Abuse

There are many kinds of abase, this section provides information on child abuse, elder abuse and spousal abuse. To view the information on abuse please click on the links below.

CHILD ABUSE

• Types of Abuse
• Indicators of Physical Abuse
• Indicators of Sexual Abuse
• Indicators of Neglect
• Abusers
• Helping the Child

An abused or neglected child is one whose physical or psychological health or development is harmed by the parents' (or caretaker's) behavior. The law defines child abuse to include physical abuse, physical neglect, sexual abuse and emotional abuse of a child under 18 years of age by a parent- or by another family member or caretaker.

• The non-accidental physical injury of a child inflicted by a parent or caretaker, which ranges from superficial bruises and welts to broken bones, burns, serious internal injuries and, in some cases, death.
• You may see frequent and unexplained bruises, burns, cuts, injuries; the child may be overly afraid of the parent's reaction to misbehavior.
  

• A parent or caretaker's failure to give the child food, clothing, hygiene, medical care and supervision.
• You may see a very young child routinely left alone at home. You may know that a severe illness or injury is not being medically treated. A neighbor child may frequently turn up at your door inadequately dressed for the weather saying their parent told them to stay away. Physical neglect can be hard to judge; sometimes what you see is poor judgment, but not neglect. Sometimes what you see is the result of poverty, not parental neglect.

• Ranges from offenses such as promoting prostitution, to fondling, intercourse, or using the child for pornographic materials.
• You may observe sexual behavior way beyond what is expected for the child's age; a young child might have sudden, unusual difficulty with toilet habits; there may be pain or itching, bruises or bleeding in the genital area. The child might tell you.
  

• Includes severe rejection, humiliation, and actions intended to produce fear or extreme guilt in a child.
• You may see a parent who verbally terrorizes the child, who continually and severely criticizes the child, or who fails to express any affection or nurturing

Special attention should be paid to injuries that are unexplained or are inconsistent with the parent's or caretaker's explanation and/or the child's developmental stage.

Note: "Behavioral indicators" of child abuse have a valid place in decision making. Particularly when there is otherwise unexplained change in behavior, these indicators provide important clues for potential reporters to pursue, and crucial corroborative evidence of maltreatment. But, behavioral indicators tend to be misused to report suspected abuse, without physical or other evidence and without statements of the child or others. Any list of behavioral indicators standing on their own and without an accompanying history of past and present behaviors, should not be the basis of a report. There are too many other explanations for such behavior. (Besharov, Douglas, Recognizing Child Abuse, A Guide for the Concerned, The Free Press 1990.)

Physical Indicators

I. Bruises welts and bite marks

• on face, lips, mouth, neck, wrists or ankles
• on torso, back, buttock, thighs
• injuries to both eyes/cheeks (accidents usually injure only one side)
• in clustered, forming patterns
• in shape of article (e.g. belt, cord)
• on several different surface areas
• evidence of human bite (compresses rather than tears)
• in various stages of healing
• regularly appearing after absence, weekend, vacation

• to mouth, lips, gums, eyes,
• to external genitalia, on back of arms, legs or torso

• cigar, cigarette, esp. on soles, palms, back, buttocks
• scalding water immersion (sock-like, glove-like, doughnut shaped on buttocks or genitalia)
• patterned like electric iron, iron, etc.
• rope burns on arms, legs, neck, torso

• Wary of contacts with parents or other adults
• Apprehensive when other children cry
• Behavior extremes
• aggressiveness, withdrawal, or extreme mood changes
• Afraid to go home, repeated incidents of running away
• Reports injury by parents (sometimes blames self, e.g., "I was bad")
• Habit disorders
• self-injurious behaviors
• psychoneurotic reactions (phobias, compulsions, obsessions, hypochondria)
• May wear long sleeves or other concealing clothing inappropriate for weather, to hide injuries
• Manifestations of low self-esteem
• Suicide attempts
  

Sexual Abuse of Children - Defining the Problem

The sexual exploitation of a child by a parent, relative, caretaker or other person, which may range from non-touching offenses such as exhibitionism to fondling, intercourse or use of child in the production of pornographic materials.

Because most sexual abuse cases do not present apparent physical evidence or indicators, identification and recognition are often very difficult. And, the many legitimate fears which child victims of sexual abuse experience make it extremely difficult for them to report the abuse, even to a very trusted adult or friend. The fact that the vast majority of child molesters are family members or friends of the child or his/her family makes disclosure of the abuse very difficult for the child. There is absolutely no profile of a child molester or of the typical victim. Do not assume that, because an alleged offender has an unparalleled reputation for good works in the community or holds a certain job, he or she could not also be a child molester.

Note: "Behavioral indicators" provide important clues for potential reporters to pursue, particularly when there is otherwise unexplained change in behavior. But, behavioral indicators should not be the basis of a report without physical or other evidence or statements of the child or others.

Physical Indicators

• Difficulty in walking or sitting
• Torn, stained or bloody underclothing
• Pain or itching in genital area
• Bruises or bleeding in external genitalia, vaginal or anal areas
• Bruises to the hard or soft palate
• Sexually transmitted diseases, especially in preteens; includes venereal oral infections
• Pregnancy, especially in early adolescent
• Painful discharge of urine and/or repeated urinary infections
• Foreign bodies in vagina or rectum

• Unwilling to change for gym or participate in physical education class
• Withdrawal, fantasy or infantile behavior
• Bizarre, sophisticated or unusual sexual behavior or knowledge; seductive or promiscuous behavior
• Poor peer relationships
• Delinquent or runaway; truancy
• Reports sexual assault by caretaker
• Prostitution
• Forcing sexual acts on other children
• Extreme fear of being touched; unwilling to submit to physical examination
• Self-injurious behaviors; suicide attempts
• Manifestations of low self-esteem, general fearfulness

Neglect & Maltreatment of Children - Defining the Problem

The withholding of, or failure to provide a child, adequate food, shelter, clothing, education, hygiene, medical care and/or supervision needed for normal growth and development.

Summary of Legal Definition: A neglected child is a child less than eighteen years of age whose physical, mental or emotional condition has been impaired or is in imminent danger of becoming impaired as a result of the failure of the parent- or other person legally responsible for his/her care- to exercise a minimum degree of care:

• in supplying the child with food, clothing, shelter or education, or medical, dental optometrical or surgical care, though financially able to do so or offered financial or other reasonable means to do so; or
• in providing the child with proper supervision or guardianship, by unreasonably

inflicting or allowing to be inflicted harm, or a substantial risk thereof, including
the use of excessive corporal punishment; or
• by misusing drugs or alcohol to the extent that he or she loses self-control of

his/her actions, or
• by any other acts of similarly serious nature requiring the aid of the court; or
• who has been abandoned by his/her parents or other person legally

responsible for the child's care.

Acts or omissions that cause or could cause serious conduct, cognitive, affective or other mental disorders as a result of such parent or caretaker behavior as torture or close confinement or the constant use of verbally abusive language to harshly criticize and denigrate a child; generally a result of the child's inability to meet unrealistic demands made by parents. Also includes emotional neglect -- the withholding of physical and emotional contact to the detriment of the child's normal emotional development, and in extreme cases, physical development.

Indicators of Neglect And Maltreatment
Note: "Behavioral indicators" of child abuse have a valid place in decision making. Particularly when there is otherwise unexplained change in behavior, these indicators provide important clues for potential reporters to pursue. But, behavioral indicators alone and without an accompanying history of past and present behaviors, physical or other evidence or statements of the child or others, should not be the basis of a report. There are too many other explanations for such behavior.

Physical Indicators of Neglect

• Failure to thrive (physically or emotionally)
• Positive indicator of toxicology, esp. in newborns; drug withdrawal symptoms, tremors, etc.
• Lags in physical development
• consistent hunger, poor hygiene (skin,teeth, ears, etc.)
• Inappropriate dress for the season
• Speech disorders
• Consistent lack of supervision, especially in dangerous activities or for long periods
• Unattended physical problems or medical needs
• Chronic truancy
• Abandonment

 

• Begging, stealing food
• Extended stays at school
• Constant fatigue, listlessness, falling asleep in class
• Alcohol or drug abuse
• Delinquency (i.e., thefts)
• States there is no caretaker
• Runaway behavior
• Habit disorder (e.g., sucking, biting, rocking)
• Conduct disorder (e.g., antisocial, destructive)
• Neurotic traits (sleep disorders, inhibition of play)
• Psychoneurotic reactions (hysteria, obsession)
• Behavior extremes; compliant/passive aggressive
• Overly adaptive behavior, adult-like or infantile
• Lags in mental/emotional development
• Attempted suicide

Possible Behavioral and Environmental Characteristics of Abusive Parents or Caretakers

These indicators are clues, not conclusive proof. Although they are useful to remember when dealing with the parent/caretaker, these characteristics also exist where a child is not abused or neglected. Typically, several clues or indicators will appear, rarely as separate entities. Except for the obvious, single clues should be treated as "flags" which indicate that the professional needs to look further and more carefully.

Parent / Caretaker History

• Parent abused or neglected as a child
• Lack of friendships or emotional support
• Isolated from supports such as friends, relatives, neighbors, community groups
• Lack of self-esteem, feelings of worthlessness
• Marital problems of parents, including spouse abuse
• Physical or mental health problems, irrational behavior
• Life crises: financial debt, unemployment / underemployment, housing problems, etc.
• Alcohol / substance abuse
• Adolescent parents

• Parent's unrealistic expectation of child's physical and emotional needs
• Mentally/developmentally disabled children are particularly vulnerable
• Parent's unrealistic expectations of child to meet parent's emotional needs (role reversal), children viewed as "miniature adults"
• Absence of nurturing child-rearing skills
• Violence/corporal punishment accepted as unquestioned child-rearing practice
• Violence accepted as a normal means of personal interaction
• Delay or failure in seeking health care for child's injury, illness, routine checkups, immunizations, etc.
• Parent views child as bad, evil, different, etc.

• Lack of social support
• inability to ask for and receive the kind of help and support parents need for themselves and their children
• Homelessness

Very seldom will a child disclose abuse immediately after the first incident has occurred. Victimized children often experience a great sense of helplessness and hopelessness and think that nobody can do anything to help them. Also, victimized children may try to make every attempt to protect an abusive parent. Or, they may be extremely reluctant to report any abuse for fear of what the abuser may do to them. Typically, a child may not report abuse for months and even years, particularly if the abuser is someone close to the child.

Sometimes an outcry may not be verbal but portrayed in a drawing left behind inadvertently for the teacher, the counselor, or a trusted relative to see. Another form of outcry may be seen in a child who will frequently go to the school nurse complaining of vague, somatic symptoms, often without organic basis, hoping that the nurse will guess what has happened. This way, in their minds, they have not betrayed nor will they be punished, since they did not directly report the abuse. Some children, while totally reluctant to report or discuss the abuse, may be more willing to express their apprehensions and anxieties about the perpetrator or the home situation. In some cases, abused children will make an outcry which may take the extreme form of a suicide gesture or attempt.

Children may disclose abuse in a variety of ways. They may blurt it out to you, especially after you have created a warm nurturing environment. They may come privately to talk directly and specifically about what is going on. But more common ways include:

Indirect Hints: "My brother wouldn't let me sleep last night." "My babysitter keeps bothering me." A child may talk in these terms because he/she hasn't learned more specific vocabulary, feels too ashamed or embarrassed to talk more directly, has promised not to tell, or for a combination of these reasons.

Appropriate responses
would be invitations to tell you more, such as "Is it something you are happy about?" and open-ended questions such as "Can you tell me more?" or "What do you mean?" Gently encourage the child to be more specific. It is important that the child use his/her own language, and that no additional words are given to the child.

Disguised Disclosure:
"What would happen if a girl told someone her mother beat her?" "I know someone who is being touched in a bad way." Here the child might be talking about a friend or sibling, but is just as likely to be talking about her/himself.

Encourage the child to tell you what he/she knows about the "other child." It is probably that the child will eventually tell you about whom he/she is talking.

Disclosure with Strings Attached:
"I have a problem, but if I tell you about it, you have to promise not to tell anyone else." Most children are all too aware that some negative consequences will result if they break the secret of abuse. Often the offender uses the threat of these consequences to keep the child silent.

Let the child know you want to help him/her. Tell them, from the beginning, that there are times when you too may need to get help with the problem. In order to help them, it may be necessary to get some special people involved. The fact that the child has chosen this particular moment to disclose is important. Usually they will agree to seeking help if you talk about it ahead of time. Assure the child that you will respect his/her need for confidentiality by not discussing the abuse with anyone other than those directly involved in getting help. And, if you can explain the process to them, it may help with their initial fear.

Responding to Disclosures
In school, if a child discloses during a lesson, acknowledge the child's disclosure and continue the lesson. Afterward, find a place where you can talk with the child alone. It is best to present child abuse curricula before a playtime or recess so that you have a natural opportunity to talk with children privately if they come forward.

Before notifying anyone outside of your school or agency, you or another designated person:
..should sit down in a quiet room without interruptions and speak with the child. If a child has chosen you as the person in whom to confide, you should take the time to speak with the child about the problem. If that is not possible, ask the child if she/he would feel comfortable discussing it with someone else. If the child indicates that he wants to tell you, you must make every effort to listen and support the child. She/he may not trust another enough to tell them.

Multiple interviews should be avoided. The child will have to share the story with many others.

When you speak with the child, sit down together, assure him/her that you are concerned and want to know more and that it's alright to tell you. Go slowly, allowing the child to explain as much as he/she can. Do not suggest in any way that any particular person may have done something to him/ her or that the child was touched in any particular way. Let the child talk as much as possible.

Explain, in age appropriate language, that the law requires you to make a report if any child discloses abuse and that the law is there to protect them. Describe for them who will be involved, for example, the social worker, principal and the CPS caseworker.

When Talking to the Child, DO

• Find a private place to talk with the child.
• Sit next to the child, not across a table or desk.
• Use language the child understands; ask the child to clarify words you don't understand.
• Express your belief that the child is telling you the truth.
• Reassure the child that it is not his/her fault, and that he/she is not bad and did nothing to deserve this.
• Determine the child's immediate need for safety.
• Let the child know you will do your best to protect and support him/her.
• Tell the child what you will do, and who will be involved in the process.

• Disparage or criticize the child's choice of words or language.
• Suggest answers to the child.
• Probe or press for answers the child is unwilling to give.
• Display shock or disapproval of parent(s), child, or the situation.
• Talk to the child with a group of interviewers.
• Make promises to the child, about "not telling" nor about how the situation will work out.

Supporting the Child After the Report Has Been Made
If it is necessary for Child Protective Services or a Law Enforcement official to interview the child at the school or agency, you should cooperate and assist by providing access for such an interview. Unless there are compelling reasons against it, a staff member the child trusts should be present during the interview to provide support for the child. (This situation may also arise when the report did not originate from your school or agency.)