The Child Abuse Prevention and Treatment Act (United States Department of Health and Human Services, 2013) defines Child Abuse and Neglect as: Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm (p. viii). Each state has its own definition of child abuse based on the federal law, and most states recognize four major types of maltreatment: neglect, physical abuse, psychological maltreatment, and sexual abuse. Each of the forms of child maltreatment may be identified alone, but they can occur in combination.
Victims of Child Abuse:
According to the United States Department of Health and Human Services (HHS) (2019), during 2017 (the most recent year data has been collected) Child Protective Services (CPS) agencies received an estimated 4.1 million referrals for abuse involving approximately 7.5 million children. This is a rate of 31.8 per 1,000 children in the national population. Professionals made 65.7% of alleged child abuse and neglect reports, and they included law enforcement (18.3%), educational (19.4%) and social services personnel (11.7%). Nonprofessionals, such as friends, neighbors, and relatives, submitted 17.3% of the reports. Approximately 3.5 million children were the subjects of at least one report. Victims in their first year of life had the highest rate of victimization (25.3 per 1,000 children of the same age). The majority of victims consisted of three ethnicities: White (44.6%), Hispanic (22.3%), and African-American (20.7%). The greatest percentages of children suffered from neglect (74.9%) and physical abuse (18.3%), although a child may have suffered from multiple forms of maltreatment. In 2017 an estimated 1,720 children died from abuse and neglect, and 71.8% of all child fatalities were younger than 3 years old. Boys had a higher child fatality rate (2.68 per 100,000 boys), while girls died of abuse and neglect at a rate of 2.02 per 100,000 girls. More than 88% of child fatalities were comprised of White (41.9%), African-American (31.5%), and Hispanic (15.1%) victims (HHS, 2019).
Sexual Abuse:
Childhood sexual abuse is defined as any sexual contact between a child and an adult or a much older child. Incest refers to sexual contact between a child and family members. In each of these cases, the child is exploited by an older person without regard for the child's developmental immaturity and inability to understand the sexual behavior (Steele, 1986). Research estimates that 1 out of 4 girls and 1 out of 10 boys have been sexually abused (Valente, 2005). The median age for sexual abuse is 8 or 9 years for both boys and girls (Finkelhorn et al., 1990). Most boys and girls are sexually abused by a male. Although rates of sexual abuse are higher for girls than for boys, boys may be less likely to report abuse because of the cultural expectation that boys should be able to take care of themselves and because of the stigma attached to homosexual encounters (Finkelhorn et al., 1990). Girls are more likely to be abused by family members and boys by strangers. Sexual abuse can create feelings of self-blame, betrayal, shame and guilt (Valente, 2005). Sexual abuse is particularly damaging when the perpetrator is someone the child trusts and may lead to depression, anxiety, problems with intimacy, and suicide (Valente, 2005).
Stress on Young Children:
Children experience different types of stressors. Normal, everyday stress can provide an opportunity for young children to build coping skills and poses little risk to development. Even more long-lasting stressful events, such as changing schools or losing a loved one, can be managed fairly well. Children who experience toxic stress or who live in extremely stressful situations of abuse over long periods of time can suffer long-lasting effects. The structures in the midbrain or limbic system, such as the hippocampus and amygdala, can be vulnerable to prolonged stress during early childhood (Middlebrooks & Audage, 2008). High levels of the stress hormone cortisol can reduce the size of the hippocampus and affect the child's memory abilities. Stress hormones can also reduce immunity to disease. The brain exposed to long periods of severe stress can develop a low threshold making the child hypersensitive to stress in the future.
Adverse Childhood Experiences (ACEs)
The toxic stress that young children endure can have a significant impact on their later lives. According to Merrick, Ford, Ports, and Guinn (2018), the foundation for lifelong health and well-being is created in childhood, as positive experiences strengthen biological systems while adverse experiences can increase mortality and morbidity. All types of abuse, neglect, and other potentially traumatic experiences that occur before the age of 18 are referred to as adverse childhood experiences (ACEs) (CDC, 2019). ACEs have been linked to risky behaviors, chronic health conditions, low life potential and early death, and as the number of ACEs increase, so does the risk for these results.
Figure \(\PageIndex{1}\). ACEs can have many lasting impacts. Image source.
When a child experiences strong, frequent, and/or prolonged adversity without adequate adult support, the child's stress response systems can be activated and disrupt the development of the brain and other organ systems (Harvard University, 2019). Further, ACEs can increase the risk for stress-related disease and cognitive impairment, well into the adult years. Felitti et al. (1998) found that those who had experienced four or more ACEs, compared to those who had experienced none, had increased health risks for alcoholism, drug abuse, depression, suicide attempt, increase in smoking, poor self-rated health, more sexually transmitted diseases, an increase in physical inactivity and severe obesity. More ACEs showed an increased relationship to the presence of adult diseases including heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. Overall, those with multiple ACEs were likely to have multiple health risk factors later in life.
Figure \(\PageIndex{2}\). How ACES affect children and adults. Image source.
Some groups have been found to be at a greater risk for experiencing ACEs. Merrick et al. (2018) reviewed the results from the 2011-2014 Behavioral Risk Factor Surveillance System, which included an ACE module consisting of questions adapted from the Centers for Disease Control and Prevention. Each question was collapsed into one of the eight ACE categories: physical abuse, emotional abuse, sexual abuse, household mental illness, household substance use, household domestic violence, incarcerated household member, and parental separation or divorce. The results indicated that 25% of the sample had been exposed to three or more ACEs, and although ACEs were found across all demographic groups, those who identified as Black, multiracial, lesbian/gay/bisexual, having less than a high school education, being low income, and unemployed experienced significantly higher ACE exposure. Assisting families and providing children with supportive and responsive adults can help prevent the negative effects of ACEs.
Separating Families at the United States Border:
Thousands of children were separated from their parents beginning in April 2018 as they approached the United States border by Immigration and Custom Enforcement (ICE). Children were placed in separate facilities from their parents when they were being processed, and they were not told when they would be reunited. When enduring stressful situations, separation from one's parents can be extremely detrimental to a child (Society for Research in Child Development (SRCD), 2018). Parental separations affect children's stress management systems by changing how the body responds to stress. Long-term stress can disrupt brain functioning, cognitive skills, emotional processing, and physiological health. When exposed to stress, children typically look to their parents for support and care, and parents can reduce children's stress. These separated children were already under extreme stress escaping their previous homes, and then were separated from the individuals who could support them through this process.
Figure \(\PageIndex{3}\). Children in a detention center. Image source.
Stress from parent separation places children at a higher risk for anxiety, depression, PTSD, lower IQ, obesity, impaired immune system functioning, and medical conditions (SRCD, 2018). Even after being reunited, children can experience attachment issues, poorer self-esteem, and physical and psychological health difficulties. As they age, they continue to exhibit an increased risk for mental health problems, problems in social interactions, difficulty with adult attachments, poorer stress management, and an increased risk for death. The American Psychological Association (2019) opposes policies that separate families given the negative outcomes suffered by children.
