Risk Factors in Child Abuse and Neglect

Our knowledge of those factors which place children at risk for physical or sexual abuse is both limited and imprecise. The reasons for these limitations derive from both practical methodological constraints and a lack ofdefinitional consensus among researchers in this field. This paper discusses the difficulties, both methodological and practical, involved in the development of a scientifically-based knowledge of risk factors in child abuse. Those factors known or commonly believed to be related to risk for child abuse and neglect are then ,described, with emphasis on those which appear to be popularly and clinically over-valued as predictors of abuse: demographic variables, psychopathology, and history of abuse. Likely foci for future research in this area are then described, with special attention to the problems inherent in each.     

An ecological approach to child abuse: a creative use of scientific models in research and practice

Over the past 40 years, considerable progress has been made in our understanding of the aetiology and processes of child abuse. This understanding has been based within two scientific paradigms: the psychodynamic and sociological models. More recently, both strands have been incorporated in a more comprehensive ‘ecological’ paradigm. This presents child abuse as occurring within the context of the child's environment at different, nested levels. The ecological paradigm is currently the most comprehensive model we have for understanding child abuse, providing a systematic framework in which to conduct both research and child protection practice. This paper begins by describing the nature and use of scientific models in both research and practice. Three levels of models are outlined: working models, paradigms and worldviews. The paper then goes on to consider how models are used in our understanding of child abuse, focusing on three major paradigms (sociological, psychodynamic, ecological). The ecological model or paradigm is then described in detail, expounding the four different levels within it. The uses and limitations of the ecological model are discussed in relation to both research and practice. Finally, some practical suggestions are provided for the reader to creatively apply this understanding at a personal and professional level. Copyright © 2001 John Wiley & Sons, Ltd.     

Differentiating Children with and without a History of Repeated Problematic Sexual Behavior

Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse. This article first discusses those differences in terms of the moderating risk factors for developing dissociative amnesia (e.g., age, ethnicity, gender, etc.) and then mediating risk factors (e.g., social support, trait dissociativity, etc.). The differences between the two types of survivors are then explored in terms of treatment issues.     

Parents' knowledge,attitudes and practices about preventing child sexual abuse: a literature review

Increased concern about high rates of child sexual abuse has led to the demand for more prevention programmes, particularly those aimed at parents. Research on how parents manage and reduce the risk of child sexual abuse can help plan programmes. This literature review explores published research on the knowledge, attitudes and practices of parents on the risk and prevention of child sexual abuse and identifies gaps and needs for further research. The majority of studies reviewed originated in North America and Asia, were quantitative, surveyed mainly mothers and were more than ten years old. Recommendations are made for more current and country specific research, further research to gain a deeper understanding of how parents manage the risk of child sexual abuse, more comprehensive research covering a range of knowledge, attitude and practice variables, and greater inclusion of fathers in research. Copyright © 2009 John Wiley & Sons, Ltd.     

Child Sexual Abuse News: A Systematic Review of Content Analysis Studies

Public knowledge and attitudes toward child sexual abuse are shaped through media depictions and coverage. Since the media are the main source of information about child sexual abuse, studies of child sexual abuse news can help us understand how news is created, how child sexual abuse is presented to the public, and what is the possible impact of such presentation and coverage on the audience. A systematic review of content analysis research is conducted using predefined criteria in order to identify quality studies, main findings, research gaps and to develop recommendations for future studies. International databases were systematically searched using keywords in September 2017. A total of 24 original quantitative content analysis studies published in the English language were included in the review and evaluated according to research methodology. The framework of child sexual abuse news media studies is developed and main findings are highlighted: (1) presentation and coverage of child sexual abuse (n = 7); (2) prevalence of coverage of CSA cases reported to the authorities (n = 2); (3) presentation and coverage of child abuse and sexual crimes where child sexual abuse is only a subtopic (n = 9); (4) presentation and coverage of specific child sexual abuse cases or issues (n = 6). Although studies represent valuable contribution, most did not meet content analysis design and reporting standards or both (e.g., calculating intercoder reliability), which seriously compromises validity and replicability requirements. Recommendation for future studies and most common errors in conducting content analysis are emphasized.     

Behind the cycle of violence, beyond abuse history: a brief report on the association of parental attachment to physical child abuse potential

Although the concept of a cycle of violence presumes that the transmission of violence is expressed directly across generations, the role of the overall quality of the parent-child relationship may ultimately be more influential in later parenting behavior. This study investigated whether mothers' poorer attachment to their parents was associated with their current increased child abuse potential and dysfunctional disciplinary style independent of a personal history of child abuse. A sample of 73 at-risk mothers raising children with behavior problems reported on their parental attachment, abuse potential, dysfunctional parenting style, and personal abuse history. An at-risk sample, rather than a sample of identified abuse victims or perpetrators, was studied to better examine the potential continuity or discontinuity from history of abuse to current abuse risk, allowing consideration of those who may break the cycle versus those who potentially initiate abuse in the absence of a personal history. Findings indicate that poor attachment significantly predicted both dysfunctional parenting practices and elevated child abuse potential, controlling for personal child abuse history. Such results highlight the importance of the overall quality of the relationship between the parent and child in potentially shaping future abuse risk. Findings are discussed in terms of continuity or discontinuity in the cycle of violence and future directions for research on attachment in relation to the development of later child abuse risk.     

Male victims of child sexual abuse

Despite the increased attention the subject of child sexual abuse has received in recent years, rarely has much consideration been given to the boys and adolescent males who are the victims of such abuse. That young girls are consistently the clear majority of sexual abuse victims is not disputed, however the extent to which they are the majority is in question. A review of existing literature has indicated that one of the leading factors for this inadvertent negligence in presenting a truer picture of the magnitude of the problem for male victims concerns the area of under-reporting of the incidence of abuse of young males. Under-reporting has served to give a false sense of the scope of child sexual abuse, particularly for male children. Many societal and methodological factors contribute to under-reporting. Reasons for the discrepancy in reporting abuse will be presented and implications for practice will be discussed.     

Risk assessment in child sexual abuse cases

Despite continuing improvements in risk assessment for child protective services (CPS) and movement toward actuarial prediction of child maltreatment, current models have not adequately addressed child sexual abuse. Sexual abuse cases present unique and ambiguous indicators to the investigating professional, and risk factors differ from those related to physical abuse and neglect. Incorporation of research on risk factors specifically related to sexual offender recidivism into existing CPS risk assessment models may improve the ability to assess the risk of future sexual maltreatment to children. This article reviews the literature on risk factors for sexual offense recidivism and discusses their relevance and application to CPS assessment models. An evidence-based model for assessing risk in child sexual abuse cases is proposed.     

Economic predictors of child maltreatment in an Australian population-based birth cohort

A correlation between socioeconomic disadvantage and child maltreatment has long been observed, but the drivers of this association are poorly understood. We sought to estimate the effects of economic factors on risk of child maltreatment after adjusting for other known influences using the Australian Temperament Project, a population-based birth cohort of 2443 individuals and their parents. We used logistic regression to estimate associations of childhood economic factors (parental education, occupation, and unemployment; type of housing; and retrospective perception of poverty) with retrospective reports of perceived child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and witnessing of domestic violence), controlling for demographic factors, parental mental health and substance use, and child health. We then used these estimates to approximate the proportions of child maltreatment—population attributable fractions—that are theoretically preventable by addressing childhood economic disadvantage. Economic factors were associated with all types of child maltreatment. For the most part, these associations diminished only partially when controlling for noneconomic confounders, supporting hypotheses of causal relationships. Jointly, economic factors were significant predictors of physical abuse, sexual abuse, and witnessing of domestic violence but not of emotional abuse or neglect. Retrospective perceptions of childhood poverty were, in particular, strongly associated with most forms of child maltreatment but not with sexual abuse after accounting for other economic factors. We estimated that 27% of all child maltreatment was jointly attributable to economic factors. These findings suggest that strategies that reduce economic disadvantage are likely to hold significant potential to reduce the prevalence of child maltreatment.     

Impact of Traumatic Events on Posttraumatic Stress Disorder among Danish Survivors of Sexual Abuse in Childhood

Childhood sexual abuse can be extremely traumatic and lead to lifelong symptomatology. The present study examined the impact of several demographic, abuse, and psychosocial variables on posttraumatic stress disorder severity among a consecutive sample of treatment-seeking, adult child sexual abuse survivors (N = 480). The child sexual abuse sample was characterized by severe trauma exposure, insecure attachment, and significant traumatization, with an estimated 77% suffering from posttraumatic stress disorder, more than twice the level of the comparison group. Regression analyses revealed risk factors associated with the development of posttraumatic stress disorder in which the strongest predictors being additional traumas, negative affectivity, and somatization. The findings add to existing research confirming the stressful nature of child sexual abuse and the variables that contribute to the development and severity of posttraumatic stress disorder.     

The "Medea complex" among men: the instrumental abuse of children to injure wives

It has been previously documented that wife and child abuse often co-occur. The present study tested competing hypotheses about the reasons for this co-occurrence, specifically trait versus instrumental theories of aggression within families. Three commonly cited catalysts (unemployment, drinking, and life-stress events) for men's abuse of family members were analyzed to determine whether they equally predict partner or child abuse. Interviews were conducted with 363 women and children about spousal and paternal abuse, and women were interviewed about sociodemographics and the stressors described above. Families were oversampled for the presence of spousal violence. Logistic regressions revealed that heavy drinking (log-odds ratio 4.86) and life stress events (log-odds ratio 1.6) predicted men's abuse of their partners. These risk factors were unrelated to child abuse. Wife battering, however, placed children at heightened risk (log-odds ratio = 2.77). Children of battered women stood a 42% chance of receiving escalated abuse from their fathers. It is proposed that men's abuse of children is in many instances instrumental in order to coerce or retaliate against women, echoing the Greek myth of Medea who killed her own children to spite their father.     

Researching Children: Methods and Ethics

The appropriateness and desirability of researching children have been issues of some debate. Children may be perceived as non-competent or vulnerable, and proxies have been used as children's representatives. Increasingly researchers are speaking to children directly. Why is this so and what are the methodological and ethical implications of researching children's views? In this paper the authors draw on their own experiences of researching children in the fields of child carers and the impact of the Child Support Act 1991. A number of social, political and legal trends are identified which form a background to the growing interest in children as potential and actual participants in the research process. The theoretical, methodological, ethical and practical issues involved are then identified and described, using examples from two separate studies conducted by the authors.     

Some methodological problems in estimating incidence and prevalence in child sexual abuse research

Research into child sexual abuse is fraught with methodological problems. This paper provides an overview of some common aspects of them. Definitional inconsistencies are frequent, including that of child sexual abuse itself and what age limits define a child. Other methodological difficulties include determining the number of children sexually abused in any period of time, choice of sample, the type and number of questions asked, factors such as publicity associated with the historical period, and estimates of the rate of increase of child sexual abuse over time. It is suggested that greater consistency, particularly of definition, would assist comparative conclusions to be made with less ambiguity and greater validity.     

The preoccupation with thresholds in cases of child death or serious injury through abuse and neglect

Thresholds into and between services emerged as a significant theme in the biennial analysis of cases of child death and serious injury through abuse and neglect ‘serious case reviews’ carried out in England for the (then) Department for Education and Skills between 2003–05. The preoccupation with thresholds was one of a number of interacting risk factors and many children's cases were on the boundary of services and levels of intervention. In most cases child protection did not come ‘labelled as such’ which reinforces the need for all practitioners, including those working with adults to be alert to the risks of significant harm. Policy makers should acknowledge that staff working in early intervention are working within the safeguarding continuum and not in a separate sphere of activity. The emotional impact of working with hostility from violent parents and working with resistance from older adolescents impeded engagement, judgement and safeguarding action. In the long term neglect cases that were reviewed, the threshold for formal child protection services was rarely met and some agencies and practitioners coped with feelings of helplessness by adopting the ‘start again syndrome’. Adequate resources are essential but not sufficient to redress the problems. Effective and accessible supervision is crucial to help staff to put into practice the critical thinking required to understand cases holistically, complete analytical assessments, and weigh up interacting risk and protective factors. Copyright © 2008 John Wiley & Sons, Ltd.     

The Child Abuse Risk Evaluation Dutch Version (CARE-NL): A retrospective validation study

Abstract

The Child Abuse Risk Evaluation – Dutch version (CARE-NL) is a structured professional guideline for assessing the risk of all types of child abuse. The CARE-NL comprises 18 risk factors: eight Parental characteristics, three Parent-Child interaction factors, five Family factors, one Child vulnerability factor, and an extra factor for child sexual abuse risk. We examined interrater reliability and predictive accuracy of the instrument in a retrospective study at Advice and Reporting Centers on Child Abuse (ARCCA) in The Netherlands. The ARCCA files contained limited information on Parental risk factors, while parental characteristics, such as mental disorder and substance abuse, are the most important risk factors for (repeated) child abuse. On the other hand, the majority of the files included ample information on child and family characteristics. The CARE-NL could be reliably coded by trained raters and the predictive accuracy for out-of-home placement (AUC = .73) and placement of the child under court supervision (AUC = .78), at two years follow-up, was adequate. Use of the CARE-NL ensures that the assessment of the risk of child abuse focuses on the most important, empirically based risk factors in a structured and coherent way.     

The Relationship between Knowledge and Child and Caregiver Distress during the Medical Examination for Child Sexual Abuse

When child sexual abuse is suspected, a child sexual abuse–related medical examination is recommended to ensure the child's well-being. While the extant research has sought to identify factors influencing child distress during this examination, only recently have studies began examining variables that may be directly associated with the child or with the medical setting. Knowledge of the child sexual abuse–related medical examination is one medical-related variable that has been implicated in child and caregiver distress during the examination. The current study contributes to the existing literature by investigating associations among examination knowledge in relation to caregiver and child anxiety at the time of a child sexual abuse–related medical examination, taking into account ethnicity, past child abuse, injury to child as result of abuse, and caregiver response to disclosure. Sixty-eight children and their nonoffending caregiver were assessed. Results indicated that understanding of the examination and caregiver response to disclosure were significantly associated with caregiver and child anxiety.     

Child protection: a new approach in South Australia

This paper argues the case for an integrated approach to child protection services, embracing children's safety, risk and needs and incorporating formal assessment instruments. It then provides a brief overview of the new child protection system in South Australia. The steady rise in child abuse/neglect reports raises questions about how best to provide child protection services. Analysis of South Australian data suggests that much of the rise can be attributed to an increase in reports of neglect and emotional abuse and an increase in re‐notifications. This in turn raises questions about the traditional investigative approach. In 1995 Messages from Research advocated that agencies re‐focus on children's needs and concentrate less on investigations into safety and risk. The critical question is how to distinguish families requiring investigation from those needing support. The latest research suggests that such decision‐making in child protection is generally inconsistent and unreliable. This paper argues that statutory agencies should use formal assessment tools to determine the level and nature of their interventions. These arguments have been critical in the development of the new child protection model in SA, which relies on a centralized intake, differential response to reports and the structured decision‐making system. Initial evaluation of the new model indicates improvements in consistency of initial screening and responses to children in danger. Copyright © 1999 John Wiley & Sons, Ltd.     

The joint contribution of experiencing and witnessing violence during childhood on child abuse in the parent role

This article examines adult respondents' abuse of children as a consequence of their own childhood experiences of abuse, both direct experiences of childhood violence (hitting) and exposure to interparental violence (witnessing). In particular, the study examines the extent to which these factors function interactively: Are both experience and exposure necessary or is either sufficient to increase disproportionately the probability of child abuse? Using data from the Second National Family Violence Survey, results of a logistic regression analysis show that either or both factors produced higher than average and relatively similar rates of child abuse. Only respondents with neither form of family violence reported lower than average rates of abuse of their own children. The analysis controlled for gender, race, family income, and family structure; race was the only control variable to be significantly associated with child abuse. Finally, no control variable modified the interaction between the family violence variables.