Child Maltreatment

1. Child Maltreatment Messinger

2. Questions • Define the four types of maltreatment? • What are features of families in which maltreatment occurs? • What are consequences of maltreatment on emotion recognition? • What pathway identify to social consequences of maltreatment? • How might a child be “buffered” from adverse effects? • Do you believe prenatal substance exposure is child abuse? • What are effects of common substances and which would and would not constitute abuse? Acosta

3. Timeline of child maltreatment • Harsh discipline viewed as parent’s right and responsibility • Idea of child maltreatment is gaining worldwide recognition • About 3 million reports made annually to child protective services Acosta

4. Spanking?

5. SpankingExternalizing Maguire-Jack, K., A. N. Gromoske, et al. (2012).. Maguire-Jack, K., A. N. Gromoske, et al. (2012). "Spanking and Child Development During the First 5 Years of Life." Child Development 83(6): 1960-1977. Using data from the Fragile Families and Child Wellbeing Study (N = 3,870) and cross-lagged path analysis, the authors examined whether spanking at ages 1 and 3 is adversely associated with cognitive skills and behavior problems at ages 3 and 5. The authors found spanking at age 1 was associated with a higher level of spanking and externalizing behavior at age 3, and spanking at age 3 was associated with a higher level of internalizing and externalizing behavior at age 5. The associations between spanking at age 1 and behavioral problems at age 5 operated predominantly through ongoing spanking at age 3. The authors did not find an association between spanking at age 1 and cognitive skills at age 3 or 5.

6. Definition • Child maltreatment refers to four acts • Physical abuse • Emotional abuse • Sexual abuse • Neglect Acosta

7. Physical abuse • World Health Organization (WHO) • Acts that result in actual or potential physical harm, resulting from an interaction that is within the control of a parent or person in a position of responsibility, power or trust • UNICEF: persons under 18 years of age who suffer occasional or habitual acts of violence Acosta

8. Emotional abuse • Failure to provide a developmentally appropriate, supportive environment, so that a child can establish a stable and full range of emotional and social competencies “commensurate with his or her personal potential” Acosta

9. Sexual abuse • Involvement of a child in sexual activity that he/she does not fully comprehend, is not able to give consent to, and that violates the laws or taboos of society Acosta

10. Neglect • Failure to provide for a child in all domains: physical and mental health, education, nutrition, shelter, and safe living conditions, when the resources are reasonably available to the family or caretakers Acosta

11. Incidence • National Incidence Study of Child Abuse and Neglect (Sedlak & Broadhurst, 1995) • Overall rate of child maltreatment of over 1,500,000 • Includes 750,000 cases of child abuse and 880,000 cases of neglect • Does not discriminate across gender, language, religion, age, ethnicity, disability, or sexual orientation Acosta

12. Results of Maltreatment • Direct effects not yet fully understood, although it is a significant risk factor for psychopathology • Affects all aspects of development Acosta

13. Family environment • Patterns seen across maltreatment types • Family environment of coercion and abuse of power • Lower levels of prosocial behavior and verbal communication • Undervaluing of children • Deviant affective displays • Maternal intrusiveness and non-responsiveness Acosta

14. Cognitive adaptations • Maltreated children create defensive structure in reaction to trauma • Cognitive distortions, dissociation, vigilance • Hypervigilance: constant scanning of environment and development of ability to detect subtle variations in it • Dissociation: alter level of self-awareness in an effort to escape an upsetting event or feeling • Psychological escape Acosta

15. Social and emotional adjustments • Maltreated children often suffer from low self-esteem, self-blame, and negative affect toward the self • Greater risk for peer rejection • The longer maltreatment occurs, the greater the likelihood of rejection, perhaps because of tendency to engage in coercive, aggressive interactions with peers as result of abuse

16. Emotion regulation • Involves ability to modify, redirect, and control emotions • Maltreated children engage in efforts to avoid, control or suppress emotion • Modulation difficulties: extreme depressive reactions and intense angry outbursts • Internalizing behavior problems

17. Anger recognition & physical abuse • Physically abused children displayed a response bias for angry facial expressions. • 8-11-year-old abused children demonstrated increased attentional benefits on valid angry trials • demonstrated delayed disengagement when angry faces served as invalid cues. • Pollak & Tolley-Schell. Journal of Abnormal Psychology. 112(3), Aug 2003, 323-338.

18. Abused see more anger Messinger

19. At expense of sadness

20. Recognizing emotion in faces • Controls viewed discrete emotions discretely • Neglected children saw fewer distinctions • Neglected children had more difficulty discriminating emotional expressions than control or physically abused children. • Physically abused children showed the most variance across emotions. • Pollak, Cicchetti, Hornung, Reed, Developmental Psychology. 36(5), Sep 2000, 679-688.

21. Neglected children don’t distinguish emotion expression pairs Mean similarity ratings by emotion pair for control (C; solid line), neglected (N; dotted line) and physically abused (PA; dashed line) children. A = angry, N = neutral, S = sad, F = fearful, D = disgusted, H = happy

22. Heart rate change scores (bpm) • Active anger: Large initial deceleration for both abused and non-abused children • Reflects attentional orienting response • Unresolved anger: Eventual recovery from initial deceleration • Resolution: Greaterrecovery for non-abused than abused children Pollak, Vardi, Bechner, & Curtin (2005). Physically Abused

23. Skin conductance level change scores • Active anger: Non-abused children had emotional arousal response during second half • Abused children had relatively steady decline in SCL • Unresolved anger: Abused children had increased mid-way • Non-abused children steadily declined • Resolution: No significant main effects or interactions

24. Impact on emotion recognition • Influence of early adverse experience on children's selective attention to threat-related signals is a mechanism in the development of psychopathology. • As children's experience varies, so will their interpretation of emotion expressions. • Pollak & Tolley-Schell. Journal of Abnormal Psychology. 112(3), Aug 2003, 323-338.

25. Overlap with risky behaviors • Increased likelihood to engage in a greater array of risky behaviors • Certain types of maltreatment associated with a greater number of sexual partners and heavier alcohol consumption • Adult survivors likely to engage in substance abuse, criminal and antisocial behavior, and eating disorders

26. Chronically maltreated kids likely to be rejected by peers • Maltreatment chronicity  higher levels of children's aggressive behavior • reported by peers, teachers, and children • Aggressive behavior accounted for association of maltreatment and rejection. • Socially withdrawn behavior associated with peer rejection • but did not account for the association between chronic maltreatment and peer rejection. • Results hold for both girls and boys • Bolger & Patterson, 2001

27. Maltreatment chronicity  peer rejection

28. Maltreatment  Aggression

29. Maltreatment, aggression, & rejection

30. Specificity of abuse effects • Sexual abuse predicted low self-esteem • but not peer relationship problems. • Emotional maltreatment was related to difficulties in peer relationships • but not to low self-esteem. • For some groups of maltreated children, having a good friend was associated with improvement over time in self-esteem. • Bolger et al., 1998

31. Does abuse predict malfunction? • Many children and adolescents who suffer maltreatment become well-functioning adults • Maltreatment can result in significant negative consequences that continue into adulthood • Although many survivors function well in adulthood, others suffer serious psychological distress and disturbance

32. Why? • Maltreating parents may fail to produce opportunities for positive social interaction for their children • Children who experienced a lack of parental supervision were less likely to be accepted by peers • Tendency to engage in unskilled or aggressive behavior

33. Possible buffers • Maltreating parents may fail to produce opportunities for positive social interaction for their children • Opportunities found elsewhere (i.e., other family members, friends, teachers, etc.) • Maltreated children with best friends are more likely to experience increased self-esteem and self-concept than other maltreated children

34. ‘Large’ violence & ubiquitous violence • How violence has been examined: • Child maltreatment • Aggression between parents • Community violence • Often looked at separately even though they co-occur • Bias toward large injurious events rather than smaller, more subtle violence. • Some definitional issues • Important to distinguish between levels of severity and acute vs. chronic • Almost all children experience violence (90% in Martinez's 1993 sample) Margolin & Gordis (2004) • Margolin & Gordis (2004) Mattson

35. Short Term vs. Long Term Effects • Short Term • Externalizing • Blanket but often specific to exposure (e.g., acting out of witnessed aggression, sexual acting out) • Social Learning (exposure to violence leads to aggressive behavior) • Internalizing • Emotion and mood (e.g., the world is unsafe, helplessness) • Somatization (e.g., exaggerated startle, sleep disturbances, academic problems) • Long Term • Ehrensaft et al. (2003) violence during childhood related to increased violence by and to a partner. BUT • Kaufman and Zigler (1987) 70% of children do not become violent adults • Widom (1998) "cycle of violence is not deterministic or inevitable” Mattson

36. Biology • Dysregulation of the HPA axis (stress response) • Cortisol levels in non-stressful situations • BUT variable… • different responses in individuals • different dysregulation of HPA axis… • Leads to different behavioral problems • Growth hormone, early puberty onset • Sympathetic nervous system over-activation • Suppressed immune function, memory functioning Mattson • Effect on behavior goes far above just genetics (twin studies and outcomes)

37. Response and Exposure • So why do some respond poorly? • We have to link episodes of violence across development to specific deficits in the individual • Study variation in context and delays of presentation, vulnerable time periods • Tertiary later effects for interpersonal relationships • Multiple exposure • May just be the effect of relationship to frequency and severity • or a compounding of effects • or a primary family system impact lowering the threshold for other aggression Mattson

38. Is maternal prenatal substance exposure child abuse? What substances would and would not constitute abuse?

39. Cocaine summary • Cocaine exposed neonates are born slightly earlier & smaller than non-exposed infants. • Slight, scattered decrements in self-regulation at 1 month but not detectable in infant feeding behavior • Although cocaine caregivers less involved at 1 & 4 months, no differences in secure attachment or quality of play at 18 months • Standardized measures of development?

40. In general • Standardized tests of cognitive achievement, motor performance, and language development often show no significant exposure effects • Effects, when present, tend to be of small magnitude • Although Singer recently found cocaine deficits in mental performance (and motor performance), Frank did not. • There may be “sleeper” effects only apparent as kids enter school

41. Alcohol impairs prenatal development of brain structures • Extensive alcohol use during pregnancy  altered facial characteristics, reduced growth, and severe cognitive deficits (Fetal Alcohol Syndrome). • Alcohol effects are dose-dependent • quantity of alcohol consumed affects severity of child deficits • Less obvious effects of alcohol exposure include reductions in general intelligence, verbal learning, social competence. • Attention problems, memory deficits, and motor skills problems have been associated with habitual social drinking by the expectant mother throughout the pregnancy.

42. Is alcohol use child maltreatment? • Prenatal exposure to alcohol affects one in four births • one in twelve mothers reporting binge drinking during the pregnancy

43. Individual Differences • It has been observed that although children have undergone similar high levels of prenatal alcohol exposure, some will manifest severe FAS symptomatology, some will manifest mild effects, and some children will appear unaffected (Able & Sokol, 1986; Phelps & Grabowski, 1992). • Genetic factors?

44. One in five women reports using tobacco while pregnant • Prenatal exposure to cigarettes associated with premature birth, low birth weight, and irritability in the newborn. • Tobacco exposure is associated with lower intelligence scores and higher risk for attention deficit disorder in school age children.

45. Current issues • Improved identification of occurrence of maltreatment • Examination of its consequences • What determines effect of abuse? • Establishing adequate services and supports for families and children to protect from exploitation and harm

46. How to make a report • 1 - 800 - 96ABUSE (1-800-962-2873) • Provide the following • Victim name, address or location, approximate age, race and sex • Signs or indications of harm or injury, including a physical description if possible • Relationship of the alleged possible responsible person to the victim. If the relationship is unknown, a report will still be taken if other reporting criteria are met.