Child abuse: causes, prevention, and intervention strategies

Child Abuse: Long-Lasting Consequences and Early Prevention

The experience of child abuse is sometimes metaphorically called "the death of childhood." Indeed, nothing robs a child more of her rights as a human being than when she is maltreated to the extent of physical, emotional, and/or social impairment. Child abuse can lead to death, debilitating injuries, trauma, risky behavior, and long-term mental illnesses (Gilbert et al., 2009). It is both sad and alarming that child abuse is persistently common in many countries, so much so that in 2006, the WHO published a special report on child maltreatment and drew important guidelines for its prevention (Butchart et al., 2006 in Gilbert et al., 2009). As such, child abuse can be considered at par with other public health concerns with lifelong consequences on children such as HIV infection, smoking, and obesity (Gilbert et al., 2009). The present paper discusses the long-term consequences of child abuse and briefly describes two intervention programs that have been effective in its prevention.

Child abuse comes in five different forms: physical abuse, sexual abuse, emotional or psycho-logical abuse, neglect, and more recently, witnessing intimate partner violence (Gilbert et al., 2009). It is not uncommon for a child to experience more than one form maltreatment on several occasions or continuously. Emotional abuse, for instance, rarely occurs by itself (Lau et al., 2005 in Gilbert et al., 2009). Narratives from U.S. child protection reports approximate 32-91% of abuse cases to be of the multiple-type (Lau et al., 2005 in Gilbert et al., 2009). High rates of repeat referrals to child protection services -- up to 22% within 24 hrs -- also indicate exposure to multiple types of abuse among victims (Hindley et al., 2006 & Bae et al., 2007 in Gilbert et al., 2009). From this perspective, child abuse can do far more damage than expected.

There is considerable evidence on the "cycle of violence" that stems from child abuse; i.e., it is not surprising if victims themselves become perpetrators of crime later in life. Data from a National Youth Survey demonstrate that adolescent physical abuse has immediate and enduring effects on a variety of non-criminal and criminal offences such as vandalism, gang fights, robbery, drug and alcohol abuse, physical and sexual assault, and intimate partner violence (Fagan, 2005). Another study reports that neglect and physical abuse during childhood increases the likelihood of arrest as a juvenile and as an adult by 31 and 48%, respectively (Butchart et al., 2006, in Gilbert et al., 2009).

Besides being at risk for aggressive behavior, which is an external mental health outcome, maltreated children are also at risk for internalising behavioral problems such as depression, anxiety, and suicidal tendencies. Sexual abuse and severe physical abuse victims are more likely than other types of victims to experience depression during childhood and also double their risk for attempted suicide in adolescence (Andrews et al., 2004; Widom, 1998; & Fergusson et al., 2008 in Gilbert et al., 2009). Studies also show associations between physical/sexual abuse or neglect and post-traumatic stress disorder (Putman, 2009; Grass-Oliveira et al., 2008). PTSD, characterized by frightening recurrent memories, sleep difficulties, and detached feelings, can be long-lasting and hence significantly affect the person's ability to function (Gilbert et al., 2009).

Not surprisingly, many child abuse victims consistently show poor academic performance and are more likely to have lower educational achievements than their non-abused peers (Lansford et al., 2002; Perez & Widom, 1994, in Gilbert et al., 2009). They are more likely to receive special education as well (Jonson-Reid et al., in Gilbert et al., 2009). Consequently, many of them end up in menial and semi-skilled employment, both of which have long-lasting economic consequences for the affected individuals (Gilbert et al., 2009).