Lectures Child Abuse
Lecture 1 – Introduction
Having a safe childhood is very important according to Freud, Harlow, Ainsworth and
Bowlby. Bowlby says: “the infant and young child should experience a warm, intimate, and
continuous relationship with his mother (or permanent mother substitute) in which both find
satisfaction and enjoyment” and that not to do so may have significant and irreversible mental
health consequences” .
Why should we learn about the long-term consequences of childhood abuse and
neglect? Because there are numerous findings that childhood abuse and neglect have
pervasive consequences for mental and physical health.
Childhood maltreatment: any act of commission or omission (doing something or not doing
something) by a parent or other caregiver that results in harm, potential for harm, or threat
of harm to a child. Harm does not need to be intended.
Omission: the failure to meet a child’s needs. Not doing something a child needs. For
omission, we generally talk about neglect. Examples of omission are:
Physical neglect: failure to meet a child’s basic physical, medical/dental, or
educational needs. E.g., failure to provide enough nutrition, proper hygiene or shelter.
Prevalence = 16%.
Emotional neglect: failure to meet a child’s emotional needs and failure to protect a
child from violence in the home or neighborhood. E.g., not giving the child love and
attention.
(Denial of access to education)
Commission: actively doing something harmful. Here we generally talk about abuse.
Examples are:
Physical abuse: intentional use of physical force or implements against a child that
results in or has the potential to result in physical injury. E.g., hitting, hurting the
child. Prevalence = 23%
Emotional abuse: intentional behavior that conveys to a child that he/she is
worthless, flawed, unloved, unwanted, endangered, or valued only in meeting
another’s needs. E.g., yelling, wrongly accusing. Prevalence = 36%
Sexual abuse: any completed or attempted sexual act, sexual contact or non-contact
sexual interaction with a child by a caregiver (but also outside of the direct family,
e.g., sports coach). Prevalence = 18% of girls, 8% of boys.
(Shaken baby syndrome)
The prevalence is lower in the Netherlands (because they are confirmed cases, instead of self-
report).
When we talk about the psychological consequences of child abuse and neglect, we look at
the classification system for psychological disorders. Based on standard criteria, people can
be diagnosed with a disorder. The DSM-5 is one of those systems, and it consists of objective
descriptions of symptoms, with no theoretical framework. This caused a decrease in the focus
on etiology (cause), except for trauma- and stressor-related disorders childhood abuse is
also a kind of trauma.
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,For many psychological disorders, the prevalence of childhood maltreatment is higher than in
the healthy population.
Disorders can be internalizing (towards yourself) and externalizing (towards others). Often
occurring disorders that are associated with childhood abuse are personality disorders,
psychotic symptoms and suicide and self-injury. People that have experienced childhood
maltreatment often have an earlier onset of disorders, have more severe/chronic disorders and
are harder to treat (because they drop out of treatment more often.
If we look at unclassified symptoms, we see that many of the symptoms that fit different
disorders show up more in people that have experienced childhood maltreatment. So, they
might experience a lot of different symptoms that just don’t fit into the framework of 1
specific disorder. They won’t be diagnosed although they have many different psychological
symptoms.
To conclude: childhood abuse and neglect are important transdiagnostic risk factors (it can
evolve in many different symptoms different outcomes for different people) for the
development of psychological problems, including depression and anxiety (internalizing) and
drug & alcohol addiction, aggression etc. (externalizing). The consequences of emotional
abuse and neglect are at least at pervasive as physical or sexual abuse.
Guest lecture
Secrecy: shame about own situation, low self-esteem as a result of the abuse, loyalty
and love to partner/parents, guilt, fear of consequences of revelation, lack of trust in
people.
Recovery as a personal process: unpredictable, develop skills and goals again,
acceptance, new possibilities.
What is required: recovery (for emotional and physical damage), listening and
recognition (about your trauma), processing (reducing behavioral and developmental
problems), offer (new development opportunities).
What do survivors need: recognition (of the abuse and wrongfulness), affirmation
(of their strength, creativity and rights), validation (not their fault, not their shame),
support (sharing experiences with others, feeling less alone, learning new skills for
coping and enhancing their lives, becoming more self-confident).
Ladder of experiential knowledge:
o Experiences – rough material. Individual, unique, isolation, vulnerable.
o Experiential knowledge – some reflection. Shared, similarities, recognition,
strength.
o Experiential expertise – bridging, using the experience to teach the audience.
Collectively, advocacy, empowerment.
What do we need for change: reflect on context and tensions (perspectives, be
inclusive; what do victims and survivors need; what will be the new expertise of the
professionals, what do they add), what do we need work on in more depth and with
more impact (embedding experiential knowledge; do not avoid the trauma of
violence, dare to work with it; attention for the relationships in the here and now; keep
experimenting, be in dialogue and ask for feedback).
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,Short recap from last week
People that experience childhood maltreatment have an increased risk on developing
psychopathology. The onset is often earlier, the disorder is more severe, more chronic, and
harder to treat in people with a history of childhood maltreatment.
Psychosocial consequences: people that have been abused during their childhood can
experience more interpersonal problems (trust issues, isolating). Self-image is an important
factor as well; they often have reduced self-esteem. There can also be re-victimization:
someone that has been abused when they were a child, more often ends up in an abusive
relationship later on (due to less clear boundaries in relationships, or you might think it’s
normal interaction).
Inter-generational transmission: about 30% of people that have experienced abuse transmit
it to the next generation. Consequences of abuse can often be a risk factor for abusive
behavior. If you interpret the world in a more hostile way, you might interpret your child’s
behavior in a more stressful or negative way. Also, abuse can cause fear of becoming an
abuser yourself too. This causes stress, which can cause abuse. This stresses the importance
of timely preventing abuse itself, but also of its consequences.
After experiencing emotional neglect or emotional abuse, you have a 3 times higher chance
of developing depression or anxiety disorder.
Lecture 2 – Psychological Consequences & Methods
The broad psychological and social consequences of childhood abuse: psychological
disorders: there is lots of comorbidity (2 or more disorders at the same time, or more than 1
type of abuse), but there can also be many symptoms without one specific disorder. People
that have experienced child abuse have a higher risk for the earlier onset of disorders, and
more severe symptoms (e.g., suicidality). Interpersonal problems: attachment problems at
younger and later age, lower epistemic trust (an individual's willingness to consider new
knowledge as trustworthy and relevant, and therefore worth integrating into their lives),
social exclusion (and bullying). Lower self-image, re-victimization, intergenerational
transmission.
The first step in doing research, is knowing who reports on what. Who has been maltreated,
when, what happened? Very young children cannot do this themselves, so in those cases an
informant usually reports (e.g., teacher). When the child is older, you can just ask the child
(victim). Here, the questions are very important (if a child has always experienced it, it might
not even know that it is abuse). You can also ask the parent (who is the perpetrator).
Statistics can become different depending on what kind of information you use (self-
report vs. informant). There was a big difference in the relation between maltreatment and
anxiety/depression self-report was much higher than informant.
Statistics can also become different depending on who you use as a reporter (parents vs.
child). According to self-report there is a higher risk to transmit abuse, and to transmit
neglect. If you feel like you have been neglected in your childhood, you more often report
neglecting your child. If you ask the child, they only report transmission of the abuse.
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, Human Research Methods
Retrospective research = you ask someone what has happened in the past (yesterday, or a
few years ago), you ask back. This is very practical when you study long term consequences
(in adults). Disadvantages of retrospective reports: there can be errors in memory, recall
bias can occur (interpreting your past in a more positive or negative light; if someone is in a
depressive episode, they might only recall the negative things), and consequences and abuse
are assessed at the same moment (causality regarding cause and effect are unclear).
Prospective research = you start at the beginning (e.g., birth) and follow the participants
over time, often longitudinal research. It is practical when you study the temporal order of
abuse, and the consequences. There is no recall bias or selective inclusion based on outcome.
Disadvantages of prospective reports: selective inclusion, drop-out, high costs and long
duration, unethical without intervening the situation (once abuse is noticed, the researchers
have to intervene).
An objective measure of parenting can be measures that are confirmed by a professional,
are obtained by multiple informants or have (visual) proof. Or you can study behavior at
home or in a lab setting.
Observational studies in the lab
In the lab, you can study parent-child interactions by observation. You can observe during a
game or assignment, or when a child shares feelings with their parent (will the parent support
or motivate the child, is the parent empathic, or negative, is there warmth, intrusions). You
can observe what is being said, behavior (pushing, not interested, frowning) and physiology
(measuring the stress of the parent by heart rate).
Example of observational research (article): in this study, parents who have
experienced childhood abuse and neglect are studied. Their behavioral and autonomic
responses to their children are measured. Autonomic nervous system puts your body
either in a state of arousal (sympathetic), or rest (parasympathetic). People differ in
how they respond to a stressor, and how relaxed they can be. In this study a parent-
child conflict interaction task was used. Parents who had experienced abuse
showed less warmth and more negativity during the conflict task. Parents who had
been neglected showed a negative relation with PEP reactivity and with RSA
reactivity they had more sympathetic arousal but less parasympathetic arousal. So,
they were more active e.g., higher heart rate.
How can we study causal impact
Bidirectionality and underlying confounders are both possible. There is no experimental
manipulation possible to research the causal impact of abuse and neglect.
Observational research
Experimental research:
o Acute stress studies: you make people temporarily stressed and see what their
changes in behavior are (mood, memory, cognition). There are 2 types: make
people experience psychosocial stress (Trier Social Stress Test) or make
people experience bodily and psychological stress (Cold Pressor Test).
Outcomes can be changes in mood, behavior, cognition, choices and coping.
This can indicate changes after chronic stress. However, acute stress response
and adaptation of behavior is healthy and adaptive. Chronicity of stress
response can become maladaptive.
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