Without normative attachment, children can move into their middle years without the tools to succeed in peer relationships, school, and extracurricular activities, opening the door to perils in adolescence.
The Child Abuse Prevention and Treatment Act defines child abuse and neglect as “Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act, which presents an imminent risk of serious harm.”1 Each state sets its own definitions of child abuse and neglect within the standard of federal law.
There were about 4.3 million reports of abuse and neglect in 2018, representing approximately 7.8 million children.2 Astonishingly, almost 1800 children died of abuse and neglect, at a rate of 2.39 per 100,000 US children.2 The most common form is general neglect, representing 60.8% of the cases. This was followed by physical abuse (10.7%), sexual abuse (7.3%), and psychological maltreatment (2.3%). Parents are most commonly identified as perpetrators (77.5%). Almost half (49.6%) of the perpetrators were white; drug use disorder was common (30.7%) among maltreatment perpetrators.2
The child’s developmental age during maltreatment exposures is an important consideration in assessment, diagnosis, and treatment. There are likely sensitive developmental periods that affect risk for psychopathology.3 For instance, maltreatment exposure during infancy and early childhood disrupts normative attachments necessary for subsequent development, including capacity for trust, recognizing cause and effect, emotional regulation, and frustration tolerance. Similarly, developmental stage affects the diagnosis of posttraumatic stress disorder.4
Without normative attachment, children can move into their middle years without the tools to succeed in peer relationships, school, and extracurricular activities. In adolescence, the impact of earlier maltreatment increases the likelihood of risk-taking behavior and subsequent health effects, including risky sexual behavior leading to sexually transmitted diseases, substance use, and suicide attempts. Subsequently, the increased risk of health and mental health problems persists through adulthood.5 Because of these potential long-term effects, obtaining a comprehensive social history, including maltreatment exposures and the characteristics of subsequent environments, is important when conducting a comprehensive psychiatric assessment and considering treatment approaches.
Dr Scheid is Associate Professor, Department of Psychiatry, Michigan State University, East Lansing, MI and Medical Consultant to the Michigan Department of Health and Human Services, Children’s Services Agency.
1. CAPTA Reauthorization Act of 2010 (P.L. 111-320)
2. US Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child Maltreatment 2018. Available at: www.acf.hhs.gov/cb/research-data-technology/statistics-research/child-maltreatment. Accessed April 14, 2020.
3. Teicher M, Samson J. Childhood maltreatment and psychopathology: a case for ecophenotypic variants as clinically and neurobiologically distinct subtypes. Am J Psychiatry. 2013;170:1114-1133.
4. Pynoos RS, Steinberg AM, Layne CM, et al. DSM-V PTSD diagnostic criteria for children and adolescents: a developmental perspective and recommendations. J Trauma Stress. 2009;22:391-398.
5. Sege RD, Amaya-Jackson L, et al. Clinical considerations related to the behavioral manifestations of child maltreatment. Pediatrics. 2017;139:e20170100.