What is child maltreatment? its effects and consequences

Child abuse or child maltreatment constitutes of physical, emotional and sexual abuse, negligence and neglect which harms the child’s development, dignity, survival and health in the context of a relationship of trust, power and responsibility (WHO, 2020).

Contents:

1. What is child Neglect?

2. What is Child Abuse?

3. Indian Scenario of child maltreatment

4. Consequences of child maltreatment: Biological and Psychological

5. Effects of child neglect

6. Effects of child sexual abuse

7. Effects of child physical abuse

8. Protection of Children from Sexual Offenses Act (POCSO), 2012

9. Mandatory Reporting

What is Child Neglect?

Neglect is when there is a failure to provide a safe space of shelter, health (physical and mental), nutrition and education even when resources are fairly available to the caretakers to provide all of the above. Basic needs of the child are neglected. The four types of child neglect are:

1. Physical Neglect: Leaving the child without supervision; therefore, threatening the safety of the child, not providing food and important nutrients to the child and failure to provide clothing and shelter all constitute physical neglect.

2. Health Neglect: Health neglect constitutes the failure to give the child medical attention, denying/delaying taking the child to a doctor when necessary, denying child of mental health help and failure to give the child medications.

3. Education Neglect: Failure to give the child educational opportunities and not sending the child to school constitutes educational neglect.

4. Emotional Neglect: Failure to provide emotional stimulation, support, lack of love, physical emotional affection, and nurturing etc. constitute emotional neglect.

What is Child Abuse?

Child abuse constitutes of:

1. Child physical abuse: It constitutes of hitting, kicking, biting, burning, strangling, poisoning, choking etc. by a caregiver or any person responsibility for the child’s safety; which harms the child’s health, development and survival. Whether these actions are done with the intention of punishment and not of the intent to harm the child; it is still taken as child physical abuse.

2. Emotional abuse: It constitutes of the failure to provide developmentally appropriate form of support which can help the child develop emotional and social skills or competencies.

3. Child sexual abuse: It constitutes of involving the child in sexual acts that he/she cannot comprehend yet or cannot give consent to. It also constitutes the involvement of the child in acts that are tabooed by society or illegal by law.

Child abuse and neglect (CAN) also involves witnessing violence or exposure to violence. Exposure to violence involves:

• Child is a direct recipient of hostile and abusive behavior.

• Child witnesses violence at home, such as domestic abuse. Child sees and hears violent behavior.

• Child indirectly witnesses the aftermath of violence. This includes seeing bruises, blood, broken things, parent in distress.

Children are at risk of perceiving abuse and violence as normal, using violence and aggression in their own future relationships and towards family and other members. In case of seeing mother at the receiving end of violence; girls are at a risk of perceiving male violence as normal, internalizing harmful patriarchal ideas such as accepting, submitting, normalizing violence/abuse in their own future relationships etc.

Indian Scenario of Child Maltreatment

Globally, according to WHO over one billion children between the ages of 2-17 are abused (physical, sexual, emotional abuse and neglect) (WHO, 2020). According to the National Crime Records Bureau of India, a total of 47,335 cases were recorder under the SLL crimes POCSO (Protection of Child from Sexual Offenses) act, in 2019. Under the IPC section of simple and grievous hurt 3305 and 957 cases were recorded respectively. In all the major cities in India, a total of 6263 cases were recorded under the POCSO act; with Delhi and Mumbai recording the highest cases (1662 and 1319 respectively) (National Crime Records Bureau , 2019). Although these numbers can be much higher because cases may go unreported. See full crime statistics.

Fig 1.1: Showing the gender distribution of child maltreatment offenses recorded under the POCSO act as per National Crime Records Bureau of India in 2019.

Fig. 1.2: Showing the age wise distribution of child maltreatment offenses recorded under the POCSO act as per National Crime Records Bureau of India in 2019.

Fig. 1.3: Showing the offenders profile distribution of child maltreatment offenses recorded under the POCSO act as per National Crime Records Bureau of India in 2019.

Consequences of Child Maltreatment

Adverse Childhood Experiences (ACEs) have long lasting effects on child, affecting their future, health both physical and psychological, behavior and their emotional regulation. Adverse Childhood Experiences study was conducted jointly by Kaiser and CDC by Dr. Vince Felitti and Dr. Bob Anda from 1995-1997. They interviewed over 17,000 people regarding their childhood experiences. (Centre for Disease Control and Prevention, 2021). For every adverse childhood experience of physical, emotional and sexual abuse, neglect, parental divorce, exposure to violence, domestic violence, substance abuse and incarceration mentioned, they received a point. They then correlated their scores to their mental and physical health outcomes. The results showed that, the higher their ACE score, the worse their outcomes were. Results also showed that ACEs are more common than people think. People with an ACE of 4 or higher, were 4.5 times more likely to develop depression, 12 times more likely to develop suicidality, three-fold risk of lung cancer. They were also at increased risk of early sex, unwanted pregnancies, substance abuse, ischemic heart disease, diabetes etc. Read More

Biological

Impact of child maltreatment is dependent on the frequency of abuse, who the abuser is, age and gender of the victim and the type of abuse. How the community deals with it will also have an impact. Child maltreatment happening at an early age when the brain is still developing can affect the functioning and structure of the brain. Impact of the toxic stress that a child goes through has an effect on various parts and functioning of the brain. Toxic stress is where the stress response system is being activated continuously, strongly and for a prolonged length of time. It can lead to the dysregulation of the HPA axis. Hypothalamic-pituitary adrenocortical axis is responsible for producing cortisol in a stressful situation. Dysregulation of the HPA axis is majorly associated with major depressive disorder, anxiety and other mental illnesses.

Child maltreatment can also lead to reduction of volume in hippocampus (learning and memory), corpus callosum (inter hemisphere communication, higher cognitive abilities, emotion etc.) and cerebellum (motor coordination, executive functions). Maltreatment can lead to over activation of the amygdala which helps in scanning whether a particular stimulus is dangerous; which explains the persistent or chronic fear response in children who have been maltreated. Higher cortisol levels were also observed among children who experienced severe emotional maltreatment. Higher levels are associated with problems in immune responses, inflammatory responses and increase the risk of affective disorders (depression, bipolar disorder, anxiety disorders etc.). (Child Welfare Information Gateway , 2015).

Severe child neglect is associated with lower cortisol levels, small prefrontal cortex which is important for emotional, behavioral and cognitive regulation. Lower cortisol levels are associated with development of autoimmune diseases, externalizing disorders like attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder and problems with socialization and learning (Child Welfare Information Gateway , 2015). Read more.

Psychological

Child maltreatment can lead to a child developing certain cognitive distortions, hyperarousal, hypervigilance, persistent fear state, internalization, low self-esteem, poor emotional regulation etc. Different type of maltreatment can lead to different psychological disturbances.

• Hyperarousal: Children who have experienced prolonged abuse can be triggered by certain non-verbal cues, touch on the arm or shoulder etc. They could be more likely to misinterpret cues even in a non-threatening environment; because of their constant scanning of their environment for threats.

• Hypervigilance: Hypervigilance is the constant scanning of threats in the environment.

• Persistent fear state: Chronic toxic stress and prolonged maltreatment in childhood can lead to a state of persistent fear. Constant activation of stress response related neural pathways can alter the child’s perception of threat and of the environment. Even last on in life, despite being in a safe environment, the individual may find it difficult to tell apart safety and danger. He/she may misinterpret a nonthreatening stimulus as threatening (Child Welfare Information Gateway , 2015).

• Poor emotional regulation: Children who have been maltreated may engage in controlling, suppressing and avoiding emotions. They may also find it difficult to modulate their emotions resulting in extreme outbursts of emotions.

• Internalization: Internalizing symptoms or problems are loneliness, anxiety, depression etc. Child maltreatment can result in the development of anxiety and depression in late adolescence. Neglect, deprivation and emotional abuse can alter the brain’s ability in using serotonin; the neurotransmitter responsible for well-being and stability of emotions (Child Welfare Information Gateway , 2015).

Effects of child neglect

Nicolae Ceauşescu, dictator of Romania was overthrown in 1989. And the world discovered that around one lakh seventy thousand orphaned children were institutionalized during the dictatorship. They faced severe neglect, deprivation and little to no stimulation. They were confined to their beds for the whole day other than their scheduled bath and feeding time. They were neglected from a very early age. The age ranged from months old to three years. Psychologists who sought to see the effects of this severe neglect and deprivation launched the Bucharest Project. They observed that children had low self-esteem, low impulse control, reduced intellectual functioning and behaviors such as tantrums, stealing and smaller brains with low gray and white matter. These children also had developmental delays in motor functioning, cognitive functioning and language. Face-to-face talk with the baby is how they start to hear the sounds, imitate and learn to speak; starting from babbling to words to sentences. If there is no such stimulation or their babbling sounds are ignored at critical periods of development at 6 months; there will be a delay in language development. The rapid language development seen between 1 ½ years to 2 years of age is absent among children who have been ignored. After some were moved to foster care; especially if they were moved before 2 years of age; children showed considerable improvements in their socio-emotional skills, intellectual abilities and language. They were also able to form secure attachments with their foster parents (Weir, 2014). Children who have been neglected also showed a lack of socio-emotional skills and developed psychiatric disorders. They showed concerns in impulse control and more importantly the theory of mind. Theory of mind is an important social, emotional and cognitive skill that helps in our ability to understand our own mental states and the mental states of others. It involves our ability to understand and show empathy (Weir, 2014).

Another important aspect observed among post-institutionalized children by Dr. Megan Gunnar is indiscriminate friendliness. A child who doesn’t even know you may come to you strike a conversation and put your arms around you and walk with you like your best friend would. Gunnar says that this could actually be their coping mechanism for their socially deprived life in the institutions. This was also reflected in the research in the Bucharest Project. This indiscriminate friendliness also reflected in their relationship with their foster caregivers. In a short period of time children were able to form strong bonds with their caregivers. But these attachments were not secure, they were disorganized attachment styles; where the child might sometimes go to the caregiver for support and sometimes show resistance. This is also shown in the fMRI scans done in a study by the University of California, LA. When children were shown pictures of their mothers and other strangers; the amygdala showed different responses for both the photos. But among children who were institutionalized, the amygdala showed a similar response to both the photos; showing their indiscriminate friendliness (Weir, 2014).

Parental risk factors associated with neglect are:

• Parents with a history of child maltreatment

• Parental mental illness such as depression etc.

• Lack of social support

• Domestic violence

• Parental substance abuse

Effects of Child Sexual Abuse

The outcomes of child sexual abuse, depends on the severity of the abuse; that is penetration or genital bleeding or sexual injury etc., is considered severe, if revictimization took place, age of the victim etc. Child sexual abuse is known to have long term effects on mental health and behaviors of the individual. Children who experienced child sexual abuse are later on known to indulge in substance abuse, risky sexual behaviors such as sex at a young age, sex without protection and multiple sexual partners and as a result of which are sexually transmitted diseases (Oshima, Jonson-Reid, & Seay, 2014). With reference to revictimization, African American children has higher rates of revictimization and if the perpetrator was the paramour of the caregiver, revictimization rates were higher. Child sexual abuse was more common among girls than boys (Oshima, Jonson-Reid, & Seay, 2014). According to a study done on adolescent girls with a history of child sexual abuse, 47% were at a higher risk of suicide; when compared to 33% without a history. Non-suicidal self-injury (NSSI) could also be predicted among adolescents with a history of early sexual abuse. 31% of adolescents with a history were at a risk of NSSI; when compared to only 14% without a history (Rabinovitch, Kerr, Leve, & Chamberlain, 2015). Severity of child sexual abuse also increased the risk of suicide; when compared to less severe sexual abuse. Those with a history of penetration were 12 times more likely to attempt suicide. Even individuals who experienced less severe sexual abuse were three times more likely to attempt suicides when compared to their counterparts with no history of child sexual abuse (Oshima, Jonson-Reid, & Seay, 2014). Adolescents with a history of sexual abuse were also twice as likely to experience cyberbullying, when compared to teens with no history; causing polyvictimization. These multiple adverse events in childhood have drastic effects on mental health causing significant psychological distress, low self-esteem and suicidal ideations (Hébert, Cénat, Blais, Lavoie, & Guerrier, 2016).

Effects of Child Physical Abuse

In child physical abuse, the severity and duration of abuse determines the outcomes or impact it has. The longer the abuse the more severe the outcome will be. Physical abuse can range from bruises, scratches, pain, burns etc. But permanent damage can also occur such as deafness, blindness, developmental delays, paralysis, neurological damage causing seizures, tremors etc. and also death. The psychological impact as a result of physical abuse is long lasting and can last well into adulthood and later on. Some psychological effects are the sleep disturbances (insomnia, excessive sleeping), low self-esteem, eating disorders, anxiety disorders, excessive fear, depression, hostility and aggression towards their peers and family etc. Socially, they can find it difficult to make and maintain friendships, they can be mistrustful of others, can be overly obedient to authority figures, show a lack of basic communication or other social skills. In the future, they can have troubles in their romantic relationships leading to divorce, could develop substance abuse, engage in criminal activities etc. (Gluck, 2012).

The Protection of Children from Sexual Offenses Act, 2012 (POCSO)

The POCSO Act of 2012, is a special law to protect children under the age of 18 against sexual harassment, sexual abuse and pornography and to establish special courts for trails of such offenses. It establishes guidelines on care for the child, taking statements and court proceedings so as to protect the child from retraumatizing during the proceedings and to protect the dignity, identity and well-being of the child. Guidelines were made to be child-friendly during recording and court proceedings. It was a landmark act defining in detail the offences and putting the burden of proof on the accused rather than the victim. It includes:

• Penetrative sexual assault- Any person penetrating penis into the mouth/vagina/anus/urethra of the child or makes the child do so to them or any other person or inserting any object/ part of the body and not the penis to cause penetration is said to be penetrative sexual assault. Applying mouth to penis/vagina/anus/urethra of the child or making the child do so to them or any other person is also included under this section. Punishment: 7 years, may extend up to life in prison and also liable to fine

• Aggravated penetrative assault- Whoever being a police officer, public servant, management staff at school/hospital/jail, armed forces commit penetrative sexual assault. Committing penetrative sexual assault using deadly weapons, causing grievous hurt, causing physical harm and mental illness, causing pregnancy (in case of a girl child), infecting the child with HIV or other diseases that incapacitate the child physically and mentally, committing offense on a child below 12 years, those who are repeat offenders, those who are blood relatives/foster care/related to the parents of the child, those who try to murder the child after committing the offence and those who provide childcare services are all included under this section. Punishment- rigorous 10 years may extend up to life in prison and also liable to fine.

• Sexual assault- Touching the breast, vagina, penis, anus of the child with a sexual intent or making the child touch breast, penis, anus of the other or any other person or does any act which involves physical contact without penetration and with sexual intent is said to be sexual assault. Punishment- 3 years, may extend up to 5 years and liable to fine.

• Aggravated sexual assault- Definition is the same as punishment for aggravated penetrative sexual assault. Punishment- 5 years, may extend up to 7 years and liable to fine

• Sexual harassment- When a person with sexual intent

1. says a word, makes a sound, exhibits a body part or any object so as to be heard or seen by the child

2. makes a child show his body or any part of the body to be seen by them or any other person

3. shows any object in any form of media to the child for pornographic purposes

4. follows, contacts or checks on the child repeatedly

5. lures a child in for pornographic purposes or gives gratification

6. threatens to use any form or media whether real or false and through any mode depicting part of the body of a child or the involvement of child in a sexual act. Punishment: 3 years and liable to fine

• Using a child for pornographic purposes- Using a child in any form of media whether television, internet, printed form etc. for personal use or for distribution for sexual gratification. This includes

1. Child engaged in real or simulated sexual act with or without penetration

2. Obscene representation of a child

3. Sexual parts of a child are represented

4. Punishment: 5 years, if it’s a second time offense then it can extend up to 7 years and liable to fine. If there is direct participation of the person then it can be 10 years may extend up to life in prison and also liable to fine.

• Abetment and attempt to commit- Abetting involves instigating a person to commit the offense, conspiring with one or more people to do the offense or aids in committing the offense. The same punishment for the crime committed as a result of abetment will apply here. The same punishment applies to attempt to commit as well. Punishment for failure to report a case can be imprisoned for six months, is liable for fine or both

A head of an organization who fails to report an offense under this act committed by his/her subordinate can be imprisoned for one year and with fine. (Ministry of Law and Justice , 2012)

Procedure for reporting cases:

• Cases can be reported at juvenile police center or your local police station. It must be recorded in a simple language so that the child can understand. If its being recorded in a language the child cannot understand, then a translator must be present.

• If the special juvenile police center or the local police station recognizes that the child is in need of protection and care, then without any delay and within 24 hours, the child should be admitted to a hospital or shelter home. This matter shall also be reported to a child welfare committee and a special code.

• It is the obligation of the media, any photographic facilities, club or hotel; in case of possession of any material that is sexually exploitative of the child like pornographic material, photos etc. shall be submitted to the special juvenile police center or the local police station.

• Any person who fails to report such offenses shall be punished with six-month imprisonment and fine or both.

• The media shall not disclose any details that reveal the identity of the child like photographs, addresses, name, family, school etc. which infringe upon the child’s privacy (Ministry of Law and Justice , 2012).

Procedure for recording the child’s statement

As far as possible a women police officer will record the statement from a child and no police officer must be in uniform while doing so. The statement should be recorded at the residence of the child or any place he/she usually lives at or of the child’s choice. A child cannot be kept at a police station overnight under any circumstances. The police officers should ensure that in this process the child does not come into contact with the accused at any point in time.

If the magistrate is recording the statement, it must be ensured that it is recorded as spoken by the child and the presence of the advocate of the accused is not necessary. The statement must only be recorded in the presence of a person the child trusts like his/her parents, relatives etc. A copy of the statement must be provided to the parents or the representative of the child. If the child has any physical or mental disability, then assistance must be taken from the expert in the appropriate field.

Medical examination must be conducted by a female doctor in case the victim is a girl. And only in the presence of parents or someone the child trusts. If any of the trusted persons cannot be present, then a woman must be nominated by the medical examiner and must be present during the entire course of the examination (Ministry of Law and Justice , 2012).

Special courts

For speedy trails of offenses under this act, the state government will for each district designate a court of session as special court. The state government will also appoint a special prosecutor for offenses under this act for every special court. Innocent until proven guilty does not apply to offenses under this act. During the proceedings the special court will assume that the accused has committed, attempted to commit or abetted to commit the crime until it is proven otherwise, for sections 3,5,7 and 9. For all the sections under this act, a culpable mental state of the accused is presumed, until it is proven otherwise (Ministry of Law and Justice , 2012).

Powers of the special court and its proceedings:

• A special court may be aware of any offense, without the accused being committed to it for trial.

• The special court must ensure that the child is not to see the accused at any time during the proceedings, testifying etc. But should also ensure that the accused is at a place where he can hear the child testifying or the child’s statements.

• Special courts must complete the trial within one year from the date of the cognizance of the offence.

• The representative of the accused, should communicate the questions being put forth to the child during examination, re-examination or cross- examination to the special court first and then to the child. The special court will also not permit any aggressive questioning or character assassination to ensure the dignity of the child is maintained at all times.

• The special courts will permit frequent breaks for the child and must also make the court child friendly.

• The special court must also make sure that the child is not asked too many times to testify

• The special courts must also ensure that the identity of the child is not disclosed at any point during the proceedings and investigations (Ministry of Law and Justice , 2012). Read more.

Mandatory Reporting

The POCSO act also brought about mandate reporting; meaning that any person who has a suspicion or has knowledge of the abuse happening are bound by law to report it to the authorities. Failing to report which will result in imprisonment and fine. Mandatory reporting is common in many countries. Professionals who are frequently in contact with children such as doctors, teachers, principals, counsellors and other mental health professionals, those who provide child care etc. are mandated to report child maltreatment. Any others who suspect child abuse or neglect must report as well. Institutional reporting, where an employee working for an organization suspects child maltreatment is mandated to report it. Internally as well, organizations may have their own rules and procedures to follow in case of child maltreatment; where they have to report it to their head; who then reports it to local authorities.

References

Centre for Disease Control and Prevention. (2021, April 6). About the CDC-Kaiser ACE Study. Retrieved from Centre for Disease Control and Prevention: https://www.cdc.gov/violenceprevention/aces/about.html

Child Welfare Information Gateway . (2015). Understanding the effects of Maltreatment on Brain Development . Retrieved from Child Welfare Information Gateway : https://www.childwelfare.gov/pubpdfs/brain_development.pdf

Gluck, S. (2012). Effects of Child Physical Abuse. Retrieved from Healthy Place : https://www.healthyplace.com/abuse/child-physical-abuse/effects-of-child-physical-abuse

Hébert, M., Cénat, J. M., Blais, M., Lavoie, F., & Guerrier, M. (2016). CHILD SEXUAL ABUSE, BULLYING, CYBERBULLYING, AND MENTAL HEALTH PROBLEMS AMONG HIGH SCHOOLS STUDENTS: A MODERATED MEDIATED MODEL. Depression and Anxiety, 623-629.

Ministry of Law and Justice . (2012). POCSO Act, 2012. Retrieved from Ministry of Women and Child Developement : https://wcd.nic.in/sites/default/files/POCSO%20Act%2C%202012.pdf

National Crime Records Bureau . (2019). Crime in India 2019 Volume 1. Retrieved from National Crime Records Bureau: https://ncrb.gov.in/sites/default/files/CII%202019%20Volume%201.pdf

Oshima, K. M., Jonson-Reid, M., & Seay, K. D. (2014). The Influence of Childhood Sexual Abuse on Adolescent Outcomes: The Roles of Gender, Poverty, and Revictimization. Journal of Child Sexual Abuse.

Rabinovitch, S. M., Kerr, D. C., Leve, L. D., & Chamberlain, P. (2015). Suicidal Behavior Outcomes of Childhood Sexual Abuse: Longitudinal Study of Adjudicated Girls. Suicide Life Threat Behavavior, 431-447.

Weir, K. (2014, June). The lasting impact of neglect. Retrieved from American Psychological Association : https://www.apa.org/monitor/2014/06/neglect

WHO. (2020, June 8). Child maltreatment. Retrieved from World Health Organization: https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

WHO. (2020, June 8). Violence against Children . Retrieved from World Health Organization: https://www.who.int/news-room/fact-sheets/detail/violence-against-children