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Quiz #1

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News Articles, AAP Policy

AAP policy opposes corporal punishment, draws on recent evidence
by Robert D. Sege M.D., Ph.D., FAAP

Parents and other adult caregivers should use effective discipline strategies for children that do not involve
spanking, other forms of corporal punishment or verbal shaming.

The guidance is part of an updated policy statement in which the Academy strengthens its opposition to corporal
punishment. The policy Effective Discipline to Raise Healthy Children, from the Council on Child Abuse and
Neglect and the Committee on Psychosocial Aspects of Child and Family Health, is available at
https://doi.org/10.1542/peds.2018-3112 and will be published in the December issue of Pediatrics.

The policy summarizes new evidence published in the 20 years since the release of the 1998 clinical report on
effective discipline, which discouraged the use of corporal punishment. Other AAP policies already call for the
abolition of corporal punishment in schools and suggest the use of alternatives to corporal punishment to
prevent child abuse.

Parents rely on pediatricians for advice on a variety of parenting matters, and most routine health care visits
involve a discussion of child behavior and discipline. This policy follows the opinions of the vast majority of U.S.
pediatricians, who do not recommend corporal punishment.

The purpose of discipline is to teach children good behavior and support normal child development. Effective
discipline does so without the use of corporal punishment or verbal shaming.

In fact, the use of corporal punishment among U.S. parents has been declining during the 21st century. Young
adults, regardless of race and ethnicity, are far less likely to endorse the use of corporal punishment than were
parents in past generations.

In the updated policy, the AAP defines corporal punishment as the “non-injurious, open handed hitting with the
intention of modifying child behavior.” Defined this way, corporal punishment is distinct from child abuse.

Harmful effects, vicious cycle

The change in guidance is brought about by an increasing awareness of the risks of corporal punishment for
normal child development. Corporal punishment can bring on a vicious cycle of escalating poor behavior and
more severe punishment.

A large national cohort study conducted in the 20 largest U.S. cities noted that children who were spanked more
than twice a month were more aggressive at subsequent surveys. Thus, each negative interaction reinforced
previous negative interactions as part of a complex negative spiral.

Children who experience repeated use of corporal punishment tend to develop more aggressive behaviors,
increased aggression in school, and an increased risk of mental health disorders and cognitive problems. In
cases where warm parenting practices occurred alongside corporal punishment, the link between harsh
discipline and adolescent conduct disorder and depression remained.

It is of concern that parental reliance on corporal punishment has been associated with physiological changes in
children. A small MRI study (n=23) reported reduced prefrontal cortical gray matter volume and performance IQ
associated with corporal punishment – even in the absence of other identified trauma. Other studies have noted
relationships between physical punishment and chronically high cortisol levels. These physiologic changes have
been associated with other adverse childhood experiences and reflect the presence of toxic stress, with lifelong
negative health effects.

https://doi.org/10.1542/peds.2018-3112

News Articles, AAP Policy

Parental factors, counseling

While many parents spank their children occasionally, a few parental factors increase the use of corporal
punishment. For example, parents who suffer from depression tended to use corporal punishment more
frequently. In addition, family economic challenges, mental health problems, intimate partner violence and
substance abuse all are associated with increased reliance on corporal punishment. One small report suggested
that parents who themselves have a history of trauma are more likely to use corporal punishment than other
parents.

Pediatricians can help parents develop effective discipline strategies appropriate to the child’s age,
developmental status and other individual factors. When counseling parents, it may be helpful to remind them
that even though spanking may transiently interrupt a child’s misbehavior, it is ineffective in the long term and
has substantial risk of future problems for the child.

For many parents, general comments about the problems associated with corporal punishment are best
embedded as part of in-depth problem-solving of difficult child behavior. Because many parents use corporal
punishment as a last resort, adoption of effective discipline strategies is likely to be extremely helpful in reducing
corporal punishment. Simply put, parents who manage their children’s behavior well may no longer feel the need
to use more violent approaches.

The Academy has a variety of resources concerning discipline issues (see resources). Other sources of
information for parents about effective discipline range from local efforts (e.g., family resource centers) to
national programs. Formal parenting programs, many of which are evidence-based, are available throughout the
country. These may be useful for parents who are struggling with behavior management for their children.

The AAP and individual pediatricians may join with others to reduce and ultimately end the use of corporal
punishment in the U.S.

Dr. Sege is a lead author of the policy statement. He was a member of the former AAP Committee on Child
Abuse and Neglect.

Resources

Bright Futures●

Information for parents on discipline from HealthyChildren.org●

Positive parenting tips from the Centers for Disease Control and Prevention●

AAP Connected Kids: Safe, Strong, Secure●

AAP News Parent Plus story “Discipline vs. punishment: What works best for children?”●

https://brightfutures.aap.org/Pages/default.aspx

http://bit.ly/1Ohp4ww

http://bit.ly/2EDPU5z

http://bit.ly/2Jfxc2A

http://www.aappublications.org/news/2018/11/05/disciplinepp110518

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Highlight

The Debate Continues

Child welfare research indicates that
corporal punishment is ineffective,
unnecessary, and a harmful form of
discipline for parents to use with
children (Gershoff & Bitensky, 2007).
Despite that knowledge some parents
still believe that in order to raise a
compliant and well-behaved child,
corporal punishment, including
spanking, hitting, and slapping, is
necessary. For decades professionals
and parents alike have debated the
differences between corporal
punishment and physical abuse.
Corporal punishment includes the
use of physical force with either the
parent’s hand or an instrument as a
way of disciplining a child for what the
parent considers to be inappropriate
behavior. Many argue that corporal
punishment helps children change
negative behaviors and promote
positive moral development. In
contrast, physical abuse involves
physical punishment that parents dole
out in anger and hostility in reaction
to a child’s behavior or action.

In this debate some parents and
professionals assert that the injuries
sustained by the child determine the

distinction between corporal
punishment and physical abuse. This
argument maintains that if a child does
not have physical injuries then physical
punishment is an acceptable discipline
method and should not be considered
abuse. Durrant (2005) argues that one
cannot assume that the absence of a
physical mark or bruise equates to the
absence of abuse. The instrument used,
the child’s physical size, and the body
part struck determine whether bruising
will occur. More importantly, the
absence of an injury does not
necessarily imply the absence of
physical or emotional pain. Another
consideration is whether the parent
uses corporal punishment for behavior
that, while labeled as negative
behavior, may in fact reflect age and
developmentally appropriate testing of
boundaries. For instance, a two-year-
old whose development requires the
practicing of separation and
individuation often demonstrates
this developmental process through
oppositional behaviors.

Support for corporal punishment
among Americans as a whole has
decreased slightly since the middle
part of the 20th century. One study
conducted in 2003 showed that

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202.408.8600 ext. 476 • SocialWorkers.org/sections

ISSUE ONE– 2010

IN THIS ISSUE

Corporal Punishment: Helping
Parents Change Their
Discipline Paradigm …………..1

Three Women, Two Mothers,
One Adoption: Reflections
Upon Reunion ………………….2

Remembering Homelessness
among Children and
Families ……………………….10

Child Welfare: The Continuing
Struggle for Reform …………13

Publication of articles does not
constitute endorsement by NASW
of the opinions expressed in the
articles. The views expressed are
those of the author(s).

(Corporal Punishment, continued on page 3)

CORPORAL PUNISHMENT: HELPING PARENTS
CHANGE THEIR DISCIPLINE PARADIGM
Ana Leon, PhD, LCSW • Michael Cepero, MSW

3 Child Welfare • Issue One – 2010

individuals within the United States who
perceived spanking as an acceptable disciplinary
method dropped 30% since the 1960s (Ripoll-
Nunez & Rohner, 2006). Still, social workers
find that many parents see corporal punishment
as a necessity in today’s society in order to keep
“children in line,” “help curb unacceptable
behavior,” and ensure that children become
“productive citizens” in the future. Supporters of
corporal punishment attribute frequent displays
of disobedient, defiant, and oppositional
behavior; talking back to adults or authoritative
figures; and temper tantrums to a parent’s
unwillingness to utilize corporal punishment.

A Global Perspective

Corporal punishment as a form of child discipline
has existed since the time of ancient civilizations.
Many cultures outside of the United States also
use corporal punishment as a method to regulate
child misconduct, instill obedience, or
demonstrate parental power and authority.
However, a total of 23 countries are slowly
banning this practice. Some of the countries
that legally ban corporal punishment include
the Netherlands, Chile, New Zealand, Sweden,
Finland, United Kingdom, Italy, Israel, Croatia,
Portugal, Spain, Uruguay, Venezuela, and
Germany. In addition, 91 countries have at least
banned corporal punishment by teachers and
school administrators within school and academic
environments (Gershoff & Bitensky, 2007;
Ripoll-Nunez & Rohner, 2006). If there are
changes in international and national perceptions
of the use of corporal punishment, why do so
many individuals within the United States still
perceive corporal punishment as being not only
an effective method of child discipline, but a
necessary one?

Factors that Contribute to Accepting
Corporal Punishment

Multiple factors contribute to the attitudes and
perceptions about the use of corporal

punishment. The definition of what is normal in
disciplining practices comes from an individual’s
own experiences. One’s own upbringing and
culture are examples of such factors. From a
learning theory perspective, some individuals
whose parents used corporal punishment tend
to utilize the same approaches in parenting their
own children. Adolescents and adults who have
experienced corporal punishment often credit
their successful and productive lives to that
method of disciplining and do not perceive
themselves as victims of abuse, but beneficiaries
of “good discipline.” Similarly, a study of 11,660
adults revealed that 74% of the individuals
severely abused as children did not perceive
themselves as abuse victims (Durrant, 2005).

Corporal Punishment and Religion

Religious beliefs that reinforce corporal
punishment as an appropriate discipline for
helping children develop respect toward authority
and developing good morals may also account
for the use of corporal punishment (Ripoll-Nunez
& Rohner, 2006). The debate over this type of
discipline is evident when religious supporters of
corporal punishment argue that the absence of
such discipline practices will lead to an increase
in youth delinquency, crime, and other negative
behaviors. Opponents of corporal punishment
advocate that the decrease of corporal
punishment will result in decreased anger and
aggression among youth, who, as a consequence
of being physically punished, resort to
delinquency, drugs, crime, and other destructive
behaviors.

Corporal Punishment, Families,
and Culture

Parents who consider their children property
and believe they have the right to choose and
implement whatever form of discipline perceived
to be appropriate, accept corporal punishment
as an extension of this right. This perspective
views disciplining children, regardless of the

(Corporal Punishment, continued from page 1)

Issue One – 2010 • Child Welfare 4

methods, as a private matter (Ripoll-Nunez &
Rohner, 2006).

Families from different cultures who come to the
United States may use disciplinary practices that
are acceptable in their homeland but may appear
to be abusive in this country. Social, cultural,
religious, and moral values influenced by culture
determine appropriate discipline utilized in any
country of origin. Upon arriving in the United
States, parents from other cultures sometimes
recognize that their own discipline practices
differ from mainstream American values that are
moving toward the use of positive reinforcement
in child discipline. Parents from other cultural
backgrounds do not always understand the
American legal parameters related to child
discipline. This may result in a higher incidence
of reports to child protection agencies. However,
even within these cultural groups, differences
related to socioeconomic status and the use of
corporal punishment exist and practitioners
should not make the assumption that everyone
in a cultural group approaches child discipline
from the same perspective (Giles-Sims &
Lockhart, 2005).

Behavior Takes Time to Change

Behavioral changes in children take time to
manifest. Parents often do not have the necessary
patience to wait for changes to be evident and
instead resort to corporal punishment. In such
cases, the parent may believe the swift delivery of
physical punishment will produce the immediate
change in behavior desired. Last but not least,
parents do not always have enough information
on age appropriate development and sometimes
mislabel normal developmental behaviors as
willful oppositional acts. In those instances,
parents are more concerned with finding a quick
way to correct and/or stop the undesirable behavior.

Recommendations for Practitioners

It is important to recognize that most parents
who utilize corporal punishment believe they are
engaging in responsible parenting practices that
will help children become productive citizens.
The practitioner’s role then is to help parents
understand the negative consequences of corporal
punishment and help parents find new ways of
reinforcing positive behaviors in their children.
Practitioners can facilitate a paradigm shift
concerning discipline by helping parents:

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5 Child Welfare • Issue One – 2010

1. Understand the relationship between corporal
punishment and a variety of problems,
including higher rates of criminal activity,
assault against a domestic partner, abuse
with one’s own children, depression, and
substance abuse (Douglas, 2006). Children
practice what they learn in their environment.
There is a danger that children who are
corporally punished may assume that
physical punishment is the only way to
change behaviors, attitudes, or actions in
someone else.

2. Distinguish developmentally appropriate or
age appropriate ‘testing’ behaviors from
behaviors that may indicate more serious
behavioral or mental health problems.

3. Learn how to appropriately use discipline and
provide information regarding alternatives to
physical punishment. It is important to help
the parent identify positive disciplining
techniques that are age appropriate and may
include using a system of earning privileges
for positive behaviors, time outs, and open
communication.

4. Identify ways to reduce parental stress, anger,
and conflict. Often times, these stressors will
influence whether a parent utilizes appropriate
discipline or reacts in anger when disciplining
a child.

5. Understand the value of appropriate parenting
and disciplinary practices as prevention
strategies. Too often parents want to introduce
appropriate, non-corporal punishment when
the child is an adolescent and already acting
out, not realizing the value of structure and
appropriate discipline during the early years.

Conclusion

Parenting is a challenging job that requires
patience, flexibility, “choosing your battles,”
and most of all understanding each child’s needs.
Most parents want to help their children learn

self-regulation, empathy, morals, values, and
appropriate behaviors so that children may
become productive members of their families,
their communities, and society. Age-appropriate
discipline helps children achieve these goals and
reach optimal levels of functioning in a variety
of contexts. The reality and challenges of daily-
living stressors, as well as the lack of knowledge
of child development and parenting techniques,
may result in parents resorting to corporal
punishment in efforts to extinguish negative
behaviors. Helping parents find positive ways
to discipline children can lead to “win-win”
situations that support both parents and
their children.

Ana Leon, PhD, LCSW, is an associate professor in the School of
Social Work at the University of Central Florida in Orlando, Florida.
She can be contacted at leon@mail.ucf.edu.

Michael Cepero, MSW, and registered clinical social work intern, is
an outpatient therapist with Devereux in Orlando, Florida. He can be
contacted at mcepero11@yahoo.com.

References
Douglas, E.M. (2006). Familial violence socialization in childhood

and later life approval of corporal punishment: A cross-cultural
perspective. American Journal of Orthopsychiatry, 76(1), 23-30.

Durrant, J.E. (2005). Distinguishing physical punishment from physical
abuse: Implications for professionals. Envision: The Manitoba
Journal of Child Welfare, 4(1), 86-92.

Gershoff, E.T., & Bitensky, S.H. (2007). The case against corporal
punishment of children: Converging evidence from social science
research and international human rights law and implications for
U.S. public policy. Psychology, Public Policy, and Law, 13(4),
231-272.

Giles-Sims, J., & Lockhart, C. (2005). Culturally shaped patterns of
disciplining children. Journal of Family Issues, 26, 196-218.

Ripoll-Nunez, K.J., & Rohner, R.P. (2006). Corporal punishment in
cross-cultural perspective: Directions for a research agenda.
Cross-Cultural Research, 40(3), 220-249.

Effective Discipline to Raise
Healthy Children
Robert D. Sege, MD, PhD, FAAP, a Benjamin S. Siegel, MD, FAAP, b, c COUNCIL ON CHILD ABUSE AND
NEGLECT, COMMITTEE ON PSYCHOSOCIAL ASPECTS OF CHILD AND FAMILY HEALTH

Pediatricians are a source of advice for parents and guardians concerning
the management of child behavior, including discipline strategies that are
used to teach appropriate behavior and protect their children and others
from the adverse effects of challenging behavior. Aversive disciplinary
strategies, including all forms of corporal punishment and yelling at or
shaming children, are minimally effective in the short-term and not effective
in the long-term. With new evidence, researchers link corporal punishment
to an increased risk of negative behavioral, cognitive, psychosocial, and
emotional outcomes for children. In this Policy Statement, the American
Academy of Pediatrics provides guidance for pediatricians and other child
health care providers on educating parents about positive and effective
parenting strategies of discipline for children at each stage of development
as well as references to educational materials. This statement supports the
need for adults to avoid physical punishment and verbal abuse of children.

abstract

INTRODUCTION

Pediatricians are an important source of information for parents.‍1 They
are often asked by parents and guardians about nutrition, development,
safety, and overall health maintenance.‍ Pediatricians form a relationship
with parents, within which they partner with parents to achieve
optimal health, growth, and development in their children, including
childhood behavior management.‍ Duncan et al2 reviewed periodic
surveys of members of the American Academy of Pediatrics (AAP) and
noted that between 2003 and 2012, pediatricians had increased their
discussions of discipline with parents.‍ By 2012, more than half (51%)
of the pediatricians surveyed responded that they discussed discipline
in 75% to 100% of health supervision visits with parents of children ages
0 through 10 years.‍

A recent survey (2016) indicated that US pediatricians do not endorse
corporal punishment.‍ Only 6% of 787 US pediatricians (92% in primary
care) who responded to this survey held positive attitudes toward

To cite: Sege RD, Siegel BS, AAP COUNCIL ON CHILD ABUSE
AND NEGLECT, AAP COMMITTEE ON PSYCHOSOCIAL ASPECTS
OF CHILD AND FAMILY HEALTH. Effective Discipline to Raise
Healthy Children. Pediatrics. 2018;142(6):e20183112

aCenter for Community Engaged Medicine, Institute for Clinical
Research and Health Policy Studies, Tufts Medical Center, Boston,
Massachusetts; and Departments of bPediatrics and cPsychiatry,
Boston Medical Center and School of Medicine, Boston University,
Boston, Massachusetts

Drs Sege and Siegel created the first draft of this statement,
responded to committee and Board comments, and edited the
Policy Statement; and all authors approved the final manuscript as
submitted.

This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors have
filed conflict of interest statements with the American Academy
of Pediatrics. Any conflicts have been resolved through a process
approved by the Board of Directors. The American Academy of
Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.

Policy statements from the American Academy of Pediatrics benefit
from expertise and resources of liaisons and internal (AAP) and
external reviewers. However, policy statements from the American
Academy of Pediatrics may not reflect the views of the liaisons or the
organizations or government agencies that they represent.

The guidance in this statement does not indicate an exclusive course
of treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

All policy statements from the American Academy of Pediatrics
automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.

DOI: https:// doi. org/ 10. 1542/ peds. 2018- 3112

Address correspondence to Robert D. Sege, MD, PhD, FAAP. E-mail:
rsege@tuftsmedicalcenter.org

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

PEDIATRICS Volume 142, number 6, December 2018:e20183112 FROM THE AMERICAN ACADEMY OF PEDIATRICS

Organizational Principles to Guide and Define the Child Health Care System
and/or Improve the Health of all Children

POLICY STATEMENT

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https://doi.org/10.1542/peds.2018-3112

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spanking, and only 2.‍5% expected
positive outcomes from spanking.‍
Respondents did not believe that
spanking was the “only way to get
the child to behave” (78% disagreed)
or that “spanking is a normal part of
parenting” (75% disagreed).‍3

This policy statement incorporates
new research and updates the
1998 AAP clinical report titled
“Guidance for Effective Discipline, ” 4
which suggested, “Parents should
be encouraged and assisted in
developing methods other than
spanking in response to undesired
behaviors.‍”

BACKGROUND

In 1989, the United Nations (UN)
Convention on the Rights of the Child,
through its Committee on the Rights
of the Child, called on all member
states to ban corporal punishment
of children and institute educational
programs on positive discipline.‍5
In the UN report, article 19 reads,
“Parties shall take all appropriate
legislative, administrative, social,
and educational measures to protect
the child from all forms of physical
or mental violence, injury or abuse,
neglect or negligent treatment,
maltreatment or exploitation,
including sexual abuse, while in the
care of [the] parent(s) [or] legal
guardian(s) or any other person who
has the care of the child.‍”

The Global Initiative to End all
Corporal Punishment of Children
provided a comprehensive
definition of spanking and corporal
punishment: “The definition of
corporal or physical punishment
adopted by the Committee on the
Rights of the Child in its General
Comment No. 8 (2006) has the key
reference point, ‘any punishment
in which physical force issued and
intended to cause some degree of
pain or discomfort, however light.‍’
According to the committee, this
mostly involves hitting (“smacking, ”
“slapping, ” or “spanking”) children

with the hand or with an implement
(a whip, stick, belt, shoe, wooden
spoon, or similar), but it can also
involve, for example, kicking, shaking,
or throwing children; scratching,
pinching, biting, pulling hair, or
boxing ears; forcing children to stay
in uncomfortable positions; burning,
scalding, or forced ingestion (for
example, washing a child’s mouth
out with soap or forcing them to
swallow hot spices).‍ Nonphysical
forms of punishment that are cruel
and degrading and thus incompatible
with the convention include, for
example, punishment which belittles,
humiliates, denigrates, scapegoats,
threatens, scares, or ridicules the
child.‍ In the view of the committee,
corporal punishment is invariably
degrading.‍” 6

For the purpose of this policy
statement, corporal punishment
is the “noninjurious, open-handed
hitting with the intention of
modifying child behavior.‍” 7 Spanking
can be considered a form of physical
punishment.‍ As Gershoff and
Grogan-Kaylor7 noted, most people
understand “corporal punishment,
physical punishment, and spanking
as synonymous.‍” The term “verbal
abuse” is used to mean nonphysical
forms of punishment as defined
above.‍

This policy statement incorporates
results accrued from research and
new knowledge of brain development
and recommend that pediatricians
advise parents against the use of
any form of corporal punishment.‍
Verbal abuse (for a definition, see
above: the Global Initiative to End All
Corporal Punishment of Children)
by parents intended to cause shame
and humiliation of the child also has
deleterious effects on children’s
self-esteem.‍ This policy statement
complements a previous AAP policy
statement that recommended the
abolishment of corporal punishment
in schools.‍8

EFFECTIVE DISCIPLINE SUPPORTS
NORMAL CHILD DEVELOPMENT

Optimal child development requires
the active engagement of adults
who, among other functions, teach
children about acceptable behavior.‍
The word “discipline” is derived
from the Latin word “disciplinare, ”
meaning to teach or train, as in
disciple (a follower or student of
a teacher, leader, or philosopher).‍
Effective disciplinary strategies,
appropriate to a child’s age and
development, teach the child to
regulate his or her own behavior;
keep him or her from harm; enhance
his or her cognitive, socioemotional,
and executive functioning skills; and
reinforce the behavioral patterns
taught by the child’s parents and
caregivers.‍

There are a number of approaches
to discipline that pediatricians may
discuss with parents during well-
child visits and those visits that are
designed to address discipline issues.‍
These approaches are reviewed in
Bright Futures Guidelines for Health
Supervision of Infants, Children, and
Adolescents, 9 on the AAP Web site
HealthyChildren.‍org, 10 and in the
AAP program Connected Kids: Safe,
Strong, Secure.‍11 Bright Futures
includes sections on discipline
for each age group.‍ Each of these
recommended approaches to
discipline is based on the broad
concepts of child development and
related common behavioral concerns.‍

CORPORAL PUNISHMENT

Use of Corporal Punishment

There is evidence that support
for corporal punishment among
parents is declining in the United
States.‍ According to a 2004 survey, 12
approximately two-thirds of parents
of young children reported using
some sort of physical punishment.‍
These parents reported that by fifth
grade, 80% of children had been
physically punished, and 85% of

FROM THE AMERICAN ACADEMY OF PEDIATRICS2
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teenagers reported exposure to
physical punishment, with 51%
having been hit with a belt or
similar object.‍12 –15 These findings
suggest that, in 2004, many parents
considered spanking to be a socially
acceptable form of discipline.‍ In
contrast, a more recent national
survey of adults shows declining
support for spanking (or hitting),
particularly among young parents.‍
A 2013 poll16 conducted by Harris
Interactive found that support for
the statement “good, hard spanking
is sometimes necessary to discipline
a child” had dropped from 84%
in 1986 to 70% in 2012.‍ Parents
younger than 36 years more often
believed that spanking was never
appropriate, and only half reported
ever spanking their own children.‍ An
analysis of a 2016 national survey
conducted by yougov.‍com revealed
that respondents with young
children in the home, regardless of
race and ethnicity, did not support
corporal punishment, “suggesting
the possibility that a generational
shift in social norms [about corporal
punishment] may be taking place.‍” 17

Direct Observations of Corporal
Punishment

Although some studies of discipline
practices used observations during
home visits, 1 a small study published
in 201418 used voice recordings to
explore parent-child interactions
during daily activities.‍ The recordings
of 15 of the 33 families in the study
(45%) included the use of corporal
punishment.‍ Most parents used a
verbal disciplinary strategy before
corporal punishment.‍ Corporal
punishment then occurred at a mean
of 30 seconds later, suggesting that
parents may have been “responding
either impulsively or emotionally
rather than instrumentally and
intentionally.‍” The effects of corporal
punishment were transient: within
10 minutes, most children (73%) had
resumed the same behavior for which
they had been punished.‍

Ineffectiveness of Corporal
Punishment

A 2016 meta-analysis showed that
current literature does not support
the finding of benefit from physical
punishment in the long-term.‍7 Several
small, older studies (including meta-
analyses), 19 –22 largely of parents who
were referred for help with child
behavior problems, demonstrated
apparent short-term effectiveness of
spanking.‍ Only a single 1981 study
of 24 children showed statistically
significant short-term improvement
in compliance compared with
alternative strategies (time-out and a
control group).‍23

Cycle of Corporal Punishment and
Aggressive Child Behavior

Evidence obtained from a
longitudinal cohort study suggested
that corporal punishment of toddlers
was associated with subsequent
aggressive behavior.‍ The Fragile
Families and Child Wellbeing Study
was based on a population-based
birth cohort of approximately
5000 children from 20 large US
cities between 1998 and 200024;
data were collected at birth and
1, 3, 5, and 9 years of age.‍ Young
children who were spanked more
than twice per month at age 3 years
were more aggressive at age 5 even
when the researchers controlled for
the child’s aggressive behavior at
age 3, maternal parenting and risk
factors, and demographic factors.‍25
A follow-up study26 assessed these
children at 9 years of age and noted
correlations between spanking at
age 5 years and higher levels of
externalizing behavior and lower
receptive vocabulary scores at age
9.‍ A subsequent study analyzed data
from all 4 waves and concluded that
an increased frequency of spanking
was associated with a subsequent
increased frequency of externalizing
behaviors, which were then
associated with more spanking in
response.‍27 This interaction between
spanking and misbehavior occurs

over time; each negative interaction
reinforces previous negative
interactions as a complex negative
spiral.‍

In a study that explored parental
discipline approaches, 28 researchers
noted that both European American
and African American parents used
an escalation strategy in disciplining
their 6- to 8-year-old children.‍ Both
groups of parents used reasoning
more frequently than yelling.‍ The
next most frequent strategy was
denying privileges, and spanking was
the least frequent method reported
by all parents.‍ Similarly, in focus
groups conducted around the country
in 2002 during the development of
the AAP Connected Kids materials,
participating parents reported the
use of corporal punishment as a last
resort.‍11, 29

Special Populations

Children in foster care who have
experienced abuse or neglect may
exhibit challenging behaviors.‍
Programs exist that assist foster
parents in addressing discipline.‍
A recent AAP clinical report
describes the behavioral effects of
maltreatment and offers suggestions
for helping these children heal.‍30
Pediatricians may advise foster
parents to consider the behavioral
consequences of past abuse in
understanding how these children
may respond differently to their
foster parents’ attempts to correct
their behavior.‍31

Parents of children with special
health care needs may need
additional assistance regarding
discipline strategies.‍ These strategies
begin with an understanding of a
child’s physical, emotional, and
cognitive capacities.‍ In some cases,
consultation with a developmental-
behavioral pediatrician may be
helpful.‍32

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Parental Factors Associated With
Reliance on Corporal Punishment

Parental Depression

A longitudinal study examined
the interactions between parental
corporal punishment, parental
depression, negative perceptions of
a child’s behavior, and the child’s
externalizing behavior.‍33 The sample
included 245 children and parents
in stable relationships from mostly
middle-class, married, European
American parents.‍ Depressive
symptoms for both mothers and
fathers were related to more negative
appraisals of the child’s behavior and
more frequent corporal punishment
and predicted higher levels of child
externalizing problems at 5.‍5 years
of age.‍

Influence of Past Parental Trauma

A recent article, Kistin et al34
reported interviews with 30 low-
income mothers and provided
an important perspective on the
complexity of disciplinary strategies
used by mothers who had themselves
experienced trauma.‍ They reported
that mothers related their children’s
negative behaviors to their own past
experiences; harsh discipline was
used in an attempt to prevent future
behavioral problems.‍

Corporal Punishment As a Risk
Factor for Nonoptimal Child
Development

There appears to be a strong
association between spanking
children and subsequent adverse
outcomes.‍35 – 53 Reports published
since the previous 1998 AAP report
have provided further evidence
that has deepened the under-
standing of the effects of corporal
punishment.‍ The consequences
associated with parental corporal
punish ment are summarized as
follows7, 19, 21, 27, 35, 54 – 62:

• corporal punishment of children
younger than 18 months of age
increases the likelihood of physical
injury;

• repeated use of corporal
punishment may lead to aggressive
behavior and altercations between
the parent and child and may
negatively affect the parent-child
relationship;

• corporal punishment is associated
with increased aggression in
preschool and school-aged
children;

• experiencing corporal punishment
makes it more, not less, likely
that children will be defiant and
aggressive in the future;

• corporal punishment is associated
with an increased risk of mental
health disorders and cognition
problems;

• the risk of harsh punishment
is increased when the family is
experiencing stressors, such as
family economic challenges, mental
health problems, intimate partner
violence, or substance abuse; and

• spanking alone is associated with
adverse outcomes, and these
outcomes are similar to those in
children who experience physical
abuse.‍

The association between corporal
punishment and adverse adult
health outcomes was examined
in a 2017 report that analyzed
original data from the 1998 Adverse
Childhood Experiences Study,
which recommended that spanking
be considered as an additional
independent risk factor, similar in
nature and effect to other adverse
childhood experiences.‍63 In their
analysis of the original 1998 Adverse
Childhood Experiences study data,
the investigators found that spanking
was associated with increased odds
of suicide attempts, moderate-to-
heavy drinking, and substance use
disorder in adulthood independent
of the risks associated with having
experienced physical and emotional
abuse.‍

Physiologic Changes Associated With
Corporal Punishment and Verbal
Abuse

A history of parental corporal
punishment and parental verbal
abuse has been associated with
changes in brain anatomy that can be
visualized by using MRI.‍ Researchers
studied a group of young adults
(N = 23; ages 18–25) who had
prolonged and repeated exposure
to harsh corporal punishment and
compared the results of brain MRIs to
those from a matched control group
(N = 22).‍ They reported reduced
prefrontal cortical gray matter
volume and performance IQ.‍64
A similar study from this group
noted MRI results that revealed
differences in white matter tracts
in young adults (N = 16) who were
exposed to parental verbal abuse and
had no history of trauma.‍65 A more
recent review noted relationships
between physical punishment and
cortisol levels.‍66 Elevated cortisol
levels reflect stress and have
been associated with toxic stress
and subsequent changes in brain
architecture.‍

Harsh Verbal Abuse Associated With
Child and Adolescent Mental Health
Problems

In 2009, the UN Children’s Fund
defined “yelling and other harsh
verbal discipline as psychologically
aggressive towards children.‍” 28 In
a longitudinal study investigating
the relationship between harsh
verbal abuse by parents and child
outcomes, researchers noted that
harsh verbal abuse before age
13 years was associated with an
increase in adolescent conduct
problems and depressive symptoms
between ages 13 and 14.‍ Adolescent
behavior affected parental behavior
as well; misconduct predicted
increases in parents’ use of harsh
discipline between ages 13 and 14
years.‍ Furthermore, parental warmth
did not moderate the longitudinal
associations between harsh discipline

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by parents and adolescent conduct
and depressive symptoms.‍67

STRATEGIES FOR PROMOTING
EFFECTIVE DISCIPLINE

Effective disciplinary techniques
grow from an understanding of
normal child development.‍ Parents
value advice from their pediatricians,
as illustrated by a 2012 study1
involving 500 parents in New
Orleans, Louisiana.‍ The investigators
found that parents were more likely
to follow the advice of pediatricians
compared with other professionals,
and nearly half (48%) indicated that
they were most likely to consult their
pediatricians for advice on corporal
punishment.‍ In a second article, 68
these investigators further noted
that perceived social norms were
the strongest predictor of having a
positive attitude toward corporal
punishment, with the second-
strongest predictor being perceived
approval of corporal punishment by
professionals.‍

Clinical Setting

Pediatricians may assist parents by
providing information about child
development and effective parenting
strategies.‍ Although parents often
seek information and hold their
pediatricians in a position of trust,
discussions of discipline may prove
challenging.‍ This section presents
approaches to counseling.‍

Anticipatory Guidance

A direct discussion advising against
any form of corporal punishment
may be useful.‍ When appropriate,
the pediatrician may counsel family
members that spanking is not an
appropriate or effective disciplinary
strategy.‍ Parents may be counseled
that although spanking seems to
interrupt a child’s misbehavior, it
is ineffective in the longer-term.‍
For many children, spanking
increases aggression and anger
instead of teaching responsibility

and self-control.‍ This advice will be
most helpful if it is combined with
teaching parents new strategies to
replace their previous use of corporal
punishment.‍ Appropriate methods
for addressing children’s behavior
will change as the children grow
and develop increased cognitive and
executive function abilities.‍9

Teaching parents effective strategies
may allow them to avoid escalating
to the point of using corporal
punishment.‍ In a randomized trial,
Barkin et al69 demonstrated that
it was possible to teach parents to
use time-outs within the constraints
of an office visit.‍ Clinicians used
motivational interviewing techniques
to help parents learn to discipline
using other techniques.‍

When discussing corporal
punishment, pediatricians may
explore and acknowledge parents’
current experiences, past social-
emotional development, attitudes,
and beliefs.‍ Because parents may
use spanking as a last resort, they
may spank less (or not at all) if they
have learned effective discipline
techniques.‍11 Specific discussions
of behavior problems and behavior
management strategies allow
pediatricians to provide useful advice
that is based on an understanding of
child behavior.‍

Educational Resources

Pediatric providers may reinforce
behavioral counseling through
recommending or distributing parent
education materials.‍ For example,
studies have shown that in-office
videos may be able to deliver
messages to multicultural parents.‍70, 71
Having parents read brief research
summaries of problems associated
with corporal punishment decreased
positive attitudes about it.‍72 Each
of these approaches reinforced
verbal advice with other means of
supporting caregivers in learning
new parenting techniques.‍

The Centers for Disease Control
and Prevention has posted positive
parenting tips on its Web site.‍73 The
AAP provides content for parents
through its HealthyChildren.‍org Web
site and its Connected Kids: Safe,
Strong, Secure11 and Bright Futures9
programs.‍ Each of these resources
encourages parents to use positive
reinforcement as a primary means
of teaching acceptable behavior.‍
For example, parents can learn that
young children crave attention, and
telling a child, “I love it when you .‍ .‍ .‍”
is an easy means of reinforcing
desired behavior.‍

Community Resources

Although pediatricians offer
anticipatory guidance, many parents
will want or need more assistance in
developing strong parenting skills.‍
The medical home can link parents
to community resources.‍ Health
care sites may implement the Safe
Environment for Every Kid74, 75
program.‍ The program includes a
brief questionnaire that examines
family risk factors.‍ Parents who
identify needs, including parenting
challenges, meet with a colocated
social worker who can link them to
parent supports in the community.‍
This program also has online
educational modules.‍76, 77

A variety of national and community-
based organizations offer parents
support through Triple P, 78 which
is one example of an evidence-based
parent education program.‍ In
another program, HealthySteps, 79
a developmental specialist is placed
in the office setting to help support
families of children ages 0 to 3 years.‍
In most states, Children’s Trust
Funds and child welfare agencies
sponsor parent resource centers.‍
Help Me Grow, 80 a state-based
information and referral network,
has been implemented in the
majority of the United States.‍ The
Center for the Improvement of Child
Caring offers resources specifically

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tailored to African American
families.‍81– 83

Many clinic- and community-based
programs are specifically oriented
toward helping parents effectively
address their children’s behavior.‍84
Examples include The Incredible
Years, 85 a brief office-based video
intervention in the office that is
used to discuss discipline issues86;
Safety Check, which is used to teach
time-outs69; the Family Nurturing
Program, which is used to improve
parenting attitudes and knowledge87;
and the Chicago Parent Program, a
comprehensive 12-week parenting
skills training program.‍88 The
Video Intervention Project is an
evidence-based parenting program
that involves feedback on parent-
child interactions by trained child
development staff in a primary care
office setting.‍89

The 2012 AAP clinical report
was focused on the psychological
maltreatment of children and
adolescents and contained a
comprehensive review of preventive
measures that provide alternatives
to the use of corporal punishment.‍90
The literature describe other
resources and programs, such as
Internet-based training and group-
based parent training programs.‍91 – 93
This list of resources is not intended
to be comprehensive; many national
organizations and local communities
also offer effective parenting
resources.‍

CONCLUSIONS

Parents look to pediatric providers
for guidance concerning a variety of
parenting issues, including discipline.‍
Keeping in mind that the evidence
that corporal punishment is both
ineffective in the long-term and
associated with cognitive and mental
health problems can guide these
discussions.‍ When parents want
guidance about the use of spanking,
pediatricians can explore parental
feelings, help them better define the

goals of discipline, and offer specific
behavior management strategies.‍ In
addition to providing appropriate
education to families, providers can
refer them to community resources,
including parenting groups, classes,
and mental health services.‍94

The AAP recommends that adults
caring for children use healthy
forms of discipline, such as positive
reinforcement of appropriate
behaviors, setting limits, redirecting,
and setting future expectations.‍ The
AAP recommends that parents do
not use spanking, hitting, slapping,
threatening, insulting, humiliating, or
shaming.‍

POLICY RECOMMENDATIONS

Parents value pediatricians’
discussion of and guidance about
child behavior and parenting
practices.‍

1.‍ Parents, other caregivers, and
adults interacting with children
and adolescents should not use
corporal punishment (including
hitting and spanking), either in
anger or as a punishment for or
consequence of misbehavior, nor
should they use any disciplinary
strategy, including verbal abuse,
that causes shame or humiliation.‍

2.‍ When pediatricians offer
guidance about child behavior
and parenting practices, they may
choose to offer the following:

a.‍ guidance on effective discipline
strategies to help parents
teach their children acceptable
behaviors and protect them from
harm;

b.‍ information concerning the
risks of harmful effects and the
ineffectiveness of using corporal
punishment; and

c.‍ the insight that although many
children who were spanked
become happy, healthy adults,
current evidence suggests that

spanking is not necessary and
may result in long-term harm.‍

3.‍ Agencies that offer family support,
such as state- or community-
supported family resource centers,
schools, or other public health
agencies, are strongly encouraged
to provide information about
effective alternatives to corporal
punishment to parents and
families, including links to
materials offered by the AAP.‍

4.‍ In their roles as child advocates,
pediatricians are encouraged to
assume roles at local and state
levels to advance this policy
as being in the best interest of
children.‍

LEAD AUTHORS

Robert D. Sege, MD, PhD, FAAP

Benjamin S. Siegel, MD, FAAP

COUNCIL ON CHILD ABUSE AND NEGLECT
EXECUTIVE COMMITTEE, 2015–2017

Emalee G. Flaherty, MD, FAAP

CAPT Amy R. Gavril, MD, FAAP

Sheila M. Idzerda, MD, FAAP

Antoinette Laskey, MD, MPH, MBA, FAAP

Lori Anne Legano, MD, FAAP

John M. Leventhal, MD, FAAP

James Louis Lukefahr, MD, FAAP

Robert D. Sege, MD, PhD, FAAP

LIAISONS

Beverly Fortson, PhD – Centers for Disease
Control and Prevention

Harriet MacMillan, MD, FRCPC – American
Academy of Child and Adolescent Psychiatry

Elaine Stedt, MSW – Office on Child Abuse and
Neglect, Administration for Children, Youth and
Families

STAFF

Tammy Piazza Hurley

COMMITTEE ON PSYCHOSOCIAL ASPECTS
OF CHILD AND FAMILY HEALTH, 2016–2017

Michael W. Yogman, MD, FAAP, Chairperson

Rebecca Baum, MD, FAAP

Thresia B. Gambon, MD, FAAP

Arthur Lavin, MD, FAAP

Gerri Mattson, MD, FAAP

Raul Montiel-Esparza, MD

Lawrence Sagin Wissow, MD, MPH, FAAP

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LIAISONS

Terry Carmichael, MSW – National Association of
Social Workers
Edward Christophersen, PhD, FAAP
(hon) – Society of Pediatric
Psychology

Norah Johnson, PhD, RN, NP-BC – National
Association of Pediatric Nurse Practitioners
Leonard Read Sulik, MD – American Academy of
Child and Adolescent Psychiatry

STAFF
Stephanie Domain, MS

PEDIATRICS Volume 142, number 6, December 2018 7

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

FUNDING: No external funding.

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

ABBREVIATIONS

AAP: American Academy of
Pediatrics

UN: United Nations

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DOI: 10.1542/peds.2018-3112 originally published online November 5, 2018;
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Barnett, Family Violence Across the Lifespan, 3e

Chapter 4: Child Physical Abuse

Lecture Outline

I.
Scope of the Problem of Child Physical Abuse

i.
U.S. Advisory Board on Child Abuse and Neglect described the level of child maltreatment in the United States as a national emergency

ii.
Definitions

.
harm standard: recognizes children as CPA victims if they have observable injuries that last at least 48 hours

2.
endangerment standard: recognized children as abuse victims if they were deemed to be substantially at risk for injury (endangerment)

3.
any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm

4.
intentional use of physical force by a parent or caregiver against a child that results in, or has the potential to result in, physical injury

5.
physical punishment—use of physical force with the intention of causing the child to experience bodily pain or discomfort so as to correct or punish the child’s behavior

6.
protective physical restraint—when parents must use physical force to prevent a child from hurting themselves is not a form of punishment

iii.
Corporal punishment

1.
children are the only group in society that may be hit legally

2.
arguments against

a.
when authority figures spank, they are condoning the use of violence as a way of dealing with frustration and settling disputes

b.
message of acceptance of this form of violence contributes to violence in other aspects of society.

c.
adults who administer punishment that reduces a behavior have modeled how, when, and why one uses violence against another

d.
ineffective in achieving the anticipated results because a punisher is an event that decreases responses, therefore, punishment cannot teach new, desirable behaviors

e.
harsh physical punishment has adverse effects on brain development

f.
counterproductive

g.
positively correlated with other forms of family violence, including sibling abuse and spouse assault

h.
children judged spanking to be the least fair method of discipline

II.
Prevalence of Child Physical Abuse

a.
Statistics on Child Physical Abuse

i.
Official estimates

1.
decreased from 1992 to 2004

2.
CPS substantiated the abuse for 25.1% of the cases in a year

3.
13.2% infants <1 week of age were victims of physical abuse

4.
Injuries/Deaths

a.
of children < 12 years of age presenting at emergency rooms for treatment, half of those treated were under 5 years of age

b.
relatives inflicted 56% of the injuries; acquaintances inflicted 34.1%; and strangers inflicted 9.7%

c.
22.9% of fatalities were attributed to physical abuse

d.
69.9% of all child fatalities were caused by parents

e.
male infants were more likely than female infants to become a fatality

f.
41.1% of fatality victims were white; 26.1% of victims were African American; 16.9% were Hispanic; and the remainder was other unknown

g.
52% fatalities occurred in children under 1 year of age

h.
fathers/father substitutes significantly more likely to be perpetrators; mothers were significantly more likely to be deemed responsible for neglect

ii.
Child Death Review Teams

1.
community leaders in medicine, child services, religion, law enforcement, and other areas

2.
careful scrutiny of the causes will lead to development of methods to intervene and prevent such deaths

3.
Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID)

a.
safe sleeping campaigns— unsafe sleeping situations caused the deaths of a number of infants

iii.
Neonaticidal Mothers

1.
75% of mothers who kill newborns fit a common profile

2.
not mentally ill, and they do not have a history of arrest

3.
often deny their pregnancy intermittently

4.
most manage to deliver the baby on their own in secret

5.
most recover sufficiently to go right on with their daily routines, such as going to school or work

iv.
Self reports

1.
75% of the parents acknowledged having used at least one violent act in rearing their children

2.
approximately 2% of the parents had engaged in one act of abusive violence (e.g. an act with a high probability of injuring the child)

3.
most frequent type of violence in either case was slapping or spanking

4.
distinguishes three levels of physical assault: minor assault (i.e., corporal punishment), severe assault (e.g. physical maltreatment), and very severe assault (e.g. severe physical maltreatment)

5.
75% reported using some method of physical assault during the rearing of their children (e.g. spanking, slapping, and pinching)

6.
50% of parents surveyed said that they had engaged in behaviors from the severe physical assault subscale at some point during their parenting (e.g. hitting the child with an object such as a stick or belt)

7.
less than 1% of the parents employed behaviors from the very severe physical assault scale (e.g. throwing or knocking down a child)

8.
half reported having experienced at least one physical assault by an adult caretaker, with the acts of violence ranging from relatively minor forms of assault (e.g., being slapped or hit) to more serious forms (e.g., being threatened with a knife or gun)

b.
Trends of Statistics on Child Physical Abuse

i.
all forms of child maltreatment decreased from 40%-70%

ii.
fewer teen pregnancies, teen suicides, and children living in poverty

iii.
improved economic factors

iv.
increased agents of social change (e.g., more social workers)

v.
psychopharmacological advances

vi.
child maltreatment was staying about the same, at least not increasing

vii.
estimated rate of violence toward children declined

viii. most substantial decline was in the use of severe and very severe violence

III.
Effects of Child Physical Abuse on Children

a.
Findings on Child Physical Abuse

i.
children who experience physical maltreatment are more likely exhibit physical, behavioral, and emotional impairments

ii.
associations between corporal punishment and negative outcomes in childhood and into adulthood, including deficits in moral internalization, poor mental health, and increased aggression, antisocial behavior, and abusive behavior toward others

b.
Types of Child Physical Abuse

i.
Physical and mental health

1.
head injuries, abdominal injuries, and burns are likely to have long-lasting effects

2.
chronic pain on into old age

3.
depression, high inflammation levels, and a clustering of metabolic risk factors including being overweight, having high blood pressure, high bad cholesterol, high blood sugar, and low oxygen consumption

4.
elevated risks for allergies, arthritis, asthma, bronchitis, high blood pressure, and other problems

ii.
Criminal and violent behavior

1.
higher likelihood of arrests for delinquency, adult criminality, and violent criminal behavior

2.
adults with histories of CPA are more likely both to receive and to inflict dating violence

3.
adults (primarily males) who were physically abused as children are more likely to inflict physical abuse on their marital partners

iii.
Genetics

1.
variations in a gene that helps to regulate neurotransmitters in the brain that are implicated in antisocial behavior

2.
maltreated children with a protective version of the gene were less likely to develop antisocial problems in adulthood

3.
children who had the less protective version of the gene later became violent criminal offenders

iv.
Substance abuse

1.
CPA among girls led to a use of substances at age 12 which then continued onward

2.
substance abuse at age 12 was related to substance abuse at ages 16 and 24

v.
Socioemotional difficulties

1.
adults with histories of CPA exhibit more significant emotional problems

c.
Mediators/Moderators of Child Physical Abuse

i.
explain the variability of effects, why some effects may be pervasive and other not

ii.
Frequency, severity, and duration of the abuse

1.
more severe and/or chronic maltreatment may have more negative outcomes

iii.
Polyvictimization

1.
greater the number of subtypes of maltreatment (e.g., physical abuse, sexual abuse, neglect) experienced by a child, the more negative the outcomes will be

iv.
Prior involvement with CPS

1.
prior involvement with CPS influenced the probability of a second determination of abuse

v.
Child’s attributions

1.
Children who tended to blame themselves for the abuse exhibited greater internalizing symptoms

vi.
Family stress

1.
negative effects of abuse are greatest for children in families in which there are high levels of stress and parental psychopathology or depression

vii.
Sociocultural factors

1.
presence of community violence can be a factor influencing the effects of CPA

viii.
Child’s intellectual functioning

1.
high intellectual functioning and/or the presence of a supportive parent figure have a protective influence

ix.
Relationships between the victim and abuser

1.
parental sensitivity, for example, has a protective influence; lack of empathy predicted symptoms following CPA victimization

x.
Trauma symptoms

1.
children whose abuse eventuated in the trauma symptom of avoidance coping were more likely to abuse their own child

xi.
Child’s temperament

1.
low fear and low sensitivity to punishment

xii.
Social support

1.
more likely to have received emotional support from a nonabusive adult during childhood, to have participated in therapy during some period in their lives, and to have been involved in nonabusive, stable, emotionally supportive, and satisfying relationships with mates

xiii.
Medical and neurological problems

1.
bruises are one of the most common types of physical injuries

2.
other marks on their bodies as the result of being grabbed or squeezed or of being struck with belts, switches, or cords

3.
chest and abdominal injuries

4.
burns

5.
fractures

6.
abdominal injuries by being struck with objects, by being grabbed tightly, or by being punched or kicked in the chest or abdomen, which can result in organ ruptures or compressions

7.
compromised brain development

8.
deficits in language skills, memory, spatial skills, attention, sensorimotor functioning, cognitive processing, and overall intelligence

9.
head injury resulting in neurotrauma

10.
shaken baby syndrome

a.
violently shaking an infant can result in mild to serious Traumatic Brain Injuries

b.
shaking a child violently can cause the child’s brain to move within the skull, stretching and tearing blood vessels

c.
damage may include bleeding in the eye or brain, damage to the spinal cord and neck, and rib or bone fractures

d.
long-term neurological or mental disability may appear

xiv.
Cognitive problems

1.
lower intellectual and cognitive functioning on general intellectual measures as well as on specific measures of verbal facility, memory, dissociation, verbal language, communication ability, problem-solving skills, and perceptual motor skills

2.
poor school achievement and adjustment, receive more special education services, score lower on reading and math tests, exhibit more learning disabilities, and are more likely to repeat a grade

3.
greater concentrations of urinary dopamine, norepinephrine, and free cortisol, as well as a number of smaller specific brain regions, resulting in negative impacts on children’s ability to regulate both emotional and behavioral responses

xv.
Behavioral problems

1.
physical aggression and antisocial behavior

2.
drinking and drug use, noncompliance, defiance, fighting in and outside of the home, property offenses, and arrests

3.
bullying

a.
use of power and aggression in order to distress a vulnerable person using verbal or physical actions and behaviors such as exclusion and ostracism

b.
relational bullying—aggression aimed at damaging someone else’s relationship

c.
relationship between parents’ harming a child physically and the child victims’ bullying behaviors; youth from violent homes often model the violence and carry out similar abusive patterns of behavior in their own relationships

d.
more prevalent before age 12, and it continues during adolescence; beginning in middle school and reaching a peak during the transition from middle school to high school followed by a decline

e.
black students report being victimized more than white students

f.
bully only, victim only, and both victim and bully

g.
physical, emotional, indirect, verbal, sexual, and relational

h.
bullies rank high on antisocial behavior and aggression, associated with anger, impulsivity, and depression

i.
bullies have lower quality parental attachment are significantly more likely to bully and to be bullied

j.
victims are submissive/nonassertive, someone who is different because of sexual orientation, race, or disability

k.
victims exhibit low self-esteem and depression, lower in prosocial behavior and girls were higher in impulsivity, intensified anxiety and depression

l.
victims suffered from an escalation of symptoms of depression, anxiety, social withdrawal, and physical complaints

m.
violent childhood does not mean that bullying behavior is inevitable, and interventions can change the way school children relate to others

xvi.
Pathology

1.
internalizing behavioral symptoms

2.
Attachment problems

a.
insecure attachment in infants where the parent-child relationship presents an irresolvable paradox because the caregiver is both the child’s source of safety and protection and the source of danger or harm

3.
Psychiatric disorders

a.
increased risk for psychiatric disorders problems (e.g. social dysfunction, somatization, revictimizations, attention-deficit/hyperactivity disorder, borderline personality disorder, bipolar disorder)

4.
Posttraumatic stress disorders

a.
81% of abused children have partial PTSD symptoms

5.
Depression

a.
greater risk of depression

b.
learned helplessness

IV.
Characteristics of Children Who Are Physically Abused

a.
Statistics on the Characteristics of Physically Abused Children

i.
Age

1.
highest report is 5.5 per 1,000 for children 6 to 8

ii.
Gender

1.
girls are generally more at risk for all abuse

2.
boys are generally at slightly greater risk than girls for CPA

iii.
SES

1.
CPA occurs disproportionately more often among economically and socially disadvantaged families

iv.
Race

1.
black children to be the most sexually abused

2.
African American families are at the greatest risk for CPA

v.
Disabled

1.
special characteristics of disabled children increase their risk for abuse

2.
association between CPA and birth complications such as low birth weight and premature birth

3.
incidence of child maltreatment was almost twice as high

4.
most common disabilities noted were emotional disturbance, learning disability, physical health problems, and speech or language delay or impairment

b.
Services Provided to Physically Abused Children

i.
CPS is less likely to initiate an investigation of disabled children compared with nondisabled children

ii.
CPS is likely to recommend services for disabled abused children instead of services for the abusive parents

V.
Characteristics of Adults Who Physically Abuse Children

a. Findings on Adults Who Physically Abuse Children (Please align)

i.
Age: Younger parents are more likely than older parents

ii.
Gender and Parental Type

1. More adult males (62%) physically abused children than

females

2. Biological parents abused more females than male children

(NIS-4)

3. Nonbiological parents/partners abused more male than

female children (NIS-4)

4. Others abused more male than female children (NIS-4).

5. Kaiser-Permanente study found gender differences related

to type of homes (e.g., substance abuse in the home)

iii
Race: Looking at child maltreatment as a whole (not just physical

abuse), Whites perpetrated more abuse than their other groups

(DHHS)

iii.
Close to half are White

b.
Relationship of Perpetrator to the Abused child

i.
birth parents (0.9%) are the perpetrators of the abuse in the majority of reported cases of any type of abuse (DHHS)

ii.
biological parents perpetrate 72% of physical abuse against children (NIS-4)

c.
Nontraditional Parenting

i.
single parents are overrepresented among abusers

ii.
highest rates of child abuse occurred among single parents who had a cohabiting partner, rate of abuse was 10 times higher than children living with married biological parents

iii.
children cared for by grandparents were less apt to be physically abused than cared for by parents

d.
Psychological, Interpersonal, and Biological Characteristics of Adults Who Physically Abuse Children

i.
Emotional and behavioral characteristics

1. Characteristics such as anger control problems, hostility, low frustration tolerance, depression, low self-esteem, deficits in empathy, and rigidity

2. Substance abuse problems are significantly related to recurrence of a CPA report

ii.
Family and interpersonal difficulties of perpetrators

1. Physically abusive adults are more likely to exhibit family and interpersonal difficulties

2. Report more verbal and physical conflict among family members, higher levels of spousal disagreement and tension, and greater deficits in family cohesion and expressiveness

3. Report more conflict in their families of origin

4. Engage in fewer interactions with their children, such as playing together, providing positive responses to their children, and demonstrating affection

5. More likely both to receive and to inflict dating violence

6. Adults (primarily males) who were physically abused as children are more likely to inflict physical abuse on their marital partners

7. Adults who were victims of physical abuse as children are more likely to be perpetrators of CPA as adults

VI.
Explaining Child Physical Abuse

a.
Perpetrators exhibit psychological, behavioral, and biological characteristics such as anger control problems, depression, parenting difficulties, physiological hyperreactivity, and substance abuse

b.
The psychiatric explanation – Only a small proportion of abusive parents (less than 10%) meet criteria for severe psychiatric disorders

c.
Postpartum depression/psychosis model

i.
they have problems in feeding, sleep routines, well-baby clinic visits, vaccinations, and safety practices

ii.
there is a biological basis for postpartum depression

iii.
few mothers actually harm their babies because of postpartum depression, many women have recurrent and disturbing thoughts of harming their babies

iv.
postpartum depression is under-identified and under-treated

v.
treatments are psychotherapy, antidepressant medications, stress reduction, massage therapy

d.
Munchausen by Proxy – A rare type of physical child abuse

i.
adult caretakers falsify to medical personnel physical and/or psychological symptoms in a child in order to meet their own (parent’s) psychological needs

ii.
fabrication of symptoms such as altering laboratory specimens, and the direct production of physical symptoms

e.
Difficult Child Model

i.
children with certain characteristics (such as mental disabilities, aggressiveness, and young age) are at increased risk for abuse

ii.
some parents may lack the skills to manage children who are annoying, defiant, argumentative, or vindictive, and their frustration may lead to child abuse

f.
Parent-Child Interaction Model

i.
difficult child behaviors interact with specific parental behaviors

ii.
behavior of both parent and child, rather than the behavior of either alone brought about the abuse

iii.
difficulties in parent-child relations develop during the abused child’s infancy, when early attachments between parent and child are formed

g.
Social Learning Theory

i.
abusive adults presumably learned through experiences with their own parents that violence is an acceptable method of child rearing

ii.
parents who had been neglected during their own childhood, relative to those who had not, were 2.6 times more likely to neglect their own children and 2 times more likely to physically abuse their own children

iii.
parents who had been physically abused during childhood, relative to those who had not, were 5 times more likely to physically abuse their own children and 1.4 times more likely to neglect their children

iv.
children who observe interparental violence were likely to engage as perpetrator or victim in their own adult intimate relationship

h.
Situational and Societal Conditions

i.
Economic disadvantage

1.
more common among low-income families and families supported by public assistance

2.
fathers who are unemployed or work part-time are also at greater risk for abusing their children

ii.
Social isolation – more interpersonal problems outside the family—such as social isolation, limited support from friends and family members, and loneliness

1.
lack an extended family or peer support network

2.
children who had grandparents were significantly less likely to be abused than those who did not, suggesting that having an extended family may have functioned to reduce isolation and abuse

i.
Stress

i.
parenting stress strongly influences both parenting behaviors and children’s behavioral and emotional problems

ii.
abuse is associated with high numbers of stressful life events as well as stress associated with parenting

iii.
stressors include a new baby, illness, death of a family member, poor housing conditions, larger-than-average family size, work-related problems and pressures, marital discord, conflicts over a child’s school performance, illness, a crying or fussy child, and military service

1.
abuse doubled during the after period, the deployment period, and increased both upon deployment and upon return from deployment

2.
parents of children with a deployed spouse had significantly elevated depression

j.
Corporal Punishment Acceptance

i.
there are no federal laws against spanking children, and only half the states ban spanking in child care settings and/or schools

ii.
certain protestant religious beliefs and sociopolitical conservatism play a role in the acceptance of physical discipline but do not incorporate acceptance of child physical abuse

iii.
United Methodist Church has now called for a ban on corporal punishment

k.
Risk Factors for Child Physical Abuse

i.
frequent spanking

ii.
spanking the buttocks with an object

iii.
polyvictimization

l.
Protective Factors

i.
Supportive family environment

ii.
Nurturing parenting skills

iii.
Household rules

iv.
Family protective community

v.
Child monitoring

vi.
Parental employment

vii.
Adequate housing

viii.
Access to healthcare

ix.
Access to social services

x.
Extended family support

VII.
Practice, Policy, & Prevention

a.
Practice Issues Regarding Child Physical Abuse

i.
Parent-Focused Treatment: improvements in parenting skills

ii.
In-Home Treatments: several in-home treatments are effective for reducing CPA

1.
Project SafeCare

2.
parents actively acquire needed skills through techniques such as completing homework assignments and demonstrating (modeling) desirable parental behaviors

iii.
Behavior-Based Treatment Programs

1.
programs focus on parent’s behavior, the child’s behavior, parent-child interactive behaviors, or all three.

2.
parent training based on behavioral (learning) or cognitive-behavioral principles that involve educating parents about the following elements:

a.
effects of reinforcement and punishment on children’s behavior

b.
appropriate methods of delivering reinforcement and punishment

c.
importance of consistency in discipline

d.
identification of events that increase negative emotions

e.
changing anger-producing thoughts

f.
relaxation techniques

g.
methods for coping with stressful interactions with their children

iv.
Parent-Child Interaction Therapy (PCIT)

1.
eliminate parents’ physical abuse of their children, observing counselor gives the parent instructions via an electronic hearing device

2.
parents learn specific skills, such as empathic listening and how to communicate the consequences for specific behaviors

v.
Cognitive-Behavioral Therapy

1.
psychoeducation, skills training, and application

2.
manifested less parental distress, risk for child abuse, and family conflict

3.
better family cohesion and a reduction in children’s externalizing behavior

vi.
Combined Parent-Child Cognitive Behavioral Treatment

1.
16 therapy session, each 90 minutes long

2.
therapist meets the parent and child separately and together

3.
engagement strategies to motivate the parent to enter and remain in treatment

4.
psychoeducational component provides information about different types of abuse and coercive behavior and their impacts on children and parents

5.
teaches child development and setting realistic expectations for children’s behavior

6.
children learn how to express their feelings

7.
parents practice communication skills, positive parenting, and behavior management

8.
whole family develops a safety plan and practices how to implement it

9.
works on communicating about abuse issues

10.
parent writes a letter of apology for being abusive, and the child writes about the traumatic elements of his abuse

11.
outcome evaluation judged the program to be effective

vii.
Therapeutic day care

1.
programs that offer child care can provide relief for overly burdened parents who need a break

2.
individual therapy, group therapy, and play sessions

3.
group activities, opportunities for peer interactions, and learning experiences to address developmental delays

4.
sharing experiences, anger management, and social skills training

5.
opportunities for informal interaction between abused children and adults and/or peers

viii.
The Incredible Years Teacher Training Series

1.
helps children deal with externalizing behaviors

2.
offered once a week

3.
children in group settings learn how to empathize and behave in prosocial ways

4.
children become less disruptive at home and in class and also improve their academic performance

5.
parent training led to many improvements in the area of disciplining children: less harsh discipline, less physical punishment, more praise/incentive behaviors, more appropriate discipline, and positive verbal discipline

ix.
Parental support interventions

1.
developing social support networks made up of personal friends as well as community contacts

2.
group therapy format that centers on identification of stressors common to parenting and how to cope with them

x.
Treatment by CPS agencies

1.
have shown only weak evidence of effectiveness, mainly because the programs are not necessarily evidence based

2.
provide assistance in obtaining services for basic necessities

3.
helps parents who need help in completing government forms that will allow them to obtain food stamps and other welfare assistance

x.
Family preservation

1.
short-term intensive and supportive interventions

2.
focus on training parents in child development and parenting skills, as well as in stress reduction techniques and anger management – prevents out-of-home placement

xi.
Out-of-home care

1.
foster care placement, court placements with relatives, and placement in residential treatment centers and institutions

2.
reaffirms the principle of family reunification but also holds paramount the concern for children’s safety

3.
risk factors for foster care re-entry include

a.
prior foster care placement

b.
being younger than 4 years of age

c.
prior placement with non-relatives

d.
being neglected or maltreated physically rather than sexually

4.
risk for re-entry into out-of-home care following physical abuse almost doubled and following neglect was tripled

xii.
Fathers Supporting Success

1.
focus on guiding fathers in methods that “help their children”

2.
video presentation depicting parent-child interactions followed by a group discussion

3.
fathers evaluate the interactions in the videos and eventually bring up their own issues, allowing experts to explain effective and nonviolent ways to parent

b.
Policy Issues Regarding Physical Child Abuse

i.
Policy Problems

1.
how to define abuse in as objective a manner as possible

2.
how to balance children’s rights with parental rights

3.
how to apply the legal system to such a complex set of human behaviors

4.
only since 2003 has CAPTA (Child Abuse and Prevention Act) provided a uniform definition of child abuse and neglect

5.
each of the 50 states, and the District of Columbia, has its own legal definition of CPA (child physical abuse) and corresponding reporting responsibilities

6.
there is a clash between mandatory reporting vs. confidentiality vs. best interest of the client

ii.
Prosecuting Problems

1.
child maltreatment offenders are still not uniformly prosecuted for their crimes

2.
prosecution and conviction rates for child abuse are still very low

3.
proportion of child maltreatment cases that proceed to trial is approximately 10%, which is similar to the proportion for criminal cases in general

iii.
Human Rights violations

1.
Human Rights protections for children clearly state that hitting children is not acceptable

2.
United Nations proclaims that no violence against children is justifiable

3.
24 nations have banished corporal punishment of children

iv.
Medical policies – Medical personnel need to respond to physical child abuse determinations by:

1.
conducting a medical exam

2.
interpreting various laboratory tests

3.
taking the child’s age and developmental status into account

4.
examining the child’s medical history

v.
Research Issues

1.
addressing parents’ social needs and providing case management are both important elements of treatment

2.
understanding high therapy drop-out rates undermine findings

3.
understanding male caregivers’ very low participation in child care

4.
making sure studies include control groups

5.
pretreatment evaluation measurement lack validity because parents minimize their parenting problems

6.
most programs are psychoeducational and do not directly address parents’ psychological needs

7.
safety screening should occur before all family members receive treatment

8.
treatment failures do not readily appear in the literature

c.
Prevention of Child Physical Abuse

i.
strategies for preventing CPA must be aimed at all levels of society

1.
early recognition

2.
specialized programs for groups

ii.
Medical setting

1.
medical professionals detect and manage infant abuse

2.
researchers are crafting a screening tool to identify parental risk of harsh punishment of infants and older children for use by medical workers

iii.
Anticipatory guidance

1.
concise discussion with parents before any children’s major health care problems occur including information about refraining from hitting, shaking, spanking, securing firearms and preventing exposure to violent media

iv.
Public awareness

1.
educating the public about the problem through mass-media campaigns on radio and television, in newspapers, magazines, and brochures, and on posters and billboards. The rationale behind this approach is that increasing knowledge and awareness about the problem of CPA will result in lower levels of abuse

2.
dramatic increase in the number of calls received by a national child abuse hotline in the period after the campaign

v.
Grandparenting

1.
assistance by grandparents may play a role in preventing abuse

2.
generally the presence of grandparents is associated with fewer incidents of child abuse and fewer incidents of severe child abuse

3.
grandparents may suffer from stress and depression associated with providing care

4.
caring for grandchildren poses an economic burden on grandparents or calls into question their legal rights

5.
Latina grandmothers had the highest scores on life satisfaction

6.
African American grandmothers who had custodial care of their grandchildren were more satisfied than grandmothers who had co-parenting responsibilities with the parent

7.
White grandmothers had the highest negative mood about their roles; they frequently stepped in to care for grandchildren when the parents were incapacitated by drugs

Barnett, Family Violence Across the Lifespan, 3e

Chapter 3: Child Neglect and Child Psychological Maltreatment

Lecture Outline

I.
Child Neglect

a.
Scope of the Problem of Neglect

i.
It is the most frequently reported form of child maltreatment

ii.
Neglect of children’s basic needs was acknowledged or defined as a social problem in early 20th century

iii.
It is the “most forgotten” form of maltreatment

iv.
It is the most difficult type of child maltreatments to define

.
deficits in meeting a child’s basic needs constitute neglect

2.
three fundamental needs of children

a.
perceived support from mothers

b.
nonexposure to family conflict

c.
early affection from mothers

3.
definitions fail to distinguish between parental failure to provide when options are available and when options are not available

v.
Measurement of Child Neglect via the National Incidence Studies (NIS0

1. The previous standard of neglect was based on the Harm Standard. To be counted as an incident of neglect, the incident had to reflect demonstrable harm to the child.

2. Now the National Incidence Studies include an endangerment standard (i.e. risk of harm). For example, leaving an infant in a hot locked car alone while a mother runs a quick errand in a grocery store endangers the infant even if no harm occurs

vi.
Other measurement variables that affect the interpretation of neglect

1. The frequency and duration of the neglect (e.g., leaving the

infant outside the grocery store for 5 minutes or 5 hours)

2.
The chronicity of neglect (e.g., mom leaves the baby

unattended outside the grocery store every day or once in 8

months)

vii.
Two Types of Families

1.
Chronically neglectful—experienced multiple problems and deficits, including lack of knowledge, skills, and tangible resources

a.
need multiple treatment interventions of long duration

2.
Nonchronically neglectful—had experienced recent significant crises that appeared to overwhelm their normally sufficient coping abilities

a.
need short-term crisis, stress management, and support group interventions

b.
Typologies

i.
Prenatal neglect (Box 3.1)

1.
actions of a pregnant woman that can potentially harm her unborn child

a.
drug exposure (e.g., alcohol-fetal alcohol syndrome)

b.
stress (e.g., effects of poverty)

c.
domestic violence (e.g., injury, prematurity)

2.
need special prevention programs rather than criminalization

ii.
Physical neglect— failure to provide a child with basic necessities of life, such as food, clothing, and shelter, and refusal to seek or a delay in seeking health care, desertion or abandonment, refusing custody responsibilities, and inadequate supervision

iii.
Educational neglect—failure to provide a child with the experiences necessary for growth and development, such as intellectual and educational opportunities

iv.
Emotional neglect—failure to provide a child with emotional support, security, and encouragement

v.
Medical neglect—failure to provide the child with basic health care needs

1.
refusal to allow medical treatment

2.
refusal to allow vaccination

c.
Cross-cultural neglect—physical neglect, abandonment, child prostitution, children living on the street, physical beatings, forcing a child to beg, and infanticide.

i.
Three events elicited nonagreement about classification the behavior as neglectful: medical neglect, parental substance abuse, and physical discipline

ii.
Globally (in US also) children often experience polyvictimization: neglect, physical abuse, and so forth (e.g., see the Dutch study)

iii.
Romanian infants: Although not physically neglected, they were severely emotionally neglected – Often induced psychiatric symptoms

d.
Prevalence of neglect

i.
Multiplicity of official estimates: NIS, DHHS (data from child protective services), NCANDS

ii.
Official estimates have increased and then decreased (Table 3.2 NIS studies). Rate per 1,000 was 10.5 for 2010 and 13.1 for 1993

iii.
Kaiser-Permanente study of adult recollections indicated that females experienced more emotional neglect while males experienced more physical neglect

iv.
Self-report surveys

1.
27% reported some form of child neglect at least once during the past year

2.
most common form was leaving a child alone even when the parent thought an adult should be present

3.
11% reported they were unable to ensure their children obtained the food they needed

4.
2% reported an inability to care for their children adequately because of problem drinking

v.
Effects of neglect on children

1.
child neglect in the first two years of life may be a more important precursor of childhood aggression than later neglect or physical abuse at any age

2.
neurobiological research has also established that early neglect has the potential to modify the body’s stress response

3.
Attachment difficulties

a.
relationship between neglect and disturbed patterns of infant-caretaker attachment

b.
potential for lifetime problem and passage on to next (i.e. intergenerational transmission)

c.
prevalence of comorbidity (i.e. dual diagnosis)

d.
parents lack sensitivity, are inconsistent and chronically unresponsive to the baby’s needs

e.
30% develop insecure (anxious) attachment that manifests in avoidant or ambiguous type of attachment

f.
behavior problems such as aggression, bullying, or social withdrawal, extreme dependence on others, low self-esteem, and unpopularity

g.
disorganized attachment when parent-infant interactions are so chaotic and the infant shows a number of symptoms, such as approach-avoidance behavior. These children are likely to develop some form of psychopathology

4.
Cognitive and academic difficulties

a.
deficits in language abilities, academic skills, intelligence, and problem-solving skills

b.
significantly poorer overall school performance and poorer math skills and language and reading skills

c.
poorer performance patterns were generally stable over time

d.
cognitive deficits generally more severe for neglected children than for physically abused children

5.
Emotional and behavioral problems

a.
more emotionally abused children met criteria for at least one clinical diagnosis (e.g., anxiety, cognitive, or impulse-control disorders)

b.
more treated for psychiatric conditions

c.
specific personality disorders (paranoid, borderline, avoidant, dependent, obsessive-compulsive) occurred significantly more often among emotionally abused children

6.
Physical consequences

a.
most serious physical consequence is death; neglect is the form of maltreatment most often associated with death (31.9% of child deaths attributed to neglect)

b.
research on whether neglect is a risk factor for either obesity or underweight has produced mixed results

c.
failure to thrive (FTT) (Box 3.2)

i.
marked retardation or cessation of growth during the first 3 years of life

ii.
height and weight gain below standardized growth patterns

iii.
initially coined to describe infants and young children hospitalized or living in institutions in the early 1900s who exhibited marked deficits in growth as well as abnormal behaviors such as withdrawal, apathy, excessive sleep, unhappy facial expressions, and self-stimulatory behaviors, including body rocking or head banging

iv.
can stem from both organic (e.g., physical problem – e.g., kidney disease) and nonorganic causes (e.g., physical and emotional neglect)

v.
strongest correlate of nonorganic FTT is poverty

II.
Characteristics of Neglected Children and Their Families

a.
Characteristics of Neglected Children

i.
71.1% of maltreated children were neglected

ii.
Most child neglect occurs in children under 5, and neglect decreases with age

iii.
educational neglect (47%) was highest for children 9–11 years of age and then declined somewhat

iv.
emotional neglect (25%) was highest for adolescents 15–17 years of age; rose steadily from birth through the late teens

v.
physical neglect occurred at a rate of 38%

vi.
2.2% were medically neglected

vii.
48% male, 51% female

viii.
58% of children physically neglected by a biological parent were White

ix.
53% of children physically neglected by a nonbiological parent (or parent’s partner) were Black

x.
There are significant numbers of neglected disabled children in Eastern Europe

b.
Characteristics of Neglectful Parents

i.
Statistics

1.
92% of neglect perpetrators were the biological parents

2.
86% of neglect perpetrators were female, a finding that may reflect the general social attitude that mothers are responsible for meeting the needs of their children

3.
12.1 per 1,000 parental neglect perpetrators were unemployed; 4.1 per 1,000 parental neglect perpetrators were employed

4.
16.1 per 1,000 neglected children were in low socioeconomic status (SES) families; 2.2 per 1,000 neglected children were not in low SES families

5.
26.9% substance abuse problem in the household

6.
19.4% mental illness problem in the household

7.
23.3% parental divorce/separation

8.
4.7% incarcerated household member

ii.
Risk Factors for Neglect of Children

1.
caregiver’s substance use/abuse

2.
prior referrals for neglect to social agencies

3.
more than one type of maltreatment during initial incident

4.
caregiver absence

iii.
Parent-Child Interactions of Neglectful Parents

1.
generally interact less with their children, and when they do interact, the interactions are less positive

2.
engage in less verbal instruction and play behavior with their children, show their children less nonverbal affection, and exhibit less warmth in discussions

3.
are more negative, including issuing commands and engaging in verbal aggression

III.
Child Psychological Maltreatment

a.
Varying Viewpoints

i.
It is a side-effect of other forms of abuse and neglect

ii.
co-occurs with all other forms of abuse

iii.
It is a unique form of child maltreatment

iv.
It is a basic element of all forms of child abuse together

v.
It is the most pervasive and destructive form of child maltreatment

vi.
It has negative consequences that are very elusive

vii.
a single act of psychological maltreatment is unlikely to result in significant and immediate harm, but the cumulative effects of this form of abuse are insidious

viii.
negative consequences for victims are just as serious, if not more so, than those related to physical and sexual abuse

b.
Scope of the Problem of Child Emotional Maltreatment

i.
Definition—repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another’s needs

ii.
dilemma in defining psychological maltreatment is determining what the focus should be:

1.
child outcomes— mental injury or impaired psychological functioning and development

a.
challenge: requires demonstration of harm; harm associated with psychological maltreatment may not be evident immediately

2.
parental behavior—spurning, terrorizing, isolating, exploiting/corrupting, and denying emotional responsiveness

3.
parent-child interactions—violation or failure to respect the elements of a child’s psychosocial being

iii.
Prevalence of Psychological Maltreatment

1.
Psychological maltreatment is the least common form of reported and substantiated child maltreatment because

a.
Of definitional ambiguity

b.
adults may not have recognized their childhood treatment as psychologically abusive

2.
polyvictimization—multiple forms of abuse

3.
86% reported using psychological aggression toward their children (e.g., yelling, screaming or shouting, using threats, and swearing) at least once (average of 22 times) a year; most common form used was verbal (shouting, yelling, or screaming)

iv.
Effects of Psychological Maltreatment on Children

1.
psychological maltreatment is the strongest predictor of long-term impacts on psychological functioning

2.
associated with negative feelings and long-term mental health risks in adulthood

3.
individuals perceive themselves as others see them; children come to believe the negative things they are called are true and may begin to act as though they are worthless, stupid, unlovable, or ugly

4.
specific effects

a.
parental terrorizing predicted anxiety and somatic concerns

b.
parental ignoring predicted depression and Borderline Personality Disorder

c.
parental degradation predicted Borderline Personality Disorder

5.
mediators of effects—maladaptive schemas adopted in childhood to cope

a.
overly accommodating behavior

b.
social isolation

c.
domineering/controlling behavior

6.
neurodevelopmental effects

a.
likely to result in significant and enduring alterations in the neurobiology of stress response systems

b.
significantly more vulnerable to stress, anxiety, depression, and other problems of adaptation

IV.
Children Exposed to Interparental Violence

a.
Scope of the Problem of Children Exposed to Interparental Violence

i.
children suffer psychological maltreatment not only directly, but also indirectly, from exposure to violence between others

1.
directly observe violent acts

2.
overhear violent behaviors

3.
see the results of assaults

ii.
interparental violence and child abuse co-occur in families at a significantly high rate

iii.
if classified as an act of omission, exposure to interparental violence is child neglect

iv.
if classified as an act of commission, exposure to interparental violence is a form of psychological maltreatment

v.
the definition influences societal responses; is a mother who does not leave her abusive husband guilty of exposing her child to interparental violence

vi.
3.3 million to nearly 10 million children witness interparental violence (Straus, 1991)

vii.
9.8% of children surveyed (Finkelhor et al., 2009) had been exposed to interparental violence

viii.
The Kaiser-Permanente study of adult recall data revealed a 13.7% rate for females and an 11.5% for males

b.
Effects of Exposure to Interparental Violence

i.
suffer problems in five general areas (Table 3.8)

1.
emotional functioning

2.
behavior problems

3.
social competence

4.
cognitive ability

5.
physical health

ii.
depression, trauma-related symptoms (e.g., anxiety and sleep disturbance), low self-esteem, alcohol and drug use, poor social adjustment, general psychological distress, and ineffective conflict resolution skills

iii.
verbal and physical violence against one’s own spouse, dating partner, or peers; verbal and physical abuse of one’s own children; and participation in violence outside the family

iv.
father-initiated violence was associated with greater risk for psychological problems

v.
the forgotten, unacknowledged, hidden, unintended, and silent victims of family violence

V.
Characteristics of Maltreated Children and Their Families

a.
Characteristics of Maltreated Children

i.
Age and gender (please align)

1. findings from NIS-4 indicated that psychological maltreatment increases with children’s age and that boys are more likely than girls to experience psychological maltreatment

2. findings from DHHS showed the peak of psychological abuse was between 4 and 11 years of age

3.
other researchers have failed to find any gender differences associated with psychological maltreatment

ii.
Resiliency (ability to cope with abuse)

1.
resilience does not extend uniformly across every sphere; children exposed to maltreatment may be resilient in only one domain, such as competency

2.
resilience is dependent upon age, gender, ethnicity, the quality of mothering, social support, the child’s exposure to other forms of violence (i.e., polyvictimization), and child characteristics such as temperament and self-esteem

3.
three crucial elements contributing to children’s resilience

a.
better parenting performance

b.
fewer maternal mental health problems

c.
less severe exposure to violence

b.
Characteristics of Maltreating Parents

i.
meta-analysis (integration of many studies’ findings) identified parental risk factors

ii.
Socioeconomic Status Risk Factors

1.
higher in families with very low income, unemployment, and dependence on social assistance

2.
SES is a stronger predictor of child neglect than of any other form of child maltreatment

3.
income level has also been associated with severity of neglect, with higher-income families generally associated with less severe forms of neglect

iii.
Family Structure/Functioning Risk Factors

1.
mothers who have a greater number of children during their teen years or who are younger at the birth of their first child

2.
teenage mothers whose first children were premature or had a low birth weight

3.
mothers who left a coresidential relationship with a biological father or entered a coresidential relationship with a nonbiological father, especially for women with less education

iv.
Intergenerational Transmission of Maltreatment

1.
neglectful parents reported childhood histories of both neglect and abuse

2.
witnessing intimate partner violence (IPV) was independently related to engaging in IPV in one’s own adult relationships

3.
intergenerational transmission of (e.g., inadequate) parenting styles

4.
mothers’ anxious attachment style predicted children’s insecure attachment to both mother and father

VI.
Parenting Problems in Neglectful and Psychologically Maltreating Families

a.
Stressful Circumstances

i.
single parenting

1.
often extremely stressful

2.
fathers who make a positive difference in their children’s lives are not just those who are present in the house, but those who are involved with their children

3.
substance-abusing fathers place their children at much higher risk when they live with their children

4.
married father in the home was beneficial

5.
marriage was not uniformly associated with better outcomes

6.
cohabitation may be associated with negative outcomes, especially for Hispanic families

ii.
being disabled

1.
some members of society may criticize a disabled woman for having children; others try to offer the support she needs to care for an infant

2.
has to struggle to maintain control over her parenting

iii.
living in a home where marital violence is occurring

1.
risks children’s emotional and behavioral adjustment

2.
custody and visitation issues usually force the mother to safeguard her child while arranging visitation with her abusive spouse

3.
most perpetrators did not realize their children had been negatively impacted by their violence

4.
mothers living with violent fathers have serious problems coping with their own fear while trying to protect their children

5.
custody problems for mothers

a.
Abusive husbands may gain custody

b.
Reporting father’s child neglect/abuse

c.
Parental alienation syndrome—non-empirically-based syndrome in which one parent forms an alliance with a child in order to denigrate the other parent

d.
Financial inequities

e.
Hostile court settings

6.
law guardians and custody disputes (guardian ad litum—court appoints a law guardian to oversee the process and report back to the court)

a.
lacked expertise

b.
unprofessional

c.
sometimes supported abusers’ custody petitions despite known child abuse by the father

d.
displayed biases and inequality

e.
committed mother bashing

iv.
coping with other stresses (risk factors for parental psychological maltreatment of children)

1.
being a stepparent

2.
being a homosexual parent

3.
managing without a spouse/parent who is deployed in the military

b.
Challenges to the research on psychological maltreatment

i.
Lack of a standard definition

ii.
Inadequate sampling

iii.
Polyvictimization effects

iv.
Sources of reports

v.
Research designs

vi.
Correlational data

vii.
Lack of theoretical underpinnings

viii.
Non-comparability of comparison groups

VII.
Policy, Practice, and Prevention

a.
Practice

i.
Types of treatments

1.
interventions with adults to enhance parenting skills

2.
interventions with children to reduce effects associated with maltreatment

3.
economic assistance to the family

4.
multiservice interventions—combination of interventions simultaneously

a.
individual, family, and group counseling; social support services; behavioral skills training to eliminate problematic behavior; and parenting education (e.g. Healthy Families New York)

ii.
Factors that enhance effectiveness of treatment for psychological maltreatment

1.
implementation by highly trained staff, professionals rather than paraprofessionals

2.
relatively high dosage (i.e., high levels/numbers) and intensity of treatment

3.
comprehensiveness of scope (i.e., multiservice)

4.
increase the focus on economic well-being

5.
comprehensive two-generation model

iii.
Services

1.
Goals of home visitation programs

a.
connect at-risk parents with mentors who come to their homes and provide social support, parenting suggestions, and help with life decisions

b.
increase parents’ knowledge about general child development

c.
improve parents’ overall child-rearing skills

d.
increase parents’ empathy for and awareness of others’ needs

e.
improve parents’ ability to provide sensitive, responsive responding

f.
improve family and parent-child communication

g.
change parents’ beliefs about the value of abusive parenting

h.
increase parents’ ability to handle stress

i.
increase parents’ use of nonviolent approaches to child discipline

j.
identify high-risk parents in a community (and intervene during pregnancy

2.
Social support programs

a.
emotional support groups are the most common type of service

b.
provide mothers with social support, parent training (including child management and nurturing skills), and training in problem-solving and decision-making skills

c.
included social support for the children with a child mentor who served as a “big brother” or “big sister”, engaging the child in interesting activities and providing positive attention and affection

3.
Successful Early Intervention Programs

a.
Healthy Families New York

b.
Nurse-Family Partnership

c.
U. S. Triple-P—Positive Parenting Program

4.
Interventions for children exposed to interparental violence

a.
Needed because of increased risks of PTSD, self-blaming behaviors, functional impairments, and depression

b.
IPV screenings by practitioners, medical professionals, researchers are needed

c.
individual treatment

d.
group therapy goals

i.
labeling feelings

ii.
dealing with anger

iii.
developing safety skills

iv.
obtaining social support

v.
developing social competence and a good self-concept

vi.
recognizing one’s lack of responsibility for a parent or for the violence

vii.
understanding family violence

viii.
specifying personal wishes about family relationships

ix.
safety planning

e.
home visitation programs

f.
shelter programs, but hampered by the lack of adequate staff

5.
Safe Start Initiative programs

a.
increase awareness about exposure to violence and identify affected children

b.
intervene with parents in order to help them ensure the safety and well-being of their children at all times

c.
need to assure that practices of programs are developmentally appropriate

iv.
Common Problems in Interventions

1.
therapy drop-outs

2.
lack of correct implementation by workers

3.
interactions with difficult children

v.
Elements for Successful Programs; a meta-analysis of content and delivery found three program components were less effective than others

1.
teaching parents how to problem solve about child problems

2.
teaching parents how to promote children’s academic and cognitive skills

3.
including ancillary services as part of the parenting program

b.
Policy

i.
Legal issues concerning parental behaviors

1.
legislators must determine when parental mistakes cross the line and require a legal response

2.
need to clarify some terms that are overly vague

3.
should rethink the requirement that a child’s injuries be substantial and observable is problematic, because the

effects of psychological maltreatment may not be readily identifiable

4.
need to recognize that some of the most damaging neglect occurs during the first two years of life before a child can verbally communicate distress

ii.
Neglect and maltreatment investigations

1.
best practices recommend conducting most investigations with a multidisciplinary team

a.
advantages include sparing the child from repeated questioning, sharing expertise, and joint decision-making, better equipped to address issues relevant to the nonoffending parent

2.
even severe cases of psychological abuse are difficult to prove in court

a.
prosecutors usually find a “tag-along” charge consisting of some other type of abuse, such as physical abuse

3.
successful investigations

a.
gather relevant information about the incident, what is observed and what is suspected

b.
question multiple sources, such as family members, neighbors, and school personnel

c.
use valid and reliable assessment instruments and procedures

d.
confer with other experts as necessary

iii.
Laws

1.
Safe Families Act— mandates that various agencies make decisions in the best interests of the child

a.
Challenge: current law instructs caseworkers to remove children from the home only when absolutely necessary for their safety and to provide a rationale for their decision-making

2.
Safe Haven laws—allows biological mothers to give up their newborn infants anonymously in specific safe locations (e.g. Texas’s Baby Moses abandoned baby law)

3.
The Child Abuse and Treatment Act—specifies that maltreated children must have access to early intervention under Part C of the Individuals with Disabilities Education Act

iv.
Shortcomings in agency policies, dependency court rulings, and Child Protection Services (CPS) workers’ actions

1.
jurisdictions enact significantly different policies

2.
counties within the same jurisdiction adopt dissimilar policies

3.
personnel fail to document maltreatment

4.
some courts do not articulate a ruling, but simply state a return date

5.
CPS workers may not state why they removed a child from his home

6.
CPS workers may not state the rationale for their out-of-home placements

7.
CPS workers had offered referral services to 53% of parents before removing a child

8.
CPS workers did believe exposure to domestic violence was harmful to children

9.
Personnel did not uniformly document findings about the identity of the abuser

10.
Workers who reported found that the mother was the victim in 65% of the cases, but 19% of the victims were incorrectly classified as co-batterers

11.
CPS sometimes unknowingly placed the child in a different abusive home because of an insufficient investigation

12.
No one specified child visitation guidelines for the offending parent

13.
82% of parents voluntarily agreed to their child’s removal without court adjudication

c.
Prevention

i.
no prevention programs have yet been established with the explicit purpose of preventing only child psychological maltreatment

ii.
state and federal funding has not been available to support intervention and prevention research or program implementation

iii.
there is a need for further government intervention

iv.
researchers suggest a two-tier approach

1.
first tier: education and support strategies

a.
parent education classes

i.
effective parenting skills

ii.
knowledge of child development

iii.
stress management techniques

iv.
conflict resolution

b.
sensitization campaigns—educate the general public regarding the harmful nature of parent-child verbal aggression (e.g. “Words Can Hurt”)

2.
second tier: prevention efforts (e.g. home visitation programs)

Barnett, Family Violence Across the Lifespan, 3e

Chapter 5: Child Sexual Abuse

Lecture Outline

I.
Scope of the Problem of Child Sexual Abuse

a.
Definitions of Child Sexual Abuse (CSA)

i.
Child Sexual Abuse—the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or stimulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children

ii.
Criminal Justice System definitions of CSA—deals with crimes committed on Federal property, interstate transport of minors for sexual purposes, and the shipment or possession of child pornography

iii.
Legal/Illegal sexual activity definitions of CSA

. In most states, the age of consent falls somewhere between 14 and 18 years.

2. Sexual contact between an adult and a minor who has not reached the age of consent is illegal (statutory rape).

3. Incest is illegal regardless of the victim’s age or consent.

4. CSA consists of acts such as sexual abuse/sexual assault, sexual exploitation, and internet exploitation.

5. Sexual assault encompasses anal or vaginal penetration by the penis or another object, oral-genital and oral-anal contact, touching of the genitals or other intimate body parts whether clothed or unclothed, and genital masturbation of the perpetrator in the presence of a child.

6. The younger the child, the greater the force/coercion, the closer the victim/perpetrator relationship, and an actual act of sexual penetration, the worse the crime is considered to be

iv.
Clinical definition of CSA—contacts or interactions between a child and an adult when the child is being used for sexual stimulation of the perpetrator or another person when the perpetrator or another person is in a position of power or control over the victim

v.
Medical definition of CSA— engaging of a child in sexual activities that the child cannot comprehend, for which the child is developmentally unprepared and cannot consent, and that violates the social taboos of society

1.
Brief—any sexual activity with a child below the age of consent

2.
Incest – sexually prohibited activities between blood-related individuals; illegal at any age

vi.
only relatively recently has CSA been recognized as a social problem

vii.
normal touching ideas/definitions:

1.
parents rarely bathed with their children at any age, particularly with children of the opposite sex, after the children were 3 to 4 years old

2.
children’s touching of mothers’ and fathers’ private areas was relatively common among preschoolers but declined as the children became older

3.
some types of sexual behavior are common in nonabused children (e.g., children touching their own sexual parts)

b.
Prevalence of Child Sexual Abuse

i.
Challenges to the Accuracy of Statistics (more alignment help needed)

1. research findings have called into question the accuracy of Child Protective System reports because the reports includes CSA perpetrated by parents and caregivers

2. research findings have called into question the accuracy of children’s memories: 44% of substantiated abuse before age 2 was not identified by 45 adolescents

3. the majority of victims do not disclose their abuse immediately, and a significant number do not disclose it for years… dependent upon

a.
victim’s relationship to the perpetrator

b.
severity of sexual abuse

c.
developmental/cognitive variables

d.
fear of negative consequences

e.
if parents provide accurate sex education to the child, disclosure improves

f.
gender differences: females are far more likely to disclose CSA

i.
male underreporting due to

1.
expectation that boys should be dominant and self-reliant

2.
notion that early sexual experiences are a normal part of boys’ lives

3.
fears associated with homosexuality, because most boys who are abused are abused by men

4.
pressure on males not to express helplessness or vulnerability

ii.
Reporting CSA

1.
Disclosure to medical personnel

a.
most CSA sufferers do not disclose their victimization right away; there is less urgency for doctors to conduct an examination immediately

b.
prompt exam is necessary when a child is in pain, needs medication, or must be tested for a disease

c.
perform an examination if forensic materials might still be collectable

d.
nurse or doctor can reiterate a child’s disclosures in court be accepted, an exception to the hearsay rule of evidence

2.
Disclosure related to memory of CSA inaccuracies

a.
children’s memory and reporting can be altered and manipulated with leading questions

b.
the greater the severity of PTSD symptomotology, the greater the accuracy of the memories

c.
children rarely lie about sexual abuse

d.
memory repression of CSA events

i.
unconscious forgetting (repression) as a protection against anxiety; cannot bring to mind under ordinary circumstances because it is so painful and/or frightening

ii.
results from either repression of negative feelings associated with the abuse or amnesia associated with dissociative defenses (i.e., multiple personality disorder) of a traumatic event

iii.
critics claim that what some individuals perceive to be memories may be fantasies or illusions of contextual cues or implantation by therapists or other perceived authority figures

iv.
research findings clearly show that repressed memories do exist

v.
CSA that was not experienced as traumatic were not inclined to report repressed memory syndrome; they appeared not to think of the CSA for years, or to simply forget it and later, environmental cues triggered their recall

c.
Estimates of CSA

i.
Official records are underestimates of the actual incidence of sexual crimes, so the true victimization rates are significantly higher

ii.
Official Reports

1.
nationally, CSA represents 9.1% of all child maltreatment cases

2.
criminal justice data generally report more sexual abuse than do Child Protective Agency data

3.
50% of children 12-years-old or below reporting in an ER for child rape were age 4 or younger

4.
96% of the cases of suspected/assessed CSA will result in a normal genital/anal exam

5.
69.9% of all child fatalities were caused by parents; of these 22.9% were attributed to sexual abuse

iii.
Self-Reports

1.
likely underestimate actual rates because some adults may not remember their experiences or may be reluctant to report them

2.
Gallop organization (Finkelhor et al., 1997) reported that 23% of children sampled had been touched in a sexual way before age18

3.
The Kaiser-Permanente sample of adults reported sexual abuse by almost 25% of women and 16% of men

4.
National Health and Life Survey (Leung et al., 2010) reported that 125 Of children had experienced sexual touching before age 12

5.
National Violence Against Women Survey (Tjaden & Thoennes,1998a) reported completed rape before age 18: 9% of females; 2% of males

6.
Adult military samples showed a prevalence rate between 27% and 49%, suggesting an overall rate of at least 33%

iv.
Trends

1.
increase in reporting rates for child sexual abuse during the 1980s and early 1990s (NIS-2)

a.
added teenagers to the category of perpetrators

2.
mid-to-late 1990s indicate a marked decline in reporting rates of CSA (NIS-4)

II.
Characteristics of Victims of Child Sexual Abuse

a.
Age

i.
maltreatment as a whole may decline with a child’s increasing age, but not CSA

ii.
peak of CSA is around age 12

iii.
most sexual touching is pre-pubertal, occurring at about age 12

b.
Gender

i.
majority of CSA victims are female

ii.
boys may be abused more often but are less likely to report

c.
Socioeconomic Status (SES)

i.
children living in families with low SES status suffer significantly more

ii.
children living in families characterized by single parenthood, lower education, parental stress, parental depression, and marital conflict/marital violence are more at risk for CSA

iii.
children whose fathers are unemployed, or both parents who are out of the house working and children left unmonitored are at increased vulnerability for CSA victimizations

iv.
living in a rural area compared with living in urban areas was a risk factor

d.
Blame for CSA

i.
blame placed on perpetrators remained high over time; use of force and/or more frequent abuse was linked with more perpetrator blame

ii.
actual penetration was linked with higher levels of self-blame

iii.
self-blame decreased over time, but initial level of victims’ self-blame predicted later level of depression

iv.
youth frequently reported confusion as to why the CSA occurred

v.
there were no significant gender differences in self-blame

vi.
self-blame and perpetrator blame are both unhealthy because of attributions (i.e. beliefs about causality)

1.
victims of CS contrasted with other victims (e.g., violent crimes) adopted significantly higher levels of global attributions (i.e., other negative events are likely to happen to me)

2.
the attributions of stability (i.e., negative events will always happen to me) increased in survivors of sexual assault survivors

III.
Characteristics of Perpetrators of Child Sexual Abuse

a.
Family Structure of Perpetrators

i.
single parents are overrepresented among sexual abusers

ii.
highest rates (10 times greater) occurred among single parents who had a cohabitating partner

b.
Age of Perpetrators

i.
majority of sex offenders are adults between 21 and 40 years of age

ii.
juveniles accounted for 17% of arrests for all types of sexual crimes in 2007

c.
Gender of Perpetrators

i.
males are disproportionately the perpetrators of sexual crimes against children

ii.
1-2% of males in the general population will be convicted of a sexual offense in their lifetime

iii.
some CSA committed by females goes unrecognized or is unacknowledged

iv.
liberal estimate suggested that female perpetrators represent no more than 10% (perhaps only 2%) of CSA abusers

v.
large percentages of female offenders are abuse victims themselves, and depression was the primary trigger for their perpetration of CSA

vi.
there are many unresolved issues surrounding female CSA offenders: do they abuse younger children than males? Do female CSA offenders frequently act in concert with male offenders Do they show significant psychopathology?

vii.
Female and male offenders have several similarities

1. fondling/touching of genitals is the most frequent type of CSA

2. they manifest inadequate social skills and display cognitive distortions

3. they have grown up in highly dysfunctional families and
suffered sexual abuse, sometimes severe abuse during childhood

d.
Relationship of Perpetrator of CSA to Victim

i.
most typical type of perpetrator is an acquaintance of the family or the child

IV.
Dynamics and Effects of Child Sexual Abuse

a.
Dynamics of Child Sexual Abuse

i.
Initiation of CSA

1.
perpetrators do not molest every child, they generally select children who are vulnerable; they select certain children

2.
perpetrators do not use uniform strategies to perpetrate abuse initially; some use force, threats, fear, or use subterfuge by telling the child the activities are for educational purposes

3.
perpetrators undertake grooming—premeditated behavior intended to manipulate the potential victim into complying with the sexual abuse through conditioning the child through rewards and punishments until sexual activity becomes routine

4.
Perpetrators use various online techniques to groom children (e.g., obtain a compromising picture of the child (adolescent) and then blackmail the child with it to obtain sexual favors

ii.
Child pornography

1.
a visual depiction of any kind, including a drawing, cartoon, sculpture, painting, photograph, film, video, or computer/ computer-generated image or picture, whether made or produced by electronic, mechanical, or other means, of sexually explicit conduct involving a minor

2.
1978: U.S. Congress passed the Protection of Children Against Sexual Exploitation Act in an attempt to halt the production and dissemination of pornographic materials involving children

3.
1986: Child Sexual Abuse and Pornography Act provides for federal prosecution of individuals engaged in child pornography

4.
child pornography may stimulate perpetration of CSA offenders, serves to educate and stimulate victims, can be used as a blackmail tool

iii.
Prostitution

1.
significant numbers of adult women began to work as prostitutes when they were children

2.
characteristics of adolescent prostitutes often include a history of childhood maltreatment, personal and parental alcohol or drug abuse, poor family functioning,

3.
many share a runaway or thrown away youth status

b.
Effects of Child Sexual Abuse

i.
Mimicking sexual behavior-sexualized behavior is most predictive of the occurrence of sexual abuse

1.
overt sexual acting out toward adults or other children

2.
, compulsive masturbation, excessive sexual curiosity, sexual promiscuity, and precocious sexual play and knowledge

ii.
PTSD is the second most predictive behavior

1.
occurs when a person lives through/witnesses an event that appears to be life-threatening and experiences intense fear or helplessness

2.
symptoms of PTSD include

a.
diminished responsiveness

b.
chronic physiological arousal leading to symptoms such as sleeplessness

c.
flashbacks

3.
components of PTSD

a.
avoidance of stimuli (person, place) that are related to PTSD

b.
reexperiencing the CSA event(s)

c.
dysphoria (depressed mood state)

d.
hyperarousal (startle, overly responsive to certain stimulus events

4.
more than one third of sexually abused children meet criteria for PTSD

5.
Children may also suffer the effects of cumulative traumas

iii.
Psychopathology

1.
CSA is associated with substantial increased risk of psychopathology

2.
CSA typically contributes to Borderline Personality Disorder

3.
17% of the preschool group (4 to 6 years of age), 40% of the school-age group (7 to 13 years of age), and 8% of the adolescent group (14 to 18 years of age) evidenced pathological symptoms

iv.
Long-term effects

1.
Anger generated by CSA

a.
not being able to disclose CSA to a parent who is emotionally fragile

b.
people’s reactions to their disclosure

c.
no one protected them

d.
they felt singled out for victimization

e.
they were assigned to out-of-home placement because their family broke up

f.
they may have to testify in open court

2.
Polyvictimization – Other victimizations also occur

a.
revictimization of CSA rates are high

b.
increase the risk for mental health problems, especially depression and anxiety

c.
mother-daughter CSA has unusually profound effects because of factors such as the betrayal of trust and the inability to cope effectively

v.
Reactions to disclosure: negative responses tend to aggravate victims’ experience of trauma

V.
Explaining Child Sexual Abuse

a.
Victim of CSA

i.
children are developmentally (and legally) incapable of consenting to take part in sexual activities with adults

b.
Perpetrator of CSA often have

i.
deviant patterns of sexual arousal

ii.
a childhood history of sex abuse

iii.
a neurobiological basis of psychopathology

iv.
personality disorders (e.g., antisocial personality disorder)

v.
d ineffective means of coping with stress

vi.
deviant sexual arousal–pedophilia—sexually attracted to children

vii.
detection of deviant sexual arousal can be made by plethysmography—procedure most often used to determine whether a CSA perpetrator is sexually aroused by children

viii.
cognitive distortions—disinhibitors of CSA where perpetrators rationalize and defend their behavior through distorted ideas or thoughts

ix.
early developmental environment that includes several stressful events, such as poor attachment between parent and child, low self-esteem, limited coping abilities, low-quality relationships with others, and a history of sexual abuse that leads the child to rely on sexualized coping methods, including masturbation and sexual acts with others, as a way to avoid current stressors

c.
Differences among CSA Offenders

i.
Child molesters are different from rapists: molesters more likely experienced (Box 5.11)

1.
CSA events

2.
Early exposure to pornography

3.
Early onset of masturbation

4.
Sexual activities with animals

5.
Displayed anxious parental

ii.
Adolescent CSA offenders are different from adolescent nonsex offenders; adolescent CSA offenders (Box 5.12)

1.
Experienced CSA abuse history

2.
Had fewer antisocial peers

3.
Were exposed to sexual violence

4.
Fewer substance abuse problems

5.
Had a less extensive criminal history

6.
Experienced early exposure to pornography

7.
Tended to be socially isolated

8.
Had atypical sexual interests

9.
Experienced other abuse or neglect (polyvictimization)

10.
Had low self-esteem

11.
Suffered from anxiety

iii.
Adolescent CSA offenders are similar to adolescent nonsex offenders; adolescent CSA offenders (Box 5.12)

1.
Had low intellectual ability

2.
Exposure to nonsexual violence

3.
Suffered from social incompetence

4.
Had conventional sexual experiences

5.
Had family communication problems

6.
Held similar beliefs or attitudes toward women/sexual offending

d.
Family of CSA Victims

i.
Some experts have (do) view the mother’s role as contributing to a child’s vulnerability by withdrawing from their children or being unavailable to them

ii.
Have significant levels of dysfunction in families of CSA victims, including marital conflict, poor relationships between children and parents, divorce, spouse abuse, frequently disorganized and lack cohesion

e.
Social Influences Contributing to CSA

i.
patriarchal social system

ii.
mass-media portrayals of sexuality and children

VI.
Practice, Policy, & Prevention of Child Sexual Abuse

a.
Practice Issues Related to CSA

i.
Needs of CSA victims

1.
tailor the services to meet the particular needs of each individual client

ii.
Needs of CSA therapists

1.
be alert to counter transference—a therapist’s own personal reactions toward victims, perpetrators, and victims’ families

a. a victim’s sexualized behavior

b. recollecting one’s own victimization

2.
be alert to vicarious traumatization (i.e. secondary trauma) as a result of being exposed to victims and their traumatic histories

iii.
Therapy for CSA Victims

1.
Goals

a.
alleviate any significant symptoms presented by the individual child or adult

b.
help patient disavow self-blame: help victims overcome negative attributions and cognitive distortions such as guilt, shame, and stigmatization

c.
help victim with cognitive restructuring—victims change their perceptions of “being different” or “to blame” for the abuse and relocate the responsibility for the abuse onto the offender

d.
help victim reduce anxiety and fear

i.
give victims the opportunity to defuse these feelings by talking about their abuse experiences in the safety of a supportive therapeutic relationship

ii.
explore therapeutic avenues, such as reenacting the abuse through play

iii.
teach child victims the strategies to manage fear and anxiety, such as relaxation techniques, problem-solving skills, and how to use positive coping statements and positive imagery

e.
help victim cope with anger/depression/low self-esteem

i.
express anger in appropriate ways

ii.
cognitive and interpersonal exercises and role-play to emphasize the clients’ survival skills and personal strengths

iii.
gain a sense of empowerment through sex education and training in self-protection skills that may also prevent any further victimization

iv.
Treatment for Perpetrators

1.
Goals

a.
reduce the likelihood of recidivism (i.e. repeated offenses)

b.
tailor approach to the offender’s needs

c.
predict recidivism more accurately, thus better protecting the public

d.
understand the offender’s childhood history to understand the determinants of CSA

e.
treatments were fairly effective

2.
Models

a.
Perpetrator offense categorization

i.
Victim Empathy Distortion

ii.
Cognitive Distortion

iii.
Emotional Identification

b.
Social needs categorization

i.
Self-Esteem

ii.
UCLA Loneliness

iii.
Underassertiveness

iv.
Personal Distress

3.
Types of treatments for CSA perpetrators

a.
Medical interventions

i.
castration—surgical removal of the testicles

ii.
chemical castration

iii.
brain surgery

iv.
drug therapy

v.
medroxyprogesterone acetate (i.e. Depo-Provera)— reduces testosterone levels

b.
Insight therapy: individual counseling to help CSA offenders understand the role sexual abuse plays in their life (mixed effectiveness, but as effective as other treatments)

c.
Family systems approach (shows some effectiveness)

i.
Tries to reunify families in which incest has occurred

ii.
Addressed a parents’ failure to protect the victim from abuse

iii.
Addresses feelings of guilt and depression

iv.
Discuss the inappropriateness of secrecy

v.
Address the victim’s anger toward the parents

vi.
Declare the perpetrator’s responsibility for the abuse, not the child’s or the mother’s

vii.
Define acceptable forms of touching

viii.
Point out confusion about blurred role boundaries

ix.
Try to improve poor communication patterns

x.
Emphasize the negative effect the CSA abuse on the child

d.
Cognitive-behavioral therapy

i.
Is the most widely implemented and actively researched forms of therapy for CSA offenders

ii.
Is concerned with altering the deviant sexual arousal patterns of CSA perpetrators

iii.
Teaches offenders how to recognize and change their distorted beliefs

iv.
Focuses on perpetrators’ nonsexual difficulties, such as anxiety

b.
Policy Issues Surrounding CSA

i.
Legal approaches

1.
Legal considerations

a.
sex offender registries

b.
governing sex offenders in the community, such as their place of residence and areas within the city where they cannot go

c.
forcing offenders to wear electronic positioning devices

2.
2006: Adam Walsh Child Protection and Safety Act calls for

a.
integration of state sex offender registries into a national registry available to every state

b.
imposition of mandatory sentences for crimes against children and civil provisions to detain dangerous sex offenders after incarceration

c.
increased prosecution of individuals who perpetrate Internet Crimes Against Children

d.
establishment of a new registry that would allow designated individuals to conduct background checks of prospective adoptive and foster parents

ii.
Case management considerations

a.
whether the child must be separated from his or her home

b.
whether the offenders must leave home

c.
whether the case merits involvement of the juvenile court and or the criminal court

d.
what type of treatment plan should be inaugurated that might necessarily include visitation and eventually family reunification

iii.
Interviewing considerations

1.
Identification of “what and how” questions were associated with more disclosure

2.
Child Advocacy Centers considerations

a.
Establish an appropriate setting

b.
Use multidisciplinary investigation team and coordinated forensic interviews

c.
Use team case reviews

d.
Use medical evaluation, therapeutic intervention, and victim advocacy

e.
Stay involved in ongoing CSA treatment, not just first-response interventions

f.
Identify the best treatment option: caregivers and children evaluated their experiences as satisfactory, but it did not achieve its goal of satisfying the children to the extent desired

3.
Police interviews findings

i.
children disclosed more nonsexual information than sexual information

ii.
children avoided the topic as much as possible

iii.
children sometimes denied the CSA despite its documentation

iv.
second and third interviews yielded twice as many sexual details as the first interview

v.
child denied and avoided more during the first interview than during subsequent interviews

iv.
Prosecuting

1.
:Prosecutors file charges in only about 66% of child abuse cases and only 49% of these reach a verdict

2.
A common practice is to plea bargain a CSA offense down to a lesser offense

v.
Mandatory reporting laws – Do they help or hurt? A disagreement is ongoing

c.
Prevention of CSA

i.
Children’s Programs

1.
School-based Empowerment Programs

a.
focused primarily on equipping children with the skills they need to respond to or protect themselves

b.
help children avoid and report victimization

c.
teach children knowledge and skills that experts believe will help them to protect themselves from a variety of dangers

d.
primary prevention (i.e. keeping the abuse from occurring) and detection (i.e. encouraging children to report past and current abuse)

e.
inexpensive way to reach many school-age children

ii.
Adults’ Programs

1.
geared toward adults who are often in a position to empower children to protect themselves

2.
target adults who can help children avoid sexually abusive experiences

3.
audiovisual materials, books, and educational workshops are available

4.
give specific instruction in how to talk to their children about sexual abuse

5.
help them to identify behaviors in children that are associated with CSA

6.
learn how to respond when a child victim discloses abuse

Child Sexual Abuse
Chapter 5

Definitions of Child Sexual Abuse
What is child sexual abuse (CSA)?
Defining sexual abuse
Noncontact CSA
Intention of the perpetrator
Exertion of power/control over the child victim
Age differences between perpetrator and victim
Types of abuse
Clusters of definitions
Impact of definitions
Cultural context
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Prevalence of Child Sexual Abuse
Disclosure Variability
Accuracy of records compiled by Child Protective Services (CPS)
School-based CSA programs and disclosure
Medical personnel and disclosure
Memory Issues, CSA, and Disclosure
Memory capacity
Memory accuracy in the laboratory
Memory accuracy in the real-world
Victim fabrication of CSA
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Estimates of Child Sexual Abuse
Official estimates
DHHS (2008) identified 758,289 maltreated children, Department of Health and Human Services – Uses only records from Child Protective Services
NIS-4 (2005-2006) identified 1,256,600 maltreated children
National Incidence Study – Uses data from CPS, professionals, school counselors, and others (Sedlak et al., 2010)The U.S. Department of Health & Human Services (2008) identified
Trends in reported child sexual abuse
Increasing rates
Decreasing rates
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Characteristics of Victims
Age of CSA victims – varies from infancy to 18 with most cases between 12-14 years of age
Gender of CSA victims-female are more likely to be victims
Race of CSA victims are heterogeneous
Socioeconomic status (SES) – varies but children in lower SES are more vulnerable
Potential for self-blame among victims of CSA
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Characteristics of Child Sexual Abuse Perpetrators
Nontraditional parenting
Age of perpetrators is often between 30 and 40 years – a significant number are under 18 years of age
Gender of perpetrators are likely to be males (93%) than females (about 7%)
Female Child Sexual Abuse Perpetrators
Race of perpetrators are heterogeneous
Socioeconomic status (SES)
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Dynamics and Consequences Associated With Child Sexual Abuse
Dynamics of Child Sexual Abuse
Severity of abuse
Initiation of abuse
Grooming
Online molesters
Child Pornography
Prostitution
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Effects of Child Sexual Abuse
Initial effects
Mimicking sexual behavior
Posttraumatic Stress Disorder (PTSD)
Psychopathology effects
Long-term effects of child sexual abuse
Emotional
Interpersonal
Sexual adjustment
Behavior dysfunction
Posttraumatic Stress Disorder
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Factors That Increase Trauma Experienced by CSA Victims
Long duration of abuse
Polyvictimization
The severity of the abuse
Abuse by someone who is a parental figure or trusted acquaintance
Abuse that involves invasive forms of sexual activity
Negative reactions by significant others to the disclosure of abuse
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Explaining Child Sexual Abuse
Risk factors associated with child sexual abuse
Explaining CSA – Focus on the victim
Explaining CSA – Focus on the offender
Deviant sexual arousal-pedophilia
Plethysmography
Childhood history of sexual abuse
Adolescent sex offenders
Sexual abused-sexual abuser hypothesis
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Explaining Child Sexual Abuse
Explaining CSA – Focus on the family
Mother’s behavior-early view
Mother’s behavior-contemporary view
General characteristics of the family
Focus on society and culture
Media input
Integrative theories
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Practice, Policy, and Prevention Issues
Practice (treatment) issues
Countertransference
A victim’s sexualized behavior
Recollecting one’s victimization
Therapists’ susceptibility to vicarious traumatization
Therapy for CSA survivors
Treatment for offenders
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Types of Treatment
Medical approaches
Insight therapies
Family system approaches
Cognitive-behavioral techniques
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Policy for Child Sexual Abuse
Legal Issues
Adam Walsh Child Protection & Safety Act of 2006
Case management considerations
Interviewing child abuse victims
Child Advocacy Centers (CACs)
Police interviewing of CSA victims
Prosecution of CSA victims
Mandatory reporting laws
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Prevention of Child Sexual Abuse
Education programs for children
Outcomes of school-based programs
Critics of programs
Parental role in child education
Family Violence Across the Lifespan, 3rd Edition
© 2011SAGE Publications
© 2011SAGE Publications

Child Neglect and Psychological Maltreatment
Chapter 3

Child Neglect
What is child neglect?
Definitions of child neglect
Comprehensive definitions
Lack of agreement
Intentionality
Harm standard vs. endangerment standard
Frequency and duration
Chronicity of neglect
Neglecting the unborn child
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Child Neglect
Typologies of Neglect
Specific behaviors
Emotional neglect vs. psychological maltreatment
Medical neglect
Cross-Cultural Abuse
Dutch prevalence study
Romanian infants
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Child Neglect
Prevalence/Incidence of Child Neglect
Official estimates
Self-report surveys
Effects of Child Neglect
Early neglect
Unique effects
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Child Neglect
Expanded Research on the Effects of Neglect
Attachment difficulties
Minnesota Longitudinal Study
Cognitive and academic deficits
Emotional and behavioral problems
Physical consequences
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Characteristics of Neglected Children and Their Families
Characteristics of Neglected Children
NIS-4. Between 2005-2006: N=771,700 (61%) were neglected according to the Harm Standard
U.S. Department of Health & Human Services, 2008; 758, 289 maltreated children
Sex of neglected children
Race of neglected children
No significant racial disparities in percentage of neglect
Disability
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Characteristics of Neglected Children and Their Families
Characteristics of Neglectful Parents
NIS-4
Gender differences
Risk Factors
Parent-Child Interactions
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Child Psychological Maltreatment
Lack of focus on child maltreatment
Definition of Psychological Maltreatment
What is psychological maltreatment?
Focus of definition
Child outcomes
Parental behaviors
Parent-child interactions

Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Child Psychological Maltreatment
Prevalence of Psychological Maltreatment
Mandating record keeping
Self-report surveys of psychological maltreatment
Effects of Psychological Maltreatment
Long-term Effects of Psychological Maltreatment
Mediators of effects
Neurodevelopmental effects
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Children Exposed to Interparental Violence
Historical introduction
Co-occurrence of child abuse and domestic violence
Defining exposure to interparental violence
Act of omission or commission?
Importance of definition
Specific aspects of defining exposure to interparental violence
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Children Exposed to Interparental Violence
Prevalence of exposure to marital violence
Effects on children’s exposure to interparental violence
Research finding about children exposed to violence
Long-term effects of exposure to marital violence
Need for services
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Characteristics of Maltreated Children and Their Families
Characteristics of maltreated children
Resilient children
Characteristics of maltreating parents

Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Explaining Child Neglect and Child Psychological Maltreatment
Socioeconomic status
Family structure/functioning
Intergenerational transmission of maltreatment
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Parenting Problems in Neglectful and Psychologically Maltreating Families
Single parenting/presence of fathers
Disabled mothers
Mothers’ parenting in father-violent families
Fathers’ parenting in violent families
Mothers’ legal difficulties coping with a violent father
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Parenting Problems in Neglectful and Psychologically Maltreating Families
Methodological issues pertaining to effects research
Lack of a standard definition
Inadequate sampling
Polyvictimization effects
Sources of report
Research designs
Correlational data
Lack of theoretical underpinnings
Noncomparability of comparison groups
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Practice, Policy and Prevention Issues for Neglected Children, Children Exposed to Parental Marital Violence and Psychologically Maltreated Children
Practice (Treatment) for child neglect and psychological maltreatment
Multiservice interventions
Home visitation programs
Social support programs
Early Intervention Programs
Healthy families New York
Nurse-family Partnership (NFP)
U.S. Triple P – Positive Parenting Program
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Interventions for children exposed to interparental violence
Group counseling
Shelter programs
The Safe Start Initiative
Common problems in implementation for all programs
Therapy drop-outs
Lack of correct implementation by workers
Interaction with difficult children
Elements of successful programs
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Policy Issues
Legal issues concerning parental behaviors
Neglect and maltreatment investigates
Safe Families Act
Safe-haven laws
The Child Abuse Prevention and Treatment Act (CAPTA; 2003)
Poverty
Who is accountable for children’s exposure to marital violence?
Lack of available programs
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Child Physical Abuse
Chapter 4

What Is Child Physical Abuse?
Definitions of Child Physical Abuse (CPA)
Harm standard
Endangerment standard
Physical Punishment and Child Rearing
Protective use of force
Physical Discipline-The Debate
Sociological objections
Learners researchers
Neurobiological effects of punishment
Spillover effects of spanking
Children’s assessments of punishment
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Prevalence/Incidence of Child Physical Abuse
Official estimates
Injuries
Child Death Review Teams
Neonaticidal mothers
Self-Report Surveys
Family Violence Survey, 1985
Survey with improved CTS
Trends in rate of physical abuse
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Effects of Child Physical Abuse on Children
“Children who experience physical maltreatment are more likely than their nonabused counterparts to exhibit physical, behavioral, and emotional impairments.”
Barnett, 2010, p.152
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Long-Term Effects Associated With Child Physical Abuse
Physical and Mental Health of CPA victims
Injuries
Pain
Specific illness
Criminal and Violent Behavior
Criminal behavior of CPA victims
Interpersonal violence
Genetic contributions
Substance Abuse
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Long-Term Effects Associated With Child Physical Abuse
Socioemotional Difficulties
Mediators/moderators of Abuse Effects
Frequency severity, and duration of abuse
Polyvictimization
Prior involvement with child protective services
Child’s attributions
Family stress
Sociocultural factors
Child’s intellectual functioning
Relationships between the victim and abuser
Trauma symptoms
Child’s temperament and social support
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Expanded Discussion of Individual Effects of Child Physical Abuse
Medical and Neurobiological Problems
Neurobiological injuries
Cognitive Problems
Behavioral Problems
Bullying in middle school
Difficulties With Psychopathology
Research Issues
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Characteristics of Children Who Are Physically Abused
Age
Gender
Socioeconomic status
Race
U.S. Department of Health and Human Services (2008)
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Characteristics of Adults Who Physically Abuse Children
Age
Gender and Parental type
Race
Relationship of perpetrator to the abused child
Nontraditional parenting
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Psychological, Interpersonal, and Biological Characteristics of Adults Who Physically Abuse Children
Emotional and behavioral difficulties
Family and interpersonal difficulties
Parenting difficulties
Biological factors
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Expanded Discussion of Psychological, Interpersonal, and Biological Characteristics of Adults Who Physically Abuse Children
Biological factors
Emotional and behavioral characteristics of perpetrators
Family and interpersonal difficulties of perpetrators
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Explaining Child Physical Abuse
The individual psychopathology model–mentally ill parent
Postpartum Depression/Psychosis
Prevalence of postpartum depression
Causes of postpartum depression
Public reactions
Medical responses
Treatment
Prevention
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Explaining Child Physical Abuse
Munchausen by Proxy
The difficult child model
Parent-Child interaction model
Social Learning theory
Situational and societal conditions
Stress
Military families
Children’s behavior during deployment
Stress related to intimate partner violence
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Explaining Child Physical Abuse
Cultural acceptance of corporal punishment
Predicting injury from physical punishment
Evangelical parenting
Risk factors for child physical abuse
Polyvictimization/overlapping risk factors
Protective factors – reduce likelihood of abuse
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Contemporary Theories of Child Physical Abuse
Transactional theories focus on the importance of factors such as the characteristic of the individual, family, community, and culture to explain child maltreatment
More than one theory may help explain child physical abuse
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Practice, Policy, and Prevention Issues
Practice (Treatment) for CPA
Treatment for physically abusive adults
Parent-Focused treatment
In-Home treatments
Behavior-Based treatment programs
Parent-Child Interaction Therapy (PCIT)
Alternatives for Families: Cognitive-Behavioral Therapy (AF-CBT)
The Combined Parent-Child Cognitive Behavioral Treatment (CPC-CBT)
Therapeutic day care
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Policy Toward Physical Child Abuse
Legal perspectives
The incredible years
Parental support interventions
Treatment by CPS agencies
Out-of-home care (foster care) and family preservation
Fathers supporting success
Mandatory reporting
Prosecuting individuals who abuse children
Human rights violation
Cross-cultural responses
Medical policies
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

Practice, Policy, and Prevention Issues
Research issues
Prevention of child physical abuse
Medical settings
Anticipatory guidance
Public awareness
Grandparenting
Family Violence Across the Lifespan, 3rd Edition
© 2011 SAGE Publications
© 2011 SAGE Publications

WEEK 1

-Readings: Barnett, Miller-Perrin, & Perrin –Ch. 1 and Ch 2

-Sipe & Hall – Prologue & Chapters 1, 2, 3, 4, 5, 6

WEEK 2

-Readings: Barnett, Miller-Perrin, & Perrin -Chapter 3, 4, 5

-Sipe & Hall – Chapters 7, 8, 9, 10, 11, 12, 13, 14, 15, 16

-Afterword Read American Academy of Pediatrics Policy opposing Corporal Punishment

-Sege, R., Siegel, B. (2020)

-Effective Discipline to Raise Healthy Children, Pediatrics, 142:6, Dec. 2018.

-NASW Child Welfare Magazine Article, Corporal Punishment: Helping Parents Change

Their Discipline Paradigm.

This is the tip that my classmate gave me that already took the quiz…

It is multiple choice and you can take it more than once. However, there is an essay question. She said read the assigned chapters in I Am Not Your Victim, by Beth Spencer. She also said to read over pages 45-56 in the textbook about the different theories of abuse. Then explain the theory that best describes the relationship that Sam and Beth have. She chose the Individual (Intrapersonal) Differences because of the correlation with antisocial personality disorder. Sam is a psychopath. He is controlling, manipulating, horribly abusive physically, etc. It isn’t hard because you can try several times. But I have a general idea about how you want to answer the essay question.