Child abuse and neglect: Neurobiological aspects and intervention – lecture notes
Lecture 1 – Introduction and consequences
Prevalence of maltreatment: 127.000 children every year in the Netherlands. Another study, focused
more internationally, found that from the children who experience maltreatment:
- 4-16% experience physical abuse
- 10% experience neglect / emotional abuse
- 5-10% experience sexual abuse
It is very hard to estimate these numbers precisely; we cannot know the exact number. For instance,
when you use self-report; what is abuse? And also, not everyone that is being maltreated will tell
about this. So this is probably just the top of the iceberg.
There are different prevalence rates for different
types of maltreatment. In the Netherlands, emotional
neglect is most prevalent, and sexual abuse the least.
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
Physical abuse: any non-accidental injury to a child under the age of 18 by a parent or caretaker.
These injuries may include beating, shaking, burns, human bites, strangulation, or immersion in
scalding water, with resulting bruises and welts, broken bones, scars, burns, retinal hemorrhage, 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: for example children who live in an institution. Institutional rearing is
characterized by:
- Regimented nature → very strictly organized or
controlled
- High child-to-caregiver ratio → less attention
- Multiple shifts
- Frequent change of caregivers
These factors deprive children of continuous and reciprocal
interactions with stable caregivers, necessary to respond to their
developmental needs.
Overview of the course →
,Consequences of child abuse and neglect
Today we will talk about:
- Can child maltreatment make you sick?
- Which illnesses can be the consequence of maltreatment?
- Does it affect your mental health? Examples?
- What are possible methodological limitations that we have to be aware of?
Study: 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 → measured
in childhood
- Emotional neglect and abuse (sexual, physical, psychological, or witnessing): self-report at
age 45 → measured in adulthood
They wanted to examine the relationship between child maltreatment and SES. They looked at:
- Long-term sickness absence
- Not in employment, education, or training
- Fewer assets
- Income-related support
- Lower educational level
- Financial insecurity
- Poor qualifications
- Manual labor
They 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 experiencing child maltreatment at an early age and
your SES at age 45. They found that the beforementioned aspects were lower for adults who
experienced child abuse and neglect. So the relationship is significant, however, how can we explain
this relationship? What can be mechanisms or factors that influence this relationship.
Paper that might give an answer to this question: Assessment of the harmful psychiatric and
behavioral effects of different forms of child maltreatment (Vachon, 2015) →
- N = 2292 (1193 or 52.1% maltreated)
- Children of 5-13 years. They are divided into groups of 5-10 children. Race was divided
between the groups and ages. So it was a representative sample.
- Research summer camp program for children from low SES, and children were either
maltreated or not.
They wanted to know: what types of maltreatment might be related to
psychiatric outcomes, and what is happening in the behavior of these
children when looking at emotional and behavioral problems.
Results: they made the graphs on the right
- Internalizing effect seizes:
o Type of maltreatment: they found that for each of these
types of maltreatment, children had more internalizing
symptoms than children who were not maltreated.
o The more severe and frequent children experienced
maltreatment, the more internalizing symptoms they
found.
, - Externalizing behavior: these types of behaviors were also
coded by peers.
o For all the different types of abuse, children
experienced more externalizing problems compared to
non-maltreated children.
o The more sever, frequent, and different types of abuse,
the more externalizing symptoms they found in
maltreated children. So the relationship between being
maltreated an experiencing externalizing behaviors
problems are getting stronger when becoming more
severe and frequent.
Another result / figure → their structural model
- On the left side, you see the different people who
reported behavior of maltreatment
- On the right side, you see the internalizing and
externalizing outcomes
- You can see: for sexual abuse something interesting is
happening → they compared sexual abuse with non-
sexual child abuse including physical emotional abuse
and neglect. They found different pathways for sexual
and non-sexual abuse.
- What they found: the relationship between sexual child maltreatment and internalizing and
externalizing behavior problems was nonsignificant. For all the other types of abuse (so non-
sexual), you can see a significant relationship between behavioral outcomes. So the
externalizing and internalizing problems were higher in the non-sexual maltreated group
than the sexual maltreated group.
So now we know that the relationship between experiencing child maltreatment and experiencing
internalizing and externalizing behavioral problems may increase when children experience more
different types of abuse and neglect, more frequently or more intense.
Another study that looked at this, was the study of Hodges et al
(2013), but they called it ‘trauma’ instead of child maltreatment.
They looked at 318 children of 8-12 years old. They looked at 2
specialized child trauma treatment centers. They looked at the
types of maltreatment, and also at the number of traumas. They
wanted to examine: is there a cumulative effect → if you
experience different frequencies of traumas, is there relationship
with the outcomes?
Results →
- If you’ve experienced more trauma’s, you have more
complexity in symptoms regarding internalizing and
externalizing behavior: self reported and reported by
caregiver. They controlled for age.
- So there is a significant relationship between types of
child maltreatment and its intensity and frequency,
and child outcomes in internalizing and externalizing
problems.
