Psychological Maltreatment and Child Welfare

Child Abuse Overview

• Child abuse involves actions that negatively impact a child's health, physical, and psychological development. These actions can be taken by adults, the society, or the state. (WHO)
• Abuse is defined as doing what should not be done.
• Neglect is defined as not doing what should be done.
• Abuse implies action, while neglect implies inaction.
• Child abuse is categorized as acts of commission (things a parent or caregiver does to the child) and acts of omission (things a parent or caregiver fails to do).

Types of Abuse

• Physical Abuse: Any non-accidental physical injury to a child by a caregiver. This includes striking, kicking, burning, biting, or any action leading to physical impairment.
• Emotional Abuse/Psychological Maltreatment: Any behavior that harms a child's emotional integrity and personality development. This includes ignoring, not showing love/attention, constantly criticizing, or humiliating.
• Economic Abuse: Work that deprives children of their childhood, potential, dignity, and harms their physical, mental, and social development. This includes work that is mentally, physically, socially, or morally dangerous or harmful to the child or interferes with their schooling (e.g., leaving school prematurely, or combining school with excessive work).
• Sexual Abuse: Any sexual activity with a child where consent is not or cannot be given or when child is being used for sexual stimulation. Acts may be contact (e.g., touching intimate parts, oral sex, penetration) or non-contact (e.g., voyeurism, sexy talk, exposure).

Physical Abuse: Specific Examples

• Jimmy (3-year-old) was playing with a puppy, pulled roughly on the dog's tail, his father punished him by pulling on his ear.
• Maria (5-month-old) had colic, her mother shook her repeatedly until the baby lost consciousness, causing injury.
• Ryan and Matthew were fighting, their mother pulled down their pants and spanked them.

Physical Abuse: Consequences

• Bruises: Injury in which capillaries are damaged, allowing blood to seep into surrounding tissue.
• Fractures: Partial or complete breaking of bone or cartilage.
• Head Injuries: Can result from shaken baby syndrome (SBS) or shaken impact syndrome (SIS). This involves an adult shaking the child, causing the brain to collide with the skull.
• Burns: Injuries caused by fire, heat, or acid, ranging in severity from first-degree (redness) to third-degree (deep skin destruction).

Physical Abuse: Indicators

• Unexplained injuries, wounds, bruises.
• Unbelievable or inconsistent explanations of injuries.
• Bruises in various stages of healing.
• Bruises located on body areas where bone is close to surface, or on protected body areas (e.g., face, ears, neck, buttocks, thighs, and back of legs/genitalia).
• Bruises resembling objects (e.g., hand, fist, belt buckle).
• Injuries inconsistent with a child's age/developmental level.
• Fear of going home, extreme apprehensiveness or vigilance.
• Delay in physical, emotional, and cognitive development.
• Extreme behavior (passivity or aggression).
• Inability to behave age-appropriately.
• Low levels of communication and interaction with child, or a child's difficulty regulating emotions.
• Problems in peer relationships.
• Low school success.
• Difficulty walking or sitting, pain or swelling/bleeding in genital/lip/mouth/anal area, pain in urination.
• Sexually transmitted disease diagnosis, physical complaints, excessive need for cleaning or neglect of cleaning.

Psychological, Interpersonal, and Biological Characteristics of Adults Who Physically Abuse Children

• Emotional and behavioral difficulties: Self-expressed anger, depression, low frustration tolerance, low self-esteem, rigidity, anger control problems, deficits in empathy, anxiety, perceived life stress, substance abuse/dependence, deficits in problem-solving skills, intellectual impairment.
• Family and interpersonal difficulties: Spousal disagreement, tension, abuse, parental history of abuse, maternal history of foster care placement, deficits in positive interactions with family members, verbal and physical conflict, domestic violence, deficits in family cohesion, isolation from friends and community.
• Parenting difficulties: Unrealistic expectations of children, disregard for children's needs/abilities, deficits in child management skills, view of parenting role as stressful. Negative bias/perceptions regarding children, poor problem-solving skills relating to child rearing, intrusive/inconsistent parenting, low levels of communication, stimulation, and interaction with children, high rates of verbal and physical aggression toward children.
• Biological factors: Reports of physical health problems and disabilities, physiological over-reactivity, neuropsychological deficits.

Possible Effects of Physical Child Abuse

• Children: Medical/neurobiological complications, cognitive difficulties, behavioral problems, socioemotional deficits.
• Adolescents and Adults: Criminal/violent behavior, substance abuse, socioemotional problems, psychiatric disorders, physical problems

Emotional Abuse/Psychological Maltreatment: Specific Examples

• Mother locks 3-year-old son in a dark attic.
• Mother calls daughter "stupidest, laziest kid on earth".
• Father threatens to kill puppy for misbehavior.
• Father repeatedly tells child "I don't love you", mother refusing to touch/look at child.

Emotional Abuse/Psychological Maltreatment: Specific Indicators

• Pretending to be emotionally absent, ignoring child's needs.
• Not showing love, attention, and closeness.
• Constantly criticizing and blaming without support/guidance.
• Making fun of, name-calling, humiliating child.
• Denying emotional responsiveness.
• Isolating child from others.
• Mental health/medical/educational neglect.

Economic Abuse: Causes

• Social, economic, and cultural problems, unequal income distribution, poverty, migrations, illegal labor, lack of educational resources.

Media Abuse: General Description

• Publications that negatively impact child health, mental/physical/moral development.
• Harm child privacy/best interest by prioritizing profit.

Sexual Abuse: Specific Examples

• 15-year-old Jamie frequently babysits neighbor, Naomi; inappropriately touches Naomi, while watching videos.
• 16-year-old Sally has sexual encounters with boyfriends and stepfather when alone.

Sexual Abuse: Specific Indicators

• Difficulty walking/sitting, pain/swelling/bleeding in genital/lip/mouth/anal area, pain in urination, sexually transmitted disease diagnosis, physical complaints, excessive need for cleaning, or neglect of cleaning.
• Developing baby-immature behaviors, imitating adult sexual behaviors, playing sexually explicit games with oneself/others.
• Demonstrating sexual knowledge beyond developmental level.
• School/discipline problems, lack of attention, tantrums.
• Depression, anxiety, dissociative disorders (forgetfulness, daydreaming, trance-like states), sleep/eating disorders, and self-harm/substance abuse/suicide attempts.

Sexual Abuse: General Descriptions

• Explicit sexual activities without consent.
• Used for sexual stimulation of another person.
• Perpetrator is in position of power or control over victim, age discrepancy.
• Includes contact (touching) and non-contact (voyeurism, sexy talk, exposure).
• Exploitation including pornography and child prostitution.