increase positive and prosocial communications, and decrease parental stress. According to the National Child Traumatic Stress Network (NCTSN), PCIT is an evidence-based treatment method that provides live coaching sessions to parents to improve the child/caregiver relationship (NCTSN, 2008). This treatment method might be particularly useful in cases of emotional neglect, whereas gaining access to resources might be a more useful intervention method for the other forms of neglect discussed. Individual therapy may be another option for parents or caregivers who are feeling overwhelmed, unmotivated, or stressed. Because of the dangers associated with child neglect, ensuring safety of the children involved is crucial, as well as improving future functioning.
Physical abuse is defined as “non-accidental trauma or physical injury caused by punching, beating, kicking, biting, burning or otherwise harming a child.… [P]hysical abuse is the most visible form of child maltreatment” (American Humane Society, p. 1). Like other forms of maltreatment, specific definitions and legal implications surrounding physical abuse vary state to state. Some states require physical injury to rise to the level of abuse while others do not (NCTSN, 2009). There is some debate associated with definitions of child physical abuse, particularly with corporal punishment. In many states, corporal punishment (spanking) is not illegal unless it crosses reasonable means. What is reasonable when considering spanking? If marks or bruises are left on the body? If an object is used? If the child is unable to sit or stand? These questions, and others, make this discussion difficult as people feel differently about what is reasonable or appropriate or not.
In 2011, there were more than 118,000 victims of child physical abuse (DHHS, 2011). The consequences of physical abuse can be significantly impairing to its victims, with death being the most severe result possible. These numbers pale in comparison with victims of neglect being more than 500,000, however, one victim of child abuse is one too many.
When considering victims of child physical abuse, it is important to discuss potential risk factors associated with physical abuse. According to Rodriguez and Tucker (2011), poor attachment was considerably related to both dysfunctional child-rearing practices and increases the likelihood of child abuse victimization. These results emphasize the importance of the child/parent relationship and abuse potential. Additionally, these authors mention that in general, research supports that harsh or inappropriate discipline as a child may be related to harsh or inappropriate (and abusive) parenting styles (Coohey & Braun, 1997; Craig & Sprang, 2007).
As can be found in almost any introductory psychology textbook, Bandura's social learning theory supports these claims—what we see is often what we do. We can become desensitized to harsh parenting techniques over time, particularly if it becomes our “normal.” Think about your own childhood for a moment. Are there things that were abnormal or strange that you did not realize were strange until you became an adult? Even in nonabusive households, we often find things that our parents did simply because their parents did, so on and so forth. When unhealthy parenting practices are carried from one generation to another, the cycle of abuse will be continued until someone or something breaks the cycle. What is the best predictor of future behavior? Past behavior. Knowing this, we can identify individuals who might be high risk for becoming perpetrators or victims of child abuse and provide services and interventions that might assist them in not crossing an inappropriate boundary.
Attachment and parenting style may also be related to child physical abuse. Rodriguez and Tucker (2011) studied at-risk mothers and found attachment to one's parents was significantly related to an increased child abuse potential and dysfunctional disciplinary style independent of individual maltreatment history. According to Cloitre, Stovall-McClough, Zorbas, and Charuvastra (2008) individuals with poor attachment histories may have characteristics such as difficulty regulating emotions, poor management of managing negative emotions, and distrustful of others. Thus, this suggests that an unhealthy attachment with one's parents may have personality characteristics that may make them more susceptible in engaging in poor parenting practices. Interestingly, poorest attachment was apparent in the mothers with reported personal histories of abuse and those women may be the most likely to maintain the cycle of violence, consistent with earlier research on attachment quality and predatory behavior (Zuravin et al., 1996, in Rodriguez & Tucker, 2011). What research like this does help us understand is how risk factors are related to child abuse; it is the hope that we can use this information in preventing abuse in the first place. If professionals can recognize the relationship between attachment, parenting style, and abuse history, interventions can take place that might offset some risk factors for future abuse.
The consequences associated with child physical abuse go beyond what many people think of initially. Not only are there potential physical injuries like broken bones, head trauma, abdominal injuries, skin injuries, and so on, there can also be behavioral, emotional, and psychological effects from exposure to abuse of this kind.
Research has found links between physical abuse, depression, and aggressive behaviors but the relationship among these variables appears different when looking at men versus women (Scarpa, Haden, & Abercromby, 2010). It appears that males and females react differently to trauma, with males engaging in more antisocial behaviors and females becoming more withdrawn. Several studies have reported that child physical abuse is a noteworthy predictor of depressive symptoms (Gover & Mackenzie, 2003; Hill, 2003; Kilpatrick et al., 2003, in Scarpa, Haden, & Abercromby, 2010). Depression can be a difficult disorder to live with as it can impact us personally and professionally, so understanding the link between depression and childhood trauma is an important area of study. In agreement, Cichetti, Rogosch, Gunnar, and Toth (2010), there are physiological differences between children who were exposed to abuse/trauma at a young age, and those who were not. Specifically, the stress hormone, cortisol, can be suppressed or released in extreme quantities (very high or very low), which can be related to health and development.
Additionally, because crucial brain development occurs early in life, any negative exposure during a formative period could lead to developmental issues. If children's abilities to adequately handle and adapt to stress are negatively impacted early on, this can be a consequence that causes life-long difficulties.
In the literature, there appears to be a link between eating disorders and early experiences of childhood abuse and trauma (Johnson, Cohen, Kasen, & Brook, 2002; Rorty, Yager, & Rossotto, 1994). Because eating disorders are often related to the desire to be in control, some believe the relationship between eating disorders and trauma could be due to the lack of control the victim experienced during the abuse situation. In general, individuals with eating disorders are more likely to report a history of child maltreatment.
Messman-Moore and Garrigus (2007) reported that women who experienced multiple forms of childhood abuse, of any kind, experienced more difficulties associated with eating behaviors (bulimic tendencies, preoccupation with weight, etc.). This suggests that the chronicity of the abuse, rather than the type, may have a more significant impact than we once thought. Additionally, women who experienced physical abuse as a child reported excessive concerns with dieting and weight and extreme measures to pursue thinness.
As has been mentioned previously, keeping a family intact, if possible, is a goal of Child Protective Services. Children often function best in their biological homes, if those homes are nurturing, loving, and appropriate.
With physical abuse, treatment methods vary, and like neglect, ensuring safety of the victim (and other children as appropriate) is a primary goal. For victims of physical abuse, the predictability of their world is often disrupted and they may live in fear. Therapy, particularly focusing on trauma and trauma-related symptoms, may be an effective intervention for victims of physical abuse. Trauma-focused therapies can assist participants by providing education about trauma, normalization of symptoms, safety planning, dispelling myths and cognitive distortions, and allowing for free expression of emotions and concerns.
For the perpetrator of physical abuse, treatment is also an important consideration. For many, learning to implement effective parenting practices is a chief concern. Educating parents on appropriate and inappropriate discipline methods, providing alternative techniques of gaining cooperation from their children, and dealing with any mental health concerns (of the child[ren] or parent) are all important. As was mentioned in the Treatment of Neglect section, Parent Child Interaction Therapy (PCIT) can be an effective technique in increasing positive interactions between parents and their children. Parents who are susceptible to “losing their cool” or crossing boundaries of appropriate punishment techniques might be urged to avoid any methods that might cause them to revert back to inappropriate practices.
Do you respond better to negative or positive feedback? Most of us would rather hear good things we are doing rather than all of the things we are doing wrong. Children are no different; if we can find ways to compliment them, even on small things, they are likely to respond more favorably. This can be easier said than done; however, experience tells us reinforcement is more effective in the long-term than punishment.
Child sexual abuse is another unfortunate reality for many of our youth. It can be uncomfortable to talk or read about, but we cannot help protect children if we are not willing to acknowledge the problem. Defining child sexual abuse can be somewhat complicated as it can encompass a diversity of behaviors and actions.
According to the American Humane Society, child sexual abuse is defined as sexual abuse and can include: sexual intercourse or its deviations, sexually touching a child (such as fondling, making a child touch an adult's sexual organs, penetrating the child's sex organs in any way with any object), as well as nontouching offenses (exposing children to pornography, deliberately exposing a child to sexual acts, including masturbation) or sexual exploitation (soliciting a child for the purposes of commercial sexual exploitation/human trafficking). As you can see, there are many behaviors and acts that can occur that would fall under the category of child sexual abuse.
According to the Children's Bureau (2011), more than 65,000 children were reported victims of sexual abuse in 2011. One of the difficulties surrounding statistics of abuse, particularly sexual abuse, is the underreporting that professionals know occurs. Because sexual abuse is often done in a secretive manner and because we cannot look at people and tell if they have been sexually abused (as we may be able to do for a child who has been neglected or physically abused), children can avoid disclosing their abuse for many years after it occurs, if they disclose at all. It is possible that we are only skimming the surface with these statistics we report related to the number of children who experience abuse. According to Olafson and Lederman (2006), there is agreement among researchers that there are a significant number of children that delay disclosure of their abuse experience until adulthood. Can you think of a reason why this might occur? There is often a lot of shame, guilt, and blame associated with abuse, particularly sexual abuse, and because of this, victims may not ever tell someone about their abuse experience. Although actual numbers vary, several research studies report between 28% and 70% of adults, who were victimized as children, delayed their disclosure until adulthood and many never reported abuse to authorities (Olafson & Lederman, 2006). This tells us that when we calculate statistics based on cases formally reported to law enforcement or child protective services, we may be missing a significant number of cases in our calculations. Additionally, research tells us children delay disclosure within childhood—meaning they often wait to report abuse experiences for months or years after the abuse occurs, which can also influence statistics. So, use caution when reviewing statistics related to child abuse and understand the numbers are likely quite a bit higher than we can imagine.
Because child sexual abuse encompasses such a wide range of behaviors and actions, summarizing the characteristics of its victims can be somewhat complex. Children often fall victim to sexual abuse in their homes, by someone close to them, but there are occasions when children are abused by a stranger or by someone who has lured them to engage in particular behaviors. The relationship of the offender to the child can impact the child's experience with the abuse. Additionally, how the children view their responsibility in the abuse can also influence their experience.
If a child meets someone online on a social networking site and gets involved in commercial sexual exploitation as a result of the new relationship, will she feel responsibility for her experience? It is easy for professionals to say she should not, she was the child involved, but the reality is that many children experience guilt or self-blame because of actions they took (or did not take) that they believe would have changed their fate. Or, consider a 13-year-old who meets a 37-year-old online and forms a romantic relationship, which does include sexual contact. This 13-year-old views the 37-year-old as her boyfriend—do you think she views herself as a victim? Most likely not and because of this, this is an example where the victim may be viewed as a compliant victim, or people who cooperate and participate in their victimization. Sometimes, compliant victims reluctantly participate in their victimization because of benefits such as money, clothing, and attention, or they may not view the situation as abusive at all, like the example provided with the 13- and 37-year-old. In either situation, complicity can make investigations more difficult and may make participation in the legal process complicated. In my experience, compliant victims often do not see themselves as victims, but as willing participants. They will often refer to the offender as their “boyfriend” and may, at first, be uncooperative to provide information about the relationship in question. As this textbook mentions, building rapport is an important consideration when interacting with victims of child abuse, and I find it especially critical when working with compliant victims. Sometimes investigators may feel it is their job to educate the victims on how dangerous their behavior has been; however, this can cause investigative difficulties. When interviewing child victims, it is no concern when the children refer to the offender as their boyfriend or girlfriend because it is their perception of the situation—if time is spent lecturing about how a 37-year-old has no business “dating” a 13-year-old, an opportunity might be lost to gather crucial information to support the case. Although safety is an obvious concern, it may be more appropriate for a victim advocate or parent to discuss these matters with victims, rather than law enforcement officials who are trying to build a case for prosecution. If you remember being a teenager, your opinions were likely strong and important to you and when people tried to tell you something different than you thought or felt, it made you want to prove them wrong, right? We often look back and realize some of the choices we made as teenagers may not have been the smartest or safest, but it sometimes takes years for these realizations to occur. Thus, when talking with compliant victims, balance the need for gathering information with the need to educate the victim about the consequences of certain behaviors and actions. Sometimes, what is intended as educational may seem blaming, so it is important to keep this in mind when interacting with child victims. Consider this: “Susie, do you know what could have happened to you? You should never meet up with someone you met online because you could be killed! If you were my daughter, you would be grounded from your computer because there are some dangerous people out there!” Do you see how this could be interpreted as blaming the victim for her circumstance?
As you will learn in Chapter 7, a forensic interview is an appropriate investigative tool that can be used when interacting with child abuse victims and witnesses, including compliant victims. Some professionals believe is not necessary to forensically interview teenage victims; but, remember that children are not miniature adults and 13 is not a magic number where children can suddenly communicate at the same level as adults. Alternatively, teenagers can be egocentric in their communication and a forensic interview may be especially important to gather accurate details by asking developmentally sensitive and legally sound questions. Additionally, trained forensic interviewers have skills in dealing with various types of child victims and witnesses, including compliant victims and provide legally defensible testimony on behalf of those they interview.
The public may view compliant victims differently than those they view as “forced” into abuse because there is a lack of understanding on how or why children would cooperate or actively participate in victimization. There is often a lack of understanding about the manipulation and grooming techniques that will often initiate and maintain abuse. Education is critical to avoid blame being put on victims due to this complex phenomenon. The next section provides helpful information about how child sexual abuse begins and how it is secretly continued over time.
As was mentioned, there can be a public lack of understanding about the dynamics of child sexual abuse. Some of this may be due to inaccurate information portrayed in the media, myths, and confusion about laws and statutes related to consent. There is often a misconception that children are more at risk for abuse by strangers (stranger danger). This is likely because it is easier to believe strangers could hurt our children, versus loved ones, and because of this, there can be confusion about the characteristics of abusive relationships.
Child sexual abuse is often predatory in nature and techniques are often employed by offenders to groom the child victim and sometimes those close to the child victim (like parents). The term groom (or grooming) refers to techniques that initiate and/or maintain abuse. These techniques may include giving gifts, making threats, treating the victim like a significant other, and other behaviors and actions that may make the child maintain interest in the relationship for one reason or another.
According to Craven, Brown, and Gilchrist (2006), research suggests that there may also be “self-grooming” that occurs where the offender prepares himself (although we know women can be offenders, for the ease of discussion, we use a male offender for an example) for the abusive behavior and justifies his actions. This can take place in cognitive distortions where the offender reports that the child victim “came on” to him or that he was teaching the child victim about sex, for example.
Secondly, offenders often target children they view as vulnerable. This may include children who are isolated, have few friends, and have poor relationships with their family members. Offenders often become somewhat integrated into the victim child's life—which can make disclosure more difficult once abuse begins. This is why we see offenders becoming coaches, tutors, camp counselors, youth leaders, and so on, and placing themselves where they have regular access to the child victim (and other potential victims). As we know, all individuals who hold these positions are not sexual predators; however, the point is that sometimes, individuals seek these positions to increase their access to children. We have to consider that if an offender seeks a position of power and trust, the public may not view this person as a threat. It is difficult for us to think about the decorated football coach, the lead youth pastor at a beloved community church, or the director of a day care center being a sexual predator. I recall a case I worked a number of years ago where a child waited to disclose about her abuse because her mother had referred to the offender, a family friend, as a “really nice and upstanding gentleman,” and she was worried her mother would not believe that he could have sexually abused her. Luckily, the child was wrong and her mom stood by her side and wholeheartedly believed her.
Grooming can also occur to individuals inside the child's frame of reference, such as parents, caregivers, and grandparents. Offenders may offer to babysit while the parents spend time outside the home or may provide gifts that the family couldn't afford. These actions may make it not only difficult for the child victim to disclose, but also difficult for the family to comprehend that someone who has been good to their family would betray them in this way.
Grooming is often gradual and can take place over a number of months or years. If children are psychologically groomed, this can lessen the likelihood they may disclose as they may be convinced the abuse is their fault, that no one will believe them, or that they will go to juvenile detention if they bring the concerns to light. With physical grooming, the contact will often begin as nonsexual touching and escalate to sexual touching as the relationship progresses. This will often desensitize the child victims and prepare them for increased sexual contact (Craven, Brown, & Gilchrist, 2006).
Grooming is a topic that is often neglected in discussion of child sexual abuse. Consider including information about this when working investigations of child sexual abuse to see if it helps paint a clearer picture of the child's experience. Imagine sharing with a jury that the reason a child didn't tell about the abuse is because she was provided free summer camp visits, given money and clothes, and promised a modeling career, and how much it would help them understand the dynamics of child sexual abuse and how abusive relationships are initiated and maintained. Participating in the relationship doesn't become the child victim's fault, but it does help us understand why it is complicated for the child to disclose or how the child may not realize the abusive relationship is inappropriate in nature.
There is no checklist of characteristics that can be provided to you that all victims will exhibit or that are diagnostic of child abuse. Research and experience tells us that there are some commonalities among child abuse victims and some mental health concerns that can exist, particularly if trauma-related issues are not handled adequately.
According to research conducted by O'Leary, Coohey, and Easton (2010), mental health symptoms were related to a number of factors. Participants who were abused by more than one offender, who reported injuries due to their abuse, who were abused by a biological relative, and who did not disclose their abuse experience in-depth within 1 year of the abuse had a greater number of mental health symptoms.
Abuse victims and their parents often report varied symptoms following abuse experiences. Sometimes, children and their families report no significant difficulties or symptoms following abuse experiences and this may be due to protective factors (mentioned in an earlier portion of this chapter). Children who are victims of sexual abuse may experience internalizing (depression, anxiety, etc.) or externalizing (angry outbursts, bullying, etc.) symptoms. Some children may meet the criteria for various psychological disorders including posttraumatic stress disorder, major depressive disorder, oppositional defiant disorder, conduct disorder, and others. Some children may not meet the full criteria for disorders, but may have symptoms such as bedwetting, nightmares, crying spells, change in school performance, and irritability. Again, these disorders and symptoms can be present without a history of abuse, so these are not diagnostic and a psychosocial assessment can assist in developing a full clinical picture.
Treatment of the symptoms mentioned earlier will often include individual, family, and/or group psychotherapy and may involve the child victim, the nonoffender caregiver(s), and possibly siblings, if appropriate.
According to the National Child Traumatic Stress Network (2008), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) can be a highly effective treatment modality for children for not only abuse victims, but also for children who have experienced other forms of trauma. This treatment method follows the acronym PRACTICE and stands for Psychoeducation and Parenting Skills, Relaxation, Affective Expression and Regulation, Cognitive Coping, Trauma Narrative, In Vivo Exposure, Conjoint Child/Parent Sessions, and Enhancing Safety and Future Development. Each of these phases is flexible as to the time spent addressing each issue and based on the child and family's needs. This model seeks to provide therapeutic intervention to children who have experienced traumatic life events by providing new skills to help process and discuss thoughts and feelings surrounding the trauma. This method is the most well-supported and effective treatment for abused and traumatized children, so it is widely used in a therapeutic setting. It does require specific training, including participation in a learning collaborative, so clinicians who are adequately trained in TF-CBT can potentially do great work for children who are abuse victims. It is recommended that families are mindful of who they select as their therapist because some individuals may claim to be “trauma-focused” or “experts” in working with children who have experienced trauma, but they may have no specific training regarding these issues. Mental health is too important to risk seeing a clinician who is not adequately trained.
Intimate partner violence (IPV) is an unfortunate phenomenon that many children witness on a regular basis. Professionals used to believe that the abuse had to actually happen to the children for it to impact them significantly; but, after years of research and experience, we now know that witnessing domestic violence can be as traumatic and damaging as actually experiencing abuse.
IPV, also known as domestic violence, is psychological, physical, or sexual harm by a significant other (current or former). Intimate partner violence, unfortunately, is also a common phenomenon, like other forms of child abuse and neglect. Children often witness these violent interactions and can be negatively impacted in many ways.
Unfortunately, those in violent relationships often stay much longer than is safe for them. There are various reasons for this, but a common reason is fear. In practice, we do see overlap among individuals who abuse children, their partners, and animals. Ascione (2000) examined 100 battered women and found that 50% of these women reported their partner had hurt or killed their pets and nearly 25% reported they delayed leaving because of concern for their animals. In these instances, animal abuse may have been used to gain control or silence from these women and likely kept them in harm's way longer.
Children who witness violence toward a parent may try to intervene and protect their parent and may get harmed because of this. Living in a constant state of fear can be detrimental to children in many ways and the unpredictability of their environment can be stressful and frightening. Wood and Sommers (2011) reported that children who witness intimate partner violence have short- and long-term consequences that impact their current and future relationships with same-sex peers and dating partners. Children may also exhibit symptoms of depression, anxiety, posttraumatic stress disorder, and externalizing and/or internalizing behaviors when they witness violent interactions in their home. Gender does appear to be a factor in symptomology as well, as Moretti, Obsuth, Odgers, and Reebye (2006) found. They reported that girls who witnessed their mothers engaging in aggressive behavior toward a partner exhibited more aggression in friendships. Additionally, boys who witnessed their fathers engaging in aggressive behavior toward a partner exhibited similar behavior in friendships. This suggests that modeling of the same-sex parent appears to predict hostility against friends. Witnessing chronic intimate partner violence or adding other forms of abuse directly to the child (neglect, physical abuse, sexual abuse, etc.) also may increase symptoms experienced.
Furthermore, witnesses to intimate partner violence may be at increased risk for intergenerational transmission of abuse; thus, intervening appropriately is crucial to stop the cycle of violence.
This information suggests that witnessing intimate partner violence may be as damaging as other forms of abuse, so professionals working in the field should consider how IPV impacts children and should inquire about other potential areas of concern (animal abuse) that may be occurring in the home to conduct thorough investigations.
This chapter has included information about the widespread nature of child abuse and neglect, and the sad reality is that hundreds of thousands of children are impacted by child maltreatment on a regular basis. So, what can we do with this information? One thing that is important to talk about is prevention—we tend to be a “reactive” society where we wait for something to happen to care about or do something about it. We know that child abuse is an epidemic, so this next section discusses ways we can look forward and improve future generations' experiences in our community.
Because of the widespread nature of child abuse, prevention efforts emerged in the 1970s and increased in popularity in the 1980s. Prevention efforts varied, based on the type of abuse concerned. Efforts to prevent neglect or physical abuse often focus on adjusting caregiver behavior and increasing positive interactions between parents and their children. Efforts to prevent sexual abuse often focus on educating children about appropriate and inappropriate touches and cyber and personal safety. According to Wertele (2009), “most child-focused personal safety programs have these objectives in common: (a) helping children to recognize potentially abusive situations or potential abusers, (b) teaching children to try to resist by saying ‘no’ and removing themselves from the potential perpetrator, and (c) encouraging children to report previous or ongoing abuse to an authority figure” (p. 4). We need more than child-focused prevention efforts, however, because children cannot ultimately be the ones held responsible for their safety.
One of the difficulties surrounding prevention programs is the lack of evidence surrounding their efficacy at actually preventing abuse. Because of this, a comprehensive approach must be taken to reduce the number of children who experience abuse. Prevention programs; education for professionals, parents, caregivers, and those who interact with children; engaging the public in a “no tolerance” view of child abuse; and swift and strict punishment of offenders can be a start to reducing the number of child abuse victims. We must dispel myths about child abuse (i.e., stranger danger—although children can be abused by strangers, it is more likely someone they know) and provide useful information for our children about the facts of child abuse and ways to get help if they do fall victim. These conversations about child protection should occur early and often, so children feel empowered and comfortable with the knowledge they are given.
Child abuse is a reality that we should not have to discuss as an epidemic in 2014, but we have the ability to educate the public about child abuse, punish those who commit such crimes, and improve criminal and civil investigations when these crimes occur. As the next generation of professionals who work with children, remember how important your job is, even on the days when you are not sure why you decided to pursue a career in child protection. Frederick Douglass once said, “It is easier to build strong children than repair broken men.” Remember this as you take on one of the most important tasks we can take on as a nation—protecting children. Child abuse will be discussed one day as a thing of the past and although many of us will not be around to see that time in our nation's history, to be a part of this movement will be one for the record books.