Intergenerational transmission of child abuse: rates, research, and clinical implications.

OBJECTIVE: The author reviews current wisdom concerning the rates and mechanisms of intrafamilial components of intergenerational transmission of child abuse and illustrates the unreliability of basic data and of assumptions made by reviewers and partisan advocates, most of whom underestimate the importance of intrafamilial factors in child abuse. METHOD: The information in the report was derived from original research plus a recently prepared compilation of 60 studies, mainly from the United States and the United Kingdom. RESULTS: The crude rates of intergenerational transmission of child abuse according to the studies reviewed are as follows: one-third of child victims grow up to continue a pattern of seriously inept, neglectful, or abusive rearing as parents. One-third do not. The other one-third remain vulnerable to the effects of social stress on the likelihood of their becoming abusive parents. Intrafamilial factors appear to be the cause of personally directed, as opposed to culturally condoned, child abuse. Broad social factors, and some medical and psychiatric conditions, lower or raise thresholds in which family and personal vulnerabilities and propensities operate. CONCLUSIONS: There is no justification for any extremist advocacy in apportioning responsibility between the "sins of the parents" and the failings of society. The contention that clinical research on abuse is inferior to, and must give way to, large-scale or statistically balanced self-report and questionnaire surveys is plausible, popular, convincing, and wrong.

Substance abuse and child abuse. Impact of addiction on the child.

At least 1 in 10 children in the United States is born into a chemically dependent family. Parental addiction has long-lasting detrimental effects on the health and safety of children. We must mobilize to free children from the double jeopardy of substance abuse and child abuse, and interrupt the multigenerational pattern of both problems. The short-term costs may be high, but the long-term costs will be much higher if we do not act. Simultaneous efforts are needed to prevent and treat both addiction and its too frequent consequence, child maltreatment.

Outcome and socioeconomic aspects of suspected child abuse scald burns.

Fifty-two children suffering from abuse-related scald burns were admitted between January 1, 1986, and June 30, 1991. Their clinical and socioeconomic aspects were compared with those of 50 nonabused scalded children. Patients were matched for age, total body surface area burn, and percentage of full-thickness burn. Patient characteristics and initial nutritional parameters were similar except for race; a higher percentage of black children were in the abused group. A significantly longer length of hospital stay was found in the abused children after using analyses of covariance to control for percentages of total and full-thickness body surface area burn. The number of operations and frequency of complications were increased in the abused group, but not significantly so. Several significant differences were found in the socioeconomic characteristics of the two groups. Children suspected of being scalded intentionally were more likely to be part of a broken home, belong to a single parent, and have a younger mother than were children in the control group. The majority of the parents of abused children were unemployed, and all but two earned less than $20,000/year. All but one of the abused children were discharged with a person other than their parents, and compliance with rehabilitation follow-up was significantly worse than with the control group. The person suspected of performing the abuse was always a family member, except in cases where the baby-sitter was the suspected abuser. Child abuse hurts not only the child but also society by increasing the need for resources to pay for extended hospital admissions.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of infant cries on alcohol consumption in college males at risk for child abuse.

This analog study examines the effect of hearing a child's cries on alcohol consumption, comprising one link in a possible association between drinking and child abuse. Thirty-two male undergraduate volunteers were preselected by age, drinking practices, and abuse potential. Subjects were assigned to either a high or low abuse potential group and were then randomly assigned to hear either an infant cry or a smoke alarm. Blood pressure was measured during each of three stimulus presentations. Following each presentation, the subject was asked to rate the stimulus on a number of different dimensions (e.g., soothing-arousing). Additionally all subjects participated in a subsequent taste-rating task as an unobtrusive measure of alcohol consumption. The results indicate that, regardless of risk group, subjects who listened to the infant cry consumed significantly more alcohol (M = 206 ml, SD = 126.43) during the taste-rating task than did those who heard only the smoke alarm (Mr = 95.68 ml, SD = 62.94) which was also rated as aversive. There was no relationship between abuse potential and alcohol consumption. Although diastolic blood pressure did not differ between groups, analysis of the infant rating scales revealed that, regardless of risk group, subjects who heard the infant cry reported feeling more aversion, arousal, and distress, than did those who heard the smoke alarm. These results lend additional support to studies depicting the infant cry as a stressful and aversive event, capable of eliciting increased drinking. Implications for arousal reduction by alcohol and a model of alcohol-induced child abuse are discussed.

Children hospitalized with child abuse and neglect: a case-control study.

A case-control study of 45 hospitalized abused children was conducted to reassess the risk factors for child abuse when confounding by social class was minimized. Cases were matched for age, sex, family structure, and social class with children admitted to hospital for an acute illness. Abused children were more likely to have younger parents, fewer siblings, and to have been separated from their mothers during the first year of life. Their parents were more likely to have been abused as children and to have a poor relationship with the child's other parent. The families of abused children had encountered more stressful life events in the preceding 12 months. Other previously recognized "risk factors" were not shown to have a statistically significant association with child abuse. Because child abuse is more prevalent in lower socioeconomic families, the association with many of these factors has been accepted as implying a causal relationship. Matching procedures which attempted to eliminate confounding by social class and family structure cast doubts on some previously held beliefs about the risk factors for child abuse.

Predicting adequacy of parenting by people with mental retardation.

While there has been increased attention placed upon the inadequacy of parenting by persons with mental retardation, such attention does little to increase our understanding of the complexities of parenting. A refocusing of research and intervention efforts is needed to examine the concomitants of adequacy of parenting. What we know about both the inadequacy as well as the adequacy of parenting by persons with mental retardation and the limitations of the information upon which we base these statements is reviewed. New foci are suggested in understanding both adequacy and the inadequacy of parenting by persons with mental retardation.

Families at risk of child maltreatment: entry-level characteristics and growth in family functioning during treatment.

Research suggests that perinatal screening and early intervention may reduce the incidence of maltreatment and improve the parenting in at-risk families. The question of whether families with different sets of entry-level characteristics differ in the way that they respond to intervention is asked in this paper. We investigated whether entry-level family functioning and family problems had an impact on length of time in treatment and the improvement or deterioration of family functioning over time. In our analyses, we used entry-level characteristics to classify families into five homogeneous groups--situationally stressed, chronically stressed, emotionally stressed, multirisk, and violent multirisk--and we found that treatment duration and rate of change in family functioning over time differed in clinically important ways across these groups. Our findings suggest that treatment is likely to be successful in stabilizing and slowly improving the family functioning of the majority of families at risk of child maltreatment.

Current parental stress in maltreating and nonmaltreating families of children with multiple disabilities.

Questionnaires were mailed to families of children with multiple disabilities to investigate whether differences in parental perception of stress and burden of care could be identified in those families who had previously been reported and substantiated as abusive or neglectful as compared to those families who had not been so reported. Two hundred and fifty-seven parents completed Friedrich's revised version of Holroyd's Questionnaire on Resources and Stress (QRS-F), an instrument designed to measure stress and burden of care in families of children with disabilities. Twenty-five (9.7%) had previously substantiated maltreatment reports. Results suggest that a history of maltreatment is not related to the family's currently perceived stress levels as measured by the Friedrich scale. Implications of the results are discussed.

The hand as a target organ in child abuse.

The authors reviewed the abuse reports submitted by the staff of The Children's Hospital, Columbus, Ohio, to determine the incidence and types of injuries inflicted to children's hands. The authors did not study hand injuries in children who were not reported as physically abused. The authors examined two time periods to ascertain changes injury severity. Of the 631 abuse reports submitted from 1980 to 1982, there were 52 injuries (8.2%) involving the hands. From July 1987 to July 1988 there were 42 hand injuries (13.4%) among 313 reports. In the 94 total cases, 19 (2%) children sustained injury to the hand only, including eight with burns, two with bruises, two with human bites, two with erythema, two with fractures, and one with a laceration. Children with burns to the hand alone were significantly younger than those with other types of injuries. Of the 94 children with hand and other injuries, 18 (20%) required hospital admission. Of the 19 with injuries to the hand only, five required hospital admission. A variety of instruments were used to injure these children. The hand is a delicate organ, and it is frequently the primary or incidental target of child abuse. Familiarity with the patterns and types of hand injury suffered in child abuse is essential for early recognition, reporting, and child protection.

Medical and developmental histories of maltreated children.

This paper represents a first attempt at delineating and summarizing the issues in a child's medical and developmental history associated with the probability of suffering abuse. The sample consisted of 96 children between 5 and 10 years of age, 61 of whom had been maltreated and 35 of whom served as controls. There were 22 items about which the medical and developmental histories of the maltreated children revealed a significantly greater risk than those of the controls. A factor analysis revealed that 78% of the variance in these items can be represented by eight independent factors. None of these factors was dominant; rather, each accounted for a significant amount of the variation among the original items. The individual items tended to load on the four strongest factors in a coherent, interpretable manner: Factor 1 represented behavior problems; factor 2, neonatal issues and failure to thrive; factor 3, familial disruption, with the child suffering mental illness and/or head injury; and factor 4, a "difficult" temperament during the first year of life. We conclude there are numerous independent factors in the medical and developmental histories of maltreated children which should be considered by pediatricians involved in cases of child abuse and neglect.

The role of the child in physical abuse: a reappraisal.

Friedrich and Boriskin's (1976) seminal review presented compelling evidence pointing toward the contribution of child factors in heightening risk for physical abuse. Indeed, many authors currently accept that certain child characteristics (e.g., prematurity, low birthweight) can directly lead to abuse. Much of the data in this area, however, is based on methodologically weak designs, and recent findings do not support the premise that children have a major role in the etiology of abuse. There is some suggestion that children with relatively circumscribed features may add to risk in families that already exhibit additional factors predisposing them to maltreatment. This paper re-examines the role of the child in abuse, reviews recent relevant research findings, and offers new directions that research in this area might take.

Birth outcomes, health problems, and neglect with prenatal exposure to cocaine.

Thirty children exposed prenatally to maternal use of cocaine were compared to 30 nonexposed subjects on maternal variables, birth outcomes, health problems in early childhood, and issues related to child maltreatment. Cocaine-exposed infants were more likely to have mothers who received inadequate prenatal care, have adverse birth outcomes including prematurity and retarded intrauterine growth, and have health problems beyond the newborn period including small stature and hypertonia. More cocaine-exposed children were placed in foster homes due to maternal neglect.

Münchausen's syndrome by proxy as a form of child abuse.

Munchausen's syndrome by proxy (MSBP) is an emotional disorder in which the parent, almost always the mother, induces or fabricates illness in her child in order to gain medical attention. Although numerous case studies exist in pediatric and medical literature, most nurses are unaware of the warning signs of this disorder. Psychiatric consultation liaison nurses are in an ideal position to identify and intervene in MSBP situations and can also support the pediatric nursing staff through feelings of denial, shock, and guilt as they recognize the syndrome and its danger to the child.

The health effects of economic insecurity.

BACKGROUND: Interest in the health and behavioral effects of economic insecurity appears to vary with the performance of the economy. The current recession in the United States and Western Europe and growing unemployment in Eastern Europe make it timely to analytically review the recent research concerned with the health effects of economic contraction. METHODS: The research concerned with the health and behavioral effects of economic insecurity is organized by dependent variable and method. Rules for determining which effects are supported by strong and which by weak evidence are developed and applied to the literature. RESULTS: Evidence for effects on symptoms of psychological distress, seeking help for psychological distress, and nonspecific physiological illness is strong. Evidence for effects on suicide, child abuse, adverse birth outcomes, and heart disease is characterized as weak or sufficiently controversial to warrant skepticism. CONCLUSIONS: The health effects of economic security are undoubtedly mediated by economic policies. Estimating the effect of policy alternatives on the incidence of various outcomes is, however, very difficult given the current state of the research. The effect of rising unemployment on health in Eastern Europe cannot, moreover, be estimated from existing research. Effects estimated from Western economies probably do not generalize to situations in which the meaning of economic insecurity is conditioned by profound social and political reforms.

Causes of child abuse and neglect.

This paper is a study of child abuse and neglect from the perspective of the child. Generally, the mistreatment of children was associated with "poor care" from parents, attributed mainly to immaturity, marital problems, alcohol abuse, unemployment, drug abuse and lack of money. Differences in attribution are noted between males and females, and some differences are noted by the age of the child. When factors other than the causes given by the children were taken into account, mistreatment was significantly related to family break-up, as well as long-term disinterest and lack of affection from the parents. When the children were asked for their "worst experience in life," the most common responses were "abuse" "family break-up," and for the juvenile offenders "getting charged with a crime."

Social and medical problems in children of heroin-addicted parents. A study of 75 patients.

Between January 1985 and December 1987, seventy-five children of intravenous heroin-addicted parents (one or both) were studied. Their ages ranged from 4 days to 14 years. All patients had suffered from several pediatric diseases. Three major types of problems were found among the children studied: infectious diseases, nutritional diseases, and parental neglect and/or disinterest. The most common diagnoses at discharge were gastroenteritis (24%), pneumonia (21%), malnutrition (17%), upper airway infectious diseases (13%), septicemia (12%), child abuse (4%), acquired immunodeficiency syndrome (3%), and other infectious diseases (24%). Their parents reported hepatitis B virus infection, acquired immunodeficiency syndrome (AIDS), and alcoholism. The unemployment rate among the fathers was 37%. Sixteen percent of mothers were prostitutes. There was an imprisonment record of 19% for mothers and fathers combined. A multidisciplinary approach for this group of children would make prevention possible and care less expensive.

[Trauma caused by shaking the infant--a special form of child abuse]. / Das Schütteltrauma des Säuglings--eine besondere Form der Kindesmisshandlung.

The shaking of infants is an often underestimated cause of head-injuries in children. Without any external signs the diagnosis can be missed. The combination of subdural hematoma of typically interhemispheric site and retinal bleeding is pathognomonic of the shaked-baby syndrome. It is caused by acceleration-deceleration movements of the head. We present three patients with whiplash-shaken-injuries who were admitted to our hospital with impaired consciousness or in coma. With little external signs of injury more detailed investigations revealed other, older injuries suggesting previous abuse. The outcome was not favourable. Two of the children were discharged with minor or mild psychomotor retardation and one child was severely handicapped. As in the battered-child-syndrome a good history, assessing child specific and familial risk-factors and the socioeconomic background are most important to confirm a diagnosis. This type of injury is usually part of the spectrum of child abuse.