Monday, October 20, 2008

Child abuse

Child abuse

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Child abuse is the physical, psychological or sexual maltreatment of children. The Centers for Disease Control and Prevention (CDC) defines child maltreatment as any act or series of acts or commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child.[1] Most child abuse happens in a child's home, with a smaller amount occuring in the organizations, schools or communities they interact with. There are four major categories of child abuse: neglect, physical abuse, psychological/emotional abuse, and sexual abuse.

Different jurisdictions have developed their own definitions of what constitutes child abuse is for the purposes of removing a child from their family and/or prosecuting a criminal charge.

Contents

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[edit] Types

Child abuse can take many forms:[2]

  • Neglect, in which the responsible adult fails to adequately provide for various needs, including physical (failure to provide adequate food, clothing, or hygiene), emotional (failure to provide nurturing or affection) or educational (failure to enroll a child in school).
  • Physical abuse is physical aggression directed at a child by an adult. It can involve striking, burning, choking or shaking a child, and the distinction between discipline and abuse is often poorly defined. The transmission of toxins to a child through their mother (such as with fetal alcohol syndrome) can also be considered physical abuse in some jurisdictions.
  • Child sexual abuse is any sexual act between an adult and a child, including penetration, fondling, exposure to adult sexuality and violations of privacy.
  • Psychological abuse, also known as emotional abuse, which can involve belittling or shaming a child, inappropriate or extreme punishment and the withholding of affection.

[edit] Prevalence

According to the (American) National Committee to Prevent Child Abuse, in 1997 neglect represented 54% of confirmed cases of child abuse, physical abuse 22%, sexual abuse 8%, emotional maltreatment 4%, and other forms of maltreatment 12%.[3] According to a UNICEF report on child well-being[4] in the United States and the United Kingdom ranked lowest among first world nations with respect to the well being of their children. This study also found that child neglect and child abuse are far more common in single-parent families than in families where both parents are present. Recently a study conducted by the Center for Disease Control and Prevention found that 1 in 50 infants in the United States are victims of nonfatal neglect or abuse.[1] In the US, neglect is defined as the failure to meet the basic needs of children including housing, clothing, food and access to medical care. Researchers found over 91,000 cases of neglect over the course of one year (from October 2005- September 30, 2006) with their information coming from a database of cases verified by protective services agencies.[1]

[edit] Effects

Children with a history of neglect or physical abuse are at risk of developing psychiatric problems,[5][6] or a disorganized attachment style.[7][8][9] Disorganized attachment is associated with a number of developmental problems, including dissociative symptoms,[10] as well as anxiety, depressive, and acting-out symptoms.[11][12] A study by Dante Cicchetti found that 80% of abused and maltreated infants exhibited symptoms of disorganized attachment.[13][14]

The effects of child abuse vary, depending on its type. A 2006 study found that childhood emotional and sexual abuse were strongly related to adult depressive symptoms, while exposure to verbal abuse and witnessing of domestic violence had a moderately strong association, and physical abuse a moderate one. For depression, experiencing more than two kinds of abuse exerted synergetically stronger symptoms. Sexual abuse was particularly deleterious in its intrafamilial form, for symptoms of depression, anxiety, dissociation, and limbic irritability. Childhood verbal abuse had a stronger association with anger-hostility than any other type of abuse studied, and was second only to emotional abuse in its relationship with dissociative symptoms.[15]

More generally, in the case of 23 of the 27 illnesses listed in the questionnaire of a French INSEE survey, some statistically significant correlation were found between repeated illness and family traumas encountered by the child before the age of 18 years.[16] These relationships show that inequality in terms of illness and suffering is not only social. It has also its origins in the family, where it is associated with the degrees of lasting affective problems (lack of affection, parental discord, the prolonged absence of a parent, or a serious illness affecting either the mother or father) that individuals report having experienced in childhood.

[edit] Treatment

There are a number of treatments available to victims of child abuse.[17] Trauma-focused cognitive behavioral therapy, while developed to treat sexually abused children, is now used for victims of any kind of trauma. It targets trauma-related symptoms in children including Posttraumatic Stress Disorder (PTSD), clinical depression, and anxiety. It also includes a component for non-offending parents. Several studies have found that sexually abused children undergoing TF-CBT improved more than children undergoing certain other therapies. Data on the effects of TF-CBT for children who experienced only non-sexual abuse was not available as of 2006.[17]

Abuse-focused cognitive behavioral therapy was designed for children who have experienced physical abuse. It targets externalizing behaviors and strengthens prosocial behaviors. Offending parents are included in treatment, to improve parenting skills/practices. It is supported by one randomized study.[17]

Child-parent psychotherapy was designed to improve the child-parent relationship following the experience of domestic violence. It targets trauma-related symptoms in infants, toddlers, and preschoolers, including PTSD, aggression, defiance, and anxiety. It is supported by two studies of one sample.[17]

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