Now, take into consideration the 'Portuguese child care scandal' -
(1) -
https://en.m.wikipedia.org/wiki/Casa_Pia_child_sexual_abuse_scandal#:~:text=The%20Casa%20Pia%20child%20sexual,children%20and%20under%2Dage%20orphans.
(a) - First revelation
Portuguese Judiciary Police (Polícia Judiciária) first accused the caretaker of a Casa Pia state-run children's home in 1981 of raping dozens of children over a period of 30 years, even though some reports of abuse pre-date the 1974 Carnation Revolution. Police accused the perpetrators of supplying children to men from Portugal and other countries, including to some prominent public figures in Portugal.[1] However, these early allegations did not result in any legal action.
Second revelations
The scandal of alleged sexual abuse at the state-run Casa Pia orphanages resurfaced when several former orphanage children came forward with accusations of abuse. The accusations linked some politicians, diplomats, and media celebrities—all of whom were alleged to have conspired in a paedophilia ring that had operated for decades. The scandal broke in September 2002 when the mother of one alleged victim, known as Joel, complained of abuse by staff at a Casa Pia house.[1]
Former Casa Pia children came forward to publicly accuse several employees of sexual abuse. The weekly magazine Visão reported that a Portuguese diplomat, Jorge Ritto, was removed from his post as consul in Stuttgart (1969–1971) after German authorities complained to Lisbon about his involvement with an under-age boy in a public park.[4]
Accused were diplomat Jorge Ritto, Carlos Cruz, Carlos Silvino (a.k.a. Bibi, an employee of Casa Pia and a former pupil in the institution), Ferreira Diniz (a physician from Lisbon), Hugo Marçal (a lawyer who represented Carlos Silvino in the early stages of the process) and among other individuals, a marine archaeologist.[1]
Secretary of State for Labor and Training from 1999 to 2001, Paulo Pedroso, who was responsible for the Casa Pia homes, which care for some 4,600 children at 10 centers around Portugal, was suspected of 15 cases of sexual violence against minors, which allegedly took place between 1999 and 2000. His case was also subsequently dropped.[1] In September 2008, a Portuguese court ordered the state to pay 100,000 euros ($140,000) to the ex-minister Paulo Pedroso, on the grounds that he was wrongly detained on paedophilia charges.[5]
The Socialist Party leader at the time, Eduardo Ferro Rodrigues, who was a close personal friend of Paulo Pedroso, offered to undergo police questioning after "he had learned of plans to implicate him in the [Casa Pia] scandal". The weekly paper Expresso published a report on 25 May 2003, from four children who said they saw Ferro Rodrigues at locations where sexual abuse was taking place. The paper said there was no evidence he was personally involved and the Attorney General José Souto de Moura insisted he was not a suspect. Ferro Rodrigues took legal action against those who said they saw him at locations where sexual abuse was taking place. Rodrigues has said, "I want it to be clear: our fight will be serene but determined and it is and will only be directed at those who are responsible for this defamation, whatever their objective is."
The Prime Minister at the time, José Manuel Durão Barroso, whose Social Democratic Party ousted the Socialists in March 2002, promised to bring life and honor back into the Casa Pia children's homes and allow new director Catalina Pestana to reform the institution. As a result, several senior staff of Casa Pia were fired after the 2002 revelations. However, Pestana told parliament and the media, as late as 2007, that there may still be paedophiles in the Casa Pia system. She also criticised the legal changes made after the start of the trial, which she claims were made in order to help those who were present to court.[6] These controversial legal changes were partially reverted just before the sentence in September 2010.[7]
The Casa Pia abuse scandal has had the effect of raising public awareness of sexual abuse of children. The number of incidents reported to Portuguese police has soared after the scandal has been revealed.[8]
Investigation and trial
The Casa Pia child sex abuse trial started in 2004. In 2004, as an arguido involved in the trial, Carlos Cruz published a book of personal reflections, Preso 374.[9] The final allegations, formerly scheduled for 20 October 2008 in Lisbon were postponed several times. The country's justice system, often accused of being excruciatingly slow, is believed by some opinion makers such as journalists and Catalina Pestana (former head of Casa Pia), to be vulnerable to external pressures of well-connected personalities and the possibility of corrupting external interference has been considered a real danger, according to those critics.[6] They feared that even if Carlos Silvino (the Casa Pia driver), whose initial trial had been twice postponed, is found guilty, better-connected abusers might go free.[10]
On 3 September 2010, Carlos Cruz (seven years), Carlos Silvino (eighteen years), Hugo Marçal (six years, two months), Manuel Abrantes (five years, nine months), Ferreira Diniz (seven years) and Jorge Ritto (six years, eight months) were convicted on charges of paedophilia and other crimes occurring in the late 1990s and early 2000s.[11] The full ruling, which allegedly runs to nearly 2,000 pages, was due to be released on 8 September 2010.[2] However, it was delayed several times due to a Microsoft Word glitch.[12][13] On 13 September 2010 the full ruling containing the verdict was released. According to chief prosecutor Miguel Matias, the victims were pleased with the outcome.[2] The court ruling was hailed as a victory by those fighting for Casa Pia children's rights in Portugal, such as Pedro Namora, a former pupil at Casa Pia and now a lawyer who publicly supported the victims, and Catalina Pestana, who was head of Casa Pia during the period when some of the cases were made public in the early 2000s.[14]
Child abuse or child maltreatment is physical, sexual, and/or psychological maltreatment or neglect of a child or children, especially by a parent or a caregiver. Child abuse may include any act or failure to act by a parent or a caregiver that results in actual or potential harm to a child and can occur in a child's home, or in the organizations, schools, or communities the child interacts with.
Child Abuse Awareness Banner in Sarasota, Florida
The terms child abuse and child maltreatment are often used interchangeably, although some researchers make a distinction between them, treating child maltreatment as an umbrella term to cover neglect, exploitation, and trafficking.
Different jurisdictions have developed their own stance towards mandatory reporting, different definitions of what constitutes child abuse to remove children from their families or for prosecuting a criminal charge.
History
Two centuries ago, cruelty to children, perpetrated by employers and teachers, was widespread, and corporal punishment customary in many countries. But, in the first half of the 19th century, pathologists studying filicide (the parental killing of children) reported cases of death from paternal rage,[1] recurrent physical maltreatment,[2] starvation,[3] and sexual abuse.[4] In 1860, a key paper gathered together a series of 32 such cases, of which 18 were fatal, the children dying from starvation and/or recurrent physical abuse; it included the case of Adeline Defert, who was returned by her grandparents at the age of 8, and for 9 years tortured by her parents – whipped every day, hung up by her thumbs and beaten with a nailed plank, burnt with hot coals and her wounds bathed in nitric acid, and deflorated with a baton.[5] Tardieu made home visits and observed the effect on the children; he noticed that the sadness and fear on their faces disappeared when they were placed under protection. He commented, “When we consider the tender age of these poor defenceless beings, subjected daily and almost hourly to savage atrocities, unimaginable tortures and harsh privation, their lives one long martyrdom – and when we face the fact that their tormentors are the very mothers who gave them life, we are confronted with one of the most appalling problems that can disturb the soul of a moralist, or the conscience of justice”.[6] His observations were echoed by Boileau de Castélnau (who introduced the term misopédie – hatred of children),[7] and confirmed by Aubry [8] and several theses.[9][10][11] But these French observations failed to cross the language barrier, and other nations remained ignorant of the cause of many traumatic lesions in infants and toddlers; it was almost one hundred years before humankind confronted Tardieu’s ‘appalling problem’. In the 20th century, evidence began to accumulate from pathology and paediatric radiology, particularly in relation to chronic subdural haematoma and limb fractures: subdural haematoma had a curious bimodal distribution, idiopathic in infants and traumatic in adults,[12] while unexplained ossifying periostitis of the long bones was similar to that occurring after breech extractions.[13] In 1946, Caffey drew attention to the association of long bone fractures and chronic subdural haematoma,[14] and, in 1955, it was noticed that infants removed from the care of aggressive, immature and emotionally ill parents developed no new lesions.[15]
As a result, professional inquiry into the topic began again in the 1960s.[16] The July 1962 publication of the paper "The Battered Child-Syndrome" authored principally by a pediatric psychiatrist C. Henry Kempe and published in The Journal of the American Medical Association represents the moment that child maltreatment entered mainstream awareness. Before the article's publication, injuries to children—even repeated bone fractures—were not commonly recognized as the results of intentional trauma. Instead, physicians often looked for undiagnosed bone diseases or accepted parents' accounts of accidental mishaps such as falls or assaults by neighborhood bullies.[17]:100–103
The study of child abuse emerged as an academic discipline in the early 1970s in the United States. Elisabeth Young-Bruehl maintained that despite the growing numbers of child advocates and interest in protecting children which took place, the grouping of children into "the abused" and the "non-abused" created an artificial distinction that narrowed the concept of children's rights to simply protection from maltreatment, and blocked investigation of how children are discriminated against in society generally. Another effect of the way child abuse and neglect have been studied, according to Young-Bruehl, was to close off consideration of how children themselves perceive maltreatment and the importance they place on adults' attitudes toward them. Young-Bruehl wrote that when the belief in children's inherent inferiority to adults is present in society, all children suffer whether or not their treatment is labeled as "abuse".[17]:15–16
Definitions
Definitions of what constitutes child abuse vary among professionals, between social and cultural groups, and across time.[18][19] The terms abuse and maltreatment are often used interchangeably in the literature.[20]:11 Child maltreatment can also be an umbrella term covering all forms of child abuse and child neglect.[16] Defining child maltreatment depends on prevailing cultural values as they relate to children, child development, and parenting.[21] Definitions of child maltreatment can vary across the sectors of society which deal with the issue,[21] such as child protection agencies, legal and medical communities, public health officials, researchers, practitioners, and child advocates. Since members of these various fields tend to use their own definitions, communication across disciplines can be limited, hampering efforts to identify, assess, track, treat, and prevent child maltreatment.[20]:3[22]
In general, abuse refers to (usually deliberate) acts of commission while neglect refers to acts of omission.[16][23] Child maltreatment includes both acts of commission and acts of omission on the part of parents or caregivers that cause actual or threatened harm to a child.[16] Some health professionals and authors consider neglect as part of the definition of abuse, while others do not; this is because the harm may have been unintentional, or because the caregivers did not understand the severity of the problem, which may have been the result of cultural beliefs about how to raise a child.[24][25] Delayed effects of child abuse and neglect, especially emotional neglect, and the diversity of acts that qualify as child abuse, are also factors.[25]
The World Health Organization (WHO) defines child abuse and child maltreatment as "all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power."[26] The WHO also says, "Violence against children includes all forms of violence against people under 18 years old, whether perpetrated by parents or other caregivers, peers, romantic partners, or strangers."[27] In the United States, the Centers for Disease Control and Prevention (CDC) uses the term child maltreatment to refer to both acts of commission (abuse), which include "words or overt actions that cause harm, potential harm, or threat of harm to a child", and acts of omission (neglect), meaning "the failure to provide for a child's basic physical, emotional, or educational needs or to protect a child from harm or potential harm".[20]:11 The United States federal Child Abuse Prevention and Treatment Act defines child abuse and neglect as, at minimum, "any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation" or "an act or failure to act which presents an imminent risk of serious harm".[28][29]
Type
As of 2006, the World Health Organization distinguishes four types of child maltreatment: physical abuse; sexual abuse; emotional (or psychological) abuse; and neglect.[30]
Physical abuse
Among professionals and the general public, there is disagreement as to what behaviors constitute physical abuse of a child.[31] Physical abuse often does not occur in isolation but as part of a constellation of behaviors including authoritarian control, anxiety-provoking behavior, and a lack of parental warmth.[32] The WHO defines physical abuse as:
Intentional use of physical force against the child that results in – or has a high likelihood of resulting in – harm for the child's health, survival, development, or dignity. This includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning, poisoning, and suffocating. Much physical violence against children in the home is inflicted with the object of punishing.[30]
Overlapping definitions of physical abuse and physical punishment of children highlight a subtle or non-existent distinction between abuse and punishment,[33] but most physical abuse is physical punishment "in intent, form, and effect".[34] As of 2006, for instance, Paulo Sergio Pinheiro wrote in the UN Secretary-General's Study on Violence Against Children:
Corporal punishment involves hitting ('smacking', 'slapping', 'spanking') children, with the hand or with an implement – whip, stick, belt, shoe, wooden spoon, etc. But it can also involve, for example, kicking, shaking or throwing children, scratching, pinching, biting, pulling hair or boxing ears, forcing children to stay in uncomfortable positions, burning, scalding, or forced ingestion (for example, washing children's mouths out with soap or forcing them to swallow hot spices).[35]
Most nations with child abuse laws deem the deliberate infliction of serious injuries, or actions that place the child at obvious risk of serious injury or death, to be illegal.[36] Bruises, scratches, burns, broken bones, lacerations — as well as repeated "mishaps," and rough treatment that could cause physical injuries — can be physical abuse.[37] Multiple injuries or fractures at different stages of healing can raise suspicion of abuse.
The psychologist Alice Miller, noted for her books on child abuse, took the view that humiliations, spankings, and beatings, slaps in the face, etc. are all forms of abuse, because they injure the integrity and dignity of a child, even if their consequences are not visible right away.[38]
Physical abuse as a child can lead to physical and mental difficulties in the future, including re-victimization, personality disorders, post-traumatic stress disorder, dissociative disorders, depression, anxiety, suicidal ideation, eating disorders, substance use disorders, and aggression. Physical abuse in childhood has also been linked to homelessness in adulthood.[39]
Sexual abuse
Main articles: Child sexual abuse and child-on-child sexual abuse
Child sexual abuse (CSA) is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation.[40] Sexual abuse refers to the participation of a child in a sexual act aimed toward the physical gratification or the financial profit of the person committing the act.[37][41] Forms of CSA include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure of the genitals to a child, displaying pornography to a child, actual sexual contact with a child, physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using a child to produce child pornography.[40][42][43] Selling the sexual services of children may be viewed and treated as child abuse rather than simple incarceration.[44]
Effects of child sexual abuse on the victim(s) include guilt and self-blame, flashbacks, nightmares, insomnia, fear of things associated with the abuse (including objects, smells, places, doctor's visits, etc.), self-esteem difficulties, sexual dysfunction, chronic pain, addiction, self-injury, suicidal ideation, somatic complaints, depression,[45] post-traumatic stress disorder,[46] anxiety,[47] other mental illnesses including borderline personality disorder[48] and dissociative identity disorder,[48] propensity to re-victimization in adulthood,[49] bulimia nervosa,[50] and physical injury to the child, among other problems.[51] Children who are the victims are also at an increased risk of sexually transmitted infections due to their immature immune systems and a high potential for mucosal tears during forced sexual contact.[52] Sexual victimization at a young age has been correlated with several risk factors for contracting HIV including decreased knowledge of sexual topics, increased prevalence of HIV, engagement in risky sexual practices, condom avoidance, lower knowledge of safe sex practices, frequent changing of sexual partners, and more years of sexual activity.[52]
As of 2016, in the United States, about 15% to 25% of women and 5% to 15% of men were sexually abused when they were children.[53][54][55] Most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, sisters, fathers, mothers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbours; strangers are the offenders in approximately 10% of child sexual abuse cases.[53] In over one-third of cases, the perpetrator is also a minor.[56]
In 1999 the BBC reported on the RAHI Foundation's survey of sexual abuse in India, in which 76% of respondents said they had been abused as children, 40% of those stating the perpetrator was a family member.[57]
United States federal prosecutors registered multiple charges against a South Korean man for reportedly running the world's "largest dark web child porn marketplace." Reportedly, the English translated website "Welcome to Video", which has now been taken consisted of more than 200,000 videos or 8TB of data showing sexual acts involving infants, children and toddlers and processed about 7,300 Bitcoin, i.e. $730,000 worth of transactions.[58]
Psychological abuse
Main article: Psychological abuse
There are multiple definitions of child psychological abuse:
In 2013, the American Psychiatric Association (APA) added Child Psychological Abuse to the DSM-5, describing it as "nonaccidental verbal or symbolic acts by a child's parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child."[59]
In 1995, APSAC defined it as: spurning, terrorizing, isolating, exploiting, corrupting, denying emotional responsiveness, or neglect" or "A repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another's needs"[60]
In the United States, states laws vary, but most have laws against "mental injury"[61]
Some have defined it as the production of psychological and social defects in the growth of a child as a result of behavior such as loud yelling, coarse and rude attitude, inattention, harsh criticism, and denigration of the child's personality.[37] Other examples include name-calling, ridicule, degradation, destruction of personal belongings, torture or killing of a pet, excessive criticism, inappropriate or excessive demands, withholding communication, and routine labeling or humiliation.[62]
In 2014, the APA stated that:[63]
"Childhood psychological abuse [is] as harmful as sexual or physical abuse."
"Nearly 3 million U.S. children experience some form of [psychological] maltreatment annually."
Psychological maltreatment is "the most challenging and prevalent form of child abuse and neglect."
"Given the prevalence of childhood psychological abuse and the severity of harm to young victims, it should be at the forefront of mental health and social service training"
In 2015, additional research confirmed these 2014 statements of the APA.[64][65]
Victims of emotional abuse may react by distancing themselves from the abuser, internalizing the abusive words, or fighting back by insulting the abuser. Emotional abuse can result in abnormal or disrupted attachment development, a tendency for victims to blame themselves (self-blame) for the abuse, learned helplessness, and overly passive behavior.[62]
Neglect
Main article: Child neglect
Child neglect is the failure of a parent or other person with responsibility for the child, to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety or well-being may be threatened with harm. Neglect is also a lack of attention from the people surrounding a child, and the non-provision of the relevant and adequate necessities for the child's survival, which would be a lack of attention, love, and nurturing.[37]
Some observable signs of child neglect include: the child is frequently absent from school, begs or steals food or money, lacks needed medical and dental care, is consistently dirty, or lacks appropriate clothing for the weather.[66] The 2010 Child Maltreatment Report (NCANDS), a yearly United States federal government report based on data supplied by state Child Protective Services (CPS) Agencies in the U.S., found that neglect/neglectful behavior was the "most common form of child maltreatment ".[67]
Neglectful acts can be divided into six sub-categories:[23]
Supervisory neglect: characterized by the absence of a parent or guardian which can lead to physical harm, sexual abuse, or criminal behavior;
Physical neglect: characterized by the failure to provide the basic physical necessities, such as a safe and clean home;
Medical neglect: characterized by the lack of providing medical care;
Emotional neglect: characterized by a lack of nurturance, encouragement, and support;
Educational neglect: characterized by the caregivers lack to provide an education and additional resources to actively participate in the school system; and
Abandonment: when the parent or guardian leaves a child alone for a long period of time without a babysitter or caretaker.
Neglected children may experience delays in physical and psychosocial development, possibly resulting in psychopathology and impaired neuropsychological functions including executive function, attention, processing speed, language, memory and social skills.[68] Researchers investigating maltreated children have repeatedly found that neglected children in the foster and adoptive populations manifest different emotional and behavioral reactions to regain lost or secure relationships and are frequently reported to have disorganized attachments and a need to control their environment. Such children are not likely to view caregivers as being a source of safety, and instead typically show an increase in aggressive and hyperactive behaviors which may disrupt healthy or secure attachment with their adopted parents. These children seem to have learned to adapt to an abusive and inconsistent caregiver by becoming cautiously self-reliant, and are often described as glib, manipulative and disingenuous in their interactions with others as they move through childhood.[69] Children who are victims of neglect can have a more difficult time forming and maintaining relationships, such as romantic or friendship, later in life due to the lack of attachment they had in their earlier stages of life.
Causes Edit
Child abuse is a complex phenomenon with multiple causes.[129] No single factor can be identified as to why some adults behave abusively or neglectfully toward children. The World Health Organization (WHO) and the International Society for Prevention of Child Abuse and Neglect (ISPCAN) identify multiple factors at the level of the individual, their relationships, their local community, and their society at large, that combine to influence the occurrence of child maltreatment. At the individual level, such factors include age, sex, and personal history, while at the level of society, factors contributing to child maltreatment include cultural norms encouraging harsh physical punishment of children, economic inequality, and the lack of social safety nets.[30] WHO and ISPCAN state that understanding the complex interplay of various risk factors is vital for dealing with the problem of child maltreatment.[30]
The American psychoanalyst Elisabeth Young-Bruehl maintains that harm to children is justified and made acceptable by widely held beliefs in children's inherent subservience to adults, resulting in a largely unacknowledged prejudice against children she terms childism. She contends that such prejudice, while not the immediate cause of child maltreatment, must be investigated in order to understand the motivations behind a given act of abuse, as well as to shed light on societal failures to support children's needs and development in general.[17]:4–6 Founding editor of the International Journal of Children's Rights, Michael Freeman, also argues that the ultimate causes of child abuse lie in prejudice against children, especially the view that human rights do not apply equally to adults and children. He writes, "the roots of child abuse lie not in parental psycho-pathology or in socio-environmental stress (though their influences cannot be discounted) but in a sick culture which denigrates and depersonalizes, which reduces children to property, to sexual objects so that they become the legitimate victims of both adult violence and lust".[130]
A girl who was burned during religious violence in Orissa, India.
Parents who physically abuse their spouses are more likely than others to physically abuse their children.[131] However, it is impossible to know whether marital strife is a cause of child abuse, or if both the marital strife and the abuse are caused by tendencies in the abuser.[131] Sometimes, parents set expectations for their child that are clearly beyond the child's capability. When parents' expectations are far beyond what is appropriate to the child (e.g., preschool children who are expected to be totally responsible for self-care or provision of nurturance to parents) the resulting frustration caused by the child's non-compliance is believed to function as a contributory if not necessary cause of child abuse.[132]
Most acts of physical violence against children are undertaken with the intent to punish.[133] In the United States, interviews with parents reveal that as many as two thirds of documented instances of physical abuse begin as acts of corporal punishment meant to correct a child's behavior, while a large-scale Canadian study found that three quarters of substantiated cases of physical abuse of children have occurred within the context of physical punishment.[134] Other studies have shown that children and infants who are spanked by parents are several times more likely to be severely assaulted by their parents or suffer an injury requiring medical attention. Studies indicate that such abusive treatment often involves parents attributing conflict to their child's willfulness or rejection, as well as "coercive family dynamics and conditioned emotional responses".[34] Factors involved in the escalation of ordinary physical punishment by parents into confirmed child abuse may be the punishing parent's inability to control their anger or judge their own strength, and the parent being unaware of the child's physical vulnerabilities.[32]
Some professionals argue that cultural norms that sanction physical punishment are one of the causes of child abuse, and have undertaken campaigns to redefine such norms.[135][136][137]
Children resulting from unintended pregnancies are more likely to be abused or neglected.[138][139] In addition, unintended pregnancies are more likely than intended pregnancies to be associated with abusive relationships,[140] and there is an increased risk of physical violence during pregnancy.[141] They also result in poorer maternal mental health,[141] and lower mother-child relationship quality.[141]
There is some limited evidence that children with moderate or severe disabilities are more likely to be victims of abuse than non-disabled children.[142] A study on child abuse sought to determine: the forms of child abuse perpetrated on children with disabilities; the extent of child abuse; and the causes of child abuse of children with disabilities. A questionnaire on child abuse was adapted and used to collect data in this study. Participants comprised a sample of 31 pupils with disabilities (15 children with vision impairment and 16 children with hearing impairment) selected from special schools in Botswana. The study found that the majority of participants were involved in doing domestic chores. They were also sexually, physically and emotionally abused by their teachers. This study showed that children with disabilities were vulnerable to child abuse in their schools.[143]
Substance use disorder can be a major contributing factor to child abuse. One U.S. study found that parents with documented substance use, most commonly alcohol, cocaine, and heroin, were much more likely to mistreat their children, and were also much more likely to reject court-ordered services and treatments.[144] Another study found that over two-thirds of cases of child maltreatment involved parents with substance use disorders. This study specifically found relationships between alcohol and physical abuse, and between cocaine and sexual abuse.[145] Also parental stress caused by substance increases the likelihood of the minor exhibiting internalizing and externalizing behaviors.[146] Although the abuse victim does not always realize the abuse is wrong, the internal confusion can lead to chaos. Inner anger turns to outer frustration. Once aged 17/18, drink and drugs are used to numb the hurt feelings, nightmares, and daytime flashbacks. Acquisitive crimes to pay for the chemicals are inevitable if the victim is unable to find employment.[147]
Unemployment and financial difficulties are associated with increased rates of child abuse.[148] In 2009 CBS News reported that child abuse in the United States had increased during the economic recession. It gave the example of a father who had never been the primary care-taker of the children. Now that the father was in that role, the children began to come in with injuries.[149]
Parental mental health has also been seen as a factor towards child maltreatment.[150] According to a recent Children’s HealthWatch study, mothers with positive symptoms of depression display a greater rate of food insecurity, poor health care for their children, and greater number of hospitalizations.[151]
Worldwi
The Child abuse is an international phenomenon. Poverty and substance use disorders are common social problems worldwide, and no matter the location, show a similar trend in the correlation to child abuse.[152] Differences in cultural perspectives play a significant role in how children are treated.[153] Laws reflect the population's views on what is acceptable - for example whether child corporal punishment is legal or not.[153]
A study conducted by members from several Baltic and Eastern European countries, together with specialists from the United States, examined the causes of child abuse in the countries of Latvia, Lithuania, Macedonia and Moldova. In these countries, respectively, 33%, 42%, 18% and 43% of children reported at least one type of child abuse.[154] According to their findings, there was a series of correlations between the potential risk factors of parental employment status, alcohol abuse, and family size within the abuse ratings.[155] In three of the four countries, parental substance use was considerably correlated with the presence of child abuse, and although it was a lower percentage, still showed a relationship in the fourth country (Moldova).[155] Each country also showed a connection between the father not working outside of the home and either emotional or physical child abuse.[155] After the fall of the communism regime, some positive changes have followed with regard to tackling child abuse. While there is a new openness and acceptance regarding parenting styles and close relationships with children, child abuse has certainly not ceased to exist. While controlling parenting may be less of a concern, financial difficulty, unemployment, and substance use remain dominating factors in child abuse throughout Eastern Europe.[155]
These cultural differences can be studied from many perspectives. Most importantly, overall parental behavior is genuinely different in various countries. Each culture has their own "range of acceptability," and what one may view as offensive, others may seem as tolerable. Behaviors that are normal to some may be viewed as abusive to others, all depending on the societal norms of that particular country.[155]
Asian parenting perspectives hold different ideals from American culture. Many have described their traditions as including physical and emotional closeness that ensures a lifelong bond between parent and child, as well as establishing parental authority and child obedience through harsh discipline.[156] Balancing disciplinary responsibilities within parenting is common in many Asian cultures, including China, Japan, Singapore, Vietnam and Korea.[156] To some cultures, forceful parenting may be seen as abuse, but in other societies such as these, the use of force is looked at as a reflection of parental devotion.[156]
The differences in these cultural beliefs demonstrate the importance of examining all cross-cultural perspectives when studying the concept of child abuse.
As of 2006, between 25,000 and 50,000 children in Kinshasa, Democratic Republic of the Congo, had been accused of witchcraft and abandoned.[157] In Malawi it is common practice to accuse children of witchcraft and many children have been abandoned, abused and even killed as a result.[158] In the Nigerian, Akwa Ibom State and Cross River State about 15,000 children were branded as witches.[159]
In April 2015, public broadcasting reported that the rate of child abuse in South Korea had increased to 13% compared with the previous year, and 75% of attackers were the children's own parents.[160]
On 4 December 2020, Joel Le Scouarnec, a retired French surgeon was sentenced to 15 years in jail at the end of his trial in a court in Saintes, western France, for the rape and sexual abuse of four children. Le Scouarnec was first charged in 2017 after testimony from one of his victims.[161]
Disclosure and assessment
Suspicion for physical abuse is recommended when an injury occurs in a child who does not yet move independently, injuries are in unusual areas, more than one injury at different stages of healing, symptoms of possible head trauma, and injuries to more than one body system.[162]
In many jurisdictions, abuse that is suspected, not necessarily proven, requires reporting to child protection agencies, such as the Child Protection Services in the United States. Recommendations for healthcare workers, such as primary care providers and nurses, who are often suited to encounter suspected abuse are advised to firstly determine the child’s immediate need for safety. A private environment away from suspected abusers is desired for interviewing and examining. Leading statements that can distort the story are avoided. As disclosing abuse can be distressing and sometimes even shameful, reassuring the child that he or she has done the right thing by telling and that they are not bad or that the abuse was not their fault helps in disclosing more information. Dolls are sometimes used to help explain what happened. In Mexico, psychologists trial using cartoons to speak to children who may be more likely to disclose information than to a adult stranger.[163] For the suspected abusers, it is also recommended to use a nonjudgmental, nonthreatening attitude towards them and to withhold expressing shock, in order to help disclose information.[164]
A key part of child abuse work is assessment. A few methods of assessment include projective tests, clinical interviews, and behavioral observations.[165]
Projective tests allow for the child to express themselves through drawings, stories, or even descriptions in order to get help establish an initial understanding of the abuse that took place
Clinical interviews are comprehensive interviews performed by professionals to analyze the mental state of the one being interviewed
Behavioral observation gives an insight into things that trigger a child's memory of the abuse through observation of the child's behavior when interacting with other adults or children
A particular challenge arises where child protection professionals are assessing families where neglect is occurring. Professionals conducting assessments of families where neglect is taking place can make the following errors:[166]
Failure to ask the right types of question, including
Whether neglect is occurring;
Why neglect is occurring;
What the situation is like for the child;
Whether improvements in the family are likely to be sustained;
What needs to be done to ensure the long-term safety of the child?
Prevention Edit
A support-group structure is needed to reinforce parenting skills and closely monitor the child's well-being. Visiting home nurse or social-worker visits are also required to observe and evaluate the progress of the child and the caretaking situation. The support-group structure and visiting home nurse or social-worker visits are not mutually exclusive. Many studies have demonstrated that the two measures must be coupled together for the best possible outcome.[167] Studies show that if health and medical care personnel in a structured way ask parents about important psychosocial risk factors in connection with visiting pediatric primary care and, if necessary, offering the parent help may help prevent child maltreatment.[168][169]
Children's school programs regarding "good touch … bad touch" can provide children with a forum in which to role-play and learn to avoid potentially harmful scenarios. Pediatricians can help identify children at risk of maltreatment and intervene with the aid of a social worker or provide access to treatment that addresses potential risk factors such as maternal depression.[170] Videoconferencing has also been used to diagnose child abuse in remote emergency departments and clinics.[171] Unintended conception increases the risk of subsequent child abuse, and large family size increases the risk of child neglect.[139] Thus, a comprehensive study for the National Academy of Sciences concluded that affordable contraceptive services should form the basis for child abuse prevention.[139][172] "The starting point for effective child abuse programming is pregnancy planning," according to an analysis for US Surgeon General C. Everett Koop.[139][173]
Findings from research published in 2016 support the importance of family relationships in the trajectory of a child's life: family-targeted interventions are important for improving long-term health, particularly in communities that are socioeconomically disadvantaged.[174]
Resources for child-protection services are sometimes limited. According to Hosin (2007), "a considerable number of traumatized abused children do not gain access to protective child-protection strategies."[where?][175] Briere (1992) argues that only when "lower-level violence" of children[clarification needed] ceases to be culturally tolerated will there be changes in the victimization and police protection of children.[176]
United States
Child sexual abuse prevention programmes were developed in the United States of America during the 1970s and originally delivered to children. Programmes delivered to parents were developed in the 1980s and took the form of one-off meetings, two to three hours long.[177][178][179][180][181][182] In the last 15 years, web-based programmes have been developed.
Since 1983, April has been designated Child Abuse Prevention Month in the United States.[183] U.S. President Barack Obama continued that tradition by declaring April 2009 Child Abuse Prevention Month.[184] One way the Federal government of the United States provides funding for child-abuse prevention is through Community-Based Grants for the Prevention of Child Abuse and Neglect (CBCAP).[185]
An investigation by The Boston Globe and ProPublica published in 2019[186] found that the 50 states, the District of Columbia, and Puerto Rico were all out of compliance with the requirements of the Child Abuse Prevention and Treatment Act, and that underfunding of child welfare agencies and substandard procedures in some states caused failures to prevent avoidable child injuries and deaths.
A number of policies and programs have been put in place in the U.S. to try to better understand and to prevent child abuse fatalities, including: safe-haven laws, child fatality review teams, training for investigators, shaken baby syndrome prevention programs, and child abuse death laws which mandate harsher sentencing for taking the life of a child.[187]
Treatments Edit
A number of treatments are available to victims of child abuse.[188] However, children who experience childhood trauma do not heal from abuse easily.[189] There are focused cognitive behavioral therapy, first developed to treat sexually abused children, is now used for victims of any kind of trauma. It targets trauma-related symptoms in children including post-traumatic stress disorder (PTSD), clinical depression and anxiety. It also includes a component for non-offending parents. Several studies have found that sexually abused children undergoing TF-CBT improved more than children undergoing certain other therapies. Data on the effects of TF-CBT for children who experienced non-sexual abuse was not available as of 2006.[188] The purpose of dealing with the thoughts and feelings associated with the trauma is to deal with nightmares, flashbacks and other intrusive experiences that might be spontaneously brought on by any number of discriminative stimuli in the environment or in the individual’s brain. This would aid the individual in becoming less fearful of specific stimuli that would arouse debilitating fear, anger, sadness or other negative emotion. In other words, the individual would have some control or mastery over those emotions.[69]
Parenting training can prevent child abuse in the short term, and help children with a range of emotional, conduct and behavioural challenges, but there is insufficient evidence about whether it treat parents who already abuse their children.[190]
Abuse-focused cognitive behavioral therapy was designed for children who have experienced physical abuse. It targets externalizing behaviors and strengthens prosocial behaviors. Offending parents are included in the treatment, to improve parenting skills/practices. It is supported by one randomized study.[188]
Rational Cognitive Emotive Behavior Therapy consists of ten distinct but interdependent steps. These steps fall into one of three theoretical orientations (i.e., rational or solution focused, cognitive emotive, and behavioral) and are intended to provide abused children and their adoptive parents with positive behavior change, corrective interpersonal skills, and greater control over themselves and their relationships. They are: 1) determining and normalizing thinking and behaving, 2) evaluating language, 3) shifting attention away from problem talk 4) describing times when the attachment problem isn't happening, 5) focusing on how family members "successfully" solve problematic attachment behavior; 6) acknowledging "unpleasant emotions" (i.e., angry, sad, scared) underlying negative interactional patterns, 7) identifying antecedents (controlling conditions) and associated negative cognitive emotive connections in behavior (reciprocal role of thought and emotion in behavioral causation), 8) encouraging previously abused children to experience or "own" negative thoughts and associated aversive emotional feelings, 9) modeling and rewarding positive behavior change (with themselves and in relationships), and 10) encouraging and rewarding thinking and behaving differently. This type of therapy shifts victims thoughts away from the bad and changes their behavior.[69]
Parent–child interaction therapy was designed to improve the child-parent relationship following the experience of domestic violence. It targets trauma-related symptoms in infants, toddlers, and preschoolers, including PTSD, aggression, defiance, and anxiety. It is supported by two studies of one sample.[188]
School-based programs have also been developed to treat children who are survivors of abuse.[191] This approach teaches children, parents, teachers, and other school staff how to identify the signs of child maltreatment as well as skills that can be helpful in preventing child maltreatment.[192]
Other forms of treatment include group therapy, play therapy, and art therapy. Each of these types of treatment can be used to better assist the client, depending on the form of abuse they have experienced. Play therapy and art therapy are ways to get children more comfortable with therapy by working on something that they enjoy (coloring, drawing, painting, etc.). The design of a child's artwork can be a symbolic representation of what they are feeling, relationships with friends or family, and more. Being able to discuss and analyze a child's artwork can allow a professional to get a better insight of the child.[193]
