Class notes
All lectures child abuse and neglect 2022/2023
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Week 1 – Introduction and consequencesLecture 1 – Introduction and consequences
Prevalence and types of maltreatment
Prevalence of maltreatment
• 127.000 children every year in the Netherlands
• 4-16% physical abuse
• 10% neglect/emotional abuse
• 5-10% sexual abuse
Types
• Sexual abuse: Involvement of children in sexual activities that they do not fully understand, are
unable to give informed consent to, for which they are not developmentally prepared, or that
violate the standards of the society in which these children live. This is not about consent. It’s
sexual abuse if the child is developmentally not ready. By law this is always the case under the
age of 16 in the Netherlands.
• Physical abuse: Any non-accidental injury to a child under the age of 18 by a parent or
caretaker. These injuries may include beatings, shaking, burns, human bites, strangulation, or
immersion in scalding water, with resulting bruises and welts, broken bones, scars, burns,
retinal haemorrhage, or internal injuries.
• Emotional abuse: 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.
• Physical neglect: The chronic failure of a parent or caretaker to provide a child under 18 with
basic needs such as food, clothing, shelter, medical care, educational opportunity, protection,
and supervision.
• Emotional neglect: The consistent failure of a parent or caretaker to provide a child with
appropriate support, attention, and affection.
• Structural neglect
o Institutional rearing characterized by:
▪ Regimented nature
▪ High child-to-caregiver ratio
▪ Multiple shifts
▪ Frequent change of caregivers
o These factors deprive children of
continuous and reciprocal interactions
with stable caregivers, necessary to
respond to their developmental needs.
Consequences of child abuse and neglect
Living standards
Pinto Pereira et al. (2017) – Child maltreatment and adult
living standards at 50 years
• 1958 British birth cohort data (N = 8076),
• Physical neglect (prospective): identified from information collected in childhood from parental
interviews and the child’s teacher by using structured questionnaires
• Emotional neglect and abuse (sexual, physical, psychological, or witnessing): self-report at age
45
• Maltreatment related to lower SES
o Long-term sickness absence
o Not in employment, education or training
, o Fewer assets
o Income-related support
o Lower educational level
o Financial insecurity
o Poor qualifications
o Manual labor
• Adjusted for maternal age, birth weight, birth order, poor childhood health, social class in 1958,
parental education, household amenities, crowding, and tenure.
• They found a significant association between early-age child maltreatment and the SES at the
age of 45, all these factors were lower. How this is possible is not explained.
Emotional and behavioral problems in children
Vachon et al. (2015) – Assessment of the harmful psychiatric and behavioral effects of different forms
of child maltreatment
• N = 2,292 (1,193 maltreated)
• 5-13 years
• Research summer camp program
• Figure 1 + 2: Internalizing and externalizing effect sizes.
o Type: For type of maltreatment, the effect sizes are pretty much the same.
o Variety: When there are more types of maltreatment, the effect sizes get much larger.
Especially for 4 types of maltreatment.
o Number of events: The more events of maltreatment, the bigger the effect sizes.
o Most severe maltreatment: the more severe, the bigger the effect sizes.
• Figure 4: Physical, emotional and neglect so highly correlated that they could not be put in the
model separately. So they are combined in non-sexual child maltreatment.
o Non-sexual child maltreatment: Significantly predicts internalizing and externalizing
problems.
o Sexual abuse separately: Effect on internalizing and externalizing problems. But when
controlled for other types of maltreatment, there is no effect of sexual abuse on
internalizing and externalizing problems (in this study).
,Cumulative effects
Cumulative trauma and symptom complexity in children: A path analysis by Hodges et al. (2013)
• N = 318 children
• 8-12 years
• 2 specialized child trauma treatment centres
• Number of trauma types is related to symptom complexity
(by self and caregiver).
Mental and physical health in adulthood
Herrenkohl (2013) – Developmental impacts of child abuse and neglect related to adult mental health
substance use and physical health
• Prospective: children in child welfare
(abuse & neglect) vs comparison
children
• Followed longitudinally until mid-30s
• Table 1: results in their mid 30’s.
o Children who are maltreated
have significantly higher
problems on depression (BDI)
and anxiety (GAD) than
children who were not
maltreated.
o Significant effect on social
functioning, role-emotional,
mental health, substance and
alcohol abuse, physical
problems, general health and
somatic problems.
o Do not need to know all the
different outcomes
o General finding: results in the expected direction, worse outcomes for maltreated group
in comparison to comparison group. Several negative outcomes for mental health,
functioning etc. → Controlled for SES and gender. On top of SES there are still
differences between the two groups.
, Somatic health in adulthood
• Vincent Felitti (1998) – ACE study: Adverse Childhood Experiences
• Consistent results: child maltreatment related to many aspects of physical and psychological
health
• Cumulative effect
ACE study
• 13,494 Kaiser Health Plan members who completed standardized medical evaluations at the
Health Appraisal Clinic (August– November 1995 and January–March 1996)
• Questionnaires mailed in week after visit
• 9,508 (70.5%) returned questionnaire
Adverse Childhood Experiences
• Psychological abuse
• Physical abuse
• Sexual abuse
• Substance abuse in household
• Mental illness in household
• Mother treated violently
• Criminal behavior in household
• → the more ACE’s the more risk of health problems.
Exam question
• ACE = ?
o ACEs stands for Adverse Childhood Experiences, which are traumatic experiences that
a child can experience during their development, such as physical, emotional, or sexual
abuse, neglect, household dysfunction, or exposure to violence.
• Explain the following sentence: “ACEs have a cumulative effect on the development of
psychological and physical problems”
o This means that experiencing multiple ACEs over time can have a significant impact
on a person's physical and mental health. The more ACEs a person experiences, the
greater their risk for developing a wide range of health problems, including depression,
anxiety, substance abuse, heart disease, and other chronic illnesses.
o The cumulative effect of ACEs means that the impact of each individual experience is
not limited to its immediate effects but can also affect the person's health in the long
term, even into adulthood. This is because ACEs can alter brain development, disrupt
hormonal systems, and affect immune function, which can all contribute to the
development of physical and psychological health problems.
o In summary, the sentence suggests that the accumulation of ACEs can have a profound
and lasting impact on a person's well-being.
Meta-analysis
Norman et al. (2012) – The long-term health consequences of child physical abuse, emotional abuse,
and neglect: A systematic review and meta-analysis
• 124 studies on the consequences of physical abuse, emotional abuse, and neglect (NO sexual).
• Table 4: Number of data points
o Number of papers or effect sizes which reported on the subject. The pooled OR (Odds
Ratio) is significant if the confidence interval range in its whole is above 1 (lower and
upper bound above 1).
o → do not need to know the specific odd ratio’s and the specific outcomes.
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