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
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
In the landmark Adverse Childhood Experiences (ACE) Study (1998) and successive research since then, it was identified that childhood experiences, both positive and negative, have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. As such, early experiences are an important public health issue. Much of the foundational research in this area has been referred to as Adverse Childhood Experiences (ACEs). Some examples of these adverse experiences include emotional, physical, sexual abuse, emotional and physical neglect, mother treated violently, household substance abuse, household mental illness, parental separation/divorce, incarcerated household member.
The Adverse Childhood Experiences (ACE) Study referred to previously also determined that these adverse experiences have been linked to:
- risky health behaviors (for example, tobacco smoking, drug use, alcohol use, unsafe sexual behavior, etc.),
- chronic health conditions (for example, obesity, diabetes, depression, suicide, sexually transmitted diseases, heart disease, cancer, stroke, chronic obstructive pulmonary disease, broken bones, etc.),
- low life potential (for example, impact on high school graduation rates, academic performance and achievement, poor occupational options, unemployment, lost time from work, etc.) , and
- early death.
As the number of ACEs increases, so does the risk for these outcomes.
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 (CDC, 2015):
- The child's age and developmental status when the abuse
or neglect occurred;
- The type of abuse (physical abuse, neglect, sexual abuse,
- 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, 2015; USDHHS-ACF, 2007):
- Pediatric Abusive Head Trauma/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, 2015).
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, 2015).
- 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. The ACE studies have consistently identified a relationship between early adverse experiences and later serious physical and mental health disorders, as described above. 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.
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.The ACE studies have consistently pointed to early adverse experiences as impact mental and physical health. In another 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.
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 use/abuse. Research consistently reflects an increased likelihood that abused and neglected children (ACE research) 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.
- 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.
According to Gelles & Perlman (2012), the cost of child abuse and neglect is conservatively estimated to cost 80 billion dollars in 2012. 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-ACFS, 2012; Gelles & Perlman, 2012).
- 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. Direct costs are estimated to total $33 billion.
- Indirect costs. Indirect costs represent the long-term economic consequences of child abuse and neglect. These include early intervention, juvenile and adult criminal justice systems and activity, mental illness, substance abuse, and domestic violence. They can also include loss of productivity due to unemployment and underemployment, adult homelessness, the cost of special education services, and increased use of the health care system. These costs are estimated to be $47 million.
Estimating the cost of child abuse and neglect/maltreatment can be difficult, and estimates vary depending on the source and what is included in the estimates. According to Fang, et al. (2012), the estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 in 2010 dollars, including $32,648 in childhood health care costs; $10,530 in adult medical costs; $144,360 in productivity losses; $7,728 in child welfare costs; $6,747 in criminal justice costs; and $7,999 in special education costs. The estimated average lifetime cost per death is $1,272,900, including $14,100 in medical costs and $1,258,800 in productivity losses. The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion. In sensitivity analysis, the total burden is estimated to be as large as $585 billion.
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