Understanding
Child Abuse
and Neglect

Panel on Research on Child Abuse and Neglect

Commission on Behavioral and Social Sciences and Education

National Research Council

NATIONAL ACADEMY PRESS
Washington, D.C. 1993

NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, N.W. • Washington, D.C. 20418



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Understanding Child Abuse and Neglect Panel on Research on Child Abuse and Neglect Commission on Behavioral and Social Sciences and Education National Research Council NATIONAL ACADEMY PRESS Washington, D.C. 1993 NATIONAL ACADEMY PRESS • 2101 Constitution Avenue, N.W. • Washington, D.C. 20418

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Page ii NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. This report was undertaken with the sponsorship of the Administration for Children, Youth, and Families of the U.S. Department of Health and Human Services. Library of Congress Cataloging-in-Publication Data National Research Council (U.S.). Panel on Research on Child Abuse and Neglect. Understanding child abuse and neglect / Panel on Research on Child Abuse and Neglect, Commission on Behavioral and Social Sciences and Education, National Research Council. p. cm. Includes bibliographical references and index. ISBN 0-309-04889-3 1. Child abuse—United States—Prevention. 2. Abused children—United States—Psychology. I. Title. HV6626.52.N38 1993 362.76'0973—dc20 93-29640 CIP Cover: Photograph by Eric Futran, copyright 1993. Printed in the United States of America Copyright 1993 by the National Academy of Sciences. All rights reserved. First Printing, October 1993 Second Printing, November 1994 Third Printing, April 1996

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Page iii Panel On Research On Child Abuse And Neglect ANNE C. PETERSEN (Chair), Vice President for Research and Dean of the Graduate School, Professor of Adolescent Development and Pediatrics, University of Minnesota J. LAWRENCE ABER, Associate Professor of Clinical and Developmental Psychology, Barnard College, Columbia University ANDREW BILLINGSLEY, Professor and Chair, Department of Family and Community Development, University of Maryland-College Park JEANNE BROOKS-GUNN, Virginia and Leonard Marx Professor of Child Development, Teachers College, Columbia University DONALD J. COHEN, Director, Child Study Center, Yale University MICHAEL I. COHEN, Chairman, Department of Pediatrics, Albert Einstein College of Medicine JON ROBERT CONTE, Associate Professor, School of Social Work, University of Washington BYRON EGELAND, Irving B. Harris Professor of Child Psychology, Institute of Child Development, University of Minnesota E. MAVIS HETHERINGTON, James Page Professor of Psychology, University of Virginia SARAH McCUE HORWITZ, Associate Professor of Public Health, Department of Epidemiology and Public Health, Yale University JILL E. KORBIN, Associate Professor, Department of Anthropology, Case Western Reserve University DOROTHY OTNOW LEWIS, Professor, Department of Psychiatry, New York University RODERICK J. A. LITTLE, Professor, Department of Biomathematics, University of California-Los Angeles MURRAY A. STRAUS, Professor of Sociology, Founder and Co-Director of the Family Research Laboratory, University of New Hampshire CATHY SPATZ WIDOM, Professor in the School of Criminal Justice and Director of the Hindelang Criminal Justice Research Center, State University of New York-Albany GAIL WYATT, Clinical Psychologist and Professor in the Department of Psychiatry and Biobehavioral Science, University of California-Los Angeles ROSEMARY CHALK, Study Director JESSICA BACKER, Research Assistant DEBBIE MacGUFFIE, Senior Project Assistant

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Page iv The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Robert M. White is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy's purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Robert M. White are chairman and vice chairman, respectively, of the National Research Council.

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Page v Preface The abuse or neglect of a child is a human tragedy. The print and broadcast media have been flooded in recent years with stories of babies abandoned by their mothers; toddlers who are beaten by their parents or who are deprived of essential forms of nutrition, compassion, emotional and physical comfort; school-age children who are sexually abused; and adolescents who run away from homes after they have been subjected to years of neglect or abuse. Although these stories attract tremendous interest and empathy for the victims of abuse and neglect, media accounts fail to reveal the complex interplay of factors that influences the origins and consequences of child maltreatment. Simple answers are often proposed for cruel behaviors against children, and easy-to-identify factors such as psychopathology, poverty, alcohol, drugs, and society itself are often blamed for destructive behaviors. Yet, after decades of research, we now recognize that no single risk factor provides the overriding catalyst for child abuse and neglect. Indeed, we have only recently discovered that a complex interplay of multiple risk factors paves the path to abuse and neglect, a discovery that challenges our search for the origins of maltreatment, but one that encourages us to recognize multiple opportunities for intervention. As scientists, we have too long neglected the study of child maltreatment. For decades, social workers, clinicians, lawyers, and others have documented the pain of child victimization. But daunting obstacles inhibit the scientific study of this topic: the nature of the subject itself is emotion-

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Page vi ally overwhelming, the field lacks consistent definitions and valid instrumentation, data collection efforts are cumbersome and often unreliable, and the presence of multiple cofactors in the study populations—including poverty, violence, and other forms of victimization—makes it exceedingly difficult to isolate key factors. In three decades of research with abusive and neglectful families, remarkable progress has been achieved. Theoretical assumptions have been revised and expanded to incorporate research findings about characteristics of individuals, families, neighborhoods, and social and cultural values that affect child maltreatment. The importance of the developmental cycle of the child has been recognized in studying the consequences of child maltreatment and in designing interventions and prevention programs. And the relationship between experiences with child abuse and neglect and a broad range of health and behavioral disorders has been explored through longitudinal studies with increasingly larger samples. Despite this progress, we still lack a solid base of research information that can guide and enhance society's efforts to intervene and prevent child abuse and neglect. The existing scientific literature on child maltreatment, though extensive, is not definitive. It lacks cohesion and organization. The literature base is highly specialized and reflects the fragmentation of the field. Some scholars have focused exclusively on physical abuse of children within their family environments. Others have concentrated on the phenomenon of sexual abuse. Still others have studied the often hidden dimensions of child neglect or the more recently recognized forms of emotional abuse and neglect. The interdisciplinary nature of the field also fosters fragmentation and uncertainties. Health professionals tend to emphasize the physical manifestations of abuse or neglect: psychologists stress the internal dynamics that may foster maltreatment or protect an abused child from the more destructive consequences of abuse. Social workers concentrate on the factors and services that foster family strengths or risks to the child, while lawyers examine the effects of laws on outcomes, among other issues. The fragmentation of the research literature, and the absence of research priorities in a field that is gaining increased attention, are the catalysts that stimulated our study. In 1991, the Commissioner for Children, Youth, and Families in the U.S. Department of Health and Human Services asked the National Academy of Sciences to convene an expert panel to develop a research agenda for future studies of child maltreatment. The charge to the panel was to examine the quality of the existing research, determine areas of strength and weakness, and offer guidance regarding ways in which current and future research resources might be directed to improve the development of this field. The panel was set up by the Commission on Behavioral and Social

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Page vii Sciences and Education (CBASSE) of the National Research Council in response to this request. This is the first study on child abuse and neglect undertaken by the National Research Council, but it was developed at a time of expanding activities in areas of violence and youth. For example, in early 1993 the Academy published the results of a major study on research on the causes, prevention, and control of violent behavior (Understanding and Preventing Violence, National Academy Press, 1993). The National Research Council was also engaged in developing a report on high-risk youth (Losing Generations: Adolescents in High-Risk Settings, National Academy Press, 1993), although the results of that effort were not available at the time that our study was in progress. In carrying out its task, the panel undertook a number of activities. The panel formed three subpanels to help organize the research literature and to identify primary themes and initial recommendations. Review materials prepared by panel members and staff, as well as a set of background papers prepared by others, guided the initial discussions and, in some cases, were incorporated into draft chapters of the report. The panel is grateful to the many presenters, consultants, authors, readers, workshop participants, and federal agency officials who provided materials on specialized topics; they are listed individually in Appendix A. A few who deserve special recognition are Diana Baumrind, Jay Belsky, Jeanne Bertolli, Rosemary Bolig, Debroah Daro, Howard Dubowitz, Richard Gelles, Jeanne Giovannoni, David Kolko, John Leventhal, Howard Morgenstern, Joan Sieber, Susan Sorenson, Penelope Trickett, and Michael Wald. In addition, the panel developed outreach activities to a broad group of scholars and organizations through two working group sessions and a national survey of more than 170 professional, educational, and advocacy groups concerned with child abuse and neglect (listed in Appendix A). With such a diversity of effort, disagreements were common, but the panel was able to achieve a consensus of views through discussions and analysis of research findings. This volume also includes two brief supplementary statements prepared and endorsed by three panel members (Appendix B). Although these members support the interactive approach taken in the panel's report, they wish to emphasize two of the risk factors identified as potential contributors to child maltreatment. To ensure that this study could both build on what is currently known about child maltreatment and develop informed insights into related fields that may contribute theroetical and methodological research, the panel was composed of experts in child maltreatment as well as others who are notable for their work in other areas of epidemiology, biostatistics, child development, and pediatric medicine. Biographical sketches of panel members and staff appear in Appendix C. Rosemary Chalk served as the study director for this project. Her

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Page viii extensive experience with earlier Academy reports as well as her wisdom about the process were essential to our steady progress and timely completion of this demanding task. Although the panel bears responsibility for any errors of inference, Rosemary deserves credit for much of the writing and for upholding high standards of evidence. Jessica Backer was the research assistant for the study, and she diligently identified and obtained hundreds of reference materials in addition to preparing background papers for the panel. Debbie MacGuffie, the project assistant, provided the panel with excellent support and guidance in organizing the panel meetings, preparing agenda materials, and guiding the report from the first drafts to the published volume. Finally, the panel wishes to acknowledge the support and assistance of officials from the U.S. Department of Health and Human Services who were instrumental in the initiation and development of this study. Wade Horn, former Administrator of Children, Youth, and Families, was the key individual who sponsored this study. David Lloyd, director of the National Center for Child Abuse and Neglect, provided financial support, guidance, and information for the panel throughout the study. Marsha Liss, special assistant to the director of the National Center on Child Abuse and Neglect, served as the project monitor for this study and helped to negotiate administrative and information requests to keep the project moving smoothly through all phases of its operation. In recognizing the contributions of these individuals, we want to affirm that the recommendations of this report are those of the panel members themselves. We have had a privileged opportunity to review, in an independent manner, the fruits of decades of research investments by governmental and private agencies. We hope that our report will stimulate those responsible for the development of this research to be encouraged by the progress that has been achieved, and to renew their sense of commitment to the tasks that must still be completed. Much remains to be done. Anne C. Petersen, Chair Panel on Research on      Child Abuse and Neglect

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Page ix Contents SUMMARY 1 1 INTRODUCTION 38   The Importance of Child Maltreatment Research 39   Research on Child Maltreatment is Currently Undervalued and Undeveloped 40   Dimensions of Child Abuse and Neglect 42   The Complexity of Child Maltreatment 43   Charge to the Panel 47   The Importance of a Child-Oriented Framework 49   An Ecological Developmental Perspective 50   Previous Reports 52   Report Overview 53 2 IDENTIFICATION AND DEFINITIONS 57   Review of Definitions 59   Principles Underlying Research Definitions 62   Specific Definitional Issues 63   Identification of Child Maltreatment 67   Research Recommendations 70 3 SCOPE OF THE PROBLEM 78   Current Estimates 79

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Page x   Methodological Issues 85   Conclusions 93   Research Recommendations 95 4 ETIOLOGY OF CHILD MALTREATMENT 106   Overview of Etiological Models 107   Individual Ontogenic Factors 111   Family Microsystem 126   The Exosystem 132   The Macrosystem 136   Summary of Etiological Factors 139   Research Recommendations 140 5 PREVENTION 161   Overview 161   The Family Microsystem 167   The Exosystem 178   The Macrosystem 188   Conclusions 190   Research Recommendations 191 6 CONSEQUENCES OF CHILD ABUSE AND NEGLECT 208   Childhood 210   Adolescence 217   Adulthood 223   Issues of Stigma, Bias, and Discrimination 226   Interaction of Risk and Protective Factors 226   Research Recommendations 232 7 INTERVENTIONS AND TREATMENT 253   Treatment Efforts at the Individual Level 256   Microsystem Approaches: Family-Oriented Interventions 261   Community Exosystem Interventions 266   Social/Macrosystem Interventions 274   Conclusions 274   Research Recommendations 275 8 HUMAN RESOURCES, INSTRUMENTATION, AND RESEARCH INFRASTRUCTURE 292   The Research Community 293   Training Issues 294   Instrumentation Issues 297

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Page xi   Information Services 299   Federal Funding for Research on Child Maltreatment 301   State Roles in Research on Child Maltreatment 312   Private Foundations 313   Conclusions 314   Research Recommendations 315 9 ETHICAL AND LEGAL ISSUES IN CHILD MALTREATMENT RESEARCH 324   Framework of Analysis 325   Issues in Research on Human Subjects 326   Ethical Issues in Child Maltreatment Research 329   Research on Children and Families 334   Research on Socially Sensitive Topics 336   Conclusions 338   Research Recommendations 338 10 PRIORITIES FOR CHILD MALTREATMENT RESEARCH 343   The Nature and Scope of Child Maltreatment 344   Understanding the Origins and Consequences of Child Maltreatment 346   Improving Treatment and Preventive Interventions 350   A Science Policy for Research on Child Maltreatment 355 APPENDICES   A PANEL ACTIVITIES 365 B SUPPLEMENTARY VIEWS 371 C BIOGRAPHICAL SKETCHES 372 INDEX 379

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