Running Head: EFFECTS OF CHILD ABUSE 1

The Effects of Physical Abuse and Neglect in Children

Rachael Thomas

Pennsylvania State University – York

Abstract

Research interest in the effects of abuse and neglect in children is relatively recent.

Clinical case reports suggest harmful physical and psychological consequences of maltreatment.

Abused and neglected children display a lack of intellectual and academic functioning. In

addition, they exhibit a variety of internalizing and externalizing disorders, such as depression,

anxiety, social withdrawal, aggressiveness, and conduct problems. This paper delivers a synopsis

of the likely consequences of child abuse and negligence and examines whether various types of

maltreatment are linked with particular adverse penalties in adolescence. Furthermore, this paper

looks at the way abused children function in various areas of development.

Child abuse and negligence is a societal and public health issue, which can lead to long

lasting effects into adulthood (Norman et al., 2012). However, all children that are exposed to

abuse and mistreatment, are not affected the same. For some, the consequences of abuse could be

ongoing and devastating; others could experience less severe results (Gupta, Berkowitz, &

Pearson, 2012). Social learning theory believes that victims of maltreatment learn and adopt

patterns of violent or delinquent behavior through processes of imitation and modeling (Felson &

Lane, 2009). Research shows that individuals who suffer from neglect in early childhood are

more likely to show academic and cognitive differences, social withdrawal, and more

internalization of problems (Kline, 1987). Additionally, different types of childhood abuse can

increase the risk of mental illness as well as behavioral problems (Herrenkohl et al., 2012).

Finally, abuse touches many areas of life including: increased risk of suicide, substance use,

violence, physical health problems, teenage pregnancy, and homelessness (McSherry, 2011).

Child abuse and negligence is any act from parent guardians, primary caregivers, other

grownup or elder youths that involves a considerable danger of producing emotional or bodily

damage to an adolescent. These behaviors may be deliberate or accidental. The five central types

of abuse are physical, emotional, neglect, sexual, and observing household violence (Fantuzzo &

Mohr, 1999). Serious issues that impact how child maltreatment touches the youth are the

regularity and length of abuse and the co-occurrence of numerous styles of abuse. Chronic

mistreatment defined as, "recurrent incidents of maltreatment over a prolonged amount of time"

(Dubowitz, 2013, p. 74) is worse than short-lived or isolated occurrences of maltreatment.

Research suggests that various forms of abuse are interconnected. Large quantities of children

that deal with mistreatment or negligence are exposed to several types of abuse, which is

classified as multi-type maltreatment. Poly-victimization is different styles of victimization, such

as harassment or assault by a peer, which typically accompany child abuse (Ammerman, Cassisi,

Hersen, & Van Hasselt, 1986). Analysis shows children that encounter multi-type mistreatment

and/or poly-victimization are at a greater risk of higher trauma levels than those who experienced

no mistreatment or only one form (McSherry, 2007).

Social Learning Theory

Social learning theory suggests that patterns of behavior are learned through interaction

with various reinforcing agents, and through these interactions, rewarded behaviors are adopted,

reinforced behaviors are maintained, and punished behaviors are extinguished. Social learning

theory, then, “favors a conception of interaction based on triadic reciprocity, and suggests that

behavior, cognitive and other personal factors, and environmental influences all operate as

interlocking determinants that affect each other bi-directionally” (Bandura, 2004) (as cited in

Prather, 2009). This view of human behavior is particularly important in families in which

children have been abused and neglected, since the social learning process links the development

of criminal behavior from involvement with others (family contextual factors and other

interfamilial processes), and the mediating influence of rewards, reinforcements and punishments

(Currie & Tekin, 2012; Felson & Lane, 2009; Prather & Golden, 2009).

According to this theory, behaviour is learned through two methods: we either learn by

being rewarded for our actions (instrumental learning), or we observe and imitate the behaviour

of those around us (modelling). Some researchers assume that abused children learn to be

abusive using these two methods and continue their abusive behaviour into adulthood. This

pattern of learned aggression is commonly referred to as the “cycle of violence,” or the

intergenerational transmission of violence. The general application of the cycle of violence

theory is questioned, finding that only 20-30% of child abuse and neglect victims become
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involved in abusive and criminal behaviour. Interventions based on social learning theory

commonly have the purpose of stopping current and preventing future child abuse and neglect by

teaching both the parent and child appropriate relationship skills within the family (Currie &

Tekin, 2012; Felson & Lane, 2009; Prather & Golden, 2009).

Learning and Mental Health Problems

Solid links have been made among child abuse, learning problems, and unsatisfactory

academic success. Mistreatment and negligence early in life can extremely affect the

developmental ability of young children, particularly in speech and language (Kline, 1987).

Research studies have confirmed that battered children have lower educational accomplishment

than other groups of kids. In a meta-analysis, 91% of studies showed that maltreatment and

negligence were connected to poor academic achievement and 86% showed delays in verbal

growth. However, researchers recognized that studies linking child cruelty and negligence with

education difficulties are problematic in that the majority of studies do not know the academic

position of children before abuse (Norman et al., 2012). A longitudinal study of abused children

in the United States concluded that the severity of abuse affected math scores negatively and

physical and/or emotional abuse affected reading scores negatively (Chemtob & Carlson, 2004).

In addition to learning difficulties, abused children may also experience mental health

issues. Research conducted by Bonomi et al. (2008) (as cited in Herrenkohl, 2012) found a

correlation between child abuse and a variety of mental health problems, with post-traumatic

stress disorder (PTSD) frequently reported. Current research from Thornberry and colleagues

(2010) (as cited in Herrenkohl, 2012) suggests that diagnosing children with PTSD does not

capture the full developmental effects of chronic child abuse and negligence. Maltreated children

dealing with PTSD symptoms are also often found to be experiencing other disorders such as
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attention deficit hyperactivity disorder, oppositional defiant and conduct disorders, substance

abuse, and anxiety, mood, psychotic, and adjustment disorders (Herrenkohl et al., 2012). A study

by De Bellis et al. (2002) (as cited in D’Andrea, 2012) found decreased volume in the corpus

callosum, prefrontal cortices, and temporal lobe and increased volume in the superior temporal

gyrus in maltreated children with PTSD as opposed to those without PTSD (D’Andrea et al.,

2012).

Mental health problems, such as depression and anxiety disorders, have consistently been

associated with child abuse and neglect, particularly for adolescents. In a review of seven large-

scale studies, all studies showed a high association between child maltreatment and depression in

adolescence. For example, the authors cited a longitudinal study, conducted by Repetti and

colleagues (2002), which found that children and adolescents who reported a history of abuse or

neglect were three times more likely to exhibit a depressive disorder than non-maltreated

children. Similarly, in a study of characteristics of children referred to a therapeutic health

service for children who had been abused or neglected (the Take Two Program), 62% of children

met the criteria for at least one mental health diagnosis (D’Andrea et al., 2012; Gupta,

Berkowitz, & Pearson, 2012).

Eating disorders, including anorexia and binge-purge behavior (bulimia), may also be

associated with child abuse and neglect. Sexual abuse has been widely linked to eating disorders

in children and adolescents; however, experiencing other maltreatment types or multiple forms

of abuse and neglect has also been shown to increase the risk of developing an eating disorder

(Dubowitz, 2013; Herrenkohl et al., 2012; Kline, 1987).

Researchers have found that child abuse and neglect are associated with behavior

problems in childhood and adolescence. The earlier children are maltreated the more likely they
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are to develop behavior problems in adolescence. Researchers have often associated

maltreatment with internalizing behaviors (being withdrawn, sad, isolated and depressed) and

externalizing behaviors (being aggressive or hyperactive) throughout childhood (Toro, 1982).

Longitudinal studies have shown that exposure to a single type of maltreatment as well as

multiple types is related to increased internalizing and externalizing behaviors in childhood and

adolescence. A large, nationally representative study in the United States reported that children

who were maltreated in multiple developmental periods (infancy, toddlerhood, preschool years

and early school years) displayed more problem behaviors than children maltreated in only one

developmental period. Additionally, children who were chronically maltreated tended to display

more behavior problems than children suffering from situational maltreatment, although this was

mediated by a range of family variables such as caregivers having alcohol or drug dependence,

lower levels of education, or diagnoses of depression (Ammerman et al., 1986; Norman et al.,

2012).

Research investigating the effect child abuse and neglect has on overall physical health

has largely focused on outcomes in adulthood. However, data from the Longitudinal Studies of

Child Abuse and Neglect (LONGSCAN) in the United States has indicated strong associations

between abuse/neglect and health problems in children/adolescents. A study by Dumont and

colleagues (2008) (as cited in Dubowitz, 2013) found that exposure to one adverse experience

doubled the odds of children having overall poor physical health at the age of 6 years, and tripled

them if children had experienced four or more adverse experiences. A further study by

Borkowski and colleagues (2010) (as cited in Dubowitz, 2013) found that all types of abuse and

neglect were associated with 8 of 10 major adolescent health risks (Dubowitz, 2013; Norman et

al., 2012).
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Abuse and At Risk Behaviors

Abuse is associated with many at risk behaviors including suicide, alcohol, aggression,

teenage pregnancy, and homelessness. A systematic review by Lieberman and colleagues (2005)

(as cited in McSherry, 2007) found a strong link between physical and sexual abuse and

attempted suicide/suicidal thoughts occurring during adolescence. Similarly, Lansford and

colleagues (2006) (as cited in McSherry, 2007) found that although all forms of maltreatment

were associated with adolescent suicidal thoughts and suicide attempts, child sexual abuse and

emotional abuse might be more important than physical abuse or neglect. Supporting this, in

2006 researchers found that risks of repeated suicide attempts were eight times greater for youths

with a sexual abuse history. The authors suggested that sexual abuse could be specifically related

to suicidal behavior because it is closely associated with feelings of shame and internal thoughts

of blame (Chemtob & Carlson, 2004; McSherry, 2007).

The psychological effects of child abuse and neglect may lead to alcohol and drug abuse

problems in adolescence and adulthood. Evidence suggests that all types of child maltreatment

are significantly related to higher levels of substance use (tobacco, alcohol and illicit drugs)

(Fantuzzo & Mohr, 1999). It is unclear if particular types of maltreatment are more closely

linked to substance abuse, although physical abuse and combinations of abuse appear to be

associated with increased substance abuse. In surveying public school students in Grades 6, 9,

and 12 in the United States, Straus and colleagues (2008) (as cited in Herrenkohl, 2012) found

that experiences of physical or sexual abuse increased the likelihood of students using alcohol,

marijuana and other drugs. A further study by Parker and colleagues (2010) (as cited in

Herrenkohl, 2012) found that 28% of physically abused adolescents used drugs compared to 14%
Running Head: EFFECTS OF CHILD ABUSE 9

of non-abused adolescents. Compared to 22% of the non-abused group, 36% of physically

abused adolescents also had high levels of alcohol use (Herrenkohl et al., 2012).

In addition to feeling pain and suffering themselves, children exposed to abuse and

neglect are at increased risk of inflicting pain on others and developing aggressive and violent

behaviors in adolescence. Research suggests that physical abuse and exposure to family violence

are the most consistent predictors of youth violence (Fantuzzo & Mohr, 1999; McSherry, 2011).

In a meta-analysis, both prospective and retrospective studies indicated strong associations

between child abuse and neglect and criminal behavior. A National Institute of Justice study in

the United States (2004) (as cited in Norman, 2012) predicted that abused and neglected children

were elven times more likely to be arrested for criminal behavior in adolescence (Norman et al.,

2012).

Teenage pregnancy and risky sexual activity may also be associated with experiences of

abuse and neglect. Research has consistently linked teenage pregnancy with experiences of

sexual abuse. Meta-analyses of 21 studies of child sexual abuse reported that this form of abuse

more than doubled the risk of adolescent pregnancy (prior to age 20 years). Additionally, a study

found that young women (18 years of age) exposed to sexual abuse as a child had significantly

higher rates of teenage pregnancy, increased rates of sexually transmitted diseases, higher rates

of multiple sexual partnerships, and appeared to be more vulnerable to further sexual assault and

rape (Bartlett & Easterbrooks, 2012; Gupta, Berkowitz, & Pearson, 2012; McSherry, 2011).

Research suggests that children and young people may encounter homelessness or

housing instability as a result of abuse and neglect. Homelessness is more likely to emerge in

adulthood, however, the Australian Bureau of Statistics (ABS) estimated that approximately

25,503 children were homeless on Census night in 2011 (29% of the homeless population). The
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Australian Institute of Health and Welfare (AIHW) indicated that 56,559 children aged up to 15

years accompanied their parents into Specialist Homelessness services in 2011-12. The main

reason for accompanied children to seek support was domestic and family violence (33%).

Young people who are removed from the care of their parents because of abuse or neglect may

also face homelessness and unemployment soon after leaving out-of-home care when they turn

18. A lack of social support networks and poor academic achievement often contribute to the

difficulties young people face in finding adequate housing and employment after care

(Dubowitz, 2013; McSherry, 2007; Norman et al., 2012).

Conclusion

Child abuse and neglect may lead to a wide range of adverse consequences for children

and adolescents. Research suggests that specific types of abuse are more closely related to some

adverse outcomes than others, for example, the links between physical abuse and violent or

aggressive behavior. However, experiencing chronic and multiple forms of abuse increase the

risk of more damaging and severe consequences for children and young people.

Factors which contribute to poorer results for youths exposed to maltreatment include

socio-economic difficulty, social separation, living in unsafe areas, oversized families, a

caregiver with depression or drug and/or alcohol addiction, and whether or not the child is

disabled. Aspects that influence an adolescent’s resilience include child qualities (e.g.,

confidence and individuality), components of the family surroundings (e.g., parenting quality),

and extra-familial and communal resources (e.g., strong peer relationships and school setting)

(Bartlett & Easterbrooks, 2012).

References

Ammerman, R., Cassisi, J., Hersen, M., & Van Hasselt, V. (1986). Consequences of physical

abuse and neglect in children. Clinical Psychology Review, 6, 291-310.

Bartlett, J., & Easterbrooks, A. (2012). Links between physical abuse in childhood and child

neglect among adolescent mothers. ScienceDirect, 34, 2164-2169.

http://dx.doi.org/10.1016/j.childyouth.2012.07.011

Chemtob, C., & Carlson, J. (2004). Psychological effects of domestic violence on children and

their mothers. International Journal of Stress Management, 11(3), 209-226. doi:

10.1037/1072-5245.11.3.209

Currie, J., & Tekin, E. (2012). Understanding the cycle. The Journal of Human Resources, 47(2),

509–549.

D’Andrea, W., Ford, J., Stolbach, B., Spinazzola, J., & van der Kolk, B. A. (2012).

Understanding interpersonal trauma in children: why we need a developmentally

appropriate trauma diagnosis. American Journal of Orthopsychiatry, 82(2), 187–200.

http://doi.org/10.1111/j.1939-0025.2012.01154.x

Dubowitz, H. (2013). Neglect in children. Healio, 42(4), 73-77.

Fantuzzo, J., & Mohr, W. (1999). Prevalence and effects of child exposure to domestic violence.

The Future of Children, 9(3), 21-32.

Felson, R. B., & Lane, K. J. (2009). Social learning, sexual and physical abuse, and adult crime.

Aggressive Behavior, 35(6), 489–501. http://doi.org/10.1002/ab.20322

Gupta, R., Berkowitz, C., & Pearson, R. (2012). Child physical abuse. Clinical Key, 805-812.
Running Head: EFFECTS OF CHILD ABUSE 12

Herrenkohl, T., Seunghye, H., Kilka, B., Herrenkohl, R., & Russo, J. (2012) Developmental

impacts of child abuse and neglect related to adult mental health, substance use, and

physical health. Springer Science, 28, 191-199. doi: 10.1007/s10896-012-9474-9

Kline, D. (1987). Educational and psychological problems of abused children. Child Abuse &

Neglect, 1, 301-307.

McSherry, D. (2011). Understanding and addressing the “neglect of neglect”: why are we

making a mole-hill out of a mountain? Child Abuse & Neglect, 31, 607-614. doi:

10.1016/j.chiabu.2006.08.011

Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term

health consequences of child physical abuse, emotional abuse, and neglect: a systematic

review and meta-analysis. PLOS Medicine, 9(11), 1-24.

Prather, W., & Golden, J. A. (2009). Learning and thinking: A behavioral treatise on abuse and

antisocial behavior in young criminal offenders. International Journal of Behavioral

Consultation and Therapy, 5(1), 75–105.

Toro, P. (1982). Developmental effects of child abuse. Child Abuse and Neglect, 6, 423-431.