Child maltreatment is far more common than suggested by official statistics of children assessed by child protection services. Every year, in the region of 1 in 10 children (about 1 million children in the UK) are maltreated but official statistics indicate that less than one tenth of this burden are investigated and substantiated by child protection services. These are among the conclusions of the first paper in The Lancet Series on Child Maltreatment, written by Professor Ruth Gilbert, Centre for Evidence-based Child Health and MRC Centre of Epidemiology for Child Health, University College London Institute of Child Health, UK, and Professor Cathy Spatz Widom, City University of New York and John Jay College of Criminal Justice, New York City, USA , and colleagues.
Child maltreatment includes physical abuse, such as hitting with an implement, punching, beating or burning: this affects 4-16% of children in high income countries each year. Sexual abuse ranges in severity from being shown pornographic material to penetrative sexual abuse. It is estimated that at least 15% of girls and 5% of boys have been exposed to any form of sexual abuse by the age of 18, but 5-10% of girls and 1-5% of boys are exposed to penetrative sexual abuse. Emotional abuse — which includes persistently being made to feel worthless, unwanted or scared, and damaging the child's emotional development — affects around 10% of children each year. Neglect, meaning failure to meet a child's basic emotional or physical needs or to ensure their safety, is a further form of child maltreatment that affects around 1% to 15% of children each year — and is largest component of agency reports of child maltreatment (UK 44%, USA 60%, Canada 38%, Australia 34%). Neglect is at least as damaging in childhood and adult life as are physical or sexual abuse. However, neglect fails to capture the attention of the press, the public, or researchers — put another way, neglect is neglected.
Most child maltreatment is perpetrated by parents apart from sexual abuse, which is most often perpetrated by other family members or acquaintances. Children exposed to one type of maltreatment are at high risk of other types and of repeated exposure over time. The more frequent the maltreatment, the more severe, and the more serious the consequences. Repeated maltreatment and high levels of persistent neglect mean that for many children, maltreatment is a chronic condition.
The most tragic manifestation of the burden of child maltreatment is the thousands of child deaths every year due to murder or neglect (manslaughter). WHO estimated that 155000 deaths in children younger than 15 years occur worldwide every year as a result of abuse or neglect — 0.6% of all child deaths and 12.7% of child deaths due to any injury. Biological parents are responsible for 80% of cases, with step-parents to blame for most of the rest (15%). In the UK, 35% of child murder victims are younger than 1 year. In the European Union, 4 in every million children die from homicide or manslaughter each year compared with 3 times this number in central and eastern Europe and the newly independent states.
More often, maltreatment has damaging effects on educational achievement, school attendance, and behaviour in childhood and adolescence. Maltreatment in early childhood is particularly damaging for behaviour, but repeated maltreatment has cumulative effects. For example, the risk of youth violence increases when child maltreatment persists into adolescence, emphasizing the importance of interventions for children of all ages to prevent ongoing abuse. A growing body of research provides clear evidence that child maltreatment has long-lasting consequences that persist well into adulthood. Maltreated children are at increased risk of perpetrating crime and violence as adults, thereby perpetuating the cycle of violence at considerable cost to themselves, their families and wider society. They are also more likely than their peers to indulge in risky sexual behaviour. For example, maltreated boys and girls are more likely to report having been arrested for prostitution or paid for sex than their peers (13% of cases v 4% of controls for girls, 15% v 8% of controls for boys). Alcohol and drug misuse are more common in maltreated children. Even at the age of 40, girls who suffered maltreatment are still more likely to misuse alcohol than their peers. Depression and post traumatic stress disorder are also more common in young adults who were abused or neglected as children. Attempted suicide has been reported in up to 1 in 5 young people exposed to maltreatment during childhood — more than twice the rate in their peers. Obesity in adulthood is strongly linked to child maltreatment.
The authors conclude: "Child maltreatment is common, and for many it is a chronic condition, with repeated and ongoing maltreatment merging into adverse outcomes throughout childhood and into adulthood... More attention needs to be given to neglected children. There is mounting evidence that the consequences of childhood neglect can be as damaging—or perhaps even more damaging—to a child than physical or sexual abuse. More attention also needs to be paid to the potentially different needs of boys and girls who are maltreated. Although classrooms and neighbourhoods are disrupted more by deviant behaviour of boys than of girls, research shows that maltreatment doubles a girl's risk of being arrested for a violent crime and increases risk for subsequent alcohol and drug problems, with implications for her children."
Professor Ruth Gilbert, Centre for Evidence-based Child Health and MRC Centre of Epidemiology for Child Health, University College London Institute of Child Health, UK T) +44 (0) 207 905 2101; Press Office Stephen Cox – +44 (0) 20 7239 3126) r.gilbert@ich.ucl.ac.uk or coxs@gosh.nhs.uk
For Professor Cathy Spatz Widom, City University of New York and John Jay College of Criminal Justice, New York City, USA, please contact either Stephen Cox as above or Doreen Vinas, Jon Jay College Communications T) +1 212-237 8645 E) cwidom@jjay.cuny.edu / dvinas@jjay.cuny.edu
Full paper: http://press.thelancet.com/childmaltreatment1.pdf
Journal
The Lancet