The "Wounded" Child
Early childhood abuse is the most significant cause of dysfunctional behaviour in schools and society. It is important that teachers and all sectors of the education community understand what constitutes abuse and its prevalence in society. This Newsletter addresses this issue.
In 1962 there was a ground-breaking publication that identified the damage and impact of early childhood abuse and neglect on their subsequent behaviour. This initiated the understanding of the link between the treatment of children in their early years and their later sense of self and ability to relate to others. Led by the psychiatrist C. Henry Kempe the paper “The Battered Child-Syndrome” identified the trauma associated with abuse and subsequent cognitive alteration. This opened a flood of research into this topic and today most developmental psychiatric illnesses have their foundations in early childhood experiences. These disorders do not include those abnormal behaviours that are the result of a physical defect, things like psychosis, autism and development delay.
This is the first in a series of Newsletters that deal with abuse and neglect and the impact these, often comorbid actions have on the child. This article will deal with a description of abuse and neglect and their prevalence in the western world.
We describe abuse as any action that invalidates a person’s worth. It is an assault on a person’s physical or psychological self. These attacks can range in intensity from mild irritation up to being perceived as life-threatening. It is at the intense level the damage is done to the developing brain. In the general literature there are three categories on abuse as mentioned. These are:
This is the use of intentional force against a child’s body or an unwanted invasion of their physical space. It can be:
- Holding Down
- Exaggerated Tickling
- Pulling Hair
- Twisting Ear
This is a form of abuse where the child’s psychological boundaries are violated. This can take the form of non-accidental verbal or symbolic actions that are likely to result in significant psychological or emotional harm. Forms of emotional abuse are:
- Attacking the worth of the child by rejecting them, terrorising or isolating them.
- Telling the child that they are stupid, un-loveable or unwanted.
- Being overly harsh in criticising the child.
- Punishing the child when they become emotional – don’t be a baby, etc. or when they show no emotion when it would be appropriate to do so.
- When the love of a parent is conditional on their behaviour (I will love you if …)
This abuse is when an adult or older adolescent uses the child for their sexual gratification or for financial profit of the person committing the act. This can include:
- Unwanted touching or penetration of the sexual organs.
- Adults exposing their own genitals to a child.
- Exposure to inappropriate sexual experiences or information (i.e. Pornography).
Sexual abuse is a silent destroyer of too many young children in our society especially with the easy availability of pornography on the Internet.
There are other forms of abuse that do not get the coverage in most literature but are equally likely to expose the child to toxic levels of stress. These are:
- Intellectual Abuse – this occurs when a child is placed in a situation where they are asked to perform a task they are developmentally incapable of successfully achieving. An example is when a child is given a glass of milk to drink before they have developed the motor skills required for this task. When they fail they are either labelled as useless by the parent or confirm to themselves the belief that they are at fault because they failed.
Intellectual abuse also occurs when a significant other compares one child’s performance against another child implying one is better than the other.
- Spiritual Abuse – One type of spiritual abuse that occurs is when the parents put themselves above the child. The child must ‘worship’ the parent. A contrary form of spiritual abuse occurs when the parents put the child above themselves. The child becomes the focus of their devotion, they can do no wrong. These children never learn to take responsibility. In the first instance the parent knows best and you just do as you’re told. In the latter form the parent will not see any faults in the child’s behaviour and so they never get the natural consequences when they make a wrong choice.
The second form of spiritual abuse occurs when ‘religions’ teach that God will punish sinners and all are condemned unless they conform to some dogma. People who work with children brought up in some cults attest to the damage done through this form of abuse but it would be a brave politician who would underline the damage done when adherence to the word of any god is criticized.
This is a complex type of abuse. It occurs not when the individual is the target of the assault but is a witness. It is an issue for all those who work in highly stressful vocations such as police, reporters and even teachers who work in very difficult communities. However, for the purposes of linking abuse with subsequent behavioural difficulties I will limit the description to incidents that occur to children. This happens predominantly on families that experience domestic violence. This is particularly challenging for children who watch their mother being beaten by a partner. In a subsequent Newsletter I will describe the acquisition of trauma but for now it is enough that the child is forced to watch what is in reality their source of life be threatened. The fear is overwhelming and equal, if not more damaging than a direct attack on their person.
Neglect, if not an overt form of abuse it is a close cousin, it is a passive form of abuse. It is the lack of stimulation that is required to meet the child’s physical, social and intellectual needs. As mentioned earlier, this neglect in a developing child will fail to construct the neural pathways that have been developmentally expected. When these genetic windows for development stages like attachment are activated, and there is no stimulation then the neurons will be pruned and the opportunity to meet the developmental threshold is lost. Forms of neglect are:
- Physical – failure to provide for physical needs such as food.
- Medical – not providing medical care when the child is sick or needs dental work.
- Emotional – lack of nurture, encouragement, love and support.
- Educational – lack of providing educational resources and ensuring regular participation in schooling.
- Abandonment – leaving the child alone for long periods of time without any support.
There are countless studies into the frequency of child abuse and these are frightening and are most likely under reported. The general view is that from 1% to 9% of the population suffer from PTSD. This means that in a school of 1000 students you could expect 10 – 90 students to suffer this syndrome. Although PTSD occurs in every socioeconomic level of society it is not equally distributed across the landscape and resource poor suburbs are reported to have levels of up to 23%. So, in the school mentioned above you would have 230 students with PTSD.
Magnitude of Childhood PTSD
When first described Dr. Kempe estimated the occurrence at 6 per 1,000 children or 0.6% of the population experienced early childhood abuse. However modern studies estimate between 15% to 43% of children will experience a traumatic event and up to 15% will develop PTSD.
These numbers vary across each countries’ economic landscape and across nations. One can only imagine the level of PTSD amongst the children in the war-torn nations in the world. The financial cost to conduct a war fails to comprehend the potential future intellectual benefits we could enjoy if these children were allowed to develop their minds to their true potential. War is societal abuse on children and is sanctioned by political leaders.
In the US the Child Protection agencies get around three million reports each year. This involves 5.5 million children. Of the reported cases, there is proof of abuse in about 30%. From these cases, we have an idea how often different types of abuse occur:
- 65% neglect
- 18% physical abuse
- 10% sexual abuse
- 7% psychological (mental) abuse
However, girls are more likely to be abused then boys because girls are more likely to internalize their feelings while the boys that attract the most attention because they act out their pain therefore being recognised as being damaged.
Studies show that about 15% to 43% of girls and 14% to 43% of boys go through at least one trauma. Of those children and teens who have had a trauma, 3% to 15% of girls and 1% to 6% of boys develop PTSD.
The next Newsletter will describe the impact abuse and neglect have on the structure of the brain.