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Chapter 14 Child Abuse and Neglect

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Title: Chapter 14 Child Abuse and Neglect


1
Chapter 14Child Abuse and Neglect
2
Terminology
  • Risk factor - A characteristic of a situation or
    person that makes a certain negative outcome MORE
    likely. Without this particular trait, the
    individuals risk for the outcome is decreased.
  • Protective factor - A characteristic of a
    situation or person that makes a certain negative
    outcome LESS likely. Without this particular
    trait, the individuals risk for the outcome is
    increased.
  • Lifetime prevalence - At some point in the
    individuals life, he or she exhibits the outcome
    of interest.

3
Healthy Child-Rearing and Families
  • Children need a balance of control and
    responsiveness
  • Healthy parenting includes knowledge of child
    development and expectations, adequate coping
    skills, healthy parent-child attachment and
    communication, home management skills, shared
    parental responsibilities, and provision of
    social services
  • Healthy parenting involves a gradual shift of
    control from parents to child and community

4
Child-Rearing and Maltreatment
  • Maltreatment represents major failures of the
    childs expectable environment
  • for infants, an expectable environment includes
    protective and nurturing adults, and
    opportunities for socialization
  • older children require a supportive family,
    contact with peers, and plenty of opportunities
    to explore and master the environment

5
Classification of Maltreatment
  • Boundaries between appropriate and inappropriate
    child rearing are not always clear or
    well-established, and may vary according to
    cultural values, community standards, and
    personal experiences.
  • Example caning punishment in Singapore
  • Example what is an appropriate medical
    intervention?
  • Medications versus cupping/coining for flu
  • Or, when disciplining a child, how much
    physical contact is okay? In our culture, none
    but in other cultures, lots.

6
Classification of Maltreatment
  • For DSM-IV, maltreatment could be noted on Axis I
    (Other conditions that may be the focus of
    clinical attention) or Axis IV (psychosocial
    and environmental problems)
  • Important to note, however, that abusing a child
    does not automatically qualify the abuser for any
    diagnostic label.
  • There is no child abuser disorder. In
    fact, we are more likely to consider the
    child/victim the sick one.

7
Types of Maltreatment
  • Physical abuse A non-accidental injury to a
    child by a parent or caretaker.
  • Examples
  • physically harmful acts including punching,
    beating, kicking,biting, burning, shaking.
  • Telltale signs
  • Frequent bruises especially on face, neck,
    forearms.
  • The child may be overly afraid of the parents
    reaction to misbehavior.

8
Types of Maltreatment
  • Neglect failure to provide for a childs basic
    physical, educational, or emotional needs. The
    child does not receive food, appropriate
    clothing, hygenic care, medical care,
    supervision.
  • Telltale signs
  • A very young child routinely left alone at
    home. A severe or recurring illness is not being
    adequately treated. A child might appear
    frequently at the homes of neighbors saying that
    their parent told them to stay away,
    inappropriate dress for the weather or time of
    day.
  • Rule out poverty.

9
Types of Maltreatment
  • Sexual abuse acts ranging from sexual touching
    to exhibitionism, intercourse, and sexual
    exploitation
  • Telltale signs
  • Sexual behavior way beyond what is expected
    for the childs age, sexual slang, trying to
    fondle other children.
  • Toileting difficulties, blood in underwear,
    walks funny.
  • Itching, burning, bleeding in genital area.

10
Types of Maltreatment
  • Emotional abuse acts or omissions that could
    cause serious behavioral, cognitive, emotional,
    or mental disorders.
  • Telltale signs
  • Parent verbally terrorizes or humiliates
    child, especially in the presence of others.
  • Parent fails to express any affection toward
    child.

11
Incidence of Maltreatment
  • 3 million suspected cases of maltreatment in the
    U.S. each year, far fewer are actually
    corroborated.
  • Neglect accounts for 60 of all documented
    incidents, 25 of cases involve physical abuse,
    12 involve sexual abuse (25 involve more than
    one type)
  • Lifetime prevalence estimates
  • Sexual abuse 4.3 of males, 12.8 of females
  • Physical abuse 31.2 of males, 21.1 of females

12
Incidence of Maltreatment (cont.)
  • Figure 14.1
  • Percentages of types of maltreatment. Source
    U.S. Department of Health and Human Services
    (USDHHS, 2000.)

13
Characteristics of Victimized Children
  • Effects of age
  • Younger children more at risk for physical
    neglect
  • Toddlers, preschoolers, and young adolescents at
    risk for physical and emotional abuse
  • Sexual abuse relatively constant after age 3
  • Effects of sex
  • 80 of sexual abuse victims female
  • Boys more likely to be sexually abused by male
    non-family members, girls by male family members
  • Racial and ethnic background is not related to
    risk

14
Characteristics of Family Perpetrator
  • More common among poor and disadvantaged
  • Single-parent (especially father-only) homes and
    large families at risk
  • Childs parent is perpetrator 80 of time, except
    in cases of sexual abuse (50 of time) mother is
    perpetrator of neglect 90 of time
  • Males are offenders in majority of sexual (90),
    emotional (63), and physical (58) abuse

15
Cross-Cultural Comparisons
  • Physical and sexual abuse are found in all
    societies
  • Estimated that 40 million children under the age
    of 15 are victims of maltreatment each year
    worldwide

16
Resilience and Adaptation to Maltreatment
  • Maltreatment does not affect each child in a
    predictable or consistent way
  • Resilience factors include positive self-esteem
    and sense of self, and a positive relationship
    with at least one important and consistent person

17
Developmental Consequences
  • Problems with early attachment and affect
    regulation
  • Insecure-disorganized attachment, characterized
    by a mixture of approach and avoidance,
    helplessness, apprehension, and general
    disorientation
  • Difficulty understanding, labeling, and
    regulating internal emotional states
  • Poor emotion regulation, which may lead to
    internalizing and externalizing problems

18
Developmental Consequences (cont.)
  • Disturbances in emerging views of self and others
  • Negative representational models of self and
    others
  • Feelings of betrayal and powerlessness, which may
    become part of the childs self-identify
  • Sometimes internal attributions of blame for the
    maltreatment

19
Developmental Consequences (cont.)
  • Problems with Peers and school adjustment
  • Easily distracted by aggressive stimuli and
    tendency to make hostile attributions for the
    actions of others
  • Physically abused and neglected children show
    little skill at recognizing distress in others,
    and respond to others distress with fear,
    attack, or anger
  • Maltreated children (especially those physically
    abused) more physically and verbally aggressive
    with peers, and are more likely to be unpopular
    and rejected
  • Maltreated children (especially those neglected)
    often withdraw from and avoid peer interaction

20
Developmental Consequences (cont.)
  • Problems with peers and school adjustment cont
  • Neglected children have the most severe and
    wide-ranging problems in school and interpersonal
    adjustment
  • Sexually abused children described as more
    anxious, inattentive, and unpopular, and having
    less autonomy and self-guidance in completing
    school work

21
Psychopathology and Adult Outcomes
  • Physically abused children at risk for later
    interpersonal problems involving aggressive
    behavior (cycle of violence)
  • Sexually abused children may develop chronic
    impairments in self-esteem, self-concept, and
    emotional and behavioral self-regulation,
    including PTSD, depression, dissociative states,
    and sexual maladjustment
  • Teens with a history of maltreatment are at much
    greater risk of substance abuse

22
Psychopathology and Adult Outcomes (cont.)
  • History of maltreatment and criminal behavior
  • Most abused children do not go on to commit
    crimes
  • However, there is a significant connection
    between maltreatment and subsequent arrests and
    sexual and physical violence
  • A history of maltreatment is associated with an
    earlier mean age at first offense, a higher
    frequency of offenses, and a greater chronicity
    of offending

23
Causes of Maltreatment
  • Physical abuse and neglect
  • Many abusive and neglectful parents have had
    little exposure to positive parental models and
    supports
  • Often a greater degree of stress in the family
    environment
  • Information-processing disturbances may cause
    maltreating parents to misperceive or mislabel
    their childs behavior, leading to inappropriate
    responses
  • Often a lack of awareness or understanding of
    developmentally appropriate expectations

24
Causes of Maltreatment (cont.)
  • Physical abuse and neglect (cont.)
  • Neglectful parents have more striking personality
    disorders, inadequate knowledge of childrens
    needs, and chronic social isolation than abusive
    parents
  • With abuse, may see a conditioning of negative
    arousal and emotions with certain events
  • Conflict and marital violence may be implicated
  • No child characteristic has been linked to the
    risk of maltreatment, once environmental and
    adult factors are controlled (with the exception
    of gender for sexual abuse)

25
Causes of Maltreatment (cont.)
  • Figure 14.3
  • An integrated model of physical child abuse. (D.
    A. Wolfe, 1999)

26
Causes of Maltreatment (cont.)
  • Causes of sexual abuse
  • Most offenders are males who meet the DSM-IV
    criteria for pedophilia
  • Victims are gradually indoctrinated into sexual
    activity, force is seldom used
  • A sense of entitlement and privilege may be
    involved
  • Offenders often have their own histories of abuse
  • Incestuous families characterized by factors that
    protect the family secret and maintain control
    and domination by the abuser, such as social
    isolation, restrictive personal autonomy,
    deference to strict morality and religiosity

27
Causes of Maltreatment (cont.)
  • Causes of Sexual Abuse cont
  • Certain situational factors increase childrens
    vulnerability to being sexually abused, which
    offenders exploit to their advantage, including
    having family problems, being unsupervised and
    spending a lot of time alone, and being unsure of
    themselves

28
Causes of Maltreatment (cont.)
  • Social and Cultural Dimensions
  • Our society condones and glorifies violence
  • Poverty, social isolation, and acceptance of
    corporal punishment contribute to maltreatment
  • Inequality is the major sociocultural factor
    contributing to abuse and neglect
  • Social and cultural disadvantage may result in an
    extra burden of stress and confusion, and limited
    alternatives
  • Maltreatment is often associated with limited
    opportunities to learn appropriate child-rearing
    and to receive needed supports

29
Prevention and Treatment
  • Physical abuse and neglect
  • Enhancing positive experiences early in the
    development of the parent-child relationship may
    help to prevent maltreatment
  • Treatment for physical abuse aims to change how
    parents teach, discipline, and attend to their
    children
  • Cognitive-behavioral methods target anger
    patterns and distorted beliefs
  • Treatment for neglect focuses on parenting skills
    and expectations, and may include training in
    social competence and management of daily demands

30
Prevention and Treatment (cont.)
  • Sexual abuse
  • Childrens treatment programs are few and
    difficult to devise as sexual abuse affects each
    child differently
  • Treatment try to restore childs sense of trust,
    safety, guiltlessness through educational and
    cognitive-behavioral methods, as well as group
    therapy
  • Child needs to express feelings about the abuse,
    and may need specialized treatment if suffering
    from PTSD

31
Other Important Facts About Abused Boys
  • New research on boys suggests that 10-20 of all
    boys are sexually abused in some way. However,
    widely differing definitions of abuse in studies
    and differences in who was being studied make it
    difficult to accurately gauge the prevalence of
    sexual abuse.

32
Other Important Facts About Abused Boys
  • Suicide rate among abused boys is 12-14 times
    higher than nonabused boys substance abuse among
    boys in 6th grade was 40 times greater than
    nonabused boys.

33
Other Important Facts About Abused Boys
  • 33 of juvenile delinquents, 40 of sex
    offenders, and 75 of serial rapists report that
    they were sexually abused as youngsters.

34
However,
  • This may only be true if the abuser was also
    maleboys who have sexual experiences with older
    females at a young age often appear to be
    unimpaired by the experience.

35
However,
  • Girls respond with fear, unpleasant confusion,
    embarrassment
  • Boys indifference tinged with mild anxiety,
    positive pleasure

36
Treating the Abuser
  • We are in need of effective treatments for
    abusers increase remorse and empathy, help them
    confront their own abuse, realize their distorted
    attitudes toward children, target the need for
    control.
  • New drug therapy Depo Provera, which is a type
    of birth control, is also used to reduce
    testosterone and reduce the desire to molest
    children.

37
The Internet
  • The internet may eventually be censored or
    targeted as a means of decreasing child abuse.
    The internet provides a convenient way to conduct
    illegal activities involving children.
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