provided figures by age of the child, over one-third of these victims were 5 years old or younger and, of the child victims killed in 1995, 77 percent were under age 3 (National Center on Child Abuse and Neglect, 1997). These official figures do not include community violence or the incidence of children who witness domestic violence, which also have pervasive detrimental impacts on young children (Osofsky, 1999). Moreover, many children are assumed to suffer multiple forms of maltreatment (Thompson and Wyatt, 1999).
Child maltreatment is associated with both short- and long-term adverse consequences for children (see reviews by Kolko, 1996; Malinosky-Rummell and Hansen, 1993; Pianta et al., 1989; Thompson and Wyatt, 1999). Physical abuse extracts a substantial toll on young children's social adjustment, as seen in elevated rates of aggression that are apparent even in toddlers (George and Main, 1979) and appear to derive, in part, from biases in social information processing that lead victims of physical harm to overattribute hostile intent to others (Dodge et al., 1990). On average, children who have experienced physical abuse also have lower social competence, show less empathy for others, have difficulty recognizing others' emotions, and are more likely to be insecurely attached to their parents. Deficits have also been noted in IQ scores, language ability, and school performance, even when the effects of social class are controlled.
These adverse effects are not short-lived. Although the vast majority of abused children do not become abusive adults, abused children are overrepresented among adults involved in both nonfamilial and familial violence (Malinosky-Rummell and Hansen, 1993). Among females, long-term effects manifest themselves as depression, anxiety disorders, and suicidal and self-injurious behaviors. Both men and women who were maltreated as children are at heightened risk for multiple forms of psychopathology (Cicchetti and Lynch, 1995; Kaufman, 1996; National Research Council, 1993). There is less research on physical or emotional neglect, although similar patterns across the same spectrum of outcomes have been reported (see Erickson and Egeland, 1996; Gaudin, 1993; Hoffman-Plotkin and Twentyman, 1984; Maxfield and Widom, 1996, for reviews).
As with maternal depression, abuse that occurs in the context of other adverse circumstances, such as multiple out-of-home placements, additional life stressors, and parental depression, reaps worse consequences. Coping and adaptation in the face of abuse are more likely when abuse is relatively isolated from other sources of adversity and, in particular, when the child receives emotional support from another important adult in his or her life (Garmezy, 1983; Rutter, 2000; Werner, 2000). As we discuss in the section below on institutionalization, the presence of a consistently available and emotionally invested adult appears to have a remarkably restorative influ-