Running head: CHILD ABUSE 1

Child Abuse: Types, Prevalence, Risks & Preventions

Lachelle Lewis-McDuffie

Liberty University
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Abstract

Child abuse is prevalent nationwide, and it exists across all races and many cultures. Children are

suffering from various forms of abuse at an alarming rate. The effects are serious, and a child

fatality is the most tragic consequence. The aim of this paper is to present the current research on

the types of child abuse, prevalence of, risks and preventions.

Keywords: child, abuse, risks, prevalence

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Child Abuse: Types, Prevalence, Risks & Preventions

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Types of Abuse

The WHO Consultation on Child Abuse Prevention defines child abuse as, “all forms of

physical and/or emotional ill-treatment, sexual abuse, neglect, or negligent treatment or

commercial or other exploitation, resulting in actual or potential harm to the child’s health,

survival, development or dignity in the context of a relationship of responsibility, trust or power”

(Babakhanlou & Beattie, p. 180). For this paper, we will concentrate on child neglect, physical

abuse, sexual and emotional/psychological abuse.

Child Neglect

Child neglect which is reported to be the most prevalent from of abuse; 74.9% in 2017,

(United States Department of Health & Human Services), is when a parent or caregiver fails to

provide for a child’s basic needs. Neglect falls into four categories: physical, medical,

educational, and emotional.

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Physical neglect. The failure to provide food or shelter, a safe environment to live in;

includes abandonment, inadequate supervision (Child Welfare Information Gateway, 2019).

Medical neglect. The failure of a parent to provide adequate medical or dental care;

especially when the child is in need of treatment due to a serious injury or illness (Babakhanlou

& Beattie, 2019).

Educational neglect. This is when a parent does not provide the necessary academic

environment in the home; hindering a child’s academic performance, allowing a child to skip

school, or failure to seek special education help for a child with learning problems (Child

Welfare Information Gateway, 2019).

Emotional neglect. This is when a parent fails to notice, attend to, or respond

appropriately to a child’s needs (Babakhanlou & Beattie, 2019). This can occur even when a

parent is providing for all the other needs of their child (Babakhanlou & Beattie, 2019).

Signs of neglect. A child displaying the following signs may be a victim of neglect:

frequently absent from school, begs or steals food or money, consistently dirty or has a severe

body odor, lacks needed medical care, or lacks sufficient clothing for the weather (Child Welfare

Information Gateway, 2019)

Physical Abuse

Physical child abuse is one of the most common types of abuse (18.3% in 2017), (United

States Department of Health & Human Services). It is described as a nonaccidental physical

injury to a child caused by a caregiver, parent, or other person responsible for a child (Child

Welfare Information Gateway, 2019). Physical abuse includes choking, punching, kicking,

shaking, throwing, burning, hitting (with a hand, stick, or other object), biting, drowning just to

name a few (Babakhanlou & Beattie, 2019).

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Signs of physical abuse. Identifying physical abuse can be difficult (Christian,

2015). Other then the child and perpetrator, witnesses to the abuse are rare and the victims are

either too young to talk (infants) or may be too severely injured or too frightened to talk

(Christian, 2015). However, common signs to look for are, bruises, scratches, strap marks, burns

and bite marks (Babakhanlou & Beattie, 2019).

Sexual Abuse

Sexual Abuse is the third most common type of abuse and is defined as any sexual

contact or inappropriate sexual stimulation of a child (Hassan, Hotz, Killian & Vicken, 2015).

Sexual abuse may include rape, fondling, genital or anal penetration, oral-genital contact,

exhibitionism, voyeurism and exposure to pornography (Babakhanlou & Beattie, 2019). The

United States Department of Health & Human Services, 2015 reported that 61,000 children

where victims of child sexual abuse in 2013 (Kenny, Abreu, 2015). In 70-90% of the cases the

child knew their perpetrator, relative/family friend and most were committed by men

(Babakhanlou & Beattie, 2019). Often these perpetrators use their authority and strength to

control their victim (Hassan, Hotz, Killion & Vicken, 2015). Females (65.9%) are more likely

than males (55.1% to be less than 12 years old when first sexually abused, boys are more likely

to be abused by strangers, and girls by a relative; oral intercourse is the most common with males

(52%), and fondling for females (63%), (Plummer & Cossins, 2018).

Signs of sexual abuse. Sexual abuse is hidden, but there are a few signs and symptoms

that may indicate abuse. The child may use sexual language, or have sexual knowledge not

expected for their age, may ask others to play sexual games, or behave sexually towards others,

display an interest in sexual acts inappropriate for their age (Babakhanlou & Beattie, 2019).
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Other signs include, soreness or inflammation in the genital area, underage pregnancy and sexual

transmitted diseases (Babakhanlou & Beattie, 2019).

Emotional/Psychological Abuse

Emotional or psychological abuse involves both the cognitive and affecting components

of maltreatment (Babakhanlou & Beattie, 2019). In 2017, 5.7% reported suffering from such

child abuse (Child Welfare Information Gateway, 2019). Emotional/psychological abuse is

defined by a repeated behavior of the caregiver that affects the child’s developmental

psychological or emotional well-being (Babakhanlou & Beattie, 2019). This type of abuse may

include verbal or non-verbal; passive or active acts, rejection, constant criticism, withholding

love, guidance or support, placing child in dangerous situations, or chaotic circumstances,

unrealistic expectations or restricting social interactions (Child Welfare Information Gateway,

2019).

Signs of emotional/psychological abuse. Signs that a child may be suffering from this

type of abuse are: withdrawn, depressed, clingy, acts out (bullying, uses profanity), exhibits

exaggerative fearfulness, suffers from sleep, speech or eating disorders, bedwetting, fecal soiling,

repetitive rhythmic movements (rocking, picking scabs, whining), suicidal thoughts (Child

Welfare Information Gateway, 2019).

Prevalence

As stated earlier, child abuse effects exist across all races. In 2017, the data showed that

3.5 million children were subjects of at least one report of abuse (USHHS, 2017). However, the

rate at which it affects each varies. African American children had the highest lifetime prevalence

of abuse investigations at 53%, followed by Hispanics at 32%, Caucasians at 28.2%, Native

Americans, 23.4%, and Asians/Pacific Islanders at 10.2% (Kim Wilderman, Jonson-Reid &
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Drake, p.277, 2017). Hispanic children had the highest lifetime prevalence for investigated

emotional abuse reports, followed by Native Americans, African Americans, Caucasians and

Asian/Pacific Islanders (Kim, Wilderman, Jonson-Reid & Drake, 2017). The above numbers only

show the number of investigations reported among each rate. These numbers can be broken

down into actual cases. It is estimated that 674,000 children were victims of child abuse and

neglect (UHHS, 2017). Children in their first year of life had the highest rate of victimization at

25.3 per 1000, children of the same age; American Indian or Alaskan Native children had the

highest rate at 14.3 per 1000 children in the population of the same race, and African American

children followed with 13.9 per 1000 children of the same race (USHHS, 2017). While the

number of victims decline as a child ages, the numbers are still high; nationwide 39, 572 5 year

old’s, reported to have been victims of child abuse, 34,342 at 9, and 26,912 at the age of 16

(USHHS< 2017). Nationally in 2017, it was reported that 327,373 males and 343,949 females

experienced some type of abuse.

Fatalities

The United States Department of Health & Human Services reported that in 2017 a

national estimate of 1,720 children died from child abuse and neglect at the rate of 2.32 per

100,000 children in the population. This is an 11% increase from the 2013 estimate of 1,550

(USHHS,2017). 72% of all children killed were younger than 3 years old, and nearly 49.6% were

younger than 1 years old and died at rate 21.92 per 100,000 children in the population of the

same age (USHHS< 2017). Child fatality rates decreased with age. Boys were more likely to

suffer a fatality than girls, 2.68 per 100,000compared to 2.02 per 100,000 girls in the population

(USHHS< 2017). Most child fatalities (88.5%0 occurred in one of three races, white (41.9%),

African American (31.5%), and Hispanic (15.1%). (USHHS, 2017). African American child
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abuse fatalities (4.86 per 100,000) is 2.6 times greater than the rate of white children (1.84 per

100,000) and 3.1 times greater than the rate of Hispanic children, (1.59 per 100,000 children),

(USHH,2017). Of the fatalities, 75.4% suffered neglect and 41.6 % suffered physical abuse alone

and or in combination with another type of abuse (USHHS, 2017).

Risk Factors

There are various factors that may contribute to child abuse. These predicators fall into

three categories, individual levels (parent, child), and community or environmental factors.

Parental. Characteristics that make a parent more likely to abuse or neglect their child

include, unwanted pregnancy (Christian, 2015), young age, limited education, single parenthood,

large number of children, mental health issues, substance abuse, parent was abused and limited

education (Ellington, 2017). Children whose parents have less than a high school education were

more three times more likely to abuse and seven times more likely to neglect their children than

parents with more education (Langsford, et al., 2015).

Children. Common characteristics associated with a child include, behavioral problems,

mental health issues, attention problems and medical conditions (physical and developmental

disabilities), (Ellington, 2017).

Community/Environment. Community/environmental issues that have been linked to

abuse are, community violence, disadvantage neighborhoods (high unemployment rates, poor

social connections, high density of liquor stores), poverty and domestic violence in the home

(Ellington, 2017). In 2015, 25% of victims were exposed to domestic violence (Ellington, 2017).

Prevention
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Prevention of child neglect early on through extended care and increased educational

services would benefit both the children and their parents. Most of the services in place to

prevent child abuse focus on working directly with the victim and at times with their families

(Klika, Haboush-Deloye & Linkenbach, 2019). In an attempt to prevent child abuse and neglect,

home visitation programs have been developed, implementing home-based parenting programs,

parenting curriculums, emotional support and connecting families with community services

(Duffy, Hughes, Asnes & Leventhal, 2014). Programs like this have traditionally targeted

families that are considered high-risk; certain sociodemographic characteristics (poverty, young

maternal age), (Duffy et al., 2014). These strategies move beyond just working with the parent

and child and recognize that understanding families in the context of their environment is crucial

to generate a lasting behavioral change (Klika et al., 2019). “Starting with the Child Abuse

Prevention & Treatment Act (CAPTA) and the Maternal Infant & Early Childhood Home

Visitation Program (MIECHV), there is a growing recognition that changing the conditions and

opportunities for families through social policies provide promise in preventing abuse and

neglect”, (Klika et al., p. 5, 2019). Based on these assumptions, the Centers for Disease Control

& Prevention implemented the, “Essentials for Childhood” child maltreatment prevention

strategy, (Klika et al., 2019). By gaining an accurate picture of what young children experience

in their world through their relationships with parents and caregivers, awareness campaigns can

be created to help create healthy neighborhoods and communities where a child can thrive,

(Klika et al., 2019).

In the prevention of child sexual abuse, preventions are placed on three levels, primary

prevention, secondary prevention and tertiary preventions (McKibbon, Humphreys & Hamilton,

2017).
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Primary prevention. Primary prevention involves child sexual abuse prevention

education. These preventions are usually school, or family based and involves informal

discussions or formal teaching sessions aimed at raising a child’s awareness about sexual abuse

and what to do in response to victimization (McKibbon et al., 2017). It may be delivered as part

of sexual education or gender-based violence prevention curriculum (McKibbon et al., 2017). It

includes teaching children about healthy relationships, how to identify a situation that could

become abusive and teaching people what to do if they suspect that someone is at risk of abusing

or being abused (McKibbon, et al., 2017).

Secondary prevention. Secondary prevention programs target children and young

people who are at risk of developing harmful sexual behavior (McKibbon et al., 2017). These

interventions focus on the development of harmful sexual behavior and are sometimes supported

by developmental or situational crime prevention theory (McKibbon et al., 2017). Stop it Now!,

a program that operates Nationwide, provides a positively-evaluated early intervention service

for adults and young people with potentially harmful sexual behavior (McKibbon et al., 2017). It

supports and provides information for those who are worried about their own sexual thoughts

and behaviors in real-life or online as well as parents, family members and professionals

concerned about child sexual abuse (McKibbon, et al., 2017). It also includes ensuring that

survivors have access to services such as, healthcare, advocacy and legal support (McKibbon et

al., 2017). Teaching responders (parents, teachers, doctors, advocates) how to screen for abuse

and what to do if they suspect it has happened or if the child discloses it (McKibbon et al., 2017).

Tertiary prevention. Tertiary prevention focuses on treating children and young people who

have committed sexual abuse, preventing further harm to child already involved in it (McKibbon

et al, 2017). The treatment model used are sensitive to the developmental stages of those who
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sexually harm (McKibbon et al., 2017). The two most common types of tertiary prevention are,

working with perpetrators to prevent them from reoffending and working with victims to prevent

long-term problems (McKibbon et al., 2017).

Interventions

Besides having child prevention programs in place, intervention services are just as

important. The United States Advisory board on Child Abuse & Neglect states that only a

universal system that is grounded in the creation of caring communities will work. Parenting-

focused intervention is important in the prevention strategy. Parent and family-based prevention

interventions are evidenced based (Prinz, 2015). Examples of these are:

 The Incredible Years- focuses on reducing problems in the child that may lead

parents to resort to abusive parenting techniques.

 Parent & Child Interaction Therapy- provides coaching to improve parenting

skills, and was effective in lowering repeat reports of child abuse among a group

of parents in Oklahoma

 Triple P (Positive Parenting Program)- a multifaceted parenting program that

includes a media campaign and various levels of training targeted at different

issues (Prinz, 2015).

These policies all have the following in common:

 Theorectically driven- the interventions are rooted in empirically derived theories

about child development, developmental psychopathology and resilience, change

processes and family interactions (Prinz, 2015). Theoretical foundations include,

cognitive-behavioral principles, social-learning and social interaction theory,

attachment theory and family systems concepts (Prinz, 2015).

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 Action-Focused- parents actively participate during the interventions (Prinz,

2015)

 Problem-Solving Oriented- specific challenges are addressed, a solution is worked

towards way that build on child and family strengths (Prinz, 2015).

 Specific Parenting Strategies- the interventions offer parenting strategies that are

specific and practical to their situation (Prinz, 2015)

 Collaborative Goal Setting- the parent and the intervention provider work together

to set goals (Prinz, 2015)

 Adoption of a positive frame- evidence-based parenting interventions are positive

based and done in non-judgmental environment (Prinz, 2015).

Another form of intervention is trauma based. Treatments extend beyond the physical injuries. 37

studies conducted during the past 7 years; cognitive-behavioral therapy is considered the leading

approach for treating children with trauma exposure (Ellington, 2017). Trauma focused CBT

(TF-CBT) is designed to treat post-traumatic stress disorder and related behavioral and emotional

problems by integrating cognitive, behavioral family and interpersonal therapy principles

(Ellington, 2017). Examples of these therapeutic psychosocial interventions are:

 Trauma Affect Regulation Guide for Education & Therapy (TARGET)- a 4-12

session therapeutic and educational intervention for traumatized youth and adults

conducted in either a group or one-on-one format, gender specific, focuses on

focusing and recognizing triggers, differentiate emotions, evaluate cognitions,

deliberate goals, options for actions

 Trauma & Grief Components Therapy for Adolescents (TGCTA)-