New Directions in Child Abuse and Neglect Research (2014) / Chapter Skim
Currently Skimming:
4 Consequences of Child Abuse and Neglect
4 Consequences of Child Abuse and Neglect
Pages 111-174
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From page 111... ...
Knowledge of sensitive periods -- the idea that for those aspects of brain development that are dependent on experience, there are stages in which the normal course of development is more susceptible to disruption from experiential perturbations -- also has increased exponentially. In addition, research has begun to explore differences in individual susceptibility to the adverse outcomes associated with child abuse and neglect and to uncover the factors that protect some children from the deleterious consequences explored throughout this chapter.
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From page 112... ...
, externalizing symptoms (e.g., oppositional defiant disorder, conduct disorder, aggression) , and posttraumatic stress
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From page 113... ...
However, it is important to note at the outset that not all abused and neglected children experience problematic outcomes. As discussed in the section on individual differences later in this chapter, a body of research is devoted to uncovering the factors that distinguish children who do not experience problematic outcomes despite facing significant adversity in the form of abuse or neglect.
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From page 114... ...
It expands on these models by highlighting the nature of interaction among risk factors and the ecology in which child maltreatment occurs. The ecological/transactional model describes four interrelated, mutually embedded categories that contribute to abuse and neglect and the potential associated consequences: • Ontogenic development -- Reflects factors within the individual that influence the achievement of competence and adaptation.
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From page 115... ...
, as was a sample of 72 never-institutionalized children who lived with their families in the greater Bucharest community. Following the baseline assessment, half of the institutionalized children were randomly assigned to a high-quality foster care program that the investigators created, financed, and maintained, and half were randomly assigned to remain in care as usual (institutional care)
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From page 116... ...
, which followed a large cohort of abused and neglected children and a matched comparison sample from childhood into adulthood. Other examples include the studies of Johnson and colleagues (1999, 2000)
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From page 117... ...
For example, children involved with child protective services because of neglect or abuse often face a number of overlapping and concurrent risk factors, including poverty, prenatal substance exposure, and parent psychopathology, among others (Dubowitz et al., 1987; Lyons et al., 2005; McCurdy, 2005)
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From page 118... ...
axis of the stress response system; the amygdala, involved in emotion processing and emotion regulation; the hippocampus, involved in learning and memory; the corpus callosum, involved in integrating functions between hemispheres; and the prefrontal cortex, involved in higher-order cognitive functions. The discussion begins, however, with a brief overview of brain development.
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From page 119... ...
. Critical to the discussion in this chapter, however, is that the functions subserved by some other regions of the brain, most notably the prefrontal cortex -- executive control, planning, cognitive flexibility, emotion regulation -- have a much more protracted course of development for the simple reason that both synaptogenesis
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From page 120... ...
Hypothalamic-Pituitary-Adrenocortial (HPA) Axis and Biological Regulation There is strong evidence across species that the HPA axis is affected by experiences of early childhood abuse and neglect (e.g., Bruce et al., 2009; Gunnar and Vazquez, 2001; Levine et al., 1993; Shonkoff et al., 2012)
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From page 121... ...
. The most consistent findings involve flatter, more blunted patterns of diurnal regulation among abused or neglected children relative to low-risk children (Bernard et al., 2010; Bruce et al., 2009; Dozier et al., 2006; Fisher et al., 2007; Gunnar and Vazquez, 2001)
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From page 122... ...
found that children living in highly challenging environments showed shorter telomeres than comparison children, but that mothers could buffer children from the environment challenge. When mothers of neglected children were sensitive to challenging environments, their children's telomeres were as long as those of low-risk children, but when mothers were insensitive, children's telomeres were shorter.
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From page 123... ...
. Relative to lowrisk children, abused and neglected children show behavioral and emotional difficulties that are consistent with effects on the amygdala, such as internalizing problems, heightened anxiety, and emotional reactivity (Ellis et al., 2004; Kaplow and Widom, 2007; Tottenham et al., 2009; van Ijzendoorn and Juffer, 2006; Zeanah et al., 2009)
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From page 124... ...
. Among adults, however, decreased hippocampal volume has been linked with the experience of childhood physical and sexual abuse (Andersen and Teicher, 2004; Andersen et al., 2008; Schmahl et al., 2003; Woon and Hedges, 2008)
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From page 125... ...
. Consistent with these findings among abused and neglected children, previously institutionalized children and adolescents have been found to demonstrate disruptions in the prefrontal network that is associated with inhibitory control.
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At baseline (mean age 20 months) , prior to random assignment to continued institutional care or foster care, institutionalized children showed higher levels of theta power (low-frequency brain activity)
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From page 127... ...
. Specifically, previously institutionalized children placed in foster care before about 2 years of age had patterns of brain activity that resembled those of never-institutionalized children, whereas children placed in foster care after 2 years of age had patterns of brain activity that resembled those of children randomly assigned to institutional care.
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From page 128... ...
Children who experience abuse and neglect appear to be especially at risk for deficits in executive functioning, which have implications for behavioral regulation. Extreme neglect, as seen in institutional care, has been related to executive functioning in a number of studies conducted by the Bucharest Early Intervention Project team (McDermott et al., 2012)
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From page 129... ...
found that many children who had been adopted following institutional care showed problems with inattention or overactivity, but that such problems were usually seen in combination with reactive attachment disorder, quasi-autistic behaviors, or severe cognitive impairment. Using NSCAW data, Heneghan and colleagues (2013)
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From page 130... ...
For example, 42 percent of abused and neglected children completed high school, compared with twothirds of the matched comparison group without histories of abuse and neglect. The average IQ score for the abused and neglected children was about one standard deviation below the average for the control group; this association was significant after controlling for age, race, gender, and social class (Perez and Widom, 1994)
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From page 131... ...
. Problems also are seen in internalizing symptoms, such as anxiety and depression, and externalizing symptoms, such as conduct disorder and substance use.
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From page 132... ...
. Furthermore, findings from the Bucharest Early Intervention Project study indicate that the inhibited type of reactive attachment disorder declined significantly once institutionalized children were placed in foster care, but the disinhibited type proved more persistent (Smyke et al., 2002; Zeanah and Gleason, 2010)
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From page 133... ...
It is likely that abused and neglected children experience not only a lack of modeling and support and an absence of positive affect but also harsh, inconsistent, and insensitive parenting (Shipman and Zeman, 2001)
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. Oppositional defiant disorder and conduct disorder  Studies have reported significant associations between a history of childhood abuse or neglect and various conduct problems, including those classified as oppositional defiant disorder or conduct disorder.
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found that childhood sexual abuse was associated with higher rates of conduct disorder in young adulthood. Furthermore, they found that childhood physical abuse was not associated with conduct disorder when sexual abuse was included in the model.
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From page 136... ...
found that sexually abused children had a significantly higher average score on depression measures than a control group just 5 years after the abuse occurred, after adjusting for individual differences in age and sex, as well as contextual factors such as socioeconomic status, family functioning, mother's mental health, and number of negative life events. Trickett and colleagues (2001)
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From page 137... ...
found that child sexual abuse was not associated with an elevated risk of major depressive disorder relative to matched controls, although physical abuse or multiple kinds of abuse did increase the risk for lifetime major depressive disorder. Additional studies have found that physical abuse increased the risk for adult depression (e.g., Brown et al., 1999)
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From page 138... ...
propose that dissociation may act as a mediator of child abuse across generations. In a longitudinal study of sexually abused girls followed into parenthood, Kim and colleagues (2010)
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From page 139... ...
found increased risk for PTSD among adults who had experienced abuse and neglect as children, with 23 percent of those who had been sexually abused, 19 percent of those who had been physically abused, and 17 percent of those who had been neglected meeting criteria for PTSD at age 29, compared with 10 percent of the comparison group. Some evidence indicates that PTSD may mediate the association between childhood abuse and neglect and later adverse outcomes.
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From page 140... ...
had a fourfold increase in personality disorders relative to those without a history of abuse or neglect. Physical abuse was associated with elevated antisocial and depressive personality disorder symptoms; sexual abuse was associated with elevated borderline personality disorder symptoms; and neglect was associated with elevated symptoms of antisocial, avoidant, borderline, narcissistic, and passive-aggressive personality disorders, as well as with attachment difficulties and other interpersonal and psychological problems.
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From page 141... ...
As a result, abused and neglected children are at higher risk for the development of attachment disorders, particularly disinhibited social engagement disorder. Finding: Abused and neglected children often fail to develop effective strategies for emotion regulation, partly as a result of differences in pro cessing of emotional cues.
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From page 142... ...
found that most children entering foster care had an abnormal physical screen involving at least one body system, and on average weighed less and were shorter than comparison children. Gross motor development often is delayed among children with a history of institutional care who have then been adopted internationally (Dobrova-Krol et al., 2008; Roeber et al., 2012)
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From page 143... ...
. The adverse experiences measured in the study include emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect, as well as indicators of household dysfunction, such as domestic violence, parental divorce or separation, household member mental illness, household member substance abuse, and household member incarceration.
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From page 144... ...
Two of these prospective longitudinal studies also found that sexual abuse increased the risk for general offending, but not violent offending (Smith et al., 2005)
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. Despite differences in geographic region, time period, youths' age and sex, definition of child maltreatment, and assessment technique, these prospective investigations provide evidence that childhood maltreatment increases later risk for delinquency and violence.
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found high rates of suicide among a New Zealand sample as well. These effects are seen for physical and sexual abuse even after accounting for other associated risk factors (Fergusson et al., 2008)
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Teen Pregnancy Evidence linking childhood sexual abuse and increased risk for teen pregnancy has been mixed. Trickett and colleagues (2011)
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Finding: Children who experience abuse and neglect may initiate sexual activity at earlier ages than comparison groups. Childhood sexual abuse also has been found to be associated with heightened risks for a range of adverse outcomes related to sexual risk-taking behaviors.
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found an association between characteristics of the abuse experience (e.g., a high level of severity of child sexual abuse, such as attempted or completed intercourse and the use of force or threats) and certain psychiatric disorders.
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. That is, some children who experience abuse or neglect do not show problematic outcomes, but as abuse, neglect, and other adverse childhood experiences accumulate, they challenge children's ability to cope with the negotiation of life tasks.
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From page 151... ...
. In a sample of sexually abused girls in foster care, family support was not found to be a protective factor, but peer influences, school plan certainty, and positive future orientation were (Edmond et al., 2006)
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From page 152... ...
Factors that influence resilience among abused and neglected children have been identified at the level of the individual child, the family, and the child's broader social context. These factors, along with risks and stressors at each level, interact with one another to predict resilient outcomes.
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From page 153... ...
. Direct nonmedical expenditures include use of the child welfare system, law enforcement, and the criminal justice system.
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Brain development is affected, as is the ability to make decisions as carefully as one's peers, or executive functioning; the
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2011. Resilience following child maltreatment: A review of protective factors.
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2008. Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development.
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2001. Features of childhood sexual abuse and the development of psychiatric and substance use disorders.
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2010. Sexual abuse and lifetime diagnosis of psychiatric disorders: Systematic review and meta-analysis.
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2001a. A pilot longitudinal study of hippocampal volumes in pediatric maltreatment-related posttraumatic stress disorder.
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Journal of Child Sexual Abuse 15(1)
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2006. Evidence for a dissociative subtype of post-traumatic stress disorder among help-seeking childhood sexual abuse survivors.
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1990. Effect of sex, psychosocial disadvantages and biological risk factors on EEG maturation.
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2010. Trajectories of childhood sexual abuse and early adolescent HIV/AIDS risk behaviors: The role of other maltreatment, wit nessed violence, and child gender.
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2010. Childhood experiences of sexual abuse and later parenting practices among non-offending mothers of sexually abused and compari son girls.
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2007. Early physical abuse and later violent delinquency: A prospective longitudinal study.
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2002. Impact of child maltreatment and interadult vio lence on children's emotion regulation abilities and socioemotional adjustment.
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2009. Examining the developmental history of child maltreatment, peer relations, and externalizing problems among adolescents with symptoms of paranoid personality disorder.
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2007. Obesity risk for female victims of childhood sexual abuse: A prospective study.
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From page 169... ...
2013. The interaction between child maltreatment, adult stressful life events and the 5-HTTLPR in major depression.
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2008. Childhood and adolescent sexual abuse and subsequent sexual risk behavior: Evidence from controlled studies, methodological cri tique, and suggestions for research.
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1997. Sexually abused children 5 years after presentation: A case-control study.
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2011. The impact of sexual abuse on female de velopment: Lessons from a multigenerational, longitudinal research study.
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2008. Posttraumatic stress symptoms mediate the relation ship between childhood sexual abuse and nonsuicidal self-injury.
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2008. A prospective study of child maltreatment and self-injurious behavior in a community sample.
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