Rizal Technological University

Pasig Campus

A Phenomenological Research entitled:

Nanay, Tatay gusto kong kalinga. Ate, Kuya wag nyo kong api:
Phenomenological Study of a Battered Child

In Partial Fulfillment of the Requirements

In Research II

Submitted to:

Mrs. Elena T. Paragas

Submitted by:

Group 6

Macaraeg, Christine Jane

Mabagos, Angelika
Austria, Rumy

MH: 12:00-1:30pm
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CHAPTER I
Problem and Context

INTRODUCTION

The occurrence of childhood abuse and neglect is a widespread problem in our

nation. Each year, approximately 800,000 children in the United States are victims of

child maltreatment, including various forms of abuse, abandonment, threats of harm,

and neglect (U.S. Department of Health and Human Services, 2010, p. xiii). The federal

law defines child abuse and neglect as a recent act or failure to act on the part of the

caregiver which results in death, serious physical or emotional harm, sexual abuse or

exploitation; or presents an imminent risk of serious harm, according to the Federal

Child Abuse Prevention and Treatment Act (CAPTA) (U.S. Department of Health and

Human Services, 2003, p. 44). Child abuse as well as other forms of maltreatment, such

as neglect, is a severe issue in the United States, but the scope of the problem is much

more broad. Internationally, between 25-50% of children report being physically abused.

Statistics such as this illustrate how child maltreatment is a global crisis with the

potential for serious lifelong implications (World Health Organization [WHO], 2010).

These childhood experiences cause detrimental, long-lasting effects during cognitive,

behavioral, and emotional development and often well into adulthood. Recent research

has shown that childhood maltreatment is associated with negative health outcomes

and adolescent violent behaviors. Many individuals who experience maltreatment such

as neglect or abuse are greatly affected beyond childhood and adolescence; there is a

significant relationship between child abuse and psychological Early Childhood Abuse
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and Neglect 2 disorders in adulthood (Hussey, Chang, & Kotch, 2006). Because of this,

it is important to recognize the severity of child maltreatment and its effects on the

psychological well-being of children and adults in order for progress regarding the

decline of maltreatment to be made.

An understanding of the physical, behavioral, and psychological effects on those

who experience abuse or neglect in early childhood was particularly important to me for

several reasons. Through my family members, I have seen the tremendous negative

impact child abuse can have on an individual, emotionally and developmentally. The

unfortunate circumstances I can attest to truly affected me and I developed an

interested in understanding the repercussions of abuse and neglect experiences,

specifically long-term. Because of my personal experiences, I felt that an internship at

the San Luis Obispo Child Development Center (SLO CDC), an educational classroom

center for children at risk of abuse and neglect, would be most suitable and valuable to

me. After spending time with the children at the center, my interests blossomed and I

developed a desire to know more about the conditions that result from abuse and

neglect. Furthermore, my goal is to attend graduate school to achieve a Masters in

Social Work, and it is likely that eventually I will work with individuals who have

experienced trauma of this sort or other situations that lead to negative behavioral or

psychological effects.
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Theoretical Framework

The Battered-Child Syndrome, transforming the way we see our society, has

inevitably made us all more suspicious of the world around us. Every medical student,

every police officer, every teacher, is fully aware of the dark side of family life, and the

possibility that children are victims and parents are perpetrators. Statistics gathered by

the U.S. Department of Health and Human Services (2010) show that younger children

are more victimized by maltreatment than older children and adolescents, in fact, infants

ages zero to one year old are the most targeted early childhood age group with 21.7%

of all maltreatment cases involving infants (Maestripieri & Carroll, 2009). The two most

common types of maltreatment are neglect and physical abuse; 71% and 16.1% of

maltreated children suffer from neglect and physical abuse, respectively (U.S. Dept. of

Health and Human Services, 2010, p. xiv). Because of these alarming numbers, there is

a great deal of research trying to uncover more about the incredible frequency at which

child maltreatment occurs as well as the detrimental effects the acts have on their

victims. Many theories have been formulated on this topic, and significant findings have

been discovered regarding each theory. The Intergenerational Transmission Theory

suggests that various levels of exposure to trauma, specifically pertaining to abuse, can

lead to the likelihood of involvement in a violent relationship later in life (Fox, Robson, &

Gover, 2005). The Intergenerational Transmission Theory presumes that individuals,

who are victims of abuse, or witness family members being victims of abuse, develop

an abnormal perspective of violence. Many women are subject to the Intergenerational

Transmission of violence because they tend to become involved in abusive romantic

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relationships as a result of an unhealthy, abuse relationship with a mother or father.

One study of the Intergenerational Transmission Early Childhood Abuse and Neglect 4

Theory found that women who reported experiencing abuse as children were two

to three times more likely to experience Intimate Partner Violence (IPV) than women

who did not report being abused as children (Alexander, 2009). Some children and

adolescents receive an unhealthy amount of exposure of aggression and violence

depending on the physical environment in which they live and grow. Those who

experience abusive situations during cognitive development are more likely to develop a

maladaptive perspective of aggression. The Mimetic Theory suggests that exposure to

trauma can generate aggression and increases the likelihood of modeled abuse

behavior. The Mimetic Theory describes individuals who view a perpetrator of abuse as

powerful or admirable and therefore learn to act violently in order to imitate, or mimic,

acts of violence (Craig & Sprang, 2007). This theory is, in some ways, the reversal of

the Intergenerational Transmission theory of abuse because individuals who are victims

of abuse learn to act violently, whereas with Intergenerational Transmission, other

victims learn to accept violence. Many individuals in this situation witnessed family

members being victims of abuse or were victims themselves. This theory of mimicked

actions incorporates a basic longing for power. The victim sees the perpetrator as

powerful, and in order to assert his own power or to recapture power that was taken

from them, the witness or victim becomes a perpetrator of aggression or abuse himself

(Craig & Sprang, 2007). Environment also has a large impact on those who are

encompassed in the Mimetic Theory. Individuals who experience or witness more

physical aggression can develop an unhealthy idea of aggression exertion. Some may
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think the Mimetic Theory only reveals a mimicking pattern of aggression for boys

because of the common general assumption is that males are more aggressive than

females, but this assumption overlooks relational aggression. Research

Early Childhood Abuse and Neglect 5 shows that aggression in boys is shown

through physical aggression, or violence, whereas the aggression exhibited in girls is

relational. Therefore, it is possible that girls may also learn aggressive behavior and

aggressive emotions by witnessing physical abuse (Maestripieri & Carroll, 1998).

Family Systems Theory, a general theory of psychology regarding the interrelatedness

of family members explains that actions of a family member cannot be understood in

isolation, but must be examined within the context of the family. Many situations that

take place within families lead to strong emotional stressors. These stressors are risk

factors for the occurrence of abuse and should be resolved as soon as possible.

Families that experience some of these severe life stressors such as severe or enduring

illnesses, unemployment, financial problems, and relational problems within the family

unit, usually have a higher rate of child abuse than families without such stressors

(Crosson-Towner, 2005). Abusive parents have been seen to have less enjoyment of

their children and of general parenting experiences. They also typically exert a more

authoritarian parenting style, characterized as restrictive, demanding, and unresponsive

(Mapp, 2006). Some cultures or families may find authoritarian parenting to work best,

but many problems have been seen when this style is used. Many families entangled in

a pattern of abuse experience substance abuse or other psychological issues or can

find little support and are extremely isolated from others (Crosson-Towner, 2005).

Social isolation is a significant risk factor whether it is within the community, extended
 7

family, or immediate family. A helpful social support network is a fundamental resource

for family members both for parents dealing with many stressors as well as for the

children in the stressful and abuse environment.

Early Childhood Abuse and Neglect 6

Without intervention and treatment, children that experience abuse within the

family system can likely develop some of the same social and psychological risk factors

of abuse that carry on to adulthood (Crosson-Towner, 2005).

A Social Support Theory of abuse and neglect and the lack of support given to

caregivers closely relate to stressors in the Family Systems Theory, as mentioned

above, but it also suggests why mothers are statistically shown to be the most common

perpetrators of abuse on children. Many researchers assume it is because although

general household duties may have become more balanced between couples in recent

decades, mothers are still the primary caregivers and are given very little direct

childrearing support. Since mothers are likely to spend the most amount of time with

their children, it provides them with the most opportunity to exert abusive behavior

toward children (Chang, Theodore, Martin, & Runyan, 2008). As well as abuse, mothers

also are most likely to neglect their children because they are largely responsible for the

daily necessary care and protection children should receive and have the control to

deny appropriate guardianship. Mothers have the ability to promote a positive,

constructive environment, but in order to do so they need social support. Women who

are in a psychologically or physically abuse relationship with an intimate partner,

possibly because of reasons explained through the Intergenerational Transmission

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Theory, are at least twice as likely to exhibit abuse towards their children than those

women who have a healthy, supportive relationship with their partner (Mapp, 2006).

Women who are depressed have a diminished ability to parent effectively; these

mothers have difficulty communicating with their children and have more naturally

negative interactions with them. The family environment of a depressed mother is often

hostile, aggressive, and rejecting (Mapp, 2006). These factors are an Early Childhood

Abuse and Neglect 7 example of how unstable family systems can lead to a higher risk

of physical abuse on children.

Research has also been conducted on Attachment Theory from a perspective

involving abuse as well as neglect. Attachment Theory states that either secure or

insecure bonds may form between infant and mother in the first several months of the

infants life for the purposes of safety and security. The bond formed between infant and

mother influences the quality of the relationships a child has throughout his or her life.

One major assumption of the Attachment Theory is that the parents are a sanctuary of

safety throughout all of early childhood. Secure attachments cause children to develop

an internal model of self-competence and a model of dependability for others. Insecure

attachments, however, promote feelings of threat, rejection, and personal unworthiness

(Tarabulsy, Pascuzzo, Moss, St-Laurent, Bernier, & Cyr, 2008). Research shows that

maltreatment during infancy can often lead to insecure attachment relationships in the

childs developmental future.

Typically, attachment styles are known to be secure, insecure-avoidant, and

insecure-ambivalent, but a forth style has recently been recognized. The newly

recognized style of attachment is labeled as disorganized attachment (Tarabulsy et al.,

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2008). In the disorganized attachment style, parents act frightened or frightening in the

presence of their child, causing distress for the child. Parents might appear to be

frightened at how to properly manage their child if they do not feel capable or supported

in their responsibilities. A parent frightening their child might occur if the parent is

extremely harsh or authoritarian in their parenting style or if the parent has a strong or

unusual reaction to the child. While insecure-avoidant and insecure-ambivalent are

associated with Early Childhood Abuse and Neglect 8 high levels of risk of future

problems, the disorganized attachment style is actually associated with a highest

probability of future problems of all the different attachment styles (Tarabulsy et al.,

2008). Unhealthy attachments not only lead to poor child-caregiver relationships, but

can also cause a maladaptive self-development, deficient peer relationships, substance

abuse problems, and educational difficulties (Toth & Ciccheti, 2004).

Similar to the Attachment theory, the Parental Investment Theory suggests that

parents sometimes decreases or completely cease investment in their young when the

opportunity costs outweigh parental benefits (Maestripieri & Carroll, 1998). Children who

have abnormal physical features or a physical or mental disability are at risk for

experiencing neglect because of the Parental Investment Theory. This could be

because the parent may not feel the child is what they expected him or her to be or

because the child has failed to fulfill the expectations of the parents, whether realistic or

unrealistic (WHO, 2010). A lack of parental investment can also occur because of an

unhealthy attachment between parent and child; if a significant amount of bonding did

not occur between the parent and the child, parental investment is likely to be lower

(WHO, 2010). Another opportunity cost of parenting that could affect parental
 10

investment is the financial burden of childrearing. If parents see a greater benefit in a

different use of their finances than investment in their children, they are likely to take

advantage of the option that appears to have more personal gain.

Statement of the Problem:

The study attempts to appraise and ascertain different effects of child abuse to

children. The researchers aim to answer the following questions:

1. What is the profile of each participant in terms of:

A. Age

B. Gender

C. Educational Attainment

D. Family Structure

2. What are the different kinds of child abuse?

3. What are the physical, mental, emotional, and social effects of child abuse to

children?

4. How child abuse affects the interpersonal relationships and self-esteem of an

individual?

5. What are a battered childs acts and views towards society?

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Research Paradigm

Research paradigm is consists of three parts: the Input, the Process, and the

Output. The Input box contains the participants profile according to age, gender,

educational attainment, and their family structure.

The Process box includes the tools they used by the researchers that are

analysis and direct observation in obtaining their data. It also contains interpretation of

the results gathered through semi-structured interview about how they face their lives.

Lastly, the output box includes the knowledge, understanding and awareness on

they face their everyday lives. It also aims to know the probable solution to help

battered children.

INPUT PROCESS OUTPUT

Age 1. Interview Knowledge and

awareness on the life
Gender 2. Analysis and Direct of battered children
Observation
Educational
Probable solution and
Random Sampling intervention program
Attainment and direct interaction to help battered
with participant
Family structure children

Assumptions

1. The instrument to be used will elicit data reliable responses

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2. The respondents will fully understand the questions they will be asked

3. The respondents will provide honest expressions of their knowledge

Scope and Delimitation of the Study

This study is limited only to the children at DSWD Marikina ages 2-10 who

happen to be a battered child to be able for them to express themselves and for us to

know their situation.

Significance of the Study

To battered children this study will help the battered children be able to express their

feelings and emotions, and let others know their situation

To family this study will help the families to become aware of the feelings and

situations of a battered child

To community this can benefit the community and become an instrument for them to

have knowledge, understanding and awareness of the situation of battered children

To government authority this research could not be just an aid for the government to

take action on helping battered children but will also illuminate the issue

To future researchers this study will benefit the future researchers to gain additional

and important information that they can use as a basis for furtherance of their research
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Definition of terms

Battered child syndrome the set of symptoms, injuries and signs of mistreatment
seen on a severely or repeatedly abused child

Child abuse is physical, sexual, or psychological mistreatment or neglected of a child,

especially by a parent or other caregiver

Intervention is the act of inserting one thing between others, like a person trying to
help

Maltreatment is a cruel or violent treatment of a person or animal; mistreatment

Psychological growth means different things to different people. For some people it
means greater freedom to do what they want, live as they want and pursue their
interests

Psychotherapy is a general term for treating mental health problems by talking with a
psychiatrist, psychologist or other mental health provider

Treatment the manner in which someone behaves toward or deals with someone or
something.
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CHAPTER II

Related Literature and Studies

Effects of child abuse and neglect for children and adolescents

CFCA Resource Sheet__ January 2014

Child abuse and neglect is a social and public health problem, as well as a

children's rights issue in Australia. Abuse and neglect can lead to a wide range of

adverse consequences for children and young people. This paper provides an overview

of the possible effects of child abuse and neglect and explores whether different types

of maltreatment are associated with specific adverse consequences in childhood and

adolescence.

Types of abuse and neglect

Child abuse and neglect refers to any behavior by parents, caregivers, other

adults or older adolescents that is outside the norms of conduct and entails a

substantial risk of causing physical or emotional harm to a child or young person. Such

behaviors may be intentional or unintentional and can include acts of omission (i.e.,

neglect) and commission (i.e., abuse) (Bromfield, 2005; Cristofel et al., 1992; Gilbert et

al., 2009). The five main subtypes of child abuse and neglect are physical abuse,

emotional maltreatment, neglect, sexual abuse, and witnessing family violence.

Factors affecting the consequences of child abuse and neglect

Not all children exposed to similar experiences of abuse and neglect are affected

in the same way. For some children and young people, the effects of child abuse and
 15

neglect may be chronic and debilitating; others may experience less adverse outcomes

(Miller-Perrin & Perrin, 2007). A range of other life experiences and family

circumstances both positive and negative impact on a child's vulnerability or resilience

in the face of maltreatment, resilience refers to the ability of a child to cope and even

thrive despite being exposed to negative experiences (Child Welfare Information

Gateway, 2008; Hunter, 2012). When a child who has experienced abuse or neglect

has few protective factors such as positive relationships with extended family and

friends, the risk of more serious adverse outcomes increases a risk factors that may

contribute to poorer outcomes for children exposed to abuse and neglect include socio-

economic disadvantage, social isolation, living in dangerous neighborhoods, large

families, a caregiver with depression or alcohol or drug dependence, and whether the

child has a disability (Dubowitz & Bennett, 2007; Jaffee & Maikovich-Fong, 2011).

Factors that contribute to a child's resilience include child attributes (e.g., self-esteem

and independence), features of the family environment (e.g., parenting quality), and

extra-familial and community resources (e.g., high quality peer relationships and school

environment) (Haskett et al., 2006; Hunter, 2012).

Critical factors that influence the way child abuse and neglect affect children and

young people include the frequency and duration of maltreatment and the co-

occurrence of multiple forms of maltreatment.

Chronic maltreatment defined as "recurrent incidents of maltreatment over a

prolonged period of time" (Bromfield & Higgins, 2005, p. 39) has been linked to worse

outcomes than transitory or isolated incidents of maltreatment (e.g., Ethier, Lemelin, &

Lacharite, 2004; Graham et al., 2010; Johnson-Reid, Kohl, & Brett, 2012).
 16

Research suggests that maltreatment types are interrelated, that is, a large

proportion of children and young people who experience childhood abuse or neglect are

exposed to more than one type of abuse (known as multi-type maltreatment). Further to

this, other forms of victimization such as bullying or assault by a peer have often been

found to co-occur with child maltreatment (known as poly-victimisation) (Finkelhor,

Ormrod, & Turner, 2006). Research indicates that those who experience multi-type

maltreatment and/or poly-victimization are more likely to experience high levels of

trauma symptoms and worse outcomes than those who are exposed to no maltreatment

or only one type (Finkelhor et al., 2006; Higgins & McCabe, 2001).

In attempting to explain some of the adverse outcomes associated with chronic

and multi-type maltreatment a concept that is often employed is complex trauma.

Complex trauma reflects the multiple and interacting symptoms, disorders, multiple

adverse experiences, and the broad range of cognitive, affective and behavioral

outcomes associated with prolonged trauma, particularly if occurring early in life and

involving an interpersonal element (e.g., sexual abuse) (Price-Robertson, Rush, Wall, &

Higgins, 2013). Complex trauma affects the developing brain and may interfere with a

child's capacity to integrate sensory, emotional and cognitive information, which may

lead to over-reactive responses to subsequent stress and long-term effects such as

cognitive, behavioral, physical and mental health problems (National Scientific Council

on the Developing Child [NSCDC], 2007; Perry, 2001; Streeck-Fischer & van der Kolk,

2000).

For further details on chronic maltreatment, the interrelatedness of sub-types of

child abuse and neglect, and complex trauma, see rarely an Isolated Incident:
 17

Acknowledging the Interrelatedness of Child Maltreatment, Victimization and

Trauma (Price-Robertson et al., 2013).

Other factors that can affect the consequences of child abuse and neglect on

children and adolescents include: The age and developmental stage at which

maltreatment occurred: some evidence suggests that the younger the child was at the

time of the onset of the maltreatment, the more likely they are to experience problems

later in life; the severity of maltreatment: the greater the severity of abuse or neglect, the

higher the likelihood of negative outcomes; the type/s of abuse and/or neglect: different

sub-types of maltreatment may be related to different negative outcomes; the child or

young person's perceptions of the abuse: worse outcomes are likely if the

victim/survivor experiences feelings of self-blame, shame or stigmatization; and the

relationship the child or young person had (or has) with the perpetrator: for example, in

child sexual abuse increased negative affects tend to be associated with the perpetrator

being a father, father-figure or someone with whom the child has an intense, emotional

relationship (Bromfield & Higgins, 2005; Miller-Perrin & Perrin, 2007; Price-Robertson et

al., 2013).

Trauma, stress and the developing brain

Trauma caused by experiences of child abuse and neglect appears to have

serious effects on the developing brain (McCrory, De Brito, & Viding, 2010; Streeck-

Fischer & van der Kolk, 2000). The Center of the Developing Child at Harvard

University has released a range of working papers that critically review the literature on

brain development (NSCDC, 2007; 2010; 2012). They have noted several key
 18

messages: Brains develop over time and through interaction with the environment.

Chronic, toxic stress of the sort experienced by maltreated children, and particularly in

the absence of consistent, supportive and interactive relationships with adult caregivers,

has been found to have an especially deleterious effect on young children's growing

brains (NSCDC, 2007; 2012). Exposure to complex and chronic trauma can result in

persistent psychological problems. The interaction between genes and environment

also plays a role in how the brain develops, particularly during the early developmental

period (NSCDC, 2007; 2010).

Consequences of child abuse and neglect

Child abuse and neglect can affect all domains of development - physical,

psychological, emotional, behavioral, and social - all of which are interrelated. The

remainder of this paper discusses the possible consequences of child abuse and

neglect identified in the research literature. The research reviewed included high-quality

systematic reviews and primary studies with large representative samples in English-

speaking countries. Adverse consequences are broadly linked to all abuse types;

however, where appropriate, associations are made between specific types of

maltreatment and negative outcomes.

Attachment and interpersonal relationship problems

Babies and young infants exposed to abuse and neglect are more likely to

experience insecure or disorganized attachment problems with their primary caregiver

(Baer & Martinez, 2006; Cyr, Euser, Bakermans-Kranenburg, & Van Ijzendoorn, 2010;

Jordan & Sketchley, 2009; Meadows, Tunstill, George, Dhudwar, & Kurtz, 2011;
 19

Schore, 2002; Streeck-Fischer & van der Kolk, 2000). Patterns of child-caregiver

attachment are extremely important for a child's early emotional and social

development. For children with an insecure attachment, the parent/caregiver, who

should be the primary source of safety, protection and comfort, becomes a source of

danger or harm (Cyr et al., 2010; Hildyard & Wolf, 2002). Without the security and

support from a primary caregiver, babies and infants may find it difficult to trust others

when in distress, which may lead to persistent experiences of anxiety or anger (Streeck-

Fischer & van der Kolk, 2000).

Insecure attachments alter the normal developmental process for children, which

can severely affect a child's ability to communicate and interact with others and form

healthy relationships throughout their life (Bacon & Richardson, 2001). Reviews of the

literature have reported that child maltreatment is associated with problematic peer

relationships in childhood and adolescence (Meadows et al., 2011; Trickett, Negriff, Ji,

& Peckins, 2011). Further to this, difficulties in peer relations may be a precursor to

difficulties in romantic relations (Trickett et al., 2011).

Learning and developmental problems

Strong associations have been made between child maltreatment and learning

difficulties and/or poor academic achievement (Gilbert et al., 2009; Mills, 2004; Veltman

& Browne, 2001). Abuse and neglect in the early years of life can seriously affect the

developmental capacities of infants, especially in the critical areas of speech and

language (Wolfe, 1999).

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Prospective research studies have consistently shown that maltreated children

have lower educational achievement than other groups of children (Gilbert et al., 2009).

In a meta-analysis by Veltman and Browne (2001), 31 of 34 studies (91%) indicated that

abuse and neglect was related to poor school achievement and 36 of 42 (86%)

indicated delays in language development. However, the authors acknowledged that

studies associating child abuse and neglect with learning problems are problematic in

that most studies do not know the intellectual status of children before maltreatment. A

more recent longitudinal study of maltreated children in the United States found that

chronicity of maltreatment affected maths scores negatively and type of maltreatment

affected reading scores negatively but higher intelligence and daily living skills (e.g.,

ability to dress oneself, ability to perform household tasks) were protective factors

against poor math and reading performance (Coohey, Renner, Hua, Zhang, & Whitney,

2011).

Mental health problems

Extensive research has identified a strong relationship between child

maltreatment and a range of mental health problems, with post-traumatic stress

disorder (PTSD) often reported (Gilbert et al., 2009; Greeson et al., 2011; Kearney,

Wechsler, Kaur, & Lemos-Miller, 2010; Schore, 2002; Streeck-Fischer & van der Kolk,

2000). Recent research suggests that diagnosing children with PTSD does not capture

the full developmental effects of chronic child abuse and neglect and as noted

previously, many researchers now prefer the term "complex trauma" (Cook et al., 2005;

Price-Robertson et al., 2013). Maltreated children experiencing PTSD symptoms are

also often found to be experiencing other disorders such as attention deficit

 21

hyperactivity disorder, oppositional defiant and conduct disorders, substance abuse,

and anxiety, mood, psychotic, and adjustment disorders (Kearney, Wechsler, Kaur, &

Lemos-Miller, 2010).

Mental health problems, such as depression and anxiety disorders, have

consistently been linked with child abuse and neglect, particularly for adolescents

(Brown, Cohen, Johnson, & Smailes, 1999; Gilbert et al., 2009; Harkness & Lumley,

2008; Kaufman, 1991). In a review of seven large-scale studies, all studies showed a

high association between child maltreatment and depression in adolescence (Harkness

& Lumley, 2008). For example, the authors cited a longitudinal study by Brown and

colleagues which found that children and adolescents who reported a history of abuse

or neglect were three times more likely to exhibit a depressive disorder than non-

maltreated children. Similarly, in a Victorian study of characteristics of children referred

to a therapeutic health service for children who had been abused or neglected (the Take

Two Program), 62% of children met the criteria for at least one mental health diagnosis

(Frederico, Jackson, & Black, 2008).

Eating disorders, including anorexia and binge-purge behavior (bulimia), may

also be associated with child abuse and neglect (Brewerton, 2007). Sexual abuse has

been widely linked to eating disorders in children and adolescents; however,

experiencing other maltreatment types or multiple forms of abuse and neglect has also

been shown to increase the risk of developing an eating disorder (Brewerton, 2007).
 22

Youth suicide

Research suggests that abuse and neglect significantly increases the risk of

suicidal ideation and attempted suicide for young people (Brodsky & Stanley, 2008;

Evans, Hawton, & Rodham, 2005; Miller, Esposito-Smythers, Weismoore, & Renshaw,

2013; Thompson et al., 2012). A systematic review by Evans and colleagues (2005)

found a strong link between physical and sexual abuse and attempted suicide/suicidal

thoughts occurring during adolescence. Similarly, in a systematic review of the

literature, Miller and colleagues (2013) found that although all forms of maltreatment

were associated with adolescent suicidal ideation and suicide attempts, child sexual

abuse and emotional abuse might be more important than physical abuse or neglect.

Supporting this, Brodksy and Stanley (2008) found that risks of repeated suicide

attempts were eight times greater for youths with a sexual abuse history. The authors

suggested that sexual abuse could be specifically related to suicidal behavior because it

is closely associated with feelings of shame and internal attributions of blame (Brodsky

& Stanley, 2008).

Alcohol and other drug use

The psychological effects of child abuse and neglect may lead to alcohol and

drug abuse problems in adolescence and adulthood (Fergusson & Lynskey, 1997;

Harrison, Fulkerson, & Beebe, 1997; Perkins & Jones, 2004). Evidence suggests that all

types of child maltreatment are significantly related to higher levels of substance use

(tobacco, alcohol and illicit drugs) (Moran, Vuchinich, & Hall, 2004). It is less clear if

particular types of maltreatment are more closely linked to substance misuse and what
 23

factors, if any, may mediate the relationship although physical abuse and combinations

of abuse do appear to be associated with increased substance abuse (Trickett et al.,

2011). In surveying public school students in Grades 6, 9 and 12 in the United States,

Harrison and colleagues (1997) found that experiences of physical or sexual abuse

increased the likelihood of students using alcohol, marijuana and other drugs. A further

study in the United States found that 28% of physically abused adolescents used drugs

compared to 14% of non-abused adolescents (Perkins & Jones, 2004). Compared to

22% of the non-abused group, 36% of physically abused adolescents also had high

levels of alcohol use.

Behavioral problems

Researchers have found that child abuse and neglect is associated with behavior

problems in childhood and adolescence (Ethier et al., 2004; Mills, 2004; Shaffer,

Huston, & Egeland, 2008). The earlier children are maltreated the more likely they are

to develop behavior problems in adolescence (Frederico et al., 2008). Researchers

have often associated maltreatment with internalizing behaviors (being withdrawn, sad,

isolated and depressed) and externalizing behaviors (being aggressive or hyperactive)

throughout childhood (Mills, 2004). Longitudinal studies have shown that exposure to a

single type of maltreatment as well as multiple types is related to increased internalizing

and externalizing behaviors in childhood and adolescence (Moylan et al., 2009). A

large, nationally representative study in the United States reported that children who

were maltreated in multiple developmental periods (infancy, toddlerhood, preschool

years and early school years) displayed more problem behaviors than children

maltreated in only one developmental period and children who were chronically
 24

maltreated tended to display more problem behaviors than children suffering situational

maltreatment, although this was mediated by a range of family variables such as

caregivers having alcohol or drug dependence, lower levels of education or diagnoses

of depression (Jaffee & Maikovich-Fong, 2011).

Aggression, violence and criminal activity

In addition to feeling pain and suffering themselves, children exposed to abuse

and neglect are at increased risk of inflicting pain on others and developing aggressive

and violent behaviors in adolescence (Gilbert et al., 2009; Haapasalo & Pokela, 1999;

Maas, Herrenkohl, & Sousa, 2008; Trickett et al., 2011). Research suggests that

physical abuse and exposure to family violence are the most consistent predictors of

youth violence (Gilbert et al., 2009; Maas et al., 2008). In a meta-analysis by Gilbert and

colleagues, both prospective and retrospective studies indicated strong associations

between child abuse and neglect and criminal behavior. A National Institute of Justice

study in the United States predicted that abused and neglected children were 11 times

more likely to be arrested for criminal behavior in adolescence (English, Widom, &

Brandford, 2004). Eighty three per cent of children in the Take Two program in Victoria

demonstrated repeated and severe violence towards others (Frederico et al., 2008).

Physical health problems

Research investigating the effect child abuse and neglect has on overall physical

health has largely focused on outcomes in adulthood. However, data from the

Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) in the United States has

indicated strong associations between abuse/neglect and health problems in

 25

children/adolescents (Flaherty et al., 2006, 2009). Flaherty et al. (2006) found that

exposure to one adverse experience doubled the odds of children having overall poor

physical health at the age of 6 years, and tripled them if children had experienced four

or more adverse experiences. A further study by Hussey, Chang, and Kotch (2006)

found that all types of abuse and neglect were associated with 8 of 10 major adolescent

health risks.

A common form of abuse affecting the health of babies is shaken baby

syndrome. Health problems resulting from shaken baby syndrome may include brain

damage, spinal cord injuries, hearing loss, speech difficulties and even death (Child

Welfare Information Gateway, 2008).

Teenage pregnancy

Adverse consequences of teenage pregnancy and risky sexual activity may also

be associated with experiences of abuse and neglect (Fergusson, Horwood, & Lynskey,

1997; Gilbert et al., 2009; Hillis et al., 2004; Mendes & Moslehuddin, 2006; Noell,

Rohde, Seeley, & Ochs, 2001). Research has consistently linked teenage pregnancy

with experiences of sexual abuse (Hillis et al., 2004; Paolucci, Genuis, & Violato, 2001).

Meta-analyses of 21 studies of child sexual abuse reported that this form of abuse more

than doubled the risk of adolescent pregnancy (i.e., prior to age 20 years) (Noll, Shenk,

& Putnam, 2009). Further to this, a study by Fergusson and colleagues (1997) found

that young women (18 years of age) exposed to child sexual abuse had significantly

higher rates of teenage pregnancy, increased rates of sexually transmitted diseases,

 26

and higher rates of multiple sexual partnerships and appeared to be more vulnerable to

further sexual assault and rape.

Homelessness

Research suggests that children and young people may encounter

homelessness or housing instability as a result of abuse and neglect (Edidin, Ganim,

Hunter, & Karnik, 2012). Homelessness is more likely to eventuate in adulthood

however, the Australian Bureau of Statistics (ABS) estimated that approximately 25,503

children were homeless on Census night in 2011 (29% of the homeless population)

(ABS, 2012). The Australian Institute of Health and Welfare (AIHW) indicated that

56,559 children aged up to 15 years accompanied their parents into Specialist

Homelessness services in 2011-12. The main reason for accompanied children to seek

support was domestic and family violence (33%) (AIHW, 2012).

Young people who are removed from the care of their parents because of abuse

or neglect may also face homelessness and unemployment soon after leaving out-of-

home care (e.g., when they turn 18). A lack of social support networks and poor

academic achievement often contribute to the difficulties young people face in finding

adequate housing and employment after care.

For a more detailed discussion on the relationship between child abuse/neglect

and adverse consequences of unemployment/homelessness in adulthood, see Effects

of Child Abuse and Neglect for Adult Survivors.

 27

Fatal abuse

The most tragic and extreme consequence of child abuse and neglect is abuse

that results in death. The World Health Organization (WHO) estimated 31,000 homicide

deaths of children aged 15 or younger around the world occur every year (WHO, 2010).

This is considered an underestimation as a large number of deaths caused by abuse

and neglect go unreported due to being misattributed to other causes such as falls or

insufficient investigations and a failure to run post-mortem examinations (Gilbert et al.,

2009; WHO, 2010).

In Australia, all deaths are registered at a state level by the Registrar for Births,

Deaths and Marriages. Statistics are compiled and reported by the ABS, and include

assault. No national data collection exists to describe deaths of Australian children due

to abuse and/or neglect. For further information on child deaths from maltreatment by

state in Australia, see Child Deaths from Abuse and Neglect.

The impact of child sexual abuse on mental health

Research has established a strong, albeit complex relationship between child

sexual abuse and adverse mental health consequences for many victims (Fergusson &

Mullen, 1999; Walsh, Fortier, & DiLillo, 2010). While much of the earlier research in this

area used cross-sectional studies with clinical or convenience samples, more recent

studies have increasingly used large random community samples, birth and twin

cohorts. These more rigorous studies have arguably generated more reliable and

generalisable findings, despite the assessment of child sexual abuse still being

predominantly retrospective in design (Cutajar et al., 2010a, 2010b).

 28

Noteworthy is a series of twin studies conducted over the last decade, which

have consistently revealed a link between child sexual abuse and adverse mental

health and related outcomes for survivors. Kendler et al. (2000), in an epidemiological

and co-twin controlled analysis of 1,411 twin pairs, reported significant odds ratios for a

range of psychiatric disorders in sexually abused women after controlling for family

environment. The effects were strongest for drug and alcohol dependence and bulimia

nervosa. Dinwiddie et al. (2000), in an Australian twin study with 5,995 twin pairs, also

found significant odds ratios for child sexual abuse and major depression, panic

disorder, and alcohol dependence. Similarly, Nelson et al. (2002) in another Australian

study involving 1,991 twin pairs found that in twins where one had been sexually

abused and the other not, the abused twins had significantly higher rates of major

depression, attempted suicide, conduct disorder, alcohol dependence, nicotine

dependence, social anxiety, rape as an adult, and divorce.

Negative mental health effects that have been consistently associated in the

research with child sexual abuse include post-traumatic symptoms (Canton-Cortes &

Canton, 2010; O'Leary & Gould, 2009; Ullman,Filipas, Townsend, & Starzynski, 2007);

depression (Fergusson et al., 2008; Nelson et al., 2002); substance abuse (Lynskey &

Fergusson, 1997; O'Leary & Gould, 2009); helplessness, negative attributions,

aggressive behaviours and conduct problems; eating disorders (Jonas et al., 2011); and

anxiety (Banyard, Williams, & Siegel, 2001; Nelson et al., 2002). More recently child

sexual abuse has also been linked to psychotic disorders including schizophrenia and

delusional disorder (Bendall, Jackson, Hulbert, & McGorry 2011; Lataster et al., 2006;

Wurr & Partridge, 1996) as well as personality disorders (Cutajar, 2010b). Child sexual
 29

abuse involving penetration has, in particular, been identified as a risk factor for

developing psychotic and schizophrenic syndromes (Cutajar et al., 2010a).

At the most serious extreme of mental health problems, the findings related to

suicide ideation, suicide attempts and actual suicides are of particular concern,

especially since the Victorian Parliamentary Inquiry into the Handling of Child Abuse by

Religious and Other Organisations was instituted at least partly on the basis that 40

Victorian people allegedly abused by Catholic clergy had committed suicide in recent

years.5 A number of studies indicate that sexual victimisation, both in childhood and

beyond, is a significant risk factor for suicide attempts and for (accidental) fatal

overdoses, among both men and women. This evidence comes from community and

clinical samples, as well as epidemiological record-matching studies and several

prospective longitudinal studies in various countries. Some earlier studies and reviews

(Briere & Zaidi, 1989; Fondacaro & Butler, 1995) reported mixed findings, but other

factors - such as co-existing child physical abuse, family dysfunction, depression, and

the consequences of disclosing child sexual abuse - were often not considered. Some

more recent and rigorous studies, however have used large-scale data sources or

longitudinal or follow-up designs, and reported significant links between child sexual

abuse and later suicidal behavior or ideation (Dube, Anda, & Whitefield 2005;

Fergusson et al., 2008; Molnar, Berkman, & Buka, 2001)

In particular, the Christchurch longitudinal study in New Zealand (noted in Box 1)

showed that exposure to childhood sexual abuse was related to "clear increases in the

risks of later mental health problems" (Fergusson et al., 2008, p. 617). These included

suicidal and depression, as well as anxiety disorders, conduct/anti-social personality

 30

disorder, and substance use. This association, from age 16 to 25 years, persisted after

taking account of other adverse factors in childhood such as physical abuse,

problematic parent-child attachment, and parental history of illicit drug use (Fergusson

et al., 2000, 2008). There was no significant association between child sexual abuse

and the family's socio-economic status. While physical abuse was also related to a

range of mental health disorders including suicide attempts, but not suicide ideation, the

long-term effects of child sexual abuse were generally larger than the long-term effects

of physical abuse. Overall, after adjusting for a range of other factors, children exposed

to sexual abuse involving attempted or completed sexual penetration had rates of

mental health disorders, including suicidal, that were 2.4 times higher than those of

children not so exposed. Estimates of the population attribute risk (PAR) suggested that

the elimination of child sexual abuse within the Christchurch cohort would have reduced

the overall rates of mental health disorder in adulthood by 13% (Fergusson et al., 2008,

p. 617).

A recent Australian study using quite a different methodology focused on

completed suicides and fatal drug overdoses. This study did not rely on self-report data

but was not able to take account of other contributory factors either early in life or closer

to the fatality. In this study, Cutajar et al. (2010b) linked the forensic medical records of

over 2,500 victims of child sexual assault in Victoria over a 30-year period with the

coronial data for a 44-year-span follow-up. They concluded that "child sexual abuse

victims are at increased risk of suicide and accidental fatal drug overdose" but that "it is

not possible to reliably attribute the association entirely to the experience of CSA"
 31

(p.186), given the non-random nature of the children who come to the attention of child

protection services and the police as a result of child sexual abuse allegations.

Importantly, not all victims of child sexual abuse develop mental health or adjustment

difficulties in adulthood. Lynskey and Fergusson (1997), for example, reported that one-

quarter of those exposed to child sexual abuse in their cohort study, did not meet the

criteria for any psychiatric diagnoses or adjustment difficulties in early adulthood.

However, it is important to be alert to sleeper effects with problems possibly emerging at

later stages in life or triggered by significant life events.

Walsh et al. (2010) have characterized child sexual abuse as a "non-specific risk

factor" (p. 2) for adjustment difficulties, since up to 25% of victims experienced no direct

psychological problems in childhood and up to 40% of victims exhibited no clear

symptomatology in adulthood. Green et al. (2010) also found that there was little

specificity for a range of childhood adversities, including sexual abuse and maladaptive

family functioning, being associated with various psychiatric disorders in a large-scale

community survey. Further, while there was a cumulative impact, this was not a straight

additive effect and it also declined with age.

Although a robust body of research demonstrates the link between child sexual

abuse and mental health problems, it is important to note that some studies fail to

control adequately for potentially confounding variables. As outlined earlier, these

include other childhood adversities, such as other forms of abuse, family functioning

and socio-demographic factors. The picture is complex, however, for two reasons. First,

there is evidence (see following section) that children who have already been victimized
 32

in various ways are more likely to be re-victimized sexually or physically both as

adolescents and adults. Second, recent large-scale studies in the US have found

evidence of a stress sensitization effect - that is, being exposed to a range of childhood

adversities including sexual abuse exacerbates the impact of stressful life events in

adulthood (Kendler et al., 2004; Espejo et al., 2006). McLaughlin et al. (2010) found, for

example, that both men and women with such adversities in childhood were more likely

to have psychiatric disorders when exposed to stressful life events in adulthood than

those without such early adversities. Finkelhor, Ormrod, and Turner (2007) also found a

similar effect within childhood, with children revealing elevated risks of trauma

symptoms if they had been subjected to several kinds of victimization within the past

year. Maker, Kemmelmeier, and Peterson (2001) highlighted that victims of child sexual

abuse are at greater risk of adult sexual assault and that the negative psychological

outcomes attributed to child sexual abuse may in fact be more strongly associated with

sexual assault in adulthood "as measures of psychological functioning may be more

sensitive to the effects of recent sexual trauma than the impact of more distal child

abuse" (p. 353). Importantly, more research is needed to examine the extent to which

interventions like counseling may improve the outcomes for survivors and mediate

some of the potentially negative consequences.

Studies that have specifically examined the long-term mental health outcomes

for male survivors of child sexual abuse are limited. Overall, research findings have

indicated that women survivors either experience more severe problems following child

sexual abuse (Ryan, Kilmer, Cauce, Watanabe, & Hoyt, 2000) compared with men, or

that their experiences are largely comparable (Boudewyn & Huser Liem, 1995; Roesler
 33

& McKenzie, 1994). However, some research findings suggest that male victims of child

sexual abuse may experience different and, in some respects, more adverse mental

health outcomes than female victims. For example, J. Hunter (1991) found that male

victims were more likely than women to experience anxiety, rumination and worry. Gold

et al. (1999) found that relative to their respective normative samples, male survivors

drawn from a clinical sample demonstrated greater symptomatology compared with

women survivors on measures of interpersonal sensitivity, depression, anxiety and

phobic anxiety. The picture, however, may be more complex than the findings using

various measures and diagnoses indicate. For example, Hillberg et al. (2011) concluded

that while a series of meta-analyses have failed to demonstrate significant gender

differences on mental health difficulties, there is empirical evidence of gender

differences at least in victims' perceived mental health consequences. This finding is

consistent with research that suggests that male survivors of child sexual abuse are

more susceptible to internalizing effects, while women are more likely to experience

externalizing effects (Dorahy & Clearwater, 2012; Romano & De Luca, 2001). This

contrasts with findings from research in other areas indicating that men are more likely

to externalize their problems. The difference may be related to gender norms that make

it difficult for men to discuss sexual abuse, and possibly even to a cultural bias that sees

women's, but not men's, promiscuity as an "externalizing" problem.

A small number of recent studies on clergy-perpetrated sexual abuse also

indicate that boys may be particularly susceptible to abuse of this type and to the effects

that play out in adulthood. A large-scale study on abuse allegations in the Catholic

Church in the US and a smaller study in Australia on allegations against Anglican clergy
 34

found that the majority of these allegations involved male victims. In the US study by the

John Jay College Research Team (2004), 81% of the victims were male, and 40% of all

victims were males aged 11-14 years.6 In the Australian study, 75% of the 180 victims

in 191 complaints were male (Parkinson, Oates, & Jayakody, 2010). The average time

from the alleged abuse to making a complaint was 25 years for males, and 18 years for

females. Neither of these studies was designed to look at the impact of the abuse on

the victims, and as Fogler et al. (2008) pointed out, "our knowledge of the effects of

CPSA [clergy-perpetrated sexual abuse] is still in its infancy" (p. 349).

There are indications, however, that sexual abuse by clergy and other powerful

authority figures may have particularly devastating effects. Brady (2008) drew strong

parallels here with the features of abuse within the family that are deemed particularly

damaging and difficult for children to deal with. These include the fact that: the families

of many victims were closely allied with the life of their church - a spiritual family; the

abuse tended to occur over an extended period of time, similar to many cases of incest;

adults frequently did not believe reports of abuse when alerted to it, which often also

occurs in cases of incest; church leaders tried to silence victims to avoid scandal, also a

repeated theme in incest; and many victims did not disclose the abuse until adulthood,

again similar to many cases of incest. (Doyle, 2003, as cited in Brady, 2008, p. 360)

In the same special issue of the Journal of Child Sexual Abuse, which was

concerned with the trauma of clergy sexual abuse, Fogler et al. (2008) drew together

the literature and provided some theoretical foundations for their conclusion that clergy-

perpetrated sexual abuse "can catastrophically alter the trajectory of psychosocial,

sexual, and spiritual development" (p. 330). Fogler et al. attributed the damaging impact
 35

of sexual abuse by clergy, which commonly occurs around the ages of 11-14 years, to

the way in which it undermines the victims' trust, sense of self, sexual identity, and

social and cognitive development.

As the body of research on the mental health consequences of child sexual

abuse continues to grow, more sophisticated and focused research is needed to tease

out possible gender differences as well as the influence of potential mediating factors on

the mental health outcomes for victims of child sexual abuse.

 36

CHAPTER III

RESEARCH METHODOLOGY

This chapter presents the research method used, participants, research

instrument, data collection and research field experience.

Method

This study will be done for the purpose of knowing the experience of a battered

child at DSWD Marikina. The researchers will use descriptive method to answer the

specific problem formulated. The use of this method is needed to realize that the

objectives in this study will be accurately obtained. It will consists of a set of gathered

data or information analyzed, summarized and interpreted among certain lines of

thought for the pursuit of the scientific purpose of the study.

The descriptive survey method is designed for the researchers to gather

information about present existing condition. This method involves collection of data in

order to test hypotheses or to answer questions concerning the current status of the

subject of the study. It involves determining information about variables rather than

about individuals and deals only with a portion of the population (Baui, 2006).

Participants

The respondents will be children from DSWD Marikina. The numeric

compositions of the respondents will be 15 boys and 15 girls whose age will range from

4 to 10 years old.
 37

Instrument

The researchers used survey questionnaires to interview the participants. The

researchers also used audio and video recording devices, as well as paper-and-pencil

notes. The survey was created using suitable questions modified from related research

and individual questions formed by the researchers. The survey was comprised of 20

questions, which were related to the participant's experience of being a battered child

and its cause and effect.

Data Collection

The data for this research were collected using a survey questionnaire. The

researchers gave time for the participants to respond then the researchers collected it

afterwards. Although the interview is recorded, the researchers took notes of the

interview using a small notebook and pencil/pen. These notes included information on

the effects of child abuse to the informant and responses by the informant on the topics.

The researchers also carefully noted the circumstances of the interviews. The

researchers also collected the personal characteristics of the participants such as age,

gender and family background. The questionnaire was distributed to the battered

children at DSWD Marikina ages 2 to 10 years old. The researchers assured the utmost

confidentiality of their survey sheets since the identities are important. There was no

money involved while conducting the survey. All the data and information collected from

the interview helped to answer and evaluate the research questions and were used only

for academic purposes.

 38

FIELD EXPERIENCE

The researchers encountered different experiences while conducting the said

study "The Phenomenological Study of Battered Child" in Marikina City. The researcher

felt glad to meet those children at the very first time. It wasn't like they were conducting

a research study rather it was like having a good time playing and telling stories with the

young ones, feeling of being a child once more as if they were friends in a very long

time. It was fun and exciting to be with the children in the fact that the researchers

longed to be back again to the place of study. It was also a good feeling when the

children always wait for the researchers to arrive at the place, you could see in their

eyes the excitement they feel as the children saw the researchers coming. The parents

and guardians of the participants were also glad to what the researchers did to their

children. According to them the researchers were good persons who didn't discriminate

them and gave a helping hand to people like them.

If there were a good times, of course there were also a bad times that the

researchers encountered in the research field. One of the huge problem of the

researchers was how would they get the children attention focusing on the interview

only and make sure they would answer the question correctly or relatively. In this

problem the two researchers come up with the simple group games to entertain the

other participants while one of them has been placed at the corner to be interviewed by

the other researcher.