SAN DIEGO– Twenty-one years after the National Research Council published its first report on child abuse and neglect, clinicians and researchers in the field wrestle with many of the same issues today as they did in 1993, according to Anne C. Petersen, Ph.D.
"Significant progress has been made since 1993, but significant gaps still remain," said Dr. Petersen, who chaired the Institute of Medicine and National Research Council report entitled "New Directions in Child Abuse and Neglect Research," which was released on Sept. 12, 2013. "That was disheartening to us as a committee to realize that many of the things we noticed in the first report 20 years ago still exist, especially in research infrastructure."
Anne Petersen, Ph.D.
At the San Diego International Conference on Child and Family Maltreatment, she characterized child abuse and neglect as "a devastating health problem that affects victims throughout their lives in every aspect of human function. It’s a very serious public health issue that carries an annual cost to society of $80.3 billion. Addressing this problem requires an immediate, coordinated response with high-level federal support."
Fiscal year 2011 data from the National Child Abuse and Neglect Data System (NCANDS) reported 3.4 million referrals of child abuse and neglect involving 6.2 million children. Of these, 75% were classified as neglect, about 15% were physical abuse, and about 10% were sexual abuse. The highest rates of child abuse and neglect occurred in children younger than 3 years old.
Since 1993, sexual abuse has declined by as much as 62%, according to NCANDS and other data, while physical abuse – especially less serious forms – has declined by as much as 56%, although the data are less consistent, Dr. Petersen said at the meeting, which was sponsored by Rady Children’s Hospital, San Diego. At the same time, neglect statistics vary significantly across states with no evidence of decline.
Understanding what drives such trends remains elusive. "Why do physical and sexual abuse appear to be going down, whereas neglect may not be going down?" she asked. "Until we get a grip on that, we really are going to be handicapped in our capacity to treat these issues, prevent them, and develop sensible policies. There are too few people looking at this bigger issue."
Although there has been a threefold increase in scientific publications related to child abuse and neglect over the past 2 decades, research in the field "continues to be disjointed and fragmented across multiple disciplines," said Dr. Petersen, a research professor in the University of Michigan’s Center for Human Growth and Development, Ann Arbor. "The field continues to be set apart from mainstream studies of child and adolescent health and development. Improved infrastructure, support, and coordination are needed for the research field to be an efficient, productive scientific enterprise."
The 365-page IOM-NRC report calls for rigorous research to further explore the process and outcomes of both screening and medical evaluation; to examine the validity of abusive head trauma diagnoses; to support the development of more uniform approaches to practice; and to arrive at a medical consensus regarding thresholds for reporting neglect. "There’s no definitive differential diagnostic technique to say that it’s been child abuse," Dr. Petersen said. "We need good diagnostic tools, for treatment and for designing effective prevention programs."
In terms of causality, parental substance abuse, depression, and a history of child abuse and neglect have the strongest evidentiary support as risk factors, according to the report. Some children who suffer from abuse and neglect "seem to do better than others," she added. "One of the approaches to studying this is looking at resilience: why some children are more resilient than others. If the problem is less chronic, there is less severity and better outcomes. Having a support figure is crucial for children who have been abused and neglected."
While much has been learned generally about pervasive consequences of child abuse and neglect, the report’s authors recommend that future research focus on improved understanding of the consequences of sexual abuse vs. physical abuse vs. neglect. "We don’t have much differential research yet to really help us understand whether different kinds of abuse and neglect have different consequences," Dr. Petersen explained. "We need a better understanding of mechanisms. There is a lot of research emerging [that] suggests that interventions can help those who have been severely abused and neglected. We don’t know if that’s true for all cases. My guess is it won’t be, but there’s research showing that interventions can generally help these young people."