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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 (cognitive delays or emotional difficulties,
for example). 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. In additional to the human consequences,
all of these consequences also have an economic impact on
a society.
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 (CWIG, 2010a; CDC, 2007a, CDC, 2007b):
- The child's age and developmental status when the abuse
or neglect occurred;
- The type of abuse (physical abuse, neglect, sexual abuse,
etc.);
- Frequency, duration, and severity of abuse;
- Relationship between the child victim and the abuser.
Physical Health Consequences
The immediate physical effects of abuse or neglect can vary
greatly; the effects may 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 never be discounted.
The long-term impact of child abuse and neglect on physical
health is just beginning to be explored. Below are some outcomes
researchers have identified (NINDS, 2010; USDHHS-ACF, 2007):
- Shaken baby syndrome. Shaken baby syndrome is
a type of inflicted traumatic brain injury that happens
when a baby is violently shaken. A baby has weak neck muscles
and a large, heavy head. Shaking makes the fragile brain
bounce back and forth inside the skull and causes bruising,
swelling, and bleeding, which can lead to permanent, severe
brain damage or death. The characteristic injuries of shaken
baby syndrome are subdural hemorrhages (bleeding in the
brain), retinal hemorrhages (bleeding in the retina), damage
to the spinal cord and neck, and fractures of the ribs and
bones. These injuries may not be immediately noticeable.
Symptoms of shaken baby syndrome include extreme irritability,
lethargy, poor feeding, breathing problems, convulsions,
vomiting, and pale or bluish skin. Shaken baby injuries
usually occur in children younger than 2 years old, but
may be seen in children up to the age of 5 (NINDS, 2010).
The majority of infants who survive severe shaking will
have some form of neurological or mental disability, such
as blindness, learning disabilities, paralysis, cerebral
palsy or mental retardation, which may not be fully apparent
before 6 years of age. Children with shaken baby syndrome
may require lifelong medical care (NINDS, 2010).
- Impaired brain development. Child abuse and neglect
have been shown, in some cases, to cause important regions
of the brain to fail to form properly, resulting in impaired
physical, mental, and emotional development. In other cases,
the stress of chronic abuse causes a "hyperarousal" response
by certain areas of the brain, which may result in hyperactivity,
sleep disturbances, and anxiety, as well as increased vulnerability
to post-traumatic stress disorder, attention deficit/hyperactivity
disorder, conduct disorder, and learning and memory difficulties.
- Poor physical health. A study of 700 children
who had been in foster care for 1 year found more than one-quarter
of the children had some kind of recurring physical or mental
health problem (National Survey of Child and Adolescent
Well-Being). A study of 9,500 HMO participants showed a
relationship between various forms of household dysfunction
(including childhood abuse) and long-term health problems
such as sexually transmitted diseases, heart disease, cancer,
chronic lung disease, skeletal fractures, and liver disease.
- Death
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 (USDHHS-ACF, 2007):
- 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. Other psychological and emotional conditions associated
with abuse and neglect include panic disorder, dissociative
disorders, attention-deficit/hyperactivity disorder, post-traumatic
stress disorder, and reactive attachment disorder.
- Cognitive difficulties. The National Survey of
Child and Adolescent Well-Being recently found 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.
- Social difficulties. Children who are abused and
neglected by caretakers often do not form secure attachments
to them. These early attachment difficulties can lead to
later difficulties in relationships with other adults as
well as with peers.
Behavioral Consequences
Not all victims of child abuse and neglect will experience
behavioral consequences; however, child abuse and neglect
appear to make the following more likely (USDHHS-ACF, 2007):
- 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.
- Juvenile delinquency and adult criminality. A
National Institute of Justice study indicated being abused
or neglected as a child increased the likelihood of arrest
as a juvenile by 59 percent. Abuse and neglect increased
the likelihood of adult criminal behavior by 28 percent
and violent crime by 30 percent.
- 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. According to the National Institute on Drug Abuse,
as many as two-thirds of people in drug treatment programs
reported being abused as children (2000).
- 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,
2001).
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 (USDHHS-ACYF, 2007).
- Direct costs. Direct costs include those associated
with maintaining a child welfare system to investigate allegations
of child abuse and neglect, as well as expenditures by the
judicial, law enforcement, health, and mental health systems
to respond to and treat abused children and their families.
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 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 recently
estimated these costs at more than $69 billion per year
(2001).
According to Prevent Child Abuse America (2007), the economic
cost of child abuse was estimated to be 103.8 billion dollars
in 2007. This estimation is considered to be conservative,
as it focuses only on the direct costs of hospitalized abused
children. There are many costs associated with child abuse
and many children's victimization did not result in hospitalization.
Additionally, the vast amount of pain and suffering and other
intangible costs have not been factored into the above dollar
amount (PCA-A, et al., 2007).
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