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Child Maltreatment
When Parenting Goes Awry
CHAPTER 12
Including the concept of child abuse in a parenting book seems incongruous:Why would a parent knowingly harm a child? Many people are under themistaken impression that parents are not likely to be perpetrators—and that strangers are much more likely to abduct and harm a child. However, in the United States, child abduction by a stranger happens only about 2,400 times a year (in contrast
Child Maltreatment Throughout History
The Four Faces of Maltreatment
Physical Abuse Neglect Sexual Abuse
Psychological Maltreatment Co-occurring Maltreatment
Maltreatment Across Time and Country
Protecting Maltreated Children: Foster Parents
Chapter Preview: True or False?
• Child abuse is caused by a “child-abusing personality” in parents.
• More than 900,000 children are confirmed as maltreated each year in the United States.
• The United States has one of the highest rates of child maltreatment in the world.
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to as many as 354,000 abductions by family members), and most of these children are returned safely (Boudreaux, Lord, & Etter, 2000). The fact is that children are targets of maltreatment and some type of injury or trauma from many sources, including siblings, peers, teachers, and neighbors (Finkelhor, Ormrod, & Turner, 2007). Not surprisingly given the time they spend with their children, parents are by far the group of individuals who pose the biggest threat to children’s safety. As we will see, parents maltreat children for many reasons and in many ways.
Child maltreatment is the most visible and obvious indicator of dysfunctional parenting. It was once thought that child abusers were very different from other parents and were characterized by a “child-abusing personality.” No such personal- ity type has been found. On the basis of research conducted mostly since the 1970s, researchers now have a much better understanding of the reasons otherwise typical parents do something as abnormal as abusing their children. Recall from Chapter 1 that parenting can be better thought of as occurring on a continuum, as is illus- trated below. This chapter focuses on the far left end of that continuum.
Abusive Poor Good Enough Good Exceptional
What is child abuse? The World Health Organization (2002) defined the problem:
Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-treatment, sexual abuse, or neglect or negligent treatment, or commercial or other exploitation, resulting in actual or potential harm to the child’s health, survival, development or dignity in the context of a relationship of responsibility, trust, or power. (p. 38)
Child Maltreatment Throughout History
The history of parental abuse of their children is extensive. Historians and anthro- pologists agree that children have been maltreated since antiquity (Ariès, 1962; deMause, 1975; Sommerville, 1982). Societies have tolerated or even sanctioned a wide range of atrocities to children that parents—and others—have committed for thousands of years. A few examples will serve to illustrate the nature and prevalence of child maltreatment.
Infanticide, the killing of a child during the first year of life, has long been used as a method for culling out unwanted or handicapped babies, as mentioned in Chapter 1. The practice was routine in ancient Greece, Rome, Arabia, and China (Sommerville, 1982; Zigler & Hall, 1989). Both Plato and Aristotle advocated killing “defective” newborns, and the Greek physician Sonorus, in his second-century CE book, included a section titled “How to recognize the newborn that is worth rear- ing” (Ruhrah, 1925, p. 6). Infanticide was often a passive act: Undesired infants were abandoned in a secluded place.
Documents can be found that allude to other practices that today we would label as abusive. Sonorus warned of potentially abusive women when he wrote of the
284 PART III • CONTEMPORARY ISSUES
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need to carefully select wet nurses, not just on the basis of health, age, and breast size but also on the basis of their personality. He recommended finding an even- tempered woman so she would be less likely to roughly handle or drop the baby. In 900 CE, a Persian physician named Rhazes wrote that many children who lived in the harems of Baghdad had been intentionally struck. About 800 years after that, a guidebook for physicians was published that warned that swelling in infants’ heads could be due to dropping the infant or hitting it against something. The swelling is an effect of what is now labeled shaken baby syndrome.
Rough treatment of children and harsh punishment have also been common practices throughout history (Greven, 1991). Recall from the first chapter that in colonial America, hitting children was an accepted method to “drive the devil out,” to “break the will,” and to teach appropriate behavior.
Child sexual abuse also has a long history. As was mentioned in Chapter 1, dur- ing the Roman Republic, the doctrine of ius primae noctis gave the father of the family the right to have sexual intercourse with any female member of his household who was socially his inferior. Similarly, the 18th-century French doctrine of the droit du seigneur allowed the head of the household to sleep with whomever he desired.
Child labor is yet another example of how children have been maltreated and exploited. During the Industrial Revolution in the latter part of the 18th century,
Chapter 12 • Child Maltreatment 285
Illustration 12.1 An angry and frustrated parent shakes his child. This is dangerous behavior as it can result in Shaken Baby Syndrome.
Source: © 2009 Jupiterimages Corporation.
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children as young as 5 years old were forced to work in factories and other settings. In the 19th and early part of the 20th century, children in the United States labored on farms as well as in factories (sweatshops), restaurants, and mines. Child labor in textile mills attracted a lot of attention from children’s rights activists because these children toiled long hours in dangerous conditions. Although labor and education laws have long prohibited child labor, the practice continues most commonly in the form of migrant labor. In many other parts of the world, especially developing nations, child labor continues to be widely practiced.
As these examples illustrate, parents and many other individuals—including nurses and teachers—have maltreated children throughout history. More broadly speaking, cultural, religious, and economic institutions have sanctioned this mal- treatment (deMause, 1975). Only during the 20th century has there been a dra- matic shift toward empathy for the welfare of children and an awareness of the problem of child abuse (Sears, 1975).
The Four Faces of Maltreatment
Consider the following headlines:
• Mother Charged for Drunken 3-Year-Old • Woman Gets 80 Years for Holding Child in Scalding Water • Man Gets Life Sentence for Injecting Son With HIV • Girl Lives on Dog Food After Mother Takes Off • Man Pleads Guilty in Attempt to Sell Daughter, 4, for $1,500 • Parents Charged in Boy’s Death: 13-Year-Old Had Been Tied to Tree for 2
Nights • Man Gets 25 Years for Microwaving His Baby
Sadly, all of those headlines have appeared in newspapers, and more appear almost daily in communities around the country. We react to such stories with shock and outrage, but not long ago, people ignored or dismissed the problem. Sigmund Freud theorized that his patients’ claims of sexual abuse were actually repressed fantasies. A watershed in efforts to combat abuse occurred in 1962, when the physician Dr. C. Henry Kempe and his colleagues published a journal article that labeled the problem of physical abuse as the “battered child syndrome” (Kempe, Silverman, Steele, Droegemueller, & Silver, 1962).
Over time, it became clear that the battering of children—what has come to be known as physical abuse—was just one of the more obvious forms of child maltreatment. The word maltreatment is preferable to the term child abuse because it subsumes two types of behaviors: actively doing something (commission) to injure a child and failing to do something (omission) and thereby harming a child. Both types of acts are damaging. Today, child maltreatment is classified into four categories: physical abuse, sexual abuse, neglect, and psychological maltreatment.
286 PART III • CONTEMPORARY ISSUES
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According to the National Child Abuse and Neglect Data System (NCANS), based on official reports of maltreatment from Child Protective Services, schools, and hospitals, there were more than 3.5 million investigations into child maltreat- ment in 2006. Of those, it was estimated that 905,000 children were truly mal- treated (U.S. Department of Health and Human Services, 2008). Based on that number, the national prevalence rate is 12 victims per 100,000 children. This is a conservative estimate, however, because it relies on confirmed cases of maltreat- ment. A much higher prevalence rate was determined from self-report data from a community sample: 49 victims per 1,000 (almost 5% of the population)—and this included only physical abuse (Wauchope & Straus, 1990). Using the govern- ment’s statistics, the percentage of child victims for the four types of maltreatment can be seen in Illustration 12.2.
Chapter 12 • Child Maltreatment 287
Illustration 12.2 Types of Child Maltreatment by Percentage of Victims
Source: U.S. Department of Health and Human Services, 2008.
64.1
16
8.8 6.6
Neglect Physical Abuse
Sexual Abuse Psychological Maltreatment
Physical Abuse
Physical abuse is the most extensively studied form of maltreatment because it is easiest to detect. It involves an act of commission whereby a parent or other care- giver injures a child. Kempe and his colleagues (1962) identified bone fractures or broken bones, bruises, neurological damage, and child deaths as common outcomes of abuse. Subsequently, many other types of injuries have been added, including sprains, dislocated bones, abrasions from ropes or straps, burns (from cigarettes, appliances, or hot water), hair or teeth loss, scars, and various internal injuries. Poisoning and suffocating a child are also examples of physical abuse. An unusual form of physical abuse, Munchausen syndrome by proxy, is described in Box 12.1.
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Physical abuse is often a reaction to a mundane event, such as when a parent becomes frustrated with an infant’s cries, overreacts to a toileting accident, or improperly disciplines a disrespectful child. In some cultures, harsh or cruel punish- ments are not uncommon. In Yemen, for example, misbehaving boys can be shackled for weeks at a time (see Illustration 12.3.) The actions that lead to abuse may begin with a shake, push, or spank and escalate into behaviors that result in injury or even death. In some cases, the abuse is inten- tional. Much more commonly, however, the injury is unintended.
The injuries are not just physical but behavioral and emotional as well. Physically abused children are likely to exhibit a wide range of consequences (Kolko, 1996; Malinosky-Rummell & Hansen, 1993). Commonly found are internalizing (e.g., depression, anxiety) and externalizing (e.g., aggression) behavior problems. Emotional deficits (e.g., low self-esteem), insecure attachments, limitations in controlling emotions, and cognitive problems (e.g., poor school performance) are also frequent consequences of abuse.
Not all children are equally likely to be physically abused. In fact, the characteristics of victims help to reveal the dynamics of the problem. Young children and infants are more likely to be victimized than older children: 51% of those abused are 5 years old or younger. Physically abused children
also tend to have difficult or challenging temperaments. Children who are handi- capped or who have serious medical problems (such as prematurity) are also at risk (Sullivan & Knutson, 2000). These and other examples of child risk factors can be found in Table 12.1.
Parents are the perpetrators of physical abuse about 80% of the time. Other rel- atives (e.g., siblings, grandparents) are implicated in 7% of the cases, and unmar- ried partners of the child’s parent constitute about 4% of the perpetrators. Mothers are more likely to be the perpetrator of abuse than fathers are (61% vs. 39%, respec- tively), undoubtedly because they spend so much more time with their children than do fathers (U.S. Department of Health and Human Services, 2007). In the case
288 PART III • CONTEMPORARY ISSUES
Illustration 12.3 In Yemen, parents can request authorities to place their misbehaving children in leg irons.
Source: Photograph by J. P. Bell.
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of child abuse fatalities, one or both parents were responsible for 76% of child fatal- ities in 2006. Mothers are the perpetrators more often than fathers: In 40% of the cases, mothers were the sole perpetrators, whereas fathers acted alone in 18% of the cases. Both parents engaged in the abuse in 17% of the cases.
A parent is at heightened risk for perpetrating abuse if he or she has a diagnos- able mental illness (such as depression, schizophrenia, or antisocial behavior). In this case, the likelihood of physical abuse doubles (Walsh, MacMillan, & Jamieson, 2002). But mental illness is not the cause of most cases of physical abuse. A large number of parental risk factors have been identified by researchers, indicating the multiple-etiology nature of the problem. The factors can be divided into biological,
Chapter 12 • Child Maltreatment 289
The Strange Form of Physical Abuse: Munchausen Syndrome by Proxy
One of the more peculiar and rare forms of physical abuse is Munchausen syndrome by proxy (MSBP). The publication of Sickened (Gregory & Feldman, 2003), written by a survivor of MSBP, attracted considerable public attention to the syndrome. This disorder is named after the 18th-century German Baron, Karl Friedrich von Munchausen, known for telling wildly imaginative stories about himself. Some individuals with Munchausen syndrome intentionally make them- selves sick to elicit medical attention and sympathy from others. MSBP goes a step further: An individual (usually a parent) either produces or feigns illness in another person (usually the child) in an effort to get attention and support for him- or herself.
MSBP is rare: There are perhaps 1,200 cases per year in the United States. In most cases (95%), the perpetrator is the mother (Schreier, 2002). Typically, the mother intentionally causes an illness in her child but then either saves the child herself or rushes to the emergency room at a local hospital to procure medical help. In other cases, the mother fabricates medical symptoms but seeks medical tests and even surgery. In one case heard in a Texas courtroom, a mother of four young girls took them to the emergency room more than 150 times over a 4-year period. The mother persuaded doctors that the girls needed treatment for cystic fibrosis, cerebral palsy, and seizures—illnesses they never had (Nielsen, 2008).
In some cases, the mother actually kills the child. For example, certain infant deaths originally attributed to Sudden Infant Death Syndrome (SIDS) have been reclassified as MSBP cases where mothers suffocate their children but blame it on SIDS (Firstman & Talan, 1997).
Although MSBP is difficult to detect, one group of researchers covertly video- taped suspected MSBP mothers when they were with their allegedly ill children in the hospital (Hall, Eubanks, Meyyazhagan, Kenney, & Johnson, 2000). Of the 41 mothers videotaped, 23 were determined to be MSBP mothers. The video monitoring revealed that almost three fourths of the suspected MSBP mothers surreptitiously engaged in such actions as tampering with hospital equipment, smothering their children, or staging a disease when their children were healthy.
BOX 12.1
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cognitive-affective, and behavior characteristics (Berger, 2005; Milner & Dopke, 1997). For example, individuals who are biologically predisposed to be hyper- reactive parents are more at risk to abuse than are calmer individuals. A large number of cognitive-affective variables have been linked to physical abuse. In par- ticular, parental social-cognition problems include poor problem-solving skills, inadequate parenting knowledge, unrealistic expectations about children, and feel- ings of powerlessness when trying to control their children (Bugental et al., 2002; Cavanagh, Dobash, & Dobash, 2007). Behavioral characteristics include a reliance on physical punishment and personal substance abuse. For example, children of substance-abusing parents are three times more likely to be abused than are other children (Califano, 2007).
In addition to individual difference factors, a parent’s context or environment can provide risks. Four commonly identified factors are poverty, poor social sup- port, having been raised in an abusive family, and experiencing partner violence. Many of these risk factors (listed in Table 12.1) can be organized into a model of physical child abuse (Tolan, Gorman-Smith, & Henry, 2006; Wolfe, 1999). The model begins with risk factors, based on parent, child, and contextual variables. Next, when the individual then has a child, he or she does not engage in effective
290 PART III • CONTEMPORARY ISSUES
Child Characteristics
Young age
Difficult temperament
Handicap
Illness
Parent Characteristics
Hyperreactive
Attachment problems (e.g., insecurely attached in childhood, unwanted child)
Childhood trauma (e.g., abused in childhood; exposed to marital violence)
Emotional problems (e.g., immature, jealous of child)
Mental illness (e.g., depression, antisocial)
Reliance on physical punishment
Social cognition deficits (e.g., unreasonable attributions, unrealistic expectations, negative perceptions of child, feelings of powerlessness)
Substance abuse (e.g., alcohol, crack, methamphetamines)
Contextual
Partner violence
Isolation or little social support
Poverty
Table 12.1 Risk Factors in Physical Abuse
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parenting, and so the child develops problems. Those problems then contribute to poor quality parent-child interactions, negative emotion, coercive cycles, and esca- lating aggression. Eventually, the negative interactions result in child abuse, as is displayed in Illustration 12.4.
Chapter 12 • Child Maltreatment 291
Risks • Cultural • Situational • Parental • Child
Relationship • Inept
Parenting • Presence of
Partner Violence
Child Behavior Problems
Negative Parent/Child Interactions
CHILD ABUSE
Illustration 12.4 A Model of Physical Child Abuse
It is clear that there are multiple pathways to becoming a perpetrator of abuse. Some hyperreactive parents, when under stress, overreact. Other parents escalate the intensity of their actions when initial disciplinary efforts fail. Still others may have emotional or mental health problems. Many abusive behaviors are likely insti- gated by stress, such that marital problems or poverty will elicit actions that other- wise would not occur.
The different pathways to physical abuse have been most clearly understood in the examination of a particularly tragic incident of maltreatment—when parents murder their children. These cases of filicide help to reveal the different causes and motivations of severe abuse as well as how it differs by gender of parent (Koenen & Thompson, 2008; Stanton & Simpson, 2002). For example, one researcher identi- fied seven different causes (Wilczynski, 1997). Mothers were most likely to kill children they hadn’t wanted (43% of cases) or if they themselves were mentally ill (21% of cases). In another 14% of the cases, mothers believed they were engaging in an altruistic act (“mercy killing”) by ending the suffering of their ailing or hand- icapped child.
Fathers had different pathways toward filicide. In 30% of the cases, the fatality happened during a disciplinary episode. In another 30% of the cases, the father was retaliating against the mother, in a syndrome known as the Medea syndrome (after the Greek tragedy by Euripedes). Here, the motivation for murder is to hurt the spouse (typically in the aftermath of a separation or divorce). In contrast to moth- ers, 20% of the fathers had a novel motivation for murder: They were jealous of the attention the child received or perceived the child as rejecting them. Illustration 12.5 graphs these gender differences in filicide.
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Neglect
In comparison to physical abuse, the omission of child care sounds benign. But it’s not. Neglect concerns the failure of a caregiver to provide the physical and social ingredients for what is considered, based on community standards, the minimal care necessary for children to grow and thrive. Some of the infants raised in under- staffed and underfunded orphanages in Romania are a prime example of neglect, as was mentioned in Chapter 10.
Neglect takes multiple forms. Consider the following illustrations of neglect:
• Karen and Bill were professionals who lived in a spacious home. While they were entertaining guests one evening, their 2-year-old child climbed into a hot tub and drowned.
292 PART III • CONTEMPORARY ISSUES
Unwanted child 43%
Mothers
“Altruistic” 14%
Munchausen syndrome by proxy
3%
Retaliating against other parent
14%
Mentally ill 21%
Fathers
Unwanted child 5%
Jealousy/ rejection
20%
Discipline 30%
Mentally ill 15%
Retaliating against
other parent 30%
Illustration 12.5 Reasons Why Parents Kill Their Children
Source: Wilczynski, 1997.
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• Jacob and Michelle left their 9-year-old son in charge of his 5-year-old autis- tic brother while they flew to Las Vegas for the weekend. (Before leaving town, they took their puppies to a dog sitter.)
• A 19-year-old boy, weighing 45 pounds, was found rummaging in a neigh- bor’s trash can. He and his malnourished brothers had survived by eating wallboard and uncooked pancake batter. Their adoptive foster parents defended themselves by arguing that the boys had eating disorders.
Each of these examples actually occurred and depicts a different type of neglect- ful parenting. Signs of neglect include inadequate nutrition, tattered clothing, poor hygiene, unsafe environments, a lack of supervision, and abandonment. Medical, dental, or mental health problems, such as failure to thrive (as indicated by small stature), can also be indicators of neglect (Stowman & Donohue, 2005). Although neglectful supervision can have fatal repercussions in a matter of minutes (as in the drowning illustration), neglect generally refers to a longer-term pattern of behavior.
Physical neglect is the classic and stereotypic manifestation. A child lives in a filthy, unsanitary, and dangerous home, where we might find piled-up garbage, exposed wiring, broken glass, bugs or rodents, and perhaps animal feces. These conditions are classic red flags of neglect. Parents who do not take care of their home are not likely to take care of their children’s basic needs. Physically neglected children sometimes look uncared for: They may have dirty, lice-filled hair, be dressed inappropriately for the weather, exhibit poor hygiene, and appear malnourished. They may also be left unsu- pervised or be put inappropriately in charge of younger children. See Boxes 12.2 and 12.3 for two types of neglect cases. One was due to ignorance; the other is more common but perplexing.
Chapter 12 • Child Maltreatment 293
The Boy Raised as a Dog
An extreme (and tragic) example of the way in which a parent’s thinking process can permanently damage a child’s development is described in a book by the child psychiatrist Bruce Perry (Perry & Szalavitz, 2007). Dr. Perry recounts his experience with Justin, a 6-year-old child hospitalized with a severe case of pneumonia. In addition to his health problem, it was clear the boy was extremely disturbed and difficult to deal with. Justin engaged in autisticlike behavior, wore diapers, and yelled at the staff. It turned out that his mother had died when he was 11 months old and so he lived with his mother’s boyfriend, Arthur.
Arthur had almost no experience with infants or children so he did not know how to rear a child. However, Arthur did know how to raise dogs. So Arthur put Justin in a dog cage beside his other dogs. Justin was fed and his diapers were changed, but he was rarely spoken to or played with. Unbelievably, Justin lived that way for 5 years—until he contracted pneumonia and was taken to the hos- pital. Despite the severe neglect Justin suffered, he moved in with a foster family and showed dramatic improvements, such that he eventually was able to attend kindergarten—when he was 8 years old.
BOX 12.2
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Medical neglect refers to a failure to provide appropriate health care for a child (despite the financial ability to do so). About 2% of all child maltreatment cases involve this form of neglect (U.S. Department of Health and Human Services, 2007). The most common reasons for this form of neglect are cultural or religious beliefs, anxiety about a medical condition or intervention, and financial considerations.
Parental beliefs are the most common problem underlying medical neglect. For example, members of certain religious groups (such as Christian Scientists and the Church of Scientology) believe that ill children must be healed through prayer alone. Consequently, they may refuse to seek medical attention for their sick children. In one case, a 2-year-old boy was stung more than 400 times by yellow jackets. The parents, members of a fundamentalist Christian church, waited 7 hours before seeking medical attention. By then, it was too late; the child died. In a review of 172 faith-related child fatalities that included 23 different denominations, 98% of the noncancerous but ill children would have had a good or excellent outcome if the parents had sought medical help in a timely manner (Asser & Swan, 1998). Sometimes medical neglect is caused by parents who do not know any better (such as those uneducated on dental hygiene) or who are under mistaken beliefs (such as an exaggerated fear of immunizations).
The other two major categories of neglect are emotional/psychological and educational. Emotional neglect will be discussed later in the chapter, under “Psychological Maltreatment.” Educational neglect refers to failing to comply with state laws requiring school attendance, failing to provide an approved home
294 PART III • CONTEMPORARY ISSUES
Left Behind: Neglected in Hot Vehicles
Every summer, a curious tragedy occurs at least 35 times across the United States: Infants and young children die when they are left in automobiles. Everyone knows that the temperature skyrockets in cars parked in the summer sun. On a 90-degree day, the interior temperature rises to about 130 degrees in about 30 minutes (McLaren, Null, & Quinn, 2005). Children can die of heat- stroke or hyperthermia in as few as 15 minutes.
How could a parent forget a child in the car? In some cases, the mother did not forget but intentionally left the child in the car while getting nails painted or going shopping. In other cases, parents were unaware that their children had entered the cars to play. However, most of the time, the parent unintentionally left a sleeping child in the parking lot of their workplace, which was what hap- pened to a university professor in California. He had forgotten to drop off his sleeping infant son at the day-care center on his way to work. Simply forgetting is the reason given in more than three fourths of these cases (Breed, 2007).
Should parents whose children die in hot cars be prosecuted for child mal- treatment, or have they already been punished enough by the death of their child? Fourteen states have laws prohibiting leaving a child unattended in a vehi- cle. Charges are filed in about 60% of the cases when a child was left uninten- tionally. Most of the cases result in convictions, including jail time (median sentence = 2 years) in about half of cases (Breed, 2007).
BOX 12.3
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curriculum, permitting truancy without appropriate reason, or not attending to special-education needs (Stowman & Donohue, 2005). To date, little research atten- tion has been devoted to educational neglect or to the parents who engage in it.
Neglect can affect not just the physical development and well-being of children (due to malnutrition and failure to thrive), but also their emotional, cognitive, lan- guage, and social functioning. Recall Box 4.1 concerning the lasting effects of extreme neglect on Genie. Neglected children tend to be apathetic and withdrawn. They exhibit low self-esteem, negative affect, and disturbed attachment and inter- action patterns. Some of these behaviors may well be due to brain damage as a result of lack of love, attention, and stimulation (see Box 12.4).
Chapter 12 • Child Maltreatment 295
Maltreatment and the Brain
Recall from Chapter 7 that during the first few years of life, the human brain undergoes significant change. Much of that change is guided by how the brain is stimulated and used (Perry, 1997). Once neurological pathways are estab- lished, they are very difficult if not impossible to unlearn (like trying to unlearn riding a bike). In the case of extreme neglect, if an infant’s brain does not get adequate stimulation or does not receive sufficient nurturance, it will likely suffer irreversible damage.
Similarly, when children are chronically exposed to stress and trauma, their brains are bathed in stress hormones. These hormones likely affect the brain’s development in abnormal ways (Glaser, 2000). Reviews of brain development in maltreated children are revealing the ways in which brain structures can be affected (see Illustration 12.6). In particular, there is evidence that the prefrontal cortex, hippocampus, amygdala, cerebellar vermis, and corpus callosum are affected by high levels of stress hormones (e.g., cortisol) (Teicher et al., 2003; Weber & Reynolds, 2004). As neurologist Martin Teicher (2000) stated: “Our brains are sculpted by our early experiences. Maltreatment is a chisel that shapes a brain to contend with strife, but at the cost of deep, enduring wounds” (p. 67).
BOX 12.4
Why does neglect occur? Occasionally, parents may be unaware of it. The psy- chiatrist Bruce Perry (Perry & Szalavitz, 2007) recounts several cases of neglect by babysitters. In one example, a working mother hired her cousin to babysit her infant. Without the mother’s knowledge, the sitter was leaving the child alone virtually all day while working at another job. When the toddler was 18 months old, the mother returned home early one day to find him alone in a dark room with no toys, music, or any other form of stimulation. Although the mother had suspected something was wrong with her son due to his developmental delays, it had never occurred to her or her pediatrician that the child, with autisticlike symptoms, was suffering from neglect. Severe lack of sensory and social stimu- lation will likely result in irreparable damage to a developing brain. Some of the regions affected by neglect and other forms of maltreatment are depicted in Illustration 12.6.
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Neglect more commonly occurs as a consequence of the parents’ own develop- mental history, unusual beliefs, poor psychological functioning, and/or lack of coping strategies and resources. Many neglectful parents were themselves abused or neglected and may have never experienced adequate parenting. Some are addicted to substances. Their addictions suck all their resources and energy and leave them in no state to care for a child. Other parents have unusual beliefs that can result in neglect. One vegan couple (who refused to consume any animal products) was found guilty in 2007 of starving their 6-week-old infant to death. Although babies at this age require breast milk or formula, the parents would feed their son only soy milk and apple juice.
Although poverty and economic stress are likely to be contributing factors to neglect, they are not sufficient to explain all cases. After all, most of the 7.67 million families who lived at or below the poverty line in the United States in 2006 were not neglectful (U.S. Census Bureau, 2007). Part of the problem can be explained by very young or inexperienced parents, who might not know how to take care of their babies or what they can reasonably expect from children at different stages of devel- opment. Another explanation for neglect is when circumstances place families under extraordinary stress—for instance, poverty, mental health problems, or dis- abilities—and it takes its toll in the maltreatment of children.
An inability to cope adequately with financial problems is illustrated by the fact that SES is a strong predictor of neglect: 51% of reports of neglect concern single- parent, mother-headed homes, and 42% of the women are unemployed. These mothers often live in poverty-stricken, dangerous neighborhoods that produce low morale and hopelessness. In an attempt to identify different patterns of maternal neglect, researchers studied 100 mothers, all confirmed by Child Protective Services to be neglectful. The mothers were similar in annual income, number of depressive symptoms, and amount of social support. No distinctive clusters of variables dif- ferentiated the mothers into distinct neglect groups. However, the mothers varied considerably in how well they functioned as caregivers, their sense of efficacy, their degree of inhibition, and the number of problems they were experiencing (Wilson, Kuebli, & Hughes, 2005).
296 PART III • CONTEMPORARY ISSUES
Cingulate gyrus
Amygdala
Hypothalamus
Prefrontal cortex
Hippocampus
Illustration 12.6 Parts of the Brain That May Be Affected by Maltreatment
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Sexual Abuse
Sexual abuse of children has received sustained research attention only since the late 1970s. Given the secretive nature of the acts, the abuse usually becomes known only when the child discloses it or an alert adult recognizes some of the behavioral indicators, such as changes in habits, sudden fear of an individual, unexplained knowledge about sex, or preoccupation with genitalia. Child sexual abuse is com- monly defined as either sexual activity between a child and a significantly older individual or a forced sexual behavior imposed by an adult. The abusive sexual behaviors vary on their degree of physical contact. A few do not involve physical contact at all, such as when a man (a flasher) unnaturally exposes his genitals to a child or when a parent lets a child view pornographic material. However, most sexual-abuse actions do involve contact. These range from fondling to intercourse. In one study of a group of child survivors of sexual abuse, 62% of the children had been fondled, 38% had experienced rape, 23% had had oral-to-genital contact, 25% had been touched in the genital or anal area, and 17% had experienced attempted rape (Kellogg & Hoffman, 1997).
Unlike physical abuse and neglect, this form of maltreatment is gendered. Girls (modal age is 10 years) are the victims in all but about 10% of the cases, and most (at least 90%) of the perpetrators are male. The victim, in as many as 90% of the cases, knows the perpetrator (e.g., a father or stepfather, neighbor, teacher, brother, cousin, uncle, grandfather). In contrast to the other forms of maltreatment dis- cussed here, biological parents are rarely the perpetrators of sexual abuse. For example, in a study of sexual abuse in New Zealand (Fanslow, Robinson, Crengle, & Perese, 2007), biological fathers and stepfathers committed the crime in 12% and 9% of the 457 cases analyzed; only one biological mother and two stepmothers did so (.2% of cases). Uncles were the most common male perpetrators (24%), fol- lowed by siblings or stepsiblings (14%), cousins (11%), grandfathers (9%), and acquaintances (8%).
Perpetrators of sexual abuse tend to be a heterogeneous group, so identifying a set of common characteristics is not possible. Risk factors include a childhood history of abuse (sexual, physical, or neglect), psychopathology (e.g., antisocial personality disorder), substance abuse, deviant sexual interests, low levels of involvement in caregiving of the victim during the first 5 years, deficits in social skills, marital dissatisfaction, and cognitive distortions (Chaffin, Letourneau, & Silovsky, 2002). Examples of cognitive distortions include these ideas: “Having sex with kids is a good way to teach them about sex,” “It is better to have sex with my daughter than to commit adultery,” and “Children usually outgrow any problems resulting from a sexual experience they had as a child” (McGrath, Cann, & Konopasky, 1998).
Childhood sexual abuse results in a number of immediate and long-term neg- ative effects on the victimized child (but see Box 12.5 to read about a controversy in the research over the effects). It is common for children to experience posttraumatic stress disorder (PTSD), characterized by frequent reexperiencing of events (flashbacks, nightmares, intrusive thoughts), a numbing of affect, and persistent symptoms of increased arousal (sleep problems, poor concentration). Other
Chapter 12 • Child Maltreatment 297
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common emotional consequences are depression, elevated anxiety, avoidance, and dissociation. Some children respond to their emotional agitation by engaging in tension-reducing activities, including cutting or self-mutilation, substance abuse, binge eating and purging, indiscriminant sexual behavior, or suicide attempts. In extreme cases, the child might develop Dissociative Identity Disorder, commonly known as multiple personality disorder (American Psychiatric Association, 2000).
The nature and extent of how children respond to sexual abuse is a function of a number of factors, including the child’s age and gender; the nature, duration, and severity of the abuse; the child’s perceptions and attributions; and the parents’
298 PART III • CONTEMPORARY ISSUES
The Controversy Over Effects of Sexual Abuse
The review, published in Psychological Bulletin (Rind, Tromovitch, & Bauserman, 1998), did not attract much attention—until the radio talk-show host Dr. Laura (Schlessinger) learned about it and publicly criticized its authors. The controversy escalated from there and culminated in a U.S. congressional resolution con- demning the review. The authors had made the claim that, based on a meta- analytic review of 59 studies, individuals who were sexually abused as children did not show pervasive negative effects by the time they were in college. Although some negative effects were noted on 17 of the 18 variables studies, the authors argued that the “negative effects were neither pervasive nor typi- cally intense, and that men reacted much less negatively than women” (p. 22). The review concluded with the provocative argument that mental health work- ers had overstated the negative effects of sexual contact. Most controversially, the authors proposed changing terminology to “value neutral” terms, such as “adult-child sex” rather than “child sexual abuse.”
Many therapists, professionals, and survivors of child sexual abuse were out- raged about the review. How could such an article have been published in a pre- mier review journal? The storm generated by the controversy resulted in several research committees evaluating the review and its conclusions. A careful evalu- ation of the article revealed a number of subtle problems with the review and not-so-subtle problems with the authors’ interpretations. For example, the reviewers included some old and poor-quality studies, did not use a consistent definition of child sexual abuse, and ignored some important negative effects (such as substance abuse and PTSD). Indeed, newer studies, compared with older research, are more likely to find negative effects. Another central problem was that the authors failed to adequately explain the limitations of the research. For instance, a key limitation was the selective nature of the sample: College students are high-functioning survivors of maltreatment. What about the many victims who did not grow up to go to college?
The fundamental conclusion of the study was patently wrong: There is no question that sexual abuse is damaging to the child. The one positive outcome from the controversy is that the review did remind people that many survivors of abuse, despite their trauma, can recover and function well as young adults.
BOX 12.5
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post-abuse response (Ullman & Filipas, 2001). In addition, some children are resilient and appear to recover from trauma more quickly than others (Waller, 2001).
Parents, assuming they were not involved in the sexual abuse, can have several important roles in helping children recover. First, they must believe the child’s dis- closure. Next, they need to keep the child safely away from the perpetrator. Third, parents should obtain therapy for the child. Finally, parents can help the child min- imize the likelihood of cognitive distortions, including self-blame, guilt, and dys- functional attributions. In this way, they work to restore the child’s self-esteem.
Psychological Maltreatment
The problem of psychological maltreatment (also called emotional abuse, verbal abuse, and mental injury or deprivation) demonstrates the obvious falsehood of the old saying, “Sticks and stones can break my bones, but words can never hurt me.” Children are greatly affected by words that degrade, denigrate, or reflect parental rejection of the child. This type of language and its accompanying actions can severely injure a child’s developing self-concept and feelings of self-worth. They are the essence of psychological maltreatment, defined as “a repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs” (Hart, Brassard, Binggeli, & Davidson, 2002).
The nature of psychological maltreatment makes it particularly difficult to docu- ment and study. Parents can readily adjust their behavior when in the presence of Child Protective Services investigators. There are no physical injuries associated with it. In addition, its consequences may not be immediately apparent. Nor are there uni- form effects on children. For all these reasons, psychological maltreatment is difficult to corroborate and prosecute. It therefore comprises only 6.6% of the substantiated child maltreatment cases. However, many experts think psychological abuse is the most widespread form of maltreatment and is at the core of all forms of maltreatment (Hart et al., 2002).
Psychological maltreatment is expressed in a variety of ways. The seven major manifestations are degrading, denying emotional responsiveness, rejecting, terror- izing, isolating, corrupting, and exploiting. These are defined and illustrated with examples in Table 12.2. However, these expressions are not exhaustive of the ways that parents can psychologically maltreat their offspring. Other child-rearing behaviors that can be abusive include excessive psychological control, showing favoritism and/or scapegoating among siblings, reversal of parent-child roles, and chaotic and incompetent parenting (Gagne & Bouchard, 2004).
Psychological maltreatment attacks children’s basic developmental need for love and affection as well as their developing self-concept (Miller, 1984). Such children consequently suffer from low self-esteem and a variety of other emotional and behavioral problems. They display developmental delays and a failure to thrive, as well as internalizing and externalizing problems (such as depression, anxiety, and aggression). These children also show physical health problems as well as cognitive deficits (Hart et al., 2002).
Chapter 12 • Child Maltreatment 299
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One of the specific populations of children who are psychologically maltreated is those whose parents or parents’ partners engage in intimate partner violence. Over the past quarter-century, research has been accumulating about these children, and they are described in Box 12.6.
Why do parents engage in psychological maltreatment? Like all dysfunctional behavior patterns, there are many reasons. It is possible that some parents may be unaware that their actions are psychologically damaging (this may be the case with some children exposed to intimate partner violence). However, in most cases, parents are likely aware of the damage they are doing. Parents psychologically abuse their offspring for many reasons, including these:
• their children are unwanted, • they dislike, disapprove of, or resent their children, • they have a deviant child-rearing belief system, • they lack child-rearing knowledge or have unrealistic expectations, • they themselves were abused as children, • they lack awareness of, or empathy for, the child, • they are stressed and have little social support, • they have emotional problems and mistreat because of their own needs, and • they are poverty-stricken, so they exploit their children for financial gain.
(See Box 12.7.)
300 PART III • CONTEMPORARY ISSUES
Type Definition Examples
Spurning (Degrading)
Labeling as inferior, shaming, or publicly humiliating
Name calling: “stupid,” “worthless,” “you’re disgusting”
Denying Responsiveness
Being detached or uninvolved
Ignoring or failing to respond to a child’s attempts to interact
Rejecting Refusing bids for contact or affection
Avoiding, criticizing, or expressing hatred for the child
Terrorizing Verbally assaulting, creating a climate of fear
Threatening injury or abandonment
Isolating Cutting off normal social experiences
Refusing to allow any peer contact
Corrupting Teaching socially deviant behavior
Promoting delinquency, racism, or substance abuse
Exploiting Using inappropriately for parent’s needs
Using the child to make money through prostitution or child labor
Table 12.2 Types, Definitions, and Examples of Seven Forms of Psychological Maltreatment
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Chapter 12 • Child Maltreatment 301
Children Exposed to Intimate Partner Violence
Children exposed to intimate partner violence can be classified as victims of psy- chological maltreatment because they are terrorized by simply living in homes characterized by a climate of tension and hostility between their parents or parent-figures. A recent study estimated that 15.5 million children live in families where partner violence had occurred in the past year, and 7 million of those children were exposed to severe partner violence (McDonald, Jouriles, Ramisetty- Mikler, Caetano, & Green, 2006). It is now well documented that children in such families show a variety of serious behavioral problems. Two different meta- analyses (Kitzman, Gaylord, Holt, & Kenny, 2003; Wolfe, Crooks, Lee, & McIntyre- Smith, & Jaffe, 2003) arrived at similar conclusions: The children are at high risk for internalizing and externalizing problems. Some 40% to 60% of these children have problems so extensive that they require clinical therapy.
Why are children affected by the exposure? In addition to the terror and trauma of marital physical and psychological violence, the children suffer from disrupted parent-child relationships, a compromised neurological and physio- logical system, high stress levels, and problems regulating their emotions. They might also be abused themselves.
Many mothers who leave these situations report that they resolved to leave their batterer only after they became aware of how their children were being neg- atively affected. For instance, when these mothers observed their sons engaging in animal cruelty or mistreating their sisters, they slowly recognized that if nothing was done to break the cycle, their sons would grow up to also become batterers.
BOX 12.6
Child Trafficking
It is estimated that around the world, more than 7.8 million children are held in slavery. Most of these children are in forced labor, including 1.8 million child prostitutes, and some 300,000 children have been coerced to become child sol- diers. Child slavery is a global problem: Asia and the Pacific are the regions with the highest incidence of child slaves, followed by Latin America, the Caribbean, Africa, Eastern Europe, and then the Middle East. But it also occurs in the United States. Boys are usually trafficked to provide labor for farms or to be involved in the drug trade. Girls are enslaved for sexual exploitation or domestic service.
Why would parents have their children enslaved? In some cases, children are abducted. The more common cause is extreme poverty. Selling or trading a child to extinguish a debt is not an uncommon practice in developing countries. When poverty is compounded by a natural disaster or an illness in the family, the parents believe they are left with no choice or other means of survival (van de Glind & Kooijmans, 2008).
BOX 12.7
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Although psychological maltreatment is regarded as a form of dysfunctional parenting, Straus and Field (2003) argued that most parents in the United States engage in at least one form of psychological aggression: yelling in anger. In their sample of parents of children aged 2 to 4 years, almost all parents reported periodic or frequent yelling, screaming, or shouting at their children. They probably did not intend to mistreat their children; parents yelled to discipline. Does this behavior constitute psychological abuse? Straus and Field (2003) argued that it does because it terrorizes children.
Co-occurring Maltreatment
Ironically, one limitation of the child maltreatment research has been that it arti- ficially categorizes child maltreatment into one of the four categories discussed above. The fact that more than one kind of maltreatment often co-occurs has frequently been overlooked in efforts to understand the different expressions of this tragedy.
Many child survivors of maltreatment have been victimized in multiple ways. In the case of physical abuse and exposure to intimate partner violence, one review (Appel & Holden, 1998) found that the percentage of co-occurrence ranged from 20% to 100%, with a median rate of 41%. This indicates that about half the studies determined that at least 4 in 10 children suffered from both forms of maltreatment. Other reviewers have found significant correlations between the incidences of other pairs of maltreatment types. For example, physical abuse and sexual abuse were found to co-occur in 18% of one sample and 31% of another sample (Higgins & McCabe, 2001). A recent study of co-occurring spouse and child abuse among more than 10,800 soldiers found that among offenders, 61% had engaged in inti- mate partner abuse, 27% in child maltreatment, and 12% in both partner abuse and some form of child maltreatment (Martin et al., 2007).
Parents are not the only perpetrators of child maltreatment, as mentioned in the introduction of this chapter. Siblings and peers lead the list of a variety of different sources of maltreatment (Finkelhor, Turner, & Ormrod, 2006). In a national study of children and youth ages 2 to 17 (Finkelhor et al., 2007), half of the participants had experienced two or more different kinds of maltreatment in a year, and 18% had experienced four or more kinds of victimization (e.g., community, property, physical, sexual, or sibling violence, bullying, or exposure to intimate partner violence).
Does experiencing two or more forms of child maltreatment make it worse for a child? The evidence indicates that it does. For example, a study of 8,667 adults (Edwards, Holden, Felitti, & Anda, 2003) investigated reports of childhood mal- treatment and current mental health. About one third (34.6%) of the participants reported multiple forms of maltreatment (physical abuse, sexual abuse, or exposure to intimate partner violence). The adults who revealed they were survivors of one form of childhood maltreatment reported lower levels of mental health well-being than did the adults who indicated they had not experienced any of these three types of abuse. This pattern was especially pronounced in individuals who were also exposed to severe emotional abuse. Similarly, those adults who reported all three types of maltreatment were functioning less well than those who reported two types. In sum, these data support a “dose-response” view of the effects of maltreatment— the stronger the dose of abuse, the worse the outcomes (see Illustration 12.7).
302 PART III • CONTEMPORARY ISSUES
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Maltreatment Across Time and Country
Determining the prevalence (proportion of the population experiencing) of child maltreatment is a difficult task. The United States maintains excellent statistical records about the occurrence of many different problems. But in the case of child maltreatment, the quality of statistical prevalence estimates depends on a variety of methodological considerations, including the source of the data (e.g., Child Protective Services reports, hospital records, self-reports), how maltreatment was defined and assessed, the time frame used (e.g., past month, past year, lifetime), the sample size, and the sample characteristics (including the sampling method).
The incidence rate of child maltreatment reported in the introduction of this chapter comes from the National Child Abuse and Neglect Data System (NCANDS). That organization collects official incidence reports from Child Protective Services and professionals in schools, hospitals, and other agencies to determine how wide- spread the problem is. However, those estimates are likely low because many forces influence which acts are recorded: budgets, political agendas, varying definitions, and so on (Tolan et al., 2006).
Is the rate of child maltreatment changing? According to the U.S. government official reports of child maltreatment (U.S. Department of Health & Human Services, Administration for Children & Families, annual Child Maltreatment reports) collected over the past 12 years, the answer is no. With the exception of a decrease in the first 3 years of data collection, the rates have been stable, ranging from a low of 11.8 per 1,000 in 1999 to a high of 12.4 per 1,000 children in 2003.
Chapter 12 • Child Maltreatment 303
None 50
55
60
65
70
75
80 79
76 77
64.5
76.5
68
75
65
M en
ta lH
ea lth
S co
re
One Two Number of Types of Maltreatment
Three
No Emotional Abuse Severe Emotional Abuse
Illustration 12.7 Dose-Response Effects of Maltreatment Source: Edwards et al., 2003.
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Each year, more evidence concerning the rates of maltreatment in other countries is becoming available. Although it is difficult to compare rates across the different studies due to methodological differences, it is clear that child mal- treatment is a pervasive problem in every country where it has been assessed. The percentage of physically abused children ranges, across the seven studies listed in Table 12.3, from a high of 38.5% in Iran to a low of 9.5% according to Portuguese adults' recollections. Sexual abuse had a high of almost one third in Tanzania, East Africa, to a low of 2.7% of the females sampled in Portugal. Based on the studies from seven countries ranging from China to Tanzania to New Zealand, the United States is not a leader in national prevalence rates of child maltreatment.
Protecting Maltreated Children: Foster Parents
Evidently, the scope of the problem of maltreatment is staggering. In 2006, Child Protective Services personnel in the United States received 3.6 million reports of possible child maltreatment involving some 6 million children. Credible reports are
On the other hand, there is some evidence of increasing rates of child fatalities. Government estimates were that 1,077 children were killed in 1996 versus 1,530 in 2006. Part of the reason could be more accurately determining the cause of child death through committees in many states that carefully review the records of all child fatalities. These Child Fatality Review committees then make official determi- nations about the cause of death. However, the data do appear to illustrate a real increase in the number of child deaths. The rate of child maltreatment over a recent 12 year period is plotted in Illustration 12.8.
304 PART III • CONTEMPORARY ISSUES
1995
R at
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A bu
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ct pe
r 1,
00 0
C hi
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6
7
8
9
10
11
12
13
14
15
16
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
15 15
13.9
12.6
11.8
12.2 12.4
12.3
12.4
11.9
12.1 12.1
Illustration 12.8 Has the rate of child maltreatment in the United States changed?
Source: U.S. Dept. of Health & Human Services, Administration for Children & Families, annual Child Maltreatment reports.
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Chapter 12 • Child Maltreatment 305
Country Incidence Sample and Reference
China Sexual Abuse
16.7% females
10.5% males
3,261 students, ages 17–18
(Chen, Dunne, & Han, 2004)
England Sexual Abuse
21% female
11% male
Physical Abuse (injury/chronic)
8% females
6% males
Psychological Abuse
8% females
4% males
Neglect
7% females
6% males
2,869 participants, ages 18–24
(May-Chahal & Cawson, 2005)
Iran Physical Abuse
38.5% (by parents)
Psychological Abuse
74.5%
1,370 students, ages 11–18
(Stephenson et al., 2006)
Portugal Physical Abuse (with injury)
10.2% females
8.6% males
Sexual Abuse
2.7% females
2.6% males
932 adult men and women
(Figueiredo et al., 2004)
Tanzania (east Africa)
Sexual Abuse
31% females
25% males
487 college students
(McCrann, Lalor, & Katabaro, 2006)
Turkey Sexual Abuse
13.4% (7.9% were raped)
1,871 female students, ages 15–20
(Alikasifoglu et al., 2006)
New Zealand Sexual Abuse
28.2% rural region
23.5% urban region
2,855 adult women
(Fanslow, Robinson, Crengle, & Perese, 2007)
Table 12.3 Child Maltreatment Around the World
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then investigated by case workers, when there is adequate staff and resources to do so. Child Protective Services investigators face the dilemma of whether to remove children from their homes (thereby protecting them from possible additional abuse but separating them from the familiarity of family) or to keep the family together, under a policy called family preservation (which may or may not place the children at risk for continued abuse).
Based on risk assessments and other considerations, about one fifth of child victims are removed from their home and placed in foster care. Foster care for children began in the late 1800s, but it wasn’t until the 1960s that the federal gov- ernment began to provide substantial funds for paying foster parents (Haugaard & Hazan, 2002). In 2007, this meant some 783,000 children spent some time in foster care. However, the system cannot handle the demand: Some 130,000 children are waiting for foster families (U.S. Children’s Bureau, 2008).
Why do adults become foster parents? Sometimes the foster parent wants to help a child, who may be a relative. Often, the adult wants to do something positive for the community, likes having children around, or does it as a source of income (Wilson, Fyson, & Newstone, 2006). However, foster parenting can be extremely difficult, given the damage that has been done to many maltreated children. Foster parents need to provide all the normal parenting functions as well as several unique ones. The parents have to work closely with the social workers and, sometimes, the child’s biological parents. Foster parents also need to form attachments with the child despite the recognition that the relationship is a temporary one.
Not surprisingly, 30% to 50% of foster parents quit their roles. The most fre- quent reasons cited include inadequate agency support (40%), poor communica- tion with foster care workers (33%), and that the children were too difficult to handle (34%) (Rhodes, Orme, & Buehler, 2001). Despite the considerable stressors and challenges, only a very small percentage of foster parents maltreat their charges. In 2006, only .5% of foster parents were found guilty of child abuse.
One recent development in dealing with the problem of child maltreatment is the advent of Child Advocacy Centers across the United States. These centers were created in an effort to minimize retraumatizing a child survivor of sexual abuse and maximize the likelihood of successful prosecution of the perpetrator. See Box 12.8 for a description of these centers.
306 PART III • CONTEMPORARY ISSUES
Reducing Additional Trauma: Child Advocacy Centers
In 1984, Bud Cramer, a district attorney in Alabama (who subsequently became a congressman), proposed a novel idea to deal with the aftermath of the dis- closure of serious child maltreatment. Rather than having a child face multiple interviews by authorities in environments that children find cold and scary (such as police stations), why not streamline the process so children would have to undergo only one interview in a child-friendly environment? A model of child
BOX 12.8
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Chapter Summary
This chapter began with a question: How could parents maltreat their children? It is not a new problem: there is ample evidence that children have been abused since antiquity. Although the matter has been a social concern since the second half of the 20th century, more than 900,000 children in the United States are maltreated each year. As is now evident, the question of why parents abuse their children is complex and has many answers. Parents mistreat their children in four basic ways: physical, neglect, sexual, and psychological. Each type of maltreatment has been associated with different causes, including high levels of stress and poverty, psy- chological problems, social cognition deficits, and having been abused themselves as children. However, it is increasingly clear that different types of maltreatment may co-occur. The consequences of abuse range from temporary bruises to behav- ior problems to brain damage and death.
Although child maltreatment is a serious problem in the United States, it is even more prevalent in many other countries. One way to protect children from future abuse is to remove them from abusive parents and place them in foster care. However, there is an inadequate supply of these temporary parents and a high rate of failure, as indicated by foster parents who prematurely return the maltreated children.
Thought Questions
• Why do children, even when they are abused, want to stay with their parents? • What variables account for fluctuating rates of maltreatment over time and
across nations? • Which causes of child maltreatment are most difficult to address? Which
ones are more amenable to intervention? • How could the foster parent system be improved?
Chapter 12 • Child Maltreatment 307
advocacy centers was subsequently created. Three of the model’s hallmarks are: (a) centers are located in houses designed to be child-friendly environments; (b) children undergo one interview and medical exam (if needed), which is con- ducted and recorded by specially trained professionals; and (c) multidisciplinary teams (law enforcement, Child Protective Services, prosecution, mental health, medical, and victim advocates) meet at the center to facilitate communication and prosecution of the perpetrators. Centers may also provide therapy and family support services.
Today, there are more than 700 such centers around the country. These centers provide a dramatic improvement for the care of traumatized children in the wake of abuse. Formal evaluations of the efficacy of the centers are begin- ning to be published (see Faller & Palusci, 2007), but to date there is no infor- mation as to whether the centers have resulted in more successful criminal prosecution of the perpetrators.
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