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Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Chapter 14 Child Maltreatment and Non-Accidental Trauma
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Overview Child abuse and neglect have been recognized as a significant problem since the early 1970s In North America, it is estimated that 1 in 12 children experience some form of sexual victimization by an adult or peer and about 1 in 10 receives harsh physical punishment by a parent or other caregiver that puts them at risk of injury Child maltreatment refers to four primary acts: physical abuse, neglect, sexual abuse, and emotional abuse Non-accidental trauma refers to the wide-raging effects of maltreatment on the child’s physical and emotional development Victimization is abuse or mistreatment of someone whose ability to protect him- or herself is limited
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Overview (cont.) Maltreatment often occurs within ongoing relationships that are supposed to be protective, supportive, and nurturing Abused/neglected children face paradoxical dilemmas: the victim wants to stop the violence but also longs to belong to the family in which they are being abused affection and attention may coexist with violence and abuse the intensity of the violence tends to increase over time, but in some cases physical violence may decrease or even stop Societies are struggling to balance parental rights with children’s right to be safe and free from harm Maltreatment harms children physically, in developing relationships with others, and in their fundamental sense of safety and self-esteem
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning History and Family Context Child maltreatment and non-accidental forms of trauma have always existed but were not seen as a problem since children were viewed as the property of their fathers who had an unchallenged right to punish until about 100 years ago 8th century Roman Law of Chastisement: “rule of thumb” Church doctrine: “spare the rod and spoil the child” 1989: Convention on the Rights of Children spurred efforts to value the rights and needs of children, to recognize their exploitation and abuse
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning History and Family Context (cont.) Healthy families Children need balance of their need for control and direction (“demandingness”) with their need for stimulation and sensitivity (“responsiveness”) Healthy parenting includes: knowledge of child development and expectations adequate coping skills normal parent-child attachment and communication home management skills shared parenting responsibilities provision of social and health services
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning History and Family Context (cont.) Healthy families (cont.) Healthy patterns depend on: parental competence and developmental sensitivity family circumstances availability of community resources (education, information, social networks/support) Context: family situation (e.g., parents’ marital relationship and child’s characteristics) Fundamental, expectable features of child’s environment: Infants: protective, nurturing adults; opportunities for socialization Older children: supportive family, peer contact, opportunities to explore/master their environment Maltreating families fail to provide these requirements
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning History and Family Context (cont.) Child maltreatment: one of the worst, most intrusive forms of stress It impinges directly on the child’s daily life, may be on-going and unpredictable, and often involves people the child depends on and trusts Children’s ability to respond to stress depends on the degree of support and assistance they receive from their parents, who serve as role models maltreated children may have a hard time adapting appropriately to stress Continuum of Care: Child care can be described along a continuum ranging from healthy to abusive and neglectful Parents who violate their children’s needs and dependency status are engaging in inappropriate and abusive behavior
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Types of Maltreatment North American states/provinces: civil laws obligate persons who come in contact with children as part of their job or volunteer work to report known/suspected cases of abuse to the police or child welfare authorities Criminal statutes specify the forms of maltreatment that are criminally punishable U.S. Child Abuse Prevention and Treatment Act (CAPTA): Acts that result in death, serious physical or emotional harm, sexual abuse or exploitation, or acts/failures to act that present imminent risk of serious harm DSM-IV-TR: Maltreatment is not a form of abnormal child behavior/psychological disorder It may be considered on Axis I (“other conditions that may be the focus of clinical attention”) and Axis IV (psychosocial and environmental problems)
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Types of Maltreatment Physical abuse: multiple acts of aggression, including punching, beating, kicking, biting, burning, shaking, or otherwise physically harming a child; injuries are often the result of overdiscipline or severe physical punishment Neglect: Physical neglect: refusal or delay in seeking health care, expulsion from the home/refusal to allow a runaway to return home, abandonment, and inadequate supervision Educational neglect: allowing chronic truancy, not enrolling a child of mandatory school age in school, failing to attend to a child’s special educational needs Emotional neglect (most difficult to define): marked inattention to a child’s needs for affection, refusal/failure to provide needed psychological care, spousal abuse in the child’s presence, permission of drug/alcohol use by the child Consider cultural values and poverty when determining neglect
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Types of Maltreatment (cont.) Sexual abuse: fondling a child’s genitals, intercourse with the child, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials may significantly affect behavior, development, and physical health of sexually abused children their reactions and recovery vary, depending on the nature of the assault and responses of important others Emotional abuse: repeated acts/omissions that may cause serious behavioral, cognitive, emotional, or mental disorders; exists in all forms of maltreatment; can be as harmful as physical abuse or neglect Exploitation: Commercial or sexual prostitution; significant form of trauma for children and adolescents worldwide
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevalence and Context Incidence of Abuse and Neglect in North America Battered child syndrome, first described in early 1960s, was thought to be rare (fewer than 300 children in the U.S.) Today over 3.5 million suspected cases of abuse and neglect are investigated in the U.S. each year; Over 900,000 cases were substantiated in 2006 (12.1 per 1000 children) Of documented maltreatment cases: neglect accounts for 64%, 16% involve physical abuse, 9% involve sexual abuse, 7% involve psychological maltreatment; 25% involve more than one type; sexual and physical abuse cases have declined since 1992 Lifetime prevalence estimates: Sexual abuse: 4.3% of males, 12.8% of females Physical abuse: 31.2% of males, 21.1% of females
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevalence and Context (cont.) Characteristics of Victimized Children Age: younger children more at risk for abuse and neglect sexual abuse is more common among older age groups (over 12) except for sexual abuse, victimization rate is inversely related to the child’s age Sex: 80% of sexual abuse victims are female; with that exception, boys and girls are victims of maltreatment almost equally (48% and 52%, respectively) boys more likely to be sexually abused by male non- family members, girls by male family members; both are more likely to be abused by someone they know and trust
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevalence and Context (cont.) Characteristics of Victimized Children (cont.) Racial characteristics: Maltreatment: 49% white, 23% African-American, 18% Hispanic Compared to children of same race/ethnicity in the U.S., highest rates of victimization are for children who are African-American (19.8/1000), American Indian or Alaska Native (15.9/1000), multiple race (15.4/1000), White and Hispanic (11/1000), Asian (2.5/1000)
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevalence and Context (cont.) Characteristics of Family and Perpetrator More common among the poor and disadvantaged Children from single-parent (especially father-only) homes and large families are at highest risk 80% of victims are abused by one or both parents, although nearly 50% of sexually abused children are abused by persons other than parents/parent figures; mother is perpetrator of neglect 90% of time Males are offenders in majority of sexual abuse (90%), and about half of those are the child’s father/father figure Except for sexual abuse, the most common perpetrator for child maltreatment is a female parent acting alone, typically younger than 30 years of age
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevalence and Context (cont.) Cross-Cultural Comparisons Physical and sexual abuse are at epidemic proportions in many societies worldwide Estimated that by age 14, 40 million children are victims of neglect and abuse each year worldwide A comparison of rates in North American and other Western societies shows comparable rates of child sexual abuse: 20% for females and between 3-11% for males
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology Resilience and Adaptation Maltreatment does not affect each child in a predictable or consistent way; outcomes depend on severity and chronicity of events and how the events interact with the child’s individual and family characteristics Core developmental processes may be impaired, resulting in emotional and behavioral problems ranging from speech and language delays to criminal behavior Protective factors: positive relationship with at least one important and consistent person in the child’s life who provides support and protection (although that might actually be a maltreating parent) and personality characteristics, such as positive self-esteem and sense of self Removing children from families can become another source of stress and disruption with undesired side effects
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Developmental Consequences Early attachment and emotion regulation (i.e., the ability to modulate/control the intensity/expression of feelings/impulses) Maltreated infants and toddlers have difficulty establishing a reciprocal, consistent pattern of interaction with their caregivers exhibit insecure-disorganized attachment, characterized by a mixture of approach and avoidance, helplessness, apprehension, and general disorientation have difficulty understanding, labeling, and regulating internal emotional states learn to inhibit emotional expression and regulation, remaining more fearful and on alert Difficulty modulating emotions can result in depressive reactions or angry outbursts and may lead to self-harm as well as internalizing and externalizing problems
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Developmental Consequences (cont.) Brain development Children and adults with a history of child abuse show long-term alterations in the HPA axis and norepinephrine systems, which have a significant affect on responsiveness to stress Affected brain areas include the hippocampus, prefrontal cortex, and amygdala, which can lead to long-term mental health problems Acute and chronic forms of stress associated with maltreatment may cause changes in brain development and structure, particularly neuroendocrine system, causing neurobiological changes that may account for later psychiatric problems
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Developmental Consequences (cont.) Emerging view of self and others Maltreated children’s emerging views of self and their surroundings are not fostered by healthy parental guidance and control, thus emotional and behavioral problems are likely to appear Develop negative representational models of self and others based on a sense of inner “badness,” self-blame, shame, or rage Feelings of powerlessness and betrayal internalize as part of the child’s self-identity; they often blame themselves for the maltreatment Maltreated girls show internalizing signs of distress such as shame and self-blame, while maltreated boys show heightened levels of verbal and physical aggression
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Developmental Consequences (cont.) Emotional and Behavioral Problems Maltreated children’s relationships with peers and teachers have elements of being a victim and a victimizer, so they are easily distracted by aggressive stimuli and tend to make hostile attributions for the actions of others Physically abused and neglected children show little skill at empathy or recognizing distress in others, and respond to others’ distress with fear, physical attack, or anger Maltreated children (especially physically abused) are more physically and verbally aggressive with peers, and are more likely to be unpopular and rejected Maltreated children (especially neglected) often withdraw from and avoid peer interaction
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Developmental Consequences (cont.) Emotional and Behavioral Problems (cont.) Neglected children have the most severe and wide-ranging problems in school and interpersonal adjustment; they perform poorly on standardized tests and lack maturity and academic readiness Sexually abused children suffer in academic performance and ability to focus on tasks, are frequently absent from school, and appear high in shyness-anxiousness may regress to behaviors of earlier levels of development (e.g., bedwetting) and self-destructive behaviors may show specific symptoms of sexualized behavior as well as depression, withdrawal, and anxiety
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Psychopathology and Adult Outcomes Physically abused children are at risk for later problems involving failure and future maladaptations, and problems with interpersonal relationships marked by aggressive and violence cycle-of-violence hypothesis: victims of violence become perpetrators of violence Child sexual abuse can lead to chronic impairments in self-esteem, self-concept, and emotional and behavioral self-regulation, including PTSD and depression Child maltreatment can lead to chronic psychiatric disorders: anxiety and panic disorders, depression, eating disorders, sexual problems, and personality disturbances Mood and Affect Disturbances: depression, emotional distress, and suicidal ideation are common among abused children and if unrecognized, can lead to later problems, especially adolescent substance abuse; symptoms can be avoided if children have social support from non-offending family members and others, as well as opportunities to develop healthy coping strategies
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Psychopathology and Adult Outcomes (cont.) Post-traumatic Stress-Related Problems: As many as half of victims of maltreatment involving sexual abuse or combined sexual and physical abuse meet criteria for PTSD during childhood or adolescence About 1/3 of childhood victims of sexual or physical abuse or neglect meet criteria for lifetime PTSD They may also dissociate, and the fragmentation of experience and affect can progress into borderline disorder, dissociative identity disorder, or chronic pain Sexual abuse can lead to traumatic sexualization, with the child’s sexual knowledge and behavior shaped in developmentally inappropriate ways Sexual abuse may also lead to weight problems, eating disorders, poor physical health care, physically destructive behavior—and in early adulthood, promiscuity, prostitution, sexual aggression, and victimization of and by others
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Developmental Course and Psychopathology (cont.) Psychopathology and Adult Outcomes (cont.) Criminal and Antisocial Behavior Although most abused children do not go on to commit crimes, a significant connection exists between maltreatment and violence (toward their parents and themselves), as well as criminal and antisocial behavior approximately 30% carry the pattern into adolescence and adulthood
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment Physical abuse and neglect are relational disorders that most often occur during periods of stressful role transitions for parents, early childhood and early adolescent oppositional periods of testing limits, and times of family instability and disruption Stress is among the multiple causes Sexual abuse is influenced by cultural and familial practices as well as stress Maltreatment is not typically caused by adult psychopathology (fewer than 10% of maltreating parents have a primary psychiatric illness); however, they are likely to have a history of learning and intellectual deficits and personality disorders
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment Physical Abuse and Neglect Many abusive and neglectful parents have had little exposure to positive parental models and supports They often had difficult childhoods They find daily living stressful and irritating and don’t have the energy to seek out support They often complain of chronic physical ailments and a pervasive mood of discontent
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Chlid Maltreatment (cont.) Physical Abuse and Neglect (cont.) Offender characteristics: less interaction with their children than other parents, responding primarily to punish misbehavior information-processing disturbances may cause maltreating parents to misperceive or mislabel their child’s behavior, leading to inappropriate responses although there is much overlap, neglecting parents are more likely than abusing parents to exhibit striking personality disorders and inadequate knowledge of their children’s needs; they also disengage under stress (escape and avoidance) rather than becoming emotionally and behaviorally reactive, which can lead to severe consequences for the child and higher risk of substance abuse for the parents lack child-rearing and information-processing skills, as well as ways to cope with anger and arousal
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment (cont.) Physical Abuse and Neglect (cont.) Child and Family Influences: no child characteristic has been linked to the risk of maltreatment, once environmental and adult factors are controlled for (with the exception of gender for sexual abuse) coercive family interactions in abusive families: child learns that misbehaving elicits predictable parent reactions, giving the child a sense of control chronic adult inadequacy in neglect family conflict and marital violence are linked to child maltreatment
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment (cont.) Physical Abuse and Neglect (cont.) Child and Family Influences (cont.) An integrated model: Parental and situational factors interact over time to increase or to decrease the risk of physical abuse or neglect Dynamic three-stage process suggests that maladaptive interaction patterns result from complex interactions among child characteristics, parental personality and style, history of the parent-child relationship, and the supportive or non-supportive nature of the family’s broader social context The process includes destabilizing and compensatory factors
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment (cont.) Sexual abuse Offender Characteristics: Sexual abusers are a mixed group who defy personality labels or psychiatric descriptors most are males who meet DSM-IV-TR criteria for pedophilia; as a group, they have significant social and relationship deficits proximate risk factors: comorbid psychiatric disorders and substance abuse over 50% of pedophiles are aware of their interests before age 17 and begin to act out by late teens or early twenties use complicated techniques to gain access and compliance from the child who is gradually indoctrinated into sexual activity; force is seldom used often a perpetrator has special status, such as teacher, religious figure, or scout leader; intentions are covered by a sense of entitlement and privilege offenders often have their own histories of abuse
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment (cont.) Sexual abuse (cont.) Family and Situational Influences In incestuous families, the abuser often attempts to maintain control and domination by isolating the family from other families and community activities may restrict what family members may do and/or enforce strict moral and religious views to protect the “family secret” the marital couple reports much relationship distress and dissatisfaction Certain situational factors increase children’s vulnerability to being sexually abused, which offenders exploit: family problems, spending a lot of time alone, lax supervision and parental unavailability, and being unsure of themselves low income and social isolation increase the risk
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment (cont.) Social and Cultural Dimensions Our society condones and glorifies violence Media and entertainment have spent years ingraining stereotypic portrayals of females as powerless and passive and males as powerful, with women deferring to powerful men and men challenging assertive women Racism and inequality are major sociocultural factors that contribute to abuse and neglect Poverty and social isolation Poverty is associated with severe restrictions in child’s expectable environment; adults below poverty level suffer more individual and family problems, e.g., substance abuse Social/cultural disadvantage creates stress/confusion/ limited alternatives, impairing family’s coping abilities
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Causes of Child Maltreatment (cont.) Social and Cultural Dimensions (cont.) Child-Rearing Practices and Family Privacy In the past 50 years, childrearing practices have moved away from disciplinary control methods toward those that encourage the child’s independence and self-control Cultural norms of corporal punishment often make it difficult to differentiate child abuse from child discipline: 75% of children in the U.S. are physically punished by their parents; for 10% the discipline is so severe the children are at risk of serious physical/emotional harm Maltreatment is not only associated with limited opportunities to learn appropriate child-rearing and to receive needed support, but also long-held social customs Cultural norms influence the prevalence of sexual abuse: erotic portrayal of children in pornography and mainstream advertising may blur boundaries and send inappropriate messages
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevention and Treatment The costs of medical, legal, educational and child welfare services related to maltreatment are estimated at $103.8 billion a year in the U.S. Obstacles to intervention and prevention services for maltreating families Those most in need are least likely to seek help They are brought to the attention of professionals after norms or laws have been violated Parents do not want to admit to problems for fear of losing their children or being charged with a crime Plausible approach to preventing maltreatment: seeing strengths and abilities rather than deficits Prevention should begin early in the formation of the parent- child relationship
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevention and Treatment (cont.) Physical Abuse and Neglect Interventions emphasize desired changes in parental behavior, but also affect children’s development Interventions for abuse involve ways to change how parents teach, discipline, and attend to their children: basic child-rearing skills, cognitive-behavioral methods to target anger patterns or distorted beliefs Interventions for neglect focus on parenting skills and expectations, plus ways to improve family organizational skills Interventions for children address their needs in the context of their family circumstances Treatment often begins with efforts to increase positive parent-child interactions and pleasant experiences
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevention and Treatment (cont.) Physical Abuse and Neglect (cont.) Cognitive-behavioral approaches for abuse are most effective basic child-rearing skills modify parental behaviors relevant to child maltreatment relaxation and self-management skills training cognitive restructuring problem-solving training stress and anger management training enhance positive experiences early in development of parent-child relationship to help prevent maltreatment Treatment for neglect focuses on ways to stimulate child development and structure child activities plus basic education and assistance in managing everyday demands Programs for maltreated children show improved social behavior, cognitive development, self-concept, and reduced aggressive and coercive behaviors
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevention and Treatment (cont.) Sexual abuse Children’s treatment programs are few and difficult to devise, as sexual abuse affects each child differently Treatments try to restore child’s sense of trust, safety, guiltlessness through education and support to help them understand why it happened to them and how they can learn to feel safe information and education about sexual abuse to help clarify false beliefs; reassurance; group therapy learn ways to prevent sexual abuse and restore sense of personal power and safety Cognitive-behavioral methods for children and non-offending parents Child needs to express feelings about the abuse and may need specialized treatment if suffering from PTSD
Mash/Wolfe Abnormal Child Psychology, 4 th edition © 2009 Cengage Learning Prevention and Treatment (cont.) Sexual Abuse (cont.) Successful interventions should result in: helping children understand that what happened to them was abuse, it was wrong, and it may have caused them some temporary problems subsidence of emotional and behavioral problems arising from the abuse; the children should have the personal resources to handle future problems putting supportive relationships in place for the children, especially with parents/other caregivers who have been trained to deal with the problems children regaining their normal rate of development
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