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Child abuse (ZT)

2011/09/20 admin 47

Child abuse (ZT)

Child abuse

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Child abuseis the physical or psychological/emotional mistreatment of children. In the United States, the Centers for Disease Control and Prevention (CDC) define child maltreatment as any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.[1] Most child abuse occurs in a child's home, with a smaller amount occurring in the organizations, schools or communities the child interacts with. There are four major categories of child abuse: neglect, physical abuse, psychological/emotional abuse, and sexual abuse.

Different jurisdictions have developed their own definitions of what constitutes child abuse for the purposes of removing a child from his/her family and/or prosecuting a criminal charge. The mental health journal[lease_clarify">clarification needed] states that child abuse is defined as "any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, an act or failure to act which presents an imminent risk of serious harm".[citation needed]

[edit] Types

Child abuse can take several forms:[2] The four main types of abuse are physical, sexual, psychological, and neglect.[3]

[edit] Neglect

Neglect is the instance in which the responsible adult fails to adequately provide for various needs, including physical (failure to provide adequate food, clothing, or hygiene), emotional (failure to provide nurturing or affection) or educational (failure to enroll a child in school).

[edit] Physical abuse

Physical abuse is physical aggression directed at a child by an adult. It can involve striking, burning, choking or shaking a child. The transmission of toxins to a child through its mother (such as with fetal alcohol syndrome) can also be considered physical abuse in some jurisdictions.

The distinction between child discipline and abuse is often poorly defined. Cultural norms about what constitutes abuse vary widely: among professionals as well as the wider public, people do not agree on what behaviors constitute abuse.[4]

Some human service professionals claim that cultural norms that sanction physical punishment are one of the causes of child abuse, and have undertaken campaigns to redefine such norms.[5]

In the United States, the National Association of Social Workers has issued statements that even the mildest forms of physical punishment, such as moderate spanking, can lower children's self-esteem, constitute acts of violence, and teach children that physical force is an acceptable way to resolve conflicts.[5] Against this latter argument, the philosopher Prof. David Benatar points out that one might as well say that fining people teaches that forcing others to give up some of their property is an acceptable way to respond to those who act in a way that one does not like. "If beatings send a message, why don't detentions, imprisonments, fines, and a multitude of other punishments convey equally undesirable messages?" He adds that "there is all the difference in the world between legitimate authorities – the judiciary, parents, or teachers – using punitive powers responsibly to punish wrongdoing, and children or private citizens going around beating each other, locking each other up, and extracting financial tributes (such as lunch money). There is a vast moral difference here and there is no reason why children should not learn about it. Punishing children when they do wrong seems to be one important way of doing this."[6]

In the United Kingdom, sociology professor Frank Furedi suggests that many advocates of a total ban on physical punishment are actually against all forms of punishing children. He sees the underlying agenda as an anti-parent crusade, and argues that the much-cited Murray Straus research is far less clear-cut than the claims made on its behalf by what he calls "anti-smacking zealots".[7]

The use of any kind of force against children as a disciplinary measure is illegal in 24 countries around the world.[8] See corporal punishment in the home for more information.

[edit] Child sexual abuse

Main article: Child sexual abuse

Child sexual abuse is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation.[9][10] Forms of CSA include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure of the genitals to a child, displaying pornography to a child, actual sexual contact against a child, physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using a child to produce child pornography.[9][11][12]

The effects of child sexual abuse include depression,[13] post-traumatic stress disorder,[14] anxiety,[15] propensity to re-victimization in adulthood,[16] and physical injury to the child, among other problems.[17] Sexual abuse by a family member is a form of incest, and can result in more serious and long-term psychological trauma, especially in the case of parental incest.[18]

Approximately 15% to 25% of women and 5% to 15% of men were sexually abused when they were children.[19][20][21][22][23] Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, fathers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbors; strangers are the offenders in approximately 10% of child sexual abuse cases.[19]

[edit] Psychological/Emotional Abuse

Out of all the different forms of abuse, emotional abuse is the hardest to identify. This form of abuse includes name-calling, ridicule, degradation, destruction of personal belongings, torture or destruction of a pet, excessive criticism, inappropriate or excessive demands, witholding communication, and routine labeling or humiliation.[24]

Some ways that victims of emotional abuse may react is by distancing themselves from the abuser, internalizing the abusive words, and to fight back by insulting the abuser. Emotional abuse can result in abnormal or disrupted attachment disorder, a tendency for the victim to blame themselves for the abuse, learned helplessness, and overly passive behavior.[24]

[edit] Prevalence

According to the (American) National Committee to Prevent Child Abuse, in 1997 neglect represented 54% of confirmed cases of child abuse, physical abuse 22%, sexual abuse 8%, emotional maltreatment 4%, and other forms of maltreatment 12%.[25]

A UNICEF report on child well-being[26] stated that the United States and the United Kingdom ranked lowest among industrial nations with respect to the wellbeing of children. This study also found that child neglect and child abuse are far more common in single-parent families than in families where both parents are present.

In the USA, neglect is defined as the failure to meet the basic needs of children including housing, clothing, food and access to medical care. Researchers found over 91,000 cases of neglect over the course of one year (from October 2005 to 30 September 2006) with their information coming from a database of cases verified by protective services agencies.[1]

Neglect could also take the form of "financial abuse" by not buying the child adequate materials for survival.[27]

The U.S. Department of Health and Human Services reports that for each year between 2000 and 2005, "female parents acting alone" were most likely to be perpetrators of child abuse.[28]

[edit] Causes

Child abuse is a complex problem which has multiple causes.[29] Understanding the causes of abuse is crucial to addressing the problem of child abuse.[30] Parents who physically abuse their spouses are more likely to physically abuse their children.[31] However, it is difficult to know whether marital strife is a cause of child abuse, or if both the marital strife and abuse are caused by tendencies in the abuser.[31]

Substance abuse is a major contributing factor to child abuse. One study found that parents with documented substance abuse, most commonly alcohol, cocaine, and heroin, were much more likely to mistreat their children, and were also much more likely to reject court-ordered services and treatments.[32]

Another study found that over two thirds of cases of child maltreatment involved parents with substance abuse problems. This study specifically found relationships between alcohol and physical abuse, and between cocaine and sexual abuse.[33]

In 2009 CBS News reported that child abuse in the United States had increased during the economic recession. It gave the example of a father who had never been the primary care-taker of the children. Now that the father was in that role, the children began to come in with injuries.[34]

[edit] Effects

Children with a history of neglect or physical abuse are at risk of developing psychiatric problems,[35][36] or a disorganized attachment style.[37][38][39] Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms,[40] as well as anxiety, depressive, and acting-out symptoms.[41][42] A study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited symptoms of disorganized attachment.[43][44]

Victims of childhood abuse, it is claimed, also suffer from different types of physical health problems later in life. Some reportedly suffer from some type of chronic head, abdominal, pelvic, or muscular pain with no identifiable reason.[45] Even though the majority of childhood abuse victims know or believe that their abuse is, or can be, the cause of different health problems in their adult life, for the great majority their abuse was not directly associated with those problems, indicating that sufferers were most likely diagnosed with other possible causes for their health problems, instead of their childhood abuse.[45]

The effects of child abuse vary, depending on its type. A 2006 study found that childhood emotional and sexual abuse were strongly related to adult depressive symptoms, while exposure to verbal abuse and witnessing of domestic violence had a moderately strong association, and physical abuse a moderate one. For depression, experiencing more than two kinds of abuse exerted synergetically stronger symptoms. Sexual abuse was particularly deleterious in its intrafamilial form, for symptoms of depression, anxiety, dissociation, and limbic irritability.[lease_clarify">clarification needed] Childhood verbal abuse had a stronger association with anger-hostility than any other type of abuse studied, and was second only to emotional abuse in its relationship with dissociative symptoms. More generally, in the case of 23 of the 27 illnesses listed in the questionnaire of a French INSEE survey, some statistically significant correlations were found between repeated illness and family traumas encountered by the child before the age of 18 years.[46] These relationships show that inequality in terms of illness and suffering is not only social. It has also its origins in the family, where it is associated with the degrees of lasting affective problems (lack of affection, parental discord, the prolonged absence of a parent, or a serious illness affecting either the mother or father) that individuals report having experienced in childhood.

New research illustrates that there are strong associations between exposure to child abuse in all its forms and higher rates of many chronic conditions. The strongest evidence comes from the Adverse Childhood Experiences (ACE's) series of studies which show correlations between exposure to abuse or neglect and higher rates in adulthood of chronic conditions, high risk health behaviors and shortened live span. [47] A recent publication entitled Hidden Costs in Health Care: The Economic Impact of Violence and Abuse[48] makes the case that such exposure represents a serious and costly public health issue that should be addressed by the health care system.

[edit] Consequences of physical abuse

Children who are physically abused are likely to receive bone fractures, particularly rib fractures,[49] and may have a higher risk of developing cancer.[50]

[edit] Prevention

April has been designated as Child Abuse Prevention Month in the United States since 1983.[51] U.S. President Barack Obama continued that tradition by declaring April 2009 as Child Abuse Prevention Month.[52] One way the Federal government of the United States provides funding for child abuse prevention is through Community-Based Grants for the Prevention of Child Abuse and Neglect (CBCAP).[53]

Resources for child protection services are sometimes limited. According to Hosin (2007), "a considerable number of traumatized abused children do not gain access to protective child protection strategies."[54] Briere (1992) argues that only when "lower-level violence" of children ceases to be culturally tolerated will there be changes in the victimization and police protection of children.[55]

[edit] Treatment

A number of treatments are available to victims of child abuse.[56] Trauma-focused cognitive behavioral therapy, while developed to treat sexually abused children, is now used for victims of any kind of trauma. It targets trauma-related symptoms in children including posttraumatic stress disorder (PTSD), clinical depression, and anxiety. It also includes a component for non-offending parents. Several studies have found that sexually abused children undergoing TF-CBT improved more than children undergoing certain other therapies. Data on the effects of TF-CBT for children who experienced only non-sexual abuse was not available as of 2006.[56]

Abuse-focused cognitive behavioral therapy was designed for children who have experienced physical abuse. It targets externalizing behaviors and strengthens prosocial behaviors. Offending parents are included in treatment, to improve parenting skills/practices. It is supported by one randomized study.[56]

Child-parent psychotherapy was designed to improve the child-parent relationship following the experience of domestic violence. It targets trauma-related symptoms in infants, toddlers, and preschoolers, including PTSD, aggression, defiance, and anxiety. It is supported by two studies of one sample.[56]

Other forms of treatment include group therapy, play therapy, and art therapy. Each of these types of treatment can be used to better assist the client depending on the form of abuse they've experienced. Play therapy and art therapy are ways to get children more comfortable with therapy by working on something that they enjoy (like coloring, drawing, painting, etc.). The design of a child's artwork can be a symbolic representation of what they are feeling, relationships with friends or family, and more. Being able to discuss and analyze a child's artwork can allow a professional to get a better insight of the child.[citation needed]

[edit] Ethics

One of the most challenging ethical dilemmas arising from child abuse relates to the parental rights of abusive parents or caretakers with regard to their children, particularly in medical settings.[57] In the United States, the 2008 New Hampshire case of Andrew Bedner drew attention to this legal and moral conundrum. Bedner, accused of severely injuring his infant daughter, sued for the right to determine whether or not she remain on life support; keeping her alive, which would have prevented a murder charge, created a motive for Bedner to act that conflicted with the aparent interests of his child.[58][59][57] Bioethicists Jacob M. Appel and Thaddeus Mason Pope recently argued, in separate articles, that such cases justify the replacement of the accused parent with an alternative decision-maker.[60][57]

[edit] Organizations

There are organizations at the national, state, and county levels in the United States that provide community leadership in preventing child abuse and neglect. The National Alliance of Children's Trust Funds and Prevent Child Abuse America are two national organizations with member organizations at the state level.

Other organizations focus on specific prevention strategies. The National Center on Shaken Baby Syndrome focuses its efforts on the specific issue of preventing child abuse that is manifested as Shaken baby syndrome. Mandated reporter training is a program used to prevent ongoing child abuse.

[edit] See also

[edit] Footnotes

  1. ^ a b Leeb, R.T.; Paulozzi, L.J.; Melanson, C.; Simon, T.R.; Arias, I. (1 January 2008). "Child Maltreatment Surveillance: Uniform Definitions for Public Health and Recommended Data Elements". Centers for Disease Control and Prevention. http://www.cdc.gov/ncipc/dvp/CMP/CMP-Surveillance.htm. Retrieved 20 October 2008. 
  2. ^"Child Abuse and Neglect: Types, Signs, Symptoms, Help and Prevention". helpguide.org. http://www.helpguide.org/mental/child_abuse_physical_emotional_sexual_neglect.htm. Retrieved 20 October 2008. 
  3. ^A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice, Office on Child Abuse and Neglect (HHS), USA, 2003.
  4. ^Noh Anh, Helen (1994). "Cultural Diversity and the Definition of Child Abuse", in Barth, R.P. et al., Child welfare research review, Columbia University Press, 1994, p. 28. ISBN 0231080743
  5. ^ a b Haeuser, A. A. (1990). "Banning parental use of physical punishment: Success in Sweden". International Congress on Child Abuse and Neglect. Hamburg. [page needed]
  6. ^Benatar, David (1998). "Corporal punishment". Social Theory and Practice 24 (2). http://www.corpun.com/benatar.htm. [page needed]
  7. ^Furedi, Frank (7 July 2004). "Punishing Parents", spiked.online-com
  8. ^"States with full abolition". Global Initiative to End All Corporal Punishment of Children. http://endcorporalpunishment.org/pages/progress/prohib_states.html. 
  9. ^ a b "Child Sexual Abuse". Medline Plus. U.S. National Library of Medicine,. 2008-04-02. http://www.nlm.nih.gov/medlineplus/childsexualabuse.html. 
  10. ^"Guidelines for psychological evaluations in child protection matters. Committee on Professional Practice and Standards, APA Board of Professional Affairs". The American Psychologist 54 (8): 586–93. August 1999. doi:10.1037/0003-066X.54.8.586. PMID 10453704. "Abuse, sexual (child): generally defined as contacts between a child and an adult or other person significantly older or in a position of power or control over the child, where the child is being used for sexual stimulation of the adult or other person.". 
  11. ^Martin J, Anderson J, Romans S, Mullen P, O'Shea M (1993). "Asking about child sexual abuse: methodological implications of a two stage survey". Child Abuse & Neglect 17 (3): 383–92. doi:10.1016/0145-2134(93)90061-9. PMID 8330225. 
  12. ^Child sexual abuse definition from the NSPCC
  13. ^Roosa MW, Reinholtz C, Angelini PJ (February 1999). "The relation of child sexual abuse and depression in young women: comparisons across four ethnic groups". Journal of Abnormal Child Psychology 27 (1): 65–76. PMID 10197407. 
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  18. ^Courtois, Christine A. (1988). Healing the Incest Wound: Adult Survivors in Therapy. W. W. Norton & Company. p. 208. ISBN 0393313565. 
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  20. ^Finkelhor D (1994). "Current information on the scope and nature of child sexual abuse". The Future of Children 4 (2): 31–53. doi:10.2307/1602522. PMID 7804768. http://www.unh.edu/ccrc/pdf/VS75.pdf. 
  21. ^Crimes against Children Research Center
  22. ^Family Research Laboratory
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  24. ^ a b http://ncvc.org/ncvc/main.aspx?dbName=DocumentViewer&DocumentAction=ViewProperties&DocumentID=32313&UrlToReturn=http%3a%2f%2fncvc.org%2fncvc%2fmain.aspx%3fdbName%3dAdvancedSearch&gclid=CJ_1q6m2oZ4CFcx25QodNG2_ow
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  26. ^Child Poverty in Respective: An Overview of Child Wellbeing in Rich Countries. UNICEF: Innocenti Research Center, Report Card 7.
  27. ^"Sometimes They Can't Afford to Leave their Abusers", Santa Ynez Valley Journal, California, ‎22 October 2009‎.
  28. ^Stats for 2000; Stats for 2001; Stats for 2002; Stats for 2003; Stats for 2004; Stats for 2005.
  29. ^Fontana VJ (October 1984). "The maltreatment syndrome of children". Pediatric Annals 13 (10): 736–44. PMID 6504584. 
  30. ^Finkelman, Byrgen (1995). "Introduction". Child abuse: a multidisciplinary survey. New York: Garland Pub. p. xvii. ISBN 0-8153-1813-8. 
  31. ^ a b Ross, S (1996). "Risk of physical abuse to children of spouse abusing parents,". Child Abuse & Neglect 20: 589. doi:10.1016/0145-2134(96)00046-4. 
  32. ^Murphy JM, Jellinek M, Quinn D, Smith G, Poitrast FG, Goshko M (1991). "Substance abuse and serious child mistreatment: prevalence, risk, and outcome in a court sample". Child Abuse & Neglect 15 (3): 197–211. doi:10.1016/0145-2134(91)90065-L. PMID 2043972. 
  33. ^Famularo R, Kinscherff R, Fenton T (1992). "Parental substance abuse and the nature of child maltreatment". Child Abuse & Neglect 16 (4): 475–83. doi:10.1016/0145-2134(92)90064-X. PMID 1393711. 
  34. ^Hughes, Sandra (20 May 2009). "Child Abuse Spikes During Recession", CBS News.
  35. ^Gauthier L, Stollak G, Messé L, Aronoff J (July 1996). "Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning". Child Abuse & Neglect 20 (7): 549–59. doi:10.1016/0145-2134(96)00043-9. PMID 8832112. 
  36. ^Malinosky-Rummell R, Hansen DJ (July 1993). "Long-term consequences of childhood physical abuse". Psychological Bulletin 114 (1): 68–79. doi:10.1037/0033-2909.114.1.68. PMID 8346329. 
  37. ^Lyons-Ruth K.; Jacobvitz, D. (1999). "Attachment disorganization: unresolved loss, relational violence and lapses in behavioral and attentional strategies". in Cassidy, J.; Shaver, P.. Handbook of Attachment. New York: Guilford Press. pp. 520–554. 
  38. ^Solomon, J.; George, C., ed (1999). Attachment Disorganization. New York: Guilford Press. ISBN 1572304804. [page needed]
  39. ^Main, M.; Hesse, E. (1990). "Parents' Unresolved Traumatic Experiences are related to infant disorganized attachment status". in Greenberg, M.T.; Ciccehetti, D; Cummings, E.M.. Attachment in the Preschool Years: Theory, Research, and Intervention. University of Chicago Press. pp. 161–184. 
  40. ^Carlson EA (August 1998). "A prospective longitudinal study of attachment disorganization/disorientation". Child Development 69 (4): 1107–28. PMID 9768489. 
  41. ^Lyons-Ruth K (February 1996). "Attachment relationships among children with aggressive behavior problems: the role of disorganized early attachment patterns". Journal of Consulting and Clinical Psychology 64 (1): 64–73. doi:10.1037/0022-006X.64.1.64. PMID 8907085. 
  42. ^Lyons-Ruth K, Alpern L, Repacholi B (April 1993). "Disorganized infant attachment classification and maternal psychosocial problems as predictors of hostile-aggressive behavior in the preschool classroom". Child Development 64 (2): 572–85. doi:10.2307/1131270. PMID 8477635. 
  43. ^Carlson, V. et al. (1995). "Finding order in disorganization: Lessons from research on maltreated infants' attachments to their caregivers". in Cicchetti, D.; Carlson, V.. Child Maltreatment: Theory and research on the causes and consequences of child abuse and neglect. Cambridge University Press. pp. 135–157. 
  44. ^Cicchetti D. et al. (1990). "An organizational perspective on attachment beyond infancy". in Greenberg, M.; Cicchetti, D; MCummings, M.. Attachment in the Preschool Years. University of Chicago Press. pp. 3–50. ISBN 0226306291. 
  45. ^ a b Takele Hamnasu, MBA. Impact of Childhood Abuse on Adult Health. Amberton University.[page needed]
  46. ^"Study of Living Conditions 1986-1987" INSEE survey with a sample of 13&nsp154 individuals, cf.Menahem G., "Problèmes de l'enfance, statut social et santé des adultes", IRDES, biblio No 1010, pp. 59-63, Paris.
  47. ^Middlebrooks, J.S.; Audage, A.C. (2008). The Effects of Childhood Stress on Health Across the Lifespan. Centers for Disease Control. 
  48. ^Dolezal, T.; McCollum, D.; Callahan, M. (20098). Hidden Costs in Health Care: The Economic Impact of Violence and Abuse. Academy on Violence and Abuse. 
  49. ^Kemp AM, Dunstan F, Harrison S, et al. (2008). "Patterns of skeletal fractures in child abuse: systematic review". BMJ 337: a1518. doi:10.1136/bmj.a1518. PMID 18832412. PMC 2563260. http://bmj.com/cgi/pmidlookup?view=long&pmid=18832412. 
  50. ^Fuller-Thomson E, Brennenstuhl S (July 2009). "Making a link between childhood physical abuse and cancer: results from a regional representative survey". Cancer 115 (14): 3341–50. doi:10.1002/cncr.24372. PMID 19472404. 
  51. ^[ http://www.childwelfare.gov/preventing/preventionmonth/history.cfm Child Welfare Information Gateway], History of National Child Abuse Prevention Month. 3 April 2009.
  52. ^Presidential Proclamation Marking National Child Abuse Prevention Month. The White House-Press Room, 1 April 2009.
  53. ^U.S. Administration for Children and Families. Department of Health and Human Services. Children's Bureau.
  54. ^Hosin, A.A., ed (2007). Responses to traumatized children. Basingstoke: Palgrave Macmillan. p. 211. ISBN 1403996806. 
  55. ^Briere, John (1992). Child abuse trauma. Sage. p. 7. ISBN 080393713X. 
  56. ^ a b c d Cohen, J.A.; Mannarino, A.P.; Murray, L.K.; Igelman, R. (2006). "Psychosocial Interventions for Maltreated and Violence-Exposed Children". Journal of Social Issues 62 (4): 737–766. doi:10.1111/j.1540-4560.2006.00485.x. 
  57. ^ a b c Appel JM (October 2009). "Mixed motives, mixed outcomes when accused parents won't agree to withdraw care". Journal of Medical Ethics 35 (10): 635–7. doi:10.1136/jme.2009.030510. PMID 19793945. 
  58. ^"Springfield man denies charges in infant assault", Rutland Herald, New Hampshire, 5 August 2008.
  59. ^"Springfield Father Charged with Baby's Murder", WCAX.com, Vermont, 21 January 2009.
  60. ^"Withdrawal Okay When Surrogate's Refusal to Consent Based on Wrong Reasons"

[edit] Further reading

[edit] External links

 
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