Child Abuse

Concept, Course, Long & Short Term

Consequences, Measures To Counteract
 Content
 Concept – Introduction ,Meaning and Definition
 Historical Background
 Types
 Prevalence
 Causes or pre disposing factors
 Indicators
 Long and short term consequences
 Measures to counteract
 INTRODUCTION
• Childhood should be a care-free time filled with love, and the joy of
discovering new things and experiences.

• However, it is a dream for many children.

• It is an increasing social problem, a world wide concern

• The effects of child abuse and neglect are not limited to childhood.
 DEFINITION

Child abuse, as defined by Gill (1968)

“nonaccidental physical injury, minimal or fatal, inflicted upon children by persons

caring for them.”
 Definition

According to world health organization (WHO), child abuse

or maltreatment constitutes 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.
 HISTORICAL BACKGROUND
 First documented and reported case of CA/CN occurred in 1874 with a child named, Mary
Ellen.
 1870s: New York society for Prevention of Cruelty to Children established to work in
coherence with “House of Refuge”
 1946: Medical discovery of child abuse was documented by Caffey on observing children
with multiple bone fractures and children with trauma unsubstantiated by parents.
 1962: Term ‘Battered child syndrome’ by Henry Kempe
 1972: Kempe founded ‘Kempe Centre’
 1974: Child Abuse Prevention and Treatment Act
 1978: Mclain: coined CAN: Child abuse and neglect
 INDIAN HISTORY
 In1998 the Indian NGO Recovery and Healing from Incest (RAHI)
conducted India's first study of child sexual abuse)
 In
2005, the international organization Save the Children and an Indian
NGO, Tulir - Centre for Healing and Prevention of Child Sex Abuse
 TheNational Commission for the Protection of Child Rights (NCPCR) was
established in 2007

 Protection of Children from Sexual Offences (POCSO) Act, 2012.

(Reference Breaking the silence CSA in India , human rights watch printed
un usa published in feb 2013 www.Hrw.Org )
 TYPES OF ABUSE

• Physical abuse
• Sexual abuse
• Emotional abuse
• Child Neglect
 PHYSICAL ABUSE

 Inflicting of physical injury upon a child.

 Include burning, hitting, punching, shaking, kicking, beating
or otherwise harming a child. The parent or caretaker may
not have intended to hurt the child.
 It may, however, be the result of over-discipline or physical
punishment that is inappropriate to the child's age.
 Prevalence
 Two out of every three children were physically abused.
 Out of 69% children physically abused, 54.68% were boys.
 Over 50% children were being subjected to one or the other form of physical
abuse.
 Out of those children physically abused in family situations, 88.6% were
physically abused by parents.
 The State of Andhra Pradesh, Assam, Bihar and Delhi have almost consistently
reported higher rates of abuse in all forms as compared to other states.
 50.2% children worked seven days a week.

Ref:-A study on Child Abuse: India 2007, conducted by Ministry of Women and Child development (GOI)
 Sexual abuse
 Inappropriate sexual behaviour with a child.
 It includes fondling a child's genitals, making the child fondle the
adult's genitals, intercourse, incest, rape, sodomy, exhibitionism
and sexual exploitation.
 To be considered ‘child abuse’, these acts have to be committed by
a person responsible for the care of a child (for example a baby-
sitter, a parent, or a daycare provider), or related to the child.
 If a stranger commits these acts, it would be considered sexual
assault and handled solely by the police and criminal courts.
 Sexual Abuse
 53.22% children reported having faced one or more forms of sexual abuse.
 Andhra Pradesh, Assam, Bihar and Delhi reported the highest percentage of sexual
abuse among both boys and girls.
 21.90% child respondents reported facing severe forms of sexual abuse and 50.76%
other forms of sexual abuse.
 Children in Assam, Andhra Pradesh, Bihar and Delhi reported the highest incidence of
sexual assault.
 50% abuses are persons known to the child or in a position of trust and
responsibility.

Ref:-A study on Child Abuse: India 2007, conducted by Ministry of Women and Child development (GOI)
 Emotional abuse
 Also known as verbal abuse, mental abuse, and psychological
maltreatment.
 Pattern of behavioral that impairs a child emotional development or
sense of self worth.
 Include constant criticism, threats or rejection as well as withholding
love, support, or guidance.
 Parents/caretakers using extreme and/or bizarre forms of punishment,
such as confinement in a closet or dark room or being tied to a chair for
long periods of time or threatening or terrorizing a child.
 Neglect

 It is the failure to provide for the child's basic needs.

 Neglect can be physical, educational, or emotional.
 CHILD NEGLECT

PHYSICAL NEGLECT INADEQUATE

SUPERVISION
•Lack of appropriate
•Abandonment
supervision
•Nutritional neglect
•Exposure to hazards
•Clothing neglect
•Inappropriate caregivers
MEDICAL NEGLECT
•Denial of EMOTIONAL NEGLECT
EDUCATIONAL NEGLECT healthcare
•Inadequate
•Delay in health care
•Permitted habitual
Affection,lack of love and
support
absenteeism
•Chronic or extreme spouse
•Failure to enroll
•Inattention to
abuse
•Permitted drug or alcohol
special education
abuse
needs.
 Emotional Abuse and Girl Child Neglect
Every second child reported facing emotional abuse.
Equal percentage of both girls and boys reported
facing emotional abuse.
In 83% of the cases parents were the abusers.
48.4% of girls wished they were boys.

Ref:-A study on Child Abuse: India 2007, conducted by Ministry of Women and Child development (GOI)
 PREVALENCE IN INDIA
• India has largest number of children in the world (375 million),
nearly 40% of its population.
• 69% of Indian children are victims of physical, emotional, or sexual abuse.

• New Delhi, has an over 83% abuse rate.

• 89% of the crimes are committed by family members.

• Boys face more abuse (>72%) than girls (65%).

• More than 70% of cases go unreported and unshared even with parents/
family.
Understanding of child
abuse in society:

Though child abuse has been prevalent in

society, especially the incidence of
physical and emotional abuse, society
continues to maintain the denial of these
facts. Seshadri S, (2004), provides the
framework “the iceberg phenomenon”
PREDISPOSING FACTORS

PARENTAL CHARACTERISTICS

CHILD CHARACTERISTICS

ENVIRONMENTAL CHARACTERISTICS
 PARENTAL CHARACTERISTICS

Pregnancy was not wanted

Parent has a background of abuse when growing up
Young, unsupported mother often with low education
Parents have unrealistic expectations of the child and lack parenting
knowledge
Parent is isolated and has few supports
Parent has a mental illness or is abusing drugs or alcohol
 CHILD CHARACTERISTCS

• Unwanted or unplanned child

• No. of children in the family
• Child's temperament
• Position in the family
• Additional physical needs if ill or disabled
ENVIRONMENTAL CHARACTERISTICS

Overcrowding in the house

Poverty or lack of opportunity to improve the family’s resources

Family violence is present

A non biological adult living in the house

Family is experiencing multiple stresses

 PHYSICAL INDICATORS
• Bruises, welts, or bite marks

– Different colors or in various stages of healing

• Fractures, scars or internal injuries
– Back, buttocks & back of legs • Head trauma
– Groups, clusters or patterns , Not common for  Black eyes
age & activity level of child  Split lips or loose teeth
– Shape of bruise ie: shape of an object  Lumps on the head
 Facial bruises, or bruising behind the ear

• Burns
– Scald and immersion burns
• Sock-like, glove-like, doughnut shaped on
buttocks or genitalia
• Splash burns

– Contact burns
• Cigar, cigarette especially on the soles,
palms, back, buttocks
• Patterned like electric iron, electric burner, fire
place tool, etc.
• Rope burns on arms, legs, neck and torso
 Behavioral indicators of physical abuse

 Afraid or reluctant to go home, or runs away

 Shows unusual aggression, rages or tantrums flinches when touched
 Changes in school performance and attendance
 Withdraws from family, friends and activities previously enjoyed
 Poor self-esteem (e.g, Describes self as bad, feels punishment is
deserved, is very withdrawn), and
 Suicidal thoughts or self-destructive behaviour (e.G., Self-mutilation,
suicide attempt, extreme risk-taking behaviour)
 Possible indicators of sexual abuse
Physical indicators
unexplained or persistent pain,
bleeding or unusual discharge in
the genital or anal area
pregnancy,
sexually transmitted diseases
Behavioural indicators
Engages in age-inappropriate sexual play or
exhibits age-inappropriate sexual knowledge
Forces or coerces another child to engage in
sexual play
Inserts objects into vagina or rectum
Directs sexually intrusive behavior to adults
Has unexplained gifts, new clothes or money
Has changes in school performance and
attendance
Secretive about “new” friends, activities,
phone calls or internet use
Unexplained developmental setbacks
Involved in sexually exploitive activities, such
as performing sex acts for money
 Possible indicators of emotional abuse
Behavioural indicators
Physical indicators » Mental Or Emotional Development Lags
Bed » Isolated And Has No Friends Or Complains Of
Wetting Or Social Isolation
» Fear Of Failure, Overly High Standards, Reluctant
Frequent Diarrhea, And To Play
» Extreme Withdrawal Or Aggressiveness, Mood
Frequent Psychosomatic Swings
» Overly Compliant, Too Well-Mannered
Complaints, Headaches, » Excessive Neatness And Cleanliness
» Extreme Attention-Seeking Behaviours
Nausea, Abdominal Pains » Poor Peer Relationships
» Severe Depression, May Be Suicidal
» Runaway Attempts
» Forbidden Contact With Other Children
» Shows Little Anxiety Towards Strangers,
» Unusual Severe Anxiety Or Worries
 Possible indicators of neglect
 Behavioural indicators
◦ Forages for, hoards or steals food
◦ Developmental delay or setbacks related to A lack of stimulation
◦ Poor school attendance, tired or unable to concentrate at school
◦ Appears sad or has flat affect
◦ Reluctant to go home; speaks of being or appears to be left alone at home A lot,
unsupervised
◦ involved in behaviours such as misuse of drugs or alcohol, stealing, fire-setting
◦ Does not respond to affection or stimulation

Kacker, L., Varadan, S., & Kumar, P. (2007). Study on Child Abuse: INDIA 2007. Ministry of Women and
Child Development, Government of India. Erişim Adresi: http://www. unodc.
org/pdf/india/publications/htvs_miniweb/childabuse
 CONSEQUENCES OF CHILD ABUSE

“Sensitive period” is a broad term that can apply to the effects of

extraordinarily strong experiences on the brain during a limited period in
development.
Critical periods are a special set of sensitive periods that result in irreversible
changes in brain function.
 CONSEQUENCES OF CHILD ABUSE AND NEGLECT

• All aspects of development are affected including brain, cognitive, and

social development.
• Characteristics of a child’s exposure to abuse or neglect—including timing,
chronicity, severity, and type of abuse—influence the risk for problematic
outcomes.

PSYCHOLOGICAL NEUROBIOLOGICAL
Short term effects of child abuse
 Anxiety

 Depression

 Low self-esteem
 Withdrawn

 Dissociation

 Difficulty with making and maintaining relationships

 Experiences flashbacks
 Hypervigilant
 Long term effects of child abuse

Depression
3 to 5 times more common. (Beitchman et al.1992)
◦ Guilt and low self esteem
◦ Depression and withdrawal symptoms were found to be common among
children who experienced emotional, physical, or environmental neglect.
(Dubowitz, Papas, Black, & Starr, 2002).
Lack of parental care after abuse is associated with depression in
adults (Fergussion et al, 1996; Mullen et al, 1993)
 Long term effects of child abuse
Self-mutilation, suicidality, self-defeating behavior

 30-50% of adult survivors manifest self defeating behavior (Briere,

1985)
 Internalized feelings of “I am bad and damaged”
 Withdraw from friends; engage in behaviors which lead to self
punishments.
 Compared with non-abused controls, CSA victims had significantly
higher frequency of suicide plans and/or deliberate self-harm or suicide
attempts 5% vs 0% (Bagley & Ramsay, 1986)
 Long term effects of child abuse

Anxiety disorders
Chronic low grade anxiety.
Phobias

Panic disorder
Life time prevalence- 37 % (Stein et al, 1998)
Negative body image– Body dysmorphic disorder
(Young, 1992; Simmons, 1991; Wenniger et al, 1998; Elizabeth Maclen 1990)
 Long term effects of child abuse

PTSD

50-60% have a history of sexual abuse.

Repressed memories of abuse
(Goodwin, 1985)
 Long term effects of child abuse

Dissociative disorder

Consequence of repressed memories of trauma

Consequence of long standing abuse (Briere, 1984)
DID- most extreme form of dissociation.
97% of DID cases have h/o CSA
(Putnam et al, 1986; Schlutz et al, 1985)
 Long term effects of child abuse

Sexual problems and sexuality

 50-60% have sexual problems (Briere, 1984; Herman, 1981)

 Promiscuity, early age of first pregnancy
 Fear of sexual experience
 Sexual dissatisfaction
 Sexual dysfunction
 Altered sexual orientation
 Consequence of internalization of “good things happen when I am
sexual” and “my sexuality means no feeling”
 Long term effects of child abuse

Revictimization.

◦ Abused women are more vulnerable to revictimization in later

adulthood.
◦ Rates of rape are as high as 33 % in victims compared to 17% (Russell
et al, 1986)
Sexual offending.
◦ Person who experience CSA will become perpetrators in adulthood,
more in men [50 – 80%] (Marvestin, 1986; Fehrenbach, 1988)
 Long term effects of child abuse

Substance use disorders

20-80% of patient (Goodwin, 1980)

As a strategy of coping
Internalization of “I am damaged”.
Early age at initiation of injection drug use.
 Inter personal relationship
Difficulty in initiating and maintaining strong relationship
needs
Avoidance vs multiple relationship
Internalization of lack of boundaries
CSA was also associated with a twofold increase in risk
for lifetime domestic violence (Brown et al, 2000)
 Management

Psychological debriefing
Cognitive Behaviour Therapy; such as Trauma- focused
(Cohen et al., 2000; Ramchandani & Jones, 2003).
Family therapy
Group therapy (Burke, 1988; Deblinger et al, 2001)
Ecosystem approaches
Preventive measures:
World Health Organization (1999) provides a comprehensive model for the prevention of violence and abuse
against children which says that the preventive activities can be taken up at three levels that is primary, secondary
and tertiary level.
 CURRENT MEASURES TO PREVENT CHILD
ABUSE IN INDIA

•The Protection of Children from Sexual Offences Act and Rules, 2012
•Section 19(1)
•Section 19 (7)
•Rule 4 (3)
•The Juvenile Justice (Care and Protection of children) Act 2000 and Delhi Rules 2009- Specific
preventive provisions
•The Right of Children to Free and Compulsory Education Act, 2009
•The Integrated Child Protection Scheme
•Adolescent Education Programme
•Guidelines for Eliminating Corporal Punishment in Schools
 The following sections of the Act deal with
child abuse ( J.J. Act)
 Section 23: Punishment for cruelty to juvenile or child: The Act provides for punishment
(imprisonment up to six months) if a person having the actual charge of, or control over, a juvenile or
the child, assaults, abandons, exposes or willfully neglects him/her, causes or procures him/her to
be assaulted, abandoned, exposed or neglected in any manner likely to cause such juvenile/child
unnecessary mental or physical suffering.
 Section 24: Employment of Juvenile or Child for Begging: The Act provides for punishment
(imprisonment for a term which may extend to 3 years and fine) if a person employs or uses any
juvenile/child for the purpose or causes any juvenile to beg.
 Section 26: Exploitation of Juvenile or Child Employee: The Act provides for punishment
(imprisonment for a term which may extend to 3 years and fine) if a person ostensibly procures a
juvenile/child for the purpose of any hazardous employment, keeps him in bondage and withholds
his earnings or uses such earning for his own purposes.
Punishments for Offences covered in the (POSCO Act)
 Penetrative Sexual Assault (Section 3) on a child — Not less than seven years which may
extend to imprisonment for life, and fine (Section 4)
 Aggravated Penetrative Sexual Assault (Section 5) — Not less than ten years which may
extend to imprisonment for life, and fine (Section 6)
 Sexual Assault (Section 7) i.e. sexual contact without penetration — Not less than three years
which may extend to five years, and fine (Section 8)
 Aggravated Sexual Assault (Section 9) by a person in authority — Not less than five years
which may extend to seven years, and fine (Section 10)
 Sexual Harassment of the Child (Section 11) — Three years and fine (Section 12)
 Use of Child for Pornographic Purposes (Section 13) — Five years and fine and in the event of
subsequent conviction, seven years and fine Section 14 (1)
 1098 child help line

• The CHILDLINE team receives & responds to the calls

• Crisis Intervention
• Direct assistance: medical, shelter, protection from abuse, intensive counselling
• On phone: Emotional support and guidance, information and referral to services for the
caller, information about CHILDLINE, silent calls
• Long-term rehabilitation
• After the emergency needs of the child have been addressed, CHILDLINE explores options
with the child to study, learn a trade, go back home etc. Based on the decision of the child,
CHILDLINE links the child to an appropriate organisation in the city.
 Child Welfare Committee
 As per section 30 of the juvenile justice (care & protection of children) act, the committee shall
perform the following functions:-
 Taking cognizance of and receiving the children produced before it
 Conducting inquiry on all issues relating to and affecting the safety and well being of the children under this
act
 Directing the child welfare officers or probation officers or district child protection unit or non-governmental
organizations to conduct social investigation and submit a report before the committee;
 Conducting inquiry for declaring fit persons for care of children in need of care and protection
 Directing placement of a child in foster care
 Ensuring care, protection, appropriate rehabilitation or restoration of children in need of care and protection,
based on the child’s individual care plan and passing necessary directions to parents or guardians or fit
persons or children’s homes or fit facility in this regard
 selecting registered institution for placement of each child requiring institutional support, based on the child’s
age, gender, disability and needs and keeping in mind the available capacity of the institution;
 Role of Police in handling Child abuse

Public can Report to police about any child abuse incident

Police will rescue the child from the situation
Shift to safe environment
FIR will be under POSCO/J.J. Act
Produce in front of CWC/JJB
 Conclusion
 Children’s abuse experiences should be acknowledged and characterized as
wrong, unlawful, and harmful in all abuse-specific interventions with children,
families, and parents.
 Child abuse is never acceptable .
 Offending parents often have a rationale for their abusive behavior that is based
upon distorted ideas of child welfare.
 Interventions should guard against being co-opted by these rationales.
 Children’s physical and emotional safety should be assessed and given
significant weight in treatment planning and the interventions undertaken