Chapter 14
Child Maltreatment and Non-Accidental Trauma
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Overview
 Child abuse and neglect have been recognized as a
significant problem since the early 1970s
 In North America, it is estimated that 1 in 12 children
experience some form of sexual victimization by an adult or
peer and about 1 in 10 receives harsh physical punishment
by a parent or other caregiver that puts them at risk of injury
 Child maltreatment refers to four primary acts: physical
abuse, neglect, sexual abuse, and emotional abuse
 Non-accidental trauma refers to the wide-raging effects of
maltreatment on the child’s physical and emotional
development
 Victimization is abuse or mistreatment of someone whose
ability to protect him- or herself is limited
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Overview (cont.)
 Maltreatment often occurs within ongoing relationships that are
supposed to be protective, supportive, and nurturing
 Abused/neglected children face paradoxical dilemmas:
 the victim wants to stop the violence but also longs to belong to
the family in which they are being abused
 affection and attention may coexist with violence and abuse
 the intensity of the violence tends to increase over time, but in
some cases physical violence may decrease or even stop
 Societies are struggling to balance parental rights with children’s
right to be safe and free from harm
 Maltreatment harms children physically, in developing
relationships with others, and in their fundamental sense of
safety and self-esteem
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
History and Family Context
 Child maltreatment and non-accidental forms of trauma have
always existed but were not seen as a problem since children
were viewed as the property of their fathers who had an
unchallenged right to punish until about 100 years ago
 8th century Roman Law of Chastisement: “rule of thumb”
 Church doctrine: “spare the rod and spoil the child”
 1989: Convention on the Rights of Children spurred
efforts to value the rights and needs of children, to
recognize their exploitation and abuse
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
History and Family Context (cont.)
 Healthy families
 Children need balance of their need for control and
direction (“demandingness”) with their need for
stimulation and sensitivity (“responsiveness”)
 Healthy parenting includes:

knowledge of child development and expectations

adequate coping skills

normal parent-child attachment and communication

home management skills

shared parenting responsibilities

provision of social and health services
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
History and Family Context (cont.)
 Healthy families (cont.)
 Healthy patterns depend on:
 parental competence and developmental sensitivity
 family circumstances
 availability of community resources (education,
information, social networks/support)
 Context: family situation (e.g., parents’ marital relationship
and child’s characteristics)
 Fundamental, expectable features of child’s environment:
 Infants: protective, nurturing adults; opportunities for
socialization
 Older children: supportive family, peer contact,
opportunities to explore/master their environment
 Maltreating families fail to provide these requirements
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
History and Family Context (cont.)
 Child maltreatment: one of the worst, most intrusive forms of stress
 It impinges directly on the child’s daily life, may be on-going and
unpredictable, and often involves people the child depends on
and trusts
 Children’s ability to respond to stress depends on the degree of
support and assistance they receive from their parents, who
serve as role models
 maltreated children may have a hard time adapting
appropriately to stress
 Continuum of Care: Child care can be described along a continuum
ranging from healthy to abusive and neglectful
 Parents who violate their children’s needs and dependency
status are engaging in inappropriate and abusive behavior
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Types of Maltreatment
 North American states/provinces: civil laws obligate persons
who come in contact with children as part of their job or
volunteer work to report known/suspected cases of abuse to
the police or child welfare authorities
 Criminal statutes specify the forms of maltreatment that are
criminally punishable
 U.S. Child Abuse Prevention and Treatment Act (CAPTA):
Acts that result in death, serious physical or emotional harm,
sexual abuse or exploitation, or acts/failures to act that
present imminent risk of serious harm
 DSM-IV-TR: Maltreatment is not a form of abnormal child
behavior/psychological disorder
 It may be considered on Axis I (“other conditions that may
be the focus of clinical attention”) and Axis IV
(psychosocial and environmental problems)
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Types of Maltreatment
 Physical abuse: multiple acts of aggression, including punching,
beating, kicking, biting, burning, shaking, or otherwise physically
harming a child; injuries are often the result of overdiscipline or
severe physical punishment
 Neglect:
 Physical neglect: refusal or delay in seeking health care,
expulsion from the home/refusal to allow a runaway to return
home, abandonment, and inadequate supervision
 Educational neglect: allowing chronic truancy, not enrolling a
child of mandatory school age in school, failing to attend to a
child’s special educational needs
 Emotional neglect (most difficult to define): marked inattention
to a child’s needs for affection, refusal/failure to provide needed
psychological care, spousal abuse in the child’s presence,
permission of drug/alcohol use by the child
 Consider cultural values and poverty when determining neglect
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Types of Maltreatment (cont.)
 Sexual abuse: fondling a child’s genitals, intercourse with the
child, incest, rape, sodomy, exhibitionism, and commercial
exploitation through prostitution or the production of
pornographic materials
 may significantly affect behavior, development, and
physical health of sexually abused children
 their reactions and recovery vary, depending on the
nature of the assault and responses of important
others
 Emotional abuse: repeated acts/omissions that may cause
serious behavioral, cognitive, emotional, or mental disorders;
exists in all forms of maltreatment; can be as harmful as
physical abuse or neglect
 Exploitation: Commercial or sexual prostitution; significant
form of trauma for children and adolescents worldwide
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Context
 Incidence of Abuse and Neglect in North America
 Battered child syndrome, first described in early 1960s, was
thought to be rare (fewer than 300 children in the U.S.)
 Today over 3.5 million suspected cases of abuse and
neglect are investigated in the U.S. each year;
 Over 900,000 cases were substantiated in 2006 (12.1 per
1000 children)
 Of documented maltreatment cases: neglect accounts for 64%,
16% involve physical abuse, 9% involve sexual abuse, 7%
involve psychological maltreatment; 25% involve more than one
type; sexual and physical abuse cases have declined since
1992
 Lifetime prevalence estimates:
 Sexual abuse: 4.3% of males, 12.8% of females
 Physical abuse: 31.2% of males, 21.1% of females
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Context (cont.)
 Characteristics of Victimized Children
 Age: younger children more at risk for abuse and neglect
 sexual abuse is more common among older age
groups (over 12)
 except for sexual abuse, victimization rate is inversely
related to the child’s age
 Sex: 80% of sexual abuse victims are female; with that
exception, boys and girls are victims of maltreatment
almost equally (48% and 52%, respectively)
 boys more likely to be sexually abused by male nonfamily members, girls by male family members; both
are more likely to be abused by someone they know
and trust
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Context (cont.)
 Characteristics of Victimized Children (cont.)
 Racial characteristics:
 Maltreatment: 49% white, 23% African-American, 18%
Hispanic
 Compared to children of same race/ethnicity in the
U.S., highest rates of victimization are for children who
are African-American (19.8/1000), American Indian or
Alaska Native (15.9/1000), multiple race (15.4/1000),
White and Hispanic (11/1000), Asian (2.5/1000)
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Context (cont.)
 Characteristics of Family and Perpetrator
 More common among the poor and disadvantaged
 Children from single-parent (especially father-only) homes
and large families are at highest risk
 80% of victims are abused by one or both parents,
although nearly 50% of sexually abused children are
abused by persons other than parents/parent figures;
mother is perpetrator of neglect 90% of time
 Males are offenders in majority of sexual abuse (90%),
and about half of those are the child’s father/father figure
 Except for sexual abuse, the most common perpetrator
for child maltreatment is a female parent acting alone,
typically younger than 30 years of age
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevalence and Context (cont.)
 Cross-Cultural Comparisons
 Physical and sexual abuse are at epidemic proportions in
many societies worldwide
 Estimated that by age 14, 40 million children are victims
of neglect and abuse each year worldwide
 A comparison of rates in North American and other
Western societies shows comparable rates of child sexual
abuse: 20% for females and between 3-11% for males
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology
 Resilience and Adaptation
 Maltreatment does not affect each child in a predictable or
consistent way; outcomes depend on severity and chronicity of
events and how the events interact with the child’s individual
and family characteristics
 Core developmental processes may be impaired, resulting
in emotional and behavioral problems ranging from speech
and language delays to criminal behavior
 Protective factors: positive relationship with at least one
important and consistent person in the child’s life who provides
support and protection (although that might actually be a
maltreating parent) and personality characteristics, such as
positive self-esteem and sense of self
 Removing children from families can become another
source of stress and disruption with undesired side effects
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)
 Developmental Consequences
 Early attachment and emotion regulation (i.e., the ability to
modulate/control the intensity/expression of feelings/impulses)
 Maltreated infants and toddlers
 have difficulty establishing a reciprocal, consistent
pattern of interaction with their caregivers
 exhibit insecure-disorganized attachment,
characterized by a mixture of approach and avoidance,
helplessness, apprehension, and general disorientation
 have difficulty understanding, labeling, and regulating
internal emotional states
 learn to inhibit emotional expression and regulation,
remaining more fearful and on alert
 Difficulty modulating emotions can result in depressive
reactions or angry outbursts and may lead to self-harm as
well as internalizing and externalizing problems
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)
 Developmental Consequences (cont.)
 Brain development
 Children and adults with a history of child abuse show
long-term alterations in the HPA axis and
norepinephrine systems, which have a significant
affect on responsiveness to stress
 Affected brain areas include the hippocampus,
prefrontal cortex, and amygdala, which can lead to
long-term mental health problems
 Acute and chronic forms of stress associated with
maltreatment may cause changes in brain
development and structure, particularly
neuroendocrine system, causing neurobiological
changes that may account for later psychiatric
problems
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)
 Developmental Consequences (cont.)
 Emerging view of self and others
 Maltreated children’s emerging views of self and their
surroundings are not fostered by healthy parental guidance
and control, thus emotional and behavioral problems are
likely to appear
 Develop negative representational models of self and
others based on a sense of inner “badness,” self-blame,
shame, or rage
 Feelings of powerlessness and betrayal internalize as part
of the child’s self-identity; they often blame themselves for
the maltreatment
 Maltreated girls show internalizing signs of distress such as
shame and self-blame, while maltreated boys show
heightened levels of verbal and physical aggression
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)
 Developmental Consequences (cont.)
 Emotional and Behavioral Problems
 Maltreated children’s relationships with peers and teachers
have elements of being a victim and a victimizer, so they
are easily distracted by aggressive stimuli and tend to make
hostile attributions for the actions of others
 Physically abused and neglected children show little skill at
empathy or recognizing distress in others, and respond to
others’ distress with fear, physical attack, or anger
 Maltreated children (especially physically abused) are more
physically and verbally aggressive with peers, and are more
likely to be unpopular and rejected
 Maltreated children (especially neglected) often withdraw
from and avoid peer interaction
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)
 Developmental Consequences (cont.)
 Emotional and Behavioral Problems (cont.)
 Neglected children have the most severe and wide-ranging
problems in school and interpersonal adjustment; they
perform poorly on standardized tests and lack maturity and
academic readiness
 Sexually abused children
 suffer in academic performance and ability to focus on
tasks, are frequently absent from school, and appear
high in shyness-anxiousness
 may regress to behaviors of earlier levels of
development (e.g., bedwetting) and self-destructive
behaviors
 may show specific symptoms of sexualized behavior as
well as depression, withdrawal, and anxiety
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)

Psychopathology and Adult Outcomes
 Physically abused children are at risk for later problems involving
failure and future maladaptations, and problems with interpersonal
relationships marked by aggressive and violence
 cycle-of-violence hypothesis: victims of violence become
perpetrators of violence
 Child sexual abuse can lead to chronic impairments in self-esteem,
self-concept, and emotional and behavioral self-regulation,
including PTSD and depression
 Child maltreatment can lead to chronic psychiatric disorders:
anxiety and panic disorders, depression, eating disorders, sexual
problems, and personality disturbances
 Mood and Affect Disturbances: depression, emotional distress, and
suicidal ideation are common among abused children and if
unrecognized, can lead to later problems, especially adolescent
substance abuse; symptoms can be avoided if children have social
support from non-offending family members and others, as well as
opportunities to develop healthy coping strategies
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)
 Psychopathology and Adult Outcomes (cont.)
 Post-traumatic Stress-Related Problems: As many as half of
victims of maltreatment involving sexual abuse or combined
sexual and physical abuse meet criteria for PTSD during
childhood or adolescence
 About 1/3 of childhood victims of sexual or physical abuse
or neglect meet criteria for lifetime PTSD
 They may also dissociate, and the fragmentation of
experience and affect can progress into borderline disorder,
dissociative identity disorder, or chronic pain
 Sexual abuse can lead to traumatic sexualization, with the
child’s sexual knowledge and behavior shaped in
developmentally inappropriate ways
 Sexual abuse may also lead to weight problems, eating
disorders, poor physical health care, physically destructive
behavior—and in early adulthood, promiscuity, prostitution,
sexual aggression, and victimization of and by others
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Developmental Course and Psychopathology (cont.)
 Psychopathology and Adult Outcomes (cont.)
 Criminal and Antisocial Behavior
 Although most abused children do not go on to commit
crimes, a significant connection exists between
maltreatment and violence (toward their parents and
themselves), as well as criminal and antisocial
behavior
 approximately 30% carry the pattern into
adolescence and adulthood
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment
 Physical abuse and neglect are relational disorders that most
often occur during periods of stressful role transitions for
parents, early childhood and early adolescent oppositional
periods of testing limits, and times of family instability and
disruption
 Stress is among the multiple causes
 Sexual abuse is influenced by cultural and familial practices
as well as stress
 Maltreatment is not typically caused by adult
psychopathology (fewer than 10% of maltreating parents
have a primary psychiatric illness); however, they are likely to
have a history of learning and intellectual deficits and
personality disorders
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment
 Physical Abuse and Neglect
 Many abusive and neglectful parents have had little
exposure to positive parental models and supports
 They often had difficult childhoods
 They find daily living stressful and irritating and don’t have
the energy to seek out support
 They often complain of chronic physical ailments and a
pervasive mood of discontent
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Chlid Maltreatment (cont.)
 Physical Abuse and Neglect (cont.)
 Offender characteristics:
 less interaction with their children than other parents,
responding primarily to punish misbehavior
 information-processing disturbances may cause maltreating
parents to misperceive or mislabel their child’s behavior,
leading to inappropriate responses
 although there is much overlap, neglecting parents are
more likely than abusing parents to exhibit striking
personality disorders and inadequate knowledge of their
children’s needs; they also disengage under stress (escape
and avoidance) rather than becoming emotionally and
behaviorally reactive, which can lead to severe
consequences for the child and higher risk of substance
abuse for the parents
 lack child-rearing and information-processing skills, as well
as ways to cope with anger and arousal
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment (cont.)
 Physical Abuse and Neglect (cont.)
 Child and Family Influences:
 no child characteristic has been linked to the risk of
maltreatment, once environmental and adult factors
are controlled for (with the exception of gender for
sexual abuse)
 coercive family interactions in abusive families: child
learns that misbehaving elicits predictable parent
reactions, giving the child a sense of control
 chronic adult inadequacy in neglect
 family conflict and marital violence are linked to child
maltreatment
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment (cont.)
 Physical Abuse and Neglect (cont.)
 Child and Family Influences (cont.)
 An integrated model: Parental and situational factors
interact over time to increase or to decrease the risk of
physical abuse or neglect
 Dynamic three-stage process suggests that
maladaptive interaction patterns result from complex
interactions among child characteristics, parental
personality and style, history of the parent-child
relationship, and the supportive or non-supportive
nature of the family’s broader social context
 The process includes destabilizing and compensatory
factors
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment (cont.)
 Sexual abuse
 Offender Characteristics: Sexual abusers are a mixed group
who defy personality labels or psychiatric descriptors
 most are males who meet DSM-IV-TR criteria for pedophilia;
as a group, they have significant social and relationship
deficits
 proximate risk factors: comorbid psychiatric disorders and
substance abuse
 over 50% of pedophiles are aware of their interests before
age 17 and begin to act out by late teens or early twenties
 use complicated techniques to gain access and compliance
from the child who is gradually indoctrinated into sexual
activity; force is seldom used
 often a perpetrator has special status, such as teacher,
religious figure, or scout leader; intentions are covered by a
sense of entitlement and privilege
 offenders often have their own histories of abuse
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment (cont.)
 Sexual abuse (cont.)
 Family and Situational Influences
 In incestuous families, the abuser often attempts to
maintain control and domination by isolating the family from
other families and community activities
 may restrict what family members may do and/or
enforce strict moral and religious views to protect the
“family secret”
 the marital couple reports much relationship distress
and dissatisfaction
 Certain situational factors increase children’s vulnerability to
being sexually abused, which offenders exploit:
 family problems, spending a lot of time alone, lax
supervision and parental unavailability, and being
unsure of themselves
 low income and social isolation increase the risk
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment (cont.)
 Social and Cultural Dimensions
 Our society condones and glorifies violence
 Media and entertainment have spent years ingraining
stereotypic portrayals of females as powerless and passive and
males as powerful, with women deferring to powerful men and
men challenging assertive women
 Racism and inequality are major sociocultural factors that
contribute to abuse and neglect
 Poverty and social isolation
 Poverty is associated with severe restrictions in child’s
expectable environment; adults below poverty level suffer
more individual and family problems, e.g., substance abuse
 Social/cultural disadvantage creates stress/confusion/
limited alternatives, impairing family’s coping abilities
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Causes of Child Maltreatment (cont.)
 Social and Cultural Dimensions (cont.)
 Child-Rearing Practices and Family Privacy
 In the past 50 years, childrearing practices have moved
away from disciplinary control methods toward those that
encourage the child’s independence and self-control
 Cultural norms of corporal punishment often make it difficult
to differentiate child abuse from child discipline: 75% of
children in the U.S. are physically punished by their parents;
for 10% the discipline is so severe the children are at risk of
serious physical/emotional harm
 Maltreatment is not only associated with limited
opportunities to learn appropriate child-rearing and to
receive needed support, but also long-held social customs
 Cultural norms influence the prevalence of sexual abuse:
erotic portrayal of children in pornography and mainstream
advertising may blur boundaries and send inappropriate
messages
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevention and Treatment
 The costs of medical, legal, educational and child welfare
services related to maltreatment are estimated at $103.8
billion a year in the U.S.
 Obstacles to intervention and prevention services for
maltreating families
 Those most in need are least likely to seek help
 They are brought to the attention of professionals after
norms or laws have been violated
 Parents do not want to admit to problems for fear of losing
their children or being charged with a crime
 Plausible approach to preventing maltreatment: seeing
strengths and abilities rather than deficits
 Prevention should begin early in the formation of the parentchild relationship
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevention and Treatment (cont.)
 Physical Abuse and Neglect
 Interventions emphasize desired changes in parental
behavior, but also affect children’s development
 Interventions for abuse involve ways to change how
parents teach, discipline, and attend to their children:
basic child-rearing skills, cognitive-behavioral methods to
target anger patterns or distorted beliefs
 Interventions for neglect focus on parenting skills and
expectations, plus ways to improve family organizational
skills
 Interventions for children address their needs in the
context of their family circumstances
 Treatment often begins with efforts to increase positive
parent-child interactions and pleasant experiences
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevention and Treatment (cont.)
 Physical Abuse and Neglect (cont.)
 Cognitive-behavioral approaches for abuse are most effective
 basic child-rearing skills
 modify parental behaviors relevant to child maltreatment
 relaxation and self-management skills training
 cognitive restructuring
 problem-solving training
 stress and anger management training enhance positive
experiences early in development of parent-child
relationship to help prevent maltreatment
 Treatment for neglect focuses on ways to stimulate child
development and structure child activities plus basic education
and assistance in managing everyday demands
 Programs for maltreated children show improved social
behavior, cognitive development, self-concept, and reduced
aggressive and coercive behaviors
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevention and Treatment (cont.)
 Sexual abuse
 Children’s treatment programs are few and difficult to devise, as
sexual abuse affects each child differently
 Treatments try to restore child’s sense of trust, safety,
guiltlessness through education and support to help them
understand why it happened to them and how they can learn to
feel safe
 information and education about sexual abuse to help
clarify false beliefs; reassurance; group therapy
 learn ways to prevent sexual abuse and restore sense of
personal power and safety
 Cognitive-behavioral methods for children and non-offending
parents
 Child needs to express feelings about the abuse and may need
specialized treatment if suffering from PTSD
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning
Prevention and Treatment (cont.)
 Sexual Abuse (cont.)
 Successful interventions should result in:
 helping children understand that what happened to
them was abuse, it was wrong, and it may have
caused them some temporary problems
 subsidence of emotional and behavioral problems
arising from the abuse; the children should have the
personal resources to handle future problems
 putting supportive relationships in place for the
children, especially with parents/other caregivers who
have been trained to deal with the problems
 children regaining their normal rate of development
Mash/Wolfe Abnormal Child Psychology, 4th edition
© 2009 Cengage Learning