research essay on child abuse

Understanding Child Abuse and Neglect (1993)

Chapter: 1 introduction, 1 introduction.

Child maltreatment is a devastating social problem in American society. In 1990, over 2 million cases of child abuse and neglect were reported to social service agencies. In the period 1979 through 1988, about 2,000 child deaths (ages 0-17) were recorded annually as a result of abuse and neglect (McClain et al., 1993), and an additional 160,000 cases resulted in serious injuries in 1990 alone (Daro and McCurdy, 1991). However tragic and sensational, the counts of deaths and serious injuries provide limited insight into the pervasive long-term social, behavioral, and cognitive consequences of child abuse and neglect. Reports of child maltreatment alone also reveal little about the interactions among individuals, families, communities, and society that lead to such incidents.

American society has not yet recognized the complex origins or the profound consequences of child victimization. The services required for children who have been abused or neglected, including medical care, family counseling, foster care, and specialized education, are expensive and are often subsidized by governmental funds. The General Accounting Office (1991) has estimated that these services cost more than $500 million annually. Equally disturbing, research suggests that child maltreatment cases are highly related to social problems such as juvenile delinquency, substance abuse, and violence, which require additional services and severely affect the quality of life for many American families.

The Importance Of Child Maltreatment Research

The challenges of conducting research in the field of child maltreatment are enormous. Although we understand comparatively little about the causes, definitions, treatment, and prevention of child abuse and neglect, we do know enough to recognize that the origins and consequences of child victimization are not confined to the months or years in which reported incidents actually occurred. For those who survive, the long-term consequences of child maltreatment appear to be more damaging to victims and their families, and more costly for society, than the immediate or acute injuries themselves. Yet little is invested in understanding the factors that predispose, mitigate, or prevent the behavioral and social consequences of child maltreatment.

The panel has identified five key reasons why child maltreatment research should be viewed as a central nexus of more comprehensive research activity.

Research On Child Maltreatment Is Currently Undervalued And Undeveloped

Research in the field of child maltreatment studies is relatively undeveloped when compared with related fields such as child development, so-

cial welfare, and criminal violence. Although no specific theory about the causes of child abuse and neglect has been substantially replicated across studies, significant progress has been gained in the past few decades in identifying the dimensions of complex phenomena that contribute to the origins of child maltreatment.

Efforts to improve the quality of research on any group of children are dependent on the value that society assigns to the potential inherent in young lives. Although more adults are available in American society today as service providers to care for children than was the case in 1960, a disturbing number of recent reports have concluded that American children are in trouble (Fuchs and Reklis, 1992; National Commission on Children, 1991; Children's Defense Fund, 1991).

Efforts to encourage greater investments in research on children will be futile unless broader structural and social issues can be addressed within our society. Research on general problems of violence, substance addiction, social inequality, unemployment, poor education, and the treatment of children in the social services system is incomplete without attention to child maltreatment issues. Research on child maltreatment can play a key role in informing major social policy decisions concerning the services that should be made available to children, especially children in families or neighborhoods that experience significant stress and violence.

As a nation, we already have developed laws and regulatory approaches to reduce and prevent childhood injuries and deaths through actions such as restricting hot water temperatures and requiring mandatory child restraints in automobiles. These important precedents suggest how research on risk factors can provide informed guidance for social efforts to protect all of America's children in both familial and other settings.

Not only has our society invested relatively little in research on children, but we also have invested even less in research on children whose families are characterized by multiple problems, such as poverty, substance abuse, violence, welfare dependency, and child maltreatment. In part, this slower development is influenced by the complexities of research on major social problems. But the state of research on this topic could be advanced more rapidly with increased investment of funds. In the competition for scarce research funds, the underinvestment in child maltreatment research needs to be understood in the context of bias, prejudice, and the lack of a clear political constituency for children in general and disadvantaged children in particular (Children's Defense Fund, 1991; National Commission on Children, 1991). Factors such as racism, ethnic discrimination, sexism, class bias, institutional and professional jealousies, and social inequities influence the development of our national research agenda (Bell, 1992, Huston, 1991).

The evolving research agenda has also struggled with limitations im-

posed by attempting to transfer the results of sample-specific studies to diverse groups of individuals. The roles of culture, ethnic values, and economic factors pervade the development of parenting practices and family dynamics. In setting a research agenda for this field, ethnic diversity and multiple cultural perspectives are essential to improve the quality of the research program and to overcome systematic biases that have restricted its development.

Researchers must address ethical and legal issues that present unique obligations and dilemmas regarding selection of subjects, provision of services, and disclosure of data. For example, researchers who discover an undetected incident of child abuse in the course of an interview are required by state laws to disclose the identities of the victim and offender(s), if known, to appropriate child welfare officials. These mandatory reporting requirements, adopted in the interests of protecting children, may actually cause long-term damage to children by restricting the scope of research studies and discouraging scientists from developing the knowledge base necessary to guide social interventions.

Substantial efforts are now required to reach beyond the limitations of current knowledge and to gain new insights that can improve the quality of social service efforts and public policy decisions affecting the health and welfare of abused and neglected children and their families. Most important, collaborative long-term research ventures are necessary to diminish social, professional, and institutional prejudices that have restricted the development of a comprehensive knowledge base that can improve understanding of, and response to, child maltreatment.

Dimensions Of Child Abuse And Neglect

The human dimensions of child maltreatment are enormous and tragic. The U.S. Advisory Board on Child Abuse and Neglect has called the problem of child maltreatment ''an epidemic" in American society, one that requires a critical national emergency response.

The scale and severity of child abuse and neglect has caused various public and private organizations to mobilize efforts to raise public awareness of individual cases and societal trends, to improve the reporting and tracking of child maltreatment cases, to strengthen the responses of social service systems, and to develop an effective and fair system for protecting and offering services to victims while also punishing adults who deliberately harm children or place them in danger. Over the past several decades, a growing number of state and federal funding programs, governmental reports, specialized journals, and research centers, as well as national and international societies and conferences, have examined various dimensions of the problem of child maltreatment.

The results of these efforts have been inconsistent and uneven. In addressing aspects of each new revelation of abuse or each promising new intervention, research efforts often have become diffuse, fragmented, specific, and narrow. What is lacking is a coordinated approach and a general conceptual framework that can add new depth to our understanding of child maltreatment. A coordinated approach can accommodate diverse perspectives while providing direction and guidance in establishing research priorities and synthesizing research knowledge. Organizational mechanisms are also needed to facilitate the application and integration of research on child maltreatment in related areas such as child development, family violence, substance abuse, and juvenile delinquency.

Child maltreatment is not a new problem, yet concerted service, research, and policy attention toward it is just beginning. Although isolated studies of child maltreatment appeared in the medical and sociological literature in the first half of the twentieth century, the publication of "The Battered Child Syndrome" by C. Henry Kempe and associates (1962) is generally considered the first definitive paper in the field in the United States. The efforts of Kempe and others to publicize disturbing medical experience with child abuse and neglect led to the passage of the first Child Abuse Prevention and Treatment Act in 1974 (P.L. 93-247). The act, which has been amended several times (most recently in 1992), established a governmental program designed to guide and consolidate national and state data collection efforts regarding reports of child abuse and neglect, conduct national surveys of household violence, and sponsor research and demonstration programs to prevent, identify, and treat child abuse and neglect.

However, the federal government's leadership role in building a research base in this area has been complicated by changes and inconsistencies in research plans and priorities, limited funding, politicized peer review, fragmentation of effort among various federal agencies, poorly scheduled proposal review deadlines, and bias introduced by competing institutional objectives. 1 The lack of comprehensive, long-term planning for a research base has resulted in a field characterized by contradictions, conflict, and fragmentation. The role of the National Center for Child Abuse and Neglect as the lead federal agency in supporting research in this field has been sharply criticized (U.S. Advisory Board, 1991). Many observers believe that the federal government lacks leadership, funding, and an effective research program for studies on child maltreatment.

The Complexity Of Child Maltreatment

Child maltreatment was originally seen in the form of "the battered child," often portrayed in terms of physical abuse. Today, four general categories of child maltreatment are generally recognized: (1) physical

abuse, (2) sexual abuse, (3) neglect, and (4) emotional maltreatment. Each category covers a range of behaviors, as discussed in Chapter 2.

These four categories have become the focus of separate studies of incidence and prevalence, etiology, prevention, consequences, and treatment, with uneven development of research within each area and poor integration of knowledge across areas. Each category has developed its own typology and framework of reference terms, revealing certain similarities (such as the importance of developmental perspectives in considering the consequences of maltreatment) but also important differences (such as the predatory behavior associated with some forms of sexual abuse that do not appear in the etiology of other forms of child maltreatment).

In addition to the category of child maltreatment, the duration, source, intensity, timing, and situational context of incidents of child victimization are now recognized as important factors in studying the origin and consequences of child maltreatment. Yet information about these factors is rarely requested or recorded by social agencies or health professionals in the process of identifying or documenting reports of child maltreatment. Furthermore, research is often weakened by variation in research definitions of child maltreatment, bias in the recruitment of research subjects, the absence of information regarding circumstances surrounding maltreatment reports, the absence of measures to assess selected variables under study, and the absence of a developmental perspective in many research studies.

The co-occurrence of different forms of child maltreatment has been examined only to a limited extent. Relatively little is known about areas of similarity and differences in terms of causes, consequences, prevention, and treatment of selected types of child abuse and neglect. Inconsistencies in definitions often preclude comparative analyses of clinical studies. For example, studies of sexual abuse have indicated wide variations in its prevalence, often as a result of differences in the types of behavior that might be included in the definition adopted by each research investigator. Emotional abuse is also a matter of controversy in some quarters, primarily because of broad variations in its definition.

Research on child maltreatment is also complicated by the fragmentation of services and responses by which our society addresses specific reports of child maltreatment. Cases may involve children who are victims or witnesses to single or repeated incidents of child abuse and neglect. Sadly, child maltreatment often involves various family members, relatives, or other individuals who reside in the homes or neighborhoods of the affected children. Adult figures may be perpetrators of offensive incidents or mediators in intervention or prevention efforts.

The importance of the social ecological framework of the child has only recently been recognized in studies of maltreatment. Responses to child abuse and neglect involve a variety of social institutions, including commu-

nities, schools, hospitals, churches, youth associations, the media, and other social structures that provide services for children. Such groups and organizations present special intervention opportunities to reduce the scale and scope of the problem of child maltreatment, but their activities are often poorly documented and uncoordinated. Finally, governmental offices at the local, state, and federal levels have legal and social obligations to develop programs and resources to address child maltreatment, and their role is critical in developing a research agenda for this field.

In the past, the research agenda has been determined predominantly by pragmatic needs in the development and delivery of treatment and prevention services rather than by theoretical paradigms, a process that facilitates short-term studies of specialized research priorities but impedes the development of a well-organized, coherent body of scientific knowledge that can contribute over time to understanding fundamental principles and issues. As a result, the research in this field has been generally viewed by the scientific community as fragmented, diffuse, decentralized, and of poor quality.

Selection of Research Studies

The research literature in the field of child maltreatment is immense—over 2000 items are included in the panel's research bibliography, a portion of which is referenced in this report. Despite this quantity of literature, researchers generally agree that the quality of research on child maltreatment is relatively weak in comparison to health and social science research studies in areas such as family systems and child development. Only a few prospective studies of child maltreatment have been undertaken, and most studies rely on the use of clinical samples (which may exclude important segments of the research population) or adult memories. Both types of samples are problematic and can produce biased results. Clinical samples may not be representative of all cases of child maltreatment. For example, we know from epidemiologic studies of disease of cases that were derived from hospital records that, unless the phenomenon of interest always comes to a service provider for treatment, there exist undetected and untreated cases in the general population that are often quite different from those who have sought treatment. Similarly, when studies rely on adult memories of childhood experiences, recall bias is always an issue. Longitudinal studies are quite rare, and some studies that are described as longitudinal actually consist of hybrid designs followed over time.

To ensure some measure of quality, the panel relied largely on studies that had been published in the peer-reviewed scientific literature. More rigorous scientific criteria (such as the use of appropriate theory and methodology in the conduct of the study) were considered by the panel, but were not adopted because little of the existing work would meet such selection

criteria. Given the early stage of development of this field of research, the panel believes that even weak studies contain some useful information, especially when they suggest clinical insights, a new perspective, or a point of departure from commonly held assumptions. Thus, the report draws out issues based on clinical studies or studies that lack sufficient control samples, but the panel refrains from drawing inferences based on this literature.

The panel believes that future research reviews of the child maltreatment literature would benefit from the identification of explicit criteria that could guide the selection of exemplary research studies, such as the following:

For the most part, only a few studies will score well in each of the above categories. It becomes problematic, therefore, to rate the value of studies which may score high in one category but not in others.

The panel has relied primarily on studies conducted in the past decade, since earlier research work may not meet contemporary standards of methodological rigor. However, citations to earlier studies are included in this report where they are thought to be particularly useful and when research investigators provided careful assessments and analysis of issues such as definition, interrelationships of various types of abuse, and the social context of child maltreatment.

A Comparison With Other Fields of Family and Child Research

A comparison with the field of studies on family functioning may illustrate another point about the status of the studies on child maltreatment. The literature on normal family functioning or socialization effects differs in many respects from the literature on child abuse and neglect. Family sociology research has a coherent body of literature and reasonable consensus about what constitutes high-quality parenting in middle-class, predominantly White populations. Family functioning studies have focused predominantly on large, nonclinical populations, exploring styles of parenting and parenting practices that generate different kinds and levels of competence, mental health, and character in children. Studies of family functioning have tended to follow cohorts of subjects over long periods to identify the effects of variations in childrearing practices and patterns on children's

competence and adjustment that are not a function of social class and circumstances.

By contrast, the vast and burgeoning literature on child abuse and neglect is applied research concerned largely with the adverse effects of personal and social pathology on children. The research is often derived from very small samples selected by clinicians and case workers. Research is generally cross-sectional, and almost without exception the samples use impoverished families characterized by multiple problems, including substance abuse, unemployment, transient housing, and so forth. Until recently, researchers demonstrated little regard for incorporating appropriate ethnic and cultural variables in comparison and control groups. In the past decade, significant improvements have occurred in the development of child maltreatment research, but key problems remain in the area of definitions, study designs, and the use of instrumentation.

As the nature of research on child abuse and neglect has evolved over time, scientists and practitioners have likewise changed. The psychopathologic model of child maltreatment has been expanded to include models that stress the interactions of individual, family, neighborhood, and larger social systems. The role of ethnic and cultural issues are acquiring an emerging importance in formulating parent-child and family-community relationships. Earlier simplistic conceptionalizations of perpetrator-victim relationships are evolving into multiple-focus research projects that examine antecedents in family histories, current situational relationships, ecological and neighborhood issues, and interactional qualities of relationships between parent-child and offender-victim. In addition, emphases in treatment, social service, and legal programs combine aspects of both law enforcement and therapy, reflecting an international trend away from punishment, toward assistance, for families in trouble.

Charge To The Panel

The commissioner of the Administration for Children, Youth, and Families in the U.S. Department of Health and Human Services requested that the National Academy of Sciences convene a study panel to undertake a comprehensive examination of the theoretical and pragmatic research needs in the area of child maltreatment. The Panel on Research on Child Abuse and Neglect was asked specifically to:

The report resulting from this study provides recommendations for allocating existing research funds and also suggests funding mechanisms and topic areas to which new resources could be allocated or enhanced resources could be redirected. By focusing this report on research priorities and the needs of the research community, the panel's efforts were distinguished from related activities, such as the reports of the U.S. Advisory Board on Child Abuse and Neglect, which concentrate on the policy issues in the field of child maltreatment.

The request for recommendations for research priorities recognizes that existing studies on child maltreatment require careful evaluation to improve the evolution of the field and to build appropriate levels of human and financial resources for these complex research problems. Through this review, the panel has examined the strengths and weaknesses of past research and identified areas of knowledge that represent the greatest promise for advancing understanding of, and dealing more effectively with, the problem of child maltreatment.

In conducting this review, the panel has recognized the special status of studies of child maltreatment. The experience of child abuse or neglect from any perspective, including victim, perpetrator, professional, or witness, elicits strong emotions that may distort the design, interpretation, or support of empirical studies. The role of the media in dramatizing selected cases of child maltreatment has increased public awareness, but it has also produced a climate in which scientific objectivity may be sacrificed in the name of urgency or humane service. Many concerned citizens, legislators, child advocates, and others think we already know enough to address the root causes of child maltreatment. Critical evaluations of treatment and prevention services are not supported due to both a lack of funding and a lack of appreciation for the role that scientific analysis can play in improving the quality of existing services and identifying new opportunities for interventions. The existing research base is small in volume and spread over a wide variety of topics. The contrast between the importance of the problem and the difficulty of approaching it has encouraged the panel to proceed carefully, thoroughly distinguishing suppositions from facts when they appear.

Research on child maltreatment is at a crossroads—we are now in a position to merge this research field with others to incorporate multiple perspectives, broaden research samples, and focus on fundamental issues that have the potential to strengthen, reform, or replace existing public policy and social programs. We have arrived at a point where we can

recognize the complex interplay of forces in the origins and consequences of child abuse and neglect. We also recognize the limitations of our knowledge about the effects of different forms of social interventions (e.g., home visitations, foster care, family treatment programs) for changing the developmental pathways of abuse victims and their families.

The Importance Of A Child-Oriented Framework

The field of child maltreatment studies has often divided research into the types of child maltreatment under consideration (such as physical and sexual abuse, child neglect, and emotional maltreatment). Within each category, researchers and practitioners have examined underlying causes or etiology, consequences, forms of treatment or other interventions, and prevention programs. Each category has developed its own typology and framework of reference terms, and researchers within each category often publish in separate journals and attend separate professional meetings.

Over a decade ago, the National Research Council Committee on Child Development Research and Public Policy published a report titled Services for Children: An Agenda for Research (1981). Commenting on the development of various government services for children, the report noted that observations of children's needs were increasingly distorted by the "unmanageably complex, expensive, and confusing" categorical service structure that had produced fragmented and sometimes contradictory programs to address child health and nutrition requirements (p. 15-16). The committee concluded that the actual experiences of children and their families in different segments of society and the conditions of their homes, neighborhoods, and communities needed more systematic study. The report further noted that we need to learn more about who are the important people in children's lives, including parents, siblings, extended family, friends, and caretakers outside the family, and what these people do for children, when, and where.

These same conclusions can be applied to studies of child maltreatment. Our panel considered, but did not endorse, a framework that would emphasize differences in the categories of child abuse or neglect. We also considered a framework that would highlight differences in the current system of detecting, investigating, or responding to child maltreatment. In contrast to conceptualizing this report in terms of categories of maltreatment or responses of the social system to child maltreatment, the panel presents a child-oriented research agenda that emphasizes the importance of knowing more about the backgrounds and experiences of developing children and their families, within a broader social context that includes their friends, neighborhoods, and communities. This framework stresses the importance of knowing more about the qualitative differences between children who suffer episodic experiences of abuse or neglect and those for whom mal-

treatment is a chronic part of their lives. And this approach highlights the need to know more about circumstances that affect the consequences, and therefore the treatment, of child maltreatment, especially circumstances that may be affected by family, cultural, or ethnic factors that often remain hidden in small, isolated studies.

An Ecological Developmental Perspective

The panel has adopted an ecological developmental perspective to examine factors in the child, family, or society that can exacerbate or mitigate the incidence and destructive consequences of child maltreatment. In the panel's view, this perspective reflects the understanding that development is a process involving transactions between the growing child and the social environment or ecology in which development takes place. Positive and negative factors merit attention in shaping a research agenda on child maltreatment. We have adopted a perspective that recognizes that dysfunctional families are often part of a dysfunctional environment.

The relevance of child maltreatment research to child development studies and other research fields is only now being examined. New methodologies and new theories of child maltreatment that incorporate a developmental perspective can provide opportunities for researchers to consider the interaction of multiple factors, rather than focusing on single causes or short-term effects. What is required is the mobilization of new structures of support and resources to concentrate research efforts on significant areas that offer the greatest promise of improving our understanding of, and our responses to, child abuse and neglect.

Our report extends beyond what is, to what could be, in a society that fosters healthy development in children and families. We cannot simply build a research agenda for the existing social system; we need to develop one that independently challenges the system to adapt to new perspectives, new insights, and new discoveries.

The fundamental theme of the report is the recognition that research efforts to address child maltreatment should be enhanced and incorporated into a long-term plan to improve the quality of children's lives and the lives of their families. By placing maltreatment within the framework of healthy development, for example, we can identify unique sources of intervention for infants, preschool children, school-age children, and adolescents.

Each stage of development presents challenges that must be resolved in order for a child to achieve productive forms of thinking, perceiving, and behaving as an adult. The special needs of a newborn infant significantly differ from those of a toddler or preschool child. Children in the early years of elementary school have different skills and distinct experiential levels from those of preadolescent years. Adolescent boys and girls demon-

strate a range of awkward and exploratory behaviors as they acquire basic social skills necessary to move forward into adult life. Most important, developmental research has identified the significant influences of family, schools, peers, neighborhoods, and the broader society in supporting or constricting child development.

Understanding the phenomenon of child abuse and neglect within a developmental perspective poses special challenges. As noted earlier, research literature on child abuse and neglect is generally organized by the category or type of maltreatment; integrated efforts have not yet been achieved. For example, research has not yet compared and contrasted the causes of physical and sexual abuse of a preschool child or the differences between emotional maltreatment of toddlers and adolescents, although all these examples fall within the domain of child maltreatment. A broader conceptual framework for research will elicit data that can facilitate such comparative analyses.

By placing research in the framework of factors that foster healthy development, the ecological developmental perspective can enhance understanding of the research agenda for child abuse and neglect. The developmental perspective can improve the quality of treatment and prevention programs, which often focus on particular groups, such as young mothers who demonstrate risk factors for abuse of newborns, or sexual offenders who molest children. There has been little effort to cut across the categorical lines established within these studies to understand points of convergence or divergence in studies on child abuse and neglect.

The ecological developmental perspective can also improve our understanding of the consequences of child abuse and neglect, which may occur with increased or diminished intensity over a developmental cycle, or in different settings such as the family or the school. Initial effects may be easily identified and addressed if the abuse is detected early in the child's development, and medical and psychological services are available for the victim and the family. Undetected incidents, or childhood experiences discovered later in adult life, require different forms of treatment and intervention. In many cases, incidents of abuse and neglect may go undetected and unreported, yet the child victim may display aggression, delinquency, substance addiction, or other problem behaviors that stimulate responses within the social system.

Finally, an ecological developmental perspective can enhance intervention and prevention programs by identifying different requirements and potential effects for different age groups. Children at separate stages of their developmental cycle have special coping mechanisms that present barriers to—and opportunities for—the treatment and prevention of child abuse and neglect. Intervention programs need to consider the extent to which children may have already experienced some form of maltreatment in order to

evaluate successful outcomes. In addition, the perspective facilitates evaluation of which settings are the most promising locus for interventions.

Previous Reports

A series of national reports associated with the health and welfare of children have been published in the past decade, many of which have identified the issue of child abuse and neglect as one that deserves sustained attention and creative programmatic solutions. In their 1991 report, Beyond Rhetoric , the National Commission on Children noted that the fragmentation of social services has resulted in the nation's children being served on the basis of their most obvious condition or problem rather than being served on the basis of multiple needs. Although the needs of these children are often the same and are often broader than the mission of any single agency emotionally disturbed children are often served by the mental health system, delinquent children by the juvenile justice system, and abused or neglected children by the protective services system (National Commission on Children, 1991). In their report, the commission called for the protection of abused and neglected children through more comprehensive child protective services, with a strong emphasis on efforts to keep children with their families or to provide permanent placement for those removed from their homes.

In setting health goals for the year 2000, the Public Health Service recognized the problem of child maltreatment and recommended improvements in reporting and diagnostic services, and prevention and educational interventions (U.S. Public Health Service, 1990). For example, the report, Health People 2000 , described the four types of child maltreatment and recommended that the rising incidence (identified as 25.2 per 1,000 in 1986) should be reversed to less than 25.2 in the year 2000. These public health targets are stated as reversing increasing trends rather than achieving specific reductions because of difficulties in obtaining valid and reliable measures of child maltreatment. The report also included recommendations to expand the implementation of state level review systems for unexplained child deaths, and to increase the number of states in which at least 50 percent of children who are victims of physical or sexual abuse receive appropriate treatment and follow-up evaluations as a means of breaking the intergenerational cycle of abuse.

The U.S. Advisory Board on Child Abuse and Neglect issued reports in 1990 and 1991 which include national policy and research recommendations. The 1991 report presented a range of research options for action, highlighting the following priorities (U.S. Advisory Board on Child Abuse and Neglect, 1991:110-113):

This report differs from those described above because its primary focus is on establishing a research agenda for the field of studies on child abuse and neglect. In contrast to the mandate of the U.S. Advisory Board on Child Abuse and Neglect, the panel was not asked to prepare policy recommendations for federal and state governments in developing child maltreatment legislation and programs. The panel is clearly aware of the need for services for abused and neglected children and of the difficult policy issues that must be considered by the Congress, the federal government, the states, and municipal governments in responding to the distress of children and families in crisis. The charge to this panel was to design a research agenda that would foster the development of scientific knowledge that would provide fundamental insights into the causes, identification, incidence, consequences, treatment, and prevention of child maltreatment. This knowledge can enable public and private officials to execute their responsibilities more effectively, more equitably, and more compassionately and empower families and communities to resolve their problems and conflicts in a manner that strengthens their internal resources and reduces the need for external interventions.

Report Overview

Early studies on child abuse and neglect evolved from a medical or pathogenic model, and research focused on specific contributing factors or causal sources within the individual offender to be discovered, addressed, and prevented. With the development of research on child maltreatment over the past several decades, however, the complexity of the phenomena encompassed by the terms child abuse and neglect or child maltreatment has become apparent. Clinical studies that began with small sample sizes and weak methodological designs have gradually evolved into larger and longer-term projects with hundreds of research subjects and sound instrumentation.

Although the pathogenic model remains popular among the general public in explaining the sources of child maltreatment, it is limited by its primary focus on risk and protective factors within the individual. Research investigators now recognize that individual behaviors are often influenced by factors in the family, community, and society as a whole. Elements from these systems are now being integrated into more complex theories that analyze the roles of interacting risk and protective factors to explain and understand the phenomena associated with child maltreatment.

In the past, research on child abuse and neglect has developed within a categorical framework that classifies the research by the type of maltreatment typically as reported in administrative records. Although the quality of research within different categories of child abuse and neglect is uneven and problems of definitions, data collection, and study design continue to characterize much research in this field, the panel concluded that enough progress has been achieved to integrate the four categories of maltreatment into a child-oriented framework that could analyze the similarities and differences of research findings. Rather than encouraging the continuation of a categorical approach that would separate research on physical or sexual abuse, for example, the panel sought to develop for research sponsors and the research community a set of priorities that would foster the integration of scientific findings, encourage the development of comparative analyses, and also distinguish key research themes in such areas as identification, incidence, etiology, prevention, consequences, and treatment. This approach recognizes the need for the construction of collaborative, long-term efforts between public and private research sponsors and research investigators to strengthen the knowledge base, to integrate studies that have evolved for different types of child maltreatment, and eventually to reduce the problem of child maltreatment. This approach also highlights the connections that need to be made between research on the causes and the prevention of child maltreatment, for the more we learn about the origins of child abuse and neglect, the more effective we can be in seeking to prevent it. In the same manner, the report emphasises the connections that need to be made between research on the consequences and treatment of child maltreatment, for knowledge about the effects of child abuse and neglect can guide the development of interventions to address these effects.

In constructing this report, the panel has considered eight broad areas: Identification and definitions of child abuse and neglect (Chapter 2) Incidence: The scope of the problem (Chapter 3) Etiology of child maltreatment (Chapter 4) Prevention of child maltreatment (Chapter 5) Consequences of child maltreatment (Chapter 6) Treatment of child maltreatment (Chapter 7)

Human resources, instrumentation, and research infrastructure (Chapter 8) Ethical and legal issue in child maltreatment research (Chapter 9)

Each chapter includes key research recommendations within the topic under review. The final chapter of the report (Chapter 10) establishes a framework of research priorities derived by the panel from these recommendations. The four main categories identified within this framework—research on the nature and scope of child maltreatment; research on the origins and consequences of child maltreatment; research on the strengths and limitations of existing interventions; and the need for a science policy for child maltreatment research—provide the priorities that the panel has selected as the most important to address in the decade ahead.

1. The panel received an anecdotal report, for example, that one federal research agency systematically changed titles of its research awards over a decade ago, replacing phrases such as child abuse with references to maternal and child health care, after political sensitivities developed regarding the appropriateness of its research program in this area.

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U.S. Public Health Service 1990 Violent and abusive behavior. Pp. 226-247 (Chapter 7) in Healthy People 2000 Report . Washington, DC: U.S. Department of Health and Human Services.

The tragedy of child abuse and neglect is in the forefront of public attention. Yet, without a conceptual framework, research in this area has been highly fragmented. Understanding the broad dimensions of this crisis has suffered as a result.

This new volume provides a comprehensive, integrated, child-oriented research agenda for the nation. The committee presents an overview of three major areas:

• Definitions and scope —exploring standardized classifications, analysis of incidence and prevalence trends, and more.
• Etiology, consequences, treatment, and prevention —analyzing relationships between cause and effect, reviewing prevention research with a unique systems approach, looking at short- and long-term consequences of abuse, and evaluating interventions.
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Description of the MUSP Cohort

Inclusion criteria for original research publications, quality of supporting literature, predictors: maltreatment types, ethical approval, prevalence and co-occurrence of maltreatment subtypes, cognition and education outcomes, psychological and mental health outcomes, addiction and substance use outcomes, sexual health outcomes, physical health, magnitude of effects, abuse, neglect, and cognitive development, psychological maltreatment: emotional abuse and/or neglect, sexual abuse, physical abuse, limitations, conclusions, long-term cognitive, psychological, and health outcomes associated with child abuse and neglect.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

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Lane Strathearn , Michele Giannotti , Ryan Mills , Steve Kisely , Jake Najman , Amanuel Abajobir; Long-term Cognitive, Psychological, and Health Outcomes Associated With Child Abuse and Neglect. Pediatrics October 2020; 146 (4): e20200438. 10.1542/peds.2020-0438

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Video Abstract

Potential long-lasting adverse effects of child maltreatment have been widely reported, although little is known about the distinctive long-term impact of differing types of maltreatment. Our objective for this special article is to integrate findings from the Mater-University of Queensland Study of Pregnancy, a longitudinal prenatal cohort study spanning 2 decades. We compare and contrast the associations of specific types of maltreatment with long-term cognitive, psychological, addiction, sexual health, and physical health outcomes assessed in up to 5200 offspring at 14 and/or 21 years of age. Overall, psychological maltreatment (emotional abuse and/or neglect) was associated with the greatest number of adverse outcomes in almost all areas of assessment. Sexual abuse was associated with early sexual debut and youth pregnancy, attention problems, posttraumatic stress disorder symptoms, and depression, although associations were not specific for sexual abuse. Physical abuse was associated with externalizing behavior problems, delinquency, and drug abuse. Neglect, but not emotional abuse, was associated with having multiple sexual partners, cannabis abuse and/or dependence, and experiencing visual hallucinations. Emotional abuse, but not neglect, revealed increased odds for psychosis, injecting-drug use, experiencing harassment later in life, pregnancy miscarriage, and reporting asthma symptoms. Significant cognitive delays and educational failure were seen for both abuse and neglect during adolescence and adulthood. In conclusion, child maltreatment, particularly emotional abuse and neglect, is associated with a wide range of long-term adverse health and developmental outcomes. A renewed focus on prevention and early intervention strategies, especially related to psychological maltreatment, will be required to address these challenges in the future.

Child maltreatment is a major public health issue worldwide, with serious and often debilitating long-term consequences for psychosocial development as well as physical and mental health. 1   In the United States alone, 3.5 million children are reported for suspected maltreatment each year, with an annual substantiated maltreatment rate of 9.1 per 1000 children. 2   Some of the long-term adverse outcomes associated with maltreatment include cognitive disability, anxiety and depression, psychosis, teen-aged pregnancy, addiction disorders, obesity, and cardiovascular disease. 3   Understanding the distinctive impact of differing types of maltreatment may help medical professionals provide more wholistic care and treatment recommendations as well as identify more specific public health targets for primary prevention.

Unfortunately, however, little is known about the long-term effects of differing types of child maltreatment, which include sexual abuse, physical abuse, emotional abuse, and neglect. 4   According to a meta-analysis review, 5   research on child maltreatment has predominantly been focused on sexual abuse, with far less attention paid to psychological maltreatment (emotional abuse and/or neglect) and the co-occurrence of different types of maltreatment. In addition, most of the current evidence is derived from cross-sectional studies, which may be subject to recall bias, 6 – 8   in which an outcome status (such as depression) may influence recall of the exposure (ie, previous maltreatment). Few previous studies have adequately controlled for confounding variables, such as perinatal risk, socioeconomic adversity, parental psychopathology, and impaired early childhood development, which may predispose to both child maltreatment and later adverse health outcomes.

Longitudinal studies offer evidence that is more robust, but these studies are relatively few in number and have generally been limited to certain sociodemographic groups 9   or to specific types of child maltreatment, such as sexual abuse. 1 , 10   Other longitudinal studies have relied on retrospective recall of maltreatment rather than prospectively collected agency-reported data. 11 – 13   In studies in which prospective data have been collected, 7 , 13 – 17   only a few have compared different types of child maltreatment. 7 , 16 , 17  

In this special article, we review findings from the Mater-University of Queensland Study of Pregnancy (MUSP), a now 40-year longitudinal prenatal cohort study from Brisbane, Australia, involving >7000 women and their children. 18   Unique features of the MUSP include its use of a population-based sample, its use of prospectively substantiated child maltreatment reports, and its consideration of different subtypes of maltreatment. In addition, the study design controlled for a wide range of confounders and covariates, including both maternal and child sociodemographic and mental health variables. This combined body of work, which includes numerous publications over the past decade, has documented a broad range of adverse outcomes associated with child maltreatment, including deficits in cognitive and educational outcomes 19 – 21   ; mental health problems, such as anxiety, depression, posttraumatic stress disorder (PTSD), psychosis, delinquency, and intimate partner violence (IPV) 22 – 25   ; substance abuse and addiction 26 – 30   ; sexual health problems 31   ; physical growth and health deficits 32 – 35   ; and overall decreased quality of life. 36  

Our purpose for this special article is to compare the effects of 4 differing types of maltreatment on long-term cognitive, psychological, addiction, and health outcomes assessed in the offspring at ∼14 and/or 21 years of age. Rather than providing a systematic review or meta-analysis of the current literature, which would include diverse study designs and purposes, we report and compare the findings of individual articles that used a common data set and standard methodology to study a broad array of outcomes. We particularly highlight the long-term impact of emotional abuse and neglect, which has received far less attention in the literature.

Between 1981 and 1983, 8556 consecutive pregnant women who attended their first prenatal clinic visit at the Mater Mothers’ Hospital in Brisbane, Australia, agreed to participate ( Fig 1 ). After excluding mothers who did not deliver a singleton infant at the Mater Mothers’ Hospital or withdrew consent, the MUSP birth cohort consisted of 7223 mother-infant dyads, who were followed over 2 decades: at 3 to 5 days, 6 months, 5 years, 14 years and 21 years. Midway through the study, this rich data set was anonymously linked to state reports of child abuse and neglect, which identified some form of suspected maltreatment in >10% of cases. 37   Notified cases, which had been referred from the community or by general medical practitioners, were investigated by the Queensland government child protection agency. Substantiated maltreatment was determined after a formal investigation when there was “reasonable cause to believe that the child had been, was being, or was likely to be abused or neglected.” 38   Substantiated maltreatment occurred when a notified case was confirmed for (1) sexual abuse, “exposing a child to or involving a child in inappropriate sexual activities”; (2) physical abuse, “any non-accidental physical injury inflicted by a person who had care of the child”; (3) emotional abuse, “any act resulting in a child suffering any kind of emotional deprivation or trauma”; or (4) neglect, “failure to provide conditions that were essential for the healthy physical and emotional development of a child,” which encompassed physical, emotional and medical neglect. 37  

Overview of the MUSP enrollment and testing.

We searched PubMed from inception to April 2020 for published MUSP articles in which agency-reported child maltreatment was evaluated as the predictor of a range of outcomes. Studies needed to meet the following criteria for inclusion in the review: (1) notified or substantiated abuse and neglect was listed as a main predictor variable and (2) outcomes included standardized measurements of cognitive, psychological, behavioral, or health functioning. From ∼340 published MUSP studies, we identified 24 articles dealing with child maltreatment, of which 21 included state-reported maltreatment versus self-reported maltreatment data ( n = 3). Nineteen of the 21 articles met all inclusion criteria and were evaluated in this review ( Fig 2 ). One study was excluded because it only examined outcomes associated with sexual abuse. 8   Another article was excluded because its outcome measures were similar to another included study. 29  

Published studies from the Mater-University of Queensland Study of Pregnancy, linking long-term outcomes with specific maltreatment subtypes (adjusted coefficients or odds ratios ± 95% confidence intervals). CES-D, Center for Epidemiologic Studies–Depression Scale; CI, confidence interval; N , number of offspring in sample; N (Mal) , number of offspring who experienced maltreatment. a In different articles adjusting for co-occurrence of maltreatment subtypes was handled in different ways: (1) statistical adjustment: each maltreatment subtype predictor was statistically adjusted for the other maltreatment subtypes (eg, neglect was adjusted for the occurrence of physical, sexual, and emotional abuse) and is reflected in the table’s odds ratios and coefficients; (2) exclusive categories: different combinations of maltreatment types are included in mutually exclusive groups (eg, physical abuse only, physical abuse and emotional abuse only, physical and emotional abuse and neglect [without sexual abuse], etc; see Table 1 ); (3) nonexclusive categories: maltreatment categories may overlap with other categories (eg, any substantiated abuse [sexual, physical, or emotional] versus any substantiated neglect); and (4) none: no statistical adjustments or combined categories were presented for co-occurring maltreatment subtypes. b Adjusted coefficients (95% CI) were reported as statistical association measures rather than adjusted odds ratios. c Cases of notified (rather than substantiated) maltreatment. In the study by Mills et al, 26   a sensitivity analysis was performed after exclusion of unsubstantiated cases of maltreatment. The associations between any maltreatment and substance use were similar to those seen in the original analysis after full adjustment. d Medium effect size, based on magnitude of the adjusted odds ratio (2 ≤ odds ratio ≤ 4). e Large effect size, based on magnitude of the adjusted odds ratio (odds ratio > 4).

Each of the reviewed articles followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for the conduct of cohort studies. 41   The quality of the studies was also evaluated by using a modified version of the Newcastle-Ottawa Scale, which is used to assess the following domains: sample representativeness and size, comparability between respondents and nonrespondents, ascertainment of outcomes, and statistical quality. 42   On the basis of this assessment, all of the MUSP studies were determined to be of low risk of bias, with a score of 4 out of 5 points ( Supplemental Information ).

In all but 2 studies (which used notified maltreatment 21 , 26   ) events were dichotomized and coded as substantiated maltreatment versus no substantiated maltreatment. According to a validated classification of maltreatment types, 43   specific categories and co-occurring forms of childhood maltreatment 44   were used to predict outcomes. In 2 studies, 19 , 20   all types of abuse were combined into 1 category and compared to neglect, whereas in another study, sexual abuse was compared to any combination of nonsexual maltreatment. 21   In 2 other studies, 26 , 40   emotional abuse and neglect (examples of psychological maltreatment) were combined, partly because of overlapping definitional constructs from the government child protection agency (emotional abuse included “emotional deprivation,” and neglect included the failure to provide for “healthy…emotional development”). In all but 2 of the included articles, 25 , 33   co-occurrence of different types of maltreatment was considered, either by examining specific combinations of maltreatment types (in exclusive or nonexclusive overlapping categories) or by statistically adjusting for all remaining types of maltreatment ( Fig 2 ).

All of the odds ratios, mean differences, or coefficients were adjusted for potential confounding variables ( Fig 3 ). All articles adjusted for a variety of sociodemographic variables, such as age, race, education, income, and marital status. Perinatal and/or childhood factors, such as birth weight, gestational age, and breastfeeding status, were used as covariates, particularly in articles in which cognitive and educational outcomes were examined. Psychological and mental health variables (such as internalizing and externalizing behavior problems, maternal depression, chronic stress, or exposure to violence) were primarily included as covariates in mental health outcome studies, especially for psychosis. Addiction studies adjusted for youth and maternal alcohol or tobacco use, among other covariates, and physical health outcome studies adjusted for relevant covariates (such as BMI in a study of dietary fat intake and parental height when studying offspring height). In selected articles, maltreatment subtypes were also statistically adjusted for the other types of maltreatment to determine independent effects.

Covariates used in published articles from the MUSP to adjust for possible confounding. a Race: child’s race, parental race, and maternal or paternal racial origin at pregnancy. b Child age: child age and gestational age. c Maternal age: maternal age at the first visit clinic or at pregnancy. d Maternal education: maternal education (prenatal or at birth). e Family income: annual family income, familial income over the first 5 years or family poverty before birth or over the first 5 years of life, family income before birth, and annual family income. f Maternal marital status and social support: same partner at birth and 14 years and social support at 5 years. g Maternal depression: maternal depression during pregnancy, 3- to 6-month follow-up, or 21-year follow-up; chronic maternal depression. h Maternal alcohol use: maternal alcohol use at 3- to 6-month or 14-year follow-up and binge drinking. i Maternal cigarette use: cigarette use during pregnancy, 6 months postpartum, or at 14-year follow-up. ADHD, attention-deficit/hyperactivity disorder; CES-D, Center for Epidemiologic Studies–Depression Scale; IPV, intimate partner violence. Covariates used in published articles from the MUSP to adjust for possible confounding.

A total of 46 outcomes were assessed at 14 years ( n = 5200) and/or 21 years ( n = 3778) ( Fig 1 ) and were grouped into 5 domains ( Fig 2 ):

Cognition and education outcomes included reading ability and perceptual reasoning measured in adolescence, and, at age 21, receptive verbal intelligence and failure to complete high school or be either enrolled in school or employed; attention problems were measured at both time points.

Psychological and mental health outcomes at 21 years included internalizing and externalizing behavior problems (which were also assessed at 14 years), lifetime anxiety disorder, depressive disorder and symptoms, PTSD, lifetime psychosis diagnosis, psychotic symptoms (such as delusional experience or visual and/or auditory hallucinations), delinquency, experience of IPV or harassment, and overall quality of life.

Addiction and substance use, measured at both time points, included alcohol and cigarette use at 14 and 21 years, and cannabis abuse and/or dependence (including early onset) and injecting-drug use at the 21-year follow-up.

Sexual health was investigated at age 21 in terms of early initiation of sexual experience, having multiple sexual partners, youth pregnancy, and miscarriage or termination.

Physical health outcomes measured at 21 years included symptoms of asthma, high dietary fat intake, poor sleep quality, and height deficits.

The 14-year assessments included a youth questionnaire ( n = 5172) and in-person cognitive testing ( n = 3796). The 21-year visit included an in-person assessment of mental health diagnoses in a subset of the cohort ( n = 2531) with the World Health Organization Composite International Diagnostic Interview (CIDI), which is based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria 45   ( Fig 1 ). All of the questionnaire and interview measures were validated, except for reported frequencies of specific events (ie, pregnancy, number of cigarettes, etc).

Associations were described by using either adjusted odds ratios or mean differences and coefficients, along with the corresponding 95% confidence intervals, and were plotted to visualize and compare the statistical significance of each association across specific outcome categories and types of maltreatment ( Figs 4 – 8 ).

Child maltreatment and cognition and educational outcomes at 14 and 21 years. A, Adjusted coefficients ± 95% confidence intervals. B, Odds ratios ± 95% confidence intervals. * P < .05.

Child maltreatment and psychological and mental health outcomes at 14 and 21 years. A, Adjusted coefficients ± 95% confidence intervals. B, Odds ratios ± 95% confidence intervals. * P < .05.

Child maltreatment and addiction and substance use outcomes at 14 and 21 years (adjusted odds ratio ± 95% confidence interval). * P < .05.

Child maltreatment and sexual health outcomes at 21 years (adjusted odds ratio ± 95% confidence interval). * P < .05.

Child maltreatment and physical health outcomes at 21 years. A, Adjusted odds ratio ± 95% confidence interval. B, Adjusted coefficients ± 95% confidence interval. * P < .05.

The MUSP was approved by the Human Ethics Review Committee of The University of Queensland and the Mater Misericordiae Children’s Hospital. Ethical approval was obtained separately from the Human Ethics Review Committee of The University of Queensland for linking substantiated child maltreatment data to the 21-year follow-up data.

In this cohort of 7214 children ( Fig 1 ), 7.1% ( n = 511 children) experienced at least 1 episode of substantiated maltreatment. Substantiated sexual abuse was reported in 2.0% ( n = 147), physical abuse in 4.0% ( n = 287), emotional abuse in 3.7% ( n = 267), and neglect in 3.7% of cases ( n = 269) ( Table 1 ). Almost 60% of the children with substantiated maltreatment had multiple substantiated episodes (293 children; range: 2–14 episodes per child; median: 3 episodes per child 37   ). Of the 3778 young adults included in the 21-year follow-up, 4.5% ( n = 171) had a history of substantiated maltreatment, 39   including sexual abuse ( n = 53), physical abuse ( n = 60), emotional abuse ( n = 71), and neglect ( n = 89).

More than half of the children who experienced substantiated maltreatment were reported for ≥2 co-occurring maltreatment types ( Table 1 ). Of the substantiated sexual abuse cases, 57.1% of the children experienced ≥1 additional maltreatment types (84 of 147); for physical abuse, this proportion was 79.1% (227 of 287); for emotional abuse, 83.5% (223 of 267); and for neglect, 73.6% (198 of 269). In particular, emotional abuse and neglect co-occurred, with or without other types of maltreatment, in ∼59% of cases. 46  

Nonexclusive and Exclusive Categorization of Child Maltreatment Subtypes (Single and in Combination) Within the MUSP Cohort

Abuse (a combined category) and neglect were both associated with significantly lower cognitive scores at both 14 and 21 years, as well as with negative long-term educational and employment outcomes in young adulthood. 19 , 20   This was after adjusting for factors such as the child’s race, sex, birth weight, breastfeeding exposure, and age; family income; and maternal education and alcohol and/or tobacco use ( Fig 3 ). Specifically, proxy measures of IQ, such as reading ability and perceptual reasoning, at age 14 years were adversely associated with both substantiated abuse and neglect. 19   Sexual abuse was associated with attention problems in adolescence, whereas nonsexual maltreatment was associated with attention problems at both time points. 21   Young adults who experienced substantiated child maltreatment had reduced scores on the Peabody Vocabulary Test at 21 years. In terms of educational outcomes in young adulthood, both abuse and neglect manifested a threefold to fourfold increase in odds of failing to complete high school and a twofold to threefold increase in the likelihood of being unemployed at age 21 years 20   ( Figs 2 and 4 ).

During adolescence, physical abuse, emotional abuse, and neglect were all significantly associated with both internalizing and externalizing behavior problems, although this was not the case for physical abuse notifications without co-occurring emotional abuse or neglect. 22   After adjustment for relevant sociodemographic variables, the associations with emotional abuse and neglect remained significant at 21 years. 39   No statistically significant association was found between sexual abuse and these behavior problems at either time point.

Psychological maltreatment in childhood was associated with all of the other 15 psychological and mental health outcomes in young adulthood, except for delinquency in women. This was true after adjustment for sociodemographic variables and psychological and mental health problems (such as attention-deficit/hyperactivity disorder, aggressive behavior problems, and maternal depression or adverse life events, in the case of psychosis and/or IPV exposure outcomes) ( Fig 3 ). Specifically, both emotional abuse and neglect were significantly associated at 21 years with all of the following outcomes: anxiety, depression, PTSD, psychosis (with some exceptions), delinquency in men, and experiencing IPV and harassment (except for neglect). 22 – 25 , 39   Emotional abuse and neglect were the only maltreatment subtypes associated with a significant decrease in quality-of-life scores. 36  

The only mental health outcomes associated with sexual abuse were clinical depression, lifetime PTSD, and experiencing physical IPV. 8 , 25 , 39   Physical abuse was associated with externalizing behavior problems and delinquency (in men), internalizing behavior problems and depressive symptoms, experience of IPV, and PTSD 22 , 24 , 25 , 39   ( Figs 2 and 5 ).

Overall, emotional abuse and/or neglect were associated with all categories of substance use and addiction at both 14 and 21 years, whereas physical and sexual abuse were associated with surprisingly few substance abuse outcomes. Specifically, childhood emotional abuse and neglect were associated with adolescent substance use at age 14, including alcohol use and smoking. 26   This was after adjustment for sociodemographic factors and youth and maternal drug use. The association with cigarette and alcohol use persisted from adolescence to adulthood. The category of "any cigarette use" was the only addiction outcome associated with all 4 types of maltreatment. 40   At 21 years, emotional abuse and neglect were both associated with the early onset of cannabis abuse after adjustment for maternal stress and cigarette use. Additionally, physical abuse, emotional abuse, and neglect all revealed increased odds of cannabis dependence at age 21, with early onset associated with physical abuse and neglect. 28   In contrast, only emotional abuse significantly predicted injecting-drug use in young adult men, after adjustment for maternal alcohol use and depression, whereas all types of substantiated childhood maltreatment were associated with injecting-drug use in women. 27   Sexual abuse was not associated with any addiction or substance use outcome except for cigarette use at 21 years ( Figs 2 and 6 ).

All forms of maltreatment were significantly associated, at 21 years, with early onset of sexual activity and subsequent youth pregnancy. This was after adjustment for factors such as gestational age, youth psychopathology, and drug use. Neglect was the only type of maltreatment associated with having multiple sexual partners and was the maltreatment type most strongly associated with most other sexual health outcomes, especially youth pregnancy. Pregnancy miscarriage was modestly associated with emotional abuse, whereas termination of pregnancy was not associated with any maltreatment subtype 31   ( Figs 2 and 7 ).

Reduced adult height at 21 years, adjusted for parental height, was associated with all maltreatment subtypes except sexual abuse (which was not associated with any of the physical health outcomes). At 21 years, physical abuse was also associated with high dietary fat intake, a risk factor for obesity (adjusted for BMI), and poor sleep quality in men (adjusted for psychopathology and drug use). Asthma at 21 years revealed a modest association with emotional abuse. The combined category of any maltreatment was also associated with high dietary fat intake ( Figs 2 and 8 ).

To estimate the magnitude of potential effects of child maltreatment on long-term outcomes, other studies have used a number of statistical techniques. In one Australian study that used the MUSP and other data sets, the population attributable risk of child maltreatment causing anxiety disorders in men and women, was estimated to be 21% and 31%, respectively, and 16% and 23% for depressive disorders. 46   Similarly, in the MUSP study on cognitive and educational outcomes of maltreated youth, the population attributable risk of child maltreatment leading to “failure to complete high school” was 13%, and 14% for “failure to be in either education or employment at 21 years.” 20  

Based on one published metric of effect size using the magnitude of the adjusted odds ratio, 47   77% of the statistically significant associations in this review were considered to have a medium to large effect size (odds ratio ≥2), including 10% with a large effect size (odds ratio >4) ( Fig 2 ).

In summary, over the past decade, the MUSP has revealed that child maltreatment is associated with a broad array of adverse outcomes during adolescence and young adulthood, including the following:

deficits in cognitive development, attention, educational attainment, and employment;

serious mental health problems, including anxiety, depression, PTSD, and psychosis, as well as delinquency and the experience of IPV;

substance use and addiction problems;

sexual health problems; and

physical health limitations and risk.

These results were seen after adjustment for a broad range of relevant sociodemographic, perinatal, psychological, and other risk factors ( Fig 3 ). Many of the studies also adjusted for the other subtypes of child maltreatment and demonstrated that specific maltreatment types were closely associated with particular outcomes.

Significant cognitive delays and educational failure were seen for both abuse and neglect across adolescence and adulthood. In another study, the authors concluded that preexisting cognitive impairments at 3 or 5 years may explain this association, rather than maltreatment per se. 16   However, other research has revealed that children neglected over the first 4 years of life show a progressive decline in cognitive functioning, which is associated with a significantly reduced head circumference at 2 and 4 years of age. 48   In rodent models, contingent maternal behavior is linked with infant cognitive development, and possible mechanisms include increases in synaptic connections within the hippocampus 49   and reduced apoptotic cell loss. 50   Prolonged maternal separation, in contrast, is associated with impaired cognitive development in rodent and primate models. 51 , 52  

One of the most striking conclusions from this review was the broad association between emotional abuse and/or neglect and adverse outcomes in almost all areas of assessment ( Fig 2 ). In stark contrast, physical abuse and sexual abuse were associated with far fewer adverse outcomes. Overall, quality of life was lower for those who had experienced emotional abuse and neglect but not for those who had experienced physical or sexual abuse. Although emotional abuse and neglect often co-occur with other types of maltreatment, 46   the associated outcomes were generally robust even after statistical adjustment or separation into differing maltreatment categories ( Fig 2 ).

Emotional abuse and neglect in early childhood may lead to psychopathology via insecure attachment, 53 , 54   which has been associated with externalizing behavior problems 55   and impaired social competence. 56 , 57   Emotional neglect, in particular, may lead to deficits in emotion recognition and regulation, as well as insensitivity to reward, 3   potentially influencing social and emotional development. Neglected children are less able to discriminate facial expressions and emotions, 58   whereas youth who have been emotionally neglected show blunted development of the brain’s reward area, the ventral striatum. 59   Reduced reward activation may predict risk for depression, 59   addiction, 60   and other psychopathologies. 61  

Neglect was also associated with the early onset of sexual activity, multiple sexual partners, and youth pregnancy, even after adjustment for other maltreatment subtypes. This suggests that neglect may result in compensatory efforts to obtain sexual intimacy, consistent with other studies revealing higher rates of unprotected sex 62   and adolescent pregnancy in neglected children. 63   In the animal literature, female rodents that experience maternal deprivation tend to have an earlier onset of puberty and increased sexual receptivity, leading to elevated reproductive activity to help offset an environment of higher offspring risk. 64 , 65  

As observed elsewhere, 66   sexual abuse was associated with early sexual experimentation and youth pregnancy as well as symptoms of PTSD and depression. Risky sexual behaviors were independent of other types of maltreatment but were not specific for sexual abuse. An additional MUSP study comparing self-reported and agency-notified child sexual abuse revealed consistent associations with major depressive disorder, anxiety disorders, and PTSD. 8   The absence of associations with other adverse outcomes, however, may be, in part, due to the lower prevalence of substantiated sexual abuse, especially at the 21-year follow-up.

Outcomes associated with physical abuse differed from those associated with sexual abuse, with increased odds of externalizing behavior problems, and delinquency in men. Jaffee 3   suggests that physical abuse, in particular, may lead to a hypervigilance response to threat, including negative attentional bias, disproportionate to relatively mild threat cues. Studies have revealed that physically abused children show selective attention to anger cues, 67   have difficulty disengaging from them, 58 , 68   and are more likely to misinterpret facial cues as being angry or fearful. 69  

Although these studies demonstrated significant associations between maltreatment and a range of long-term outcomes, association does not equal causality. The causal mechanisms proposed above are tentative and may relate to multiple types of maltreatment.

Other limitations should also be considered. Firstly, selective attrition of socioeconomically disadvantaged and maltreated young people was evident in the MUSP cohort ( Supplemental Information ). However, based on multiple imputation calculations and inverse probability weighting of MUSP data, 18 , 70   differences in the rate of loss to follow-up, for both dependent and independent variables, made little difference to either the estimates or their precision, mirroring findings from other longitudinal studies. 71   In addition, the findings were mostly unchanged when using propensity analysis, which is used to assess the effects of nonrandom sampling variation by analyzing the probability of assignment to a particular category within an observational study given the observed covariates. 72   Specifically, the sample was weighted so that it better resembled sociodemographic characteristics at baseline to minimize bias from differential attrition in those with greater socioeconomic disadvantage.

Secondly, differences in the prevalence of specific maltreatment subtypes might have influenced the statistical power to detect true effects, particularly regarding sexual abuse ( Table 1 ).

Finally, the co-occurrence of different types of maltreatment may have impacted the ability to accurately predict the associations between specific types of maltreatment and outcomes. Other studies have revealed that emotional abuse and neglect, in particular, are more likely to co-occur with each other and with other types of maltreatment. 73   However, even in those articles that statistically adjusted for other co-occurring maltreatment subtypes, the associated outcomes linked with emotional abuse and/or neglect were generally robust. In articles that did not adjust for these co-occurrences, some of the strongest associations were still observed for emotional abuse and/or neglect.

Child maltreatment, particularly psychological maltreatment, is associated with a broad range of negative long-term health and developmental outcomes extending into adolescence and young adulthood. Although these data do not establish causality, neurodevelopmental pathways are likely influenced by stress and early social experience through epigenetic mechanisms, which may affect gene expression and regulation and, ultimately, behavior and development. 3 , 74  

Understanding the developmental roots of these adverse outcomes may motivate physicians to more systematically inquire about early-life trauma and refer patients to more appropriate treatment services. 75 , 76   Even more importantly, early intervention and prevention programs, such as prenatal and infancy nurse home visiting, 77   have demonstrated, in randomized clinical trials, diminished rates of child abuse and neglect. 78 , 79   Long-term benefits to the offspring include decreased childhood internalizing problems, 80   reduced antisocial behavior and substance abuse in adolescence, 81   and improved cognitive skills extending into young adulthood. 80 , 82   Supporting at-risk parents and young children should thus be an urgent priority.

Dr Strathearn conceptualized and designed the original study linking the Mater-University of Queensland Study of Pregnancy data set with substantiated reports of child maltreatment, drafted the special article, and reviewed and revised the manuscript; Dr Giannotti assisted in drafting the manuscript and prepared all tables and figures; Drs Mills, Kisely, and Abajobir conceptualized and wrote the original research articles summarized in this article; Dr Najman was the original principal investigator of the Mater-University of Queensland Study of Pregnancy; and all authors critically reviewed the manuscript for important intellectual content and approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: Partially supported by the US National Institute on Drug Abuse (R01DA026437). The content is solely the responsibility of the authors and does not necessarily represent the official views of this institute or the National Institutes of Health. Funded by the National Institutes of Health (NIH).

Composite International Diagnostic Interview

intimate partner violence

Mater-University of Queensland Study of Pregnancy

posttraumatic stress disorder

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The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders

• Elizabeth T.C. Lippard , Ph.D. ,
• Charles B. Nemeroff , M.D., Ph.D.

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A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.

“It is not the bruises on the body that hurt. It is the wounds of the heart and the scars on the mind.” —Aisha Mirza

“We can deny our experience but our body remembers.” —Jeanne McElvaney, Spirit Unbroken: Abby’s Story

It is now well established that childhood maltreatment, or exposure to abuse and neglect in children under the age of 18, has devastating consequences. Over the past two decades, research has begun not only to define the consequences in the context of health and disease but also to elucidate mechanisms underlying the link between childhood maltreatment and medical, including psychiatric, outcomes. Research has begun to shed light on how childhood maltreatment mediates disease risk and course. Childhood maltreatment increases risk for developing psychiatric disorders (e.g., mood and anxiety disorders, posttraumatic stress disorder [PTSD], antisocial and borderline personality disorders, and substance use disorders). It is associated with an earlier age at onset and a more severe clinical course (i.e., greater symptom severity) and poorer treatment response to pharmacotherapy or psychotherapy. Early-life adversity is also associated with increased vulnerability to several major medical disorders, including coronary artery disease and myocardial infarction, cerebrovascular disease and stroke, type 2 diabetes, asthma, and certain forms of cancer. The net effect is a significant reduction in life expectancy in victims of child abuse and neglect. The focus of this review is to expand on previous reviews by synthesizing the literature and integrating much recent data, with a focus on investigating childhood maltreatment interactions with risk for mood disorders, disease onset, and early disease heterogeneity, as well as emerging data suggesting modifiable mechanisms that could be targeted for early intervention and prevention strategies. A major emphasis of this review is to provide a clinically relevant update to practicing mental health practitioners.

Prevalence and Consequences of Childhood Maltreatment

It is estimated that one in four children will experience child abuse or neglect at some point in their lifetime, and one in seven children have experienced abuse over the past year. In 2016, 676,000 children were reported to child protective services in the United States and identified as victims of child abuse or neglect ( 1 ). However, it is widely accepted that statistics on such reports represent a significant underestimate of the prevalence of childhood maltreatment, because the majority of abuse and neglect goes unreported. This is especially true for certain types of childhood maltreatment (notably emotional abuse and neglect), which may never come to clinical attention but have devastating consequences on health independently of physical abuse and neglect or sexual abuse. Although rates of children being reported to child protective services have remained relatively consistent over recent decades ( Figure 1 ), our understanding of the devastating medical and clinical consequences of childhood maltreatment has grown, and childhood maltreatment is now well established as a major risk factor for adult psychopathology. In this review, we seek to summarize the burgeoning literature on childhood maltreatment, specifically focusing on the link between childhood maltreatment and mood disorders (depression and bipolar disorder). The data converge to point toward future directions for education, prevention, and treatment to decrease the consequences of childhood maltreatment, especially in regard to mood disorders.

FIGURE 1. National estimates of childhood maltreatment in the United States a

a Panel A graphs the prevalence of maltreatment (calculated national estimate/rounded number of victims by year, and panel B graphs rates of victimization per 1,000 children, between 1999 and 2016, as reported by the Children’s Bureau, which produces an annual Child Maltreatment report including data provided by the United States to the National Child Abuse and Neglect Data Systems. Estimated rates of maltreatment have remained high over the past two decades. The asterisk calls attention to the fact that before 2007, the national estimates were based on counting a child each time he or she was the subject of a child protective services investigation. In 2007, unique counts started to be reported. The unique estimates are based on counting a child only once regardless of the number of times he or she is found to be a victim during a reporting year. (Information obtained from https://www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment .)

Childhood Maltreatment Increases Risk for Illness Severity and Poor Treatment Response in Mood Disorders

The link between childhood maltreatment and risk for mood disorders and differences in disease course following illness onset has been well documented ( 2 – 8 ). Multiple studies have demonstrated greater rates of childhood maltreatment in patients with major depression and bipolar disorder ( 9 – 11 ). Indeed, a recent meta-analysis revealed that 46% of individuals with depression report childhood maltreatment ( 12 ). Patients with bipolar disorder also report high levels of childhood maltreatment ( 13 , 14 ), with estimates as high as 57% ( 15 ). Childhood maltreatment is associated with an increased risk and earlier onset of unipolar depression, with syndromal depression occurring on average 4 years earlier in individuals with a history of childhood maltreatment compared with those without such a history ( 12 ). Childhood maltreatment is also associated with a more pernicious disease course, including a greater number of lifetime depressive episodes and greater depression severity, with the majority of studies showing more recurrence and greater persistence of depressive episodes ( 16 – 18 ). For example, Wiersma et al. ( 19 ), in an analysis of 1,230 adults with major depressive disorder drawn from the Netherlands Study of Depression and Anxiety, found that childhood maltreatment (measured with the Childhood Trauma Interview) was associated with chronicity of depression, defined as being depressed for ≥24 months over the past 4 years, independent of comorbid anxiety disorders, severity of depressive symptoms, or age at onset. Increased risk for suicide attempts and comorbidities, including increased rates of anxiety disorders, PTSD, and substance use disorders, are reported in individuals with depression who experience childhood maltreatment. Individuals with major depressive disorder and atypical features report significantly more traumatic life events (including physical abuse, sexual abuse, and other forms of trauma) both before and after their first depressive episode, independently of sex, age at onset, or duration of depression ( 20 ). Additionally, childhood maltreatment has consistently been shown to be associated with poor treatment outcome (after psychotherapy, pharmacotherapy, and combined treatment) in depression, as assessed by lack of remission or response or longer time to remission ( 12 , 18 , 21 , 22 ).

Although the studies cited above describe a link between childhood maltreatment and a more pernicious depression course, most studies have been cross-sectional, and the possibility of recall bias and mood effects (owing to the retrospective investigation of childhood maltreatment in individuals who are currently depressed) cannot be ruled out. However, studies over the past few years comparing retrospective and prospective measurement of childhood maltreatment suggest consistency between retrospective reports and prospective designs ( 23 , 24 ), although a recent meta-analysis ( 25 ) suggested poor agreement between these measures, with better agreement observed when retrospective measures were based on interviews and in studies with smaller samples. Longitudinal and prospective studies are emerging that have further confirmed and extended our understanding of the devastating consequences of childhood maltreatment on illness course ( 5 , 7 ). Ellis et al. ( 26 ) recently reported that childhood maltreatment increased risk for more severe trajectories of depressive symptoms during a 7-year longitudinal study in 243 adolescents in the Orygen Adolescent Development Study. Gilman et al. ( 27 ) reported that childhood maltreatment increased the risk for recurrent depressive episodes and suicidal ideation by 20%−30% during a 3-year follow-up of 2,497 participants diagnosed with major depressive disorder in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Additionally, Widom et al. ( 7 ), in a study that followed a cohort of 676 children with documented childhood maltreatment and compared risk for major depression in adulthood between them and a cohort of 520 children matched on age, race, sex, and family social class who were not exposed to childhood maltreatment, found a clear association between childhood maltreatment and both increased risk for depression and earlier onset of the disorder.

Although more research has been reported investigating the link between childhood maltreatment and disease onset and course in unipolar depression, more recent evidence supports the link between childhood maltreatment and disease onset and course in bipolar disorder ( 28 ). Childhood maltreatment is associated with increased disease vulnerability and earlier age at onset of bipolar disorder ( 29 ). Jansen et al. ( 30 ) sought to determine whether childhood maltreatment mediated the effect of family history on diagnosis of a mood disorder. The findings indicated that one-third of the effect of family history on risk for mood disorders was mediated by childhood maltreatment. As with depression, studies on bipolar disorder with a prospective or longitudinal approach are few, but they are informative. Using data from the NESARC (N=33,375), Gilman et al. ( 31 ) found that childhood physical and sexual abuse were associated with increased risk for first-onset and recurrent mania independently of recent life stress. An association between childhood maltreatment and prodromal symptoms has also been reported in bipolar disorder ( 32 ), suggesting that childhood maltreatment may contribute to disease vulnerability before onset of the first manic episode. Childhood maltreatment in the context of bipolar disorder is also associated with a more pernicious disease course, including greater frequency and severity of mood episodes (both depressive and manic), greater severity of psychosis symptoms, and greater risk for comorbidities (i.e., anxiety disorders, PTSD, substance use disorders), rapid cycling, inpatient hospitalizations, and suicide attempts ( 28 , 33 – 41 ). Studies are beginning to emerge investigating treatment response in bipolar disorder following childhood maltreatment. Such studies remain few, but they suggest that childhood maltreatment is associated with a poor response to benzodiazepines ( 42 ) and anticonvulsants ( 41 ) in bipolar disorder. The concatenation of findings in depression and bipolar disorder are concordant in that childhood maltreatment increases risk for, and early onset of, first mood episode and episode recurrence. Childhood maltreatment affects disease trajectories, including in its association with more insidious mood episodes, poor treatment response, a greater risk for comorbidities, and a greater risk for suicide ideation, attempts, and completion. The link between childhood maltreatment and increased prevalence of suicide-related behaviors is of particular importance given the high rate of suicide ideation, attempts, and completion in depression and bipolar disorder. Despite many prevention strategies (e.g., education and outreach and clinical studies to identify risk factors for impending suicide attempts in individuals with mood disorders), suicide rates have not decreased but in fact have increased in the United States. The link between childhood maltreatment and suicide-related behavior has been reviewed by several groups ( 21 , 33 , 43 – 47 ). Dube et al. ( 48 ) reported that adverse childhood experiences, including childhood maltreatment, increased the risk for suicide attempts twofold to fivefold in 17,337 adults in the now classic Adverse Childhood Experiences Study. Gomez et al. ( 49 ) reported that physical or sexual abuse increased the odds of suicide ideation, planning, and attempts among the 9,272 adolescents in the U.S. National Comorbidity Survey Adolescent Supplement. Miller et al. ( 50 ) examined the relationship between childhood maltreatment and prospective suicidal ideation in a cohort of 682 youths followed over a 3-year period. Emotional maltreatment predicted suicidal ideation, independently of previous suicidal ideation and depressive symptom severity. Childhood maltreatment is also associated with earlier age at first suicide attempt ( 51 ). Additionally, an association between childhood maltreatment and suicide risk in 449 individuals age 60 or older was recently reported from the Multidimensional Study of the Elderly, in the Family Health Strategy in Porto Alegre, Brazil ( 52 ). The effect was independent of depressive symptom severity. These findings suggest that childhood maltreatment increases risk for suicide-related behavior across the lifespan. More work is warranted in investigating the biological mechanisms that may mediate the association between childhood maltreatment and suicide-related behaviors.

Timing of Childhood Maltreatment: Are There Periods of Heightened Sensitivity?

Although childhood maltreatment at any age can result in long-lasting consequences ( 53 ), there is evidence that the timing, duration, and severity of maltreatment mediate the risk for later psychopathology ( 54 ). Childhood maltreatment that occurs earlier in life and continues for a longer duration is associated with the worst outcomes ( 55 ). This is supported by preclinical models (rodent and nonhuman primate) that investigated maternal separation ( 56 , 57 ), a paradigm more similar to neglect in humans. One study in rodents found that maternal separation during the early postnatal period (days 2–15) but not the later postnatal period (days 7–20) is associated with anxious and depressive-like behaviors in adulthood ( 57 ). Although this postnatal period coincides with in utero development in humans, there is evidence that in utero insults in the form of stress can have consequences similar to early-life trauma ( 58 , 59 ), supporting the translational validity of these models. Clinical studies also support the importance of timing of childhood maltreatment in moderating risk for psychopathology. Cowell et al. ( 60 ) investigated the timing and duration of childhood maltreatment in 223 maltreated children between the ages of 3 and 9 and found that children who were maltreated during infancy and those who experienced chronic maltreatment had poorer inhibitory control and working memory. Dunn et al. ( 61 ) investigated the relationship between timing of childhood maltreatment and depression and suicidal ideation in early adulthood among 15,701 participants in the National Longitudinal Study of Adolescent Health, and found that exposure to early maltreatment, especially during the preschool years (between ages 3 and 5), was most strongly associated with depression. Additionally, sexual abuse occurring during early childhood, compared with adolescence, was reported to be more strongly associated with suicidal ideation ( 61 ). While these studies suggest that childhood maltreatment that occurs earlier in development may further increase risk for developing mood disorders and associated behaviors in adulthood, it is important to emphasize that evidence suggests that exposure to maltreatment during later childhood and adolescence also independently increases risk for mood disorders. Emotional abuse and neglect, especially if it occurs between ages 8 and 9, increases depressive symptoms ( 62 ). Emotional abuse during adolescence also increases risk for depression ( 63 ).

More work is emerging investigating the negative consequences of bullying. A study of 1,420 participants (ages 9–16) revealed that victims of bullying showed an increased prevalence of generalized anxiety disorder, depression, and suicide-related behavior ( 64 ). A recent study of more than 5,000 children that comprised a longitudinal data set (the Avon Longitudinal Study of Parents and Children in England and the Great Smoky Mountains Study in the United States) ( 65 ) found an increased risk for mental health problems, including anxiety, depression, and self-harm, in individuals who experienced bullying, but not other maltreatment. Additionally, an association between childhood bullying by peers and risk for suicide-related behaviors (ideation, planning, attempting, and onset of plan among ideators), independent of childhood maltreatment by adults, was reported in a sample of U.S. Army soldiers ( 66 ).

Some studies suggest that differential periods of sensitivity to different subtypes of maltreatment are distinctly associated with an increased risk for mood disorders. Recently, a stronger relationship was reported between adult depression and early childhood sexual abuse (occurring at age 5 or earlier) and later childhood physical abuse (occurring at age 13 or later), compared with maltreatment that occurred during other developmental periods ( 67 ). Harpur et al. ( 68 ) reported that early childhood maltreatment (between birth and age 4) predicted more anxiety symptoms, and maltreatment that occurred in late childhood or early adolescence (between ages 10 and 12) predicted more depressive symptoms in adolescence. Taken together, these studies suggest that maltreatment at any age and across different contexts (physical and emotional, familial- and peer-induced) often result in long-lasting and severe consequences and that there may be specific sensitive periods in development when exposure to distinct types of maltreatment may differentially increase risk for affective disorders in adulthood. To date, the majority of research investigating the impact of childhood maltreatment timing on illness risk and course in mood disorders has focused on depression. One study ( 69 ) reported that early sexual or physical abuse (before age 11) in 225 early psychosis patients (6.7% with a bipolar disorder diagnosis) coincided with lower scores on the Global Assessment of Functioning Scale and the Social and Occupational Functioning Assessment Scale during a 3-year follow-up period, whereas late sexual or physical abuse (between ages 12 and 15) did not. More work investigating timing of maltreatment and associated clinical outcomes is warranted.

Experiencing Single Subtypes of Abuse and Neglect Versus Experiencing Multiple Types

Several groups have sought to determine the impact of single types of childhood maltreatment on mood disorders. Although all types of childhood maltreatment (physical, emotional, and sexual) increase disease vulnerability and risk for more severe illness course in mood disorders, including increased risk for suicide ( 52 ), there may be some distinctions between individual subtypes and associated outcomes ( 70 ). An association between sexual abuse and lifetime risk for anxiety disorders, depression, and suicide attempts independent of other types of maltreatment has been reported ( 2 , 71 , 72 ). In bipolar disorder, physical abuse and sexual abuse independently increase risk for illness vulnerability and more severe course ( 13 ). One study of 446 youths (ages 7 to 17) found that physical abuse was independently associated with a longer duration of illness in bipolar disorder, a greater prevalence of comorbid PTSD and psychosis, and a greater prevalence of family history of a mood disorder when compared with sexual abuse, which was only associated with a greater prevalence of PTSD ( 13 ). Recent life stress in adulthood was found to increase risk for first-onset mania in individuals with a history of childhood physical maltreatment, but not individuals with a history of sexual maltreatment ( 31 ). However, it should be noted that early-life sexual abuse in the study was a strong risk factor for mania even in the absence of recent life stress.

Neglect is the least studied form of early-life adversity, and emerging data suggest differential consequences following neglect as compared with abuse ( 73 ). Similarly, long-lasting consequences following emotional maltreatment, independently of other forms of maltreatment, have also been reported ( 47 , 74 , 75 ). In a 2015 meta-analysis, emotional abuse showed the strongest association with depression, followed by neglect and sexual abuse ( 76 ), a finding supported by another recent meta-analysis ( 77 ). Spertus et al. ( 78 ) reported that emotional abuse and neglect predicted depressive symptoms even after controlling for physical and sexual abuse, further suggesting emotional abuse and neglect to be independently related to illness severity in depression. Parental “verbal aggression” was found to increase risk for depression and anxiety in adolescents, with risk suggested to be greater following verbal aggression compared with physical abuse ( 79 ). Khan et al. ( 63 ) recently reported that nonverbal emotional abuse in males and peer emotional abuse in females are important predictors of lifetime history of major depression and are more predictive than number of types of maltreatment experienced. Another recent meta-analysis ( 12 ) reported that in individuals with depression, emotional neglect was the most common reported form of childhood maltreatment, and emotional abuse was most closely related to symptom severity. High prevalence of emotional maltreatment is also reported in bipolar disorder (approximately 40%), with emotional maltreatment associated with disease vulnerability and more severe illness course, including rapid cycling, comorbid anxiety or stress disorders, suicide attempts or ideation, and cannabis use ( 80 ).

Although studies on subtypes of maltreatment are only now burgeoning, they are concordant in implicating emotional maltreatment, in addition to physical and sexual maltreatment, in increasing risk for, and differences in disease course of, mood disorders. Emotional maltreatment and neglect are clearly the least studied of all forms of childhood adversity. This is in part because they are often overlooked and least likely to come to clinical attention, as compared with physical and sexual abuse, which can, of course, result in physical injury. Because emotional maltreatment and neglect are likely the most prevalent forms of childhood maltreatment in psychiatric populations ( 81 ), and given findings suggesting that independent of other forms of maltreatment, emotional maltreatment has long-lasting consequences that increase risk for mood disorders and illness outcome ( 74 , 75 ), more research on the role of emotional maltreatment and neglect are urgently needed.

Although the findings described above suggest the hypothesis that different subtypes of early-life adversity may independently increase risk for mood disorders and that some subtypes may be more closely related to specific differences in illness course and severity, it is clear that subtypes of abuse and neglect, as a rule, do not occur in isolation but instead occur together in the same individuals. For example, individuals experiencing physical or sexual abuse likely also experience emotional maltreatment. Some studies have investigated the impact of multiple types of childhood maltreatment. A recent meta-analysis reported that 19% of individuals with major depression report more than one form of childhood maltreatment and, while all childhood maltreatment subtypes have been shown to increase the risk of depression, experiencing multiple forms of childhood maltreatment further elevates this risk ( 12 ). The Adverse Childhood Experiences study provided evidence of an additive effect of eight early-life stress events (including abuse but also other early-life stressors, such as divorce, domestic violence, household substance abuse, and parental loss) on adult psychopathology. Specifically, individuals with four or more early-life stress events had significantly increased risk for depression, anxiety, suicide attempts, substance use disorders, and other detrimental outcomes ( 82 , 83 ). An additive or cumulative effect of early-life stress on increased risk for mood, anxiety, and substance use disorders has also been reported by others ( 5 , 6 ). Multiple adverse childhood experiences (maltreatment plus other forms of stressful events) also result in higher rates of comorbidities ( 7 , 82 ). Likewise, a dose-response relationship between number of types of childhood maltreatment and illness severity in bipolar disorder has been suggested, including increased risk for comorbid anxiety disorders and substance use disorders ( 84 ).

Underlying Mechanisms by Which Childhood Maltreatment Increases Risk for Mood Disorders and Contributes to Disease Course

As depicted in Figure 2 , several putative biological mechanisms by which childhood maltreatment may increase the risk for mood disorders and disease progression have been described ( 21 , 85 ). These include, but are not limited to, inflammation and other immune system perturbations, alterations in the hypothalamic-pituitary-adrenal (HPA) axis, and genetic and epigenetic processes as well as structural and functional brain imaging changes. These studies provide insight into modifiable targets and provide direction to improve both treatment and prevention strategies.

FIGURE 2. Child maltreatment, its consequences, and windows for intervention across development a

a The gray arrow represents the development of disease vulnerability, disease onset, and variations in disease course and treatment. Exposure to childhood maltreatment at any point during development (red bar) can result in long-lasting consequences, including increasing disease vulnerability and illness severity in mood disorders. There may be optimal windows (black arrows) across development when interventions could decrease disease burden by decreasing disease vulnerability and improving illness course; these include before and after birth (parenting classes and parenting support groups), at the time of maltreatment, when prodromal symptoms begin to emerge, immediately following disease onset, and during disease course (e.g., improving treatment response). Modifiable targets are beginning to emerge (green arrows and text) and point to behavioral and environmental factors, as well as genetic and other molecular factors, that could be focused on for interventions.

Biological Abnormalities Associated With Childhood Maltreatment

Several persistent biological alterations associated with childhood maltreatment may mediate the increased risk for development of mood and other disorders. Childhood maltreatment is associated with systemic inflammation ( 86 , 87 ) as assessed by measurements of C-reactive protein (CRP) and inflammatory cytokines including tumor necrosis factor-alpha and interleukin-6. Childhood maltreatment was found to be associated with increased plasma CRP levels and increased body mass index in 483 participants identified as being on the psychosis spectrum ( 88 ). Patients with depression and bipolar disorder have also been reported to exhibit increased levels of inflammatory markers ( 89 – 92 ). It is unclear whether childhood maltreatment–associated inflammation is responsible for the observations in patients with mood disorders. Anti-inflammatory drugs are a promising novel therapeutic strategy in the subgroup of depressed patients with elevated inflammation ( 93 ), although the findings thus far are preliminary, and further study on inflammation as a modifiable target is warranted.

Another mechanism through which childhood maltreatment may increase risk for mood disorders is through alterations of the HPA axis and corticotropin-releasing factor (CRF) circuits that regulate endocrine, behavioral, immune, and autonomic responses to stress. Research documenting how childhood maltreatment contributes to altered HPA axis and CRF circuit activity in preclinical and clinical studies has been reviewed in detail elsewhere ( 21 ). Childhood adversity likely increases sensitivity to the effects of recent life stress on the course of both unipolar and bipolar disorder. Soldiers exposed to childhood maltreatment have a greater risk for depression or anxiety following recent life stressors ( 94 ). Likewise, individuals exposed to childhood maltreatment have a greater risk of mania following recent life stressors compared with individuals without childhood maltreatment ( 31 , 34 ). Individuals with depression or bipolar disorder and early-life stress report lower levels of stress prior to recurrence of a mood episode compared with individuals with depression or bipolar disorder without early-life stress ( 34 , 95 ); this suggests that less stress is required to induce a mood episode in individuals who were exposed to childhood maltreatment. These findings support theoretical sensitization frameworks on the role of stress in unipolar depression and bipolar disorder ( 96 – 99 ). Alterations in the HPA axis and CRF circuits following childhood maltreatment are mechanisms that likely contribute to increased risk for mood episodes following stressful life events and may be modifiable targets. Indeed, Abercrombie et al. ( 100 ) recently reported that therapeutics targeting cortisol signaling may show promise in the treatment of depression in adults with a history of emotional abuse.

In addition to the biological mechanisms noted above, genetic predisposition undoubtedly also plays a role in the pathogenesis of mood disorders following early-life stress. As previously reviewed ( 21 ), studies support the interaction of genetic predisposition and childhood maltreatment in increasing risk for mood disorders and affecting disease course. Indeed, this is now considered a prototype of how gene-by-environment interactions influence disease vulnerability. Polymorphisms in genes comprising components of the HPA axis and CRF circuits increase the risk for adult mood disorders in adults exposed to childhood maltreatment. For example, polymorphisms in the FK506 binding protein 5 (FKBP5) gene interact with childhood maltreatment to increase risk for major depression, suicide attempts, and PTSD ( 101 – 105 ). Caspi et al. ( 106 ) found that adults exposed to childhood maltreatment who carried the short arm allele of the serotonin transporter promoter polymorphism (heterozygotes and homozygotes) exhibited an increased risk for a depressed episode, greater depressive symptoms, and greater risk for suicidal ideation and attempts compared with homozygotes with two long arm alleles. A large number of studies now support the interaction between early-life stress, the serotonin transporter promoter, and other serotonergic gene polymorphisms and disease vulnerability and illness course in depression and bipolar disorder ( 107 – 111 ), although conflicting findings have also been reported ( 112 ). Childhood maltreatment has also been reported to interact with corticotropin-releasing hormone receptor 1 gene (CRHR1) polymorphisms to predict syndromal depression and increase risk for suicide attempts in adults ( 113 – 115 ). Early-life stress interactions with other genetic polymorphisms to influence risk for mood disorders and illness course include, but are not limited to, brain-derived neurotrophic factor (BDNF) Val66Met polymorphism ( 116 , 117 ), toll-like receptors ( 118 ), the oxytocin receptor ( 119 ), inflammation pathway genes ( 120 ), and methylenetetrahydrofolate reductase ( 121 ), although negative findings have also been reported ( 122 ). Studies employing polygenic risk score (PRS) analyses, an approach assessing the combined impact of multiple genotyped single-nucleotide polymorphisms, have reported that PRS is differentially related to risk for depression in individuals with a history of childhood maltreatment compared with those without maltreatment ( 123 , 124 ), although negative findings have also been reported ( 125 ).

Studies investigating the role of epigenetics (e.g., the modification of gene expression through DNA methylation and acetylation) in mediating detrimental outcomes following early-life stress have recently appeared ( 126 ). For example, a recent study reported that hypermethylation of the first exon of a monoamine oxidase A (MAOA) gene region of interest mediated the association between sexual abuse and depression ( 127 ). Childhood maltreatment is also associated with epigenetic modifications of the glucocorticoid receptor ( 128 ), the FKBP5 gene ( 101 ), and the serotonin 3A receptor ( 129 ), with these modifications associated with suicide completion, altered stress hormone systems, and illness severity, respectively. Childhood maltreatment–associated epigenetic changes in individuals who died by suicide have been identified in human postmortem studies ( 130 ). These studies, and others not cited here, support gene–by–childhood maltreatment interactions, including epigenetic modifications, in risk for mood disorders and in illness course.

Epigenetics may also be one mechanism that contributes to the intergenerational transmission of trauma ( 131 – 133 ), although it is important to note that nongenomic mechanisms are also implicated in the intergenerational transmission of behavior ( 134 ). There is a robust literature in rodent models supporting the intergenerational transmission of maternal behavior—maternal traits being passed to offspring—including abuse-related phenotypes ( 132 , 135 ). Intergenerational transmission of behavior is also implicated in humans. Yehuda et al. ( 136 , 137 ) investigated risk for psychopathology in offspring of Holocaust survivors. These pivotal studies identified increased risk for PTSD, mood disorders, and substance use disorders in offspring. These offspring also reported having higher levels of emotional abuse and neglect, which correlated with severity of PTSD in the parent ( 136 , 137 ), implicating early-life stress in transmission of psychopathology. While there is evidence that children with developmental disabilities are at a higher risk for neglect ( 138 – 140 ), there is a paucity of studies investigating whether offspring of individuals with mental illness are more liable to abuse. However, as discussed above, higher rates of maltreatment are reported in individuals with mood disorders, but whether and what familial factors may drive these elevated rates, or whether these interactions contribute to the intergenerational transmission of psychopathology, are not known. In light of the emerging data on intergenerational transmission of trauma, this is an important, complex area in need of further study. There have not been many genetic studies in this area. In a study investigating early-life maltreatment in a rodent model, early-life abuse (defined as stepping on, dropping, or dragging offspring, and active avoidance) was associated with altered BDNF expression and methylation in the prefrontal cortex in adult offspring, with adult offspring also showing poorer maternal care patterns when rearing their own offspring ( 135 ). Altered expression and methylation of BDNF is reported in individuals with mood disorders ( 141 , 142 ). These studies highlight the importance of understanding the intergenerational transmission of trauma and psychopathology to identify modifiable targets to improve outcomes, for example, the family unit and interpersonal relationships. It is noteworthy that while the majority of research has focused on intergenerational transmission of maternal traits, research is also emerging that supports the important role of paternal care on intergenerational transmission of behavior ( 131 ). More study on intergenerational transmission of trauma is needed.

Pathways to Mood Disorder Outcomes

More work on mechanisms and pathways by which childhood maltreatment increases risk for and ultimately results in adult mood disorders is essential for early intervention. Childhood maltreatment is associated with a marked increase in medical morbidities and an array of physical symptoms, and in general it predicts poor health and a shorter lifespan ( 143 , 144 ). Higher rates of comorbid substance use disorders in individuals with mood disorders who report experiencing childhood maltreatment is of particular interest. Childhood maltreatment has consistently been associated with a number of high-risk health behaviors, including smoking and alcohol and drug use—behaviors thought to contribute to the association between childhood maltreatment and poor health ( 145 – 148 ). These behaviors on their own increase risk for, and alter disease course in, mood disorders ( 149 – 153 ). More study on the relationship between early-life adversity, substance use disorders, and mood disorders is therefore warranted. For example, childhood maltreatment is associated with increased risky alcohol use, alcohol-related problems, and alcohol use disorders ( 154 , 155 ), and alcohol use disorders are an established risk factor for both depression and bipolar disorder ( 149 – 151 ) in addition to increasing risk for a more severe clinical course, such as further increasing risk for suicide ( 152 , 153 ). A recent study reported that depression mediates the relationship between childhood maltreatment and alcohol abuse ( 156 ). Another study recently reported that sexual abuse increased risk of alcohol use and depression in adolescence, which then influenced risk for adult depression, anxiety, and substance abuse ( 157 ). In a longitudinal study investigating changes in patterns of substance use over time in 937 adolescents, childhood maltreatment was associated with an increased progression toward heavy polysubstance use ( 158 ). More research is needed looking at the interactions between childhood maltreatment and other drugs of abuse. This is especially true in light of the current opioid epidemic, as increased rates of childhood maltreatment are also reported in individuals with opioid use disorders ( 159 – 161 ), and greater reported childhood maltreatment is associated with faster transmission from use to dependence ( 162 ) and with higher rates of suicide attempts in this population ( 163 ).

Interestingly, certain genes described above that exhibit gene–by–childhood maltreatment interactions on risk for mood disorders, including FKBP5 and the serotonin transporter promoter polymorphisms, also exhibit gene-by-childhood maltreatment interactions on risk for alcohol use disorders ( 164 – 168 ). Alterations in the stress hormone system are also associated with an increased risk for alcohol use disorders in individuals with a history of childhood maltreatment ( 169 ), and past-year negative life events have been reported to increase drinking and drug use, an effect that is dependent on genetic variation in the serotonin transporter gene ( 170 ). Childhood maltreatment has been found to be associated with an earlier age at initiation of alcohol and marijuana use, with this association mediated by externalizing behaviors ( 171 ). Impulsivity may mediate the relationship between childhood maltreatment and increased risk for developing alcohol or cannabis abuse ( 172 ). Etain et al. ( 173 ) conducted a path analysis in 485 euthymic patients with bipolar disorder and uncovered a significant association between impulsivity and emotional abuse, and impulsivity was associated with an increased risk for substance use disorders. These studies suggest that in some individuals with a history of childhood maltreatment, although not all, interventions that focus on alcohol or drug use problems, and specifically externalizing behaviors that may mediate the link between childhood maltreatment and alcohol or drug use problems (e.g., impulsivity), could decrease disease burden by decreasing risk for developing mood disorders or by improving illness course (e.g., decreasing symptom severity and risk for suicide).

Substance use disorders are also associated with increases in inflammatory markers ( 174 , 175 ). Inflammation is suggested to contribute to comorbid alcohol use disorders and mood disorders ( 176 ), and it contributes to a variety of medical morbidities ( 177 ), and these in turn are associated with an increased risk for mood disorders ( 177 ). Speculatively, inflammation may be one mechanism by which childhood maltreatment increases risk for medical morbidity and through that pathway increases risk for mood disorders. While there is a paucity of studies on the pathways described above, the associations between childhood maltreatment, risky health behaviors, inflammation, and medical morbidities warrant more study, as identifying pathways (mediators and moderators) to illness outcomes could foster the development of more effective interventions and treatment strategies.

It should be noted that not all individuals who experience childhood maltreatment develop mood disorders. This may be related in part to genetics. However, other resiliency factors are likely of importance. In a recent meta-analysis, Braithwaite et al. ( 178 ) identified interpersonal relationships, cognitive vulnerabilities, and behavioral difficulties as modifiable predictors of depression following childhood maltreatment. Specifically, social support and secure attachments were reported to exert a buffering effect on risk for depression, brooding was suggested to be a cognitive marker of risk, and externalizing behavior was suggested to be a behavioral marker of risk. Other researchers have also reported that social support may be protective and that interventions directed toward enhancing social support may decrease disease vulnerability and improve illness course ( 179 ). Metacognitive beliefs, or beliefs about one’s own cognition, are suggested to mediate the relationship between childhood maltreatment and mood-related and positive symptoms in individuals with psychotic or bipolar disorders ( 180 ). Specifically, beliefs about thoughts being uncontrollable or dangerous mediated the relationship between emotional abuse and depression or anxiety and positive symptom subscale score on the Positive and Negative Syndrome Scale. Affective lability was found to mediate the relationship between childhood maltreatment and several clinical features in bipolar disorder, including suicide attempts, anxiety, and mixed episodes ( 181 ), and social cognition was suggested to moderate the relationship between physical abuse and clinical outcome in an inpatient psychiatric rehabilitation program ( 182 ).

Childhood Maltreatment and Associated Alterations in Neural Structure and Function

Research on neurobiological consequences that may mediate the relationship between childhood maltreatment and risk for, and affect disease course in, mood disorders is clearly integral to addressing the question of whether the consequences of early-life stress are reversible. Although a comprehensive review of neuroimaging findings is beyond the scope of this review, over the past 5 years, review articles summarizing the neurobiological associations with childhood maltreatment have emphasized the long-lasting neurobiological structural and functional changes in the brain following maltreatment ( 21 , 83 , 183 , 184 ). In brief, while null and conflicting findings have been reported, data are converging to suggest that childhood maltreatment is associated with lower gray matter volumes and thickness in the ventral and dorsal prefrontal cortex, including the orbitofrontal and anterior cingulate cortices, hippocampus, insula, and striatum, with more recent studies also suggesting an association with decreased white matter structural integrity within and between these regions ( 185 – 194 ). Smaller hippocampal and prefrontal cortical volumes following childhood maltreatment are consistently reported in unipolar depression and other psychiatric disorders ( 189 , 195 – 199 ), with gene-by-environment interactions suggested ( 200 – 202 ). These studies suggest mechanisms that may cross diagnostic boundaries in conferring risk for psychopathology and genetic variation that may link neurobiology, childhood maltreatment, and vulnerability for detrimental outcomes.

Studies investigating differences in function within, and functional connectivity between, these regions following childhood maltreatment are emerging, with more recent results suggesting that these changes may relate to risk for psychopathology. It was recently reported that decreased prefrontal responses during a verbal working memory task mediated the relationship between childhood maltreatment and trait impulsivity in young adult women ( 203 ). In a study investigating functional responses to emotional faces in 182 adults with a range of anxiety symptoms ( 204 ), the authors found that increased amygdala and decreased dorsolateral prefrontal activity to fearful and angry faces—as well as increased insula activity to fearful and increased ventral but decreased dorsal and anterior cingulate activity to angry faces—mediated the relationship between childhood maltreatment and anxiety symptoms. Differences in functional connectivity, measured with multivariate network-based approaches, within the dorsal attention network and between task-positive networks and sensory systems have been reported in unipolar depression following childhood maltreatment ( 205 ). Altered reward-related functional connectivity between the striatum and the medial prefrontal cortex has also been reported in individuals with greater recent life stress and higher levels of childhood maltreatment, with increased connectivity associated with greater depressive symptom severity ( 206 ). Childhood maltreatment–associated changes in functional connectivity between the amygdala and the dorsolateral and rostral prefrontal cortex have been suggested to contribute to altered stress response and mood in adults ( 207 ). Additionally, childhood maltreatment has been reported to moderate the association between inhibitory control, measured with a Stroop color-word task, and activation in the anterior cingulate cortex while listening to personalized stress cues, an individual’s recounting of his or her own stressful events ( 208 ). As discussed above, it has been hypothesized that childhood maltreatment may increase risk for mood disorders through alterations of the HPA axis and CRF circuits in the brain. Therefore, research aimed at identifying neurobiological changes in function of CRF circuits in the brain that may mediate the relationship between childhood maltreatment and risk for mood disorders and affect disease course, including interactions with recent life stress, is a promising area of investigation.

Recent studies investigating altered function could suggest neurobiological mechanisms of risk but may also suggest possible mechanisms underlying resilience ( 183 ). Functional studies, such as those discussed above, that link functional changes in the brain following childhood maltreatment to mood-related symptoms can provide some clues to help identify mechanisms underlying risk. However, in the absence of longitudinal study of outcomes, these results must still be interpreted with caution. While the majority of studies have been cross-sectional, longitudinal studies are beginning to emerge. Opel et al. ( 209 ) recently reported that reduced insula surface area mediated the association between childhood maltreatment and relapse of depression among 110 patients with unipolar depression followed prospectively. A longitudinal study incorporating structural MRI in 51 adolescents (37% of whom had a history of childhood maltreatment) found that reduced cortical thickness in prefrontal and temporal cortices was associated with psychiatric symptoms at follow-up ( 210 ). Swartz et al. ( 211 ) followed 157 adolescents over a 2-year period and reported results suggesting that early-life stress is associated with amygdala hyperactivity during threat processing, with this finding preceding syndromal mood or anxiety. Longitudinal study of outcomes following childhood maltreatment and underlying neurobiology (predictors and trajectories) is critically needed to identify modifiable targets that confer risk and disentangle mechanisms of risk and resilience.

Only recently have studies investigating childhood maltreatment in bipolar disorder and neurobiological associations begun to emerge. Similar to unipolar depression and other psychiatric disorders, decreased ventral and dorsolateral prefrontal, insula, and hippocampal gray matter volume are reported in individuals with bipolar disorder with a history of childhood maltreatment compared with individuals with bipolar disorder without childhood maltreatment ( 202 , 212 , 213 ). Decreased white matter structural integrity across the whole brain, including lower structural integrity in the corpus callosum and uncinate fasciculus, have been reported in individuals with bipolar disorder who reported having experienced child abuse compared with those who did not and a healthy comparison group ( 214 , 215 ). Interestingly, one study ( 214 ) found that the effects of childhood maltreatment on white matter structural integrity were specific to individuals with bipolar disorder; decreased structural integrity was not observed in healthy comparison individuals with a history of childhood maltreatment compared with healthy individuals without maltreatment. In light of this finding, along with recently published data from other groups ( 216 – 218 ), it is possible that some consequences following childhood maltreatment may be more robust or distinct in some individuals—or that perhaps individuals with a genetic predisposition for mood disorders may be more vulnerable to the detrimental effects of childhood maltreatment.

Altered amygdala and hippocampal volumes are suggested to be differentially modulated following childhood maltreatment in patients with bipolar disorder compared with a healthy comparison group ( 216 ), although interactions with history of treatment (e.g., duration of lithium exposure) cannot be ruled out, as this was not investigated. Souza-Queiroz et al. ( 217 ) found that childhood maltreatment was associated with decreased amygdala volume, decreased ventromedial prefrontal connectivity with the amygdala and hippocampus, and decreased structural integrity in the uncinate fasciculus—the main white matter fiber tract connecting these regions. The bipolar group primarily drove these effects, with only smaller amygdala volume associated with childhood maltreatment in the healthy comparison group. While these findings could be driven by higher rates of maltreatment reported in the bipolar disorder group, or other clinical factors such as medication exposure and history of depressed or manic episodes, they could also suggest interactions between genetic vulnerability to bipolar disorder (or other environmental factors) and neurobiological consequences following childhood maltreatment.

More research is needed to identify genes that may influence neurobiological vulnerability following childhood maltreatment. An example of a potential gene that may mediate this relationship is the serotonin transporter promoter. Genetic variation in the serotonin transporter promoter is associated with differences in structural integrity of white matter in bipolar disorder ( 219 ). Because a large number of studies support the interaction between early-life stress, the serotonin transporter promoter, and disease vulnerability and illness course in depression and bipolar disorder ( 106 – 111 ), this example highlights the potential of genes to contribute to long-lasting structural consequences in the brain following childhood maltreatment in mood disorders. Genetic imaging studies are emerging and suggest gene-by-environment interactions on structural and functional alterations following childhood maltreatment. For example, one study found that hippocampal volume differences following childhood maltreatment are mediated by genetic variation in bipolar disorder ( 202 ). Additionally, polymorphisms in stress system genes, including FKBP5 and NR3C1, are suggested to moderate the effects of childhood maltreatment on amygdala reactivity ( 220 – 222 ) and hippocampal volumes ( 223 ). Studies investigating interactions between familial risk for mood disorders and childhood maltreatment and associated structural and functional changes in the brain would be useful to test whether familial factors (genetic and environmental vulnerability) may interact with childhood maltreatment to alter brain structure and function while avoiding confounders such as medication exposure.

Limitations and Future Directions

A sizable percentage of patients with mood disorders have a history of childhood maltreatment. While the devastating consequences of childhood maltreatment cannot be disavowed, several limitations in research should be noted. Research groups often assess childhood maltreatment differently, and this can result in a measurement bias. Demographic characteristics and differences in assessments (age and sex ratio of participants; clinical versus nonclinical populations being studied; observer-rated versus self-rated depression measures) are all suggested to contribute to differences in prevalence of childhood maltreatment and relation with illness severity ( 12 ). For example, studies using the Childhood Trauma Questionnaire report higher rates of emotional abuse compared with studies using other measures to investigate childhood maltreatment ( 12 ). Further study is warranted investigating the neurobiological mechanisms, underlying genetics, familial factors, and modifiable targets that may drive development of mood disorders following childhood maltreatment. A promising area is network-based approaches to understand this link ( 224 ). Additionally, consequences following different types of maltreatment require further investigation, as different forms of childhood maltreatment may be associated with distinct neural consequences, and a better understanding of these relations is critical for the development of more effective interventions and prevention strategies. For example, Heim et al. ( 225 ) reported that victims of sexual abuse exhibit more alterations in the somatosensory area, whereas victims of emotional abuse exhibit differences in areas mediating emotional processing and self-awareness, including the anterior cingulate and parahippocampal gyrus. More work is needed to investigate whether there are sensitive periods in development when maltreatment has more robust consequences on neurobiology. Humphreys et al. ( 226 ) recently reported that hippocampal volume differences were associated with stress severity during early childhood (≤5 years of age), but there was no association between hippocampal volumes and stress occurring during later childhood. Studies investigating interactions between childhood maltreatment and genetic variation or familial risk for mood disorders could identify mechanisms underlying risk and resiliency in the absence of some study-related confounders (e.g., medication).

Longitudinal studies are critically needed to distinguish what behaviors and mechanisms (genetic and neurobiological) may contribute to risk and whether alterations in behaviors or neurobiology are secondary to mood disorder onset. It is important to emphasize that sex differences likely contribute to outcomes following childhood maltreatment ( 227 ). These include females, compared with males, having a higher risk for internalizing disorders (depression and anxiety) ( 228 , 229 ), greater deficits in neural systems underlying emotional regulation ( 187 , 230 ), and being more susceptible to stress-induced changes in the HPA axis ( 231 ) following maltreatment. Males, compared with females, may be more vulnerable to developing externalizing disorders (conduct disorders and substance use disorders) ( 232 ). However, few studies have investigated sex differences following childhood maltreatment. More research on sex differences is critically needed, including on the underlying neurobiology. As previously reviewed ( 21 ), early-life adversity is associated with increased vulnerability to several major medical disorders, including coronary artery disease and myocardial infarction, cerebrovascular disease and stroke, type 2 diabetes, asthma, and certain forms of cancer. More work is needed on medical morbidities that may increase risk for early mortality following early-life adversity. Additionally, more research is needed on disparities that contribute to, and minority communities that show, elevated rates of early-life adversity. As discussed above, rates of early-life adversity are higher among individuals with developmental disabilities ( 138 – 140 ). Rates of trauma are also higher in youths in the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) community ( 233 ). Few studies have been published in this area. Youths in the LGBTQ community show higher rates of mood disorders, anxiety, suicide, and alcohol and drug use ( 234 ). In a recent study, Rhoades et al. ( 235 ) investigated the relationship between parental rejection, homelessness, and mental health outcomes in LGBTQ youths. Parental rejection was associated with higher rates of homelessness, with experience of homelessness associated with greater feelings of hopelessness, PTSD and depressive symptoms, and greater prevalence of past suicide attempts and more individuals saying they are likely to attempt suicide in the future. More work is critically needed in vulnerable populations, including work focused on interventions that may improve mental health outcomes, for example, interventions that focus on the family unit and interpersonal relationships to foster support and educational interventions, which may decrease peer victimization and cyberbullying ( 236 , 237 ).

In summary, studies converge on and consistently support the finding that childhood maltreatment increases disease vulnerability for mood disorders, as well as a more pernicious disease course. A reduction in the prevalence of childhood maltreatment would have a substantial impact on decreasing disease burden ( 238 ). Studies suggesting modifiable targets are only just beginning to emerge and point to behavioral and environmental factors that could be focused on for early interventions.

Dr. Nemeroff has served as a consultant for Bracket (Clintara), Fortress Biotech, EMA Wellness, Gerson Lehrman Group, Intra-Cellular Therapies, Janssen Research and Development, Magstim, Navitor Pharmaceuticals, Sunovion Pharmaceuticals, Taisho Pharmaceutical, Takeda, TC MSO, and Xhale; he holds stock in AbbVie, Antares, BI Gen Holdings, Celgene, Corcept Therapeutics Pharmaceuticals Company, EMA Wellness, OPKO Health, Seattle Genetics, TC MSO, Trends in Pharma Development, and Xhale; he is a member of the scientific advisory boards of the Anxiety Disorder Association of America (ADAA), the American Foundation for Suicide Prevention (AFSP), Bracket (Clintara), the Brain and Behavior Research Foundation, the Laureate Institute for Brain Research, Skyland Trail, and Xhale and on the boards of directors of ADAA, AFSP, Gratitude America, and Xhale Smart; he has had income sources or equity of $10,000 or more from American Psychiatric Publishing, Bracket (Clintara), CME Outfitters, EMA Wellness, Intra-Cellular Therapies, Magstim, Takeda, TC-MSO, and Xhale; he holds patents on a method and devices for transdermal delivery of lithium (US 6,375,990B1), a method of assessing antidepressant drug therapy via transport inhibition of monoamine neurotransmitter by ex vivo assay (US 7,148,027B2), and compounds, compositions, methods of synthesis, and methods of treatment (CRF receptor binding ligand) (US 8,551,996 B2). Dr. Lippard reports no financial relationships with commercial interests.

Dr. Lippard’s research is supported by NIH grant K01AA027573. Dr. Nemeroff’s research is supported by NIH grants MH117293 and AA-024933.

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• The Association of Abuse and Depression With Suicidal Ideation in Chinese Adolescents: A Network Analysis 28 March 2022 | Frontiers in Psychiatry, Vol. 13
• The Mediating Role of Forgiveness and Self-Efficacy in the Relationship Between Childhood Maltreatment and Treatment Motivation Among Malaysian Male Drug Addicts 11 March 2022 | Frontiers in Psychology, Vol. 13
• Lateral Habenula Beyond Avoidance: Roles in Stress, Memory, and Decision-Making With Implications for Psychiatric Disorders 3 March 2022 | Frontiers in Systems Neuroscience, Vol. 16
• Substance use disorders in bipolar disorders: Clinical correlates and treatment response to mood stabilizers Journal of Affective Disorders, Vol. 300
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• Bipolar Disorder
• Études expérimentales
• The influence of childhood trauma on the treatment outcomes of pharmacological and/or psychological interventions for adolescents and adults with bipolar disorder: A systematic review and meta-analysis Journal of Affective Disorders, Vol. 296
• Dissociative-Traumatic Dimension and Triple Network: An EEG Functional Connectivity Study in a Sample of University Students 17 November 2021 | Psychopathology, Vol. 55, No. 1
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• Effect of a collaborative multidimensional approach versus usual care on the resolution of adult depression in primary care in Chile: study protocol for a single blinded cluster randomized controlled trial 17 February 2022 | F1000Research, Vol. 11
• Neuroinflammation, Early-Life Adversity, and Brain Development Harvard Review of Psychiatry, Vol. 30, No. 1
• Absence of a Healthy Parent: Mental and Physical Illness, Substance Misuse, and Trauma in the Life of Parents, Caregivers, and Significant Others 8 November 2022
• Overview of Psychological and Psychiatric Interventions After Trauma: Counseling, Psychotherapy, and Medications 8 November 2022
• Maltrato infantil y trastorno mental 29 December 2021 | Revista de Psiquiatría Infanto-Juvenil, Vol. 38, No. 4
• The Incredible Years Parenting and Child Treatment Programs: A Randomized Controlled Trial in a Child Welfare Setting in Spain Psychosocial Intervention, Vol. 31, No. 1
• Behavioral and pharmacological interventions for the prevention and treatment of psychiatric disorders with children exposed to maltreatment Pharmacology Biochemistry and Behavior, Vol. 211
• Fatty acid dysregulation in the anterior cingulate cortex of depressed suicides with a history of child abuse 18 October 2021 | Translational Psychiatry, Vol. 11, No. 1
• Feminism, gender medicine and beyond: a feminist analysis of "gender medicine" 3 August 2021 | International Journal for Equity in Health, Vol. 20, No. 1
• Age- and sex-specific effects of stress on parvalbumin interneurons in preclinical models: Relevance to sex differences in clinical neuropsychiatric and neurodevelopmental disorders Neuroscience & Biobehavioral Reviews, Vol. 131
• WITHDRAWN: The influence of psychological abuse on children's aggressive behaviour Aggression and Violent Behavior, Vol. 11
• The association of child neglect with lifestyles, depression, and self-esteem: Cross-lagged analyses in Chinese primary schoolchildren Behaviour Research and Therapy, Vol. 146
• Multiomic biological approaches to the study of child abuse and neglect Pharmacology Biochemistry and Behavior, Vol. 210
• Investigation of the Relationship between Premenstrual Syndrome, and Childhood Trauma and Mental State in Adolescents with Premenstrual Syndrome Journal of Pediatric Nursing, Vol. 61
• Mental disorders and cardiovascular disease: what should we be looking out for? 28 January 2021 | Heart, Vol. 107, No. 21
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• A retrospective study examining the adverse effect of childhood abuse among adult psychiatric service users in Britain 15 March 2021 | International Journal of Mental Health Nursing, Vol. 30, No. 5
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• How childhood trauma and recent adverse events are related to hair cortisol levels in a large adult cohort Psychoneuroendocrinology, Vol. 126
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• Maltreatment
• Posttraumatic Stress

Child Abuse - Essay Samples And Topic Ideas For Free

Child abuse encompasses physical, sexual, emotional abuse, or neglect of a child. Essays on child abuse could delve into the statistical understanding of child abuse incidents, the psychological and long-term impacts on survivors, and the various protective measures and legal frameworks in place to combat child abuse. Moreover, discussions could extend to the systemic issues contributing to child abuse and strategies for prevention and support for survivors. We’ve gathered an extensive assortment of free essay samples on the topic of Child Abuse you can find at Papersowl. You can use our samples for inspiration to write your own essay, research paper, or just to explore a new topic for yourself.

Cause and Effect of Child Abuse

Cause and Effect of Child Abuse Abuse impacts an individual negatively and follows them the rest of their life. Child abuse is horrific as the abuse is often from the very person that is supposed to protect the child. The abuse isn't always physical but can be mental, sexual, and neglectful. Many factors can influence a child's reaction to the traumas that they experience such as age, how far developmentally they are, the type of abuse, how long the abuse […]

Family Violence and Child Abuse

Family Violence and Child Abuse Seldomly do people realize how often child are abused by parents, not always through violence, but in other various factors that can traumatize a child. The textbook Heavy Hands written by Denise Kindschi Gosselin has an entire chapter on child abuse and the different types of abuse that are involved against these children. Historical accounts tell us that children have always been abused and neglected by one or both parents; it is not uncommon or […]

The Effects of Childhood Sexual Abuse

Abstract This paper discusses the effects that childhood sexual abuse has on children. It states the basics and statistics of sexual abuse in children in our society. The immediate symptoms and signs of childhood sexual abuse are discussed as well as long term emotional effects, long lasting physical effects and psychological disorders due to sexual abuse. The treatment of childhood sexual abuse is also discussed to show how positive resources can help victims of sexual abuse. Introduction In the United […]

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A Report of Child Abuse

A report of child abuse is made every ten seconds meaning there are more than 3 million child abuse reports every year. In one study, 80% of 21-year-olds who reported childhood abuse met the criteria for at least one psychological disorder. What is child abuse you might be asking? Child abuse is a physical maltreatment or sexual molestation of a child. You might not know it but there are many cases of child abuse around us some may include family […]

The First Type of Child Abuse

Globally in 2014, 1 billion children aged 2 to 17 experienced physical, sexual, and emotional types of violence, according to www.compassion.com. Millions of children around the world are being abused by someone they know and are meant to trust. This includes parents, grandparents, siblings, and close family and friends. These children, very young in age, often don't understand why they are being mistreated. There are many different types of abuse. I chose to discuss this topic because I feel deeply […]

Social Problems that Existed in 19th a 20th Century

A social problem basically refers to a state of difficulty experienced by members of a given society which makes them unable to reach their goals as individuals and the society at large. Social problems may have direct or even indirect effects on the people and such problems include substance abuse, poverty, poor hosing infrastructures, criminal activities, and unemployment's, and lack of properly balanced diet leading to malnutrition among others. Between 19th and 20th century, there were many social problems which […]

Child Abuse has been a Major Problem

Child abuse has been a major problem for a long time and most people are completely unaware of this act. This act affects many children and no one really knows what goes on behind closed doors with parents and their child. This is scary to think about, but this is reality and children are put through this everyday. Parents need to be aware that this act is not tolerable and can not be accepted. It is everyone's job in today's […]

Child Abuses Defines the Mistreatment

Child abuses defines the mistreatment of a child. Abuse comes in many different forms (sexual, physical, mental, emotional). While the primary reason for this is unknown, there are many speculations over what causes a parent to act out in such a way of violence, however, it is believed that abuse is a cycle that will never truly end. The mental effects of child abuse can last a lifetime because it manifests itself in many ways such as anxiety, depression and […]

How are Fast Food Advertising and Childhood Obesity Related

By 1950s, fast food industry boom was in full swing. It was secured in 1951. In the 1950s, McDonald has become a staple of the American diet. Fast food restaurants have been grown more and more and by now, there are over one hundred and sixty thousands fast food restaurants in the United States, becoming a one hundred and ten billion dollar industry. One can’t deny that fast food has become really important in American life nowadays. Whether Americans are […]

Child Abuse has Many Impacts

Child abuse has many impacts towards the child and can cause a long term defect for the child's future. Nationwide over 2 million children suffer from child abuse, some will even die from neglect or by unmeasurable physical abuse. The supreme court does not have a constitutional law against child abuse, but they hold each state accountable to make their own child abuse laws (D.O.). Most of the laws set by each state have the same proposal about what is […]

Child Abuse is Widespread

Child abuse is widespread and can occur in any cultural, ethnic, or income group. Child abuse can be physical, emotional, verbal, or sexual. While child abuse is often in the form of an action, there are also examples of inaction that cause harm, such as neglect. Outcomes of child abuse can result in both short and long-term injury, and even death. Child abuse can result from physical, emotional, or sexual harm. Physical abuse involves the intentional harming of a child […]

Children and Domestic Violence

Domestic Violence has effected and still continues to effect the lives of many individuals. Statics on domestic violence states Every 9 seconds in the US a woman is assaulted or beaten Domestic violence is not only found amongst adults but even children and teenagers are victims of domestic violence or are the abuser in an abusive violent relationship .To briefly define and understand Domestic violence, it is an abusive relationship between individuals who abuse one another, aggressively, physically and even […]

Child Abuse and Neglect

English Composition Final Proposal Essay: Child Abuse and Neglect There have been countless studies focused around how the mind of a child is warped when transitioning into their adulthood after experiencing neglect and abuse. It's evidently very difficult for a victim of this certain issue to forget their traumatic experiences, ultimately impacting their physiological and physical health. Child abuse and neglect refer to any harmful behavior by caregivers, parents, legal guardians, and other adults that is outside the norms of […]

Child Abuse VS Discipline

Adults consider having children and acknowledge that it comes with commitments. As parents, one most significant consideration is how to discipline our kids to do what is right and avoid doing wrong. Love, values, and moral ethics are attributes some parents use to discipline their children. Other parents exercise discipline towards their children by assuming the authoritative parenting style whereby they offer the most incredible combination of discipline and love while being compassionate without domineering and yet having firm authority. […]

National Center on Child Abuse

According to the Staus, over 14 out of every 100 American children, ranging from 3 to 17, are subjected to abusive violence each year. This means that approximately six and a half million are abused each year in the United States out of the 46 million children that are categorized into the age group 3 to 17. These statistics are different from the statistic represented by the U.S. National Center on Child Abuse. According to the U.S. National Center on […]

The Effects on Child Abuse

The Effects on Child Abuse in Children Like many children, Pete thought physical abuse he suffered was normal from his mother. In the article, Pete's story, Pete explains his tragic memories from his mother, My earliest memory of my mum's temper is from when I was a toddler, and she was throwing books down the stairs at my dad. I was so young at the time that I thought it was a game. When my dad moved out, when I […]

Childhood Poverty

Abstract Poverty is viewed throughout the world as a large social problem that continues to advance with time. Since 1960, poverty has continued to flourish into a problem that has affected a large majority of the population, including our children. Childhood poverty affects the psychological and biological development, as well as three main levels of social systems: micro, mezzo and macro. Even though there has been active research on poverty, generational poverty and childhood poverty, no active changes have been […]

Child Abuse and Neglect Refers

It is estimated that from 1.2 to 3 million children in the United States have been victims of child abuse and neglect annually, representing 2% to 5% of American children from birth to age 18 (National Research Council). Child abuse and neglect occur during a child's most formative years, affecting the child's growth and development, as well as their social, emotional, and cognitive development. The effects of child abuse and neglect can last into adulthood. By definition, child abuse is […]

Factor of Child Abuse

The uprising in child abuse cases in America is forcing the country to open its eyes and investigate the underlying issue. Psychologist, social workers, law enforcement and researcher are all working hand and hand to combat the dilemma, yet all face the puzzling question “Why does this continue happen? And “Where does the issue stem from?”. These are two question that once solved could substantially decrease cases of child abuse. Erik Erikson in 1963 was one the first to divulge […]

Child Abuse is Happening

Child abuse is happening all over the world.The major abuse in are society is child abuse more than 80 percent has child abuse in are world.America has to stop child abuse in are country.Nearly more than a thousand plus more children was victims of child abuse or neglect.Child abuse has ruined the worlds of little children,More parents are abusing children and hurting their lives with abusing them. Child abuse can be prevented. People can prevent child abuse by training parents,getting […]

Child Abuse: Battling Neglect and Seeking Understanding

"Childhood should be carefree, playing in the sun; not living a nightmare in the darkness of the soul," (Pelzer). A child should never have to question, "Does my mommy or daddy love me?" or "Why was I not good enough?" Those are the questions that ran through the back of my mind for many years. Though I never quite understood why I had these fears of being alone and abandonment. My biological parents brought me home from the hospital when […]

Early Childhood and the Effects of Abuse and Neglect

Child abuse, neglect, or maltreatment and even intimate partner violence are all considered to be factors with negative effects for children. Neglect or maltreatment leads to many forms of abuse. Some of these are domestic violence, sexual abuse, and emotional abuse. These could impact a child's overall health if not treated early. More so, if children are not treated with therapy at an early stage, serious mental health issues could develop when children become adolescents. It has been stated that […]

Child Abuse and Neglect and Negative Physical Health

The topic of the research paper is the child abuse and neglect and negative physical health. Both of these topics are very important to look into and research. One reason would be to find out consequences, because the consequences of child abuse and neglect can be very extensive and may not only affect the victim's mental health, like it is known to do, but also possibly their physical health which may often be overlooked because it can take longer to […]

Child Abuse Means a Physical Maltreatment

Child abuse means a physical maltreatment or sexual molestation of a child. When a child is starting to experience abuse, they change. They suddenly don't show affect for a certain relative or they don't want to go over to that relative's house. They get an attitude or change their behavior. Most people just see this as they are growing up and rebelling. When children start making sexual remarks or start displaying sexual behaviors with other young children, those are signs […]

Catherine Roerva: a Complex Figure in the Narrative of Child Abuse

Catherine Roerva, a name that has become synonymous with the heart-wrenching narrative of child abuse in Dave Pelzer's memoir "A Child Called 'It'," stands as a controversial and complex figure in the realm of autobiographical literature. Pelzer's portrayal of his mother as an abusive figure has sparked discussions and debates about the nature of abuse, the dynamics of family dysfunction, and the resilience of the human spirit in the face of adversity. This essay aims to explore the multifaceted character […]

Child Abuse by Maid: Unmasking a Hidden Threat

Every parent's nightmare? Trust someone with their child, only to discover that trust might've been misplaced. Now, imagine this breach of trust coming from someone right within your home — the maid or nanny you believed would care and nurture. A topic we often tiptoe around, preferring the comfort of ignorance, is child abuse by those entrusted to care for them. Let's shed light on this hushed matter, not to provoke fear but to arm ourselves with awareness and action […]

Adverse Childhood Experiences and their Effects on High School Graduation Rates

Introduction The startling effect adverse childhood experiences (ACEs) have on children and adults came to light in a groundbreaking study first published twenty years ago. Andra et al. reported a strong link between exposure to abuse, divorce, substance abuse, and more to several health risk factors in adults (1998). The Adverse Childhood Experiences (ACE) Study opened our eyes to the long-term impact of direct and indirect abuse and how child did not have to be abused themselves to suffer serious […]

Child Abuse in India: Unveiling the Harsh Realities

Child abuse. Two words, heavy implications. But let's not just gloss over them—especially when discussing a country as vast and multifaceted as India. With its rich tapestry of cultures and traditions, India showcases unity in diversity. But beneath these layers, there are some unsettling truths we cannot and should not ignore. Among them? The lurking shadow of child abuse. It's not an easy topic. Even bringing it up feels like wading into stormy waters. But if we're aiming for a […]

Gap between Health Care and Child Abuse

Disparity: The Gap between Health Care and Child Abuse The disparity gap between health care and child abuse has the potential to impact a professional's life in an emotional way. Besides legal practices and the training undergone to protect a child from child abuse, professionals have gone through previous studies that have determined the emotional and psychological doubts that professionals go through at the time to report child abuse. The three research papers that I have chosen that contribute to […]

Domestic Violence with Children

Even though domestic violence for adults is harmful enough to lead to suicide children play a tremendou role in this by affecting their development growth and high risk of depression, Exposure to domestic violence impact children in different types of ways because children exposed to domestic violence usually never recover from it and can follow up to affect their future family and this affects children's education, social, emotional, and behavioral growth though it's different with every kid. According to the […]

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How To Write an Essay About Child Abuse

Understanding child abuse.

Before writing an essay about child abuse, it's essential to understand its forms and implications. Child abuse refers to any emotional, physical, or sexual harm inflicted on a child by an adult or older adolescent. It can also include neglect, where a child's basic needs for safety, affection, and education are not met. Begin your essay by defining the different types of child abuse and their characteristics. Discuss the prevalence of child abuse and the various factors that contribute to it, such as family stress, substance abuse, and historical abuse within the family. Understanding the psychological, physical, and social impact of abuse on children is crucial for a comprehensive analysis of this topic.

Developing a Thesis Statement

A strong essay on child abuse should be centered around a clear, concise thesis statement. This statement should present a specific viewpoint or argument about child abuse. For instance, you might discuss the long-term psychological effects of child abuse, analyze the societal factors contributing to its prevalence, or argue the need for improved child protection policies and interventions. Your thesis will guide the direction of your essay and provide a structured approach to your analysis.

Gathering Supporting Evidence

To support your thesis, gather evidence from credible sources such as child welfare studies, psychological research, and statistics from child protection agencies. This might include data on the incidence of child abuse, findings from studies on the effects of abuse, or examples of successful intervention programs. Use this evidence to support your thesis and build a persuasive argument. Remember to consider different perspectives and address potential counterarguments to your thesis.

Analyzing the Effects and Responses to Child Abuse

Dedicate a section of your essay to analyzing the effects of child abuse and society’s response to it. Discuss the short-term and long-term impacts on a child's physical health, psychological well-being, and social development. Explore the role of child protective services, legal systems, and non-governmental organizations in responding to and preventing child abuse. Consider both the successes and challenges faced in addressing child abuse.

Concluding the Essay

Conclude your essay by summarizing the main points of your discussion and restating your thesis in light of the evidence provided. Your conclusion should tie together your analysis and emphasize the importance of addressing child abuse both as a societal and individual issue. You might also want to suggest areas for future research, policy development, or public education campaigns to prevent child abuse.

Reviewing and Refining Your Essay

After completing your essay, review and refine it for clarity and coherence. Ensure that your arguments are well-structured and supported by evidence. Check for grammatical accuracy and ensure that your essay flows logically from one point to the next. Consider seeking feedback from peers, educators, or professionals in the field of child welfare to further improve your essay. A well-written essay on child abuse will not only demonstrate your understanding of the issue but also your ability to engage with a sensitive and complex social problem.

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123 Child Abuse Research Topics & Essay Examples

📝 child abuse research papers examples, 💡 essay ideas on child abuse.

• ✍️ Child Abuse Essay Topics for College

🏆 Best Child Abuse Essay Titles

🎓 simple research topics about child abuse, ❓ child abuse research questions.

• Posttraumatic Stress Disorder: Effects of Child Sexual Abuse Psychology essay sample: Child sexual abuse is among the common problems facing children. This paper looks at the causes and effects of child sexual abuse, the posttraumatic stress disorder, and its treatment.
• Family Violence: Adult-Child Sexual Abuse Psychology essay sample: This paper explores the risk and protection factors for child abuse in the light of Macro-system, microsystem, mesosystems; and programs that target the prevention of child abuse.
• Childhood Sexual Abuse and Its Impact on Future Life Psychology essay sample: The paper explores how sibling incest and childhood sexual abuse affect persons’ interpersonal relationships and adulthood sexual functioning.
• Child Abuse: Perpetrated by Parents on Children Psychology essay sample: ‘Child neglect’ is an ambiguous and all-encompassing term used to describe actions perpetrated by parents on children which are universally deemed harmful by society.
• The Link Between Child Abuse and Delinquency Psychology essay sample: Five elements of parenting that can be positive or negative influences include: Discipline, Monitoring, Reinforcement, Involvement and Problem-solving.
• Social and Emotional Outcomes of Child Abuse Psychology essay sample: This can be further and in a meaningful manner determine the results by paying attention to a sound and the experience of the child.
• Understanding Child Abuse and Neglect Psychology essay sample: A paper explores reasons for the prevalence of child abuse in society and possible remedies. Child abuse is an activity that subjects a child to physical, emotional, or sexual trauma.
• Child Advocacy. Keeping an Eye Out Psychology essay sample: In the current social settings, the voice of young people and particularly children have been occasionally neglected.
• Child Sexual Abuse Issue Review Psychology essay sample: Posttraumatic stress disorder, increased stress levels and poor health in individuals are some of the long-term effects of child sexual abuse.
• Catholic Church and Child Sexual Abuse Allegations Psychology essay sample: Over the last two years, the Catholic church has come under a lot of criticism due to allegations of its priests sexually assaulting children in their congregation.
• Abuse and Neglect: An Orientation Psychology essay sample: Child abuse and neglect are severe issues, affecting the most vulnerable section of the population and often causing permanent trauma.
• Bullying Children: The Analysis of Various Examples Psychology essay sample: This discussion provides a detailed analysis of various examples of bullying and some of the evidence-based strategies to prevent the malpractice.
• Child Neglect and Abuse: Causes, Effects, Prevention, and Treatment Psychology essay sample: Child maltreatment is a broad and complex concept that entails a wide range of problematic issues, including neglect, sexual, physical, and emotional abuse.
• Should There Be a Law Banning Spanking of Children Psychology essay sample: Spanking is a disciplinary method that has over the years been fought against in many countries, spanking has a long-run negative effect on the child.
• The Children Abuse and Social Behavior Psychology essay sample: This research paper will define child abuse, review the statistics and other data on the topic and discuss the impact of abuse on the social behavior of children.
• The Level of Abuse to Children Psychology essay sample: This paper highlights the extent of child abuse cases in our society with a special focus on its relation to our culture.
• The Long-Term Impact of Abuse and Neglect on Children Psychology essay sample: The purpose of this paper is to explain the impact of abuse on children, examine how different types of abuse impact a child’s cognitive and socio-emotional development.
• Child Abuse: The Case Study Psychology essay sample: The abused child is vulnerable because he needs parental care more than any sort of support does. In fact, providing support only caters for the physical aspects of the problem.
• Neglect and Abuse in "Romanian Orphanage" Video Psychology essay sample: This article focuses on the video "Romanian Orphanage" - a good example of how emotional neglect negatively affects the development of young people.
• Child Abuse and Neglect in Daycares Psychology essay sample: Millions of children face acts of negligence in various forms. During the tender age, the child needs and depends on the parent or caregiver critically.
• The False Memories of Abuse in Sexual Child Abuse Psychology essay sample: In circumstances where a child is sexually abused theirs follows trauma on the child leading to a series of memories that occur from time to time.
• Child Abuse and Elder Abuse Psychology essay sample: Child and elder abuses are worldwide problems that are on the increase. The paper represents two recent criminal cases, one of child abuse and the other of elder abuse.
• Child and Elder Abuse Are Underreported Psychology essay sample: Elderly abuse and child abuse take different forms, including physical and psychological. The paper discusses how and why elder abuse and child abuse are underreported.
• Childhood Trauma Etiology Associated With Social and Mental Disorders Psychology essay sample: This paper will showcase the five themes that were revealed during the review process to better understand the associations between childhood trauma and various disorders.
• Identifying Child Abuse and Neglect: Teacher Training Psychology essay sample: Apart from physical and psychological trauma, the experience of abuse or neglect impacts executive functioning and cognitive skills, potentially causing difficulties in learning.
• Child Emotional Neglect and Its Risk Factors Psychology essay sample: Child emotional neglect is a common phenomenon observed in terms of raising healthy children. Negligent parents experience the same attitude from their parents in childhood.
• Childhood Traumatic Experience Psychology essay sample: This paper examines the effect of childhood traumas on adulthood, including cognitive abilities, social behavior, and mental health, through the prism of scientific evidence.
• Physical Punishment as an Ineffective Way to Influence a Child Psychology essay sample: Physical punishments such as spankings always have a more comprehensive range of consequences that increase aggressiveness and violence.
• Child Abuse and Neglect: “A Child Called It” Psychology essay sample: This paper compares symptoms of abuse detailed within the work by Dave Pelzer known as “A child called It” and analyzes them using recognized guidelines for child abuse victims.
• Sexual and Emotional Child Abuse Examination Psychology essay sample: This paper focuses on the issues of sexual and emotional aggression towards children in their homes, discussing relevant concepts, and abuse statistics.
• Experience of Childhood Trauma from Child Abuse/Maltreatment Psychology essay sample: This paper aims to analyze the experience of childhood trauma from child abuse/maltreatment, outcomes included, and relevant literature search results and annotated bibliography.
• Child Abuse and Depression Psychology essay sample: This essay argues that neglect, emotional distress, and limited access to psychological treatment during childhood alleviate depression and other mental conditions.
• Childhood Maltreatment and Behavior Problems Psychology essay sample: The research centers on examining whether or not early childhood maltreatment (before the age of four) affected the long-term behavioral deviations.
• Early-Life Stress and Behavioral Outcomes Psychology essay sample: The study aims to understand the mechanisms behind the long-lasting consequences of early-life stress exposure. It is accomplished by comparing the results of tests.
• Child Abuse: Corporal Punishment, Intimidation Psychology essay sample: The paper describes that the problem of violence and ill-treatment of children in the family today is an issue that needs to be discussed and taken measures to solve.
• Suicidal Ideation as a High-Risk Event Psychology essay sample: People with a tendency toward suicidal ideation represent one of the largest high-risk populations because thoughts of death affect a high percentage of humans.
• Child Neglect and Its Impact on Self-Esteem of a Young Adult Psychology essay sample: The investigation of the theme of child neglect and its mediating effect on the self-esteem of young adults can be conducted with the help of a quantitative questionnaire.
• Spanking as a Punishment Method Psychology essay sample: Raising children is arduous as parents are tasked with introducing their children to society and acceptable norms of behavior in it.
• Death Due to Childhood Abuse and Household Dysfunction Psychology essay sample: The paper discusses how health risk behavior and various diseases in adults are related to household dysfunction and different types of abuse during childhood.
• Complex a Child Abuse Situation Psychology essay sample: The case of James is a unique illustration of how complex a child abuse situation can become due to the involvement of a multitude of parties.
• Experience of Trauma from Child Maltreatment Psychology essay sample: Summing up the findings of various researchers as well as using databases, studies confirm an undeniable influence of maltreatment on the later development and life of a child.
• Child Abuse and Attention Deficit Hyperactivity Disorder Psychology essay sample: The given case illustrates child abuse and neglect as a problem involving not only a child and a parent but also grandparents.

✍️ Abuse Child Essay Examples for College

• Child Maltreatment: Background Psychology essay sample: The phenomenon of child maltreatment in the home setting is thoroughly examined by researchers, who intend to present a link between the unhealthy environment in families.
• Impacts of Physical Trauma on Children and Family Psychology essay sample: In the presented scenario the main recipient of physical trauma as a result of abuse is Kolomalu. It discusses the short-term impacts of physical abuse.
• Profiles of Childhood Trauma and Psychopathology Psychology essay sample: This article presents the results of studying the long-term effects of childhood traumas and reveals a connection between types of traumas and mental disorders.
• Child Maltreatment Factor of Personality Formation Psychology essay sample: This research aims to analyze the external factors involved in developing personality formation, particularly race and ethnicity.
• Growth Mindset Considering Spanking Issue Psychology essay sample: On the basis of learning, I have changed my belief related to the spanking of children that had been previously regarded as a common and even beneficial practice.
• Mental Health of Children: A Study of Human Rights Violations Through Terrorism Psychology essay sample: It can be concluded that there is a direct interlink between terrorist acts and various mental health disorders, including those among children, who are highly prone to mental trauma.
• The Problem of Child Abuse and Maltreatment Psychology essay sample: In this paper, the authors focus on how corporal punishment may lead to abusive acts, injury, and maltreatment among children and adolescents.
• Preventing Child Maltreatment by Caregivers Psychology essay sample: In the paper, the strategies to reduce maltreatment involving older children by promoting healthier interactions between them and their caregivers.
• Long-Term Outcomes of Childhood Sexual Abuse Psychology essay sample: The paper reviews the literature providing information on the psychological, psychiatric, and physical outcomes of child sexual abuse.
• Sexual Violence and Mental Health Effects Psychology essay sample: Sexual violence is widespread and is used even against children. There are treatment options for negative mental health effects for sexually abused children.
• Childhood Trauma and Attachment Theories Psychology essay sample: Childhood trauma is a life-threatening and violent event in a child's life. It significantly impacts a person's behavioral and emotional functioning.
• Bullying: Collaborating with Parents to Increase Proactive Bystander Message Psychology essay sample: Bullying could potentially lead to anxiety, depression, and post-traumatic stress. These symptoms could be typical also to the bystanders.
• Secondary Post Traumatic Stress Disorder in Children Psychology essay sample: Understanding child PTSD is fundamental in determining or predicting the future tendencies and outcomes of future life in terms of health, behavior, and social well-being.
• Codependence, Narcissism, and Childhood Trauma: Analysis of Article Psychology essay sample: In their research, the authors wanted to test the concept of codependency and how it is relevant to real-life situations.
• Childhood Trauma: Causes, Effects, and Preventive Measures Psychology essay sample: It is salient to understand the causative factors and the effects of childhood trauma while also highlighting applicable preventive measures.
• The Child Maltreatment and Anxiety Relationship Psychology essay sample: This paper discusses the impact of maltreatment on children's well-being and protects their physical and psychological health and research brings attention to the problem.
• Prevention of Child Abuse and Neglect Psychology essay sample: Child abuse and neglect are cases when an underaged individual's emotional needs are overlooked and three out of eight children in the United States are affected by this problem.
• Spanking Is Detrimental and Should Be Outlawed Psychology essay sample: Spanking teaches children ways of avoiding being caught instead of generating forms of positive behaviors. It is detrimental to children and should be outlawed.
• Children’s Mental Health: Codependency and Alcoholic and Narcissistic Parents Psychology essay sample: The concept of codependency is one of the recurring themes in the discussions of childhood struggles, caused by alcoholic and narcissistic parents.
• Trauma and Its Effect on Children Psychology essay sample: The paper examines the notion of trauma and its effect on children. Moreover, it looks into the consequences, causes, reactivation of trauma, and prospective treatment.
• Child Abuse and Special Needs or Behavioral Challenging Children
• Child Abuse Has Severe Negative Psychological Effects on Children
• The Characteristics and Forms of Child Abuse: Physical Abuse, Physical Neglect, Sexual Abuse, and Emotional Abuse
• Child Abuse Detection by Healthcare Professionals Discussions of violence against children have always been challenging in the healthcare context due to the significant trauma to which young minds are being subjected.
• Child Abuse Potential: Correlates With Child Maltreatment Rates and Structural Measures of Neighborhoods
• Child Abuse and Children Can Be Saved From Experiences
• Connection Between Child Sexual Abuse & Dissociative Identity Disorder
• Child Abuse as a Major Social Dilemma Healthcare professionals examine possible signs of child abuse and offer adequate education to empower more members of the community to deal with this problem.
• The Reasons and Factors Contributing to Child Abuse in Our Society
• Child Abuse and Adolescent Dating Violence
• Defining Child Abuse With the Aid of a Case Study
• Contemporary Quebec Cinema Social Problem of Child Abuse Child abuse and neglect have been an issue that has occasionally gained attention and measures to address them.
• Approaching Child Abuse from a Multi-Dimensional Perspective
• The Fine Line Between Child Abuse and Parental Punishment with Justification
• Behind Closed Doors: The Correlation Between Multiple Personality Disorder and Child Abuse
• How to Prevent Child Abuse Child abuse is one of such delicate topics that arise several controversies and discussions. Violence against children is a serious and widespread problem.
• Protecting Our Children from Domestic Violence and Child Abuse
• Juvenile Who Commit Homicide or Parricide and the Presence of Child Abuse
• Child Abuse and Children Are Being Abused Each Day
• The Factors Involved in Child Abuse This paper is aimed to designate all factors involved in the cause-and-effect connection of main variables making more or fewer impacts on this problem.
• Child Abuse and Neglect: Recognizing the Signs and Symptoms
• The Inspiration and Enlightenment from the Film Confronting Child Sexual Abuse
• Early-Intervention Service for Non-Abusing Parents of Victims of Child Sexual Abuse
• Child Abuse Trauma: Theory and Treatment There are also instances when children undergo intense catastrophes that may alter the rest of their lives. One example of these life-altering catastrophes is child sexual abuse.
• Child Sexual Abuse: The Repressed Memories Recovered
• Describing Child Abuse, Its Different Forms, and Solutions to the Problem
• Child Abuse and Lack of Communication in Marriages the Main Factors of Failed Family
• Socioeconomic Conditions Can Lead to Physical, Emotional, and Sexual Abuse of Children Wealth, access to education, parents’ occupation, health, income, and housing are significant in avoiding child abuse. Discussion of the importance of socioeconomic conditions.
• Long and Short-Term Consequences of Child Abuse and the Different Treatment
• Child Abuse and Its Effects on Social And Personality Development
• Child Abuse and How it Relates to the Developmental Stages
• Child Abuse and Maltreatment Is Not Limited to a Particular Age and Can Occur in the Infant, Toddler, Preschool, and School-Age Years
• Dealing with the Growing Concern About Child Sexual Abuse in Our Society
• Child Abuse and Its Effects on the Physical, Mental, and Emotional State of a Child
• Mandated Reporters’ Statute in Child Abuse Case Texas-mandated reporter statute requires any individual with knowledge of suspected child abuse or neglect to communicate this information to the appropriate authorities.
• Children are Suffering From a Hidden Epidemic of Child Abuse and Neglect
• Family Interventions With Child Physical Abuse and Neglect
• Child Abuse and Its Effects on Our Nation’s Most Serious Public Health
• Canadian Law: Systematic and Methodical Inquiry in to Child Abuse Canada became a U.N. Convention signatory in 1991 and agreed to uphold the rights of children. Canada is therefore accountable with regard to children’s rights.
• Child Sexual Abuse, Sexual Coercion in College, and the Effects of Intervention
• Treatment For Women Survivors Of Years of a Child Abuse
• International Society for the Prevention of Child Abuse and Neglect
• Criminal Law Crimes Against Children The paper looks at the criminal offenses committed against children, laws safeguarding the rights of children and ways of protecting a child from abuse.
• Child Abuse Leads to Anxiety and Social Disorders
• Child Abuse Too Much or Too Little Emphasis in Today’s Society
• Adverse Effects and Prevention of Child Abuse Social Work
• The Difference Between Child Abuse and Child Discipline
• Modern Beliefs Regarding The Treatment Of Child Abuse Victims
• Mass Media’s Role and Possible Solutions on Child Abuse
• The Relationship Between Child Abuse and Adult Psychopathy
• Are There Any Biomarkers for Pedophilia and Sexual Child Abuse? A Review.
• How Childhood Sexual Abuse Affects the Child Through?
• Should Pregnant Drug Abusers Be Charged With Child Abuse?
• Why are Child Victims of Sexual Abuse at Greater Risk of HIV?
• When Does Discipline Cross the Line to Child Abuse?
• How Children Carry the Weight of Child Abuse?
• Why Child Abuse Should Be Addressed as a Social Problem?
• How the Government and Society have a Responsibility to Help Child Abuse Victims?
• What are the Negative Effects of Child Abuse?
• When Should Teachers Report Child Abuse?
• Why Might the Experience of Child Sexual Abuse Lead to Mental Health Problems in Adulthood?

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106 Child Abuse Essay Topics

🏆 best essay topics on child abuse, ✍️ child abuse essay topics for college, 🎓 most interesting child abuse research titles, 💡 simple child abuse essay ideas, ❓ child abuse research questions.

• Child Abuse: Risks, Causes, Effects, Treatment
• Child Abuse and the Minimalist and Maximalist Perspectives
• Preventing Child Abuse and Neglect
• The Portrayal of Child Abuse and Neglect in Media
• Identifying Child Abuse Scenario
• Child Abuse and Neglect in Ukraine
• Problem of Child Abuse in Modern Society
• Child Abuse Management: Multidisciplinary Approach This paper investigates the efficacy of multidisciplinary and non-multidisciplinary approaches in child abuse management.
• Impact of Child Abuse and Neglect on Perception of Reality in Adulthood Child abuse is a serious societal issue in the present socioeconomic situation of the majority of households worldwide.
• Child Abuse and Family Violence: A Personal Response In the author’s opinion, child abuse and family violence can be compared with a malignant tumor that slowly poisons and erodes the foundations of society.
• Causes and Results of Child Abuse Child abuse can be emotional, sexual, and physical, but all its forms may lead to severe psychological problems. The effects vary from social discomfort to dangerous pathologies.
• Child Abuse Problem and Perspectives on Child Abuse The abuse can be emotional, physical, or sexual. It can be an act of omission or commission that results in harm, potential for harm or threat of harm to a child.
• Child Abuse in the Clothing Production Bangladesh’s garment production is projected to quadruple over the next twenty years, which means that millions of new women, young and old, will enter the garment industry.
• Different Types of Child Abuse There are different types of child abuse. Only half of all cases are associated with physical violence. Neglect, beatings, and rape are the most common types.
• Child Abuse Problem Overview According to social statistics that focus on child abuse and neglect rates in the United States based on victims’ race and ethnicity, it is possible to notice huge disparities.
• Medical Examination for Children with Allegations of Child Abuse There are several functions of medical examination. They include collecting and documenting physical evidence of child abuse.
• Mandatory Reporting in Child Abuse and Neglect Mandatory reporting is the responsibility given to specific individuals in different states in the United States to report cases of child abuse and neglect to the responsible governmental bodies.
• Child Abuse, Sexual Assault and Domestic Violence The paper analyzes three types of victimization: child abuse, sexual assault and domestic violence. It gives definitions, describes causes and effects of these crimes.
• Child Abuse and Ways for Its Elimination This paper will discuss the problems of violence in various forms of manifestation to find the causes of their occurrence and a solution for them.
• Child Abuse or a Parental Discipline According to the state laws within the United States, physical discipline is recommended if it is solely for discipline and does not lead to the injury of a child.
• The Problem of Child Abuse A practical approach to dealing with child abuse is to tackle the social, economic, and human factors that contribute to its prevalence.
• Child Abuse and Its Impact on Society One of the most pressing issues affecting children worldwide is child abuse, which has garnered the attention of countries internationally.
• Advocacy for Negligence and Child Abuse Amongst Black Teenagers Negligence and abuse amongst black teenagers require rehabilitation therapy and parental counseling to prevent further negative effects.
• Child Abuse: Keep Kids Safe Child abuse is a case when a parent or guardian, regardless of whether through activity or neglecting to act, causes injury, intended damage, or danger of genuine mischief.
• Shaken Baby Syndrome and Child Abuse The attention of the world was first drawn to the shaken baby syndrome in the widely covered trial of Louse Woodward, a British nanny accused of killing Matthew Eappen, her charge.
• Different Factors and Approaches of Child Abuse and Neglect The discussion centers on the 5 articles cited that relate to child abuse and neglect. Important points are provided to identify the ideas of the reporters in the articles accordingly.
• Child Abuse and Health of Nation: Cause and Effect The fact is that today, regardless of multiple attempts to create a beneficial environment for children, many of them experience various forms of domestic violence.
• The Canadian Incidence Study of Reported Child Abuse Preventing child abuse or addressing it promptly is much more efficient than handling the consequences which find their way into adulthood.
• Child Abuse: Physical, Emotional, Social Effects The effect of child abuse and abandonment is repeatedly debated in regards to physical, emotional, interactive, and social significances.
• Health Data Reporting: Child Abuse and Security Breaches The healthcare organization at times are obliged to report not only information related to the health status of a population but also to the security of healthcare data.
• Long-Term Consequences of Child Abuse and Neglect Child abuse can be manifested in different forms; however, the most common forms are physical, emotional, and sexual harassment.
• Adverse Effects and Prevention of Child Abuse
• Child Abuse and Its Effects on Thousands of Children in the United States and Around the World
• Behind Closed Doors: The Correlation Between Multiple Personality Disorder and Child Abuse
• Child Abuse and Its Role in “Bastard Out of Carolina” by Dorothy Allison
• Approaching Child Abuse From a Multi-Dimensional Perspective
• Child Abuse and Lack of Communication in Marriages – The Main Factors of Failed Family
• How Child Abuse Affects a Hero, a God, and a Monster in Greek Mythology
• Child Abuse and Neglect Is Not About Being Psychical
• Physical and Emotional Child Abuse and Neglect: The Effect on Physical, Emotional, and Social Development
• Defining Child Abuse and Its Different Forms in the 21st Century
• Child Abuse and Neglect: Recognizing the Signs and Symptoms
• Localities, Social Services, and Child Abuse: The Role of Community Characteristics in Social Services Allocation and Child Abuse Reporting
• Promoting Help for Victims of Child Abuse: Which Emotions Are Most Appropriate to Motivate Donation Behavior
• Child Abuse and the Importance of Belonging Discussed in David Pelzer’s “A Child Called It”
• How Child Abuse Has Been Conceptualized and Addressed in Terms of Policy and Law Since 1945
• When Child Abuse Overlaps With Domestic Violence: The Factors That Influence Child Protection Workers’ Beliefs
• The Developments, Forms, and Perception of Physical Child Abuse Through History
• Mass Media’s Role and Possible Solutions to Child Abuse in the Philippines
• Child Abuse: Cause and Effect on the Rest of Their Lives
• Risk Factors for Child Abuse and Neglect Among Former TANF Families: Do Later Leavers Experience Greater Risk?
• Child Abuse Prevention and Control: Can Physical, Sexual or Psychological Abuse Be Controlled Within the Household?
• The Impact and Consequences of Child Abuse and Its Portrayal in Mark Twain’s Novel “The Adventures of Huckleberry Finn”
• The Social Worker’s Role in Preventing Child Abuse and Neglect
• Child Abuse: Too Much or Too Little Emphasis in Today’s Society
• How the United States Is Dealing With Child Abuse Problem
• Causes and Long-Term Consequences of Child Abuse and Neglect
• Neighborhood Poverty and Child Abuse and Neglect: The Mediating Role of Social Cohesion
• Child Abuse and How It Relates to the Developmental Stages of Erickson
• Dealing With the Effects of Child Abuse, Overcoming Obstacles, and Friendship in Barbara Kingsolver’s “The Bean Trees”
• Neo-Liberal and Neo-Conservative Perspectives on Child Abuse
• Child Abuse and Neglect of a County Welfare Department
• The Gap Between Child Abuse and Parental Discipline
• Child Abuse and Neglect: The Need for Change
• Exposing Child Abuse and Neglect – Physical Violence Against Kids
• Child Abuse and Its Effects on the Physical, Mental, and Emotional State of a Child
• The Effect of Child Abuse and Neglect in an Urban Community
• Child Abuse and Neglect: A Social and Public Health Concern Worldwide
• Physical and Behavioral Indicators of Possible Child Abuse
• Homosexual: Child Abuse and Sexual Identity
• Child Abuse: Protecting Children From Abuse and Neglect
• Protecting Our Children From Domestic Violence and Child Abuse
• How Sexual Child Abuse Can Affect the Child’s Psychological Development
• Child Abuse: Saddest and Most Tragic Problem Today
• Juvenile Who Commit Homicide or Parricide and the Presence of Child Abuse
• Child Abuse: The Four Major Types of Abuse, Statistics, Prevention, and Treatment
• Relationship Between Domestic Violence and Child Abuse and How to Protect the Children From It
• How the Government and Society Have a Responsibility to Help Child Abuse Victims
• Child Abuse Victims and Whether or Not They Become Abusers in Adulthood
• Modern Beliefs Regarding the Treatment of Child Abuse Victims
• Children Are Suffering From a Hidden Epidemic of Child Abuse
• Does Child Abuse and Neglect Lead to Bullying?
• What Are the Negative Effects of Child Abuse?
• Is There Correlation Between Child Abuse and Schizophrenia?
• How Can Spanking Lead to Child Abuse?
• Are Recovered Memories From Child Abuse Reliable?
• What Are the Types of Child Abuse and How to Prevent Them?
• Does Child Abuse Cause Crime?
• What Does Victimology Say About Child Abuse?
• How Can the Community Stop Child Abuse and Neglect?
• Are There Any Biomarkers for Pedophilia and Sexual Child Abuse?
• What Are the Devastating Clinical Consequences of Child Abuse?
• Does Child Abuse Create a Psychopath?
• How Do Child Abuse and Neglect Affect Childhood?
• Why Should Child Abuse Be Addressed as a Social Problem?
• How Does Child Abuse Affect Student’s Education?
• What Are the Signs or Symptoms of Child Abuse?
• How Do Children Carry the Weight of Child Abuse?
• Is There a Link Between Child Abuse and Sexual Identity?
• What Are the Effects of Child Abuse?
• How Can Therapy Help Victims of Child Abuse?
• Does Good Child Abuse Lead to Anxiety and Social Disorders?
• What Are the Long-Term Consequences of Child Abuse and Neglect?
• Is There the Gap Between Health Care and Child Abuse?
• How Can Child Abuse Be Prevented?
• What Is the Connection Between Child Abuse and Delinquency?

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This essay topic collection was updated on December 27, 2023 .

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Child Abuse and Neglect

Charles h. zeanah.

Tulane University School of Medicine, New Orleans, LA.

Kathryn L. Humphreys

Vanderbilt University, Nashville, TN.

Physical, sexual, and emotional abuse and various forms of neglect of children are associated with substantially increased risk for concurrent and subsequent psychopathology and are among the common problems encountered by clinicians in many clinical settings. Such cases pose additional challenges for clinicians because of the many complex family and system forces that engulf these children and their families. Assessing maltreated children generally requires more time than evaluations of children who have not experienced maltreatment. Young children, who experience the highest rates of maltreatment, present especially complex assessments because they are so dependent upon their caregiving environments. Treatment of psychopathology associated with maltreatment, which is often multimodal, requires addressing a variety of external factors that may perpetuate or exacerbate symptoms and impaired functioning. We suggest that the more clinicians understand the different cultures of the legal and child protective services systems will help them advocate more effectively for maltreated children’s bests interests so that the complexity of their problems is matched by the comprehensiveness of our efforts to minimize their suffering, enhance their development, and promote their competence.

Maria, a 12-year-old bilingual undocumented immigrant, disclosed to her school counselor that her stepfather sexually abused her for several years. After an investigation by child protective services (CPS), she was placed in foster care because her mother initially denied that any abuse had occurred. Following this, the stepfather disappeared. Maria was referred by CPS to receive an evaluation for depressed mood.

James, an 8-year-old boy, was flagged by his teacher for cuts and bruising on his forehead. He reported that his father (a single parent) smashed his head into a glass table because he had not cleaned his room. The school reported his injuries to CPS who placed him in foster care after investigating. James’s father was arrested. James and his father were referred for assessment and treatment as indicated.

Jacqueline, a 22-month-old girl, was found wandering by a police officer several houses away from her home. After Jacqueline waited 30 minutes outside her home with the police, her mother arrived. She was combative towards the police and had a long history of substance-related arrests. Jacqueline was taken into custody and placed with nonrelative foster parents since no relatives were identified by CPS. Her mother was referred to substance abuse intervention and to a parenting intervention. Jacqueline was also referred for evaluation of her status.

Maltreatment of children, comprising various types of abuse and neglect, is a major public health challenge and one of the most powerful risk factors for concurrent and subsequent psychopathology, later health morbidity, and compromised development. In severe cases of maltreatment, children are often placed in foster care, and as a group are at particularly at high risk for negative mental health consequences. Halfon and colleagues 1 found that foster children represented less than 4% of Medicaid eligible children in California but accounted for 41% of all users of mental health services. Costs of the maltreatment that occurred in the United States in 2008 was estimated to be $124 billion, with a per victim lifetime cost estimated to be $210,012 for nonfatal and $1,272,900 for fatal maltreatment. 2

Clinicians working with children who have experienced maltreatment will be more effective when their approach extends beyond a focus on symptom patterns and functional impairment. In order to do so, they must become knowledgeable about the systems in which maltreated children are entwined. Specifically, the child protection system and the legal system each play an important role in the physical placement and well-being of children who have experienced abuse and neglect. Clinicians may be asked and should be willing to provide input regarding visits, transitions, custody, and related issues. In addition, work in this arena is a potent elicitor of countertransference, 3 and having trusted colleagues with whom to review perceptions and plans is essential.

SCOPE OF THE PROBLEM

In Federal Fiscal Year 2016, approximately 676,000 children in the United States were confirmed as victims of abuse and neglect by child protective service (CPS) systems, an incidence of 0.91%; a much greater number (approximately 3.5 million children) were referred for potential maltreatment. 4 Younger children are more likely to be maltreated and are more likely to die from abuse and neglect. American Indian/Alaskan Native (1.42%) and African American (1.39%) children experience the highest rates of maltreatment. Nevertheless, underreporting of child maltreatment is widely recognized as a problem, 5 and adult retrospective reports of maltreatment are substantially higher 6 , 7 than substantiated rates of maltreatment in official records. Failure of true cases to be identified by legal authorities, in addition to the challenges of measurement, infantile amnesia, recall bias in retrospective reports, and differing definitions for maltreatment, make ascertaining true prevalence rates challenging.

For the past several years, roughly 250,000 to 275,000 children are taken into foster care each year and a total of 400,000 to 500,000 children are in foster care at any time in the United States. 8 Thus, the majority of child victims who have maltreatment substantiated are maintained with their families and provided with access to services designed to prevent removal. These cases are often referred to as family services, “in home” services, family preservation, or similar terms.

CLASSIFICATION

Types of maltreatment are shown in Table 1 . 9 Each of the major headings subsumes many specific types within the broad type. Although neglect is by far the most prevalent type of maltreatment identified by CPS, 4 the important point is that co-occurrence of different types is the rule rather than the exception. In fact, in a recent study of more than 2,200 maltreated school-aged children and adolescents, a minority of children experienced only a single type of maltreatment 10 : only 1% of sexually abused children, 4% of physically abused children, 10% of emotionally maltreated children, and 25% of neglected children had no co-occurrence with one or more other types of maltreatment. 10

Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) Modified Maltreatment Classification System

Note: Adapted from 9 . Severity ratings 1–5 are included for each type of maltreatment.

ADVERSE EFFECTS

Maltreatment is associated with compromises in development across virtually every domain (eg, cognitive, language, socioemotional, and neurobiological development.) 11 Mental health problems are among the most salient sequelae of child abuse and neglect. For example, using data from the National Survey of Child and Adolescent Well Being, Burns et al . 12 reported that nearly half (48%) of 3,803 children (2 14 years old) who had completed child welfare investigations had clinically significant emotional or behavioral problems. A study of more than 1,000 children 5 to 9 years old who were recruited from pediatric practices determined that those children who had been maltreated were nearly three times more likely to be diagnosed with an internalizing or externalizing disorder. 13 Population estimates attribute that the proportion of childhood psychiatric disorders due to experiences of adversity, including abuse and neglect, is approximately 45%, 7 suggesting that there may be no single greater environmental predictor of mental health difficulties than experiences of maltreatment.

Developmental psychopathologists have highlighted the importance of considering both multifinality and equifinality in the course of adverse experiences and psychopathology. 14 Although many children who have experienced severe neglect in early life develop a psychiatric disorder in childhood and adolescence, a greater proportion do not. 15 , 16 For some disorders, there is an explicit requirement for the role of environmental circumstances in order to meet diagnostic criteria (eg, trauma is required for posttraumatic stress disorder [PTSD], and inadequate care is a necessary criterion for reactive attachment disorder). For other disorders, although experiences of stress are known risk factors, such experiences are not required for diagnosis (eg, major depressive disorder). Furthermore, even diverse forms of maltreatment that are thought to have different consequences for brain development 17 may result in risk for the same forms of psychopathology 18 (eg, both abuse and neglect are associated with increased risk for externalizing psychopathology). Taken together, we understand that maltreatment is associated with dramatically increased risk for psychopathology, but that several individual (eg, genetics, temperament) and external factors (eg, consistent and attentive caregivers) may be protective and/or promote resilience in children who have experienced significant adversity. 19 In addition, there is no one-to-one mapping between the severity or type of maltreatment experience and subsequent neurobiological or behavioral consequence. In fact, nearly all psychiatric disorders common in childhood and adolescence (eg, internalizing disorders, externalizing disorders, trauma and stress-related disorders, neurodevelopmental disorders [eg, attention deficit/hyperactivity disorder], and substance use disorders) have been linked to experiences of maltreatment, such that abuse and neglect may play either an etiological role and/or worsen the presentation and course of the disorder. Impairments in functioning, including academic problems, delinquency, and difficulties in social relationships are also associated with maltreatment.

Recent attempts to clarify the potential mechanisms underlying increased risk for psychopathology following maltreatment have examined the processes and constructs that represent intermediate phenotypes (eg, Research Domain Criteria). 20 This approach often focused on the processing and response to emotional content, including rewards, threats, as well as alterations in executive function, among individuals with histories of neglect. 21 These processes are theoretically linked to disorders (eg, threat processing to anxiety disorder and reduced reward sensitivity to depression) and may be useful targets in developing interventions to prevent or treat psychopathology following onset. McCrory and Viding 22 have proposed the theory of latent vulnerability, positing that targeting intermediate phenotypes provides a means of altering risk trajectories following maltreatment but before psychiatric disorders emerge.

In addition to attempts to characterize mechanism, it is important to consider how development might moderate the presentation of symptoms. For example, PTSD presents somewhat differently in preschool age children compared to adolescents, 23 and recent adaptations to the DSM have begun to define developmental differences. 24

For young children (age 5 years and younger), alternative diagnostic criteria for a number of disorders of early childhood are provided by DC:0–5. 25 Although new and incompletely validated, the criteria for disorders in DC:0–5 were empirically derived in an effort to identify the manifestations of psychopathology in young children. In addition, the approach outlined provides an emphasis on characterizing the relational context of child behavior problems. Furthermore, there is an impetus to identify and treat these children at the youngest possible ages, in order to improve long-term outcomes and reduce the risk for intergenerational transmission of maltreatment. 26

SYSTEMS ISSUES

In our experience, clinical effectiveness is enhanced greatly if clinicians are knowledgeable about and engage with child protection and legal systems when needed. These systems are best thought of as distinct cultures, each with its own language, values, and priorities. Understanding how they differ from the values and priorities of the clinical enterprise is an important asset when evaluating and treating maltreated children.

Child Protection System

CPS generally includes distinct divisions responsible for hotline receipt of allegations, investigations of alleged maltreatment, services to families who have a substantiated finding of maltreatment where children are not removed, children placed in foster care, and adopted children following termination of parental rights. It is important to understand which of these divisions is involved with the child, because the roles of the professionals in each are quite different.

CPS is based either at the state or county level. Foster care may be provided by CPS and/or contracted with private entities—some systems (eg, Florida’s Community Based Care) are entirely privatized, meaning that foster care and related services are outsourced to local community agencies. When agencies are contracted to provide foster care, understanding their relationship to CPS staff is critical. Staff within CPS are hierarchically arranged; for example, frontline case workers report to supervisors who report to managers who report to directors. Identifying how best to access information and implement leverage within these hierarchies is key to useful collaboration.

Key events in child welfare in the United States are noted in Table 2 . 27 , 28 As directed by the Federal government, child welfare systems in the United States were originally focused on children’s physical safety. There is increasing emphasis on permanency in child welfare systems, 29 because many children seemed to be languishing in foster care, which was intended to be a temporary intervention. Throughout the past 100 years, the proverbial pendulum has swung back and forth between a primary emphasis on protecting children and another on preserving families. Still, as Table 2 indicates, there has been a steady broadening of scope of what we mean by child protection over time.

Selected Key Developments in American Child Welfare

Note: Adapted from references 27 and 28 .

In cases in which there are substantiated reports of maltreatment but parental rights are not immediately terminated, the emphasis has been focused on time-limited opportunities for parents to rehabilitate and resume unencumbered care of their children. Much more recently, child well-being has been made an explicit Federal priority. 30 This provides more impetus for mental health services, although well-being remains a newer and less well integrated emphasis in many settings.

In virtually every case, reunification of children with the parents from whom they have been removed is the goal for CPS. Furthermore, reunification hinges on demonstration of minimal safety and caregiving effectiveness, which typically falls far below the standard approach in clinical treatment. Often, continuing treatment after children are returned to parents is necessary to address a child’s symptoms and functional impairment and/or to assist with family stabilization.

Legal System

Courts concerned with child protection are called juvenile court, family court, dependency court, or something similar in different states. Larger jurisdictions may have full-time judges in these courts, but in smaller jurisdictions, judges may oversee child protection cases as only one of many other roles. Judges are “triers of fact” and make the ultimate decisions regarding most phases of child protection and child custody. There are differences in state-level laws and within individual judges about how to interpret and implement the law. Judges’ perspectives derive from the United States Constitution, especially the due process clause of the 14th Amendment, which has been used to limit government interference in family life. As an initial assumption from a legal perspective, parents are presumed by courts to have their children’s best interest guiding their parenting behavior. Thus, the thrust of most laws pertaining to governmental intervention restricts it to instances in which the child’s physical safety is endangered. Furthermore, at the earliest indication that parents can be minimally safe, many judges are inclined to return children and eliminate the state’s involvement in the family’s life. This inclination runs counter to clinical efforts to delay return until it is clear that parents are sufficiently rehabilitated so that risk of recidivism is minimized.

Nevertheless, courts in all 50 states are required to consider whether their decisions about placement of children, services provided to them, and custody are in the child’s “best interest.” 31 Although the best interests of the child are considered, they do not trump parental rights in cases in which those conflict. Mental health professionals may be called as experts to testify about what is in children’s best interest, providing an opportunity to address current and future needs of the child.

Safety, permanence, and well-being of the child also should inform psychiatric assessments of maltreated children. The most important initial question to address is ensuring that children are physically and psychology safe in their current placements. Second, understanding the timeline and whether the current placement is short-term or long-term and what CPS plans for the child may affect treatment strategies. Finally, child well-being, which encompasses psychiatric symptoms and functional impairment, as well as adequacy of the caregiving environment, form the crux of the assessment.

Assessment of children involved with CPS is complicated by the need for information from multiple sources. Having CPS records available at the time of the evaluation is important. Speaking to the case worker before or during the evaluation provides important supplemental information that may be unavailable from the records, such as information about the legal status and timeline of the case, for example. If the child is in foster care, meeting with foster parents is essential, but biological parents also will provide important history when that is possible. Observing interactions of children with their foster parents as well as with their biological parents will often reveal important differences in children’s behavior. For young children (less than 5 years old), this is essential.

PTSD deserves special mention. It is clearly important to assess for PTSD symptomatology in every child with a history of maltreatment and exposure to violence. In our experience, PTSD may be both over- and underdiagnosed in these children. That is, not every symptomatic child assessed after exposure to a trauma has signs or symptoms of PTSD—many disorders can result from trauma, although there is some evidence that PTSD serves a gateway function to new-onset disorders following traumatic exposure. 32 Regarding underdiagnosis, PTSD in children can be challenging to identify, especially if children present with re-experiencing and hyperarousal in the form of aggressive behavior. Systematic inquiry about exposure to possible traumatic exposures is key, as well as assessing triggers of challenging behaviors.

Special Issues in Early Childhood

Because the majority of maltreatment cases onset in children less than 5 years old, and because of the developmental vulnerability of the early years, there has been increasing recognition of the importance of bringing insights from developmental science to bear on practice in child welfare. 33 This rationale derives from a convergence of neuroscience documenting the effects of experience on the developing brain, child development data about the centrality of relationships in promoting adaptive relationships, and economic data about the return on investment of early intervention. 34

From a clinical perspective, we know that young children may be markedly symptomatic with one caregiver and asymptomatic with another caregiver. 35 This is especially likely in the context of young children seen with foster parents and biological parents. In addition to the usual history and developmentally modified mental status examination, a relationship assessment between the young child and all important caregivers is recommended for young children who have been maltreated. 36 Importantly, AACAPPractice Parameters on assessments of infants and toddlers 37 recommends that assessments of young children should typically involve three to five sessions—evaluating young maltreated children will be among the more complex assessments conducted. Formal methods for assessing relationships in young children are available, 38 , 39 but attending to observed interactions and parents’ perceptions of their children in order to understand the relationship are recommended. In addition, Axis II of the DC:0–5 25 pro-vides guidelines for comprehensive characterization of the relational context of young children. Although derived from a large body of evidence regarding the importance of primary caregiving relationships and co-parenting for young children’s development, the specific DC:0–5 guidelines about the relational context of young children await explicit validation.

We have argued that foster care is a different intervention for younger children (especially less than 3 years old but generally up to age 5 years) than for older children. 40 , 41 This derives from our understanding that the quality of the young child’s attachment relationships is a foundational component of young children’s socioemotional development and an important predictor of subsequent psychosocial functioning, especially within high-risk groups. 42 , 43 Furthermore, young children develop and sustain attachments through substantial contact with caregiving adults. 44 This means that for young children in foster care, foster parents must function as primary attachment figures for them. The vital role of foster parents is too often under recognized, not only by CPS and the courts, but even by mental health professionals. Recognizing its importance has obvious implications for young children and their relationships with foster parents.

Reports from childcare and preschool teachers are especially valuable to include in the assessment, because they provide data about the child’s functioning outside of the family context. This is important for determining which behaviors are pervasive and which are context specific. Given the sometimes contentious relationships between foster and biological parents, teachers can provide a perspective from more objective observers and also from professionals who likely have a keen appreciation of age typical and age-atypical behaviors.

Because of the high rates of cognitive, motor, and language delays in young maltreated children, 45 , 46 referrals for developmental assessments to address suspected or apparent language and/or motor delays are often indicated.

INTERVENTIONS

One component of treatment of maltreated children is virtually identical to treatment of nonmaltreated children—psychotherapy and/or medication as determined by a thorough assessment. Of course, given that maltreated children are at the extreme of the risk continuum, there are compelling reasons to apply evidenced-based interventions to treat their symptoms and impaired functioning. 47 These treatments are key elements of the therapeutic arsenal for the complex pictures of comorbidity with which maltreated children often present, even though most of the interventions, including medication, have not been studied systematically in maltreated children. Fortunately, there are many evidence-based treatments available for infants through adolescents who have experienced maltreatment (eg, trauma-focused cognitive-behavioral therapy; parent–child interaction therapy; child–parent psychotherapy).

Overuse and misuse of psychotropic medication among foster children has become an increasing concern. 48 Reviewing Medicaid data from one month in 2004 in Texas, for example, Zito et al. 49 found that among foster children prescribed psychotropic medication, 41% took three different classes of medication, and 16% took four different classes. Care should be taken about using multiple classes of psychotropic medication in foster children, given the lack of evidence supporting the safety and efficacy of combined pharmacotherapy, particularly for three or more medications. Reduced access to and investment in evidenced-based psychotherapy may contribute to unwarranted psychotropic medication use.

What is different about treatment of maltreated children is that symptom reductions through evidenced-based treatments is rarely sufficient. Comprehensive and multimodal treatments are required, and often over long durations. Myriad factors beyond maltreatment are likely to cause or exacerbate symptoms in maltreated children (eg, maladaptive family interactions, quality of placements, stress of visits, separation inherent in foster placements, separations from siblings, and court and CPS decisions). These challenging stressors require additional clinical efforts to help the child navigate the aftermath of maltreatment.

CASE INTERVENTIONS

Maria had a 5-day inpatient hospitalization for depression with suicidal intent, and completed 4 months of trauma focused cognitive-behavioral therapy (TF-CBT). During this time, her mother received several months of therapy focused on Maria’s stepfather’s controlling relationship with her and how this contributed to her failure to protect Maria. She accepted that the abuse had occurred and indicated that initially her fear of the police and CPS had led her to deny her daughter’s allegations. In addition, the clinical team intervened to address a conflicted relationship between Maria’s family and CPS. Six additional months of family therapy were directed at a role-reversed mother–daughter relationship and the mother’s failure to protect Maria from the stepfather. In the midst of these multifaceted intervention efforts, Maria was successfully returned to her mother’s care, and treatment continued for another 9 months after her return home.

James was treated with 4 months of TF-CBT. His father was enrolled in a 4-month skill-building group therapy for parents (Effective Black Parenting). Following this, James’s father was seen for grief counseling about the loss of James’s mother to cancer 2 years earlier. James and his older and younger sister were seen with their father for family therapy, which focused on the father’s sensitivity to rejection and angry outbursts. James was returned home after 12 months in foster care.

Jacqueline was overly active, aggressive, and socially indiscriminate when she entered her foster placement. Immediate work with her foster parents focused on restricting her contact with unfamiliar adults and establishing a reward-oriented behavior management plan. The foster mother was coached in using the PRIDE skills (labeled praise, reflections, imitations, descriptions, and enthusiasm) from parent–child interaction therapy. Her symptoms gradually dissipated, and she was able to attend childcare without difficulty. Her biological mother tested positive for substances, did not enroll in an intervention program, and after several months stopped attending scheduled visits with Jacqueline. When Jacqueline was 34 months old, her maternal aunt appeared and requested that she be placed with her. Following a hearing on the matter, including expert testimony about best interest, the judge denied the aunt’s request. Jacqueline was adopted by her foster parents after a termination of parental rights trial.

Key Messages

• Child maltreatment—physical, sexual, and emotional abuse, as well as various forms of neglect—leads to increased risk for psychopathology across development, including internalizing disorders, externalizing disorders, trauma and stress related disorders, neurodevelopmental disorders (eg, attention-deficit/hyperactivity disorder), and substance use disorders, as well as academic problems, delinquency, and difficulties in social relationships.
• Maltreatment is associated with a substantial proportion of the psychiatric morbidity that presents to clinical settings for children and adolescents, so that affected children are overrepresented in these settings.
• Racial and ethnic disparities are apparent. African American and American Indian children have the highest rates of maltreatment, and clinicians should be alert for structural racism affecting decision making.
• More effective care will be provided to maltreated children in need of treatment when clinicians are knowledgeable about the legal and child protection systems, each of which has its own priorities, values, and languages and differs from those of clinical work.
• Assessments of children presenting for evaluation of problems related to maltreatment, especially if they are involved with legal and child protective systems, are necessarily complex and likely require more time than evaluations of children who have not experienced maltreatment.
• Treatment of symptoms and disorders related tomaltreatment should be multimodal and often needs to address external factors that may contribute to their perpetuation and exacerbation.
• Young children, who comprise the majority of maltreatment cases, require careful evaluation of the child’s caregiving contexts, which often includes multiple caregivers, so that both assessments and treatment are comprehensive.

Disclosure:

Dr. Zeanah has received funding from the John D. and Catherine T. MacArthur Foundation Research Network on “Early Experience and Brain Development” (Charles A. Nelson, PhD, Chair), the National Institute of Mental Health (NIMH; 1R01MH091363, Nelson), the Substance Abuse and Mental Health Services Administration (SAMHSA; 1U79SM080030-01, Lieberman), the Palix Foundation, the Lumos Foundation, and the Irving Harris Foundation (Zeanah). He has received royalties from Guilford Press and Harvard University Press and honoraria for speaking engagements to professional audiences. Dr. Humphreys has received support from NIMH (F32MH107129), the Brain and Behavior Research Foundation (formerly NARSAD) Young Investigator Award 23819, the Klingenstein Third Generation Foundation Fellowship, and the Jacobs Foundation Early Career Research Fellowship.

Contributor Information

Charles H. Zeanah, Tulane University School of Medicine, New Orleans, LA.

Kathryn L. Humphreys, Tulane University School of Medicine, New Orleans, LA. Vanderbilt University, Nashville, TN.

Child Abuse and Neglect Essay

Introduction, events to strengthen the family.

Children are vulnerable individuals whose welfare is dependent on their parents or guardians. This exposes the children to the risk of suffering abuse and neglect from their caretakers. Hunt (2014) declares that the maltreatment of children occurs across all socio-economic, cultural and ethnic groups with negative consequences on the development of the child. Child abuse and neglect have deleterious effects on the future life of the child.

It is therefore necessary to take steps to tackle these issues and ensure the healthy emotional and physical development of the child. This paper will describe four events that can be implemented to strengthen the family and therefore reduce or eliminate incidents of child abuse and neglect.

Playgroup events can play a major role in strengthening the family on issues of child abuse and neglect is playgroups. Parents who come from the same neighborhood or those whose children attend the same school or daycare facility can form playgroups. The events provide a chance for families with similar interests and children of the same ages to connect with each other and share their experiences. Selph and Bougatsos (2013) reveal that the events are hugely beneficial to both the parents and their children.

The children are able to develop through play and interaction with their peers. The social skills and learning of the children is enhanced as they engage in play activities. Research indicates that play groups contribute to shaping family life and equipping parents with the tools necessary to engage in the challenging task of raising children (Hunt, 2014). Playgroup events provide an informal forum for parents to discuss their parenting issues and concern.

Nilsen (2010) confirms that parents are not only able to obtain important advice from their peers, but they also get to realize that other people are going through the same hurdles as they are. This is empowering especially to new parents who might feel overwhelmed by the difficulties of parenting.

These events also promote a feeling of community and each parent begins to take an interest in the wellbeing of the children of his/her friend. This makes it possible to identify incidents of abuse among children in the playgroup and take appropriate action in response.

A church/synagogue/mosque retreat activity for parents and they children can be beneficial in strengthening parents to deal with the issues of child abuse and neglect. Religion plays an important role in the lives of many individuals and they rely on their faith to inform their actions in many situations. The religious institute can therefore play a major role in promoting child safety in the community (Nilsen, 2010).

A retreat event can be planned for the parents in the congregation on a weekend. This retreat will be sponsored by the religious body, which will make it affordable to all the parents. An important advantage of faith-based events is that they possess significant resources since the congregation is made up of a variety of professionals including teachers, nurses, pediatricians, and social works. These professionals will be able to provide free advice on how to safeguard children during the retreat (Hunt, 2014).

Another benefit of the faith-based event is that it relies on the shared religious beliefs of the participants. The religious beliefs of the parents can therefore be used to exhort them to engage in good parenting practices. The religious-based family retreat will provide numerous opportunities for the families to socialize with each other.

There will be coffee breaks during which the parents and children will interact with each other and exchange contacts. Veteran parents will share their experiences and provide advice to the younger parents. The faith-based event will therefore serve as a good opportunity for the parents to establish social support systems.

Technological events can play a part in mitigating child abuse and neglect in the society. Specifically, parents can make use of online forums to learn about appropriate parenting practices and acquire skills for protecting their children against abuse. The online forum should be designed to attract parents who wish to improve the safety and wellbeing of their children. This technological tool can include a facilitator who will initiate discussion topics and moderate the discussions taking place on the website.

Online forums enable parents to express their concerns and issues in a safe environment. Through online forums, parents can be linked to numerous resources for strengthening families. Nilsen (2010) documents that there is a correlation between exposure to educational resources and a decrease in incidents of child abuse and neglect. Parents are also able to gain tangible benefits from the online events. Through the event, parents are made aware of the community resources available to them as they raise their child.

Nilsen (2010) asserts that information on available community resources is of great importance especially to parents who are at-risk of neglecting their children due to limited economic resources. A benefit of online events is that they are accessible to many parents at their convenience.

Parents do not need to adjust their schedules in order to participate in these events. This is an important factor since most parents might be overwhelmed by obligations that make it impossible for them to engage in events that require them to be physically present at venues outside their home or work setting.

Parents can enroll on home visitation programs to assist in the prevention of child abuse and neglect. The home visitation event should be voluntary and semi-formal in nature. An important feature of these events is that Nurses or Educators, who possess expert knowledge on childhood development, carry them out. These experts are able to convey to the parents professional information on subjects such as positive parenting practices.

Selph and Bougatsos (2013) reveal that such events can be of great service to pregnant women as well as families with young children. Through the home visitation, the parents are provided with information about their child’s development. The professionals can also help parents to gain a better understanding about age-appropriate behavior for their children. The home visitation events should be developed with cultural factors in mind.

Different cultures have varying values and customs that influence how the parents deal with their children. Nilsen (2010) asserts that the professionals engaging in the visitation must demonstrate sensitivity to cultures whose values and customs are different from their own. The strengths of the specific culture should be exploited to increase the safety of the child. In cultures were extended family bounds are strong, the visitation events can be scheduled to include some of the members of the extended family.

These members can be equipped to provide assistance to at-risk children and parents within their family. Parents who enroll in home visitation events are well equipped to engage in positive parenting and as a result, they engage in fewer acts of physical aggression towards their children (Promising Practices Network, 2010).

Child abuse and neglect have a lasting negative impact on the lives of children. This paper set out to discuss events that can be used to strengthen families and therefore mitigate or prevent these damaging issues from happening.

The paper has described playgroup events, faith-based activities, technological events, and home visitation programs that can be used to strengthen families. By implementing these events, the family will be equipped to prevent child abuse and neglect therefore ensuring the healthy psychological and physical wellbeing of the child.

Hunt, K. (2014). Safeguarding children – the need for vigilance. Practice Nurse, 44 (6), 18-22.

Nilsen, B. A. (2010). Week by Week: Plans for Documenting Children’s Development. NY: Cengage Learning.

Promising Practices Network. (2010). Promising Practices for Preventing Child Abuse and Neglect . NY: RAND Corporation.

Selph, S. & Bougatsos, C. (2013). Behavioral Interventions and Counseling to Prevent Child Abuse and Neglect: A Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Annals of Internal Medicine, 158 (3), 179-190.

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Bibliography

IvyPanda . "Child Abuse and Neglect." March 26, 2020. https://ivypanda.com/essays/child-abuse-and-neglect/.

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