CHAPTER
1
Incidence
and Prevalence
Over
the ten-year period from 1987 to 1997, Massachusetts
saw a 98 percent increase in the number of children reported
for abuse or neglect. This is in contrast to an increase
of 54 percent nationally during the same period. Based on
Massachusetts' child population of 1.5 million[9] in 1997
and the number of reported children that year, we see that
roughly 46 of every 1,000 children was involved in a
child abuse report.[10]
Although
child abuse statistics for 1998 showed a reduction of 2,000
reports from the previous year, state officials believe
the transition into new data systems may have accounted
for the slight decrease. Recently released 1999 statistics
confirm a persistent and ever worsening problem, even while
the state's violent crime rate decreased 21 percent from
1993 to 1998.[11]
* Incidents of Violent Crime include murder,
rape, robbery, and aggravated assault
Source: DSS Child Maltreatment Statistics (1997), FBI Crime
Index for Massachusetts (2000)
National
reporting figures provide some picture of how many children
are identified as abused each year, an estimated 3.1 million
reported in 1998,[12] but they do not indicate the cumulative
total of children who are maltreated at some time during
their childhoods. Attempting to estimate the total prevalence
rate from the yearly incidence figures is confounded by
a number of factors, including differences in the incidence
of abuse among different age and socio-economic groups,
and the likelihood that victims of long-term abuse are identified
repeatedly through child abuse reporting.[13]
Underreporting
is also a significant factor that prevents accurate quantification
of the prevalence of child abuse. For example, one study
indicates that 84 percent of children who are sexually abused
never report the abuse.[14]
The
"Adverse Childhood Experiences Study"[15] recently completed
by Dr. Vincent Felitti of Kaiser Permanente and several
noted research groups including, the U.S. Centers for Disease
Control and Prevention and the National Center for Chronic
Disease Prevention and Health Promotion, gives us a startling
picture of the pervasiveness of child abuse.
A questionnaire
was mailed to over 13,000 adults who had completed a standardized
medical evaluation at Kaiser Permanente, a large HMO. Over
70 percent responded to inquiries about seven categories
of adverse childhood experiences including: living with
household members who were substance abusers, witnessing
violence, or experiencing physical, emotional, or sexual
abuse as a child. While substance abuse in the household
was the most prevalent exposure of the seven categories
described, more than half of the respondents experienced
more than one or equal to four categories of abuse.
Who
Are These Children?
Boys
and girls are neglected, physically abused, and emotionally
maltreated in approximately equal numbers.[16] Reports of
sexual abuse generally involve girls. The lower reporting
rate for boys is thought to be a result of less disclosure.
The recent organizing of support groups among adult men
who were child victims of sexual abuse makes it clear that
underreporting is a main factor, particularly underreporting
of sexual abuse of boys by their mothers and other female
caretakers.[17]
Children
from every city and town in Massachusetts and from every
social and economic group are suffering from abuse or neglect.
Some communities, however, have higher reporting rates accompanied
by similar high rates of domestic violence, poverty, homelessness,
and substance abuse.
The
following are cities and towns with the highest and lowest
reporting rates in 1997.[18] The rate is based on the number
of reported children per 1,000 resident children under the
age of eighteen and includes only those cities or towns
in Massachusetts that had 275 or more children in residence
who were reported for maltreatment. (For the reporting rates
of other Massachusetts cities and towns, see Appendix C.)
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12
Cities/Towns
with the Highest Number of Children Reported
1997
Holyoke
Pittsfield
Greenfield
Chelsea
North Adams
Fall River
Lynn
New Bedford
Brockton
Chicopee
Lawrence
Fitchburg
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12
Cities/Towns
with the Lowest Number of Children Reported
1997
Waltham
Medford
Weymouth
Methuen
Woburn
Leominster
Peabody
Cambridge
Attleboro
Marlborough
Quincy
Plymouth
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Neglect
was the most common type of maltreatment in Massachusetts
in 1997, totaling about 68% of substantiated cases, followed
by physical abuse at 24%. Cases involving emotional maltreatment
as the prime concern comprised 2% of the cases. Substantiated
sexual abuse cases (6%) in Massachusetts were less than
half the national average (15%)[19] but still represented
far too many violated children.[20]
The
following represents substantiated cases in Massachusetts
in 1997:
Source:
DSS Child Maltreatment Statistics (1997)
Neglect
In
1997, almost 70% of reports to child protective services
in Massachusetts were because of neglect or deprivation
of necessities.
Child
neglect is a complex and multi-faceted type of maltreatment.
It can be fatal or it can slowly and almost invisibly undermine
a child's cognitive and psychological development until
the child has little ability to bond with others.[21] Sometimes
neglect is defined as the failure of a parent or caretaker
to provide a child with needed care and protection, e.g.
proper food, clothing, shelter, or supervision. Other definitions
focus on the condition of the child, regardless of the specific
cause or intent of the parent or caretaker. For example,
educational neglect affects children who are truant chronically,
oftentimes because of a need to care for younger siblings
or because of the emotional or substance abuse problems
their parents face.
The
impact of neglect can be devastating, particularly since
it affects disproportionately infants and preschoolers who
are at their most vulnerable developmental stage. The short-term
effect is often the increased exposure of children to dangerous
or life-threatening conditions. Some infants are "failure
to thrive" victims, their physical and developmental growth
arrested, sometimes fatally. Irreversible brain damage can
be caused by lack of parental affection and stimulation
in the first years of life. Studies have concluded that
40 percent of child fatalities due to child maltreatment
are the result of neglect.[22]
A review
of recent studies by the National Center on Child Abuse
Prevention Research at Prevent Child Abuse America confirms
that the long-term effects of neglect can result in serious
and lasting cognitive and emotion harm to children of a
young age, and an increased rate of delinquency, drug and
alcohol abuse, and teenage pregnancy as they grow older.[23]
Physical
Abuse
One-quarter
of the children reported to DSS are victims of physical
abuse. Physical abuse can include a range of injuries including:
bruises and welts from being hit with hands, fists, or objects
such as straps, wooden boards, wire hangers. Broken bones
and fractures, organ damage from being punched, kicked or
thrown, and burns from cigarettes, irons, and from immersion
in scalding water, constitute the types of abuse that can
cause serious or fatal injury.
Brain
injury is reported in nearly 44 percent of all cases of
reported physical abuse. According to the American Academy
of Pediatrics Committee on Child Abuse and Neglect, child
abuse is the source of 95 percent of serious head injuries
in infants less than 1 year of age, and accounts for up
to 80 percent of deaths from head traumas in infants less
than 2 years of age.[24]
A major
form of physical violence contributing to brain injury among
infants and young children is Shaken Baby (or Infant) Syndrome
(SBS). Children under two can easily be injured from shaking
because their weak neck muscles are not yet strong enough
to fully control their head movements. When a child is shaken,
the head whips back and forth slamming the fragile brain
tissue against the hard skull, causing bruising, bleeding,
and swelling inside the brain. When the shaking is combined
with throwing an infant or child against a mattress or hard
surface, the instant deceleration applies more force to
the brain and more damage can occur.
In addition
to brain and retinal injuries associated with SBS, a Philadelphia
study conducted by prominent researchers Duhaime, Gennarelli,
and Thibault documented frequent skull fractures among fatal
cases of infant abuse, suggesting that these children are
also struck with objects or thrown against them with significant
force.[25] As a result, Duhaime and colleagues have suggested
referring to this syndrome as Shaken Impact Syndrome.
Depending
on the age of the child and how severe the shaking or impact,
injuries can include: learning disabilities, delays in development,
speech problems, impaired use of arms and legs, brain damage
and seizures, hearing loss, partial or total blindness,
spinal injury, paralysis, and mental retardation. According
to Dr. Jacy Showers, a prominent expert in the field, it
is estimated that up to one-third of children who are victims
of SBS die from their injuries while 50 percent sustain
severe lifelong neurological problems.[26]
Sexual
Abuse
Sexual
abuse of a child is defined as inappropriately subjecting
or exposing a child to sexual contact, activity, or behavior.
Non-touching sexual offenses include indecent exposure or
exhibitionism, exposing children to pornographic material,
deliberately exposing a child to the act of sexual intercourse
and/or masturbation in front of a child. Touching offenses
include sexual fondling, making a child touch an adult's
sexual organs, forcing a child to engage in sexual intercourse
or activity. Sexual exploitation of children can include
engaging a child for the purposes of prostitution or using
a child to film or model pornography.
Nationwide,
reports of child sexual abuse declined from an estimated
425,000 in 1991 to an estimated 223,000 in 1997.[27] In
considering any declines, it is important to remember that
only a subset of child sexual abuse cases are actually identified
or reported to child protective services each year.[28]
Researchers estimate that as many as 85 percent of child
sexual abuse cases are never reported to authorities.
Retrospective
surveys are now supporting the estimate that at least 20
percent, and possibly higher, of all American women and
5 percent to 16 percent of American men experience some
form of sexual abuse as children.[29] If the number of sexually
abused children today is as great as the number of adults
who claim to have been child victims, we can then conclude
that less than one-third of sexually abused children
are being currently identified and reported.
Declines
in reports may be completely or partly due to factors that
are not related to the actual incidence of sexual abuse.
For example, "child abuse backlash" reported by some researchers
may play a role.[30] The dominant and incorrect message
to the public has often been that false allegations are
frequent and that innocent people are unfairly stigmatized.
As a result, media coverage of child sexual abuse cases
may be fueling a more skeptical attitude toward the problem
than in the past and causing the public and professionals
to be more reluctant to report such cases. Legislative initiatives
to increase the rights of alleged perpetrators have also
taken hold in certain states and, as a result, victims may
be more reluctant to seek help.
A number
of other factors may account for the decrease in investigations
and substantiation of cases after they are reported.[31]
For example:
- The required level of evidence is not possible to meet
because the child victim is too young to communicate,
or the abuser is also a child.
- Child protective services may be excluding cases of
extra-familial child sexual abuse and redefining their
definition of "caretaker" to exclude non-immediate family
members. These cases may be referred directly to the police,
eliminating child protective services involvement.
- Cases involving adolescent victims or offenders may
also be referred to the police.
- More stringent screening practices by child protective
service workers may be turning away less serious cases
and raising the threshold for cases needing investigation.
- State investigators may be more conservative in the
criteria they use to substantiate cases because they fear
entanglement in an appeals process, particularly when
able counsel represent alleged offenders.
- Structured risk-assessment protocols may be substituting
clinical judgments about whether or not the abuse should
be substantiated. Such protocols could result in accurate
judgments. However, if they are based solely on meeting
legal burdens of proof, more children are likely to remain
in dangerous situations.
A review
of national incidence studies by researcher David Finkelhor
found that girls are sexually abused three times more often
than boys.[32] Despite the public's perception that highly
publicized cases of sexual assaults by teachers, clergymen
and other unrelated adults are the norm, they make up less
than 10 percent of sexual assaults against children. According
to child abuse researchers, in 90 percent of child sexual
abuse cases, the child knows and trusts the person who commits
the abuse. Most sexual abusers are fathers, mothers,
stepparents, grandparents and other family members or adults
who have close contact with the child.[33]
Sexual
abuse exists in low, middle, and high-income families across
the state. There are no markers to help us identify when
sexual abuse is more likely to occur. However, some studies
show that the most important indicator of risk for sexual
abuse is the compromised ability of a parent to provide
adequate supervision to their child, e.g. marital conflicts,
unavailability, substance abuse. The factors that reduce
appropriate parental supervision can also produce emotionally
vulnerable children who in turn can fall prey more easily
to sexual abusers offering affection, attention, and friendship.[34]
The
effects of sexual abuse on children can be devastating and
long-term, especially when timely and effective treatment
is not available. A variety of studies show that sexually
abused children can experience a chronic self-perception
of helplessness, hopelessness, depression, impaired trust,
self-blame, self-destructive behavior, and low self-esteem.[35]
Anger and emotional distress are also cited, as well as
alcohol and drug dependency when the child reaches adolescence
or adulthood.[36]
Emotional
Abuse
In
1997, emotional maltreatment was the presenting problem
in 2 percent of the reports made to DSS. While clinical
descriptions of child abuse and neglect suggest psychological
harm from other forms of maltreatment, practitioners and
researchers still struggle to clearly define the nature
and consequences of emotional abuse.
A study
conducted by noted researchers Garbarino, Guttman, and Seeley
in 1987 suggests a pattern of psychologically destructive
behavior that constitutes a concerted attack on the child's
development of self and social competence.[37] Included
are behaviors that reject, isolate, terrorize, ignore, and
corrupt the normal development of the child.
Consequences
for child victims are devastating. Infants can show non-organic
failure to thrive, anxiety, and inadequate social responses.
Older children can show signs of feeling unloved, inferior,
and negative in their view of the world and themselves.
They may show symptoms of fear, anxiety, and aggression.
Internalized, these feelings may provoke self-destructive,
depressed, withdrawn or even suicidal behavior. Externalized,
they can lead to aggressive, impulsive, and violent behaviors.
Emotional
maltreatment of children remains one of the least reported
and potentially devastating forms of abuse.[138]
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Section
I: Incidence and Impact of Abuse and Neglect on Children
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