The long-term health consequences of child physical abuse, emotional abuse, and neglect : a systematic review and meta-analysis

Background Child sexual abuse is considered a modifiable risk factor for mental disorders across the life course. However the long-term consequences of other forms of child maltreatment have not yet been systematically examined. The aim of this study was to summarise the evidence relating to the possible relationship between child physical abuse, emotional abuse, and neglect, and subsequent mental and physical health outcomes. Methods and Findings A systematic review was conducted using the Medline, EMBASE, and PsycINFO electronic databases up to 26 June 2012. Published cohort, cross-sectional, and case-control studies that examined non-sexual child maltreatment as a risk factor for loss of health were included. All meta-analyses were based on quality-effects models. Out of 285 articles assessed for eligibility, 124 studies satisfied the pre-determined inclusion criteria for meta-analysis. Statistically significant associations were observed between physical abuse, emotional abuse, and neglect and depressive disorders (physical abuse [odds ratio (OR) = 1.54; 95% CI 1.16–2.04], emotional abuse [OR = 3.06; 95% CI 2.43–3.85], and neglect [OR = 2.11; 95% CI 1.61–2.77]); drug use (physical abuse [OR = 1.92; 95% CI 1.67–2.20], emotional abuse [OR = 1.41; 95% CI 1.11–1.79], and neglect [OR = 1.36; 95% CI 1.21–1.54]); suicide attempts (physical abuse [OR = 3.40; 95% CI 2.17–5.32], emotional abuse [OR = 3.37; 95% CI 2.44–4.67], and neglect [OR = 1.95; 95% CI 1.13–3.37]); and sexually transmitted infections and risky sexual behaviour (physical abuse [OR = 1.78; 95% CI 1.50–2.10], emotional abuse [OR = 1.75; 95% CI 1.49–2.04], and neglect [OR = 1.57; 95% CI 1.39–1.78]). Evidence for causality was assessed using Bradford Hill criteria. While suggestive evidence exists for a relationship between maltreatment and chronic diseases and lifestyle risk factors, more research is required to confirm these relationships. Conclusions This overview of the evidence suggests a causal relationship between non-sexual child maltreatment and a range of mental disorders, drug use, suicide attempts, sexually transmitted infections, and risky sexual behaviour. All forms of child maltreatment should be considered important risks to health with a sizeable impact on major contributors to the burden of disease in all parts of the world. The awareness of the serious long-term consequences of child maltreatment should encourage better identification of those at risk and the development of effective interventions to protect children from violence.

Differences between journalistic and academic accounts of child sexual abuse in Australia

The paper uses qualitative textual analysis to compare journalistic and academic accounts of child sexual abuse. There are seven main differences. Academic accounts suggest higher levels of neglect, emotional abuse, and physical abuse than sexual abuse in Australia, by contrast, journalistic accounts highlight sexual abuse. Academic accounts suggest that child sexual abuse in Australia is decreasing; journalistic accounts suggest that it is increasing. Academic accounts suggest that the majority of cases of child sexual abuse are perpetrated by family members; journalistic accounts focus on abuse by institutional figures (teachers, priests) or by strangers. Academic accounts have shown that innocent sexual play is a normal part of childhood development; journalistic accounts suggest that any sexual play is either a sign of abuse, or in itself constitutes sexual abuse. Academic accounts suggest that one of the best ways to prevent sexual abuse is for children to receive sex education; journalistic accounts suggest that children finding out about sex leads to sexual abuse. Academic accounts can gather data from the victims; journalistic accounts are excluded from doing so. Academic researchers talk to abusers in order to understand how child sexual abuse can be prevented; journalistic accounts exclude the voices of child sexual abusers.

Bad apples, bad barrel: Exploring institutional responses to child sexual abuse by Catholic clergy in Australia

This paper considers constructions of institutional culture and power in the cover-up of child sexual abuse (CSA) by clergy in the Roman Catholic Church of Australia. The issue of cover-up has previously been considered in international inquiries as an institutional failing that has caused significant harm to victims of CSA by Catholic Clergy. Evidence given by select representatives of the Catholic Church in two government inquiries into institutional abuse carried out in Australia is considered here. This evidence suggests that, where cover-up has occurred, it has been reliant on the abuse of institutional power and resulted in direct emotional, psychological and spiritual harm to victims of abuse. Despite international recognition of cover-up as institutional abuse, evidence presented by Roman Catholic Representatives to the Victorian Inquiry denied there was an institutionalised cover-up. Responding to this evidence, this paper queries whether the primary foundation of cover-up conforms to the ‘bad apple theory’ in that it relates only to a few individuals, or the ‘bad barrel theory’ of institutional structure and culture.

Mandatory Reporting Laws and Identification of Child Abuse and Neglect: Consideration of Differential Maltreatment Types, and a Cross-Jurisdictional Analysis of Child Sexual Abuse Reports

Mandatory reporting laws have been created in many jurisdictions as a way of identifying cases of severe child maltreatment on the basis that cases will otherwise remain hidden. These laws usually apply to all four maltreatment types. Other jurisdictions have narrower approaches supplemented by differential response systems, and others still have chosen not to enact mandatory reporting laws for any type of maltreatment. In scholarly research and normative debates about mandatory reporting laws and their effects, the four major forms of child maltreatment—physical abuse, sexual abuse, emotional abuse, and neglect—are often grouped together as if they are homogenous in nature, cause, and consequence. Yet, the heterogeneity of maltreatment types, and different reporting practices regarding them, must be acknowledged and explored when considering what legal and policy frameworks are best suited to identify and respond to cases. A related question which is often conjectured upon but seldom empirically explored, is whether reporting laws make a difference in case identification. This article first considers different types of child abuse and neglect, before exploring the nature and operation of mandatory reporting laws in different contexts. It then posits a differentiation thesis, arguing that different patterns of reporting between both reporter groups and maltreatment types must be acknowledged and analysed, and should inform discussions and assessments of optimal approaches in law, policy and practice. Finally, to contribute to the evidence base required to inform discussion, this article conducts an empirical cross-jurisdictional comparison of the reporting and identification of child sexual abuse in jurisdictions with and withoutmandatory reporting, and concludes that mandatory reporting laws appear to be associated with better case identification.

Dealing with a problem that doesn't exist?:Professional responses to female perpetrated child sexual abuse

Female involvement in sexual offences against children is more common than is generally thought and has serious implications for the long-term emotional and psychological well-being of victims. Drawing on findings from: a comprehensive review of the literature; an overview of relevant literature and legislation; and an electronic survey of Multi-Agency Public Protection Panels; this paper explores the criminal justice response to female sex offending in England, Wales and Northern Ireland. The literature highlights that the way in which professionals identify and respond to child sexual abuse has been shown to be influenced by the gender of the perpetrator. Equally, whilst similar to male sex offending in terms of the intrusiveness and seriousness of the abuse, some aspects of female sex offending can cause particular problems for professionals. The fact that some sexual abuse can be disguised as childcare can make it difficult for professionals to identify this type of abuse whilst high rates of co-offending bring additional difficulties in determining the degree of female involvement and assigning responsibility. The survey findings indicate that risk assessment tools for female sex offenders is a key area requiring development and point towards small inconsistencies in the current practice of risk assessing females in the community. The survey also identifies the lack of treatment programmes for this group of offenders as well as drawing attention to the need for national policies and procedures, staff training and the identification of areas of good practice. Increased discussion and debate about how best to work with this group of sex offenders is also required. Copyright © 2007 John Wiley & Sons, Ltd.

Impact of abuse and neglect on the health and wellbeing of children:Child sexual abuse

During the past 30 years, the focus on the extent and nature of child abuse and neglect has been coupled with an increasing interest in the impact on children’s development, health and mental wellbeing. Child maltreatment is both a human rights violation and a complex public health issue, likely caused by a myriad of factors that involve the individual, the family, and the community. Child abuse includes any type of maltreatment or harm inflicted upon children and young people in interactions between adults (or older adolescents). Such maltreatment is likely to cause enduring harm to the child.
The different forms of abuse and neglect often occur together in one family and can affect one or more children. These include, in deceasing level of frequency: neglect; physical abuse and non-accidental injury; emotional abuse; and sexual abuse (Cawson et al, 2000; 2002). Recently, bullying and domestic violence have been included as forms of abuse of children.
There is a sizeable body of literature on the relationship between types of child maltreatment and a variety of negative health and mental health consequences. These include biological, psychological, and social deficits (for reviews, see Crittenden, 1998; Kendall-Tackett, 2001; 2003). Aside from the serious physical and health consequences of child maltreatment, several emotional and behavioural consequences for children have been noted in the literature.

Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice

Objective: There were two aims to this study: first to examine whether emotional abuse and neglect are significant predictors of psychological and somatic symptoms, and lifetime trauma exposure in women presenting to a primary care practice, and second to examine the strength of these relationships after controlling for the effects of other types of childhood abuse and trauma. Method: Two-hundred and five women completed the Childhood Trauma Questionnaire (Bernstein et al., 1994), Trauma History Questionnaire (Green, 1996), the Symptom Checklist-revised (Derogatis, 1997), and the Revised Civilian Mississippi Scale for posttraumatic stress disorder (Norris & Perilla, 1996) when presenting to their primary care physician for a visit. Hierarchical multiple regression analyses were conducted to examine unique contributions of emotional abuse and neglect variables on symptom measures while controlling for childhood sexual and physical abuse and lifetime trauma exposure. Results: A history of emotional abuse and neglect was associated with increased anxiety, depression, posttraumatic stress and physical symptoms, as well as lifetime trauma exposure. Physical and sexual abuse and lifetime trauma were also significant predictors of physical and psychological symptoms. Hierarchical multiple regressions demonstrated that emotional abuse and neglect predicted symptomatology in these women even when controlling for other types of abuse and lifetime trauma exposure. Conclusions: Long-standing behavioral consequences may arise as a result of childhood emotional abuse and neglect, specifically, poorer emotional and physical functioning, and vulnerability to further trauma exposure. (C) 2003 Elsevier Ltd. All rights reserved.

Child Physical Abuse: Evaluating Psychological Risk Factors in Accused Caregivers

It was verified to what extent cognitive and affective/emotional variables could distinguish caregivers accused of committing physical abuse (G1) from those without physical abuse records (G2). The Child Abuse Potential Inventory (CAP), which is an instrument designed to assess psychological risk factors in caregivers, was used. A questionnaire on socio-demographic characterization and another on economic classification were also employed to equate the groups. G1 presented a greater potential risk than G2, higher levels of Distress, Rigidity, Problems with the Child and with Themselves, Problems with Others, and a lower level of Ego Strength. These variables contribute with the composition of physical abuse risk, since, in agreement with the Social Information Processing Model, they would be related to cognitive and affective basic processes which are veiled to the perceptions and evaluation/interpretations, associated to abusive parental behavior.

Teachers reporting suspected child sexual abuse : results of a three-state study

Over 3000 cases of child sexual abuse are identified every year in Australia, but the real incidence is higher still. As a strategy to identify child sexual abuse, Australian States and Territories have enacted legislation requiring members of selected professions, including teachers, to report suspected cases. In addition, policy-based reporting obligations have been developed by professions, including the teaching profession. These legislative and industry-based developments have occurred in a context of growing awareness of the incidence and consequences of child sexual abuse. Teachers have frequent contact and close relationships with children, and possess expertise in monitoring changes in children’s behaviour. Accordingly, teachers are seen as being well-placed to detect and report suspected child sexual abuse. To date, however, there has been little empirical research into the operation of these reporting duties. The extent of teachers’ awareness of their duties to report child sexual abuse is unknown. Further, there is little evidence about teachers’ past reporting practice. Teachers’ duties to report sexual abuse, especially those in legislation, differ between States, and it is not known whether or how these differences affect reporting practice. This article presents results from the first large-scale Australian survey of teachers in three States with different reporting laws: New South Wales, Queensland, and Western Australia. The results indicate levels of teacher knowledge of reporting duties, reveal evidence about past reporting practice, and provide insights into anticipated future reporting practice and legal compliance. The findings have implications for reform of legislation and policy, training of teachers about the reporting of child sexual abuse, and enhancement of child protection.

The impact of child sexual abuse on victims/survivors: Exploring posttraumatic outcomes as a function of childhood sexual abuse

There is sparse systematic examination of the potential for growth as well as distress that may occur for some adult survivors of childhood sexual abuse. The presented study explored posttraumatic growth and its relationship with negative posttrauma outcomes within the specific population of survivors of childhood sexual abuse (N = 40). Results showed that 95% of the participants experienced clinically significant post-traumatic stress disorder symptomatology related to their childhood sexual abuse. In conjunction with these high levels of negative symptoms, the population evidenced posttraumatic growth levels that were comparable to other trauma samples. This research has clinical relevance in terms of adding to the knowledge base on sexual abuse and the usefulness of this knowledge in therapeutic interventions and relationships.

Developments in Australian laws requiring the reporting of suspected child sexual abuse

Thousands of Australian children are sexually abused every year, and the effects can be severe and long lasting. Not only is child sexual abuse a public health problem, but the acts inflicted are criminal offences. Child sexual abuse usually occurs in private, typically involving relationships featuring a massive imbalance in power and an abuse of that power. Those who inflict child sexual abuse seek to keep it secret, whether by threats or more subtle persuasion. As a method of responding to this phenomenon and in an effort to uncover cases of sexual abuse that otherwise would not come to light, governments in Australian States and Territories have enacted legislation requiring designated persons to report suspected child sexual abuse. With Western Australia’s new legislation having commenced on 1 January 2009, every Australian State and Territory government has now passed these laws, so that there is now, for the first time, an almost harmonious legislative approach across Australia to the reporting of child sexual abuse. Yet there remain differences in the State and Territory laws regarding who has to make reports, which cases of sexual abuse are required to be reported, and whether suspected future abuse must be reported. These differences indicate that further refinement of the laws is required

‘Keep telling until someone listens’ : understanding prevention concepts in children’s picture books dealing with child sexual abuse

Children’s picture books dealing with the topic of child sexual abuse appeared in the 1980s with the aim of addressing the need for age-appropriate texts to teach sexual abuse prevention concepts and to provide support for young children who may be at risk of or have already experienced sexual abuse. Despite the apparent potential of children’s picture books to convey child sexual abuse prevention concepts, very few studies have addressed the topic of child sexual abuse in children’s literature. This article critically examines a selection of 15 picture books (published in the US, Canada and Australia) for children aged 3–8 years dealing with this theme. It makes use of an established set of evaluative criteria to conduct an audit of the books’ content and applies techniques of literary discourse analysis to explain how these picture books satisfy criteria for child sexual abuse prevention. The analysis is used as a way to understand the discourses available to readers, both adults and children, on the topic of child sexual abuse. Key themes in the books include children’s empowerment and agency, and the need for persistence and hope.

Teachers reporting child sexual abuse : towards evidence-based reform of law, policy and practice

This report presents the results of the largest study ever conducted into the law, policy and practice of primary school teachers’ reporting of child sexual abuse in New South Wales, Queensland and Western Australia. The study included the largest Australian survey of teachers about reporting sexual abuse, in both government and non-government schools (n=470). Our research has produced evidence-based findings to enhance law, policy and practice about teachers’ reporting of child sexual abuse. The major benefits of our findings and recommendations are to: • Show how the legislation in each State can be improved; • Show how the policies in government and non-government school sectors can be improved; and • Show how teacher training can be improved. These improvements can enhance the already valuable contribution that teachers are making to identify cases of child sexual abuse. Based on the findings of our research, this report proposes solutions to issues in seven key areas of law, policy and practice. These solutions are relevant for State Parliaments, government and non-government educational authorities, and child protection departments. The solutions in each State are practicable, low-cost, and align with current government policy approaches. Implementing these solutions will: • protect more children from sexual abuse; • save cost to governments and society; • develop a professional teacher workforce better equipped for their child protection role; and • protect government and school authorities from legal liability.