8 Page Essay

Child Abuse and Neglect

Child abuse and neglect are examined in this new edition—the latest research, what it entails, and how to recognize and report it. Federal law mandates the reporting of suspected child maltreatment by many professionals. This book will appeal to those who may one day fi nd themselves in the role of a mandated reporter.

Engaging learning tools are integrated throughout: Focus on Research boxes provide an in-depth look at research or methodologies. Case Examples and Debates encourage discussion about the gray areas in the fi eld. Legal Examples and Focus on Law sections explain judicial rulings including guides

for locating relevant state statutes. Discussion questions promote dialogue and deepen understanding of the material. Bold-faced key terms defi ned when fi rst introduced also appear in the book’s

glossary. Conclusions and Defi nitions help students focus on the key concepts introduced

in each chapter.

The new edition also includes the following features: A thorough updating of the citations and state and federal laws, along with the

latest statistics on incidence and prevalence based on the new National Inci- dence Study NIS-4.

A new chapter on resiliency (Chapter 10) and more discussion of resilience in the face of maltreatment in the chapters on types of abuse ( Chapters 4 –9 ) pro- vide a better understanding of why some children thrive despite experiencing maltreatment.

New “Profi les” boxes that feature information about graduate training in child maltreatment, descriptions of jobs in the fi eld, or biographies of people who work in the fi eld to increase students’ awareness of possible career opportuni- ties.

Web-based instructor and student resources including PowerPoints, weblinks, and a test bank with multiple-choice, short-answer, and essay questions.

More tables, fi gures, and photos to better illustrate and summarize key points. New sections on child maltreatment in military families ( Chapter 2 ), child obe-

sity as a result of maltreatment ( Chapter 5 ), teen “sexting” and its possible prosecution as child sexual abuse, and Susan Clancy’s controversial thesis published in The Trauma Myth ( Chapter 7 ).

Updated and more case examples including recent events that captured the pub- lic’s attention such as the case of Jessica Beagley convicted of child abuse for forcing her son to ingest hot sauce and of Latrece Jones convicted of negligent homicide for failing to have her son in a car seat.

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The book opens with the background on child maltreatment including its history, an overview of the research, and the risk factors. Details about mandated report- ing are also explored. Different forms of maltreatment—physical abuse, neglect, psychological maltreatment, sexual abuse, fetal abuse, and Munchausen by Proxy Syndrome—are then examined, along with resiliency, in a new chapter to this edition. Incidence estimates and consequences for each type of maltreatment are provided. Legal issues including forensic interviewing are then reviewed. The book concludes with an example of what happens to a child after a report is fi led along with suggestions for preventing child maltreatment.

Intended as a text for courses in child abuse, child maltreatment, family vio- lence, or sexual and intimate violence taught in psychology, human development, education, criminal justice, social work, sociology, women’s studies, and nursing, this book is also an invaluable resource to workers who are mandated reporters of child maltreatment and/or anyone interested in the problem.

Monica L. McCoy is a professor of psychology at Converse College in Spartanburg, South Carolina.

Stefanie M. Keen is an associate professor of psychology at the University of South Carolina Upstate in Spartanburg, South Carolina.

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Child Abuse and Neglect Second Edition

Monica L. McCoy

Stefanie M. Keen

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First edition published 2009 by Psychology Press

This edition published 2014 by Psychology Press 711 Third Avenue, New York, NY 10017

and by Psychology Press 27 Church Road, Hove, East Sussex BN3 2FA

Psychology Press is an imprint of the Taylor & Francis Group, an informa business

© 2014 Psychology Press

All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identifi cation and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data McCoy, Monica L. (Monica Louise) Child abuse and neglect / Monica L. McCoy, Stefanie M. Keen. — [Second edition]. pages cm 1. Child abuse—United States. 2. Child abuse—Law and legislation—United States. I. Keen, Stefanie M. II. Title. HV6626.52.M336 2014 362.76—dc23 2013028231

ISBN: 978-1-84872-605-5 (hbk) ISBN: 978-1-84872-529-4 (pbk) ISBN: 978-0-203-12069-9 (ebk)

Typeset in Stone Serif by Apex CoVantage, LLC

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Dedication xi

Preface xiii

Acknowledgments xvii

Author Biographies xix

PART I Introduction/Purpose 1

CHAPTER 1 Introduction 3

A Brief History of Child Maltreatment 4

Responding to Children in Crises 7

Research on Maltreatment 16

Conclusion 21

Discussion Questions 21

CHAPTER 2 Risk Factors for Child Maltreatment 23

Family Factors 23

Child Factors 32

Extrafamilial Factors 33

Cultural Factors 37

Conclusion 39

Discussion Questions 40

CHAPTER 3 Mandated Reporting 42

The History of Mandated Reporting 42

Persons Required to Report 43

When to Report 45

How to Report 47

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Failure to Report 49

Education Regarding Mandated Reporting 52

Confi dentiality and Mandated Reporting 55

Is Mandated Reporting a Good Thing? 56

Conclusion 57

Discussion Questions 58

PART II Types of Abuse and Their Effects 61

CHAPTER 4 Physical Abuse 63

Defi nition 63

Prevalence and Incidence 68

Corporal Punishment 69

Consequences of Physical Abuse 71

Caution: Not All Marks Are Signs of Abuse 82

Marks From Folk Medicine Practices 82

Nonphysical Consequences of Physical Abuse 84

Conclusion 88

Discussion Questions 88

CHAPTER 5 Child Neglect 90

Defi nition 90

Subtypes of Neglect 92

Incidence 113

Consequences of Neglect 114

Intergenerational Transmission of Neglect 121

Conclusion 122

Discussion Questions 122

CHAPTER 6 Psychological Maltreatment 123

Defi nition 123

Defi ning a Line on a Continuum of Behavior 133

Incidence 135

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Consequences of Psychological Maltreatment 138

Conclusion 145

Discussion Questions 145

CHAPTER 7 Sexual Abuse 146

Defi nition 148

Incidence and Prevalence 153

Perpetrators 156

Victims 161

Extrafamilial Child Sexual Abuse 163

Child Sexual Exploitation 168

Consequences of Sexual Abuse 170

Conclusion 187

Discussion Questions 188

CHAPTER 8 Fetal Abuse 189

Defi nition 189

Incidence 190

Causes of Fetal Abuse 190

Effects of Drugs on Prenatal Development 191

Responding to Fetal Abuse 197

Conclusion 209

Discussion Questions 209

CHAPTER 9 Munchausen by Proxy Syndrome 210

Defi nition 210

Victims 214

Perpetrators 215

Incidence 216

Risk Factors 216

Consequences of MPS 218

Investigation of MPS 220

Controversies Related to MPS 224

Conclusion 228

Discussion Questions 229

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CHAPTER 10 Resilience 230

Defi nition 230

Conclusion 243

Discussion Questions 243

PART III Legal Issues 245

CHAPTER 11 Forensic Interviewing of Child Victims 247

Children Providing Testimony 247

The Accuracy of Children’s Testimony 247

Recommendations for Conducing Good Forensic Interviews 269

Conclusion 271

Discussion Questions 276

CHAPTER 12 The Legal System and Child Maltreatment 277

Children and the Courtroom 277

Types of Courts 281

Testifying in Court 299

Conclusion 300

Discussion Questions 300

PART IV What Happens Next 301

CHAPTER 13 The Maltreated Child and Child Protective Services’ Response: What Happens After a Report Is Made? 303

Intake and Screening 310

Investigation and Initial Assessment 312

Family Assessment 319

Case Planning 320

Service Provision 322

Family Progress 323

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Case Closure 324

Decision Making 324

Conclusion 326

Discussion Questions 326

CHAPTER 14 Preventing Child Maltreatment 328

Overview of Prevention Programs 329

A Public Health Issue 330

Primary Prevention 331

Secondary Prevention 339

Conclusion 343

Discussion Questions 344

Appendix of Abbreviations 345

Glossary 347

References 359

Subject Index 391

Author Index 401

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I dedicate this book to my mother, Julie McCoy, and to the memory of my father, Gary McCoy, who gave me the priceless gift of a happy childhood.

Monica L. McCoy

To Hannah and Leah, you are my sunshine.

Stefanie M. Keen

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Our purpose in writing this book was to create a textbook that was appropriate for an undergraduate course in Child Abuse and Neglect. There is a demand for this type of information because students preparing to enter many disciplines (psychology, edu- cation, social work, pre-med) are aware that they will be mandated reporters for child maltreatment while also realizing that they are not prepared to meet this obligation. In order to fulfi ll this role, students need education about what maltreatment entails, how to recognize and report it and how the issue is handled by Child Protective Services and the courts. The current research indicates that many professionals who are mandated reporters think that their training in this area has not been adequate. It is our hope that having a textbook that is grounded in research and the law will provide a more adequate preparation for those who are now, or who will become, mandated reporters of child maltreatment.


The text is divided into four main sections. In Part I , we provide background infor- mation on the problem of child maltreatment. This includes a brief history of child maltreatment as well as an introduction to some of the research limitations in the fi eld. The second chapter in Part I covers many of the possible risk factors for child maltreatment. It is diffi cult for some students to understand how a parent could harm their own child. It is our hope, that by considering many of the factors a family may be dealing with, students will recognize how maltreatment can occur, even among families who love their children. The fi nal chapter in Part I covers man- dated reporting in depth. It is good to fully understand what the role of a mandated reporter is before learning about the different forms of maltreatment, which make up Part II of the text. Chapters 4 to 9 cover each type of maltreatment (physical abuse, neglect, psychological maltreatment, sexual abuse, fetal abuse, and Munchausen by Proxy Syndrome) in detail. For each form of maltreatment, we provide defi nitions, estimates of incidence, and possible consequences. As appropriate, we cover issues and controversies that are relevant to that form of maltreatment. The last chapter in Part II covers the topic of resilience. Despite the many negative consequences asso- ciated with maltreatment that are addressed in chapters 4 to 9 , some victims go on to lead normal and even remarkable lives. Part III of the text deals with legal issues related to child maltreatment. Chapter 11 focuses on forensic interviewing, and Chapter 12 covers the legal system as it pertains to child maltreatment. Although mandated reporters have less to do with this part of the process, it is still valuable information for them to have. For instance, knowing how suggestible children are to certain forms of questioning, should make mandated reporters realize that they


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should not attempt to interview children about allegations of maltreatment unless they have been trained to do so. Finally, Part IV of the book examines what occurs after a report of child maltreatment is made and prevention efforts. Chapter 13 details what happens to a child after a report of child maltreatment has been made to Child Protective Services. Although mandated reporters are not involved in this process, it is natural to be concerned about what happens after a reporter sets the investigative process in motion. Finally, the last chapter addresses the more optimis- tic issue of the prevention of child maltreatment. Although mandated reporters are required to notice and report child maltreatment, it would be better for everyone if the problem could be prevented.


The book has several features that have been included to deepen understanding about child maltreatment. The fi rst time an important term or unfamiliar word appears, it is in bold type, and the defi nition appears in the margin. At the end of the book, you will fi nd a glossary of all the terms defi ned throughout the book. Many chap- ters have “Focus on Research Boxes.” This feature allowed us to go into depth about representative research studies, and to explain research methodologies that students may not be familiar with. We have also used “Case Examples” throughout the text, some fi ctional and some real. We have added these for two reasons. First, students tend to fi nd case studies interesting and easier to grasp than more theoretical mate- rial. Second, the cases provide you with a starting point to engage in discussion with your classmates about the many gray areas in this fi eld. Many chapters also contain “Profi les” of professionals working in the fi eld. These give students informa- tion about possible careers in the fi eld while highlighting how much good can be accomplished by dedicated people. Another learning tool involves instructions to “Search the Web.” The purpose of these sections is to encourage further reading on certain topics and to guide students to the laws relevant to their state. Finally, the “Legal Examples” and “Focus on Law” sections explain, in detail, legal cases, and judicial rulings that have had a signifi cant impact on how child maltreatment cases are handled by the courts. By studying these cases, we hope students gain a deeper appreciation for the legal complexities surrounding child maltreatment. At the end of each case example and at the end of every chapter, you will fi nd discussion ques- tions related to the material you have just read. Thinking about these questions and discussing your answers with your peers will help to test and expand your knowledge of the material.


We have made a signifi cant number of changes to this edition in an effort to provide up-to-date information and to attempt to cover the wide range of issues related to maltreat. This edition includes:

More 250 new, updated references Updated statistics including National Incidence Study-4 data

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Updated state laws to refl ect new legislation More Case Examples, Legal Examples, and Focus on Research boxes Profi les of professionals working in the fi eld An expanded section on child fatalities A section on child maltreatment in the military Expanded information on the consequences of neglect Added coverage of child obesity as related to possible neglect Signifi cant expansion of sexual abuse chapter to cover extrafamilial abuse (in

churches, day-care centers, schools, and sports organizations) as well as sexual exploitation (child pornography, prostitution, and sex traffi cking)

An entirely new chapter on resilience Increased coverage of cultural issues Addition of new prevention programs that have been recently developed and/

or evaluated A teacher’s companion website (www.psypress.com/cw/mccoy) that includes

test questions (multiple choice, true/false, and essay), video suggestions, addi- tional discussion questions, and more case examples

We realize that no textbook can answer all of the questions students will ever have about child maltreatment. However, the goal of this book is to help future mandated reporters be better prepared to meet the challenges of fulfi lling that role.

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A large number of people helped to make this book possible. We would like to take this opportunity to acknowledge the professional and personal support that we received while working on this book.

Our Professional Colleagues and Institutions The psychology department at Converse College: Dr. Rich Keen, Dr. Tracy

Ksiazak, Dr. Marie LePage, and Dr. Jan LeFrancois. Many thanks for being sup- portive throughout this entire process.

Converse College and Dean Jeff Barker, for granting me a sabbatical leave to work on this second edition.

Dr. Narina Nunez and Dr. Jennifer Gray for their feedback and suggestions for additions and revisions.

Dell Morgan, tireless interlibrary loan offi cer. This edition owes much to his amazing work at tracking down any and every source I needed.

The Department of Psychology and Center for Child Advocacy Studies at the University of South Carolina Upstate, I could not have asked for more won- derful colleagues.

Angela Talley Robinson, Program Coordinator for Adult and Child Protective Services with the Spartanburg County Department of Social Services, for tak- ing the time to talk with us about child protective services and for helping us to understand the child protection process.

Our Families A special thanks to Julie McCoy for proofreading and constant encouragement. With gratitude to Jud Stubbs for his help with pictures, photographs, and all

things technical. Thanks too for the support and love while I worked on this edition.

Thank you to Lynn and Al Dodd, for instilling in me the importance of educa- tion and the pursuit of knowledge. I attribute my love of learning wholly to their infl uence, and am grateful to them for their guidance in my own educa- tional achievements.

A special thanks also to Rich Keen. His patience and support during this project has been seemingly endless. Thank you for always being a stable presence and for taking up the slack when I was too immersed to know which end was up.

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Our Reviewers Further thanks are directed toward the reviewers who made many helpful sugges- tions during the writing process, including the following:

Mary Breaux, Sam Houston State University Mick Coleman, University of Georgia Alberta Ellett, University of Georgia Warren Galbreath, Ohio University Lisa Litz, Child Advocacy Center, Inc. Charisa Kiyô Smith, Juvenile Justice Project Derrik Tollefson, Utah State University Stephannie Walker, University of Wyoming Christine Wekerle, McMaster University Hillary Wing-Richards, James Madison University C. Thresa Yancey, Georgia Southern University along with other reviewers who prefer to remain anonymous.

Our Publisher Finally, we would like to thank the professionals at Psychology Press/Taylor & Francis for their assistance during this project; especially Fred Coppersmith and Debra Riegert.

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Monica L. McCoy, PhD Dr. McCoy is a professor of psychology at Converse College in Spartanburg, South Carolina. She earned her bachelor’s degree in psychology from Grove City College and her master’s degree in experimental psychology from Villanova University. She then obtained her PhD in experimental/developmental psychology, with a minor in statistics, from the University of Wyoming. Dr. McCoy currently teaches a broad range of undergraduate courses including Child Abuse and Neglect, Human Growth and Development, Statistics and Experimental Design, Social Psychology, and Sen- ior Seminar. Dr. McCoy’s research has focused on determining what factors have an impact on jurors’ decisions in cases of alleged child maltreatment. She is also inter- ested in exploring what the public knows about child abuse and neglect, and how mandated reporters become educated about maltreatment. In addition to her work at the college, Dr. McCoy has served as a guardian ad litem, and she has offered training for others who serve as court advocates for abused children and for volunteers at the local children’s shelter. She also serves on the board of directors for the Children’s Advocacy Center of Spartanburg, Cherokee, and Union Counties.

Stefanie M. Keen, PhD Dr. Keen is an associate professor of psychology at the University of South Carolina Upstate in Spartanburg, South Carolina. She earned her Bachelor of Arts degree in psychology from the State University of New York at Binghamton and her doctoral degree in clinical psychology from Indiana University. Dr. Keen currently teaches a variety of undergraduate courses including a senior seminar in Trauma and Posttrau- matic Stress, Introduction to Child Maltreatment, Developmental Psychology, and Abnormal Psychology. She is also involved in the education and training of future child welfare advocates through the University of South Carolina Upstate’s academic minor in Child Advocacy Studies. She is engaged in an active research program related to the psychological effects of traumatic stress including child maltreatment, intimate partner violence, and military-related trauma. Dr. Keen previously worked at the National Center for Posttraumatic Stress Disorder, within the VA Boston Health- care System, where she was engaged in both clinical work and research with military veterans. She serves on the board of directors for the Children’s Advocacy Center of Spartanburg, Cherokee, and Union Counties and is a trained facilitator for Darkness to Light’s Stewards of Children.

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The purpose of this textbook is to provide you with an over-view of child maltreatment. This umbrella term includes both the abuse and the neglect of children. Child abuse is the term used for acts of commission—things a parent or caretaker does to a child that are inappropriate. Child abuse can include such diverse acts as beating, sexually assaulting, or verbally abusing a child. In each case, the adult is doing something to the child that is defi ned as maltreatment.

Conversely, child neglect is the term used for acts of omission— things a parent or a caretaker fails to do for a child when appropriate care would require that such things be done. Child neglect can include failure to provide for a child’s physical, emotional, medi- cal, or educational needs. In cases of child neglect, the parent fails to provide for the child even the minimum necessary for adequate care. Together, child abuse and child neglect make up child maltreat- ment. Although most researchers in the fi eld would agree to this terminology, it is important for readers of this literature to note that child abuse is also sometimes used synonymously with child mal- treatment. In other words, when some authors write of child abuse, they often mean both abuse and neglect. I also follow this usage largely because abuse is often a less awkward term than is maltreat- ment. On the other hand, child neglect does not include child abuse, so when you see that term, you can be fairly certain that the focus is on acts of omission. The problem of confusing terminology is something we will need to keep in mind as we explore the literature on child maltreatment. This particular fi eld is plagued with defi nitional issues. For example, what one author means by “sexual abuse” may be quite different from what another means by the same term. To be as clear as possible, I begin each chapter that focuses on a type of maltreatment by establishing a working defi nition for that form of maltreatment. When you read other authors’ chapters, you must be attentive to the defi nitions with which they are working.

Many students become frustrated by the lack of defi nitional consistency in the fi eld of child maltreatment. Although it does not make the situation any easier to deal with, it is helpful to note that the fi eld is a new one. Certainly, the mistreatment of children is not new; all recorded history includes references to acts we would today defi ne as maltreatment. However, the professional examination of child mal- treatment has a fairly short history. Many date the beginning of the professional research in this fi eld to the early 1960s.



child maltreatment

the abuse and/or neglect

of children. Specifi c

defi nitions vary by state

and purpose (legal,

research, etc.).

child abuse

an act, generally

deliberate, by a parent or

a caregiver that results in

harm or death to a child.

child neglect

the failure of a parent or

a caregiver to meet the

minimal physical and

psychological needs of a


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Although we defi nitely hear more about child abuse today than we did in the past, this does not mean it is a new phenomenon. The psychohistorian Lloyd deMause edited The History of Childhood in 1974, which he began with the now familiar quotation:

The history of childhood is a nightmare from which we have only recently begun to awake. The further back in history one goes, the lower the level of child care and the more likely children are to be killed, abandoned, beaten, terrorized and abused.

deMause, 1974, p. 1

Ancient History

Historical research seems to support this rather grim statement. A study of ancient history reveals that infanticide (the act of killing an infant) was practiced in many

societies. While we still use this term today, there are two impor- tant differences to note between ancient and modern usage. First, modern developmental psychologists defi ne infancy as the period covering only the fi rst year or two of life (Farlex, 2013). In ancient times, the term infancy covered a much longer range, being identi-

fi ed as the period between birth and 7 years. Second, whereas infanticide is clearly illegal today, in ancient times it was often condoned by society. The historians Ten- Bensel, Rheinberger, and Radbill (1997) noted that in ancient times children did not have the right to live until that right was bestowed on them by their father. If the father withheld this right, then the infants were abandoned. In some cases, even fathers could not grant their child the right to live. For instance, the Roman Law of Twelve Tables actually required that any “dreadfully deformed” child be put to death, no matter what the parents’ desires were for that child. Reasons for infanticide included population control, appeasement of god(s), limitation of family size, and a way for an unwed mother to deal with shame. Allowing the murder of infants for any of these reasons suggests that children did not have even the most basic right—the right to life. Children who were permitted to live were considered the property of their fathers. As such, the rule of the father over the child was nearly complete. There is ample evidence that it was even socially acceptable in certain circles in ancient Greece for fathers to allow other men to use their sons sexually (Kahr, 1991). The respected philosopher Aristotle wrote, “The justice of a master or a father is a differ- ent thing from that of a citizen, for a son or a slave is property and there can be no injustice to one’s own property” (as cited in Helfer, Kempe, & Krugman, 1997, p. 5).

Middle Ages

During the Middle Ages, laws forbidding infanticide were passed. It is not clear whether the laws were carefully enforced, but the idea was taking hold that the child at least had the right to live. This does not mean that the Middle Ages were a glori- ous time for children. The widespread poverty of this time made children a liability. There are horrifi c stories of children who were severely mistreated by their parents in order to bring more money into their household. Some children were actually sold


the killing of an infant,

particularly a newborn.

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for profi t by their own parents. Other children were mutilated so that they would be more effective beggars. Although wealthy strangers may have turned their back on a healthy child who was begging in the streets, it was harder to ignore a child who was blind or missing a limb; therefore, a child who was injured or deformed was likely to have more success on the streets.


A dramatic change in the view of children occurred as a result of the Reformation of the 16th century. This religious movement, marked by a rise in Protestantism, had a signifi cant impact on how children were regarded. On a positive note, children were seen as fragile creatures of God who needed to be safeguarded. As persons created in God’s image, they had a soul and the right to life. On the other hand, all humans were born marked with the stain of original sin. These beliefs led to a resurgence of interest in educating children in a way that would overcome the stain of original sin. Parents and teachers were urged to use strict discipline in the hopes of molding chil- dren into moral human beings (Stone, 1977). John Robinson, a pastor of the Pilgrim Fathers in the Netherlands, wrote, “Surely there is in all children a stubbornness, and stoutness of mind arising from natural pride, which must in the fi rst place be broken and beaten down” (Stone, 1977, p. 116). The general acceptance of this approach was clear when the birch rod became a symbol of education. The normative view seemed to be an acceptance of the saying “Spare the rod and spoil the child.” Flog- ging became the normal punishment for any academic lapse, and records of the beatings reveal that they were often quite harsh. Children were whipped, generally with a bundle of birches, on their bare buttocks until they bled. Other teachers used a ferula (a fl at piece of wood that had a rounded end with a hole in the middle) to hit students on the hand or mouth which resulted in a painful blister (Stone, 1977). The beatings extended even into the college years. Students working toward their bachelor’s degree in the early 1600s could be fl ogged, not only by the college head but also by their deans and even their tutors.

While this paints a very bleak picture of childhood during the Reformation, there is some good news being reported in recent scholarship. Moran and Vinovskis (1986) found that this harsh child-rearing strategy may have been true of the prevailing public opinion, but many parents were resistant to using harsh discipline and instead raised their children with love and affection. This is also an important reminder that at any point in time, there will be great diversity in how children are treated, no mat- ter what the current prevailing public opinion is.


It was not until the Enlightenment that things begin to improve for children in terms of the generally accepted views of child rearing. The next shift in how childhood was viewed has been largely attributed to the writings of John Locke and Jean-Jacques Rousseau. Locke saw children as tabula rasa, which means blank slate. Locke viewed children not as innately fl awed, but simply as blank or neutral. If children are tabulae rasae, then parents and teachers need only to shape children, to mold them into whatever is good; there is no need to eliminate innate

tabula rasa

a blank slate; a mind

that has not yet been

affected by experiences

or impressions.

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badness. Certainly, this would suggest that a kinder, gentler parent and educator were required. Rousseau’s philosophy went even further by saying that children were noble savages, neither evil nor blank, but endowed with an innate sense of right and wrong. Rousseau believed that a parent’s training would only interfere with a child’s innate, orderly, moral development. Instead of forcing or molding a child, an adult needs to be sensitive to a child’s needs (Berk, 1997). Children should be permitted to grow with very little constraint by parents or teachers.

Industrial Revolution

This shift in the view of human nature, from evil to neutral to good, does not mean that children have been treated gently since the Enlightenment! In fact, some of the saddest stories about the mistreatment of children come from the 19th cen- tury and the Industrial Revolution. Although the Industrial Revolution brought relief from hard labor for many, it was merely a new age of abuse for poor children who were brought into the labor force. Even very young children were forced to work long hours in horrifi c conditions in which they were exposed to occupational hazards.

Some of the most compelling child labor stories in the United States were about the “breaker boys,” who worked in the anthracite coal industry. The job for these boys was to pick impurities, such as slate, out of the coal before it was sold. In order to do this, the boys sat on benches that were suspended over the conveyor belts that carried the coal. They spent their days bent over, picking through the coal in order to remove any impurities. The air was thick with coal dust that settled in their lungs and led to harsh coughs. Their hands were covered with cuts and calluses from deal- ing with the rough and sharp material. The long days of their work were fi lled with noise and danger. Boys who fell from their suspended benches suffered burns, cuts, and occasionally death by suffocation. Some adults indicated that the work done by the breaker boys was even more dangerous than working in the mines (Hindman, 2002).

These abuses continued in the United States until child labor laws were passed and enforced. By the late 1800s, advocates for children began pushing for legislation that would protect children. By 1900, all industrialized states had some law that dealt with child labor, but the laws at this time varied substantially in terms of the rules they proposed and the seriousness of their enforcement. This discrepancy led advo- cates to fi ght for a federal law to protect children in the workforce. Initial attempts at passing and sustaining a federal child labor law were not successful for a variety of reasons, including charges that they were unconstitutional or that they gave the federal government too much power. The issue was not resolved until 1941, when the U.S. Supreme Court upheld the Fair Labor Standards Act, which limited child labor. In many ways, the passing of this federal law was anticlimatic, because most child labor in the United States had been eliminated by that time (Hindman, 2002). Children living in the United States today are well protected by the child labor laws. With only a few exceptions (acting, newspaper delivery, some types of family busi- nesses), children younger than the age of 14 are not permitted to work. Between the ages of 14 and 15, work for pay is limited by law. When school is in session, young adolescents may work a maximum of 3 hours per day and no more than 18 hours per week. When school is not in session, they can work no more than 40 hours per week. Some dangerous jobs such as coal mining, roofi ng, and logging may only be done by

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adults. Although the enforcement of the child labor laws in the United States is not perfect, it is generally considered to be fairly good. Although these laws were directed at eliminating child maltreatment at work, they were not relevant to what went on in the home.

Looking at maltreatment from a historical perspective can give us hope when we consider how far we have come in protecting children. Although children today still suffer from abuse and neglect, many would argue that the lot of children is far better now than it has ever been. The progress we have made is, to a large degree, the result of the work of child advocates. Although some may judge the response to child mal- treatment as too slow and too little, there have always been people who were willing to fi ght for children, and progress has been made.


History is peppered with notes that in some cases children were protected or treated gently. More than 6,000 years ago in Mesopotamia, there was a patron goddess for orphans who was believed to protect any child who did not have parents (Ten- Bensel et al., 1997). Continuing concern for orphans is seen in the presence of orphanages throughout recorded history. For example, both Athens and Rome had homes for orphans. In the 12th century, Pope Innocent III established some of the fi rst foundling houses to care for children who had been left behind in the wake of the Crusades. A more personal illustration can be found in the writings of Sir Thomas Moore, who lived from 1478 to 1535 and who clearly did not refl ect the punitive approach to child rearing that was prevalent during his lifetime. He wrote to his children:

I never could endure to hear you cry. You know, for example, how often I kissed you, how seldom I whipped you. My whip was invariably a peacock’s tail. Even this I wielded hesitantly and gently, so that sorry welts might not disfi gure your tender seats. Brutal and unworthy to be called father is he who does not himself weep at the tears of his child.

(Stone, 1977, pp. 119–120)

Colonial America

Despite these fl ashes of benevolence, the widespread recognition of and response to child abuse is a modern phenomenon. In colonial America, the father had nearly complete control over his wife and his children. Strict discipline was considered to be appropriate and was justifi ed by looking to the harsh justice meted out in the Bible. It was also permissible to turn a child over to another household as an indentured servant or an apprentice (who would receive training). The earliest recorded cases of child abuse involved masters and their apprentices. In severe cases of abuse, a child might be released from indentures, and in fatal cases a master could be punished. However, prosecutions for child abuse were rare and differed from modern cases in that they did not generally involve parents (J. Jones, 1978).

The fi rst recorded cases of child abuse charges against parents occurred in the 1670s and involved removing children from unsuitable homes. Study of these cases

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reveals that the homes were labeled “unsuitable” because the parents were not instilling the proper values (religious training and a strong work ethic) in their children (Myers, 2008–2009). Not until the 1820s did child neglect cases appeared in court. These cases, like the early abuse cases, rarely involved parents. Instead, child neglect charges were generally related to children living in institutions such as almshouses. For the most part, parents were allowed to treat their own children as they saw fi t (J. Jones, 1978). Some exceptions paved the way for the modern response to child maltreatment. For example, a father in Illinois was brought to trial for locking his blind son in a cold basement. The defense attorney argued that a parent could raise his or her child any way he or she saw fi t. The court did not agree. In 1869, the Illinois Supreme Court ruled that a parent must treat their child humanely and that needless cruelty would be punished by the law (Myers, 2008–2009).

The Case of Mary Ellen

Even though the earliest records of criminal cases of child abuse in the United States date back to the mid-1600s, the public recognition of child maltreatment in the United States is often tied to the case of Mary Ellen Wilson in the 1870s. The story of Mary Ellen’s early life is a sad one. According to public records, Mary Ellen was the biological daughter of Francis “Fanny” Connor and Thomas Wilson. Although Thomas may have known about the birth of his daughter, he never had the chance to meet her. Mr. Wilson, a soldier in the Civil War, was killed in May of 1864. As a young widow, Fanny Connor was not able to survive on the benefi ts she received from the government, so she went to work as a laundress and paid a woman named Mary Score to care for her daughter. After placing Mary Ellen with Ms. Score, Fanny would visit her daughter and act in a loving way toward her. However, after a short time, Fanny stopped showing up to visit her daughter, and she failed to send money for her care. After Mary Score had not received payment for 3 weeks, she left Mary Ellen at the Department of Charities and Corrections on July 7, 1865. This was the fi rst time the young Mary Ellen turned out to be a survi- vor. Despite the 85% death rate for infants in orphanages in New York at that time, Mary Ellen survived.

In 1866, when Mary Ellen was approximately 18 months of age (her exact birth date was never known), she was indentured to Mary and Thomas McCormack. Although Mary McCormack had given birth to three children prior to this time, none had survived. At the almshouse, Mr. Thomas McCormack alleged that Mary Ellen was his daughter and that her birth was the result of an affair he had with her mother. He was never asked to prove this claim, and the adoption was permit- ted without any proof of his paternity. Seven months after the adoption, Thomas McCormack died of cholera, and Mary McCormack subsequently married a man named Francis Connolly (Shelman & Lazoritz, 2005). Mary Ellen (shown in Figure 1.1 ) was living with Francis and Mary Connolly in 1873 when her plight came to the attention of Etta Wheeler (pictured in Figure 1.2 ), a Methodist missionary who vis- ited with the poor in New York. During Etta’s visits with a dying woman, she heard about a young girl, Mary Ellen, living in the same tenement house who was beaten and whipped by her mother. The dying woman told Ms. Wheeler about the small

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FIGURE 1.1 Mary Ellen. Photo Credit: The George Sim Johnston Archives of the New York Society for the Prevention of Cruelty to Children.

child, who was frequently heard crying and screaming amid the sounds of beat- ings. The pitiful sounds moved the ill woman to beg Etta Wheeler to fi nd help for the girl. Ms. Wheeler was moved by the plight of Mary Ellen and attempted to have her removed from this abusive home. She was not successful in obtaining assistance from the police or from any benevolent societies that existed at that time (TenBensel et al., 1997; Watkins, 1990).

It is at this point that the story gets a bit confused. What we do know is that Ms. Wheeler approached Henry Bergh, who was the president of the American

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FIGURE 1.2 Etta Wheeler. Photo Credit: The George Sim Johnston Archives of the New York Society for the Prevention of Cruelty to Children.

Society for the Prevention of Cruelty to Animals (ASPCA). After hearing about the case, Mr. Bergh sent a man to investigate Ms. Wheeler’s claims. While pretending to be a census taker, this gentleman gained access to every room in Mary Ellen’s home and was able to see the child in person. His report corroborated the story told by Etta Wheeler. Based on this information, Mr. Bergh was able to use his infl uence to have the child removed from her home by police offi cers the next day. Mary Ellen’s story has grown to include the myth that she was protected under the exist- ing animal protection laws. It has been said that Bergh argued for Mary Ellen to be considered an animal and given the rights any other animal would have, because she could not get aid as a child. This makes a good story, and it points out the fact that the American Society for the Prevention of Cruelty to Animals predates the

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Society for the Prevention of Cruelty to Children (SPCC) , but it is not exactly what happened. Instead, it seems that Mr. Bergh advocated for Mary Ellen as a prominent citizen, not as head of the American Society for the Prevention of Cruelty to Animals. Mr. Bergh also used his infl uence to get the case covered by the New York Times (Watkins, 1990) .

When Mary Ellen was brought before Judge Lawrence, he lis- tened to her story as well as testimony from Ms. Wheeler, neighbors, and the investigator for the New York Society for the Prevention of Cruelty to Animals. Judge Lawrence agreed that Mary Ellen needed to be rescued, and he appointed himself her temporary guard- ian. Not only did Judge Lawrence work to protect Mary Ellen, but he also punished Mrs. Connolly. After being found guilty of felonious assault, she was sentenced to 1 year of hard labor in the penitentiary (Watkins, 1990).

When no relatives could be found to take Mary Ellen, she was placed into a home for children until Ms. Wheeler again intervened and had Mary Ellen placed with Ms. Wheeler’s mother. Because of the deprivation of her early life, there was much Mary Ellen had to learn. For example, Etta Wheeler’s mother remarked that because the child had so rarely been outside, she did not know how to walk on uneven ground. She also had no experience with peers or appropriate discipline. However, Mary Ellen seemed to thrive in her new surroundings. Unfortunately, less than 5 months later, her new guardian died of tuberculosis. Mary Ellen was then taken in by Etta’s sister and brother-in-law, Elizabeth and Darius Spencer. There are not many details avail- able about Mary Ellen’s subsequent life, but we do know that when she was 24 years old, she married a widower, Lewis Schutt, who had two sons, and Mary Ellen and Lewis subsequently had two daughters. We also know that Mary Ellen named her fi rstborn “Etta,” in honor of the woman who had rescued her, and her second daugh- ter was named Florence. Both of her daughters went to college and became teachers. When asked about their mother, Etta and Florence said that she did not talk much about her childhood, but that she still carried the physical scars from the years of abuse. They also added that she was never a very strict disciplinarian with them! Mary Ellen lived to be 92 years old, a success story for child protection (Shelman & Lazoritz, 2005).

Largely as a result of the attention garnered by the Mary Ellen case, the Society for the Prevention of Cruelty to Children was founded in New York. Very quickly, this type of society spread across the nation. By 1900, there were 161 societies that had as their primary mission the protection of children (National Association of Counsel for Children, n.d.), and by 1922, there were more than 300 nongovernmental societies devoted to the protection of children. Although the number of groups advocating for children was growing rapidly, there were still many areas of the country, particularly rural areas where no such societies existed (Myers, 2008–2009).

Juvenile Court

Not long after the case of Mary Ellen, there was a major change in how children were treated by the legal system in the United States. In 1899, the fi rst juvenile court was founded in Illinois, and by 1920, all but three states had juvenile court systems. These court

Society for the

Prevention of Cruelty

to Children (SPCC)

a nonprofi t organization

that was founded in

1875 to protect children

and strengthen families.

The SPCC offers mental

health, legal, and

educational services.

Juvenile Court

a court established in

1899 to hear cases of

dependency and juvenile


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systems were established to deal with cases of juvenile delinquency as well as with children who were neglected or dependent on the state. With regard to delinquency, this court’s goal was to rehabilitate youthful offenders by keeping them separate from adult criminals and by focusing more on treatment than on punishment. Even though these were humanitarian goals, things did not work as smoothly as hoped. Because the focus was to be on helping children, it was deemed unnecessary to grant the juveniles the protective rights that adult defendants have in criminal court. Unfortunately this resulted in children, who had neither lawyers nor other constitutional rights granted to adults, receiving harsher sentences than their adult counterparts in criminal court. Instead of treatment or guidance, delinquents were simply being locked away.

In re Gault The practice of denying due process rights to juveniles was modifi ed after the pivotal case In re Gault (1967). Gerald Francis Gault, a 15-year-old boy, was found guilty of making lewd remarks over the telephone. If an adult had been found guilty of such a crime, the maximum sentence would have been a fi ne of $50 or 2 months in jail. Gerald Gault was sentenced to 5 years in a state industrial school in Arizona. So the “gentler” system of the juvenile court was planning to incarcerate a child for years for making what amounted to a dirty phone call. Clearly, the court was not working as intended—a move that was supposed to help children was in fact hurting them. After this case, juveniles were granted due process rights such as the right to an attorney, the notice of charges, the right to cross-examine witnesses, and the right to remain silent (Sagatun & Edwards, 1995). Although the early cases heard in juvenile court dealt more with delinquency than dependency, the use of this court to protect children has grown steadily, and today most child maltreatment cases are heard in this court (see Chapter 10 ).

Prince v. the Commonwealth of Massachusetts Another major legal step for the protection of children was the 1944 Supreme Court ruling in Prince v. the Commonwealth of Massachusetts. This ruling confi rmed that states do have the right to interfere in family relationships to protect children. The highest court in the land said that the government had the right to intervene in a family in order to protect the children, even when challenged with claims of religious freedom. The facts of this case revolved around Sarah Prince, a Jehovah’s Witness, who was convicted for violating the child labor laws. Ms. Prince had custody of her 9-year-old niece, Betty M. Simmons, and she had the child distributing religious lit- erature. She claimed that her rights to exercise her religious freedom as guaranteed by the Fourteenth Amendment were being violated by the child labor laws. In his majority opinion, Justice Rutledge wrote,

And neither rights of religion nor rights of parenthood are beyond limitation. Acting to guard the general interest in youth’s well being, the state as parens patriae may restrict the parent’s control by requiring school attendance, regulating or prohibit- ing the child’s labor, and in many other ways. Its authority is not nullifi ed merely because the parent grounds his claim to control the child’s course of conduct on

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religion or conscience. . . . the state has a wide range of power for limiting parental freedom and authority in things affecting the child’s welfare; and that this includes, to some extent, matters of conscience and religious conviction.

(p. 5)

One important term that may be unfamiliar is the Latin phrase, parens patriae (pa-renz pa-tree). The translation is “father of his country,” and it asserts that the state is the ultimate guardian for children and the mentally incompetent. Although the care of chil- dren is entrusted to their parents, the state is the fi nal guardian. Whereas historically fathers had nearly total control of their chil- dren, the state was now clearly saying that it had the ultimate say in child rearing.

Professional Publications Related to Child Maltreatment

As the public and the legal system began to move forward in child protection, it also became an area of interest for professionals to study and write about. The article that truly seemed to spur the research in this fi eld was “The Battered-Child Syndrome.” This article was written in 1962 by fi ve medical doctors: Kempe, Sil- verman, Steele, Droegemueller, and Silver, and it was published in the very well respected Journal of the American Medical Association. In this article, Kempe et al. defi ned battered-child syndrome and described its incidence, its clinical manifes- tations, and its psychiatric aspects. A good portion of the article was devoted to techniques used to evaluate children, and this section was focused on the use of radiologic examination. It was the invention and application of pediatric X-rays that most aided doctors in moving from having a hunch about physical abuse to having concrete proof of maltreatment. Kempe et al. concluded their report by stating, “Above all, the physician’s duty and responsibility to the child requires a full evaluation of the problem and a guarantee that the expected reposition of trauma will not be permitted to occur” (p. 24). Many believe that this article created the study of child maltreatment as a distinct academic fi eld. This statement is supported by an examination of the number of papers related to child maltreatment that were published in the years before and after Kempe et al.’s article. In the decade prior to Kempe et al.’s article, only nine articles had been published that dealt primarily with child maltreatment. In contrast, in the decade following, 260 such articles were pub- lished (Dorne, 2002). This information explosion continues at an amazing rate. If you type the term “child maltreatment” into the PsycINFO search engine and limit it to 2007, you get 172 hits for just that 1 year. If you search the decade 1997 to 2007, you will get 1,618 entries! What professionals and students today need to do is to attempt to digest this information while keeping in mind that it is still a new fi eld of study.

Kempe et al.’s (1962) article not only spurred a dramatic increase in research, it was also the reason that the Children ’ s Bureau hosted a symposium focused on child abuse in 1962. It was at this

parens patriae

a Latin term meaning

that the State acts on

behalf of a child or

mentally ill person. The

State is the guardian of

those who cannot protect



an electronic database

produced by the

American Psychological

Association that indexes

the psychology literature.

Children ’ s Bureau

a division of the

Administration for

Children and Families

that is primarily

concerned with child

protection, child abuse

prevention, foster care,

and adoption within the

United States.

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conference that professionals began to set up the standards for the mandatory report- ing of child abuse by professionals (see Chapter 3 ).

Although most researchers agree that Kempe et al.’s (1962) article was a ground- breaking publication, it was not the fi rst professional publication on child abuse. A century before it appeared, a French physician, Ambroise Tardieu, wrote fairly extensively about child maltreatment. In the 1860s, Tardieu described the negative effects of child labor, the severity of physical abuse committed by some parents, the problem of infanticide, and even the sexual abuse of both female and male children (Labbe, 2005). Clearly, Tardieu was a man ahead of his time. Many things that are believed to be true concerning child abuse today were noted in Tardieu’s 37-page article. For instance, Tardieu noted that the victims who suffered the most serious injuries were the very young; that bruises on abused children’s bodies var- ied in coloration, indicating that they occurred at different times; that many of the marks on the children were in the shape of fi ngers; that there were a “frightening multiplicity” of wounds; and that doctors should inform the police if they see such injuries (Knight, 1986).

Although Tardieu’s paper was very thorough, it did not radically change the way physicians interpreted suspicious injuries in children. In 1888, 28 years after the publication of Tardieu’s paper, Dr. Samuel West published an article in the British Medical Journal examining severe swelling in the membranes surrounding the bones of several infants in the same family. This article on differential diagno- sis (selecting the correct diagnosis when several options are possible) considered scurvy, syphilis, and rickets as possible causal factors. That the injuries could be the result of trauma infl icted by parents was not even mentioned, despite the fact that none of the natural diseases discussed adequately explained the symptoms (Knight, 1986).

Considering that it took 100 years for the explosion of professional writing on child maltreatment to begin after it was fi rst addressed in the professional litera- ture, it becomes clear that more than interest and attention must be present for a topic to become popular: Society has to be ready to hear about the issue and act on it.

Federal Regulation and Law in the United States

In the beginning of the 1900s, there was a push to move the protection of children from private societies to government agencies. This was in line with a more gen- eral trend for both state and federal government to play a larger role in providing social services (Myers, 2008–2009). The Children’s Bureau was founded in 1912 to explore all issues related to child welfare including such diverse topic as infant mor- tality, orphanages, and dangerous occupations. The early work of the Bureau was to study and examine issues related to child welfare, not to develop regulations. Later the Children’s Bureau was instrumental in drafting the legislation behind mandated reporting (see Chapter 3 ). From the 1960s, the Children’s Bureau has had the author- ity to award grants to educate professionals who work in the child welfare fi eld. Over the last 100 years, the Bureau has guided the development of an educated, skilled workforce of social workers and provided signifi cant policy guidance in order to pro- mote child welfare (Thomas, 2012).

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National Clearinghouse

on Child Abuse and

Neglect (NCCAN)

a national resource

for professionals that

provides information

regarding child

maltreatment including

prevalence, incidence,

treatment, statistics, and


dispositional hearing

a hearing during which

the judge enters their

decision as to what is in

the best interest of the


The Social Security Act of 1935 included a section (521) on Child Welfare Services within the Title IV—Grants to States for Aid to Dependent Children. This section outlines the willingness of the federal government to help fund agencies “establish- ing, extending, and strengthening, especially in predominantly rural areas, public welfare services (hereinafter in this section referred to as child-welfare services) for the protection and care of homeless, dependent and neglected children and children in danger of becoming delinquents” (The Social Security Act, Part 3, Section 521, a). Although this law marks the beginning of the practice of child protection being partially funded by the federal government, it is striking that there is no mention of physical abuse.

This also illustrates the fact that the federal government does not have direct control over how states respond to children in need. However, Congress does have the right to decide how money should be spent to further national welfare. Therefore, the federal government can infl uence policy and practice by insisting that the states follow certain rules if they wish to be eligible for funding (Myers, 2002).

It was not until 1974 that the fi rst federal law on child abuse was passed in the United States, the Child Abuse Prevention and Treatment Act (CAPTA). This legislation provided states with funding for the investigation and prevention of child abuse as long as the states had mandated reporting laws. The act also established the National Clearinghouse on Child Abuse and Neglect (NCCAN) to serve as a clearinghouse for information about child maltreatment (see Search the Web 1.1). Since this time, the federal government has maintained an active role in the prevention and treatment of child abuse by funding states for complying with federal guidelines. The federal laws are regularly reviewed and updated to better meet the needs of children. For instance, when it was noted that many children were being “lost” in foster care and simply moving from one home to another with no permanent plan, the Adoption Assis- tance and Child Welfare Reform Act (PL 96–272) was passed in 1980. This law required that cases be reviewed every 6 months and dispositional hearings be held every 18 months (changed to 12 months in 1997). The law also required that each case have a case plan. All these steps were designed to ensure that no child would be lost in the system (Association for Natural Psychology, 2011). Today, in order to receive federal funding, states must comply with the CAPTA Reauthorization Act of 2010 (Child Welfare Information Gateway, 2011). This bill was passed by the U.S. Congress on December 8, 2010 and it extended CAPTA funding through 2015 ($1.039 billion over 5 years). One of the three main goals of the reauthoriza- tion was to improve the training of people who prevent, report, and respond to child maltreatment (Wengrovius, 2011). As you will see in Chapter 3, “Mandated Reporting,” a lack of training has been a signifi cant problem for professionals who work with children. The funding and regulations are constantly adjusted and updated, but it seems clear that the federal government will continue to play an active role in protecting children.

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This textbook is based on the existing research on child maltreatment. Great strides have been made in understanding abuse and its consequences, but there is still much to learn. Progress has been impeded by how diffi cult it is to conduct research in this area. There are several concerns about research methodology that must be kept in mind as you consider the information presented in this book.

Only Identifi ed Children Are Studied

First, the research on maltreated children is conducted on identifi ed children. If you read an article that is comparing neglected children to nonneglected children, you need to remember a few things about the children in the groups that are being compared. If we know children in the neglected group have been neglected, then someone has labeled them this way. So, research on neglected children does not include children who are being neglected but have not yet been identifi ed as victims.

It is certainly possible that children who are suffering undetected neglect may differ from those who have been identifi ed. This may have led you to the next possible problem: Are there unidentifi ed neglected children in our nonneglected group? One or two such children in a large study should not cause any major problems, but researchers should not lose sight of the fact that these are diffi cult groups to clearly identify.

Because not all victims of maltreatment are known as children, some researchers have worked with a retrospective design. These studies collect data in the present that are based on recollections


To see how information about child welfare that is gathered by the U.S. government, go to the following website: www.childwelfare.gov. This site is produced by the U.S. Department of Health and Human Services: Administration for Children and Families and is called the Child Welfare Information Gateway. Under the link for Child Abuse and Neglect, you will fi nd the following subheadings:

Overview Defi nition Identifi cation Statistics Risk and Protective Factors Perpetrators Impact Fatalities

retrospective design

a research design that

uses data based on

recollections of past

events. This type of

design is limited because

of concerns about

memory degradation

over time.

6241-171-P1-001.indd 16 10/19/2013 10:13:49 AM




of the past. In these cases, adults are asked to recall their past and any maltreat- ment they suffered, and then answer questions about their present situations. The most obvious limitation of this research is that we all have faulty memories. Our memory of our past is not like a video recording. Instead of being perfect records, our memories are biased by our life experiences, our current mood, and even the situation we are recalling. Furthermore, even if a person does accurately recall abuse, it is not a given that he or she will report the maltreatment. Just as children may be ashamed or unwilling to report abuse while it is happening, adults may also keep secrets for myriad reasons. Adults may deny being abused as children because they do not want to recall the painful events, because they are ashamed, or because they do not want to make their families look bad. On the other hand, and probably less common, it is also possible that a person would report a history of abuse when no maltreatment was actually suffered. For instance, a man who is currently charged with abusing his children may report that he too was a victim of abuse in an attempt to excuse or explain his current behavior. Finally, it is evident that there is not likely to be any corroborating evidence of abuse years after it allegedly occurred. For all of these reasons, one must be careful when interpreting data that have been collected retrospectively.

Problems With Separating Different Forms of Maltreatment

A further research concern arises when we want to compare the effects of differ- ent types of maltreatment. Take, for instance, a researcher who wants to study the impact of sexual abuse, physical abuse, emotional abuse, and neglect on attachment (the emotional bond between child and caregiver). This design assumes that we can identify children who suffer from just one type of maltreatment and compare them to others who suffer from one other type of abuse. If a parent is beating a child, can we truly say there is no emotional abuse involved? Unfortunately, as you will learn throughout this text, many children suffer simultaneously from multiple types of abuse. However, grouping maltreated children together also has its disadvantages, as a child who is raped is likely to be affected quite differently from a child who is not fed consistently (see Focus on Research 1.1 ).


Consider the following excerpt from a study by Alink, Cicchetti, Jungmeen, and Rogosch (2012). They do an excellent job of describing their maltreated sample that consisted of 125 children.

More than half of the maltreated children (60%) experienced multiple subtypes of abuse.

Among the maltreated children, 6% had experienced sexual abuse, 26% had experienced

physical abuse, 70% had experienced neglect, and 62% had experienced emotional mal-

treatment. Given the low frequency of sexual abuse and physical abuse, relative to neglect

and emotional maltreatment, children experiencing these forms of abuse were catego-

rized into an abuse group (PASA, n = 40). The remaining maltreated children had not been

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Effects of Maltreatment May Not Be Immediately Obvious

Also, when determining the effects of abuse, one needs to con- sider timing. Imagine that a researcher is interested in aggressive behavior among preschool boys who were the victims of physical abuse. This researcher may measure aggression among boys who come to the attention of Child Protective Services (CPS) when their abuse has been discovered. Imagine further that he fi nds no differences in aggressiveness between the physically abused boys and a comparison group of nonabused boys. Does this mean the boys have not learned aggressive behavior from their parents? Is it possible that children who are not initially aggressive as a result of abuse may become aggressive later in life when they are physically stronger? Could it be that boys only recently removed

abused, but had experienced neglect or emotional maltreatment; they were categorized in

a physical neglect/emotional maltreatment group (PNEM, n = 78). Most of the children

in the PASA group had also experienced neglect or emotional maltreatment. Finally, the

individual subtype of seven children (6%) could not be determined as a result of incom-

plete records (p. 227).

These conscientious researchers provide a thorough description of the types of mal- treatment suffered by the children in their sample. This gives you an idea of how diffi cult it can be tease apart the impact of one form of maltreatment. Due to small sample size, the researchers combined sexual and physical abuse into one group and physical and emo- tional neglect into a second group. What impact might this have on the interpretation of their results?

Alink et al. (2012) also matched the control group to the maltreated group in terms of socioeconomic status (SES):

The maltreated children were predominantly from low SES families, which is consistent

with national demographic characteristics of maltreating families (Sedlak et al., 2010).

Consequently, the nonmaltreated group was comprised of children from families who

were eligible for Temporary Assistance for Needy Families so we could ensure a low SES

group that was demographically comparable with the maltreated group (p. 226).

Because 94% of the maltreated children’s families were receiving public assistance, the researchers choose children from low-income families to be part of the control group (Alink et al., 2012). This meant the researchers were able to control for the effects of pov- erty and therefore avoid the problem trying to separate the impact of maltreatment and the impact of poverty on the children.

Any time you read research about child maltreatment, pay careful attention to how the groups involved are described. Be sure you have a clear picture of who the participants were before you think about the fi ndings of the study.

Child Protective Services


a government agency

charged with protecting

children and preserving

families. This is the agency

that responds to charges

of child maltreatment.

Not all states use the

title CPS; variations

include Department of

Family Services (DFS)

and Department of Social

Services (DSS).

6241-171-P1-001.indd 18 10/19/2013 10:13:49 AM




from abusive homes may be in shock and somewhat withdrawn at the time of the study and that this behavior will change later? Questions like these point to the importance of longitudinal research. This is research that follows participants for a long time: years, decades, a lifetime. Although this type of research provides excellent data, it takes years to complete, and it is costly. Of course, even with the nec- essary time and money, one would still need to fi nd participants who are willing to be a part of a continuing study and who will stay with the project. Attrition among participants can be a major impediment to longitudinal research. It is not unusual for partici- pants to drop out, move away, or even die.

Diffi culty Separating the Effects of Poverty and Maltreatment

Yet another concern about the research on child maltreatment is the fact that abuse is very often confounded with poverty. This means that many children who are identifi ed as victims of mal- treatment are also living in poverty. Therefore, if researchers fi nd that maltreated children exhibit language delays, we need to know if these delays are due to the maltreatment or to the poverty. Researchers work to control this problem by carefully selecting their control (nonabused) groups. If most of the children in the maltreated group live below the poverty line, then the same per- centage of children in the control group should be from families with similarly low incomes.

Socioeconomic status (SES) is only one variable that research- ers need to consider when they are selecting a comparison group. Other issues that should be considered include the make-up of the family, family dysfunction, age and sex of child, and environmental stresses. If we want to say that something about a group of children is the result of the maltreatment they suffered, then we must be confi dent that the groups we are comparing differ only in terms of maltreatment status. As you can imagine, this makes devising appropriate control groups an extremely challenging prospect.

Inability to Make Causal Statements

Another aspect of research on child maltreatment makes it diffi cult to make causal statements—to say this act caused this effect. We cannot make causal statements based on correlational research, and much of the research in this fi eld is, of necessity, correlational. In a correlational research study, an exper- imenter measures two variables to determine if they are related. The researcher does not manipulate anything. I can ask, for example, if there is a relationship between the number of hours a child is left alone and his or her vocabulary at age 3. I may fi nd that the two vari- ables are related: As hours left alone increase, vocabulary decreases. This would be a negative correlation, which means as one variable goes up, the other goes down. Now, it may be tempting and even

longitudinal research

a research design that

involves repeated

observations of a group

of participants at regular

intervals over a relatively

long time.


a situation in which

income and resources are

inadequate to obtain and

maintain an acceptable

standard of living.

Offi cial poverty levels are

set by the Social Security


socioeconomic status


a measure of a person’s

standing within a social

group based on factors

such as income and


correlational research

a study in which two

or more variables are

measured so that the

degree of relationship

between them can be


6241-171-P1-001.indd 19 10/19/2013 10:13:49 AM




correct to say that being left alone for many hours causes a decrease in vocabulary, but we do not know this to be true from correlational work. Is it not possible that children with low vocabularies are left alone more often? That is, could it be that having a low vocabulary causes people to leave you alone more often? It could also be that some other, unexamined factor causes both of these things. Perhaps parents with low educa- tion are forced to work long hours to make ends meet. These parents may also have a lower vocabulary than do more educated parents and may feel that it is less important to speak to their children, so the children are alone more and speak less as a result of their parents’ educational level. Children who are left alone for a large number of hours but have parents who make speaking to them while they are at home a priority may have perfectly adequate vocabularies.

It is only when we conduct an experiment that we can be confi dent about cause-and-effect relationships. In an experiment, participants are randomly assigned to groups, and the groups are treated identically except for the one variable of interest. This would mean taking a sample of 100 children, assigning half of them to the condition of spending 1 hour alone per day and assigning the others to a second condition of spending 3 hours alone per day, and then measuring their vocabulary at some later date. Obviously, this is not an ethical solution to our research dilemma. If this sort of experimental manipulation is unethical,

it should be clear that we cannot ethically conduct true experiments that explore the consequences of child maltreatment.

This may be a bit confusing to those who do not have a background in research methods, so I want to provide a crazy example to help you remember the limitations of correlational data. I can tell you (quite truthfully) that there is a positive correla- tion between Coca-Cola sales and murder. As the number of Cokes sold increases, so does the murder rate. If I try to make a causal statement based on these data, you will fi nd that I sound a bit ridiculous. I could say that buying Coca-Cola makes you murder people. After all, there is a lot of sugar and caffeine in Coke, so maybe it leads to murder! Or, maybe committing murder causes an increase in Coca-Cola sales. Committing murder is hot, thirsty work, and you need a cool drink to refresh yourself! Either way, I look crazy. Can you fi gure out what causes this correlation? If you guessed heat or summertime, you are correct. This third variable explains the relationship between the other two; they are not causally linked.

Lack of Clear Defi nitions

Another issue in child maltreatment that has an impact on research is the lack of clear, consistent defi nitions for terms. As I mentioned earlier, this fi eld is plagued with defi nitional ambiguity. One place to look for defi nitions is in the law. However, because each state has its own laws, you will fi nd 50 defi nitions for child maltreat- ment instead of 1! Also, the defi nitions all include terms that are not operational. For

a term to be operationally defi ned, it must have a precise meaning that can be measured by way of observable operations. It is ideal in research situations for all variables to have operational defi ni- tions; this is the only way the exact meaning of a term can be clear. For example, “fails to meet child’s emotional needs” is a vague phrase. It is likely that multiple observers would disagree if they


a form of scientifi c

research in which a

researcher manipulates

one or more variables in

order to see the effects

on another variable or


operational defi nition

a precise defi nition of

a variable in terms of

observable procedures or


6241-171-P1-001.indd 20 10/19/2013 10:13:49 AM




were rating the interaction of a mother and her infant over time using this criterion. A possible operational defi nition would be “the parent fails to respond to the child’s cry within 5 minutes.” Although we would have better interrater reliability with this second measure, we also lose something. After all, meeting a child’s emotional needs surely entails more than responding to cries. We could add to this by measur- ing the amount of time a parent makes eye contact with the child, the number of times a child is praised, and so forth. By all these ratings, we are trying to precisely measure a complex phenomenon. We are using these behavioral observations to measure, in a consistent way, how well a parent is meeting a child’s emotional needs. Even though there is no perfect solution to this problem, researchers can work on using the same or similar measures, and we can all be attentive to how researchers operationally defi ne their variables. (This information is generally included in the Methods section of a research report.)

The Secrecy Surrounding Child Maltreatment

Finally, abuse is by defi nition a private event. We are talking about behavior that occurs within the privacy of the home. This is an arena that is typically not open to intense examination. Also, parents and often children are motivated to keep abuse secret. Although it may seem obvious for parents to not want anyone to know because they fear punishment and loss of their children, why would children remain silent? Some children are threatened into silence. They are told explicitly not to let anyone know what is happening or something terrible will happen. Parents may even coach children to tell stories to account for injuries they have suffered. Other children have more complex reasons for not telling about abuse, reasons that range from a deep sense of shame to a lack of knowledge that what is happening is wrong or different from what goes on in other families. Because so many children will never self-identify, we need to be as observant as possible in order to fi gure out which chil- dren are being maltreated.


Although the mistreatment of children is not new, the formal, public study of it has a relatively short history, as does the consistent, legal response. Furthermore, even though a number of issues make research on child maltreatment challenging, none of them stops researchers from trying. Although progress may seem frustratingly slow at times, a historical context can help us maintain perspective. We know more today about child maltreatment than we ever have, and the research literature con- tinues to grow at an amazing rate.


1. You may have heard newscasters making statements such as “Our children are at a greater risk today than ever. There is an epidemic of child abuse. Something must be done.” Based on the information presented in this chapter, would you agree or disagree with the points made by the newscaster? Why or why not?

6241-171-P1-001.indd 21 10/19/2013 10:13:49 AM




2. Which is worse: child abuse or child neglect? (Return to this question at the end of the course to see if your opinion has changed.)

3. Over time, there has been a trend toward more governmental intervention to protect children. Is this a good thing or a bad thing?

4. Some of the research limitations seen in this fi eld can be overcome, but oth- ers cannot (for ethical reasons). Does this mean we should stop attempting to study child maltreatment empirically? Why or why not?

5. Find a recent article that deals with either physical abuse or neglect. Does the researcher clearly defi ne the maltreatment term? Compare the operational defi – nition you fi nd with those found by your classmates. Did all of the researchers use the same defi nitions? Discuss how using different defi nitions has an impact on progress in the fi eld.

6241-171-P1-001.indd 22 10/19/2013 10:13:49 AM




There are many factors to consider when attempting to fi gure out why child maltreatment occurs. We are not able to simply say, “If x is true, then abuse will occur.” If it were determined that x caused child maltreatment, Child Protective Ser- vices (CPS) would have a much easier job. First, professionals could work to prevent or fi x x. Second, if x were present, CPS would know a child was at risk, and if x were absent, they would know the child was safe from maltreatment. Sadly, the picture that has emerged from research is not nearly so clear-cut. There does not seem to be any one factor that will cause maltreatment or prevent it from occurring. Instead, a multitude of factors increases the likelihood that a particular child will be the vic- tim of maltreatment. In trying to understand the complex phenomenon of child abuse, many researchers have found it helpful to keep the work of Bronfenbrenner in mind. This well-known psychologist says that in any attempt to understand human behavior, we must consider many levels of infl uence. We cannot look only at the child or even only at the family if we want to truly understand the problem. We must consider the broader social contexts in which these families exist. Researchers must examine the roles played by communities, local and federal government, the media, and even the time in which we live (Bronfenbrenner, 2000). Factors that increase the risk for child maltreatment have been identifi ed in all of these contexts. Although none of the factors discussed in this chapter means that a child will defi nitely be maltreated, each increases the likelihood that maltreatment will occur.


Parental Factors

Because parents are the ones who abuse and neglect their children, we start with examining what issues increase the likelihood that a parent would become abusive. Although most parents will not maltreat their children, no matter what challenges those children or the environment they live in pose, other parents are more likely to succumb to abusive behavior. For instance, parents who struggle with issues such as depression, low self-esteem, substance abuse, emotional instability, or poor impulse control are more likely to maltreat, as are parents who were themselves the victims of child abuse.

Parental Sex Men and women are not equally likely to be perpetrators of child maltreatment. When it comes to child neglect, female caregivers are more likely to be guilty. Of all


Risk Factors for Child Maltreatment

6241-171-P1-002.indd 23 10/19/2013 10:14:01 AM




neglect charges, 86% are made against women. This is largely accounted for by the fact that, in our culture, women are far more likely to be the primary caregivers for children than are men. On the other hand, 62% of all abuse charges are made against men, and men account for 87% of the charges of sexual abuse (Sedlak et al., 2010).

Parental Substance Abuse Parental substance abuse is frequently associated with all types of maltreatment; almost 80% of the families who come to the attention of CPS have some sort of sub- stance abuse problem (Winton & Mara, 2001). However, the relationship between parental substance abuse and child neglect is stronger than is the relationship between parental substance abuse and other types of maltreatment (M. G. Smith & Fong, 2004). When states were asked to report which problems were most likely to lead to child maltreatment, 85% listed substance abuse as one of the top two (poverty was the other leading cause). Substance abuse has also been noted in approximately two thirds of all cases involving child maltreatment fatalities. The relationship between substance abuse and maltreatment has been found among samples taken from CPS and in community samples. Another depressing fi nding has been that a history of substance abuse on the part of the parent increases the chance that he or she will maltreat a child. Ammerman, Kolko, Kirisci, Blackson, and Dawes (1999) conducted a research study aimed at exploring the link between substance use disorders and child abuse. They found that parents who currently had substance use disorders and those who had previously had a substance use disorder were at an increased risk for abusing their children. There was no difference in risk between parents who cur- rently had a substance use disorder and those who had had a substance use problem. The authors concluded that for mothers and fathers, both past and present substance use disorders are strongly linked to an increased risk for child maltreatment (see Focus on Research 2.1 ). Therefore, even if the parent is currently not using drugs, a history of drug use still increases the likelihood that he or she will maltreat children (Kelley, 2002). Not only does the abuse of drugs or alcohol inhibit the parents’ ability to be fully present for the child; the child may also have access to the substances or be endangered by riding in a car with an impaired parent.


Scannapieco and Connell-Carrick (2007) studied maltreating families in Texas who had at least one child between the ages of 0 and 48 months. The authors reviewed 9 months of records from a high-risk unit of CPS. They found that in families in which parents used alcohol or drugs, the rate of substantiation for child maltreatment was 52%. The rate of substantiation in families who did use alcohol or drugs was only 23%. They also found that children being maltreated by parents who used alcohol or drugs were more likely to face a host of negative circumstances including more dangerous living conditions, more impover- ished homes, a greater number of family stressors, a higher number of people living in the home, fewer available resources, a lower knowledge of children, and weaker parenting skills than were children being raised by nonmaltreating parents who used drugs and alcohol.

6241-171-P1-002.indd 24 10/19/2013 10:14:02 AM




There are a number of mechanisms whereby substance abuse may lead to child mal- treatment. First, the direct effects of the drugs, or withdrawal from those drugs, may cause the parents to act out in anger or frustration. Many drugs are noted for their disinhibition of aggressive impulses. In an unim- paired state, an adult may well be able to resist the temptation to strike a child who is pestering him or her. However, while a person is under the infl uence of drugs, his or her inhibition mechanism is compromised. Even if adults do not become aggressive when under the infl uence, they are likely to show impaired judgment in other ways. You have probably noted, in yourself or others, the tendency to make particularly poor decisions when a substance like alcohol is involved. Parents who are addicts may also focus on the drug to the point that they cannot meet their chil- dren’s need (Kelley, 2002). Finally, if a pregnant woman uses drugs, she may have a direct impact on the fetus (see Chapter 8 , “Fetal Abuse”).

Although women who use drugs may value motherhood, they are likely to strug- gle with fulfi lling that role. Kearney, Murphy, and Rosenbaum (1994) interviewed 68 cocaine-using mothers who were not in treatment. Most of these women were heavy drug users; 85% had used cocaine more than 1,000 times. The women reported that they placed a high value on motherhood, they had high standards for raising chil- dren, and they tried to protect their children from their drug habit (e.g., they would not use in front of their children, but they would hire sitters or wait until the children were in bed). However, even though they did not want their drug use to interfere with their parenting, they did note that the cocaine use interfered with their paying attention to their children. Furthermore, their use of cocaine took money that could have gone to the children, and it decreased their ability to be a good role model for their children. Of the women in this study, 69% had, at some point, either lost custody of their children or voluntarily placed their children with family members. Although substance abuse is a substantial risk factor for child maltreatment, it is not the case that all parents who abuse substances also maltreat their children. When working with families, it is important to assess a range of factors that may lead to maltreatment (see Focus on Research 2.2 ).


a loss of the ability

to restrain from or to

suppress behaviors or



Although parental substance abuse puts children at increased risk for child maltreatment, not all substance-abusing parents mistreat their children. Scannapieco and Connell- Carrick (2007) examined the factors that differentiated substance-abusing parents who were maltreating their children from those who were not. They reviewed the cases of 95 families that were all identifi ed as users of drugs or alcohol. Of these families, 52% had their cases substantiated for maltreatment whereas 48% did not. Scannapieco and Connell-Carrick found a large number of factors that differed signifi cantly between the two groups. With regard to home characteristics, parents who were abusive were also liv- ing in environments that were impoverished and/or dangerous, with more stressors and more people in their homes than were nonabusive parents. Caregiver factors also differed between the groups. Maltreating substance abusers had fewer resources, knew less about

6241-171-P1-002.indd 25 10/19/2013 10:14:02 AM




children and development, and had fewer parenting skills and less parental capacity than did the nonabusive substance users. With regard to social characteristics, the abusive par- ents seemed to suffer from social isolation and/or negative interpersonal relationships. Finally, it was noted that the abusive families were more likely to have had a history that included out-of-home care for the children and/or a history of previous maltreatment. The authors recommend that social workers assess not only substance abuse but also other risk and protective factors within the child’s environment.

Parental Mental Illness and Problematic Personality Traits As a group, people who abuse children are more likely to suffer from mental illness than are nonabusers. Maternal sociopathy and serious mental illness are both asso- ciated with an increased risk for child maltreatment (J. Brown, Cohen, Johnston, & Salzinger, 1998). For example, Sidebotham, Heron, and the ALSPAC Study team at the University of Bristol (2006) based their research on 114,256 children. Of these chil- dren, 293 were investigated for suspected maltreatment by the time they were 6 years old. Mothers who had a history of psychiatric problems were twice as likely to maltreat their children. However, the vast majority of people who maltreat their children do not meet the criteria for a major mental illness. The strongest relationship between mental illness and child maltreatment is depression, particularly maternal depression.

Depression Depression is the most common mental disorder. Between 10% and 25% of women and between 5% and 12% of men will struggle with depression at some point during their lives. People who suffer from a major depressive episode experience a host of symptoms including a depressed mood, lack of interest in most activities, weight loss without dieting, sleeping problems, fatigue, problems concentrating, and thoughts of death. By defi nition, these symptoms impair the person’s social functioning (American Psychiatric Association, 1994). Given these symptoms, it is not diffi cult to imagine that people who suffer from depression are at an increased risk for maltreat- ing their children. Zuravin, Bliss, and Cohen-Callow (2005) reviewed the literature on the link between maternal depression and child maltreatment and concluded that there is a positive correlation between the two. The relationship was particularly strong for mothers of young children. Across studies, it was noted that depressed mothers were less emotionally involved with their children and showed less affec- tion than did nondepressed mothers. Not only were depressed mothers lacking in positive interactions with their children; they were also more likely to be overtly hostile and to use harsh punishment than were other mothers.

Postpartum Depression If the onset of symptoms for depression occurs within four weeks of delivery, the descriptor postpartum is added to the diagnosis. Postpartum depression can be either nonpsychotic or psychotic. Although psychotic postpartum depression is rare (only one in 500 to 1,000 births), it is more likely if the mother has suffered from a


mental disorders marked

by the loss of contact

with reality; generally

marked by delusions,

hallucinations, or serious

thought disturbance.

6241-171-P1-002.indd 26 10/19/2013 10:14:02 AM




previous mood disorder, including postpartum depression following an earlier birth (American Psychiatric Association, 1994). In either case, it interferes with the rela- tionship between the mother and her infant. Researchers have found that even mild maternal depression during the fi rst months of a child’s life has a signifi cant, nega- tive impact on bonding between the mother and infant (Moehler, Brunner, Wiebel, Reck, & Resch, 2006). With regard to psychotic depression, one study of 108 women who suffered from severe mental illness during the postpartum period found that 53% of the mothers reported delusions about their infants. The nature of the delu- sions had a great impact on the mother’s interaction with her child. If the mother’s delusions were of persecution, she tended to provide competent, affectionate care. These mothers did differ, however, from normal mothers in that they were overly anxious if separated from their children. On the other hand, a mother who had delusions that her child was evil (e.g., a devil) or that the baby was not hers was signifi cantly more likely to be abusive (Chandra, Bhargavaraman, Raghunandan, & Shaligram, 2006). We should take special precautions with mothers experiencing psychotic depression because it is associated with abuse and infanticide; however, the Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DMS-IV ; Ameri- can Psychiatric Association, 1994) notes that any maternal mood disorder increases the risk for infanticide.

Although most abusers do not have a mental illness, they are more likely than nonabusers to have the following personality traits: feelings of inadequacy, impul- sivity, violent tendencies, low self-esteem, immaturity, low frustration tolerance, and anxiety (Dorne, 2002). Raising children is a challenge for even the most even- tempered, well-balanced parents. People hampered by these types of personality traits are often unable to adequately meet the needs of their children.

Lack of Preparation It seems that many maltreating parents are simply not prepared to adequately fulfi ll the parental role. It has been reported, for example, that neglecting parents tend to lack basic caregiving skills such as food preparation and housecleaning, which are important in meeting a child’s physical needs. Neglectful parents also know less about children and child development than do nonneglecting parents. This lack of knowledge can lead to unrealistic expectations about what children should be able to do for themselves (Burke, Chandy, Dannerbeck & Watt, 1998; Dubowitz, Black, Starr, & Zuravin, 1993). A mother may fail to provide adequate food or supervision simply because she is unaware that her child needs such care. It is also possible that some neglectful mothers are not likely to learn the necessary parenting skills because they lack maternal motivation and they have less empa- thy for their children than do nonmaltreating mothers (Slack, Holl, McDaniel, Yoo, & Bolger, 2004).