Prevention of child abuse and neglect

With the dramatic increase in recent reports of physical and sexual child abuse and neglect, professionals are well as the public are increasingly concerned about the prevention of child abuse. This article provides an overview of existing child abuse prevention programs (physical abuse and sexual abuse programs are treated separately). Five computerized data bases (psychology, social work, criminal justice, education, and social sciences) were searched for literature published between 1982 and 1991. We also call attention to critical issues that need to be considered in the development and planning of future prevention efforts and evaluations.     

Correlates of child abuse potential

Coercion theory provided the theoretical rationale for the present study. The hypothesis was that mothers' reports of child behavior problems and mothers' reports of external locus of control would be related to abuse potential. A total of 95 mother-child pairs were screened for child abuse potential during visits to a hospital-based pediatrie clinic. Following brief interviews, mothers completed three measures: Milner's Child Abuse Potential Inventory, Levenson's Locus of Control Scales, and the Revised Behavior Problem Checklist. Perceptions of control by powerful others and by chance were related to abuse potential for mothers of both sexes. Mothers' reports of their sons' anxiety-withdrawal and conduct-disorder behavior problems were related to abuse potential. There was a significant association among lie scores, internality, and abuse potential for mothers of female children. Mothers with high abuse potential reported significantly more behavior problems in their children. The findings were discussed in relation to coercion theory.Portions of this paper were presented at the biennial meeting of the Society for Research in Child Development, Detroit, April 1983. This research was conducted by the first author in partial fulfillment of the requirements for the Ph.D. at the University of Miami under the direction of Drs. Keith G. Scott and Annette M. La Greca. The first author wishes to thank the members of the committee, Drs. Herbert C. Quay, Simon B. Miranda, Daryl Greenfield, and Julia Rosenkrans, for their many contributions. Also, special thanks to the University of Miami Child Protection Team for their continuous support and guidance, and special appreciation to the mothers and children who participated in the study.     

The assessment of child abuse potential and the prevention of child abuse and neglect: A policy analysis

A frequently advocated strategy for increasing the efficiency of child abuse prevention programs is to deliver prevention services to "high-risk" populations. This article critically reviews procedures for the reliable and valid assessment of child abuse potential within an ecological perspective. Factors that limit the usefulness of child abuse risk assessment are discussed. These factors include the uncertain criteria of child abuse and neglect, the low base rate of the phenomenon, and the financial and social costs of such procedures. Finally, the prevention implications of the current and future state of the art in child abuse risk assessment are considered and preventive interventions that do not depend on individual case risk screening are advocated.     

Child-rearing and child abuse antecedents of criminality

A number of studies reviewed here show that those who are exposed to negative child-rearing practices varying from punitive and lax parenting to severe punishment and abuse in childhood tend to be antisocial, aggressive and commit violent crimes later in life. Both the record approach (Widom) studying later outcomes among abused children and the retrospective approach (Lewis) studying violent childhood experiences among offenders provide support for the violence breeds violence hypothesis. It appears clear that punishment in child-rearing increases the risk for maladaptive developmental outcomes but that the mechanism explaining the link between negative parenting and later maladjustment is still an unresolved issue. The review argues that a trauma model is the most interesting theoretical approach in explaining the mechanism.     

Sequelae of child sexual abuse: a child and parent assessment

We present a case example of a 9-year-old, biracial girl and her mother. We integrate data collected from rating scales (e.g., Child Behavior Checklist; Achenbach & Rescorla, 2001), a free response measure (Thematic Apperception Test; Murray, 1943), and a direct observation measure (Parent-Child Interaction Assessment-II; Holigrocki, Kaminski, & Frieswyk, 1999, 2002) and reveal how a child sexual abuse victim's internal representations and symptoms manifest in both an interpersonal context and in the realm of play. We discuss assessment findings regarding how they provide for an idiographic understanding of the child.     

Treatment of co-occurring child maltreatment and substance abuse

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065–1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197—211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 27, 215–229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.     

Risk factors for child sexual abuse

We review the risk and protective factors for child sexual abuse. Overall, characteristics of perpetrators, victims, and families of victims were moderate to strong risk factors for child sexual abuse. However, it is difficult to distinguish between risk factors for extra-familial and intra-familial child sexual victimization because most of the studies combined these two types of child sexual abuse, although the risk factors for these two types of child sexual abuse most likely differ. Research in this area is difficult because etiological and prevention models of victimization would differ substantially from those of perpetration. Given the low yearly prevalence of child sexual victimization, very large samples would be necessary to obtain sufficient power. Thus, most studies have used lifetime prevalence, which may provide much useful information but which add substantial time confounds. Finally, child sexual victimization is probably a misnomer, as the nature, impact, and etiology of sexual victimization most likely differs over the large age span of childhood and gender. Because improved models and prevention programs require improved etiological models (based on knowledge of risk and protective factors), we hope that this review will focus stakeholders on the need for continued research in this area.     

Infants at risk for child abuse

Child abuse is most likely to occur when socially isolated parents react impulsively to aversive stimuli emitted by their children. Certain child signals and characteristics are aversive to adults. Infant cries are aversive to all parents, but children who are unusually irritable or whose cries are especially grating may become aversive to their parents even when they are not crying. Studies show that the cries of premature infants and the cries of babies incorrectly labelled premature are more aversive to parents, and that abusive mothers and the mothers of premature infants find cries more aversive than other mothers do. The incidence of abuse would be reduced by the availability of supportive social networks and the elimination of distorted parental expectations.     

Risk factors for child psychological abuse

We review the risk and protective factors for child emotional abuse. Two main directions can be derived from this review. First and foremost, definitional issues must be resolved. Second, some clues as to important future research directions emerged from the current risk factor literature. Distal historical variables (e.g., relationships with fathers perceived as less caring, and being yelled at daily as a child), current enduring personality factors (e.g., aggression and hostility, neuroticism), environmental stressors (e.g., very low income) and proximal variables (verbal and physical aggression between parents) all appear to be related to child psychological abuse. Once definitional issues are resolved, models beginning with these risk factors should be developed and tested.     

Risk factors for child physical abuse

We review the risk and protective factors for child physical abuse (CPA). An etiological model based on moderate to strongly supported risk factors would begin with distal perpetrator variables of being abused as a child/teen and receiving less family social support as a child. Next might come current family variables such as parents' youth, father's drinking, and family's living in a community that is impoverished and/or has a lower percentage of two parent families. More proximal variables that increase the probability of parents, especially mothers, employing severe or abusive physical tactics could include mothers' dysphoria (e.g., unhappiness, emotional distress, anxiety, loneliness and isolation, depression, somatic complaints, interpersonal problems, feelings of incompetence as a parent, a tendency toward becoming upset and angry), and stress (more stressful life events, including parenting and other family stresses) and coping (most likely a protective factor, including problem solving and social support). Finally, risk factors that are proximal to abuse could include mothers' high reactivity (impulsivity, high negative affect and autonomic nervous system arousal), high-risk parenting (harsh discipline strategies, verbal aggression, yelling), and negative attributions, and children's behavior problems (e.g., socialized aggression, attention deficits, and internalizing and externalizing problems).     

Neurobehavioral sequelae of child sexual abuse.

This study examined intellectual and memory functioning in a sample of sexually abused children compared to demographically and age-matched controls. The severity of abuse and other pertinent factors were also examined in relation to cognitive performance. Elevated levels of psychopathology were present in the abused children, as well as diminished performance on tasks influenced by attention/concentration. However, after controlling for differences in IQ and socioeconomic status (SES), significant differences in memory function were not found. Results are discussed in the context of stress effects on cognition and the potential resiliency of cognitive function in children undergoing treatment for sexual abuse.     

The emotional impact of treating child abuse

The author agrees with the need for pastoral intervention in child abuse and neglect, but warns that pastors need to be prepared to handle the intense emotional effects that result. The emotional impact of treating child abuse and neglect is examined under the rubric countertransference. Three sources of countertransference are outlined: identification with the child, identification with the parent, and encountering resistance. Finally, ways to cope with countertransference engendered by treating child abuse and neglect are explored. The need for quality supervision is especially stressed.