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Chapter 14

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Psychology 2042A/B
Scott Wier

Child Psychology Chapter 14: Child Maltreatment and Non-Accidental Trauma Introduction  Family violence occurs in numerous forms, from mild acts of frightening or yelling at children, to severe acts of assaulting and abuse wax and wane in a cyclical manner that creates tension, uncertainty, and fear in children, forcing them to cope with harsh realities and fearful demands  Child maltreatment is a generic term that refers to four primary acts: physical abuse, neglect, sexual abuse, and emotional abuse  Maltreatment can take many forms, including acts experienced by the majority of children, such as corporal punishment, sibling violence, and peer assault, as well as acts experienced by a significant minority, such as physical abuse  It cuts across all lines of gender, national origin, language, religion, age, ethnicity, disability, and sexual orientation  Non-accidental trauma refers to the wide-ranging effects of maltreatment on the child’s ongoing physical and emotional development  Victimization, which is defined as the abuse or mistreatment of someone whose ability to protect him-or-herself is limited  Children from abusive and neglectful families grow up in environments that fail to provide consistent and appropriate opportunities to guide their development; instead these children are placed in jeopardy of physical and emotional harm  Child victims may feel torn between a sense of belonging and a sense of fear and apprehension  The victim wants to stop the violence but also longs to belong to a family  Affection and attention may coexist with violence and abuse  The intensity of the violence tends to increase over time History and Family Context  Child maltreatment and non-accidental forms of trauma have always existed, but these acts were seldom identified as a problem or concern  For generations, children were viewed as the exclusive property and responsibility of their fathers, who had full discretion as to how punishment could be administered  Ironically, the same legal system that was designed to support and assist the family has tolerated and, in some respects, condoned the abuse of family members, including children, women, and the elderly  Two major cultural traditions have influenced this position until recently: absolute authority over the family by the husband, and the right to family privacy  Particularly, the last 30 years, the legal systems response has shifted to one of condemnation of such behaviour throughout much of the Western world Health Families  Family relations are the earliest and most enduring social relationships that significantly affect a child’s competence, resilience, and sense of well-being  Individuals who are ill-prepared for the vital and challenging role of being parents may rely heavily on child-rearing methods form their own childhood  For healthy development, children need a caregiving environment that balances their need of control and direction, or “demanding-ness” with their need for stimulation and sensitivity or “responsiveness”  Determinants of healthy parent-child relationships and family roles derived from these two primary developmental needs include o Adequate knowledge of child development and expectations, including knowledge of children’s normal sexual development and experimentation o Adequate skill in coping with stress related to caring for small children, and knowledge of ways to enhance child development through proper stimulation and attention o Opportunities to develop normal parent-child attachment and early patterns of communication o Adequate parental knowledge of home management, including basic financial planning, proper shelter, and meal planning o Opportunities and willingness to share the duties of child care between both parents, when applicable o Provision of necessary social and health services  These healthy patterns depend not only on parental competence and developmental sensitivity, but also on family circumstances and the availability if community resources, such as education and child-rearing information, as well as social networks and supports  The family situation provides the basic context for child-rearing  Certain features of a child’s environment should be fundamental and expectable  For infants, an expectable environment requires protective and nurturing adults, as well as opportunities to explore and master their environment  Moreover, responsible parenting involves a gradual shifting of control from the parent to the child and the community  Seldom is this process a smooth one, but healthy families learn to move gradually from nearly complete parental control, through shared control, to the child’s growing self-control and eventual independence as an adult Family Stress and Disharmony  Children have an amazing ability to adapt to changing demands, an ability that is essential for healthy development  Nevertheless, they need a basic expectable environment to adapt successfully, or their development may be comprised  All children must cope with various degrees of stress, and these exceed the child’s coping ability  A child’s method of adapting to immediate environmental demands may later compromise his or her ability to form relationships with others  Stressful events in the family affect each child in different and unique ways  However, certain situations trigger more intense stress reactions and consequences than others  Child maltreatment impinges directly on the child’s daily life, may be ongoing and unpredictable, and is often the result of actions and unpredictable, and is often the result of actions or inactions of people the child is supposed to trust and depend on  Even traumatic events like abuse, neglect, and family violence do not affect each child in a predictable, characteristic fashion  Rather, their impact depends on the child’s makeup and available supports  A prime factor in how children respond to various forms of stress is the degree of support and assistance they receive form their parents to help them cope and adapt  Parents provide a model that teaches the child how to exert some control even in the midst of confusion and upheaval  Maltreated children may have the hardest time adapting appropriately to any form of stress when they are deprived of positive adult relationships, effective models of problem-solving, and a sense of personal control or predictability Continuum of Care  Competent parents encourage their child’s development in a variety of ways and match their demands and expectations to the child’s needs and abilities  Of course, parents are human, and many occasions will scold, criticize, or even show insensitivity to the child’s state of need; in fact, discipline often requires such firm control, with accompanying verbal statements and affect  Borderline actions, however, represent greater degrees of irresponsible and harmful child care  Parents who show any discernable degree of these actions toward their child often need instruction and assistance in effective child care methods  Finally, parents who violate their child’s basic needs and dependency status in a physical, sexual, or emotional manner are engaging in inappropriate and abusive behaviour Types of Maltreatment  All states and provinces in North America have civil laws, or statutes, that obligate persons who come in contact with children as part of their job or volunteer work to report known or suspected cases of abuse to the police or child welfare authorities  Note that incidents of maltreatment that affect children’s helath and well- being involve abuse and neglect by adults, and therefore are not forms of abnormal child behaviour or psychological disorders  Thus, specific definitions of types of child maltreatment do not appear in DSM  DSM considers severe maltreatment under the Axis I category  If a child who was abused is also suffering from a clinical disorder, such as depression, the maltreatment would be noted on Axis IV because maltreatment may affect the diagnosis, treatment, and prognosis of the child’s depression Physical Abuse  Physical abuse is multiple acts of aggression that include punching, beating, kicking, biting, burning, shaking, or otherwise physically harming a child  In most cases, the injuries from physical abuse are not intentional, but they occur as a result of over discipline or severe physical punishment  As a result of their harsh and insensitive treatment, physically abused children are described as more disruptive and aggressive than their age- mates, with disturbances that reach across a broad spectrum of emotional and cognitive-functioning  Physical injuries may range from minor, to moderate, to severe Neglect  Physical neglect includes refusal or delay in seeking health care, expulsion form the home or refusal to allow a runaway to return home, abandonment, and inadequate supervision  Educational neglect involved actions such as allowing chronic truancy, failing to enroll in school a child who is of mandatory school age, and failing to attend to a child’s special educational needs  Emotional neglect, one of the most difficult categories to define, includes actions such as marked inattention to the child’s needs for affection, refusal or failure to provide needed psychological care, spousal abuse in the child’s presence and permission of drug or alcohol use by the child  Neglected children may suffer physical health problems, limited growth, and increased complications in other healthy conditions, such as diabetes, allergies, and failure-to-thrive  They also may show behaviour patterns that vacillate between undisciplined activity and extreme passivity due to their ways of adapting to an unresponsive caregiver  Emotional neglect also includes children who witness parental or partner violence in the home  Younger abused children are fearful and often show regressive and somatic signs of distress, such as sleep problems, bed-wetting, headaches, stomachaches, diarrhea, ulcers, and enuresis  Older boys tend to be more aggressive with peers and dating partners  Girls tend to be more passive, withdrawn, and low in self-esteem Sexual Abuse  Sexual abuse includes fondling a child’s genitals, intercourse with the child, incest, rape, sodomy, exhibitionism, and commercial exploitation through prostitution or the production of pornographic materials  The behaviour and development of sexually abused children may be affected significantly, especially in relation to the duration or frequency of abuse, the use of force, penetration, and a close relationship to the perpetrator  The physical health of these children may be comprised by urinary tract problems, gynecological problems, sexually transmitted diseased and pregnancy  Children’s reports of sexual abuse and their reactions and recovery vary, depending on the nature of the sexual assault and the response of their important others, especially the mother  Many acute symptoms of sexual abuse resemble children’s common reactions to stress, such as fears, increased anger, anxiety, fatigue, depression, passivity, difficulties focusing and sustaining attention, and withdrawal from usual activities  In reaction to an abusive incident, it is common for younger children to regress temporarily  In later childhood and early adolescence, these signs of distress may take the form of acting-out behaviours, such as delinquency, drug use, promiscuity, or self-destructive behaviour  Some sexually abused children may exhibit sexualized behaviours with other children or toys  Any of these symptoms of distress may be associated with a decline or sudden change in school performance, behaviour, and peer relations  Sexual abuse has no connection to child-rearing, discipline, or inattention to developmental needs  Rather, it constitutes a breach of trust, deception, intrusion, and exploitation of a child’s innocence and status Emotional Abuse  Emotional abuse includes repeated acts or omissions by the parents or caregivers that have caused, or could cause, serious behavioural, cognitive, emotional, or mental disorders  Emotional abuse also includes verbal threats and put-downs as well as habitual scapegoating, belittling, and name calling  Emotional abuse exists, to some degree, in all forms of maltreatment, so the specific psychological consequences of this form of maltreatment are poorly understood Exploitation  Children also suffer trauma from commercial or other sexual exploitation, such as child labor and child prostitution  Many exploited children began as victims of abuse and rape in their homes, and are forced into commercial sexual activity at a young age  Rates of child prostitution tend to be higher in Asia and Latin America, growth recorded in Africa, North America, and Europe  Eastern Europe recently has emerged as the newest market in the worldwide sexual exploitation of children  Poverty is the greatest factor in the child prostitution explosion Incidence of Abuse and Neglect in North America  The difference in incidence between these otherwise similar countries is due to a higher number of neglect cases in the US, which may be a function of higher poverty rates and less access to medical services  Interestingly, both sexual abuse and physical abuse cases have decline considerably  This decline most likely stems form several factors occurring over the last 15 years  Economic improvement coupled by more law enforcement and child protection resources and more aggressive prosecution and incarceration policies  More public awareness about abuse and neglect, and more forms of treatment have become available  Rates of child neglect, on the other hand, have remained fairly stable, perhaps because it has not received the same level of policy attention and public awareness as sexual and physical abuse  Lifetime prevalence estimates of maltreatment are derived by asking adults if they experienced particular forms of maltreatment as children  A history of physical abuse during childhood was reported more often by males than females, whereas sexual abuse during childhood was more commonly reported by females than males Characteristics of Victimized Children  Improvements in data collection methods over the past decade indicate that child maltreatment affects more vulnerable or disadvantaged children disproportionately, as indicated by age, sex, and racial differences  Child maltreatment occurs at all ages, but there is correspondence between certain types of maltreatment and children’s age  Younger children, who have the greatest need for care and supervision, are the most common victims of abuse and neglect, which corresponds to the emergence of their greater independence and to parental conflict during this developmental period  Sexual abuse, in contrast, is more common among the older age groups  Other than for sexual abuse, the rate of victimization is inversely related to the age of the child  Child maltreatment affects boys and girls almost equally except for sexual abuse  The dynamics of sexual abuse differ considerably for boys and girls  Boys are more likely to be abused by male nonfamily members whereas girls are more likely to be sexually abused by male family members  This finding suggests different patterns of vulnerability for boys and girls, and has implications for safety and prevention Characteristics of Family and Perpetrator  Maltreatment is more common among poor and disadvantaged  This connection is not likely due to a reporting bias, because it has remained constant for the past 30 years, despite increased awareness, and reporting  What it does imply is that economically based context of maltreatment is a powerful backdrop to the high incidence rates  Family structure also is connected to the probability of child maltreatment  Children living with a single parent are at significantly greater risk of both physical; abuse and neglect  Those living with single fathers are almost twice as likely to be physically abused as those living with single mothers  Maltreatment – especially physical and educational neglect – is more common in larger families  There are important exceptions, as well as key sex differences in the nature of abuse or neglect  Child neglect is committed predominately by mothers, sexual abuse is committed more often by fathers Cross-Cultural Comparisons  Child abuse is found in all societies and is almost always a highly guarded secret  Rates of child sexual abuse in other Western societies are comparable to those rates in North America Developmental Course and Psychopathology  Abuse and neglect are more than physical pain and transitory fear; to a child or adolescent, these events often represent threats to their emerging sense of self, their world, and their feelings of safety and well-being Resilience and Adaptation  Under abnormal and unusual circumstances, especially abuse and neglect, predictability and organization are disrupted and thrown off course, which results in developmental failure and limited adaptation  Also must adapt to environmental circumstances that pose developmental challenges  Children who are sexually abused undergo pronounced interruptions in their developing view of themselves and the world which result in significant emotional and behavioural changes, indicative of their attempts to cope with such events  Children who are maltreated are challenged regularly to find ways to adapt that pose the least risk, and offer maximum protection and opportunity for growth  Does not affect each child in a predictable or consistent fashion  The impact of maltreatment depends not only on the severity and chronicity of the specific events, but also on how the events interact with the child’s individual and family characteristics  Without proper support and assistance, young children who initially may have achieved normal developmental milestones can show a dramatic downturn in their developmental progress as a result of chronic or acute maltreatment and similar types of stress  Consequently, their core developmental processes are impaired, which results in emotional and behavioural problems ranging from speech and language delays to criminal behaviour  Children may be protected, in part, by a positive relationship with at least one important and consistent person in their lives who provides support and protection, such as other family members or peers  Many maltreated children do not think of their patients as abusive, rather, they adapt to their own experiences as best as possible  Personality characteristics such as positive self-esteem and sense of self also are related to fewer negative outcomes among maltreated children  It may be more adaptive for children to focus on what their parents provide, rather than what they don’t provide Early Attachment and Emotion Regulation  Episodes of child abuse and neglect, whether chronic or sporadic, can disrupt the important process of attachment, and interfere with children’s ability to seek comfort and to regulate their own physiological and emotional processes  As a result, maltreated children are more likely than other children to show an absence of an organized attachment strategy  Parent child attachment and the home climate play a critical role in emotion regulation  Emotion regulation refers to the ability to modulate or control the intensity and expression of feelings and impulses, especially intense ones, in an adaptive manner  They show a pattern described as insecure disorganized attachment, characterized by a mixture of approach and avoidance, helplessness, apprehension, and a general disorientation  The lack of a secure, consistent basis for relationships places maltreated children at greater risk of falling behind in their cognitive and social development, and can result in problem regulating their emotions and behaviour with others  Maltreated children live in a world of emotional turmoil and extremes, making it difficult for them to understand, label, and regulate their internal states  They show increased attention to anger-and-threat related signals like facial expressions, and less attention to other emotional expressions  Difficulties modulating emotions can be expressed as depressive reactions as well as intense angry outbursts  Over time, this inability to regulate emotions is associated with internalizing disorders, such as depression and fearfulness, as well as externalizing disorders, such as hostility, aggression, and various forms of acting out Brain Development  Maltreated children and adults with a history of childhood abuse show long- term alterations in the HPA axis and norepinephrine systems, which have a pronounced effect on one’s responsiveness to stress  Brain areas implicated in the stress response include the hippocampus the prefrontal cortex, and the amygdala, which can lead to long-term mental health problems  In effect, acute and chronic forms of stress associated with maltreatment may cause changed in brain development and structure  The neuroendocrine system is designed to handle sudden stressful events y releasing cortisol to produce a fight-or-flight response  However, after prolonged and unpredictable stressful episodes associated with all forms of child abuse an neglect, cortisol levels become depleted and the feedback systems that control hormone levels in the brain may not function correctly  Stress floods the brain with cortisol is produced, so that ultimately it circulates at a dramatically low level  As a result, the neuroendocrine system becomes highly sensitive to stress Emerging View of Self and Others  As normal development progresses, regulation of affect and behaviour becomes less dependent on the caregiver and more and more autonomous  Children form complex mental representations of people, relationships, and the world during this developmental period  Their emerging view of themselves and their surroundings is fostered b healthy parental guidance and control that invoke concern for the welfare of others  Representational model of oneself an others are significant because they contain experience, knowledge, and expectations that carry forward to new situations  Maltreated children, often lack core positive beliefs about themselves and their world  Instead, they may develop negative representational models of themselves and others based on a sense of inner “badness”, self-blame, shame, or rage, all of which further impair their ability to regulate their affective responses  Feelings of powerlessness and betrayal often are described by children and adults who have been victims of maltreatment  Betrayal involves the degree to which the child feels the perpetrator gained his confidence through manipulations and coercion, as well as the position of trust or authority held by the perpetrator  As a consequence, the child’s emotional needs may be compromised by intense and contradictory feelings of the need for closeness and the fear of it  One’s sense of personal power or self-efficacy can be undermined by physical and verbal abuse, as well as by physical and emotional neglect  Emotional reactions elicited by harsh punishment or sexual exploitation require the child to search for an answer to a fundamental question concerning responsibility and blame  Girls and boys tend to differ in the ways they process and express their turmoil  Maltreated girls tend to show more internalizing signs of distress, such as shame and self-blame  Boys tend to show heightened levels of physical and verbal aggression Emotional and Behavioural Problems  Instead of a healthy sense of autonomy and self-respect, their models of relationships have elements of being a victim and a victimizer and during interactions with peers, maltreated children may alternate between being the aggressor and being the victim  Some maltreated children may be more distracted by aggressive stimuli, and misread the intentions of their peers and teachers as being more hostile than they actually are  Physically abused and neglected children show less skill at recognizing or responding to distress in others since this has not been their experience  Physically abused children engaged in more stealing behaviour, and neglected children engaged in more cheating behaviour and less rule compatible behaviour  The general nature of maltreated children’s peer relationships can be organized into two prominent themes: o First, maltreated children, particularly physically abused children and those who witness violence between parents, are more physically and verbally aggressive toward their peers  As a result they are less popular and have atypical social networks o The second theme is that maltreated children, especially neglected children, withdraw from and avoid peer interactions  They perform worse than other maltreated children on standardized tests of reading, language, and math  This pattern of poor adjustment often persists, leading to higher rates of personality disorders in early adulthood  Children with histories of sexual abuse are more likely than non-abused children to suffer in their academic performance and their ability to focus on tasks, be frequently absent from school, and receive teacher ratings of shyness-anxiousness  Due to stress and fear, sexually abused children may regress to behaviours of earlier levels of development, such as bed-wetting, clinging, sleeping problems, and self-destructive behaviours  Some child sexual abuse victims may show specific symptoms of sexualized behaviour as well as depression, withdrawal, and anxiety Psychopathology and Adult Outcomes  They are at a much greater risk for significant emotional and adjustment problems  Increased risk to develop interpersonal problems marked by their own acts of aggression and violence  This relationship between being abused as a child and becoming abusive toward others as an adult is known as the cycle-of-violence hypothesis, which infers that victims of violence become perpetrators of violence  Persons with histories of sexual abuse are more likely to develop chronic impairments in self-esteem, self-concept, and emotional and behavioural self-regulation, including severe outcomes such as PTSD and depression  Developmental impairments that stem from child maltreatment can lead to more pervasive and chronic psychiatric disorders, including anxiety and panic disorders, depression, eating disorders, sexual problems, and personality disturbances  Four prominent developmental outcomes of maltreatment – mood and affect disturbances, post-traumatic stress-related problems, sexual adjustment, and criminal and antisocial behaviour Mood and Affect Disturbances  The causes of these symptoms som
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