Are you sad that your stupidity is mostly by your own hands?
https://www150.statcan.gc.ca/n1/daily-quotidien/170216/dq170216b-eng.htm
Profile of Canadian adults who experienced childhood maltreatment
Just under one-third of Canadians report experiencing childhood physical and/or sexual abuse
Experiencing physical and/or sexual abuse at the hands of an adult before the age of 15 was reported by 30% of Canadians aged 15 and over. Physical abuse was the most common form of child maltreatment, reported by about one-quarter (26%) of Canadians. Meanwhile, childhood sexual abuse was reported by 8% of people in Canada aged 15 and over. A smaller proportion (5%) said that they had been subjected to both physical and sexual abuse during childhood.
Overall, childhood physical and/or sexual abuse was more common among males (32%) than females (27%). Men aged 15 and older reported childhood physical abuse more often (31%) than women (22%), while women were three times more likely than men to report childhood sexual abuse (12% versus 4%).
Chart 1
Self-reported childhood physical and/or sexual abuse, 2014
Most victims (66%) of childhood physical and/or sexual abuse reported that they were abused between 1 and 6 times, 20% reported between 7 and 21 instances, while 1 in 7 victims (15%) reported that they were abused more than that.
The vast majority of victims (93%) of childhood physical and/or sexual abuse did not speak to either the police or child protection services about their experiences before they turned 15. About two-thirds of victims (67%) did not speak to anyone, including friends or family.
Most children who witness violence by parents against other adults are also victims of physical and/or sexual abuse
About 10% of Canadians stated that as a child, they had witnessed violence by their parent or guardian against another adult. A large majority of child witnesses—7 in 10 (70%)—also reported that they had been the victim of childhood physical and/or sexual abuse.
Chart 2
Self-reported childhood physical and/or sexual abuse and witnessing violence by a parent or guardian against another adult, 2014
Male victims of childhood sexual abuse more likely to have been abused by non-relatives
Childhood sexual abuse was most often perpetrated by someone outside the family. In particular, someone other than a relative was identified by four out of five male victims as the person responsible for the most severe instance of sexual abuse. Among female victims, 54% indicated that their abuser was a non-relative. A parent was identified as the person responsible by about 1 in 10 (11%) childhood sexual abuse victims.
In contrast, most victims of childhood physical abuse indicated that a family member was responsible for the most serious instance. Specifically, just over 60% of victims reported that the most serious instance of abuse had been committed by a parent, including about 7 in 10 (71%) female victims and just over half (54%) of male victims.
Aboriginal people more likely to report childhood maltreatment
Overall, 40% of Aboriginal people were the victims of childhood physical and/or sexual abuse, compared with 29% for non-Aboriginal people.
However, this difference was found only among those aged 30 or above. Among those in this older age group, almost half of Aboriginal people reported physical and/or sexual abuse compared with 31% of their non-Aboriginal counterparts. Aboriginal women aged 30 and older were more likely to have been victims of childhood physical and/or sexual abuse (49% compared with 28% of non-Aboriginal women), as were Aboriginal men (47% versus 35% of non-Aboriginal men).
Of note, there were no differences between Aboriginal people and non-Aboriginal people when it came to the prevalence of childhood physical and/or sexual abuse among those aged 15 to 29. Just under one-quarter of each group reported childhood physical and/or sexual abuse, something which held true regardless of gender.
The analysis in this report could not take into account the impact of residential schools on Aboriginal families and communities, as this information was not collected.
Chart 3
Self-reported childhood physical and/or sexual abuse, by Aboriginal identity and age group, 2014
Individuals with history of childhood physical and/or sexual abuse at higher risk of negative life outcomes
Those who reported a history of childhood physical and/or sexual abuse were more likely to experience a range of negative outcomes in adulthood. Under 1 in 10 (7%) of those who were physically and/or sexually abused as children reported that they experienced violent victimization as adults during the 12 months preceding the survey. This proportion was almost double that reported by people who had no history of child abuse (3%). In addition, after controlling for other factors, victims of childhood physical and/or sexual abuse were at a higher risk of being the victim of both spousal and non-spousal violence later in life.
Similarly, adult victims of childhood physical and/or sexual abuse were more likely (10%) to report a mental or psychological disability or limitation than non-victims (4%), and were more likely to report poor physical health (14% versus 9%).
Of note, when it came to key socioeconomic elements such as education, employment and income, very few differences were found between people who had experienced abuse as children and those who had not.
https://www.ncbi.nlm.nih.gov/books/NBK195987/
Consequences of Child Abuse and Neglect
Since the 1993 National Research Council (NRC) report on child abuse and neglect was issued, dramatic advances have been made in understanding the causes and consequences of child abuse and neglect, including advances in the neural, genomic, behavioral, psychologic, and social sciences. These advances have begun to inform the scientific literature, offering new insights into the neural and biological processes associated with child abuse and neglect and in some cases, shedding light on the mechanisms that mediate the behavioral sequelae that characterize children who have been abused and neglected. Research also has expanded understanding of the physical and behavioral health, academic, and economic consequences of child abuse and neglect. Knowledge of sensitive periods—the idea that for those aspects of brain development that are dependent on experience, there are stages in which the normal course of development is more susceptible to disruption from experiential perturbations—also has increased exponentially. In addition, research has begun to explore differences in individual susceptibility to the adverse outcomes associated with child abuse and neglect and to uncover the factors that protect some children from the deleterious consequences explored throughout this chapter. An important message is that factors relating to the individual child and to the familial and social contexts in which the child lives, as well as the severity, chronicity, and timing of abuse and neglect experiences, all conspire to impact, to varying degrees, the neural, biological, and behavioral sequelae of abuse and neglect.
This chapter begins by exploring background topics that are important to an understanding of research on the consequences of child abuse and neglect, including an ecological framework and methodological attributes of studies in this field. Next is a review of the research surrounding specific outcomes across the neurobiological, cognitive, psychosocial, behavioral, and health domains, many of which can be seen in childhood, adolescence, and adulthood. The chapter then examines outcomes that are specific to adolescence and adulthood, reviews factors that contribute to individual differences in outcomes, and considers the economic burden of child abuse and neglect. The final section presents conclusions.
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CASCADING CONSEQUENCES
Newborns are almost fully dependent upon parents to help them regulate physiology and behavior. Under optimal conditions, parents buffer young children from stress and serve as “co-regulators” of behavior and physiology (
Hertsgaard et al., 1995;
Hofer, 1994,
2006). Over time, children raised by such parents gradually assume these regulatory capacities. They typically enter school well regulated behaviorally, emotionally, and physiologically; thus, being prepared for the tasks of learning to read, write, and interact with peers.
For some children, parents cannot fill these roles as buffer and co-regulator effectively. When children have caregivers who cannot buffer them from stress or who cannot serve as co-regulators, they are vulnerable to the vicissitudes of a challenging environment. Although children can cope effectively with mild or moderate stress when supported by a caregiver, conditions that exceed their capacities to cope adaptively often result in problematic short- or long-term consequences.
Studies conducted with some nonhuman primate species and rodents have shown that the young are dependent on the parent for help in regulating behavior and physiology (
Moriceau et al., 2010). Thus, young infants are dependent on parents fulfilling the functions of carrying, holding, and feeding. The period of physical immaturity and dependence lasts an extended time in humans. Even beyond the point at which young children are physically dependent, they remain psychologically dependent throughout childhood and adolescence. Thus, inadequate or abusive care can have considerable consequences in terms of children's health and social, psychological, cognitive, and brain development.
Children who have experienced abuse and neglect are therefore at increased risk for a number of problematic developmental, health, and mental health outcomes, including learning problems (e.g., problems with inattention and deficits in executive functions), problems relating to peers (e.g., peer rejection), internalizing symptoms (e.g., depression, anxiety), externalizing symptoms (e.g., oppositional defiant disorder, conduct disorder, aggression), and posttraumatic stress disorder (PTSD). As adults, these children continue to show increased risk for psychiatric disorders, substance use, serious medical illnesses, and lower economic productivity.
This chapter highlights research supporting the association between these outcomes, among others, and experiences of child abuse and neglect. The potential dramatic and pervasive consequences of child abuse and neglect underscore the need for research to illuminate the myriad pathways by which these ill effects manifest in order to guide treatment and intervention efforts. However, it is important to note at the outset that not all abused and neglected children experience problematic outcomes. As discussed in the section on individual differences later in this chapter, a body of research is devoted to uncovering the factors that distinguish children who do not experience problematic outcomes despite facing significant adversity in the form of abuse or neglect. Further, as discussed in
Chapter 6, the past two decades have seen substantial growth in proven models for treatment of the consequences of child abuse and neglect, indicating that these effects are potentially reversible and that there is opportunity to intervene throughout the life course.
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BACKGROUND
Several key concepts need to be considered in attempting to understand potential pathways that lead from abuse and neglect to the various consequences discussed in this chapter and the context in which those consequences manifest. First, positive and negative influences found among individual child characteristics, within the family environment, and in the child's broader social context all interact to predict outcomes related to child abuse and neglect. Second, child abuse and neglect occur in the context of a child's brain development, and their potential effects on developing brain structures can help explain the onset of certain negative outcomes. Finally, abused and neglected children often are exposed to multiple stressors in addition to experiences of abuse and neglect, and potential consequences may manifest at different points in a child's development. Therefore, the most rigorous research on this topic attempts to account for the many factors that may be confounded with abuse or neglect.
Ecological Framework
Since 1993, transactional-bioecological or ecological models have guided attempts to conceptualize the relative contributions of risk and protective factors to children's developmental outcomes, particularly in relation to child abuse and neglect (
Belsky, 1993;
Cicchetti and Lynch, 1993;
Cicchetti and Toth, 1998). Versions of this approach consider the development of the child in the context of the broader social environment in which he or she functions, within the context of a family; in turn, children and families are embedded in a larger social system that includes communities, neighborhoods, and cultures. The assumption underlying these models is that behavior is complex, and development is multiply determined by characteristics of the individual, parents and family, and neighborhood and/or community and their interactions.
In examining the role of contextual factors in the onset of consequences due to child abuse and neglect,
Cicchetti and Lynch's (1993) ecological/transactional model is particularly useful because it successfully incorporates multiple etiological frameworks (
Lynch and Cicchetti, 1998). This model is based on
Belsky's (1980,
1993) ecological model and Cicchetti and
Rizley's (1981) transactional model. It expands on these models by highlighting the nature of interaction among risk factors and the ecology in which child maltreatment occurs. The ecological/transactional model describes four interrelated, mutually embedded categories that contribute to abuse and neglect and the potential associated consequences:
- Ontogenic development—Reflects factors within the individual that influence the achievement of competence and adaptation.
- Microsystem—Defined as the “immediate context” (i.e., the family) in which the child experiences abuse or neglect, including the bidirectional influence of parent and child characteristics and other relationships (such as marriage) that may impact parent-child interactions directly or indirectly.
- Exosystem—The exo- and macrosystemic levels reflect social or cultural forces that contribute to and maintain abuse or neglect. The exosystem encompasses the effects of broader societal systems (e.g., employment, neighborhoods) on parent and child functioning.
- Macrosystem—Mirrors temporally driven, sociocultural ideologies (e.g., cultural views of corporal punishment), or a “larger cultural fabric,” that inevitably shape functioning at all other levels. It is represented by social attitudes (such as attitudes toward violence or the value of children).
The model is based on the fact that a child's multiple ecologies influence one another, affecting the child's development. Thus, the combined influence of the individual, family, community, and larger culture affect the child's developmental outcomes. Parent, child, and environmental characteristics combine to shape the probabilistic course of the development of abused and neglected children.
At higher, more distal levels of the ecology, risk factors increase the likelihood of child maltreatment. These environmental systems also influence what takes place at more proximal ecological levels, such as when risk and protective factors determine the presence or absence of maltreatment within the family environment. Overall, concurrent risk factors at the various ecological levels (e.g., cultural sanction of violence, community violence, low socioeconomic status, loss of job, divorce, parental substance abuse, maladaptation, and/or child psychopathology) act to increase or decrease the likelihood that abuse will occur.
The manner in which children handle the challenges associated with maltreatment is seen in their own ontogenic development, which shapes their ultimate adaptation or maladaptation. Although the overall pattern is that risk factors outweigh protective factors, there are infinite permutations of these risk variables across and within each level of the ecology, providing multiple pathways to the sequelae of child abuse and neglect.
Types of Evidence
Many studies of the consequences of abuse and neglect have been conducted with methodologies ranging from prospective to retrospective designs, from observational measures to self-report, and from experimental to case-controlled designs to no-control designs. The strongest conclusions could be reached with experimental designs whereby children would be randomly assigned to different abusive or neglectful experiences; however, this is obviously neither desirable nor possible.
Nonhuman studies involving primates and other species have allowed experimental assessment of different rearing conditions that may parallel human conditions of neglect and abuse (e.g.,
Sanchez, 2006;
Suomi, 1997). One salient human study involved random assignment of children abandoned to institutions to high-quality foster care (a randomized controlled trial of foster care as an alternative to institutional care) (
Nelson, 2007). In this prospective, longitudinal study, known as the Bucharest Early Intervention Project, 136 children abandoned at or around the time of birth and then placed in state-run institutions were extensively studied when they ranged in age from 6 to 31 months (mean age = 21 months), as was a sample of 72 never-institutionalized children who lived with their families in the greater Bucharest community. Following the baseline assessment, half of the institutionalized children were randomly assigned to a high-quality foster care program that the investigators created, financed, and maintained, and half were randomly assigned to remain in care as usual (institutional care). These children were followed extensively through age 12 (for discussion, see
Fox et al., 2013;
Nelson et al., 2007a,
b;
Zeanah et al., 2003). Although at first glance it may not be obvious why the study of children reared in institutions is relevant to a report on child abuse and neglect, institutional care, which affects as many as 8 million children around the world, can involve an extreme and specific form of neglect—broad-spectrum psychosocial deprivation. Therefore, neglectful institutional care settings can serve as a model system for understanding the effects of neglect on brain development. The neglect experienced by children in such settings should not serve as a proxy for the type of neglect experienced by noninstitutionalized children in the United States, who are more likely to experience neglect in such domains as food, shelter, clothing, or medical care rather than broad-spectrum psychosocial deprivation. Nevertheless, this study can provide important insight into the effects of neglect on behavioral and neurological development because of its randomized, controlled, and longitudinal nature.
The discussion in this chapter necessarily relies primarily (although not exclusively) on the strongest nonexperimental studies conducted. These studies involve longitudinal prospective designs, which assess child abuse and neglect objectively at the time of occurrence and assess outcomes longitudinally. A good example is the study of
Widom and colleagues (1999), which followed a large cohort of abused and neglected children and a matched comparison sample from childhood into adulthood. Other examples include the studies of
Johnson and colleagues (1999,
2000),
Noll and colleagues (2007), and
Jonson-Reidz and colleagues (2012). Retrospective designs that ask participants to recall whether abuse and neglect were experienced are more troublesome because recall of child abuse and neglect can be affected by a variety of factors and open to a number of potential biases (
Briere, 1992;
Offer et al., 2000;
Ross, 1989;
Widom, 1988). Results of studies based on treatment samples of adults who experienced maltreatment as children may be potentially biased because not all victims of child abuse and neglect seek treatment as adults, and because people who do seek treatment may have higher rates of problems than people who do not seek treatment (
Widom et al., 2007a). When participants are asked to report on conditions such as current depression and previous history of child abuse and neglect, the added problem of shared method variance arises. On the other hand, use of official records raises the problem of underreporting (
Gilbert et al., 2009a).
The federal government has supported an effort, launched since the 1993 NRC report was issued—the National Survey of Child and Adolescent Well-Being (NSCAW)—to expand understanding of the consequences of child abuse and neglect. This study includes use of multiple data sources and record reviews, as well as interviews with children and youth who have experienced child abuse and neglect, their caretakers, and child welfare workers. Several of its findings are discussed in
Chapter 5.
This chapter contains an extensive review of the more recent biologically based studies of child abuse and neglect because of the important advances that have been made in this area. To the extent possible, the discussion relies on findings from studies characterized by the greatest methodological rigor.
Despite recent methodological advances, researchers face many challenges in attempting to understand the short- and long-term consequences of the various types of child abuse and neglect (e.g., physical abuse, sexual abuse, neglect from caregivers) for child functioning and development. One of those challenges is teasing apart the impact of child abuse and neglect from that of other co-occurring factors. For example, children involved with child protective services because of neglect or abuse often face a number of overlapping and concurrent risk factors, including poverty, prenatal substance exposure, and parent psychopathology, among others (
Dubowitz et al., 1987;
Lyons et al., 2005;
McCurdy, 2005). These concurrent risk factors can make it particularly difficult to draw causal inferences about the specific consequences of abuse and neglect for children's functioning, but need to be disentangled from the specific effects of abuse and neglect (
Widom et al., 2007a). Controlling for other relevant variables becomes vital, since failure to take such family variables into account may result in reporting spurious relationships (
Widom et al., 2007a). Some studies consider and covary other risk factors, and some do not. Considering the course of abuse and neglect may also be particularly important, as
Jonson-Reid and colleagues (2012) found that the number of child abuse and neglect reports powerfully predicted adverse outcomes across a range of domains.
Finding: Risk factors that co-occur with child abuse and neglect, such as poverty, prenatal substance exposure, and parent psychopathology, can confound attempts to draw causal inferences about the specific consequences of abuse and neglect for children's functioning. These factors need to be controlled for in studies seeking to identify the specific consequences of child abuse and neglect.
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NEUROBIOLOGICAL OUTCOMES
An adequate caregiver is needed to support developing brain architecture and the developing ability to regulate behavior, emotions, and physiology for young children. When children experience abuse or neglect, such development can be compromised. The effects of abuse and neglect are seen especially in brain regions that are dependent on environmental input for optimal development, and on aspects of functioning especially susceptible to environmental input. Early in development, infants are completely reliant on input from their caregivers for help in regulating arousal, neuroendocrine functioning, temperature, and other basic functions. With time and with successful experiences in co-regulation, children increasingly take over these functions themselves. Abuse and neglect represent the absence of adequate input (as in the case of neglect) or the presence of threatening input (as in the case of abuse), either of which can compromise development. The following sections present a review of evidence with respect to key neurobiological systems that are altered as a result of abuse and neglect early in life: the hypothalamic-pituitary-adrenal (HPA) axis of the stress response system; the amygdala, involved in emotion processing and emotion regulation; the hippocampus, involved in learning and memory; the corpus callosum, involved in integrating functions between hemispheres; and the prefrontal cortex, involved in higher-order cognitive functions. The discussion begins, however, with a brief overview of brain development.