Child Maltreatment

Messinger

Questions

Define the four types of maltreatment? What are some features of families in which maltreatment occurs? What are the consequences of maltreatment on emotion recognition?

What was the pathway Bolger identified to social consequences of maltreatment? How might a child be buffered from adverse effects?

Do you believe prenatal substance exposure is child abuse?

What are effects of common substances and which Acosta would and would not constitute abuse?

Timeline of child maltreatment

Harsh discipline viewed as parents right and responsibility Idea of child maltreatment is gaining worldwide recognition About 3 million reports made annually to child protective services

Acosta

Definition

Child maltreatment refers to four acts

Physical abuse Emotional abuse Sexual abuse Neglect

UNICEF: persons under 18 years of age who suffer occasional or habitual acts of violence
Acosta

Physical abuse

World Health Organization (WHO)

Acts that result in actual or potential physical harm, resulting from an interaction that is within the control of a parent or person in a position of responsibility, power or trust

Acosta

Emotional abuse

Failure to provide a developmentally appropriate, supportive environment, so that a child can establish a stable and full range of emotional and social competencies commensurate with his or her personal potential

Acosta

Sexual abuse

Involvement of a child in sexual activity that he/she does not fully comprehend, is not able to give consent to, and that violates the laws or taboos of society

Acosta

Neglect

Failure to provide for a child in all domains: physical and mental health, education, nutrition, shelter, and safe living conditions, when the resources are reasonably available to the family or caretakers

Acosta

Maltreatment Statistics

National Incidence Study of Child Abuse and Neglect (Sedlak & Broadhurst, 1995)

Overall rate of child maltreatment of over 1,500,000

Includes 750,000 cases of child abuse and 880,000 cases of neglect

Does not discriminate across gender, language, religion, age, ethnicity, disability, or sexual orientation
Acosta

Results of Maltreatment

Direct effects not yet fully understood, although it is a significant risk factor for psychopathology Affects all aspects of development

Acosta

Family environment

Patterns seen across maltreatment types

Family environment of coercion and abuse of power Lower levels of prosocial behavior and verbal communication Undervaluing of children Deviant affective displays Maternal intrusiveness and non-responsiveness

Acosta

Cognitive adaptations

Maltreated children create defensive structure in reaction to trauma

Cognitive distortions, dissociation, cognitive vigilance

Hypervigilance: constant scanning of environment and development of ability to detect subtle variations in it Dissociation: alter level of self-awareness in an effort to escape an upsetting event or feeling

Psychological escape
Acosta

Social and emotional adjustments

Maltreated children often suffer from low self-esteem, self-blame, and negative affect toward the self Greater risk for peer rejection

The longer maltreatment occurs, the greater the likelihood of rejection, perhaps because of tendency to engage in coercive, aggressive interactions with peers as result of abuse

Emotion regulation

Involves ability to modify, redirect, and control emotions Maltreated children engage in efforts to avoid, control or suppress emotion Modulation difficulties: extreme depressive reactions and intense angry outbursts Internalizing behavior problems

Anger recognition & physical abuse

Physically abused children displayed a response bias for angry facial expressions.

8-11-year-old abused children demonstrated increased attentional benefits on valid angry trials

demonstrated delayed disengagement when angry faces served as invalid cues. Pollak & Tolley-Schell. Journal of Abnormal Psychology. 112(3), Aug 2003, 323-338.

Abused recognition of anger

More prone to see anger than other children

Recognizing emotion in faces

Neglected children had more difficulty discriminating emotional expressions than control or physically abused children. Controls viewed discrete emotions discretely Neglected children saw fewer distinctions Physically abused children showed the most variance across emotions.

Pollak, Cicchetti, Hornung, Reed, Developmental Psychology. 36(5), Sep 2000, 679-688.

Emotion expression pairs Neglected children dont distinguish

Mean similarity ratings by emotion pair for control (C; solid line), neglected (N; dotted line) and physically abused (PA; dashed line) children. A = angry, N = neutral, S = sad, F = fearful, D = disgusted, H = happy

Impact on emotion recognition

Influence of early adverse experience on children's selective attention to threat-related signals is a mechanism in the development of psychopathology. As children's experience varies, so will their interpretation of emotion expressions.

Pollak & Tolley-Schell. Journal of Abnormal Psychology. 112(3), Aug 2003, 323-338.

Overlap with risky behaviors

Increased likelihood to engage in a greater array of risky behaviors Certain types of maltreatment associated with a greater number of sexual partners and heavier alcohol consumption Adult survivors likely to engage in substance abuse, criminal and antisocial behavior, and eating disorders

Chronically maltreated kids likely to be rejected by peers

Maltreatment chronicity with higher levels of children's aggressive behavior

reported by peers, teachers, and children

Aggressive behavior accounted for association of maltreatment and rejection.

Socially withdrawn behavior associated with peer rejection

but did not account for the association between chronic maltreatment and peer rejection.

Results hold for both girls and boys

Bolger & Patterson, 2001

Maltreatment chronicity peer rejection

Maltreatment Aggression

Maltreatment, aggression, & rejection

Specificity of abuse effects

Sexual abuse predicted low self-esteem

but not peer relationship problems.

Emotional maltreatment was related to difficulties in peer relationships,

but not to low self-esteem.

For some groups of maltreated children, having a good friend was associated with improvement over time in self-esteem. Bolger et al., 1998

Does abuse predict malfunction?

Many children and adolescents who suffer maltreatment become well-functioning adults Maltreatment can also result in significant negative consequences that continue into adulthood Although many survivors function well in adulthood, others suffer serious psychological distress and disturbance

Why?

Maltreating parents may fail to produce opportunities for positive social interaction for their children Children who experienced a lack of parental supervision were less likely to be accepted by peers

Tendency to engage in unskilled or aggressive behavior

Possible buffers

Maltreating parents may fail to produce opportunities for positive social interaction for their children

Opportunities found elsewhere (i.e., other family members, friends, teachers, etc.)

Maltreated children with best friends are more likely to experience increased self-esteem and self-concept than other maltreated children

Margolin & Gordis (2004)

How violence has been examined:
Child maltreatment Aggression between parents Community violence
Often looked at separately even though they co-occur

Bias toward large injurious events rather than smaller, more subtle violence. Some definitional issues
Important to distinguish between levels of severity and acute vs. chronic
Almost all children experience violence (90% in Martinez's 1993 sample)

Mattson

Short Term vs. Long Term

Short Term
Externalizing
Blanket but often specific to exposure (e.g., acting out of witnessed aggression, sexual acting out) Social Learning (exposure to violence leads to aggressive behavior)

Internalizing
Emotion and mood (e.g., the world is unsafe, helplessness) Somatization (e.g., exaggerated startle, sleep disturbances, academic problems)

Long Term
Ehrensaft et al. (2003) violence during childhood related to increased violence by and to a partner
Kaufman and Zigler (1987) 70% of children do not become violent adults Widom (1998) "cycle of violence is not deterministic or inevitable

Mattson

Response and Exposure

So why do some respond poorly?
We have to link episodes of violence across development to specific deficits in the individual Study variation in context and delays of presentation, vulnerable time periods Tertiary later effects for interpersonal relationships

Multiple exposure
May just be the effect of relationship to frequency and severity
or a compounding of effects or a primary family system impact lowering the threshold for other aggression

More reactive to aggression? Further investigation needed

Mattson

Biology
Dysregulation of the HPA axis (stress response) Cortisol levels in non-stressful situations BUT variable
different responses in individuals different dysregulation of HPA axis
Leads to different behavioral problems

Growth hormone, early puberty onset Sympathetic nervous system over-activation

Suppressed immune function, memory functioning

Effect on behavior goes far above just genetics (twin studies and outcomes)

Mattson

Further Directions
What do we need to do most:
Look at developmental impacts of violence Look at adaptation and resilience
Especially how it changes over time

Improved models
Leads to improved treatment

Mattson

Is maternal prenatal substance exposure child abuse?

What substances would and would not constitute abuse?

Cocaine summary

Cocaine exposed neonates are born slightly earlier & smaller than non-exposed infants. Slight, scattered decrements in self-regulation at 1 month but not detectable in infant feeding behavior Although cocaine caregivers were less involved at 1 & 4 months, there were no differences in secure attachment or quality of play at 18 months Standardized measures of development?

In general

Standardized tests of cognitive achievement, motor performance, and language development often show no significant exposure effects Effects, when present, tend to be of small magnitude

Although Singer recently found cocaine deficits in mental performance (and motor performance), Frank did not. There may be sleeper effects only apparent as kids enter school

Alcohol impairs prenatal development of brain structures

Extensive alcohol use during pregnancy altered facial characteristics, reduced growth, and severe cognitive deficits (Fetal Alcohol Syndrome). Alcohol effects are dose-dependent

quantity of alcohol consumed affects severity of child deficits Less obvious effects of alcohol exposure include reductions in general intelligence, verbal learning, social competence. Attention problems, memory deficits, and motor skills problems have been associated with habitual social drinking by the expectant mother throughout the pregnancy.

Is alcohol use child maltreatment?

Prenatal exposure to alcohol affects one in four births

one in twelve mothers reporting binge drinking during the pregnancy

Individual Differences

It has been observed that although children have undergone similar high levels of prenatal alcohol exposure, some will manifest severe FAS symptomatology, some will manifest mild effects, and some children will appear unaffected (Able & Sokol, 1986; Phelps & Grabowski, 1992).

Genetic factors?

One in five women reports using tobacco while pregnant

Prenatal exposure to cigarettes associated with premature birth, low birth weight, and irritability in the newborn. Tobacco exposure is associated with lower intelligence scores and higher risk for attention deficit disorder in school age children.

Current issues

Improved identification of occurrence of maltreatment Examination of its consequences

What determines effect of abuse?

Establishing adequate services and supports for families and children to protect from exploitation and harm

How to make a report

1 - 800 - 96ABUSE (1-800-9622873)

Provide the following

Victim name, address or location, approximate age, race and sex Signs or indications of harm or injury, including a physical description if possible Relationship of the alleged possible responsible person to the victim. If the relationship is unknown, a report will still be taken if other reporting criteria are met.