Child Abuse & Neglect: Neurobiological Aspects and Interventions
Lecture 1: introduction and consequences
Prevalence of maltreatment
When we speak of child maltreatment, we speak of abuse and neglect. In the
Netherlands, according to the National Prevalence Study of Child abuse and neglect (a yearly
study) 127.000 children every year are victim to some kind of childhood maltreatment.
Gilbert et al. reported that 4-16% of abused children reported physical abuse; 10% of
children reported neglect/emotional abuse and 5-10% of children reported sexual abuse. If
we think critically about these numbers; these are estimates and we cannot know how many
children are maltreated (e.g., if you use self-report, some children might not be honest –
some may be ashamed or are unaware of abuse or neglect). We speak of the top of the
iceberg; it is the same with numbers of Child Protective Services (CPS): many families are not
reported to CPS but do experience problems. Thus, when we look at these numbers, we
must think about these problems critically.
There are different prevalence rates for the different types of child maltreatment;
emotional neglect is most prevalent and sexual abuse is least often the case. In the past
year, emotional neglect has seemed to become higher, maybe because we measure it better
or ask better questions, or there could be other more specific reasons why this is the case.
Sexual abuse
According to WHO, sexual abuse is the 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
This is 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 hemorrhage, or internal injuries.
This is interesting because; is it only physical abuse when you see evidence on the child’s
body? This is merely something interesting to think about.
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. Examples may be telling your child that they’re not good enough, wish they
weren’t there or any other undermining of the healthy development (mentally). Emotional
abuse might be much more subtle than physical abuse, but also very much linked to negative
outcomes.
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. E.g., when the child needs to see a doctor, but the parents don’t bring their
,child, or not bringing them to school (denying their education), or when there are financial
problems making it difficult to provide food, clothing, or shelter.
Emotional neglect
The consistent failure of a parent or caretaker to provide a child with appropriate support,
attention, and affection. Emotional abuse is more ‘active’; emotional neglect it’s more
‘passive’.
Structural neglect
This is an interesting type of neglect. There are some interesting studies, like the one in
Romania where children lived in rearing institutions (not with a (foster care) family) and
during the time of those research they didn’t know whether it was worse to place children in
an institution or in foster care. In this course we will speak of some studies which compare
foster care with these institutions, and we will see that it’s very troublesome to place
children in an institution.
Institutional rearing is characterized by a regimented nature (it’s all very strictly planned;
individual children don’t get the space or attention they need); there is a high child-to-
caregiver ratio; there are multiple shifts in caregivers (multiple times daily, making it difficult
to bond with caregivers, thus a frequent change of caregivers). These factors deprive
children of getting continuous and reciprocal interactions with stable caregivers; every child
wants and needs to form a relationship of attachment with a caregiver and for these children
it was difficult to obtain that.
The consequences of child abuse and neglect
The questions we talk about today are as follows; can child maltreatment make you sick?
Which illnesses might be the consequence of child maltreatment? This may be physical, but
you can also think of mental health issues. Also, if we read these studies, what are possible
methodological limitations that we must be aware of when we interpret the results?
Paper (only the information from the slides and lecture are exam material): Child
maltreatment and adult livings standards at 50 years, by Pereira, Li & Power
This study specifically focusses on SES of maltreated people in their adult lives. They
looked at a big sample of more than 8000 people, born in 1958 born in the UK. They looked
at different types of maltreatment; physical neglect measured in childhood (prospective
measure) and they identified this with interviews with parents and asking the child’s teacher.
They also wanted to know more about emotional neglect and abuse; and measured it by
self-report at the age of 45. Thus: be aware that physical neglect was measures during the
childhood, and the other types of neglect were measured during adulthood.
They wanted to examine the relationship between child maltreatment at the one end, and
socio-economic status at the other end. They looked at long-term sickness absence (did they
show long-term absence, the people who were abused during childhood?); education and
employment; financial insecurities; poor qualifications and manual labor. They corrected for
a few confounders: they adjusted for maternal age, birth weight, birth order, poor childhood
health, social class in 1958, mothers’ education, household amenities.
They found a significant association between experiencing child maltreatment at an early
age and SES at adult age (45). They saw that the above things were lower for people who
experienced child abuse and neglect. Thus, child maltreatment led to a lower SES, but what
,may be mechanisms or factors that influence this relationship? Which other factors may be
related to this relationship?
Assessment of the Harmful psychiatric and behavioral effects of different forms of
child maltreatment (Vachon, Krueger, Rogosch, & Cicchetti, 2015)
This paper may give us some ideas on what is happening in above described relationship.
This paper is about a summer camp for children, especially chosen for children from families
with low SES. These children were either maltreated or not; 25% was maltreated. A good
thing about this study; if you think of studies comparing groups, it is always interesting to
see how they constructed the control groups. In this study, for the children who were low
SES but weren’t maltreated, they confirmed this via interviews with the mother to confirm
whether these children were surely not maltreated. Thus, it was a solid control group. They
were children between 5 and 13 years old, put in groups of 8-10 children with a counselor.
Race was well divided between groups; it was a representative sample. They wanted to find
out what types of maltreatment might be related to different types of outcomes and what
happened with the behavior of the children when we look at emotional- and behavioral
problems.
How can we interpret the results of the summer camp-study? They made interesting
looking graphs, with two figures looking similar with bars: these are about internalizing
problems. On the X-axis, they have the success-rates, with a type of effect size to analyze
whether the maltreated group had more psychiatric disorders such as depression compared
to their non-maltreated peers. They looked at different things, e.g.: type of maltreatment (S,
P E and N): for each of these types they looked at different internalizing symptoms. They
noticed for types of maltreatment that for each of these types the maltreated had more
symptoms; and, the more frequent and severe maltreatment, the more internalizing
symptoms they witnessed in these children.
They also have a figure for externalizing behavior (aggression, disruptive behavior). They
had instruments that were used with counselors, parents, and peers to rate each other on
for instance disruptive behavior. The same as internalizing behavior; they saw those
different types of abuse and more severe or frequent maltreatment, children experienced
more externalizing behavior problems. We can conclude from this graph that the experience
of maltreatment has a relationship with more externalizing behavioral problems, and it gets
stronger when there are more different types of abuse, more severe and/or more frequent
abuse.
They have another interesting figure, below is the structural model of their study. On the
left side of the figure, it shows the different people who reported on the
behavior/maltreatment, and on the right side we have the different types of
internalizing/externalizing problems. We can see that for sexual abuse there is something
interesting happening in this study: non-sexual child-abuse (at the bottom) includes physical
and emotional abuse and neglect. They compare these types of maltreatment and neglect
with sexual abuse, and they wanted to know whether there were different pathways for
sexual abuse versus these other types of abuse. We can see that when there is sexual abuse,
there are low regression weights towards internalizing behavior, which means that for sexual
abuse the relationship between being sexually abused and internalizing/externalizing
behavior problems was not significant. For all the other types of (non-sexual) abuse they
found significant pathways; internalizing and externalizing behaviors were higher than for
the non-maltreated group.
, What we now know from the Vachon study is 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.
Hodges et al: cumulative effects?
They researched 318 children between the age of 8 and 12 years and they looked at two
specialized child trauma treatment centers. Similarly to the other study, they looked at
different types of maltreatment and the total number of different experienced trauma
(cumulative effects). They wanted to examine whether there is something called a
‘cumulative trauma’.
This figure explains this quite well:
The number of trauma types experienced is on the left and they looked at pathways to self-
reported symptom complexity and caregiver-reported symptom complexity. What they
found is that if you’ve experienced more traumas, you have more complexity in symptoms
regarding internalizing and externalizing behavior (self-reported and reported by caregiver).
They also looked at gender and age to control for these relationships.
The previous two studies give us an example on what kind of relationships and
consequences we can think of in experiencing maltreatment, but there are a few other
studies we will discuss.
