Child Abuse Identification and Reporting: The Pennsylvania Requirement _____________________________
compared with those parents who abused their children dur- ing preadolescence [21]. It is believed that the psychosocial effects of physical abuse manifest similarly in late childhood and adolescence. Research findings regarding the effects of childhood physical abuse on adult survivors indicate an increased risk for major psychiatric disorders, including depression, post-traumatic stress disorder, and substance abuse [36]. Some adult survivors function well socially and in terms of mental and physical health, even developing increased resilience as a result of their experiences, while others exhibit depression, anxiety, post- traumatic stress, substance abuse, criminal behavior, violent behavior, and poor interpersonal relationships [3; 17; 46]. A meta-analysis found that adult survivors of child abuse were more likely to experience depression than non-abused coun- terparts, with the rates varying according to the type of abuse sustained (1.5-fold increase for physical child abuse, 2.11-fold increase for neglect, and 3-fold increase for emotional abuse) [24]. Similar results were found in a longitudinal study that compared a child welfare cohort to a group with no child wel- fare involvement. The child welfare group was twice as likely to experience moderate-to-severe depression and generalized anxiety compared with the control group [25]. There is some evidence that vulnerability to long-term effects of maltreatment in childhood may be at least partially genetically mediated [50]. Although not all adult survivors of sexual abuse experience long-term psychological consequences, it is estimated that 20% to 50% of all adult survivors have identifiable adverse mental health outcomes [23]. Possible psychological outcomes include [10]: • Affective symptoms: Numbing, post-traumatic stress disorder, anxiety, depression, obsessions and compulsions, somatization • Interpersonal problems: Difficulties trusting others, social isolation, feelings of inadequacy, sexual difficulties (e.g., difficulties experiencing arousal and orgasm), avoidance of sex • Distorted self-perceptions: Poor self-esteem, self- loathing, self-criticism, guilt, shame • Behavioral problems: Risk of suicide, substance abuse, self-mutilation, violence • Increased risk-taking behaviors: Abuse of substances, cigarette smoking, sexual risk-taking Adult male survivors of child sexual abuse are three times as likely to perpetrate domestic violence as non-victims. In addi- tion, female survivors of child sexual abuse are more vulnerable to bulimia, being a victim of domestic violence, and alcohol use disorder [28]. In more recent years, research has focused on the impact of adverse childhood experiences (ACEs) in general. ACEs are defined as potentially traumatic experiences that affect an individual during childhood (before 18 years of age) and increase the risk for future health and mental health problems
• Exhibiting hypervigilance or paranoid behaviors • Expressing interest in or being in relationships with adults or much older men or women Some of the types of behaviors and symptoms discussed in the definitions of physical, sexual, and emotional abuse/neglect are also warning signs. For example, any of the injuries that may result from physical abuse, such as a child presenting with bruises in the shape of electric cords or belt buckles, should be considered risk factors for abuse. CONSEQUENCES OF CHILD ABUSE The consequences of child abuse and neglect vary from child to child, and these differences continue as victims grow older. Several factors will mediate the outcomes, including the [17]: • Severity, intensity, frequency, duration, and nature of the abuse and/or neglect • Age or developmental stage of the child when the abuse occurred • Relationship between the victim and the perpetrator
• Support from family members and friends • Level of acknowledgment of the abuse by the perpetrator • Quality of family functioning
In examining some of the effects of physical abuse, it is help- ful to frame the consequences along a lifespan perspective [3]. During infancy, physical abuse can cause neurologic impair- ments. Most cases of infant head trauma are the result of child abuse [19]. Neurologic damage may also affect future cognitive, behavioral, and developmental outcomes. Some studies have noted that, in early childhood, physically abused children show less secure attachments to their caretakers compared to their non-abused counterparts [20]. By middle to late childhood, the consequences are more nota- ble. Studies have shown significant intellectual and linguistic deficits in physically abused children [3]. Other environmental conditions, such as poverty, may also compound this effect. In addition, a number of affective and behavioral problems have been reported among child abuse victims, including anxiety, depression, low self-esteem, excessive aggressive behaviors, conduct disorders, delinquency, hyperactivity, and social detachment [3; 8; 10; 12]. Surprisingly, there has been little research on the effects of childhood physical abuse on adolescents [3]. However, differ- ences have been noted in parents who abuse their children during adolescence rather than preadolescence. It appears that lower socioeconomic status plays a lesser role in adolescent abuse as compared with abuse during preadolescence [21]. In addition, parents who abuse their children during adolescence are less likely to have been abused as children themselves
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