Child Abuse and Neglect: Literature Review
According to the U.S. Department of Health and Human Services (as cited in Child Welfare Information Gateway, 2008), there were 905,000 children who were victimized by child abuse and neglect in 2006. Aside from the physical injuries, which may or may not be readily visible, the abuse and neglect can have lifetime consequences for children, their families, and the society. In particular, the consequences of child abuse and neglect can be classified as societal, behavioral, psychological, and physical, although in reality, it would be impossible to separate them completely from each other (Child Welfare Information Gateway, 2008). Some of the physical consequences of child abuse and neglect include poor physical health, impaired brain development, and the shaken baby syndrome while the psychological consequences include social difficulties, cognitive difficulties, poor mental and emotional health, and difficulties during infancy (Child Welfare Information Gateway, 2008). On the other hand, behavioral consequences include difficulties during adolescence, adult criminality juvenile delinquency, abusive behavior, and alcohol and other drug abuse (Child Welfare Information Gateway, 2008). This is supported by the findings of Briere & Ricards (2007), which showed that childhood sexual and emotional maltreatments -- especially when involving maternal emotional abuse – contributed to the development of disturbed self-capacities. As well, this is affirmed by the findings of Widom (1989), which showed that compared to a control group, the recipients who were victims of abuse and neglect had higher rates of arrests for violent offenses and adult criminality, but not for adult arrests for child neglect or abuse.
In a study conducted by Briere & Elliott (2003), it was determined that childhood physical and sexual abuse had significant long-term effects and that this may in part be causative of the psychological disorders that exist in American society today. As Freud posited, children who were sexually molested were likely to develop hysteria in adulthood (Briere & Conte, 1991). This was supported by current research, which showed that childhood sexual trauma was related to various long-term outcomes such as anxiety and depression, sexual problems, suicide attempts, substance abuse, somatization, and dissociation (Brier & Conte, 1991). Similarly, the findings of Briere, Kaltman & Green (2008) showed that cumulative childhood trauma was related to symptom complexity, that is, multiple symptoms may result from multiple traumas where the risk factors and outcomes that resulted from such traumas could elaborate and persist over time, leading to a multitude of symptoms in adulthood.
Finally, societal consequences include direct costs, such as those associated with child welfare systems, and indirect costs, which are representative of the long-term economic effects of child abuse and neglect (Child Welfare Information Gateway, 2008).
Although child protection laws exist, the main challenge when it comes to ensuring the protection and safety of children is the lack of universal standards in terms of what qualifies as child maltreatment (Lewitt, 1994). In particular, the definition of child maltreatment is largely dependent on social norms. Despite the establishment of the Federal Child Abuse Prevention and Treatment Act (Public Law 93-247), which indicated “uniform operating standards with respect to the identification and management of child maltreatment cases,” (Lewitt, 1994, p. 233) the different states continue to have their own definitions of maltreatment, their own procedures for conducting investigations, their own services, and their own monitoring systems.
Even with the clinical assessment of victims of abuse, difficulties can arise due to the psychometric quality; the distortion and misidentification; the malingering and overreporting; the underreporting and avoidance; the co-morbid sources of trauma-related stress; and the general versus the specific effects of trauma (Briere & Elliott, 1997). This is affirmed by Briere, Johnson & Bissada et al. (2001) who claimed that despite the advances in the understanding of experts with regards to psychological trauma and its possible effects, along with the availability of more effective treatments for conditions that are related to trauma, there remain to be very few, standardized and relevant measures for trauma-related conditions among children.
Child maltreatment includes emotional or psychological harm, sexual abuse, physical injury, and general, educational, and medical neglect. However, these categories remain quite vague or broad in that personal judgment would still be required in the determination of the intent, purpose, or outcome of an action. According to Briere & Jordan (2009), childhood maltreatment consists of various types of abuse, including psychological neglect, such that abused children may have experienced various combinations of psychological and physical abuse, as well as exposure to parental domestic violence. Moreover, the different forms of neglect or abuse may vary with regards to the extent, duration and frequency, severity, and age of onset of the injury (Briere & Jordan, 2009).
Lewitt (1994) asserted the importance of obtaining accurate statistical information about instances of child abuse. Although this data in itself will not protect children from maltreatment, such data will enable society to better fight against child maltreatment. It will enable the proper staffing, planning, and budgeting of CPS (Child Protection Services) agencies. Moreover, it will enable the evaluation of the effectiveness of the various CPS programs.
Although the instances of child fatalities as a result of child maltreatment has fairly stabilized, a study conducted by Lewitt (1994) showed that only 70 percent of reported cases were pursued by CPS agencies and that more than 40 percent of the deaths that resulted from child maltreatment had prior contact with CPS agencies. Moreover, with a large number of cases being misreported or underreported, the proper assessment of policies that are intended to address the problem of child abuse and neglect is impeded. This makes it even more important to come up with accurate measures of maltreatment, as this will enable the progress made in fighting and preventing this problem to be monitored (Lewitt, 1994).
Similarly, with the complexity of the tasks that caseworkers have, Larner, Stevenson & Behrman (1998, p. 11) recommended that “state legislatures [. . .] allow, and local agencies [. . .] undertake, experiments with screening systems that differentiate between reports of maltreatment representing higher or lower risk to the child, and that build in evaluations tracking outcomes for both groups.” They also recommended that CPS agencies raise their staff qualifications in terms of competency-based pre-service training, social work courses, and general education (Larner, Stevenson & Behrman, 1998). As well, they recommended that findings from child maltreatment research and intervention be applied to CPS agency guidelines and used to enable their staff to make better decisions. In addition, they asserted that CPS agencies should be provided with sufficient funding and that the government should make an effort to reduce poverty among families with children (Larner, Stevenson & Behrman, 1998). In the same regard, the government should provide for the necessary support and resources that would enable children’s relatives and the community members to be of assistance to caseworkers. This is supported by the findings of Lanktree, Gilbert & Briere, et al. (2008), which suggested that report measures from both the child and the child’s caretaker be considered in the evaluation of traumatized children in order to simultaneously obtain multiple sources of information. Moreover, Larner, Stevenson & Behrman (1998) suggested that CPS agencies can be effective only if legislators give them manageable, clear, and stable parameters, together with the resources, that would enable them to perform their assigned responsibilities.
One of the popular services provided for the prevention of child abuse is home visits. In a study conducted by Howard & Brooks-Gunn (2009), little evidence was gathered with regards to the contribution of home-visiting programs to the prevention of child abuse and neglect. However, their study showed that home visits had a positive impact on the improvement of the mothers’ parenting practices, the children’s development, and the quality of the children’s home environment. In turn, the improved parenting skills would lead to the improvement of the child’s well-being and subsequently to the decrease of maltreatment instances. In addition, Howard & Brooks-Gunn (2009) suggested that home-visiting programs would have the most benefit for low-income and first-time adolescent mothers. In the same regard, policy makers and theorists asserted that home visits could be a cost-effective and beneficial way of providing services to children and families (Howard & Brooks-Gunn, 2009). However, they asserted that in order to maximize the impact of such services, it would be necessary for service providers to carefully follow the guidelines established by the respective programs, to implement the programs in accordance to their theoretical models, to provide prenatal intervention for at-risk populations, and to employ staff whose credentials match the program goals (Howard & Brooks-Gunn, 2009).
Briere, J. & Conte, J. (1993). Self-reported amnesia for abuse in adults molested as children.
Journal of Traumatic Stress, 6 (1), 21-31.
Briere, J. & Elliott, D. M. (1997). Psychological assessment of interpersonal
victimization effects in adults and children. Psychotherapy, 34 (4), 353-364.
Briere, J., Johnson, K. Bissada, A., Damon, L. Crouch, J. Gil, E., Hanson, R. & Ernst, V.
(2001). The Trauma Symptom Checklist for Young Children (TSCYC): Reliability and
association with abuse exposure in a multi-site study. Child Abuse & Neglect, 25, 1001-
Briere, J. & Elliott, D. M. (2003). Prevalence and psychological sequelae of self-reported
childhood physical and sexual abuse in a general population sample of men and women.
Child Abuse and Neglect, 27, 1205-1222.
Briere, J. & Rickards, S. (2007, June). Self-awareness, affect regulation, and relatedness:
Differential sequels of childhood versus adult victimization experiences. The Chicago
Journal of Nervous and Mental Disease, 195 (6), 497-503.
Briere, J., Kaltman, S. & Green, B. L. (2008, April). Accumulated childhood trauma and
symptom complexity. Journal of Traumatic Stress, 21 (2), 223-226.
Briere, J. & Jordan, C. E. (2009, October). Childhood maltreatment, intervening variables, and
adult psychological difficulties in women: An overview. Trauma, Violence, & Abuse, 10
Child Welfare Information Gateway. (2008, April). Long-term consequences of child abuse and
neglect. Retrieved from http://www.childwelfare.gov/pubs/factsheets/.
Howard, K. S. & Brooks-Gunn. (2009). The role of home-visiting programs in
preventing child abuse and neglect. The Future of Children, 19 (2), 119-146.
Lanktree, C. B., Gilbert, A. M., Briere, J., Taylor. N., Chen, K., Maida, C. A. & Saltzman, W.R.
(2008). Multi-informant assessment of maltreated children: Convergent and
discriminant validity of the TSCC and TSCYC. Child Abuse & Neglect, 32, 621-625.
Larner, M. B., Stevenson, C. S. & Behrman, R. E. (1998). Protecting children from
abuse and neglect: Analysis and recommendations. The Future of Children, 8 (1), 4-22.
Lewitt, E. M. (1994). Child indicators: Reported child abuse and neglect. The Future of
Children, 4 (2), 233-242.
Widom, C. S. (1989, July). Child abuse, neglect, and adult behavior: Research design and
findings on criminality, violence, and child abuse. American Journal of Orthopsychiatry,
59 (3), 355-367.