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Questioning four assumptions about childhood abuse

Geoff Ferguson - October 20th 2015
Neglected playground

Amongst the assumptions made about childhood abuse and neglect, there are four assumptions that are widely held and that affect treatment, prevention and the response of the legal system. These four assumptions are:

  • That childhood abuse and neglect causes substantial harm to the child (harmfulness).
  • That some forms of abuse and neglect are less harmful than others (non-equivalence).
  • That each form of abuse and neglect has specific consequences (specificity).
  • That the effects of childhood abuse and neglect vary according to gender and race (non-universality).

The assumption of harmfulness is supported by sound evidence and the experience of clinicians. However, evidence for the other assumptions is either very doubtful or contradictory, for example, the assumption that some forms of abuse are less harmful than others. A recent American study, reported in JAMA Psychiatry, set out to test all four assumptions.

The study looked at 2,292 children aged 5 to 13 years, with an average age of 9, who attended a summer camp research program between July 1, 1986 and August 15, 2012. The camp was designed for school-aged children from low-income families. The children recruited for the study included approximately equal numbers of those with a history of abuse or neglect and those with no such history. Members of both groups were comparable in terms of racial/ethnic diversity and family demographics. A little over half of the children were boys.

Department of Human Services (DHS) records were used to code various forms of maltreatment, based upon specifications from the Maltreatment Classification System (MCS). In this way instances of maltreatment were categorised as emotional abuse, neglect, physical abuse or sexual abuse.

Each child’s adaptive functioning was evaluated using the child’s self-report (the Children’s Depression Inventory), peer evaluations from each peer group (e.g. who in the group was most disruptive) and reports from the counsellors. The report of the study states that ‘these measures provided emotional, behavioral, and temperament indicators of the internalizing and externalizing spectra, the 2 broad factors that underlie common psychiatric disorders’.

In line with other studies, this study found that ‘abused and neglected children experience all types of maladjustment at significantly higher rates than their nonmaltreated counterparts and that this maladjustment increases as (the maltreatment) grows more diverse, frequent, and severe’. However, given the way in which various forms of maltreatment often overlapped, a more detailed structural analysis was undertaken in order to test the four assumptions. This was intended to tease out the relative contributions made by the overlapping forms of maltreatment. The result of this analysis showed that:

Harmfulness assumption…that childhood maltreatment can predict later psychiatric problems.

  • There was evidence to support this assumption in the case of physical abuse, emotional abuse and neglect, which all significantly predicted an internalising or externalising psychiatric disturbance. However, there was no evidence from this study that sexual abuse in itself was a significant factor – more of this later.

Non-equivalence assumption…that some types of maltreatment are more likely to lead to later psychiatric problems than others.

  • There was no evidence to support this assumption.

Specificity assumption…that different forms of maltreatment may be linked to specific mental health difficilties.

  • There was no evidence to support this assumption.

Non-universality assumption…that the effects of maltreatment vary according to race/ethnicity and gender.

  • There was no evidence to support this assumption.

In summary, the study provided evidence that non-sexual abuse and neglect predicted later disturbance, with no distinction between the outcomes from emotional abuse, physical abuse and neglect.

The authors give detailed consideration to the most surprising outcome of their study – a lack of evidence that sexual abuse predicted later difficulties. They point out that this replicates the mixed findings of several earlier studies. However, this finding appears to contradict much clinical experience. One possible explanation they suggest for this anomaly is that sexual abuse is more rarely reported than the other forms of maltreatment and is almost always concurrent with one or more of these other forms. These two factors together made it very difficult to adequately analyse the specific contribution that this form of maltreatment makes to the child’s later difficulties.

The study gives important confirmation that all forms of maltreatment are harmful to the growing child and can have long-term psychological consequences – emotional abuse is just as harmful to the child as physical abuse. This is not surprising from a psychoanalytic perspective. A benign relationship with their main carers is essential for the young child to internalise a secure sense of self and safety. Any assault on that sense can have profound psychological consequences – whether that assault is physical, emotional, sexual or a neglect of care.

Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment

JAMA Psychiatry. Published online October 14, 2015. doi:10.1001/jamapsychiatry.2015.1792


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Welcome to ourNews, where we keep up-to-date with research and other news related to infant mental health. These articles can be of interest to both parents and professionals.
We are keen to know your views and so please do comment on our articles.
Is there a topic that you would like us to write about? Just send us a message via 'Contact us'.

ourAdvice, our other blog, has brief posts with advice for parents.

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