Cries for help: A literature review of the psychological effects of child maltreatment

Tara McPherson

Child maltreatment is a generic term referring to four primary acts: physical abuse, sexual abuse, emotional abuse and neglect. Child maltreatment occurs in our society at alarming rates. Over a hundred thousand cases each year are reported to Child Welfare agencies in Canada. Child maltreatment affects children in a number of ways, such as higher rates of psychiatric and psychological disorders. This paper reviews the literature on the psychological effects of child maltreatment.

As you are sitting in the living room watching television, you hear that familiar sound. You hear the yelling, the crashing, and the crying. In the background of all the sound, you faintly hear a child's voice pleading for their life.

Unfortunately, this scenario is not that uncommon. Child maltreatment still occurs at alarming rates. In 1998, 135,573 child maltreatment investigations were conducted in Canada by Child Welfare agencies (Stats Canada, 2001). Child neglect accounted for 40% of the cases, physical abuse accounted for 31%, emotional maltreatment accounted for 19%, and sexual abuse accounted for 10%. Family members or other persons related to the child victim constituted the vast majority of the alleged perpetrators (93%). Of the substantiated cases of child maltreatment, 43% continued for more than six months. When looking at violence against children and youth reported to police in 1999, children and youth under the age of 18 years made up 23 % of the Canadian population and were the victims in 24% of assaults reported to a sample of police departments. They represented 60% of all sexual assault victims and 20% of physical assault victims. These children had their innocence torn away.

Does anyone sit back and really think about what we are doing to these children? Too many people assume that these children grow up and just “get over" the abuse. If only it were that simple. Research has shown us that child maltreatment can be very psychologically damaging. Many children end up suffering life long problems.

In a number of studies, it has been shown that physical abuse has a damaging effect on children (Augoustinos, 1987; Briere & Runtz, 1988, 1990; Claussen & Crittenden, 1991; Kaplan, Pelcovitz & Labruna, 1999). A common problem found in children who have been physically abused is disruptive disorders. It has been shown that at least 30% of people who have been physically abused have lifetime disruptive disorder diagnosis, such as oppositional defiant disorder or conduct disorder (Kaplan et al., 1999). Individuals who were physically abused also showed higher aggressive and delinquent behaviours (Kaplan et al., 1999; Briere & Runtz, 1990). Research has also indicated that physically abused children tend to be less popular and liked and had fewer friendships. As well, physically abused children showed less intimacy and more conflict and negative affect towards their close friends in comparison to the non-abused group (Kaplan et al., 1999). physically abused children also tend to be more shy and inhibited in interpersonal contacts than the non-abused group. This would have an affect on their social functioning (Augoustinos, 1987). Another effect that has been demonstrated in children who have been physically abused is a deficit in various cognitive abilities (Augoustinos, 1987; Kaplan et al., 1999). On the WISCR-R, physically abused children had a lower mean score than the mean of the non-abused group. They also scored significantly lower on the Performance and Verbal Scales and the Verbal Language Development Scale, as well as showed deficits in mathematics and language tests, and in both receptive and expressive language (Augoustinos, 1987; Helm, Newport, Bonsall, Miller & Nemeroff, 2001; Kaplan et al., 1999). From all of this evidence, one can conclude that physical abuse can have a damaging effect on children.

Sexual abuse also has long-lasting negative effects on children. Sexually abused children have a higher prevalence of psychiatric disorders. This has been illustrated in several studies (McLeer, Dixon, Henry, Ruggiero, Escovitz, Niedda & Scholle, 1998; Zlotnick, Mattia & Zimmerman, 2001). Research shows that having a history of childhood sexual abuse is a risk factor for a broad range of psychiatric disorders and a higher rate of multiple Axis 1 disorders. As well, there is a strong presence of Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms in sexually abused children (McLeer et al., 1998; Zlotnick et al., 2001). Depression is also found in sexually abused children (Briere & Runtz, 1988; McLeer et al., 1998; Roosa, Reinholtz & Angelini, 1999; Zlotnick, 2001). These studies have indicated that sexually abused children are more likely to report symptoms of depression on various tests, such as the Children's Depression Inventory, the Hopkins Symptom Checklist, and the Epidemiological Studies Depression Scale (McLeer et al., 1998; Briere & Runtz, 1988; Roosa et al., 1999). It was also noted that having a history of childhood sexual abuse appeared to be linked to a longer duration of the index depressive episode and longer bouts of depression (Zlotnick et al., 2001). Another effect noted in victims of childhood sexual abuse is anxiety. Research has shown that anxiety levels in victims of childhood sexual abuse were significantly higher than the non-abused group. This was indicated on many measures (McLeer et al., 1998; Briere & Runtz, 1988; Mian, Marton & LeBaron, 1996). Suicidal ideation has also been linked to sexual abuse. In one study, it was shown that close to half of the sexually abused children reported depression and suicidal ideation. This has been displayed in other studies as well (McLeer et al., 1998; Molnar, Berkman & Buka, 2001; Zlotnick et al., 2001). Many children who are sexually abused display maladaptive sexual behaviours. Previous studies indicate that sexually abused children display more inappropriate sexual behaviours than non-abused children. There is evidence that this carries over into adulthood as well (Briere & Runtz, 1990; Mian et al., 1996). Similar to those that were physically abused, sexually abused children tend to have impaired social functioning. sexually abused children as adults tend to have fewer social resources, have fewer social interactions, and have problems with social adjustment (Abdulrehman & De Luca, 2001). A final note on sexual abuse is that research has revealed that sexually abused children have sleep disruption. They had higher levels and percentages of nocturnal activity, were twice as active at night and they emitted a higher percentage of their total daily activity during the night than the control groups. They took three times longer to fall asleep and had significantly poorer mean sleep efficiency (Glod, Teicher, Hartman & Harakal, 1997). This would affect the normal functioning of these children in all areas, as a good night sleep is very important. Sexual abuse has detrimental effects on children and leaves scars that lasts a lifetime.

But what about the types of abuse that are not that obvious? Emotional abuse has devastating effects on children. Some studies have shown that children who suffer from emotional abuse have the worst outcome of all abuse and are better predictors of later problems (Augoustinos, 1987; Briere & Runtz, 1988, 1990; Claussen & Crittenden, 1991; Glauthier, Stollak, Messe & Aronoff, 1996; Kaplan et al., 1999; Simeon, Guralnik, Schmeidler, Sirof & Knutelska, 2001). Emotional abuse appeared to be specifically associated with subsequent low self-evaluation. This is probably due to the child's internalization of parental statements as a basis for self-perception (Briere & Runtz, 1990). This could lead to other problems in the child's life. Emotionally abused children also showed more psychological difficulties. It was found that subjects who were emotionally abused as children showed higher rates of anxiety, depression, interpersonal sensitivity and dissociation. The researchers estimated that having above average levels of psychological or physical maltreatment increases the likelihood of above average interpersonal sensitivity, dissociation, and/or depression by 45-50% (Briere & Runtz, 1988). In fact, it was shown that emotional abuse had a stronger relationship to long-term psychological functioning than other forms of maltreatment and was a stronger predictor of a wide range of problems (Kaplan et al., 1999). Emotional abuse was the most significant predictor of both depersonalization disorder diagnosis and depersonalization severity (Simeon et al., 2001). Emotional abuse often goes unnoticed because it does not leave any marks. The damage is done on the inside, but the damage that is done is detrimental to the individual and will affect them for the rest of their lives.

The last form of abuse to look at is neglect. Neglect, like all the other forms of maltreatment, has long lasting effects. Researchers have only begun to explore the effects of neglect on children. The findings so far paint a gruesome picture. Language deficits are common among neglected children. Children who are neglected had more problems in receptive and expressive language than physically abused children and the non-abused control group (Augoustinos, 1987; Gauthier et al., 1996). One could assume that this is because these children are not getting the language exposure through verbal interaction with their caregivers. Individuals who have reported neglect in childhood were also more likely to report current symptoms of anxiety, depression, somatization, paranoia, and hostility than those who were only physically abused and the non-abused control group (Gauthier et al., 1996). As well, neglect was shown to be a strong predictor of some dimensions of psychological functioning and general psychological problems (Gauthier et al., 1996). Neglect, as the research points out, has a lasting impression on individuals.

One would think that in year 2002 child abuse would be a thing of the past. There is more education and exposure on this topic than there was in the past. Unfortunately this is not the case. Child maltreatment is still very much alive in our society. The struggles that these children have to go through are often unbearable and leave them vulnerable to a variety of problems in the future. The message that I hope to send from writing this article is that child maltreatment is very much apart of our society and that it has a very psychologically damaging affect on the victims. I urge people to do the right thing and report any suspicions that they may have to any Child Welfare agencies in their community, such as the Children's Aid Society, Catholic Children's Aid Society, Jewish Child and Family Services or the Native Child and Family Services.

References

Abdulrehman & De Luca (2001). The implications of childhood sexual abuse on adult social behavior. Journal of Family Violence, 16(2), 193-204.

Augoustinos (1987). Developmental effects of child abuse: Recent findings. Child Abuse and Neglect, 11, 15-27.

Briere & Runtz (1988). Multivariate correlates of childhood psychological and physical maltreatment among university women. Child Abuse and Neglect, 12, 331-341.

Briere & Runtz (1988). Symptomatology associated with childhood sexual victimization in a nonclinical adult sample. Child Abuse and Neglect, 12, 51-59.

Briere & Runtz (1990). Differential adult symptomatology associated with three types of child abuse histories. Child Abuse and Neglect, 14, 357-364.

Claussen & Crittenden (1991). Physical and psychological maltreatment: Relations among types of maltreatment. Child Abuse and Neglect, 15, 5-18.

Gauthier, Stollak, Messe & Aronoff (1996). Recall of childhood neglect and physical abuse as differential predictors of current psychological functioning. Child Abuse and Neglect, 20(7), 549-559.

Glod, Teicher, Hartman & Harakal (1997). Increased nocturnal activity and impaired sleep maintenance in abused children. Journal of the American Academy of Child and Adolescent Psychiatry, 36(9), 1236-1244.

Heim, Newport, Bonsall, Miller & Nemeroff (2001). Altered pituitary-adrenal axis responses to provocative challenge tests in adult survivors of childhood abuse. The American Journal of Psychiatry, 158(4), 575-581.

Kaplan, Pelcovitz & Labruna (1999). Child and adolescent abuse and neglect research: A review of the past 10 years. Part 1: Physical and emotional abuse and neglect. Journal of American Academy of Child and Adolescent Psychiatry, 38(10), 1214-1221.

Mash & Wolfe (1999). Abnormal child psychology. Belmont, CA: Wadsworth Publishing Company.

McLeer, Dixon, Henry, Ruggiero, Escovitz, Niedda & Scholle (1998). Psychopathology in non-clinical referred sexually abused children. Journal of the American Academy of Child and Adolescent Psychiatry, 37(12), 1326-1333.

Mian, Marton & LeBaron (1996). The effects of sexual abuse on 3 to 5 year old girls. Child Abuse and Neglect, 20(8), 731-745.

Molnar, Berkman & Buka (2001). Psychopathology, childhood sexual abuse and other childhood adversities: Relative links to subsequent suicidal behaviour in the US. Psychological Medicine, 31, 965-977.

Roosa, Reinholtz & Angelini (1999). The relation of child sexual abuse and depression in young women: Comparison across four ethnic groups. Journal of Abnormal Child Psychology, 27(1), 65-76.

Simeon, Guralnik, Schmeidler, Sirof & Knutelska (2001). The role of childhood interpersonal trauma in depersonalization disorder. The American Journal of Psychiatry, 158(7), 1027-1033.

Statistics Canada (2001). Family violence in Canada: A statistical profile. Canadian Center for Justice Statistics.

Zlotnick, Mattia & Zimmerman (2001). Clinical features of survivors of sexual abuse with major depression. Child Abuse and Neglect, 25, 357-367.