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Dr. Gellner: It's hard to imagine someone intentionally hurting a child, yet nearly a million children are abused every year just in the United States alone. Child abuse is today's topic on The Scope. I'm Dr. Cindy Gellner.

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Dr. Gellner: Child abuse happens when a parent or other adult causes serious physical or emotional harm to a child. Child abuse can take the forms of physical abuse, sexual abuse, neglect and abandonment, or emotional or psychological abuse. The most serious cases of child abuse can end in death. Those who survive may suffer emotional scars that can linger long after the physical bruises have healed. Kids who are abused are more likely to have problems building and maintaining relationships throughout their lives and they are also more likely to have low self-esteem, depression, and thoughts of suicide.

When people think of child abuse their first thought is of physical abuse, such as striking, kicking, or shaking a child. But physical abuse can also include holding a child underwater, tying a child up, intentionally burning a child with scalding hot water or other objects like cigarettes, using an object to beat a child, starving a child, or failing to provide a child with food intentionally. Abusive head trauma or Shaken Baby Syndrome is a specific form of child abuse and is the leading cause of death in child abuse cases in the United States. Most incidents last just a few seconds but that's enough time to cause brain damage and kill a baby.

Sexual abuse happens when a child is raped or forced to commit a sexual act. It's also any sort of sexual contact with a child that is meant to sexually arouse the abuser. So in addition to having sex with a child or even just inappropriate touching with a child, sexual abuse includes making a child pose or perform for pornographic pictures or videos, showing a child pornographic material, forcing a child to undress, not just normally like changing your clothes, but forcing a child to undress in front of you for gratification purposes, and flashing a child or showing one's privates.

Neglect is any action or inaction on the part of a caregiver that causes a child physical or emotional harm such as withholding food, withholding warmth in cold weather, or not providing proper housing. Basically anything that interferes with a child's growth and development constitutes neglect. This also includes failing to provide medical care when a child is injured or critically sick, locking a child in a closet or a room, and placing them in a dangerous situation that could lead to physical injury or death. Abandonment is a type of neglect.

Emotional abuse or psychological abuse is a pattern of behavior that has negative effects on a child's emotional development and sense of self-worth. Ignoring a child or withholding love, support, or guidance is considered emotional abuse. Just like threatening, terrorizing, belittling, or constantly criticizing a child.

Child abuse due to substance abuse problems include allowing a child to drink alcohol or take illegal drugs, manufacturing, ingesting, or distributing illegal drugs in the presence of a child, and in some states, exposing a fetus to illegal drugs or other substances while pregnant.

It would be easier if all child abusers followed a pattern and were easy to recognize, but the truth is that child abusers come from all walks of life. It's also sometimes difficult to tell the difference between ordinary scrapes and scratches of childhood and a physical sign of child abuse. Pediatricians often can tell the difference but not always.

Some ways that kids who are being abused might act include sad or angry, they may act withdrawn, fearful, have low self-esteem, or engage in self-harm, and many have persistent nightmares. Those who are abused usually have trouble developing and maintaining relationships. They are often unable to love or trust others, especially adults with whom they can be afraid of. A telling sign that something is just not right is when a child fails to seek comfort from a parent or other caregiver who happens to be their abuser.

Kids who are abused sometimes act out. They may lose interest in activities they once loved. They may turn to drug and alcohol abuse as well as sexual promiscuity. Other kids might not act out in the typical ways but will avoid going home after school or doing any activity that would cause them to spend time alone with the abuser. But just because a child is showing these signs doesn't necessarily point to abuse. Children who are going through stressful situations, like a parent separation or divorce, a family move, or the loss of a friend or family member, may also may undergo changes in their mood or disposition.

So what should you do if you suspect some child that you know is being abused? Remember that abuse is not a private family matter, although it most often occurs within families and is often kept as a family secret. Once you suspect child abuse, you need to act to protect the child from further possible harm.

It is your responsibility to contact your local child protective services agency, police, hospital, or emergency hot-line. You may remain anonymous. Pediatricians, by law, are required to call child protective services if there is any concern that a child has been abused. If you think you may have abused your own child or you're worried that you might make sure the child is somewhere safe away from you. Speak to a trained professional and that can be an effective way to work through the reasons behind your abusive feelings.

If you suspect that someone you know is abusing a child, keep the child away from that person until authorities have been notified. Never threaten a person or take the law into your own hands. Let the legal system decide an appropriate punishment for the abuser.

Pediatricians recommend that children who are suspected abuse victims be taken to a local children's hospital where the initial diagnosis can be made and treatment can be given. Hospitals often see abused kids, especially battered children, and they can do the needed X-rays or cultures for a diagnosis to be made. They also work very closely with social workers, child protective services, and the police department to file all the necessary paperwork for the child abuser to be charged.

Psychological help is also strongly recommended. Without it, children who may have been abused may suffer emotional problems or repeat the pattern of abuse with their own children.

Abuse does not have to ruin a child's life as long as it is stopped and dealt with. The earlier abuse can be identified and stopped, the less destructive it will be.

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Interviewer: For victims, admitting to domestic violence is the first step to ending the abuse. But what about the abuser? Coming up next on The Scope, we're talking about whether or not abusers really want to stop being abusive.

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Interviewer: We're talking today with Wendy James, a social worker at the University of Utah. Wendy, in my knowledge, not knowledge necessarily, just what I've seen, abusers kind of just don't really care. That's probably not the case though, right, from your experience?

Wendy: I don't think that is the case. I think they may act like that, in a macho way like they don't care, but most of them are filled with shame and guilt.

Interviewer: Why do they continue then?

Wendy: Because it's a pattern that they've learned either growing up and witnessing this, and they don't know how to do anything different. They need counseling. They need intervention. Some of them are just bullies, okay. And they want . . .

Interviewer: Bullies are not nice.

Wendy: No, and they want power and control, and they will blame anyone, not just their wives, but they will blame anyone in their lives about their problems. They don't accept their own problems, and they don't want help. But a larger majority do feel shame and guilt and want to do something different, and they love their wives, and they feel tremendous remorse.

Interviewer: Because isn't it true that a lot of the times why women stay is because their partner promises that it's going to stop, but it doesn't stop.

Wendy: But it doesn't stop, and I believe at that very moment, they may really want it to stop. Some of them may be just manipulative and say that and make promises that they don't intend to ever keep. Some really want it to, but they need help and counseling in order to do that. On the other hand, there's people who have mental illnesses that have impulse control problems and issues, and they may need medication and intervention in that form.

Interviewer: For the abusers that do genuinely want to stop, and they go to counseling and they get the help to stop abusing other people in their lives, do you think that relationship will work out? Do you think the woman should still stay with their partner?

Wendy: That's debatable. I think if women stay, they put themselves and children at risk. Oftentimes counselors will suggest that they live separately and then do counseling together. So that oftentimes works better. The other piece is some men won't get help unless there are allegations against them. So truly the most loving thing a woman can do is press charges, because they're often surprised that what they're doing is wrong. That can be helpful in them getting help as well.

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Interviewer: Four thousand women die each year from domestic violence and about 75% of those deaths occur when the victim finally decides to leave the relationship. Why is domestic violence happening in the first place? We're talking about that next on The Scope.

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Interviewer: We're here today with Wendy James, social worker at the University Utah and the topic is domestic violence. Why does this even happen? We know it's bad. It's a terrible thing but yet it still happens and it happens often. Why?

Wendy: Unfortunately a lot of the time it's a learned pattern that it is witnessed...

Interviewer: From the abuser?

Wendy: From the abuser. Well and it can be from the abused, the victim as well that's why she stays but we'll... but poor self image. They don't feel good about themselves so they bully and take it out on the underdog. A stereotype view of women that wives should be submissive and that it's okay to beat them into submission. Poor childhood experiences, like I said they came from violent homes. Fear of change, when a woman is pregnant she's more vulnerable to abuse and that tends to be when the abuse may occur.

Interviewer: When she's pregnant? Really?

Wendy: Oftentimes men are challenged by having another child either jealousy or they're concerned about financial responsibility, emotional responsibility, so it's a challenge for them. Sometimes lack of communication between the two. Women can be more passive and a man doesn't have the words perhaps to say how he feels or is frustration or anger and it comes out physically. Economic pressures for sure. Loss of jobs. Yeah, not adequate jobs provide for the family and their beliefs that they want to be good providers.

Interviewer: We just went through some of the trigger points for men as to why and I know you say that, not all the time but most of the time are the abuser. That they're included and they're involved in this terrible pattern. What about the women? Are they doing anything that might put them at harm for this?

Wendy: Unless they're really into a pattern of abuse there's a cycle of abuse where a woman gets abused and beat up and then the husband feels guilty and shameful, brings flowers, whatever. Then the tension builds and the abuse happens again. Often times it's if there's an event coming up or a woman wants to get this over with that she will actually do some things to irritate and aggravate the other person so that the abuse will occur.

Interviewer: So taking it back a step then let's assume that the woman is not provoking domestic violence here.

Wendy: Exactly.

Interviewer: Are there some things though that she might be doing that she doesn't know is provoking?

Wendy: I don't think, you know what, overall no. I do not believe. It's not just me. Research indicates as well that it's not that these men are provoked by anything that she does. She is not at fault for this. There's reasons she stays.

Interviewer: So in the final end of this women still stay regardless of how painful and bad for them and their kids. They're still staying in these harmful relationships. Why?

Wendy: A lot of them fear that if they leave that their husband will take the children and they'll be without their children. They feel fear and shame themselves. A failure of a broken marriage. They have low self esteem so they don't know if they can survive without their partner. They have hope that their partner will change and it doesn't happen. Financially often times they're very dependent on the man and there's family pressure that the children need a father and they disapprove of divorce. There's societal pressure. Oftentimes people will blame the victim for provoking it and that's just not true. I know I said something earlier about that and that happens rarely that...

Interviewer: The provoking?

Wendy: ...but it does happen. The provoking. Yeah, and they want to be able to just... the people will tell them just to forgive and forget about this. People who don't understand and aren't educated about domestic violence.

Interviewer: So it all comes full circle. In order to end domestic violence both sides, especially the woman need to be educated and know that it's not their fault.

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Dr. Jason Hunziker: Today we're going to talk about the long-term consequences of child abuse and neglect.
I'm Jason Hunziker from the University of Utah Department of Psychiatry and this is what's coming up next on The Scope.

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Dr. Jason Hunziker: Information from the Child Welfare Gateway and the U.S. Department of Health and Human Services suggests that in the physical year of 2011 over 650,000 children were the victims of abuse and neglect. Those injuries that those children suffer can take many different forms, including physical, behavioral, societal, and psychological and have consequences that ripple through their families for generations to come.
It is often difficult at times to separate out which of the physical, behavioral, societal, or psychological injuries are responsible for the signs and symptoms that we see in our children as they are growing up and turn into adults.
An example of this would be let's say a child gets brain injury and ends up causing significant psychological issues such as depression, emotional problems, and cognitive problems. Those emotional problems or cognitive problems can then go on to lead to poor decision making and risk taking behavior that we wouldn't normally see. And those then can lead on to more societal problems such as long-term disability or crime.
There are several different factors that can lead to these consequences from abuse and neglect that we can possibly see and a few of those include age and developmental status when the abuse occurred. So if the abuse occurs younger we could see different problems than if it occurs at an older age.
The types of abuse or mistreatment; physical abuse leaves different long-term scars than sexual abuse would. The frequency, the duration or severity of the abuse; if it happens more often or if it's very severe that trauma can also be significant in long-term consequences.
And then of course who the perpetrator is makes a big difference. Often it's a family member and that is much worse than someone that you don't know who is causing this severe abuse.
While it is not yet really understood why some children have long-term consequences and others don't, even when they have similar circumstances, so often siblings will experience the same abuse in the same household environment, and may not have the same consequence. And they postulated that resilience is often used or the term used to describe why these children are able to cope with this abuse or neglect. Most children are not born with the resilience; it comes from either within themselves or from the family environment or from the community in which they live.
There are often a lot of different things that can contribute to resilience including good self esteem, having a good sense of humor, strong positive attachments with people around you, and good emotional regulation.
Some of the psychological consequences of abuse can occur immediately after the abuse. These things that we would see are children isolating from their friends or from their family or having extreme fear around strangers; or the loss of ability to trust anyone. These immediate emotional effects can lead to depression, anxiety, long-term trust issues, relationship instability, and self doubt. When the abuse occurs in an infant and in younger children it primarily affects their ability to form strong healthy attachments.
In a document titled, Call to Action On Behalf of Maltreated Infants and Toddlers it reported that half of infants in foster care who have been mistreated experience some type of cognitive delay. Of these they all have lower IQ scores, language difficulties, learning disabilities, and other challenges compared to other children who have not been abused.
Later in childhood the abuse can lead to formation of borderline personality disorder, severe major depression, anxiety disorders, and in some cases PTSD. There have been some studies that show a connection in suicide rate and depression rates in women associated with child and adolescent sexual abuse. Other studies have shown that over 50% of women that have an eating disorder have suffered some type of sexual abuse.
While not all children of abuse will struggle with emotional or behavioral problems, more than half of the youth reported some type of abuse and therefore were at increased risk of emotional or behavioral problems.
Some of those behavioral problems that can occur in adolescents include having to repeat a grade because they keep failing and have to start over, using illicit substances, alcohol, tobacco, prescription drugs, criminal activity of any type, skipping school and early teenage pregnancy.
Some studies have also shown an increase in this high-risk sexual behavior and there is a nine times increase in the criminal activity of adolescents and in adults who have suffered childhood abuse or neglect.
As mentioned briefly, substance abuse is a huge problem in this population. There is a lot of research that consistently reports the increased likelihood of abuse and neglect will lead to cigarette smoking, drinking alcohol, and using street drugs and other prescription drug abuse in men that have greater than six episodes of abuse or neglect in their lifetime. They have an increased likelihood of more than 4,000% that they will use IV drugs later in their life.
Lastly this abuse behavior seems to create a cycle of abuse that is passed down from generation to generation to generation. Girls from physically abusive homes were 1% to 7% more likely to perpetrate youth violence; and 8% to 10% more likely to perpetrate interpersonal violence.
In boys who experience sexual violence in their adolescence or childhood were 3% to 12% more likely to commit youth violence, and 1% to 17% more likely to commit an interpersonal violence.
Abuse and neglect in childhood clearly leads to a range of different consequences later in life. Even though some children seem to escape the long-term problems from abuse, everyone suffers the short term. The cost to the individual, the family, the community is so high when abuse or neglect goes unnoticed, and the symptoms go untreated. It is important to recognize when abuse is happening and to seek help from counselors, primary care providers, pediatricians, psychologists, psychiatrists, and anyone who can help and perhaps avoid more long-term problems from childhood abuse and neglect.

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