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ISLAMIC MEDICAL EDUCATION RESOURCES-04

0703-Child Abuse and Neglect (Revisited)

Background reading for Year 2 Semester 2 PPSD Session on Wednesday 28th March 2007

1.0 DEFINITION OF CHILD ABUSE AND NEGLECT

The spectrum of child abuse is wide. It includes not only children who have suffered physical abuse with fractures and bruises (“the battered child”) but also those who have experienced emotional abuse, sexual abuse, deliberate poisoning, and the infliction of fictitious illness on them by their parents (Munchausen syndrome by proxy).

 

Children under the age of two are most liable to suffer direct physical abuse at the hands of their parents. Such abuse is more common in families who are poor and are living under stress and in which the parents themselves suffered cruelty as children. Frequently, the child shows other evidence of poor nutrition or neglect.

 

Sexual abuse, in which dependent, developmentally immature children are involved in sexual activities that they do not fully comprehend and to which they cannot give informed consent, has become increasingly recognized. Girls are involved mainly, and their fathers are the usual offenders. Sexual abuse frequently does not come to light until the older girl develops a psychosomatic illness, runs away from home, or is truant from school.

 

2.0 PREVALENCE OF CHILD ABUSE

Surveys in North America and Europe that ask adult subjects to recall childhood mistreatment indicate that between 10 and 30 percent of young girls are subjected to exploitation or abuse as widely defined above. Estimates of abuse or neglect by parents or guardians range from about 1 out of every 100 children to more than 1 in 7, and figures are far higher if emotional abuse and neglect are included.

 

Although widely prevalent, child abuse often is overlooked by family, friends, and health professionals. Prejudice, anxiety, and shame—not lack of information—seem to be the major reasons for the failure to recognize these private acts of violence—a form of tacit denial that leads to their perpetuation.

 

Child abuse can have serious future consequences for its victims, including delays in physical growth, impaired language and cognitive abilities, and problems in personality development, learning, and behaviour.

 

3.0 CAUSES OF CHILD ABUSE

Cruelty to children has several major causes. Abusive patterns of behaviour by parents can be viewed as maladaptive responses to stressful situations and feelings of powerlessness. As such, they represent the warped efforts of adults to master situations that are out of their control and to regain a psychological equilibrium through the imposition of their will on defenseless children.

 

Psychiatric and pediatric studies have shown that a large proportion of parents who abuse their children were themselves physically or emotionally mistreated during their childhood. Typically overdisciplined and deprived of parental love in their infancy, these parents repeat the pattern with their own children, often in the belief that they are legitimately exercising their parental right to punish a child. This “cycle of abuse” is a particularly important factor in cases of sexual abuse, and it is now widely believed that many child molesters were victims of abuse as children.

 

 

LEGAL ISSUES

Legal remedies for child abuse range from the incarceration of the offender to the removal of the abused child from the custody of parents or others guilty of committing the crime. With proper social and psychotherapeutic intervention, many child abusers can be helped. In fact, many emotionally troubled abusers are relieved to be discovered, and often they respond well to the therapeutic help they receive. However, some recent theories about child molesters suggest that their conditions are less susceptible to intervention than was once believed, and many jurisdictions have resorted to strict penal solutions, such as sexual-predator laws, which provide for indefinite incarceration for habitual sexual offenders. The treatment or cure of offenders is thought to be more difficult when the victims are young children or toddlers, and compulsive pedophiles are viewed as intractable problems for both therapy and the justice system.

 

The legal definition of child abuse differs between societies and has changed significantly over time. For example, the age of sexual consent varies greatly between and even within countries. Some European countries prohibit the use of physical violence to enforce discipline, though others permit moderate forms of coercion. Despite these differences, the abusive treatment of children, however it is defined, is widely proscribed by criminal statutes.

 

Child-protection legislation proliferated during the 1960s. First developed in the United States, these laws soon became models for criminal statutes in many other countries. In 1962, American medical authorities discovered the phenomenon of “baby battering”—the infliction of physical violence on small children—and both the federal government and states adopted laws to investigate and report such acts; eventually, these laws were applied to cases of sexual abuse and molestation. In 1974 the United States created a National Center on Child Abuse and Neglect.

 

Since the 1970s, conservative and feminists groups, for different reasons, have sought aggressive measures to combat child abuse. Although earlier campaigns against child molestation had emphasized the threat posed by strangers, feminists stressed what they perceived as the vastly greater danger posed by male intimates, such as fathers, stepfathers, uncles, and brothers. Because abuse by male relatives is rarely reported by the family involved, child-welfare advocates called for new laws that would allow greater intervention by outside professionals. During the 1970s and '80s, most states adopted some form of mandatory-reporting procedure whereby doctors, teachers, and social workers were required to report any circumstances that might reveal suspected child abuse. The courts also revamped their procedures to grant more protection to victims. For example, to remove the need for child witnesses to confront the accused, children often were permitted to testify from behind screens or even by video link from another room, and judges and lawyers were encouraged to frame questions and language in a way that did not baffle or intimidate children.

 

Along with the changes in laws and attitudes came a dramatic upsurge in the number of reported abuse cases. Between 1976 and 1986, reports of child abuse and neglect across the United States rose threefold to over two million, with a further increase to nearly three million reports by the mid-1990s. However, a majority of these reports were judged to be unfounded. Reports of sexual abuse rose 18-fold between 1976 and 1985. The increases in recorded child-abuse figures, which may have been a result of greater awareness of the problem rather than a surge in abuse, contributed to a widespread impression that society was suffering an “epidemic” of child abuse, and concern reached immense proportions during the 1980s.

 

DANGERS OF OVERREACTION

By the mid-1980s, child abuse was considered a leading social problem in the United States and other Western countries. The extent of the problem seemed to many to be increasing, and many claims were made about the prevalence of incest, child abduction, and even child murder, as well as the operation of organized child-abuse rings. In part these charges were the result of new methods used by social workers and psychotherapists to interview children suspected of being victims of abuse. Interviews conducted with these methods often suggested that the child had been exploited, and some interviews, especially with toddlers, appeared to yield details of sexual abuse so bizarre and shocking as to suggest that it had been committed in ritualistic fashion by some kind of cult. Also contributing to the perceived increase in the incidence of child abuse was the controversial practice of some psychotherapists of attributing the problems reported by adult patients to repressed memories of sexual abuse suffered during childhood.

 

In fact, however, many of the children who reported sexual and other forms of abuse through the new methods were inventing the stories they told. As critics later pointed out, the methods—which involved repeatedly asking leading and suggestive questions and rewarding children for giving the “right” answers—encouraged children to tell false stories of abuse or to believe, contrary to fact, that abuse had taken place. One significant series of cases involving such reports were the trials beginning in 1984 of Virginia McMartin, founder of the McMartin Preschool in Manhattan Beach, California, and others on dozens of counts of child abuse. Most of the charges, which were based on reports of abuse collected in interviews with hundreds of students, were eventually dropped for lack of evidence. In 1990, the last case resulting from the affair ended in a mistrial; thus, no convictions were ever secured. Even so, the careers of the McMartin family, as well as their reputations, were ruined. During the decade after the revelations in the McMartin case, thousands of people worldwide were likewise accused of involvement in ritual abuse.

 

 

RECENT DEVELOPMENTS

During the early 1990s, charges of ritual abuse and recovered memory encountered serious criticism, which dealt a setback to the child-protection movement. Although concern about sexual threats to children remained undiminished, doubts about charges of abuse by parents and intimates led to renewed attention to child abuse—especially molestation—committed by strangers. These fears were often centred on the Internet, which some considered a potential means for pedophiles to stalk and seduce children and which others denounced for making child pornography widely available. Following a number of well-publicized cases of child sexual abuse and murder in the early 1990s, many U.S. states passed sexual-predator laws, which provided for the lengthy detention of sex offenders, especially those who had preyed upon children. Jurisdictions also passed other stringent laws, including variations of Megan's law, which required that local schools, day-care facilities, and residents be notified by police of the presence of convicted sex offenders in their communities. Although these measures posed a serious threat of vigilantism and arguably infringed the legal rights of the offenders, supporters justified them by citingthe extreme danger posed to children by molesters and pedophiles. The laws were widely imitated in Europe. Nevertheless, reports of child abuse in developed countries grew sharply in the 1990s. Japan, for example, recorded a ten-fold increase in the period 1990–2000.

 

Opinions about the scale and nature of child abuse have changed dramatically since the 1960s, and the notion that children are widely subject to abuse and exploitation has become firmly fixed in the public consciousness. Child abuse also has become a major topic of study in academia; themes of incest and abuse are now common in the social and behavioral sciences, as well as in such diverse subjects as literature, social theory, and cultural and women's studies. The surging interest in child abuse, child protection, and children's rights was one of the most significant social developments of the late 20th century.

ŠProfessor Omar Hasan Kasule, Sr. March 2007