| An
estimated 905,000 children were victims of child
abuse or neglect in 2006 (U.S. Department of
Health and Human Services, 2008). While physical
injuries may or may not be immediately visible,
abuse and neglect can have consequences for
children, families, and society that last lifetimes,
if not generations.
The impact
of child abuse and neglect is often discussed
in terms of physical, psychological, behavioral,
and societal consequences. In reality, however,
it is impossible to separate them completely.
Physical consequences, such as damage to a child's
growing brain, can have psychological implications
such as cognitive delays or emotional difficulties.
Psychological problems often manifest as high-risk
behaviors. Depression and anxiety, for example,
may make a person more likely to smoke, abuse
alcohol or illicit drugs, or overeat. High-risk
behaviors, in turn, can lead to long-term physical
health problems such as sexually transmitted
diseases, cancer, and obesity.
This fact sheet
provides an overview of some of the most common
physical, psychological, behavioral, and societal
consequences of child abuse and neglect, while
acknowledging that much crossover among categories
exists.
Factors
Affecting the Consequences of Child Abuse and
Neglect
Not all abused
and neglected children will experience long-term
consequences. Outcomes of individual cases vary
widely and are affected by a combination of
factors, including:
- The child's age and developmental
status when the abuse or neglect occurred
- The type of abuse (physical
abuse, neglect, sexual abuse, etc.)
- The frequency, duration,
and severity of abuse
- The relationship between
the victim and his or her abuser (English
et al., 2005; Chalk, Gibbons, & Scarupa,
2002)
Researchers
also have begun to explore why, given similar
conditions, some children experience long-term
consequences of abuse and neglect while others
emerge relatively unscathed. The ability to
cope, and even thrive, following a negative
experience is sometimes referred to as "resilience."
A number of protective and promotive factors
may contribute to an abused or neglected child’s
resilience. These include individual characteristics,
such as optimism, self-esteem, intelligence,
creativity, humor, and independence, as well
as the acceptance of peers and positive individual
influences such as teachers, mentors, and role
models. Other factors can include the child's
social environment and the family’s access
to social supports. Community well-being, including
neighborhood stability and access to safe schools
and adequate health care, are other protective
and promotive factors (Fraser & Terzian,
2005).
Physical
Health Consequences
The immediate
physical effects of abuse or neglect can be
relatively minor (bruises or cuts) or severe
(broken bones, hemorrhage, or even death). In
some cases the physical effects are temporary;
however, the pain and suffering they cause a
child should not be discounted. Meanwhile, the
long-term impact of child abuse and neglect
on physical health is just beginning to be explored.
According to the National Survey of Child and
Adolescent Well-Being (NSCAW), more than one-quarter
of children who had been in foster care for
longer than 12 months had some lasting or recurring
health problem (Administration for Children
and Families, Office of Planning, Research,
and Evaluation [ACF/OPRE], 2004a). Below are
some outcomes researchers have identified:
Shaken
baby syndrome. Shaking a baby is a
common form of child abuse. The injuries caused
by shaking a baby may not be immediately noticeable
and may include bleeding in the eye or brain,
damage to the spinal cord and neck, and rib
or bone fractures (National Institute of Neurological
Disorders and Stroke, 2007).
Impaired
brain development. Child abuse and
neglect have been shown, in some cases, to cause
important regions of the brain to fail to form
or grow properly, resulting in impaired development
(De Bellis & Thomas, 2003). These alterations
in brain maturation have long-term consequences
for cognitive, language, and academic abilities
(Watts-English, Fortson, Gibler, Hooper, &
De Bellis, 2006). NSCAW found more than three-quarters
of foster children between 1 and 2 years of
age to be at medium to high risk for problems
with brain development, as opposed to less than
half of children in a control sample (ACF/OPRE,
2004a).
Poor
physical health. Several studies have
shown a relationship between various forms of
household dysfunction (including childhood abuse)
and poor health (Flaherty et al., 2006; Felitti,
2002). Adults who experienced abuse or neglect
during childhood are more likely to suffer from
physical ailments such as allergies, arthritis,
asthma, bronchitis, high blood pressure, and
ulcers (Springer, Sheridan, Kuo, & Carnes,
2007).
Psychological
Consequences
The immediate
emotional effects of abuse and neglect—isolation,
fear, and an inability to trust—can translate
into lifelong consequences, including low self-esteem,
depression, and relationship difficulties. Researchers
have identified links between child abuse and
neglect and the following:
Difficulties
during infancy. Depression and withdrawal
symptoms were common among children as young
as 3 who experienced emotional, physical, or
environmental neglect. (Dubowitz, Papas, Black,
& Starr, 2002).
Poor
mental and emotional health. In one
long-term study, as many as 80 percent of young
adults who had been abused met the diagnostic
criteria for at least one psychiatric disorder
at age 21. These young adults exhibited many
problems, including depression, anxiety, eating
disorders, and suicide attempts (Silverman,
Reinherz, & Giaconia, 1996). Other psychological
and emotional conditions associated with abuse
and neglect include panic disorder, dissociative
disorders, attention-deficit/hyperactivity disorder,
depression, anger, posttraumatic stress disorder,
and reactive attachment disorder (Teicher, 2000;
De Bellis & Thomas, 2003; Springer, Sheridan,
Kuo, & Carnes, 2007).
Cognitive
difficulties. NSCAW found that children
placed in out-of-home care due to abuse or neglect
tended to score lower than the general population
on measures of cognitive capacity, language
development, and academic achievement (U.S.
Department of Health and Human Services, 2003).
A 1999 LONGSCAN study also found a relationship
between substantiated child maltreatment and
poor academic performance and classroom functioning
for school-age children (Zolotor, Kotch, Dufort,
Winsor, & Catellier, 1999).
Social
difficulties. Children who experience
rejection or neglect are more likely to develop
antisocial traits as they grow up. Parental
neglect is also associated with borderline personality
disorders and violent behavior (Schore, 2003).
Behavioral
Consequences
Not all victims
of child abuse and neglect will experience behavioral
consequences. However, behavioral problems appear
to be more likely among this group, even at
a young age. An NSCAW survey of children ages
3 to 5 in foster care found these children displayed
clinical or borderline levels of behavioral
problems at a rate of more than twice that of
the general population (ACF, 2004b). Later in
life, child abuse and neglect appear to make
the following more likely:
Difficulties
during adolescence. Studies have found
abused and neglected children to be at least
25 percent more likely to experience problems
such as delinquency, teen pregnancy, low academic
achievement, drug use, and mental health problems
(Kelley, Thornberry, & Smith, 1997). Other
studies suggest that abused or neglected children
are more likely to engage in sexual risk-taking
as they reach adolescence, thereby increasing
their chances of contracting a sexually transmitted
disease (Johnson, Rew, & Sternglanz, 2006).
Juvenile
delinquency and adult criminality.
According to a National Institute of Justice
study, abused and neglected children were 11
times more likely to be arrested for criminal
behavior as a juvenile, 2.7 times more likely
to be arrested for violent and criminal behavior
as an adult, and 3.1 times more likely to be
arrested for one of many forms of violent crime
(juvenile or adult) (English, Widom, & Brandford,
2004).
Alcohol
and other drug abuse. Research consistently
reflects an increased likelihood that abused
and neglected children will smoke cigarettes,
abuse alcohol, or take illicit drugs during
their lifetime (Dube et al., 2001). According
to a report from the National Institute on Drug
Abuse, as many as two-thirds of people in drug
treatment programs reported being abused as
children (Swan, 1998).
Abusive
behavior. Abusive parents often have
experienced abuse during their own childhoods.
It is estimated approximately one-third of abused
and neglected children will eventually victimize
their own children (Prevent Child Abuse New
York, 2003).
Societal
Consequences
While child
abuse and neglect almost always occur within
the family, the impact does not end there. Society
as a whole pays a price for child abuse and
neglect, in terms of both direct and indirect
costs.
Direct
costs. Direct costs include those associated
with maintaining a child welfare system to investigate
and respond to allegations of child abuse and
neglect, as well as expenditures by the judicial,
law enforcement, health, and mental health systems.
A 2001 report by Prevent Child Abuse America
estimates these costs at $24 billion per year.
Indirect
costs. Indirect costs represent the
long-term economic consequences of child abuse
and neglect. These include costs associated
with juvenile and adult criminal activity, mental
illness, substance abuse, and domestic violence.
They can also include loss of productivity due
to unemployment and underemployment, the cost
of special education services, and increased
use of the health care system. Prevent Child
Abuse America estimated these costs at more
than $69 billion per year (2001).
Summary
Much research
has been done about the possible consequences
of child abuse and neglect. The effects vary
depending on the circumstances of the abuse
or neglect, personal characteristics of the
child, and the child’s environment. Consequences
may be mild or severe; disappear after a short
period or last a lifetime; and affect the child
physically, psychologically, behaviorally, or
in some combination of all three ways. Ultimately,
due to related costs to public entities such
as the health care, human services, and educational
systems, abuse and neglect impact not just the
child and family, but society as a whole.
Resources
on the Child Welfare Information Gateway Website
Child Abuse
and Neglect
http://www.childwelfare.gov/can/
Defining Child Abuse and Neglect
http://www.childwelfare.gov/can/defining/
Preventing Child Abuse and Neglect
http://www.childwelfare.gov/preventing/
Reporting Child Abuse and Neglect
http://www.childwelfare.gov/responding/reporting.cfm
References
Administration
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(PDF - 221 KB)
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NSCAW Research Brief No. 5. Washington, DC:
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