Child abuse: A study of the child's perspective

Child Ahusr & N~,&tr, Yrmted m the l..S.A

0145-2134186 33 MI + .W CopyrIght c I986 Pergamon .iuurnak Ltd

Vol. IO, pp 511-518. 1986 All right\ reserved.

CHILD ABUSE: A STUDY OF THE CHILD’S PERSPECTIVE PHILIPG. NEY, M.D., F.R.C.P.(C) Department

of Psychiatry,

University

of Calgary Alberta.

Health Sciences Center, Canada T2N 4N 1

3330 Hospital

Dr. N.W.,

Calgary.

CHRISTINEMOORE,M.SC.,JOHNMCPHEE,M.SC.,PENELOPE TROUGHT,B.A. Christchurch,

New Zealand

Abstract-This

study ascertained the child’s response to various types of abuse and neglect. With interviews for the staff of a child psychiatric unit, the mothers and the children involved, we assessed the severity, frequency and duration of physical abuse, verbal abuse, physical neglect, emotional neglect or sexual abuse of children. The physically abused children accepted blame for mild but not severe mistreatment. Verbally and sexually abused children did not believe it was their fault if the mistreatment was moderately extensive but did if it was mild or severe. The relationship between extent of abuse and blame was le\s clear for neglect, but children usually thought it was their fault. Verbal and sexual abuse appeared to have a greater impact on the children’s perception of themselves and the world. Verbally abused children were more angry and more pessimistic about their future. Although physical abuse appeared to make some children feel they were unwanted at birth, how much the mother wanted her children was not related to the extent of any type of abuse. Both the type and extent of mistr~tment appear to have different effects on the child’s subjective experience. The use of the visual analogue scale in this study made it possible to differentiate a continuum of severity and frequency of five types of mistreatment without the need for de~nition.

and questionnaires

R&urn&-Dans cette etude on a &al& la r6action de I’enfant P I’&ird des s&ices et de la negligence. L.e\ methodes consistaient en interviews et en questionnaires. On a interroge de la sorte les enfants maltrait& et leur mere, ainsi que le personnel de I’unite de psychiatric infantile OB se trouvaient les e&ants. Les questions tournaient autour du sujet des s&ices physiques, de la violence verbale, de la nCgligence affective, des aggressions sexuelles. Les enfants victimes de sevices physiques acceptaient la r6primande pour des chases peu graves mais critiquaient par contre les s&ices sCvtres comme punition. Les enfants victimes de violences verbales et jexuelles n’avaient pas I’impression que c’&ait de leur faute lorsqu’ils Ctaient punis modCrt?ment, mais par contre pensaient @tre coupables lorsque les mauvais traitements etaient ICgers ou t&s s&&es. En ce qui concerne la negligence, la relation avec la s&&-it6 de la punition ou de la reprimande etait moins Claire. l,e\ e&ants en gCn&al se sentaient fautifs. La violence verbale et les s&ices sexuels semblent avoir un impact plus grand sur la perception que I’enfant a de sa propre personne et sa perception du monde quc les autres formes de violence. Les enfants victimes de violences verbales &aient plus rCvoltCs et aussi plus pessimistes en ce qui concerne leur avenir. Les s&vices physiques semblent avoir conduit certains des enfants g penser que leur naissance n’6tait pas dtsirCe; en fait combien la m&-e desirait I’enfant n’avait pas de relation avec la sCvt?ritC des mauvais traitement qu’elle infligeait & ses enfants. II semble qu’a la fois le type et la gravitC des mauvais traitements ont des effets diffkrents sur I’exptrience subjective de I’enfant. Dans cette etude, I’utilisation d’une 6chelle d’analogie visuelle a permis de distinguer un continuum de gravite et de frkquence h travers 5 types de mauvais traitements, \ans avoir B recourir B des d&initions precises.

INTRODUCTION MANY CLINICIANS BELIEVE that it is not the event, but the interpretation of the event by individuals that determines its impact upon them. Ausubel et al. believe that parental behavior would be expected to influence the child’s development “only to the extent and in the form in which it is perceived” [I]. In discussing the etiology of schizophrenia, Rabkin states “pathological parental attitudes and behaviors lead to a certain

512

P. G. Ney. C. Moore.

J. McPhee.

and Penelope

Fought

outcome not as a cause sui, but, because they are perceived and reacted to a certain way by the child, a way perhaps unrelated to the manner in which both parents and researcher construe them” [2]. Although there have been many investigations of child abuse. there has been very little research that examines the child’s perception of those experiences. This study analyzed the responses of children in a psychiatric unit to determine the difference in the perceptions of those who were abused or neglected compared to those who were not. The environment in which an abused child lives is described as being deprived of nurturing and love and filled with fear-provoking unpredictable events [3. 41. Unfortunately many statements of children’s experiences are derived from adult observations of abused children and characteristics of abusive parents. Because children usually perceive their environment in a manner different from that of adults, it is important to understand the impact of abuse upon the child directly from data recording his experience. Kempe [S] concluded that abused children feel they deserve to be punished, but did not measure that directly. Amsterdam [6] analyzed the responses of adolescents and young adults and found the more severely physically abused they were as children. the more likely they were to feel that punishment was deserved. In that study the fact that the abused respondents were more likely to be delinquent than the nonabused may be important in the assessment of self blame. Hertzberger, Potts and Dillon studied 25 children. 8 to 14 years, who were residents in a group home [7]. They found that abused children were more likely to describe their parents in negative terms. The more severe the mother’s abuse of her child, the more likely her son would perceive himself to be emotionally neglected. Children who had been verbally abused by their mothers were more likely to express fear of them. Almost invariably, both abused and nonabused children accepted responsibility for being spanked. Father-abused children were more likely to feel they deserved what happened than motherabused children. Emotional reactions did not invariably accompany physical abuse. The majority of physically abused children still felt loved, wanted, and cared for by their parent. The authors concluded that emotional and physical abuse should be considered distinct phenomenon with different consequences.

METHODOLOGY Fifty-seven children (5-12 years) were given a structured interview containing 84 questions regarding their perceptions of abuse, views of their family, feelings about themselves, and thoughts about the world in general. These children had been admitted to the Child and Family Psychiatric Unit, Christchurch Hospital, for a variety of problems, but none of them were so intellectually handicapped, brain damaged. or psychotic to impose any restriction on the quality of the interview. Sixty-five mothers of children in this unit were interviewed and asked 181 questions. The staff were also asked to give their estimate of the extent of abuse to these children by either father or mother, sibling. or someone else. The parents and staff rated the extent of five types of mistreatment: physical abuse (hits, shakes, burns, etc.); verbal abuse (criticism, blaming, humiliating): physical neglect (insufficient food, clothing, shelter); emotional neglect (avoidance. lack of recreation or education); and sexual abuse (exposure. titillation, incest, etc.). The frequency and severity of abuse were scored on visual analogue scales. The subjects were asked to indicate a point on the line between two extremes which most clearly applied to their situation. The duration and description of these five types of abuse were also recorded. Mothers were also asked to fill in a self-report containing many of the same

The child’s

513

perspective

questions asked by the interviewer. The data provided a three-way estimate of the abuse experience: mother, staff and child. The data was analyzed by the SPSS statistical programs of the University of Canterbury.

RESULTS There was an 85% correlation between parent self-report and data obtained by the trained observer during interviews. There was a 60% correlation between the staff’s estimate and the parents’ self-report of the frequency of child abuse, and a 75% correlation between the parents’ self-report and the staff’s estimate on the severity of abuse. The staff’s estimate was usually higher. There was an 85% average agreement of responses to questions by two trained observers. There were very few children in our clinical populations that had not been abused or neglected to some extent. The visual analogue scale is sensitive to small amounts of mistreatment. Findings from the mother’s experience as a child and her abuse of a child appear to indicate that certain types of abuse and neglect are more likely to be perpetuated (Table I). Sexual abuse of a child is more likely to be related to physical neglect than other types of mistreatment (Table 2). In the mother’s experience as a child, physical abuse was frequently associated with other types of mistreatment (Table 3). The frequencies of abuse as reported by the parents usually have a high correlation with the severities of abuse, but they vary from I to .84. There were interesting correlations between the extent of abuse and the tendency of children to blame themselves (Figures 1 to 3). The combined extent of abuse score by staff was calculated as the frequency of abuse plus severity of abuse each on the visual

Mother's abuse Of her child PA1

PAZ

VA1

VA2

PNI

PNZ

ENI

EN2

SAl

SA2

I = severity 2 = frequency PA = physlfal abuse VA = verbal abuse PN = physical neglect EN = emotional

neglect

SA = sexual sbuie

Shaded

.ZB plur on Spearman correlation coefficients

5 = SIgnlflcant

p<

001

P. G. Ney, C. Moore, .-~___

J. McPhee.

and Penelope

Trought

Abuse of child PAi

PAZ

VA1

PNl

PN2

ENI

EN2

SAi

SAZ

l=

vserity

2=

frequency

PA - physical abuse VA = verbal abuse PN = physical EN i emotional

neglect neglect

SA = sexual abuse

345

/ ,400

G-k n.s. 177 "5. --i

n.s. 191 "5. Shaded

.43 plus on Spearman correlation

5 = slgnlflcdnt

coefficients

p-C.001

Abuse of niother as child PA1

PA2

VA1

PHI

VA2

PM2

ENI

EN2

SAl

SR2

l=

sewrity

2=

frequency

PA = physical abuse VA - verbal abuse PN = physical neglect EN = emotiona?

oegiect

SA = sexual abuse

Shaded

.45 plus on Spearman CorrelatiOn

I = sliJ"lfrcd"t pc

001

coefflclentr

The child’s

515

perspective

analogue scale (reduced to a 4-point scale: 1 = mild abuse, 4 = severe abuse) for mother, father, sibling and anyone else. Children’s tendency to blame themselves was a measure of the frequency with which children thought it was their fault (score +2); sometimes their fault (score + 1); not their fault (score -2); sometimes not their fault (score -1). There was significant level of agreement, x p < .Ol, between the parents’ statements they hit the child and the child’s admission that he/she was being hit. There was a significant agreement, x p < .05, between the parents’ statement that their children were sexually abused and the frequency with which children felt they were being sexually abused. There was not the same level of agreement between emotional neglect and the child feeling they were not cuddled or talked to, or between verbal abuse and the child feeling he was being usually blamed or criticized. Forty-six percent of the children interviewed felt that if they were not wanted, they would be sent away, placed in a foster home, or adopted. To the question, Did your parents want you when you were born, 67% said yes and 28% did not know. To the question, Do they want you now, 77% said yes and 14% said they did not know. There were no children who definitely said no to either of the questions. The remainder said they were wanted or probably wanted by one parent. There was no significant correlation between statements by the children that they felt wanted at birth or wanted presently and the mother’s self-report of emotional neglect of her children. There was a significant correlation, x p < .05, between children feeling they were not wanted when born and the frequency and severity of physical abuse. There was no significant correlation between the extent of abuse and the mother’s statement she did not want the child except at the time she was interviewed when it was inversely related. The mother’s estimate of how much she wanted the child increased during her pregnancy (Figure 4). The experience of being abused appeared to affect the child’s view of the world. There was a significant association, x p < .08, between verbal abuse and children’s expectation there will be a nuclear war and also that they will be killed in it. Other types of abuse and neglect, age, or sex were not significantly associated with that expectation. Verbal abuse is also associated with children’s feeling of wanting to hurt themselves or to hurt someone

I

Not my

Child blames self for Physical

Abuse

4

fault -1 -6A

Staffs estimate

I

I

I

1

1

2

3

4

of combined

mothers,

fathers, other abuse

516

p. G. Ney.

C. Moore.

Ii

and Penelope Trought

J. McPhee,

Child blames self for Verbal Abuse

-6

Staffs estimate

I

I

I

1

1

2

3

4

of combined mothers, fathers,

other abuse

else, x p < .05. Those children who feel hopeless also appear to feel angry, unhappy want to run away but without any idea of to whom they would run, x p < .05.

and

DISCUSSION From this data it appears children who are physically abused will blame themselves when that abuse is less extensive, but when it is frequent (every day) or severe (fractures or burns), children do not accept the blame. Children who are verbahy abused tend to Ill

Child blames self for Sexual Abuse

8-1

Not my fault

-6

J

I 1

Staffs estimate of combined

I 2

I 3

1 4

mothers. fathers, other abuse

517

The child’s perspective WANTEDNESS HIGH MEDIUM

100

q

90 80 70 m

60

t 2

50

i

u

E

40

30 20 10

8

I,

BEFORE PREGNANCY

k EARLY

PREGNANCY

LATE

PREGNANCY

AFTER BIRTH

blame themselves when it is mild, blame someone else when it is moderate, and strongly blame themselves when the criticizing or humiliating is severe. The shape of the curve relating the amount of self-blame and the extent of sexual abuse is similar to that of verbal abuse, except it appears that these children always blame themselves, regardless of the severity or frequency. The data relating the child’s self-blame and physical, verbal and sexual abuse has been analyzed a number of ways and the curves of these relationships are consistent. The relationship of emotional neglect frequently reported and physical neglect infrequently reported to the child’s self-blame is less clear and consistent. However, in both instances, children are more likely to blame themselves than someone else for both physical and emotional neglect. The tendency of children to blame themselves seems to depend on the type and extent of abuse. If our evidence that verbal abuse is more likely than the other kinds of abuse to affect children’s view of themselves and the world can be accepted, one can speculate about why and how. Possibly the humiliating, blaming abuse is more entrapping. Verbal abuse is more likely to make it difficult for the child to recognize the assault and defend himself from it. If children do to themselves as they have been done, there is a limit to which both the perpetrator and victim can physically abuse a child without the child beginning to realize he won’t survive. Under most conditions the pain results in a self-defending anger and the child soon begins to attack back. With verbal abuse, however, the nature of the attack is such that the child adds to his own distress especially when it is severe. He realizes that to survive he must trust his parents’ perceptions of good and bad, right and wrong. To survive he must agree with his abusing parent; he deserved what he received. Sexual abuse may have the same effect. While a child might accept the need to be hit, he will protest severe physical abuse as unjust or unreasonable. Verbal abuse appears to interfere with the child’s ability to dis-

rtx

I? G. Ney. C. Moore.

J. McPhee.

and Rne!ope

Trought

himself from the experience. It makes him angry at himself and pessimistic about the world. If verbal and sexual abuse are more conflict engendering, they are more likely to be transmitted to the next generation. Because verbal abuse is more ego syntonic. it is harder for parents to recognize they are doing it. Because it does not result in visible wounds. it is harder for the community to react to its effects and more difficult for professionals to intervene. If verbal abuse increases a child’s expectation of war and if expectations are sought after. verbal abuse may contribute to the possibility of nuclear war. Physical neglect appears to be infrequent in this sample or the last thing to which both children and parents will admit. In the New Zealand culture, which has a long history of special resources for children, neglect is usually picked up by Piunkett nurses very soon after it occurs. New Zealand parents are taught to provide for their children and physical neglect is most unacceptable. Partly because emotional neglect was so readily reported, it is the hardest to measure and analyze. The use of the visuaf anaioguc makes it possible to measure on a continuous scafe ati types of abuse which occur on a continuum of severity and frequency. It avoids the need for definitions and categories. However, it may make it too easy to report vague feelings of dissatisfaction with childhood as being abuse. Our questionnaire was therapeutic to the extent it helped children and parents specify and conceptualize their experience of abuse and neglect. Though children blame themselves, they will still look for an explanation of why. Only those children who were physically abused thought it was because they were unwanted when they were born. There was no significant correlation between the mothers not wanting their child and either the extent or severity of any kind of abuse. c\lthough 85% of these children were wanted after they were born, mothers’ ambivalence about their pregnancy appears to have been greatest during the early stages. Physical abuse may make children feel Llnw~~ntedand the belief that abused children were unwanted may be an aduft reconstruction of an impression held as a child. This research tends to support the clinical and experimental findings of others; abused and neglected children do tend to blame themselves. Fiowever, it is important to gain each child”s perspective because it differs according to the type and extent of abuse. tance

REFERENCES