Episode 9

Type of Trauma: Childhood Abuse 

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Child abuse is when a parent or caregiver, whether through action or failing to act, causes injury, death, emotional harm or risk of serious harm to a child. There are many forms of child maltreatment, including physical abuse, sexual abuse, emotional abuse, and neglect.

Toxic Stress

Strong, frequent, or prolonged activation of a person’s stress response system, often referred to as toxic stress, can have long-lasting damaging effects on an individual’s health, behavior, and ability to learn. Toxic stress can be caused by experiencing adverse childhood experience (often referred to as ACEs). It can change an individual’s brain architecture, which can cause the person’s stress response system to be triggered more frequently and for longer periods of time. Toxic stress increases the risk for a variety of physical and mental health problems, including cardiovascular disease, depression, and anxiety.

Physical Abuse

Physical abuse includes striking, kicking, burning, biting, hair pulling, choking, throwing, shoving, whipping or any other action that injures a child. Even if the caregiver didn’t mean to cause injury, when the child is injured it is abuse.

Physical abuse can result in:

  • Bruises, blisters, burns, cuts and scratches

  • Internal injuries, brain damage

  • Broken bones, sprains, dislocated joints

  • Emotional and psychological harm

  • Lifelong injury, death

Signs of physical abuse in parent or caregiver:

  • Can’t or won’t explain injury of child, or explains it in a way that doesn’t make sense

  • Displays aggression to child or is overly anxious about child’s behavior

  • Indicates child is not trustworthy, a liar, evil, a troublemaker

  • Delays or prevents medical care for child

  • Takes child to different doctors or hospitals

  • Keeps child from school, church, clubs

  • Has history of violence and/or abuse

Signs of physical abuse in a child:

Physical:

  • Any injury to a child who is not crawling yet

  • Visible and severe injuries

  • Injuries at different stages of healing

  • On different surfaces of the body

  • Unexplained or explained in a way that doesn’t make sense

  • Distinctive shape

  • Frequency, timing and history of injuries (frequent, after weekends, vacations, school absences)

Behavioral:

·       Aggression toward peers, pets, other animals

·       Seems afraid of parents or other adults

·       Fear, withdrawal, depression, anxiety

·       Wears long sleeves out of season

·       Violent themes in fantasy, art, etc.

·       Nightmares, insomnia

·       Reports injury, severe discipline

·       Immaturity, acting out, emotional and behavior extremes

·       Self-destructive behavior or attitudes

Sexual Abuse

Sexual abuse occurs when an adult uses a child for sexual purposes or involves a child in sexual acts. It also includes when a child who is older or more powerful uses another child for sexual gratification or excitement.

20.7% of adults report being sexually abused as a child.

Sexual abuse of children includes:

  • Contact abuse

    • Fondling and oral sex

    • Penetration

    • Making children perform a sex act

    • Child prostitution and child pornography

  • Non-contact abuse

    • Making a child view a sex act

    • Making a child view or show sex organs

    • Inappropriate sexual talk

Signs of sexual abuse in parent or caregiver:

  • Parent fails to supervise child

  • Unstable adult presence

  • Jealous/possessive parent

  • Sexual relationships troubled or dysfunctional

  • Parent relies on child for emotional support

Signs of sexual abuse in a child:

Physical:

  • Difficulty sitting, walking, bowel problems

  • Torn, stained, bloody undergarments

  • Bleeding, bruises, pain, swelling, itching of genital area

  • Frequent urinary tract infections or yeast infections

  • Any sexually transmitted disease or related symptoms

Behavioral:

  • Doesn’t want to change clothes (e.g., for P.E.)

  • Withdrawn, depressed, anxious

  • Eating disorders, preoccupation with body

  • Aggression, delinquency, poor peer relationships

  • Poor self-image, poor self-care, lack of confidence

  • Sudden absenteeism, decline in school performance

  • Substance abuse, running away, recklessness, suicide attempts

  • Sleep disturbance, fear of bedtime, nightmares, bed wetting (at advanced age)

  • Sexual acting out, excessive masturbation

  • Unusual or repetitive soothing behaviors (hand-washing, pacing, rocking, etc.)

  • Sexual behavior or knowledge that is advanced or unusual

  • Reports sexual abuse

Emotional abuse

When a parent or caregiver harms a child’s mental and social development, or causes severe emotional harm, it is considered emotional abuse. While a single incident may be abuse, most often emotional abuse is a pattern of behavior that causes damage over time.

10.6% of adults report being emotionally abused as a child.

Emotional abuse can include:

  • Rejecting or ignoring

    • Telling a child he or she is unwanted or unloved, showing little interest in child, not initiating or returning affection, not listening to the child, not validating the child’s feelings, breaking promises, cutting child off in conversation

  • Shaming or humiliating

    • Calling a child names, criticizing, belittling, demeaning, berating, mocking, using language or taking action that takes aim at child’s feelings of self-worth

  • Terrorizing

    • Accusing, blaming, insulting, punishing with or threatening abandonment, harm or death, setting a child up for failure, manipulating, taking advantage of a child’s weakness or reliance on adults, slandering, screaming, yelling

  • Isolating

    • Keeping child from peers and positive activities, confining child to small area, forbidding play or other stimulating experiences

  • Corrupting

    • Engaging child in criminal acts, telling lies to justify actions or ideas, encouraging misbehavior

Signs of emotional abuse in parent or caregiver:

  • Routinely ignores, criticizes, yells at or blames child

  • Plays favorites with one sibling over another

  • Poor anger management or emotional self-regulation

  • Stormy relationships with other adults, disrespect for authority

  • History of violence or abuse

  • Untreated mental illness, alcoholism or substance abuse

Signs of emotional abuse in a child:

Physical:

  • Delays in development

  • Wetting bed, pants

  • Speech disorders

  • Health problems like ulcers, skin disorders

  • Obesity and weight fluctuation

Behavioral:

  • Habits like sucking, biting, rocking

  • Learning disabilities and developmental delays

  • Overly compliant or defensive

  • Extreme emotions, aggression, withdrawal

  • Anxieties, phobias, sleep disorders

  • Destructive or anti-social behaviors (violence, cruelty, vandalism, stealing, cheating, lying)

  • Behavior that is inappropriate for age (too adult, too infantile)

  • Suicidal thoughts and behaviors

Child Neglect

Child neglect is when a parent or caregiver does not give the care, supervision, affection and support needed for a child’s health, safety and well-being.

Child neglect includes:

  • Physical neglect and inadequate supervision

  • Emotional neglect

  • Medical neglect

  • Educational neglect

Physical Neglect

Children need enough care to be healthy and enough supervision to be safe. Adults that care for children must provide clothing, food and drink. A child also needs safe, healthy shelter, and adequate supervision. Physical, emotional, medical, educational,

Examples of physical neglect:

  • Deserting a child or refusing to take custody of a child who is under your care

  • Repeatedly leaving a child in another’s custody for days or weeks at a time

  • Failing to provide enough healthy food and drink

  • Failing to provide clothes that are appropriate to the weather

  • Failing to ensure adequate personal hygiene

  • Not supervising a child appropriately

  • Leaving the child with an inappropriate caregiver

  • Exposing a child to unsafe/unsanitary environments or situations

Emotional Neglect

Children require enough affection and attention to feel loved and supported. If a child shows signs of psychological illness, it must be treated.

Examples of emotional neglect:

  • Ignoring a child’s need for attention, affection and emotional support

  • Exposing a child to extreme or frequent violence, especially domestic violence

  • Permitting a child to use drugs, use alcohol, or engage in crime

  • Keeping a child isolated from friends and loved ones

Medical Neglect

Parents and caregivers must provide children with appropriate treatment for injuries and illness. They must also provide basic preventive care to make sure their child stays safe and healthy.

Examples of medical neglect:

  • Not taking child to hospital or appropriate medical professional for serious illness or injury

  • Keeping a child from getting needed treatment

  • Not providing preventative medical and dental care

  • Failing to follow medical recommendations for a child

Educational Neglect

Parents and schools share responsibility for making sure children have access to opportunities for academic success.

Examples of educational neglect:

  • Allowing a child to miss too much school

  • Not enrolling a child in school (or not providing comparable home-based education)

  • Keeping a child from needed special education services

Signs in Child

While a single indicator may not be cause for alarm, children who are neglected often show that they need help:

  • Clothing that is the wrong size, in disrepair, dirty, or not right for the weather

  • Often hungry, stockpiles food, seeks food, may even show signs of malnutrition (like distended belly, protruding bones)

  • Very low body weight, height for age

  • Often tired, sleepy, listless

  • Hygiene problems, body odor

  • Talks about caring for younger siblings, not having a caregiver at home

  • Untreated medical and dental problems, incomplete immunizations

  • Absenteeism from school without good reason, frequently incomplete homework, frequent changes of school

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Signs in Caregiver

There is no “typical neglectful parent.” Nevertheless, certain indicators may suggest a parent or caregiver needs help to nurture and protect the child or children in their care:

  • Displays indifference or lack of care toward the child

  • Depression, apathy, drug/alcohol abuse and other mental health issues

  • Denies problems with child or blames the child for problems

  • Views child negatively

  • Relies on child for own care and well-being

Consequences

Childhood maltreatment can be linked to later psychological, behavioral, and physical consequences as well as costs to society as a whole.

Psychological and mental effects of child abuse and neglect

Child abuse and neglect can cause a variety of psychological problems. Maltreatment can cause victims to feel isolation, fear, and distrust, which can translate into lifelong psychological consequences that can manifest as educational difficulties, low self-esteem, depression, and trouble forming and maintaining relationships. Researchers have identified links between child abuse and neglect and the following psychological outcomes.

  • Anxiety

  • Depression

  • Low self-esteem

  • Withdrawn

  • Dissociation

  • Difficulty with making and maintaining relationships

  • Experiences flashbacks

  • Hyper-vigilant

  • Persistent fear

Attachment and social difficulties

Infants in foster care who have experienced maltreatment followed by disruptions in early care giving can develop attachment disorders. Attachment disorders can negatively affect a child’s ability to form positive peer, social, and romantic relationships later in life. Additionally, children who experience abuse or neglect are more likely to develop antisocial traits as they grow up, which can lead to criminal behavior in adulthood.

Post traumatic stress

Children who experienced abuse or neglect can develop post traumatic stress disorder (PTSD), which is characterized by symptoms such as persistent re-experiencing of the traumatic events related to the abuse; avoiding people, places, and events that are associated with their maltreatment; feeling fear, horror, anger, guilt, or shame; startling easily; and exhibiting hyper vigilance, irritability, or other changes in mood. PTSD in children can lead to depression, suicidal behavior, substance use, and oppositional or defiant behaviors well into adulthood, which can affect their ability to succeed in school, and create and nurture important relationships.

Behavioral effects of child abuse and neglect

  • Self-harm

  • Eating disorders

  • Alcohol and drug use (Adults who had been maltreated as children are at a significantly higher risk of substance use disorders than adults who have not been maltreated.)

  • Trouble sleeping

  • Uncomfortable with physical contact with others

  • Repeating school grades

  • Absent from school often

  • Criminal activity (Juvenile delinquency leading to adult criminality.)

  • Future perpetration of maltreatment (although most children who have experienced abuse and neglect do not go on to abuse or neglect their own children, research suggests they are more likely to do so compared to children who were not maltreated.)

There is a difference between girls and boys in the way child maltreatment influences delinquent behavior. In the study, girls tended to express internalizing behaviors (e.g., depression, social withdrawal, anxiety), while boys tended to express externalizing behaviors (e.g., bullying, aggression, hostility) leading up to adult criminal behavior

Physical health consequences

Childhood maltreatment has been linked to higher risk for a wide range of long-term and/or future health problems, including—but not limited to—the following 

  • Diabetes

  • Lung disease

  • Malnutrition

  • Vision problems

  • Functional limitations (i.e., being limited in activities)

  • Heart attack

  • Arthritis

  • Back problems

  • High blood pressure

  • Brain damage (Child abuse and neglect also has been associated with certain regions of the brain failing to form, function, or grow properly.

  • Disrupted brain development as a result of maltreatment can cause impairments to the brain’s executive functions: working memory, self-control, and cognitive flexibility (i.e., the ability to look at things and situations from different perspectives) Children who were maltreated also are at risk for other cognitive problems, including difficulties learning and paying attention. Fortunately, however, there is promising evidence that children’s brains may be able to recover with the help of appropriate interventions

Treatment

Treatment can help both children and parents in abuse situations. The first priority is ensuring the safety and protection for children who have been abused. Ongoing treatment focuses on preventing future abuse and reducing the long-term psychological and physical consequences of abuse.

Psychotherapy

Talking with a mental health professional can:

  • Help a child who has been abused learn to trust again

  • Teach a child about normal behavior and relationships

  • Teach a child conflict management and boost self-esteem

Several different types of therapy may be effective, such as:

  • Trauma-focused cognitive behavioral therapy. This type of therapy helps a child who has been abused to better manage distressing feelings and to deal with trauma-related memories. Eventually, the supportive parent who has not abused the child and the child are seen together so the child can tell the parent exactly what happened.

  • Child-parent psychotherapy. This treatment focuses on improving the parent-child relationship and on building a stronger attachment between the two.

Coping and support

If a child tells you he or she is being abused, take the situation seriously. The child's safety is most important. Here's what you can do:

  • Encourage the child to tell you what happened. Remain calm as you assure the child that it's OK to talk about the experience, even if someone has threatened him or her to keep silent. Focus on listening, not investigating. Don't ask leading questions — allow the child to explain what happened and leave detailed questioning to the professionals.

  • Remind the child that he or she isn't responsible for the abuse. The responsibility for child abuse belongs to the abuser. Say "It's not your fault" over and over again.

  • Offer comfort. You might say, "I'm so sorry you were hurt," "I'm glad that you told me," and "I'll do everything I can to help you." Let the child know you're available to talk or simply listen at any time.

  • Report the abuse. Contact a local child protective agency or the police department. Authorities will investigate the report and, if necessary, take steps to ensure the child's safety.

  • Help the child remain safe. Ensure the child's safety by separating the abuser and the child, and by providing supervision if the child is in the presence of the abuser. Help the child get medical attention if needed.

  • Consider additional support. You might help the child seek counseling or other mental health treatment. Age-appropriate support groups also can be helpful.

  • If the abuse has occurred at school, make sure the principal of the school is aware of the situation, in addition to reporting it to the local or state child protection agency.