| An
estimated 905,000 children were victims of child
abuse or neglect in 2006 (U.S. Department of Health
and Human Services, 2008). While physical injuries
may or may not be immediately visible, abuse and
neglect can have consequences for children, families,
and society that last lifetimes, if not generations.
The impact of child abuse and
neglect is often discussed in terms of physical,
psychological, behavioral, and societal consequences.
In reality, however, it is impossible to separate
them completely. Physical consequences, such as
damage to a child's growing brain, can have psychological
implications such as cognitive delays or emotional
difficulties. Psychological problems often manifest
as high-risk behaviors. Depression and anxiety,
for example, may make a person more likely to smoke,
abuse alcohol or illicit drugs, or overeat. High-risk
behaviors, in turn, can lead to long-term physical
health problems such as sexually transmitted diseases,
cancer, and obesity.
This fact sheet provides an overview
of some of the most common physical, psychological,
behavioral, and societal consequences of child abuse
and neglect, while acknowledging that much crossover
among categories exists.
Factors Affecting the Consequences
of Child Abuse and Neglect
Not all abused and neglected children
will experience long-term consequences. Outcomes
of individual cases vary widely and are affected
by a combination of factors, including:
- The child's age and developmental status when
the abuse or neglect occurred
- The type of abuse (physical abuse, neglect,
sexual abuse, etc.)
- The frequency, duration, and severity of abuse
- The relationship between the victim and his
or her abuser (English et al., 2005; Chalk, Gibbons,
& Scarupa, 2002)
Researchers also have begun to
explore why, given similar conditions, some children
experience long-term consequences of abuse and neglect
while others emerge relatively unscathed. The ability
to cope, and even thrive, following a negative experience
is sometimes referred to as "resilience."
A number of protective and promotive factors may
contribute to an abused or neglected child’s
resilience. These include individual characteristics,
such as optimism, self-esteem, intelligence, creativity,
humor, and independence, as well as the acceptance
of peers and positive individual influences such
as teachers, mentors, and role models. Other factors
can include the child's social environment and the
family’s access to social supports. Community
well-being, including neighborhood stability and
access to safe schools and adequate health care,
are other protective and promotive factors (Fraser
& Terzian, 2005).
Physical Health Consequences
The immediate physical effects
of abuse or neglect can be relatively minor (bruises
or cuts) or severe (broken bones, hemorrhage, or
even death). In some cases the physical effects
are temporary; however, the pain and suffering they
cause a child should not be discounted. Meanwhile,
the long-term impact of child abuse and neglect
on physical health is just beginning to be explored.
According to the National Survey of Child and Adolescent
Well-Being (NSCAW), more than one-quarter of children
who had been in foster care for longer than 12 months
had some lasting or recurring health problem (Administration
for Children and Families, Office of Planning, Research,
and Evaluation [ACF/OPRE], 2004a). Below are some
outcomes researchers have identified:
Shaken baby syndrome.
Shaking a baby is a common form of child abuse.
The injuries caused by shaking a baby may not be
immediately noticeable and may include bleeding
in the eye or brain, damage to the spinal cord and
neck, and rib or bone fractures (National Institute
of Neurological Disorders and Stroke, 2007).
Impaired brain development.
Child abuse and neglect have been shown, in some
cases, to cause important regions of the brain to
fail to form or grow properly, resulting in impaired
development (De Bellis & Thomas, 2003). These
alterations in brain maturation have long-term consequences
for cognitive, language, and academic abilities
(Watts-English, Fortson, Gibler, Hooper, & De
Bellis, 2006). NSCAW found more than three-quarters
of foster children between 1 and 2 years of age
to be at medium to high risk for problems with brain
development, as opposed to less than half of children
in a control sample (ACF/OPRE, 2004a).
Poor physical health.
Several studies have shown a relationship between
various forms of household dysfunction (including
childhood abuse) and poor health (Flaherty et al.,
2006; Felitti, 2002). Adults who experienced abuse
or neglect during childhood are more likely to suffer
from physical ailments such as allergies, arthritis,
asthma, bronchitis, high blood pressure, and ulcers
(Springer, Sheridan, Kuo, & Carnes, 2007).
Psychological Consequences
The immediate emotional effects
of abuse and neglect—isolation, fear, and
an inability to trust—can translate into lifelong
consequences, including low self-esteem, depression,
and relationship difficulties. Researchers have
identified links between child abuse and neglect
and the following:
Difficulties during infancy.
Depression and withdrawal symptoms were common among
children as young as 3 who experienced emotional,
physical, or environmental neglect. (Dubowitz, Papas,
Black, & Starr, 2002).
Poor mental and emotional
health. In one long-term study, as many
as 80 percent of young adults who had been abused
met the diagnostic criteria for at least one psychiatric
disorder at age 21. These young adults exhibited
many problems, including depression, anxiety, eating
disorders, and suicide attempts (Silverman, Reinherz,
& Giaconia, 1996). Other psychological and emotional
conditions associated with abuse and neglect include
panic disorder, dissociative disorders, attention-deficit/hyperactivity
disorder, depression, anger, posttraumatic stress
disorder, and reactive attachment disorder (Teicher,
2000; De Bellis & Thomas, 2003; Springer, Sheridan,
Kuo, & Carnes, 2007).
Cognitive difficulties.
NSCAW found that children placed in out-of-home
care due to abuse or neglect tended to score lower
than the general population on measures of cognitive
capacity, language development, and academic achievement
(U.S. Department of Health and Human Services, 2003).
A 1999 LONGSCAN study also found a relationship
between substantiated child maltreatment and poor
academic performance and classroom functioning for
school-age children (Zolotor, Kotch, Dufort, Winsor,
& Catellier, 1999).
Social difficulties.
Children who experience rejection or neglect are
more likely to develop antisocial traits as they
grow up. Parental neglect is also associated with
borderline personality disorders and violent behavior
(Schore, 2003).
Behavioral Consequences
Not all victims of child abuse
and neglect will experience behavioral consequences.
However, behavioral problems appear to be more likely
among this group, even at a young age. An NSCAW
survey of children ages 3 to 5 in foster care found
these children displayed clinical or borderline
levels of behavioral problems at a rate of more
than twice that of the general population (ACF,
2004b). Later in life, child abuse and neglect appear
to make the following more likely:
Difficulties during adolescence.
Studies have found abused and neglected children
to be at least 25 percent more likely to experience
problems such as delinquency, teen pregnancy, low
academic achievement, drug use, and mental health
problems (Kelley, Thornberry, & Smith, 1997).
Other studies suggest that abused or neglected children
are more likely to engage in sexual risk-taking
as they reach adolescence, thereby increasing their
chances of contracting a sexually transmitted disease
(Johnson, Rew, & Sternglanz, 2006).
Juvenile delinquency and
adult criminality. According to a National
Institute of Justice study, abused and neglected
children were 11 times more likely to be arrested
for criminal behavior as a juvenile, 2.7 times more
likely to be arrested for violent and criminal behavior
as an adult, and 3.1 times more likely to be arrested
for one of many forms of violent crime (juvenile
or adult) (English, Widom, & Brandford, 2004).
Alcohol and other drug
abuse. Research consistently reflects an
increased likelihood that abused and neglected children
will smoke cigarettes, abuse alcohol, or take illicit
drugs during their lifetime (Dube et al., 2001).
According to a report from the National Institute
on Drug Abuse, as many as two-thirds of people in
drug treatment programs reported being abused as
children (Swan, 1998).
Abusive behavior.
Abusive parents often have experienced abuse during
their own childhoods. It is estimated approximately
one-third of abused and neglected children will
eventually victimize their own children (Prevent
Child Abuse New York, 2003).
Societal Consequences
While child abuse and neglect
almost always occur within the family, the impact
does not end there. Society as a whole pays a price
for child abuse and neglect, in terms of both direct
and indirect costs.
Direct costs. Direct
costs include those associated with maintaining
a child welfare system to investigate and respond
to allegations of child abuse and neglect, as well
as expenditures by the judicial, law enforcement,
health, and mental health systems. A 2001 report
by Prevent Child Abuse America estimates these costs
at $24 billion per year.
Indirect costs.
Indirect costs represent the long-term economic
consequences of child abuse and neglect. These include
costs associated with juvenile and adult criminal
activity, mental illness, substance abuse, and domestic
violence. They can also include loss of productivity
due to unemployment and underemployment, the cost
of special education services, and increased use
of the health care system. Prevent Child Abuse America
estimated these costs at more than $69 billion per
year (2001).
Summary
Much research has been done about
the possible consequences of child abuse and neglect.
The effects vary depending on the circumstances
of the abuse or neglect, personal characteristics
of the child, and the child’s environment.
Consequences may be mild or severe; disappear after
a short period or last a lifetime; and affect the
child physically, psychologically, behaviorally,
or in some combination of all three ways. Ultimately,
due to related costs to public entities such as
the health care, human services, and educational
systems, abuse and neglect impact not just the child
and family, but society as a whole.
Resources on the Child
Welfare Information Gateway Website
Child Abuse and Neglect
http://www.childwelfare.gov/can/
Defining Child Abuse and Neglect
http://www.childwelfare.gov/can/defining/
Preventing Child Abuse and Neglect
http://www.childwelfare.gov/preventing/
Reporting Child Abuse and Neglect
http://www.childwelfare.gov/responding/reporting.cfm
References
Administration for Children and Families,
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Who are the children in foster care? NSCAW
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(PDF - 221 KB)
Administration for Children and Families,
Office of Planning, Research and Evaluation. (2004b).
Children ages 3 to 5 in the child welfare system.
NSCAW Research Brief No. 5. Washington, DC: Author.
Chalk, R., Gibbons, A., & Scarupa,
H. J. (2002). The multiple dimensions of child
abuse and neglect: New insights into an old problem.
Washington, DC: Child Trends. Retrieved April 27,
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