Causes of Child Abuse and Neglect* PHILIP
G.
NEY M.D.', TAK FUNG Ph.D. 2, ADELE ROSE WICKETI B.S.N. 3
concensus on the etiological categories of child mistreatment. These include parental psychopathy, parents' childhood experiences of abuse and neglect, substance abuse, privation, marital turmoil, lack of parenting skills, poor bonding, ignorance of the child's needs and unrealistic expectations of the child. In previous studies we found strong correlations between the mistreatment of children and spousal abuse (1), the abuse and neglect of parents as children (2), unresolved losses, and abnormal responses to the children crying (3). A search of the recent literature shows far more research and clinical investigation into the apparent causes of childhood injuries than into considerations of root causes, and little from the child's perspective. There are some notable exceptions. Crittenden (4) observed the behaviour of abusive mothers and their children, and found that: 1. siblings of abused children learned their mother's parenting style and 2. some abused children develop behaviours that help maintain their mother's maltreating responses (5). Azar and her col1eagues (6) found that parents most likely to be maladapted parents have unrealistic expectations of their children. Parents with unrealistic expectations blame their children more frequently, and use more punishment and less explanation (7). There are many explanations of child abuse and neglect which are based on psychopathology. These include identification with the aggressor (8), wounding and neglecting the inner-child (9), and the parents' desire for medical attention which is achieved by inducing illness in the child (10). Mothers' mental il1nesses have been singled out as causative factors for various social and mental disorders in their children (11). As was previously suggested by Ney (12) parents who mistreat children may be attempting to understand the conflicts engendered as a result of abuse they suffered as children, by recreating similar experiences. We wondered if children could detect the reasons they were abused or neglected. There appeared to be few studies of the children's explanations of their own mistreatment. However, one study found that col1ege students are more likely to blame their behaviours on their mother's emotional problems, shyness, and dependency than they are to blame their father's abusing and alcoholism (13).
This paper is a study of child abuse and neglect from the perspective of the child. Generally, the mistreatment of children was associated with "poor care" from parents, attributed mainly to immaturity, marital problems, alcohol abuse, unemployment, drug abuse and lack ofmoney. Differences in attribution are noted between males and females, and some differences are noted by the age of the child. When factors other than the causes given by the children were taken into account, mistreatment was significantly related to family break-up, as well as long-term disinterest and lack of affectionfrom the parents. When the children were asked for their "worst experience in life," the most common responses were "abuse" "family break-up," and for the juvenile offenders "getting charged with a crime".
T
,
here have been many studies of the possible causes of child abuse and neglect, but very few that have actual1y examined them from a child's point of view. This study quantifies and analyzes factors which, according to children who were victims, explain early mistreatment. Children may have a more accurate view of what is going on in their own mind than adults who try to perceive it. Many articles record expressions of pain and grief that are more in accord with adults' memories of their own mistreatment. Clinical interviews'and research interviews are often structured in such a way.that the child must respond to the expectations imposed upon him by the adult. In this study we examine the correlations between the children's estimate of their abuse and neglect and the causes the child feels are important. We have identified five types of mistreatment: physical abuse, physical neglect, verbal abuse, emotional neglect and sexual abuse. We asked respondents to estimate the frequency and severity of the abuse they suffered in each category. Literature Review
Although there is no absolute agreement on the basic causes of child abuse and neglect, there is a reasonable
Manuscript received December 1991, revised June 1992. lClinical Professor, Dep,artment of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, B.C. 2Biostatistician, University of Calgary, Calgary, Alberta. 3Research Assistant Address reprint requests to: Dr. Philip G. Ney, Box 24003, 4440 West, Saanich Rd., Victoria, B.C. V8Z 7E7
Method
As part of an ongoing study of child abuse and neglect, we collected data from 167 children and adolescents who completed the Child Experience questionnaire. These children were from two psychiatric units for children and adolescents (n = 107), a young offender's centre (n = 23), a private
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Table I Extent of Mistreatment Correlated with Quality of Parental Care Extent of Mistreatment" Physical Abuse Physical Neglect Verbal Abuse Emotional Neglect n = 106 n = 100 n = 91 n =67 Poor care by mother 0.33 (p = 0.00I) 0.26 (p = 0.009) 0.20 (p = 0.057) 0.34 (p = 0.006) Poor care by father 0.31 (p = 0.002) 0.30 (p = 0.019) 0.20 (p = 0.052) 0.21 (p = 0.043) *Expressed as Pearson correlation coefficients
psychiatric practice (n = 11) and a local high school (n = 26). These numbers represent over 85% of the patients and young offenders who were asked to participate. The computing services of the University of Calgary analyzed the data. The Child Experience Questionnaire, a device that has been used for a number of years and appears to have good reliability and validity, was administered to our sample (14). To make it easier for the children and adolescents, we used a number of visual analog scales with extreme responses on either end. The respondents were asked to make a mark on the lines to estimate of the degree abuse or neglect they suffered. There were scales for frequency, severity, abnormality, whose fault it was and how damaging it was to their lives. Other questions determined the age of onset, duration and specific types of abuse. We asked how well they were looked after, their worst experiences in life, what their parents expected them to become and the reasons for each type of mistreatment. Subjects were asked to check one or more of the eight possible causes of their maltreatment, or to suggest other reasons for it. The eight choices were derived from a review of the literature on the etiology of child abuse and neglect. The choices were: alcohol abuse, drug abuse, immature parents, professional interference, too many children, not enough money, unemployment and marital problems. While there were a few other reasons cited by individuals, these were not numerous or significant enough to affect the given data. For 65 of the respondents who were receiving treatment on a psychiatric unit, the staff, as well as the parents, were asked to fill out questionnaires on the extent of abuse to corroborate the patients' self-reports. There was an 0.85 Pearson correlation between the parents' and children's estimation of abuse. In addition, the parents' and staff's estimates had a 0.60 correlation with each other on the severity of abuse, and a 0.75 correlation on the frequency of abuse.
Results We found that physical abuse, verbal abuse, physical neglect, emotional neglect, intellectual neglect or sexual abuse seldom occur alone; in less than five percent of the cases, a child was mistreated in only one way (14). We also found that a significant percentage of children were mistreated in all five ways, and that some combinations of mistreatments had a more detrimental effect than others (15). One of the volunteer high school students reported no abuse or neglect of any kind. Table I indicates the children's perceptions of how well they were looked after by either their mother or father, corre-
Vol. 37, No.6
Sexual Abuse n =34 -0.10 (p = 0.568) 0.18 (p = 0.299)
lated with their estimate of the extent of abuse they experienced. The extent of abuse is a multiple of the frequency and severity. According to the children, physical abuse and neglect appear to be most strongly related to poor care by the parents. Table II indicates what this population considered to be their worst experiences in life. It appears that being abused or neglected by their parents, family breakup, getting charged with a crime and a death in the family were considered to be the worst life experience by the largest number of children. (Some respondents indicated more than one "worst experience," leading to figures which total more than 100%.) Table III indicates the strong correlation between what the children believe their parents expect them to become and what the children themselves expect. Of the children who expected to become criminals, for example, 72% perceived that their parents expected the same. Table IV shows the relationship between the various causes of abuse and neglect described by the young people and the various types of abuse or neglect. It appears that children ascribe most types of abuse to their parents' immaturity, lack of money and marital problems. Alcoholism strongly correlated with physical neglect and sexual abuse. When we asked the same questions of adults abused as children, we had similar responses, with somewhat heavier weighting on the "too many children" factor. About one-half of the respondents were below the age of 15. The respondents who were 16 and over gave roughly twice the number of reasons for their abuse per person, on average, than was given by the the younger group. Older Table II Worst Life Experiences of Abused Children Types of Abuse % (n = 162)* Abused by parents or others 37.0% Family breakup 32.7% Charged with a crime 32.7% Deathof family member 29.6% Beatenup by peers 16.7% Failingschool 15.4% Moving 12.3% Friend's death 9.9% Accident 5.6% Adopted 1.9% Crimecommitted by relative 1.1 % 'because the subjects were not limited to only one choice, the total is more than 100%.
August, 1992
403
CAUSES OF CHILD ABUSE AND NEGLECT
Table III Children's Expectations of What They Will Become and Their Understanding of Their Parents' Expectations" Parent's expectations Successful Business Financial Person Failure 5.6
Good Parent
Ordinary Working Person
Child's Expectations _n_ Criminal Bum 16.7 Criminal 18 72.2 20.0 20.0 40.0 Bum 5 20.0 17.1 204 7.3 Successful business person 41 26.8 42.5 4.9 50.0 Financial failure 2 50.0 43.5 4.3 Good parent 23 34.8 4.3 8.7 4.6 39.5 Ordinary working person 43 23.3 14.0 9.3 4.7 Prostitute 2 50.0 *57 out of 64 of the valid cells have expected cell frequency of less than 5.0. Minimum expected cell frequency = 0.060. Chi square = 125.363 with 49 degrees of freedom, significance = 0.0000; Pearson's R = 0.38850. significance = 0.0000.
children attributed their physical abuse to the immaturity of their parents ten times more often than the younger children did. The older teens were four times as likely as the younger ones to attribute their emotional neglect and physical abuse to the perpetrator's drug abuse. In all other areas, the older and younger groups gave similar responses to the causes of their abuse. There were about twice as many boys as girls in the sample. When we examined the differences in attributing the causes for their abuse, we found that alcohol abuse and unemployment were cited about equally by boys and girls. Drug abuse, professional interference and marital problems were cited proportionally more often by girls. Boys attributed their abuse proportionally more often to "too many children" and "not enough money." Immature parents was cited more often by the girls, although boys who had been physically neglected cited parental immaturity quite often. When we examined the differences in attributing cause of the abuse between the various groups in the sample, we found that the young offender group produced the largest number of citations of cause - for physical abuse, an average of 2.4 causes were given by each child in the young offender group. The private practice patients gave an average of 1.7 reasons for their mistreatment. The inpatients on the child psychiatric unit offered an average of I. I reasons. The local high school
Prostitute 5.6
4.3 4.7 50.0
children, most of whom suffered significantly less abuse than the other groups, gave an average of only 0.2 causes per subject. Sixty-nine percent of the young offenders blamed alcohol abuse for their physical abuse, and 48% of them pointed to marital problems. The young offender group tended to finger alcohol abuse proportionally more frequently than other groups for all types of mistreatment. Private patients and young offenders also blamed drug abuse more frequently than others did. When a stepwise regression analysis was performed with the self-ascribed causes left out, strong correlations appear between mistreatment, family break-up, and lack of affection. Table V indicates the correlations and most significant causes of abuse identified by this analysis. When a stepwise regression analysis was used to determine the factors that correlate with less abuse, good parental care is the only significant factor to emerge. Discussion It appears that children attribute their mistreatment to causes that might surprise adults. If their perceptions are accurate, it seems that even young people can detect their parents' immaturity and are aware of how their marital conflict affects their treatment. They show remarkable insight
Table IV Causes of Mistreatment as Identified by the Children Correlated with More Extensive Abuse Type of Mistreatment Major Causes Ascribed by Physical Abuse Abused Children n = 134 Immature parents 0.315 (p < 0.000) Not enough money 0.311 (p < 0.000) Unemployment 0.301 (p < 0.(00) Marital problems 0.287 (p < 0.00 I) Alcohol abuse 0.235 (p < 0.006 Too many.children 0.097 (n.s.) Drug abuse 0.156 (n.s.) *expressed as Pearson correlation coefficients
Physical Neglect n = 84 0.372 (p < 0.0(0) 0.202 (n.s.) 0.174 (n.s.) 00408 (p < 0.000) 0.340 (p < 0.002) 0.153 (n.s.) 0.275 (p < 0.011)
Verbal Abuse n = 121 0.372 (p < 0.000) 0.272 (p < 0.002) 0.232 (p < 0.010) 0.338 (p < 0.000) 0.091 (n.s.) 0.099 (n.s.) 0.093 (n.s.)
Emotional Neglect n = 105 0.334 (p < 0.000) 0.206 (p < 0.000) 0.084 (n.s.) 0.298 (p < 0.002) 0.040 (n.s.) 0.162 (n.s.) 0.071 (n.s.)
Sexual Abuse . n=46 0.013 (n.s.) 0.048 (n.s.) 0.196 (n.s.) 0.132 (n.s.) 0.313 (p < 0.034) 0.104 (n.s.) 0.179 (p < 0.034)
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CANADIAN JOURNAL OF PSYCIIIATRY
into the nature of the problems that result in their mistreatment. We need to validate these findings, but it may be difficult to measure such subjective responses in any other way. The same questions asked of adults regarding the causes of their own mistreatment have similar answers. The differences between children's and adults' perceptions may indicate a more mature outlook on the part of the adults, but may also reflect the influence of the media and culture. From our data, it appears that the young people know that alcoholism, parental conflict and immaturity contribute to their neglect. We have found that neglect increases a child's propensity to be mistreated and vulnerability to abuse (3). Too often neglected children seek what they need in the wrong places at wrong times and from the wrong people. The neglect damages their self-esteem and they cannot face the bleak realization that their parents are unable or unwilling to nurture them. It seems easier for children to believe they are mistreated because of some defect or deficiency in themselves, because if that were so, they might correct the whole problem by being better children, or loving their parents more intensely. When they realize nothing they can do will stop the neglect, they search elsewhere, but always with a conviction that they don't really deserve anything better. With tragic consequences, adults who were neglected children may try to correct the effects of a neglected childhood by seeking sustenance from neglecting or abusing partners. The evidence seems to indicate that there is an association between what some young people perceive to be their parents' Table V Factors Associated with More Abuse Associated Factors Physical abuse • Family break up • Less affection Physical neglect • Neglected longer • Parents not interested • Less affection Verbal abuse • Abused longer • Immature parents Emotional neglect • Neglected longer • Less affection • Marital problems Sexual abuse • Abused longer
---..!:L
__ T_
Significance ofT *
- 3.343 -2.230
P =0.001 p =0.028
- 4.525 - 2.385 - 2.408
P < 0.000 P =0.020 P =0.019
-4.715 -2.326
p < 0.000 p =0.022
-5.314 - 3.730 -2.688
p < 0.000 p =0.000 p =0.008
-2.323
p =0.026
134
84
121
105
46
• This stepwise regression analysis does not include causes ascribed by the children, but looks at other factors, such as quality of parenting, failing school, getting charged with a crime, family breakup, moving, accidents, getting beaten up, deaths of family members or friends, early or long-term abuse, missing out on travel, challenges, money, clothes or education.
expectations regarding their future and their own expectations of their future. How can children know what is expected of them? Probably they absorb the repeated phrases, both derogatory ("You're going to be a bum, just like your old man"), or encouraging ("Keep it up; someday you'll be very successful") spoken by their parents. The children may misperceive these but, whether real or imagined, there is a connection between how the child expects his future will tum out and what he thinks his parents expect of him. This connection may also give us a clue to the frequently observed phenomenon of abuse which is passed down from generation to generation. The causes of abuse become effects in the children, and then cause mistreatment when the children become parents themselves. There may be more difficult experiences than the ones we have considered, but, of these, mistreatment by parents and family break-up are the worst from the child's point of view. Children must be aware that a broken family leaves them vulnerable to the vagaries of their environment. Do children intuitively perceive that for their fuller development they require the nurturing and guidance of two parents? Like most research, this study raises more questions than it answers. It does, however, illustrate the necessity of carefully considering abuse and neglect from a child's point of view. The child may be wiser about these matters than we are. References I. Ney PG. Transgenerational child abuse. Child Psychiatry Hum Dev 1988; 18(3): 151-168. 2. Ney PG. Child abuse: a study of the child's perspective. Child Abuse Negl 1986; 10: 511-518. 3. Ney PG. Child neglect and aggression. Paper given to Canadian Academy of Child Psychiatry, Western Branch, Vancouver, BC, March 1992. 4. Crittenden PM. Sibling interaction: evidence of a generational effect in maltreating infants. Child Abuse Negl 1984; 8(4): 433-438. 5. Crittenden PM. Maltreated infants: vulnerability and resilience. J Child Psychol Psychiatry 1985; 26(1): ~5-96. 6. Azar ST, Robinson DR, Hekimian E, et al. Unrealistic expectations and problem-solving ability in maltreating and comparison mothers. J Consult Clin Psychology 1984; 52(4): 687-691. 7. Azar ST, Twentyman CT. Cognitive-behavioral perspectives on the assessment and treatment of child abuse. Advances in Cognitive-Behavioral Research and Therapy 1986; 5: 237-267. 8. Sugar M. Sexual abuse of children and adolescents. Adolesc Psychiatry 1983; II: 199-211. 9. Kneisl CR. Healing the wounded, neglected inner child of the past. Nurs Clin North Am 1991; 26(3): 745-755. 10. Yorker BC, Kahan BB. Munchausen's syndrome by proxy as a form of child abuse. Arch Psychiatr Nurs 1990; 4(5): 313-318. II. Bagedahl-Strindlund M, Rosencrantz-Larsson L, WilknerSvanfeldt P. Children of mentally ill mothers: social situation and psychometric testing of mental development. Scand J Soc Med 1989; 17(2): 171-179. 12. Ney PG. Child mistreatment: possible reasons for its transgenerational transmission. Can J Psychiatry 1989; 34(6): 594601. 13. Der-Karabetian A, Preciado M. Mother-blaming among college students. Percept Mot Skills 1989; 68(2): 453-454.
August, 1992
CAUSES OF CHILD ABUSE AND NEGLECT
14. Ney PO. Does verbal abuse leave deeper scars: a study of children and parents. Can J Psychiatry 1987; 32(5): 371-378. 15. Ney PO. Child abuse and neglect: the worst combinations. Presented to the Annual Meeting of the Canadian Academy of Child Psychiatry, Saskatoon, Saskatchewan, October 1991.
Resume
Une etude effectuee aupres d' un groupe d' enfants sur la violence et la negligence aleur egard permet de les examiner de la perspective des enfants. Generalement, ils associent la violence dont ils font l'objet a des «mauvais soins» que prodiguent les parents principalement en raison de leur
405
immaturite, de difficultes conjugales, de l' alcoolisme, du chomage, de la toxicomanie et du manque d' argent. Les raisons avancees different selon Ie sex et, dans une certaine mesure, l' age de l' enfant. En tenant compte de parametres non mentionnes par les enfants, on note une correlation significative entre la violence a l'egard de l' enfant et la dislocation de la famille, ainsi que Ie desinteret et Ie manque d' affection manifestes a long terme par les parents. Pour decrire la «plus mauvaise experience de leur vie», la plupart des enfants mentionnent les «mauvais traitements» et la «dislocation de la [amille»; Ie groupe des delinquants juveniles indique egalement «le fait d' etre inculpe».
G.
NEY M.D.', TAK FUNG Ph.D. 2, ADELE ROSE WICKETI B.S.N. 3
concensus on the etiological categories of child mistreatment. These include parental psychopathy, parents' childhood experiences of abuse and neglect, substance abuse, privation, marital turmoil, lack of parenting skills, poor bonding, ignorance of the child's needs and unrealistic expectations of the child. In previous studies we found strong correlations between the mistreatment of children and spousal abuse (1), the abuse and neglect of parents as children (2), unresolved losses, and abnormal responses to the children crying (3). A search of the recent literature shows far more research and clinical investigation into the apparent causes of childhood injuries than into considerations of root causes, and little from the child's perspective. There are some notable exceptions. Crittenden (4) observed the behaviour of abusive mothers and their children, and found that: 1. siblings of abused children learned their mother's parenting style and 2. some abused children develop behaviours that help maintain their mother's maltreating responses (5). Azar and her col1eagues (6) found that parents most likely to be maladapted parents have unrealistic expectations of their children. Parents with unrealistic expectations blame their children more frequently, and use more punishment and less explanation (7). There are many explanations of child abuse and neglect which are based on psychopathology. These include identification with the aggressor (8), wounding and neglecting the inner-child (9), and the parents' desire for medical attention which is achieved by inducing illness in the child (10). Mothers' mental il1nesses have been singled out as causative factors for various social and mental disorders in their children (11). As was previously suggested by Ney (12) parents who mistreat children may be attempting to understand the conflicts engendered as a result of abuse they suffered as children, by recreating similar experiences. We wondered if children could detect the reasons they were abused or neglected. There appeared to be few studies of the children's explanations of their own mistreatment. However, one study found that col1ege students are more likely to blame their behaviours on their mother's emotional problems, shyness, and dependency than they are to blame their father's abusing and alcoholism (13).
This paper is a study of child abuse and neglect from the perspective of the child. Generally, the mistreatment of children was associated with "poor care" from parents, attributed mainly to immaturity, marital problems, alcohol abuse, unemployment, drug abuse and lack ofmoney. Differences in attribution are noted between males and females, and some differences are noted by the age of the child. When factors other than the causes given by the children were taken into account, mistreatment was significantly related to family break-up, as well as long-term disinterest and lack of affectionfrom the parents. When the children were asked for their "worst experience in life," the most common responses were "abuse" "family break-up," and for the juvenile offenders "getting charged with a crime".
T
,
here have been many studies of the possible causes of child abuse and neglect, but very few that have actual1y examined them from a child's point of view. This study quantifies and analyzes factors which, according to children who were victims, explain early mistreatment. Children may have a more accurate view of what is going on in their own mind than adults who try to perceive it. Many articles record expressions of pain and grief that are more in accord with adults' memories of their own mistreatment. Clinical interviews'and research interviews are often structured in such a way.that the child must respond to the expectations imposed upon him by the adult. In this study we examine the correlations between the children's estimate of their abuse and neglect and the causes the child feels are important. We have identified five types of mistreatment: physical abuse, physical neglect, verbal abuse, emotional neglect and sexual abuse. We asked respondents to estimate the frequency and severity of the abuse they suffered in each category. Literature Review
Although there is no absolute agreement on the basic causes of child abuse and neglect, there is a reasonable
Manuscript received December 1991, revised June 1992. lClinical Professor, Dep,artment of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, B.C. 2Biostatistician, University of Calgary, Calgary, Alberta. 3Research Assistant Address reprint requests to: Dr. Philip G. Ney, Box 24003, 4440 West, Saanich Rd., Victoria, B.C. V8Z 7E7
Method
As part of an ongoing study of child abuse and neglect, we collected data from 167 children and adolescents who completed the Child Experience questionnaire. These children were from two psychiatric units for children and adolescents (n = 107), a young offender's centre (n = 23), a private
Can. J. Psychiatry Vol. 37, August 1992
401
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CANADIAN JOURNAL OF PSYCHIATRY
Table I Extent of Mistreatment Correlated with Quality of Parental Care Extent of Mistreatment" Physical Abuse Physical Neglect Verbal Abuse Emotional Neglect n = 106 n = 100 n = 91 n =67 Poor care by mother 0.33 (p = 0.00I) 0.26 (p = 0.009) 0.20 (p = 0.057) 0.34 (p = 0.006) Poor care by father 0.31 (p = 0.002) 0.30 (p = 0.019) 0.20 (p = 0.052) 0.21 (p = 0.043) *Expressed as Pearson correlation coefficients
psychiatric practice (n = 11) and a local high school (n = 26). These numbers represent over 85% of the patients and young offenders who were asked to participate. The computing services of the University of Calgary analyzed the data. The Child Experience Questionnaire, a device that has been used for a number of years and appears to have good reliability and validity, was administered to our sample (14). To make it easier for the children and adolescents, we used a number of visual analog scales with extreme responses on either end. The respondents were asked to make a mark on the lines to estimate of the degree abuse or neglect they suffered. There were scales for frequency, severity, abnormality, whose fault it was and how damaging it was to their lives. Other questions determined the age of onset, duration and specific types of abuse. We asked how well they were looked after, their worst experiences in life, what their parents expected them to become and the reasons for each type of mistreatment. Subjects were asked to check one or more of the eight possible causes of their maltreatment, or to suggest other reasons for it. The eight choices were derived from a review of the literature on the etiology of child abuse and neglect. The choices were: alcohol abuse, drug abuse, immature parents, professional interference, too many children, not enough money, unemployment and marital problems. While there were a few other reasons cited by individuals, these were not numerous or significant enough to affect the given data. For 65 of the respondents who were receiving treatment on a psychiatric unit, the staff, as well as the parents, were asked to fill out questionnaires on the extent of abuse to corroborate the patients' self-reports. There was an 0.85 Pearson correlation between the parents' and children's estimation of abuse. In addition, the parents' and staff's estimates had a 0.60 correlation with each other on the severity of abuse, and a 0.75 correlation on the frequency of abuse.
Results We found that physical abuse, verbal abuse, physical neglect, emotional neglect, intellectual neglect or sexual abuse seldom occur alone; in less than five percent of the cases, a child was mistreated in only one way (14). We also found that a significant percentage of children were mistreated in all five ways, and that some combinations of mistreatments had a more detrimental effect than others (15). One of the volunteer high school students reported no abuse or neglect of any kind. Table I indicates the children's perceptions of how well they were looked after by either their mother or father, corre-
Vol. 37, No.6
Sexual Abuse n =34 -0.10 (p = 0.568) 0.18 (p = 0.299)
lated with their estimate of the extent of abuse they experienced. The extent of abuse is a multiple of the frequency and severity. According to the children, physical abuse and neglect appear to be most strongly related to poor care by the parents. Table II indicates what this population considered to be their worst experiences in life. It appears that being abused or neglected by their parents, family breakup, getting charged with a crime and a death in the family were considered to be the worst life experience by the largest number of children. (Some respondents indicated more than one "worst experience," leading to figures which total more than 100%.) Table III indicates the strong correlation between what the children believe their parents expect them to become and what the children themselves expect. Of the children who expected to become criminals, for example, 72% perceived that their parents expected the same. Table IV shows the relationship between the various causes of abuse and neglect described by the young people and the various types of abuse or neglect. It appears that children ascribe most types of abuse to their parents' immaturity, lack of money and marital problems. Alcoholism strongly correlated with physical neglect and sexual abuse. When we asked the same questions of adults abused as children, we had similar responses, with somewhat heavier weighting on the "too many children" factor. About one-half of the respondents were below the age of 15. The respondents who were 16 and over gave roughly twice the number of reasons for their abuse per person, on average, than was given by the the younger group. Older Table II Worst Life Experiences of Abused Children Types of Abuse % (n = 162)* Abused by parents or others 37.0% Family breakup 32.7% Charged with a crime 32.7% Deathof family member 29.6% Beatenup by peers 16.7% Failingschool 15.4% Moving 12.3% Friend's death 9.9% Accident 5.6% Adopted 1.9% Crimecommitted by relative 1.1 % 'because the subjects were not limited to only one choice, the total is more than 100%.
August, 1992
403
CAUSES OF CHILD ABUSE AND NEGLECT
Table III Children's Expectations of What They Will Become and Their Understanding of Their Parents' Expectations" Parent's expectations Successful Business Financial Person Failure 5.6
Good Parent
Ordinary Working Person
Child's Expectations _n_ Criminal Bum 16.7 Criminal 18 72.2 20.0 20.0 40.0 Bum 5 20.0 17.1 204 7.3 Successful business person 41 26.8 42.5 4.9 50.0 Financial failure 2 50.0 43.5 4.3 Good parent 23 34.8 4.3 8.7 4.6 39.5 Ordinary working person 43 23.3 14.0 9.3 4.7 Prostitute 2 50.0 *57 out of 64 of the valid cells have expected cell frequency of less than 5.0. Minimum expected cell frequency = 0.060. Chi square = 125.363 with 49 degrees of freedom, significance = 0.0000; Pearson's R = 0.38850. significance = 0.0000.
children attributed their physical abuse to the immaturity of their parents ten times more often than the younger children did. The older teens were four times as likely as the younger ones to attribute their emotional neglect and physical abuse to the perpetrator's drug abuse. In all other areas, the older and younger groups gave similar responses to the causes of their abuse. There were about twice as many boys as girls in the sample. When we examined the differences in attributing the causes for their abuse, we found that alcohol abuse and unemployment were cited about equally by boys and girls. Drug abuse, professional interference and marital problems were cited proportionally more often by girls. Boys attributed their abuse proportionally more often to "too many children" and "not enough money." Immature parents was cited more often by the girls, although boys who had been physically neglected cited parental immaturity quite often. When we examined the differences in attributing cause of the abuse between the various groups in the sample, we found that the young offender group produced the largest number of citations of cause - for physical abuse, an average of 2.4 causes were given by each child in the young offender group. The private practice patients gave an average of 1.7 reasons for their mistreatment. The inpatients on the child psychiatric unit offered an average of I. I reasons. The local high school
Prostitute 5.6
4.3 4.7 50.0
children, most of whom suffered significantly less abuse than the other groups, gave an average of only 0.2 causes per subject. Sixty-nine percent of the young offenders blamed alcohol abuse for their physical abuse, and 48% of them pointed to marital problems. The young offender group tended to finger alcohol abuse proportionally more frequently than other groups for all types of mistreatment. Private patients and young offenders also blamed drug abuse more frequently than others did. When a stepwise regression analysis was performed with the self-ascribed causes left out, strong correlations appear between mistreatment, family break-up, and lack of affection. Table V indicates the correlations and most significant causes of abuse identified by this analysis. When a stepwise regression analysis was used to determine the factors that correlate with less abuse, good parental care is the only significant factor to emerge. Discussion It appears that children attribute their mistreatment to causes that might surprise adults. If their perceptions are accurate, it seems that even young people can detect their parents' immaturity and are aware of how their marital conflict affects their treatment. They show remarkable insight
Table IV Causes of Mistreatment as Identified by the Children Correlated with More Extensive Abuse Type of Mistreatment Major Causes Ascribed by Physical Abuse Abused Children n = 134 Immature parents 0.315 (p < 0.000) Not enough money 0.311 (p < 0.000) Unemployment 0.301 (p < 0.(00) Marital problems 0.287 (p < 0.00 I) Alcohol abuse 0.235 (p < 0.006 Too many.children 0.097 (n.s.) Drug abuse 0.156 (n.s.) *expressed as Pearson correlation coefficients
Physical Neglect n = 84 0.372 (p < 0.0(0) 0.202 (n.s.) 0.174 (n.s.) 00408 (p < 0.000) 0.340 (p < 0.002) 0.153 (n.s.) 0.275 (p < 0.011)
Verbal Abuse n = 121 0.372 (p < 0.000) 0.272 (p < 0.002) 0.232 (p < 0.010) 0.338 (p < 0.000) 0.091 (n.s.) 0.099 (n.s.) 0.093 (n.s.)
Emotional Neglect n = 105 0.334 (p < 0.000) 0.206 (p < 0.000) 0.084 (n.s.) 0.298 (p < 0.002) 0.040 (n.s.) 0.162 (n.s.) 0.071 (n.s.)
Sexual Abuse . n=46 0.013 (n.s.) 0.048 (n.s.) 0.196 (n.s.) 0.132 (n.s.) 0.313 (p < 0.034) 0.104 (n.s.) 0.179 (p < 0.034)
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CANADIAN JOURNAL OF PSYCIIIATRY
into the nature of the problems that result in their mistreatment. We need to validate these findings, but it may be difficult to measure such subjective responses in any other way. The same questions asked of adults regarding the causes of their own mistreatment have similar answers. The differences between children's and adults' perceptions may indicate a more mature outlook on the part of the adults, but may also reflect the influence of the media and culture. From our data, it appears that the young people know that alcoholism, parental conflict and immaturity contribute to their neglect. We have found that neglect increases a child's propensity to be mistreated and vulnerability to abuse (3). Too often neglected children seek what they need in the wrong places at wrong times and from the wrong people. The neglect damages their self-esteem and they cannot face the bleak realization that their parents are unable or unwilling to nurture them. It seems easier for children to believe they are mistreated because of some defect or deficiency in themselves, because if that were so, they might correct the whole problem by being better children, or loving their parents more intensely. When they realize nothing they can do will stop the neglect, they search elsewhere, but always with a conviction that they don't really deserve anything better. With tragic consequences, adults who were neglected children may try to correct the effects of a neglected childhood by seeking sustenance from neglecting or abusing partners. The evidence seems to indicate that there is an association between what some young people perceive to be their parents' Table V Factors Associated with More Abuse Associated Factors Physical abuse • Family break up • Less affection Physical neglect • Neglected longer • Parents not interested • Less affection Verbal abuse • Abused longer • Immature parents Emotional neglect • Neglected longer • Less affection • Marital problems Sexual abuse • Abused longer
---..!:L
__ T_
Significance ofT *
- 3.343 -2.230
P =0.001 p =0.028
- 4.525 - 2.385 - 2.408
P < 0.000 P =0.020 P =0.019
-4.715 -2.326
p < 0.000 p =0.022
-5.314 - 3.730 -2.688
p < 0.000 p =0.000 p =0.008
-2.323
p =0.026
134
84
121
105
46
• This stepwise regression analysis does not include causes ascribed by the children, but looks at other factors, such as quality of parenting, failing school, getting charged with a crime, family breakup, moving, accidents, getting beaten up, deaths of family members or friends, early or long-term abuse, missing out on travel, challenges, money, clothes or education.
expectations regarding their future and their own expectations of their future. How can children know what is expected of them? Probably they absorb the repeated phrases, both derogatory ("You're going to be a bum, just like your old man"), or encouraging ("Keep it up; someday you'll be very successful") spoken by their parents. The children may misperceive these but, whether real or imagined, there is a connection between how the child expects his future will tum out and what he thinks his parents expect of him. This connection may also give us a clue to the frequently observed phenomenon of abuse which is passed down from generation to generation. The causes of abuse become effects in the children, and then cause mistreatment when the children become parents themselves. There may be more difficult experiences than the ones we have considered, but, of these, mistreatment by parents and family break-up are the worst from the child's point of view. Children must be aware that a broken family leaves them vulnerable to the vagaries of their environment. Do children intuitively perceive that for their fuller development they require the nurturing and guidance of two parents? Like most research, this study raises more questions than it answers. It does, however, illustrate the necessity of carefully considering abuse and neglect from a child's point of view. The child may be wiser about these matters than we are. References I. Ney PG. Transgenerational child abuse. Child Psychiatry Hum Dev 1988; 18(3): 151-168. 2. Ney PG. Child abuse: a study of the child's perspective. Child Abuse Negl 1986; 10: 511-518. 3. Ney PG. Child neglect and aggression. Paper given to Canadian Academy of Child Psychiatry, Western Branch, Vancouver, BC, March 1992. 4. Crittenden PM. Sibling interaction: evidence of a generational effect in maltreating infants. Child Abuse Negl 1984; 8(4): 433-438. 5. Crittenden PM. Maltreated infants: vulnerability and resilience. J Child Psychol Psychiatry 1985; 26(1): ~5-96. 6. Azar ST, Robinson DR, Hekimian E, et al. Unrealistic expectations and problem-solving ability in maltreating and comparison mothers. J Consult Clin Psychology 1984; 52(4): 687-691. 7. Azar ST, Twentyman CT. Cognitive-behavioral perspectives on the assessment and treatment of child abuse. Advances in Cognitive-Behavioral Research and Therapy 1986; 5: 237-267. 8. Sugar M. Sexual abuse of children and adolescents. Adolesc Psychiatry 1983; II: 199-211. 9. Kneisl CR. Healing the wounded, neglected inner child of the past. Nurs Clin North Am 1991; 26(3): 745-755. 10. Yorker BC, Kahan BB. Munchausen's syndrome by proxy as a form of child abuse. Arch Psychiatr Nurs 1990; 4(5): 313-318. II. Bagedahl-Strindlund M, Rosencrantz-Larsson L, WilknerSvanfeldt P. Children of mentally ill mothers: social situation and psychometric testing of mental development. Scand J Soc Med 1989; 17(2): 171-179. 12. Ney PG. Child mistreatment: possible reasons for its transgenerational transmission. Can J Psychiatry 1989; 34(6): 594601. 13. Der-Karabetian A, Preciado M. Mother-blaming among college students. Percept Mot Skills 1989; 68(2): 453-454.
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CAUSES OF CHILD ABUSE AND NEGLECT
14. Ney PO. Does verbal abuse leave deeper scars: a study of children and parents. Can J Psychiatry 1987; 32(5): 371-378. 15. Ney PO. Child abuse and neglect: the worst combinations. Presented to the Annual Meeting of the Canadian Academy of Child Psychiatry, Saskatoon, Saskatchewan, October 1991.
Resume
Une etude effectuee aupres d' un groupe d' enfants sur la violence et la negligence aleur egard permet de les examiner de la perspective des enfants. Generalement, ils associent la violence dont ils font l'objet a des «mauvais soins» que prodiguent les parents principalement en raison de leur
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immaturite, de difficultes conjugales, de l' alcoolisme, du chomage, de la toxicomanie et du manque d' argent. Les raisons avancees different selon Ie sex et, dans une certaine mesure, l' age de l' enfant. En tenant compte de parametres non mentionnes par les enfants, on note une correlation significative entre la violence a l'egard de l' enfant et la dislocation de la famille, ainsi que Ie desinteret et Ie manque d' affection manifestes a long terme par les parents. Pour decrire la «plus mauvaise experience de leur vie», la plupart des enfants mentionnent les «mauvais traitements» et la «dislocation de la [amille»; Ie groupe des delinquants juveniles indique egalement «le fait d' etre inculpe».
