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A study of the needs of abused and neglected children

In the last 10 years the reported cases of abused and neglected children more than doubled, from 1.

  • Research On Child Maltreatment Is Currently Undervalued And Undeveloped Research in the field of child maltreatment studies is relatively undeveloped when compared with related fields such as child development, so- Page 41 Share Cite Suggested Citation;
  • The interdependency of myriad factors operating at multiple levels and in multiple domains complicates understanding of the causes and consequences of child abuse and neglect and challenges the ability to design, implement, and sustain effective responses;
  • Variations in research methods e.

A recent survey of State child welfare administrators found that parental substance abuse was a factor in at least 50 percent of substantiated cases of child abuse and neglect. Moreover, 80 percent reported that substance abuse and poverty were the two primary factors contributing to abuse and neglect U. Substance abuse is a contributing factor to the abuse of at least one third of the children in the child welfare system DHHS, 1999. It is estimated that each day five children die as a result of child abuse or neglect--up from three a day reported in 1994 CASA, 1999; McCurdy and Daro, 1994.

In reported cases, the most pervasive form of child maltreatment is neglect 60 percentfollowed by physical abuse 25 percentsexual abuse 13 percentand emotional maltreatment 5 percent. More than 50 percent of the victims were 7 years old or younger; slightly more than half of victims were girls Sedlak and Broadhurst, 1996. Statistics will vary because of differences in criteria and methodology and because many cases of child maltreatment involve overlapping forms of abuse or neglect.

More details regarding the prevalence of child abuse and neglect are provided later in this chapter, along with specific definitions of what is meant by the terms "child abuse" and "neglect. However, researchers, counselors, and program administrators agree that the rise in substance abuse disorders as a factor in child abuse and neglect cases has severely complicated efforts by child welfare systems to protect children and rehabilitate families CASA, 1999; DHHS, 1999.

Parents with substance abuse problems are less educated and less likely to be employed full time; they are much less likely than other parents to be married and much more likely to be involved in the welfare system DHHS, 1999. However, these statistics may result from a population's reliance on public welfare systems; parents in higher socioeconomic classes can afford private systems where reporting is not mandated.

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Many clients in substance abuse treatment have histories of child abuse or neglect that might affect their chances for recovery. There is accumulating research and clinical evidence that physical, sexual, and emotional abuse and neglect during childhood increase a person's risk of developing substance abuse disorders DHHS, 1999.

In addition, relapse and treatment complications may be more likely if issues related to maltreatment are not identified and treated Brown, 1991 ; Rose, 1991; Young, 1995. The counselor might have more difficulty engaging clients with abuse histories, and these clients may have a variety of disabling comorbid conditions, such as posttraumatic stress disorder PTSD and dissociative disorders.

Language Problems Among Abused and Neglected Children

Given the presence of substance abuse in the majority of child abuse or neglect cases, alcohol and drug counselors may also have reason to suspect, or may discover, that clients are abusing or neglecting their own children. The children of substance-abusing parents will also face an increased risk of developing a substance abuse disorder themselves.

A recent study confirms what has long been suspected, that children of alcoholics whether or not they have been abused have an altered brain chemistry that may make them more likely to become alcoholics themselves Wand et al. If the cycle of intergenerational substance abuse and child abuse and neglect is to be broken, counselors must address these issues. This is discussed in Chapter 5.

THE 1993 REPORT

Counselors will sometimes find it challenging to maintain the therapeutic alliance with clients that is central to successful treatment while meeting their legal obligations to report suspected or known maltreatment see Chapter 6. Substance Abuse and Child Abuse and Neglect Treatment providers have observed that a large proportion of their clients report being physically, emotionally, or sexually abused as children.

  • Race, class, and gender in theory, policy, and practice;
  • In addition, relapse and treatment complications may be more likely if issues related to maltreatment are not identified and treated Brown, 1991 ; Rose, 1991; Young, 1995.

This clinical knowledge is increasingly supported by research findings. Most of this research has focused on one of two questions: Are people with substance abuse disorders more likely to have been abused or neglected as children than are people without substance abuse disorders?

Are those who report a history of childhood abuse or neglect more likely than their peers to have a substance abuse disorder? Specific answers to these questions depend to some extent on gender, and therefore the literature for men and women should be examined separately. Because most of the available information in this area focuses on childhood sexual and physical abuse, this TIP primarily addresses these two forms of maltreatment. As noted above, however, neglect is the most prevalent type of child maltreatment, and witnessing domestic violence is also a common and potentially damaging form of childhood trauma.

Rates Among Adolescent Girls and Women A review of several studies found that women who abuse alcohol reported higher rates of childhood sexual and physical abuse than their peers without such disorders Langeland and Hartgers, 1998. The likelihood of substance abuse disorders was directly related to the severity of childhood abuse as well. A more exhaustive literature review found that women with substance abuse disorders were nearly two times more likely than women in the general population to report childhood sexual abuse.

These women were also more likely to have experienced physical abuse Simpson and Miller, in press. Miller and her colleagues found that 70 percent of women in treatment for alcohol use disorders reported some form of childhood sexual abuse, while only 35 percent of the women in the general population did the same Miller et al.

Twelve percent of the women with alcohol use disorders did not suffer any a study of the needs of abused and neglected children of sexual or physical abuse, compared with 41 percent of the control sample.

The study concluded that parental alcoholism and child abuse were both independent risk factors for problematic drinking among adults, suggesting that childhood abuse itself contributes uniquely to the genesis of substance abuse disorders. A 1995 literature review reveals a link between childhood sexual abuse and substance abuse Polusny and Follette, 1995.

In community samples, the authors found that the lifetime diagnosis rate of substance abuse disorders was 14 to 31 percent among women who had been sexually abused and 3 to 12 percent among women who had not been abused. In clinical samples, the rate of lifetime substance abuse diagnoses among sexual abuse survivors ranged from 21 to 57 percent, compared with a range of 2 to 27 percent for women without such histories.

Another representative study of young adults found that 43. The available research does indicate that women with substance abuse disorders are more likely than other women to report childhood abuse and women with childhood abuse histories are more likely than other women to have substance abuse disorders. Despite these findings, it is unclear to what extent the relationship between childhood abuse and the development of substance abuse is causal.

Genetics, for example, might account for the association--child abuse might simply be incidental to the process in which the genetic propensity for drinking is passed from parent to child. Childhood stress from sources other than abuse and neglect a study of the needs of abused and neglected children also contribute to substance abuse among adults Malinosky-Rummell and Hansen, 1993.

However, even when parental history of alcohol problems and measures of childhood stress are statistically controlled, childhood sexual and physical abuse still seem to contribute significantly to the alcohol-related problems of women Bennett and Kemper, 1994 ; Miller et al.

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Rates Among Adolescent Boys and Men There are fewer studies a study of the needs of abused and neglected children child abuse among boys and men with substance abuse disorders, and findings are less consistent than those generated for girls and women. One group of researchers believes that data are insufficient to determine 1 whether men with alcohol abuse disorders are more likely than their peers to have suffered childhood abuse, or 2 whether men with childhood abuse histories are more likely than other men to have alcohol abuse disorders Langeland and Hartgers, 1998.

Simpson and Miller found 27 studies that addressed the issue of childhood abuse and neglect among men with substance abuse disorders Simpson and Miller, in press. Only 10 of these studies found childhood sexual abuse rates higher than the national average of 16 percent Finkelhor et al.

Most studies reveal that men with substance abuse disorders actually suffered less sexual abuse than their peers; however, these men did report unusually high rates of childhood physical abuse. The few prospective studies of childhood abuse among men suggest that abuse does increase the risk of alcohol abuse Simpson and Miller, in press.

Men who report childhood abuse also may be more likely to have a substance abuse disorder, but this conclusion is not certain. Societal expectations of self-reliance and fear of homosexual stigmatization may prevent these men from disclosing childhood sexual abuse Briere et al. Current trends, however, suggest that men are becoming more willing to disclose histories of sexual abuse.

Although the incidence of abuse has remained stable for women, far more men are reporting sexual abuse than have done so in the past Simpson and Miller, in press. Men with substance abuse disorders are also reporting more childhood physical abuse. Current study techniques simply may be more sensitive for sexual abuse among men, but further study is needed. Most studies that have examined the rates of substance abuse among men with child abuse histories have found elevated rates of substance abuse disorders Simpson and Miller, in press.

One important exception to this pattern is a study that examined the rates of arrest for alcohol- and drug-related offenses among young adults with and without documented histories of childhood abuse or neglect Ireland and Widom, 1994. This study found no relationship between a history of childhood abuse and neglect and substance abuse problems among men. It should be mentioned, however, that Ireland and Widom did not assess whether the study participants experienced child abuse or neglect that was not officially reported.

Some of those who were classified as not having been abused or neglected may have experienced such maltreatment, and the results of this study are therefore difficult to interpret.

Most of the available literature indicates that men with childhood abuse histories are more likely to have substance abuse disorders than men without childhood abuse histories Simpson and Miller, in press. The rates of childhood physical abuse appear to be higher among men with substance abuse disorders than among men from the general population.

However, men with substance abuse disorders do not report more childhood sexual abuse than other men. Holmes and his colleagues uncovered several factors that contribute to the reluctance of men to report sexual abuse Holmes et al. The shame, homosexual stigmatization, and perceptions of weakness associated with disclosure are perceived by many men to be more burdensome than the secret of abuse.

Also, men are prone to minimize the negative effects that childhood sexual abuse may have, though men who were sexually abused as children are at greater risk than their nonabused peers for later psychological and emotional difficulties.

Holmes and colleagues found that when men disclose a history of child abuse to their mental health counselors, its importance is often dismissed. The researchers concluded that the childhood sexual abuse of males is viewed with far less gravity then the childhood abuse of girls and women Holmes and Slap, 1998; Holmes et al.

Implications for Treatment of Clients With Child Abuse Histories Mental Health Issues Adults with histories of child abuse and neglect may differ from other clients in a number of ways.

  1. Research on general problems of violence, substance addiction, social inequality, unemployment, poor education, and the treatment of children in the social services system is incomplete without attention to child maltreatment issues.
  2. Ohio State University, College of Business; 1990.
  3. Most studies that have examined the rates of substance abuse among men with child abuse histories have found elevated rates of substance abuse disorders Simpson and Miller, in press. However, the federal government's leadership role in building a research base in this area has been complicated by changes and inconsistencies in research plans and priorities, limited funding, politicized peer review, fragmentation of effort among various federal agencies, poorly scheduled proposal review deadlines, and bias introduced by competing institutional objectives.

Although the research base is still limited, clients with childhood abuse histories have been found to have more severe substance abuse disorders, to have started using at younger ages, and to use substances for reasons that differ from other clients. They are also more likely to have attempted suicide, to have PTSD, and to have personality or relationship problems that make them hesitant to accept help Felitti et al.

Clients who have been sexually or physically abused as children often attribute at least part of their substance abuse to their childhood victimization. Hayek found that more than two thirds of women with incest histories believed that the abuse contributed to their alcoholism Hayek, 1980. Another study revealed that 25 percent of incest victims in alcohol treatment programs believed their drinking problems were caused by their incest experiences Janikowski and Glover, 1994.

Individuals with alcohol abuse disorders and histories of sexual or physical abuse believe that their trauma was a considerable factor in causing their drinking problems and that it was a moderate factor in precipitating their most recent relapses Brown et al. Researchers who have focused on women and girls have found that those with histories of childhood abuse are likely to have developed their substance abuse problems at a younger age Edwall and Hoffman, 1987 ; Jarvis et al.

Women in substance abuse treatment programs who were sexually abused as children use alcohol to facilitate sexual encounters more often than do other women Hayek, 1980 ; Hurley, 1990 ; Lammers et al. They are also more likely than their nonabused peers to use substances to alleviate pain Jarvis et al.

Women might also use substances to escape memories of sexual abuse Miller and Downs, 1995 ; Young, 1995. Alcohol abuse disorders are more severe among men who were sexually abused as children Simpson, in press; Simpson et al. They are also more likely to have gone on "suicidal drinking" binges Kroll et al.

Suicide is a major problem among clients who were abused as children. These clients are more likely than their nonabused peers to attempt suicide, according to most studies Harrison et al. Moreover, the first attempt increases the risk of others Linehan, 1993aso that these clients are more likely to attempt suicide again. Research is inconclusive about whether clients with childhood abuse histories are more depressed than their peers.

Some findings suggest they are Benward and Densen-Gerber, 1975 ; Boyd et al. PTSD is relatively common a study of the needs of abused and neglected children people who were abused physically or sexually as children Polusny and Follette, 1995 ; Rowan and Foy, 1993. Among people with substance abuse problems, those with histories of childhood abuse are more likely to meet diagnostic criteria for PTSD Brady et al.

People abused as children are also prone to dissociative disorders Polusny and Follette, 1995but it is unclear whether people who have substance abuse disorders and childhood abuse histories engage in more dissociative behaviors than those without childhood abuse histories. Research on male clients in substance abuse treatment has found that those with childhood abuse histories do not report more dissociation than their nonabused peers Dunn et al.

Ostendorf, however, found that female incest victims with alcohol problems scored lower on an index of dissociation than those without alcohol problems Ostendorf, 1995. Alcohol, the author suggested, may serve the same functions for some as dissociation does for others. More research is needed in this area to clarify the importance of dissociative disorders among clients with childhood abuse histories. Clients abused as children also seem to be at higher risk than their peers for other mental health and social problems.

These include antisocial personality disorder Windle et al. Women with substance abuse disorders and childhood abuse histories are more likely than other women in treatment to report sexual problems and abnormal sexual behaviors Edwall et al.