Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey

G Model CHIABU-2750; No. of Pages 10

ARTICLE IN PRESS Child Abuse & Neglect xxx (2014) xxx–xxx

Contents lists available at ScienceDirect

Child Abuse & Neglect

Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey夽 Jinah Kim a,b,∗ , Kwanghyuk Kim c a Department of Arts Therapy, College of Medical Science, Jeonju University, Hyojadong 3 ga, 1200, Wansangu, Jeonju 560-759, South Korea b Arts Therapy Research Center, Research Institute of Health Science, Jeonju University, South Korea c Department of Social Welfare, College of Social Science, Jeonju University, Hyojadong 3 ga, 1200, Wansangu, Jeonju 560-759, South Korea

a r t i c l e

i n f o

Article history: Received 7 January 2013 Received in revised form 15 February 2014 Accepted 13 March 2014 Available online xxx

Keywords: Child abuse Poverty Behavioral problems Musical experience

a b s t r a c t A preliminary survey was conducted on primary school aged children (N = 302) between seven to twelve years of age, who attend the local Community Child Centers (CCC) in the economically deprived areas of Jeollabukdo in South Korea for the purpose of identifying the children who have been exposed to on-going child maltreatment and poverty, and their needs. Both standardized and non-standardized self-report types of surveys were carried out and completed by both the children and the teachers of the CCC. As would be expected, emotional and behavioral problems are more pronounced by the children who are exposed to child maltreatment and poverty compared to the children who were not exposed to these adversities, or who were not poor. The more severely abused children in terms of frequency and co-occurrence of different abuses appear to display more behavioral problems than less severely abused children. Teachers reported that the children who were able to play a musical instrument and had arts therapy experiences appear to have less behavioral problems, particularly delinquent and aggressive behavior in comparison to the children who did not have such ability and experiences. Through the survey, it was possible to identify the children in need of therapeutic intervention and discover clinically relevant information. Clinical implications will be discussed further. © 2014 Elsevier Ltd. All rights reserved.

Introduction South Korea has gained a reputation for rapid economic development as one of the fastest growing developed countries. However, there have been long standing issues of underprivileged and vulnerable sections in the society who have been left behind from these economic developments (H. Kim, 2010; Kim, 2013; Lee, Kim, Lee, & Lee, 2009; Korean Ministry of Health & Welfare, 2010). “Gongbubang (study room)” started as one of social movements in the mid-1980s for children from working poor families in city slums in South Korea. Gongbubang was a voluntary organization with the strong belief that education is a key factor for upward mobility to escape the poverty (Kim, 2013; H. Kim, 2010; Lee, Kim, Lee, & Lee, 2009). Therefore, the

夽 This work was supported by the Korea Research Foundation Grant funded by the Korean Government (KRF-2009-32A-B00203). ∗ Corresponding author. http://dx.doi.org/10.1016/j.chiabu.2014.03.005 0145-2134/© 2014 Elsevier Ltd. All rights reserved.

Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model CHIABU-2750; No. of Pages 10

2

ARTICLE IN PRESS J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

initial priority of Gongbubang was to assist children with their school work for better grades, and to prepare them for post-secondary education, which will ensure job and economic security. Volunteers of Gongbubang discovered that many of these children were exposed to on-going child maltreatment, domestic violence and alcoholism. Therefore the priority shifted from assisting children with school work to child protection and basic care (H. Kim, 2010; Kim, 2013; K. Kim, 2010; Lee et al., 2009). The Korean government gradually began to recognize the need for child protection and care in the economically deprived neighborhoods. In 2004, the government made amendments in child welfare policies and the child welfare law, and subsequently legalized Gongbubang as Community Child Centers (CCCs), providing social and financial support. CCCs have now extended child welfare services (i.e., day and night care after school, providing free meals and child protection) to children under single-parent and grand-parents’ care, and children with both parents working (H. Kim, 2010; Kim, 2013; Lee et al., 2009). The majority of children who attend the local CCCs are from low-income, working families below middle class. All participating children in this study have attended local CCCs after school in Jeollabukdo. Due to strong Confucian values of education, it is common for Korean children to attend extra-curricular activities after school that local CCCs tend to provide. (i.e., English, math, arts, etc.), and help children with their homework. Under the influence of Confucianism, Korean culture has a steady hierarchical order in the family and places high value on family fealty (Chang, Rhee, & Weaver, 2006; Lee & Kim, 2007, 2009; Park, 2001). Although parental dedication to one’s children is a common feature in child rearing, corporal punishment is viewed as a necessary way to educate children by some parents. In some cases, this provides the rationalization of physical abuse (Ju & Lee, 2010; Kim, 2013; Lee & S. Kim, 2005, Lee & K. Kim, 2007; Park, 2001). Within that culture, child abuse that occurs within the home environment has been difficult to recognize, or intervene (Ju & Lee, 2010; Kim, 2009; H. Kim, 2010; Kim, 2013; K. Kim, 2010; Park, 2001). Social recognition and help for the abused children tend to readily focus on severe types of child maltreatment such as sexual and severe physical abuse that needs immediate medical attention. Incidents of other types of child maltreatment such as relatively less severe types of maltreatment – neglect, emotional and physical abuse within the home environment are easily regarded as a private family matter, leaving the children without support, or appropriate intervention (Ju & Lee, 2010; Kim, 2013; Lee & Kim, 2007). Therefore, the study primarily deals with three types of child maltreatment (physical, emotional abuse and neglect) that happen within some families in Jeollabukdo, Korea. A substantial body of studies have indicated a strong association of poverty with child maltreatment (Coulton, Korbin, & Su, 1999; Drake & Pandey, 1996; Gelles, 1992; Gillham et al., 1998; Ju & Lee, 2010; Lee and Kim, 2007, 2009). Kim and Ko (1990) reported higher incidents of severe physical abuse in the students from the impoverished areas than the students from affluent areas. Kim (1995) determined that the mother’s employment in low income families often led to child neglect since child caring has generally been regarded as the mother’s responsibility in Korea. Lee and Kim (2005) investigated the role of neighborhood poverty on child maltreatment. They found poorer neighborhoods with higher rates of government income support had higher divorce rates and higher substantiated child maltreatment rates than neighborhoods without such conditions. Previous studies conducted in the last two decades attributed the significant risk factors for child maltreatment to the social-economic aspects such as persisting economic hardship affecting the level of family poverty (the increasing number of people below the poverty line) and family life (the rising divorce rate, single-parenthood, family violence and family dissolution) (Ju & Lee, 2010; D. Kim, 1995; K. Kim, 2009, 2010; Lee & S. Kim, 2005; Lee & K. Kim, 2007, 2009; Lee et al., 2009). Several authors of these studies explained the relationship between poverty and child maltreatment based on two major theories. According to human capital theory, impoverished parents do not have enough resources for appropriate child care and protection, leaving their children at higher risk of child maltreatment than the children who are not poor. Moreover, economic stress in family life often leads the family to be in discord among their members and distressed parents are more likely to employ stricter or harsher measures in child rearing, which may develop into child maltreatment (family process model). There have been accumulating studies investigating the effects of child maltreatment, especially by state run studies (Korean Association for the Prevention of Child Abuse and Neglect, 2000; Korean Ministry of Health and Welfare, 2000, 2010). These studies have confirmed that developmentally adverse effects of poverty and child abuse on children tend to increase according to the severity, length of exposure, and the age of the child: abused children tend to display internalized (depressive, anxious, withdrawn behaviors) and externalized behavioral problems (aggressive and delinquent behaviors). Kim (2009) investigated effects of different types of child abuse on children that the co-occurrence of emotional abuse with other types of abuses was found to be most damaging to the children while effects of physical abuse alone was relatively less damaging. Ju and Lee (2010) also found numerous cases of co-occurrences in physical and emotional abuse with severe neglect among 357 severely abused children placed in child protective care. Many of these children were from low income working families. Previous research has pointed out the strong correlation between adverse childhood experiences to later adult mental health problems. (Afifi, Brownridge, Cox, & Sareen, 2006; Kim, 2009; Korean Association for the Prevention of Child Abuse and Neglect, 2000; Korean Ministry of Health and Welfare, 2000, 2010; Lee & Kim, 2011; Van der Kolk, 2005). As mentioned before, many parents in South Korea routinely send their children to extra-curricular classes after school despite the heavy financial burden. Piano lesson is one of the most popular extra-curricular activities in South Korea. There have been many studies indicating active involvement with music, such as how piano lessons in childhood have longlasting positive effects for the developing mind and brain of the individuals throughout their life-time (Costa-Giomi, 2004; Hallam, 2010; Hogan & Huesman, 2008; Schellenberg, 2006; Wetter, Koerner, & Schwaninger, 2009). Dunbar, Kaskatis, MacDonald, and Barra (2012) discovered active involvement with the music-making process such as drumming, singing, and dancing to music, which trigger an endorphin release resulting in elevated positive affects where mere music listening Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model CHIABU-2750; No. of Pages 10

ARTICLE IN PRESS J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

3

does not. They claim that active involvement of music-making enhances social and community bonding, and discusses the mechanisms of community bonding through music-making While these studies discussed mainly positive effects of music, there has been public concern on a causative relationship between certain genres of music such as pop, heavy metal and rock with aggressive behaviors, suicidal thoughts, and poor mental health (Baker & Bor, 2008; North & Hargreaves, 2005; Scheel & Westerfeld, 1999). Listening to pop music is often the favorite indoor activity chosen by children and adolescents in South Korea. Therefore, it will be relevant to investigate musical experiences and preferences, and their effects on the developmental aspects of children in this study. This is the first part of a larger longitudinal study focusing on effects of music therapy on children with ongoing childhood adversities. Since the 1990s, there have been some studies advocating positive effects of music therapy on children and adolescents with histories of child abuse (Coulter, 2000; Kim, 2013; Lindberg, 1995; Pavlicevic, 1994; Rogers, 1995). The findings of these music and music therapy studies may have significant clinical implications for children with a history of childhood adversities. To the present knowledge of the authors, there has been no systematic investigation on behavioral and musical characteristics of the children who have experienced both child maltreatment and poverty in South Korea, nor elsewhere. The purpose of this preliminary investigation is to identify children who have been exposed to child maltreatment and poverty, and to discover their musical and behavioral characteristics as well as their potential needs for therapeutic intervention. In this study, child maltreatment is defined according to recent Article 2 of the Korean Child Welfare Law, as violence against children including physical, emotional abuse, and neglect by adults. As sexual abuse was beyond the scope of this study, sexual abuse was not included. Methods Ethical approval was obtained from the Human Research Ethics Board at Jeonju University, South Korea, and was registered with the Current Controlled Trials. Informed consents were obtained from the primary care giver (parents, or grandparents) and that of assents from children who attended the local CCCs, South Korea. Participants We advertised a three-year music therapy project on child abuse and poverty to 200 local Community Child Centers (CCCs) in Jeollabukdo. Some CCCs (13) responded with enthusiastic interest and began to participate in this study. After obtaining informed institutional consent from the local CCCs, we recruited primary school children between the ages of seven to 12 from these local CCC (N = 302). The majority of children who participated in this study were from low income families below middle class. Measures A survey was administered using both standardized and non-standardized tools completed by the children and the teachers from the CCC during March–April, 2010. The Self Esteem Scale. The SES is a self-report scale consisting of a four-point Likert scale (Rosenberg, 1965). The higher scores refer to a better self-esteem and it was completed by the children. The Child Behavior Checklist. The Korean version of the CBCL (Oh, Ha, Lee, & Hong, 2007; Achenbach, 1991) is an informantbased three-point Likert-type scale. In this study, two forms of the CBCL were used: Teacher Report Forms completed by the teachers from the CCC, and Youth Self-Reports (YSR) completed by the children. The CBCL is designed to investigate emotional and behavioral problems in both children and adolescents. This study employed five sub-scales that were relevant for the children who were exposed to dual adversities (poverty and child abuse): depressed/anxious, withdrawn, attention problems, aggressive and delinquent behavior subscales. The higher scores represent more problems. Child Abuse Screening Checklist. A self-report type of child abuse checklist was used to identify children who have experienced abuse and neglect at home. The Conflict Tactic Scale (Straus, 1979) was amended in line with needs of the Korean society and culture. A final version of the child abuse screening checklist was developed by the Korean Institute of Social Health (Kim et al., 2003). It consists of three sub-scales: Physical, emotional abuse, and neglect. The physical abuse questionnaire consists of items such as ‘I was kicked, and/or bitten, and/or punched with fists by a parent’. The emotional abuse includes items like ‘I was scolded by a parent till I felt ashamed,’ while the neglect questionnaire contained statements like ‘my parents leave me alone till it gets dark’. Each sub-scale consists of a five-point Likert scale (0 = never, 1 = once or twice a year, 2 = every two to three months, 3 = every month, 4 = every week). For the purpose of statistical analyses, all frequencies of child maltreatment (from once a year up to every week) were defined as child abuse. In this study, child maltreatment and abuse will be used interchangeably as an inclusive term for physical, emotional abuse, and neglect. Poverty Screening. An income-to-needs ratio was calculated based on the minimum living costs defined by the Ministry for Health, Welfare and Family Affairs of the Korean government. In this study, children from families below the poverty line are purposefully targeted. When the household’s mean monthly income is less than the minimum living costs (incometo-needs ratio < 1) with no other resources, the families are on government income support for basic living. In this study, poverty is defined by the income-to-needs ratio and the fact that the family is on government income support. Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model

ARTICLE IN PRESS

CHIABU-2750; No. of Pages 10

J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

4

Musical Questionnaires. Children were asked about their favorite music genre, whether they listen to any music (mostly songs) when they feel bad, instruments they can play, extracurricular music lessons after school, and previous experiences of arts therapies (music, art, dance and movement therapy). Data Analyses Data was analyzed using the SPSS 19.0. Cronbach’s alpha was used to determine the reliability of each measure. Overall, the teacher’s measures ranged from .78 up to .93 and the children’s measures from .63 up to .85 indicating that all measures were either acceptable or reliable (Nunnally, 1978). The homogeneity test was calculated using Chi-square/Fisher’s exact tests and the Analysis of Variance (ANOVA) in order to determine clinically relevant differences among three groups of children regarding demographic information (Table 1). The ANOVA was employed to learn the effects of childhood adversities on children’s behavioral problems. Scheffe’s Post Hoc test was conducted in order to detect the differences among three groups of children (Tables 2–4). An independent t-test was applied in order to investigate whether different musical experiences produced differences in children’s behavioral problems and their self-esteem (Table 5). Results Demographic Statistics on Children with or without Childhood Adversities Table 1 shows the analysis of the pooled scores regarding demographic information. In this table, analyses were done in four groups: all children who participated (n = 302), children without abuse and poverty experience (n = 126), children Table 1 Demographic statistics on children with or without childhood adversities. Variable

Total

NA (n = 126)

AO (n = 22)

DA (n = 149)

Gender

11.180** 151(50.8) 146(49.2) 9.31 ± 1.78 41.60 ± 5.65 38.38 ± 5.58

53(42.1) 73(57.9) 9.43 ± 1.71 41.32 ± 5.09 38.38 ± 5.29

8(36.4) 14(63.6) 9.33 ± 1.83 41.00 ± 5.32 37.56 ± 3.54

90(60.4) 59(39.6) 9.20 ± 1.84 41.94 ± 6.15 38.53 ± 6.12

Married Divorced Separated Died Other

148(60.7) 59(24.2) 17(7.0) 9(3.7) 11(4.5)

62(62.0) 19(19.0) 9(9.0) 5(5.0) 5(5.0)

14(62.0) 3(15.8) 1(5.3) 1(5.3) 0(0.0)

72(57.6) 37(29.6) 7(5.6) 3(2.4) 6(4.8)

Korean pop Children’s Drama/Movie Classic Korean Folk Western pop Commercial Church

187(67.8) 50(18.1) 19(6.9) 9(3.3) 4(1.4) 2(0.7) 2(0.7) 3(1.1)

75(64.1) 24(20.5) 7(6.0) 5(4.3) 3(2.6) 1(0.9)

14(66.7) 3(14.3) 2(9.5) 1(4.8)

98(71.0) 23(16.1) 10(7.2) 3(2.2) 1(0.7) 1(0.7) 2(1.4)

2(1.7)

1(4.8)

No Yes

222(75.0) 74(25.0)

98(77.8) 28(22.2)

17(77.3) 5(22.7)

108(72.5) 41(27.5)

Yes No

153(51.9) 142(48.1)

65(51.6) 61(48.4)

17(77.3) 5(22.7)

71(48.0) 77(52.0)

Yes No

50(16.9) 245(83.1)

18(14.4) 107(85.6)

6(27.3) 16(72.7)

26(17.6) 122(82.4)

Piano Guitar Violin Others

160(64.5) 20(8.1) 31(12.5) 121(48.8)

72(66.7) 7(6.5) 18(16.7) 51(47.2)

13(65.0) 2(10.0) 2(10.0) 8(40.0)

75(62.5) 11(9.2) 11(9.2) 62(51.7)

Low High

198(66.7) 99(33.3)

76(60.3) 50(39.7)

13(59.1) 9(40.9)

109(73.2) 40(26.8)

Male Female Child age Father age Mother age Marital status

Favorite Music genre

2 /F

.565 .316 .201 6.634†

11.923†

Song to listen to when feeling bad

1.156

Music lessons

6.588*

*Arts Therapies

2.283

Ability to play instruments

5.266

Academic achievement

5.676

2 /Fisher exact (†) tests: N (%); ANOVA for age – mean and standard deviation (±); NA = children with no abuse and poverty experience; AO = children with abuse experience only; DA = children with double childhood adversities (abuse and poverty).

Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model

ARTICLE IN PRESS

CHIABU-2750; No. of Pages 10

J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

5

Table 2 Group differences in childhood adversities and behavioral characteristics. Childhood adversities and behavioral problems

Self-esteem Teacher Dep/Anx Attention Withdrawn Delinquent Aggressive Child Dep/Anx Attention Withdrawn Delinquent Aggressive

NA

AO

DA

28.29 ± 5.70

27.45 ± 5.12

28.11 ± 5.06

F .231

15.96 14.54 11.63 13.15 23.78

± ± ± ± ±

3.83 4.07 3.19 2.11 6.43

15.86 13.59 11.18 13.18 23.05

± ± ± ± ±

3.30 2.91 1.92 2.02 4.75

16.49 15.26 11.94 13.59 25.32

± ± ± ± ±

4.50 4.14 3.30 2.53 7.35

.633 2.185 .691 1.310 2.263

17.60 14.63 11.64 13.55 22.87

± ± ± ± ±

4.03b 4.08b 3.17b 2.05b 4.43b

18.50 16.00 12.68 14.32 24.33

± ± ± ± ±

4.75ab 3.60ab 2.48ab 1.91ab 3.97ab

19.84 16.56 13.32 14.55 26.53

± ± ± ± ±

5.32a 3.88a 3.49a 2.32a 5.74a

7.586** 8.162*** 8.818*** 7.224** 17.616***

a,b: Scheffe’s Post Hoc test; NA = children with no abuse and poverty experience; AO = children with abuse experience only; DA = children with double childhood adversities (abuse and poverty). ** p < .01. *** p < .001. Table 3 Co-occurrence of different types of abuse and its effects. Single Dep/Anx Attention Withdrawn Delinquent Aggressive

18.92 15.85 12.69 14.31 25.73

± ± ± ± ±

4.99b 3.44b 2.82b 2.17 5.23b

Double 18.82 15.96 12.87 14.45 25.51

± ± ± ± ±

4.11b 3.83b 3.29b 2.07 4.77b

Triple 24.00 19.63 15.78 15.33 29.52

± ± ± ± ±

6.29a 4.53a 4.14a 2.83 7.16a

F 11.773*** 12.164*** 10.144*** 2.147 5.797**

Scheffe’s Post-Hoc test: there is no significant difference where same letters were presented in the same line (=.05). Single: One type of abuse; Double: co-occurrence of two types of abuse; Triple: co-occurrence of three types of abuse (neglect, physical, and emotional abuse). ** p < .01. *** p < .001.

who experienced abuse only (n = 22), and children who experienced abuse and poverty (n = 149). Almost two thirds of the children were from families below the poverty line (n = 202). There were no significant differences among different groups of children regarding demographic information and music questionnaires, except for gender (p < .01) and extracurricular music lessons (p < .05). The majority of those who experienced both abuse and poverty were male (60.4%). About half (51.9%) of total 302 children had extracurricular music lessons, while 77.3% of children who were abused, but not poor had music lessons. The parents of the children who experienced child abuse and poverty had the highest divorce rate (29.6%), though not statistically significant. Although statistically not significant, these are the general findings of the music related questionnaires: the children’s favorite music genre was as follows: Korean pop song (67.8%); children’s songs including animation (18.1%); drama/movie music (6.9%); classic (3.3%), etc. When being asked whether they listen to music when they feel bad, the children who experienced both abuse and poverty appeared to listen to music somewhat more (27.5%) than the other two groups of children (22.2% ∼22.7%). Children who experienced abuse only had the highest rate (27.3%) in previous experiences of arts therapies. Academic achievement at school almost reached a significance (p = .059). Children who experienced both abuse and poverty had a much lower school achievement than the other two groups of children. Group Differences in Childhood Adversities and Behavioral Characteristics Table 2 shows an analysis of the pooled scores (means and standard deviations) made by the teachers and the children on both internalized and externalized problems, and the children’s self-esteem in three groups of children. The results of the ANOVAs indicated that the children who were exposed to abuse and poverty scored higher in internalizing and externalizing problems, indicating these children were markedly more depressed and anxious (p < .01), more withdrawn (p < .001), had more attention problems (p < .001), more aggressive (p < .001) and more delinquent (p < .01) than the children who did not have such adversity, or who were not poor. The teacher’s results were quite similar though it did not reach significance. Co-occurrence of Different Types of Abuse and its Effects Effects of co-occurrence in different types of abuse on children using the YSR were conducted. The results of the ANOVAs indicated that there were significant differences between the children who experienced three types of abuses (i.e., neglect, Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model CHIABU-2750; No. of Pages 10

ARTICLE IN PRESS J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

6

Table 4 Differences in severity of abuse experience and its effect. Mild P

E

N

Teacher Dep/Anx Attention Withdrawn Delinquent Aggressive Child Dep/Anx Attention Withdrawn Delinquent Aggressive Teacher Dep/Anx Attention Withdrawn Delinquent Aggressive Child Dep/Anx Attention Withdrawn Delinquent Aggressive Teacher Dep/Anx Attention Withdrawn Delinquent Aggressive Child Dep/Anx Attention Withdrawn Delinquent Aggressive

Moderate

Severe

F

16.16 14.13 11.94 13.16 24.13

± ± ± ± ±

3.42 3.58b 3.26 2.19 5.96

17.68 15.61 12.71 14.10 25.48

± ± ± ± ±

5.83 3.77ab 3.33 3.31 8.37

17.38 18.25 11.29 14.38 27.75

± ± ± ± ±

4.93 4.40a 1.25 3.58 10.38

.832 4.072* .803 1.079 .783

18.97 15.03 13.16 13.84 25.63

± ± ± ± ±

4.31b 2.95b 2.70 1.78b 4.08

21.10 17.78 14.22 14.97 26.09

± ± ± ± ±

6.12ab 4.43b 4.16 2.38ab 6.37

25.63 20.13 15.88 16.25 31.13

± ± ± ± ±

7.39a 5.33a 3.83 3.65a 8.66

4.813* 7.024** 2.074 4.180* 3.011

17.09 14.88 12.00 13.50 25.38

± ± ± ± ±

5.00 4.67 3.33 2.85 8.12

18.88 16.00 12.50 14.52 27.44

± ± ± ± ±

6.77 4.02 3.71 3.22 8.81

17.50 15.79 11.78 13.55 26.60

± ± ± ± ±

4.02 3.55 2.44 2.31 7.29

.795 .574 .281 1.043 .461

19.00 16.81 13.09 14.06 26.19

± ± ± ± ±

4.20b 4.02 3.46 1.98b 5.61

23.17 18.84 15.20 15.80 28.56

± ± ± ± ±

6.15a 4.03 4.60 2.48a 6.47

22.70 18.25 14.50 15.05 28.50

± ± ± ± ±

6.34a 4.51 3.61 2.76a 7.52

4.887* 1.802 2.160 3.846* 1.213

15.87 15.15 12.00 12.98 24.54

± ± ± ± ±

4.26 4.37 3.32 1.46b 6.75

16.36 14.97 11.81 13.81 24.97

± ± ± ± ±

4.81 3.97 3.25 2.47ab 7.08

18.06 17.17 12.06 14.67 27.17

± ± ± ± ±

4.90 4.36 3.25 4.23a 9.64

1.523 1.995 .065 3.621* .882

18.59 16.11 12.33 14.04 25.89

± ± ± ± ±

3.92b 3.17b 2.31b 1.85b 5.19

19.57 16.29 13.42 14.68 26.14

± ± ± ± ±

5.43ab 4.27b 4.06ab 2.41ab 5.58

22.59 18.94 15.17 15.78 28.94

± ± ± ± ±

6.74a 3.83a 3.47a 2.65a 6.17

4.037* 4.087* 5.010** 4.242* 2.223

P: physical abuse, E: emotional abuse, N: neglect. * p < .05. ** p < .01. *** p < .001.

physical and emotional abuse) and the children who experienced one or two types of abuse, indicating children who were exposed to the multiple type of abuses were markedly more depressed, anxious, withdrawn, aggressive, and had more attention problems than children with one or two types of abuse experiences. Differences in Severity of Abuse Experience and its Effect According to children’s rating, the results of the ANOVA indicated that children who were exposed to severe physical abuse were more depressed and anxious (p < .05), delinquent (p < .05) and had more attention problems (p < .01); to severe neglect, more depressed and anxious (p < .05), withdrawn (p < .01), delinquent (p < .05) and attention problem (p < .05) than children who were exposed to mild and moderate abuse experiences. For emotional abuse, behavioral problems of the children were more pronounced by moderate abuse than severe and mild abuses, particularly for depressive and anxious, and delinquent behavior (p < .05). The rest of the results showed similar clinical tendencies that severe exposure to physical abuse and neglect seemed to produce more marked externalized and internalized behavioral problems, while moderate exposure to emotional abuse, showed more marked behavioral problems, although not statistically significant. In general, the independence t-test indicated that there were significant differences between teachers’ and children’s ratings (p < .01) in almost every scale (except aggressive behavior) where children’s ratings were higher (more problems) than teachers’ ratings. Music and Arts Related Experiences and Behavioral Characteristics of the Children Exposed to Abuse and Poverty We investigated whether certain musical (music lessons, playing instruments, and music listening) and arts therapy experiences (music, art, dance and movement therapy) had any impact on the behavior of the children who were exposed Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model

ARTICLE IN PRESS

CHIABU-2750; No. of Pages 10

J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

7

Table 5 Music and arts related experiences and behavioral characteristics of the children exposed to child abuse and poverty. Ability to play musical instruments

Self-esteem Teacher Dep/anx Attention Withdrawn Delinquent Aggressive Child Dep/anx Attention Withdrawn Delinquent Aggressive

Songs to listen when feeling bad

Yes

No

t

Yes

No

29.23 ± 5.52

27.89 ± 4.96

1.242

28.49 ± 5.64

27.98 ± 4.86

15.54 14.35 11.46 12.50 22.08

± ± ± ± ±

2.53 2.23 2.83 0.76 3.77

16.64 15.39 12.02 13.84 25.99

± ± ± ± ±

4.78 4.39 3.40 2.72 7.77

−1.743 −1.867 −.812 −4.621*** −3.865***

15.90 14.39 11.03 13.88 26.34

± ± ± ± ±

3.48 3.38 2.71 2.91 7.83

16.64 15.52 12.25 13.50 24.91

± ± ± ± ±

4.80 4.32 3.45 2.38 7.19

−.896 −1.508 −2.226* .810 1.060

21.15 17.35 14.85 15.12 27.35

± ± ± ± ±

5.50 4.60 3.96 2.52 6.39

19.53 16.39 12.97 14.43 26.39

± ± ± ± ±

5.27 3.73 3.31 2.28 5.61

1.388 .989 2.231 1.369 .797

20.83 16.66 13.56 14.71 27.37

± ± ± ± ±

5.41 4.02 3.61 2.19 6.24

19.42 16.52 13.20 14.49 26.25

± ± ± ± ±

5.27 3.86 3.46 2.39 5.54

1.442 .194 .567 .516 1.055

Music lessons

Self-esteem Teacher Dep/anx Attention Withdrawn Delinquent Aggressive Child Dep/anx Attention withdrawn Delinquent Aggressive

t .507

Previous experience in arts therapies

Yes

No

28.97 ± 5.60

27.23 ± 4.33

t 2.099*

Yes

No

t

29.23 ± 5.52

27.88 ± 4.94

1.242

16.51 14.60 11.49 13.33 25.23

± ± ± ± ±

4.54 3.49 3.09 2.14 7.17

16.49 15.88 12.36 13.86 25.48

± ± ± ± ±

4.52 4.62 3.47 2.84 7.58

.027 −1.902 −1.589 −1.265 −.210

15.54 14.35 11.46 12.50 22.08

± ± ± ± ±

2.53 2.23 2.83 0.76 3.77

16.69 15.45 12.04 13.83 26.01

± ± ± ± ±

4.80 4.42 3.40 2.71 7.74

−1.743 −1.867 −.812 −4.621*** −3.865***

20.27 16.87 13.86 14.35 26.58

± ± ± ± ±

5.73 4.34 3.58 2.13 6.27

19.47 16.23 12.84 14.74 26.49

± ± ± ± ±

4.95 3.43 3.36 2.50 5.28

.902 .994 1.778 −1.012 .088

19.56 16.39 12.99 14.43 26.36

± ± ± ± ±

5.26 3.71 3.31 2.27 5.60

21.15 17.35 14.85 15.12 27.35

± ± ± ± ±

5.50 4.60 3.96 2.25 6.39

−1.388 −.989 −2.231* −1.280 −.731

* p < .05. ** p < .01. *** p < .001.

to childhood adversities. The results of the independence t-test indicated that children who can play musical instruments appeared to the teachers to be less delinquent and less aggressive than children who cannot play musical instruments. The children who listened to music when they felt bad appeared to the teachers to be less withdrawn than the children who did not listen to music (p < .05). The children who had music lessons had higher self-esteem than the children who did not (p < .05). Regarding previous experiences in arts therapies, the children who had previous arts therapy experiences had higher self-esteem and lower mean scores in all CBCL and YSR sub-scales, particularly delinquent and aggressive scales by the teachers’ measures (p < .001), and withdrawn scales by the children (p < .05) indicating certain clinical tendencies of arts therapies on children’s internalized and externalized behavior, although some scales are not significant. Regarding musical experiences (ability to play instruments, songs to listen to when feeling bad, music lessons), the results of children’s and teachers’ ratings were slightly contradictory to each other, even though most results did not reach significance. While the teacher’s mean scores indicated that children who had musical experiences scored lower in almost every scale (except a few) than the children who did not have such experiences, the children’s mean scores indicated otherwise. Discussion The first goal of the study was to identify children who were exposed to abuse and poverty, and these effects on the children. As would be expected, the results of the YSR (children’s ratings) have indicated that the children who experienced both abuse and poverty were markedly more depressed and anxious, withdrawn, aggressive, delinquent and reported more attention problems than the children who did not experience such adversities, or at least who were not poor. The mean scores of the CBCL (teachers’ rating) indicated analogous tendencies with the YSR although statistically not significant. The results were consistent with previous findings (Korean Association for the Prevention of Child Abuse and Neglect, 2000; Korean Ministry of Health and Welfare, 2000, 2010). Further analyses revealed that when multiple abuses (neglect, physical and emotional) co-occurred, the children were at a highest risk of having emotional and behavioral problems, except for the delinquent behavior. For neglect and physical abuse, severely abused children were more depressed and anxious, delinquent, and had more attention problems than less severely abused children. The results are consistent with previous studies, which found that physical abuse often co-occurred Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model CHIABU-2750; No. of Pages 10

8

ARTICLE IN PRESS J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

with emotional abuse and neglect (Ju & Lee, 2010; Korean Association for the Prevention of Child Abuse and Neglect, 2000; Korean Ministry of Health and Welfare, 2000, 2010), and problems were greater when different types of abuse were inflicted alongside emotional abuse on children (Kim, 2009). What is unexpected was the effects of moderate emotional abuse. Moderate emotional abuse produced the highest mean scores of all the scales, especially higher depressive and anxious, and delinquent behavior ratings by the children, indicating moderate emotional abuse produced more depressed and anxious, and delinquent behavior than severe and mild emotional abuse. How would a child respond to a prolonged verbal and emotional mistreatment that happens every so often? What happens if a child becomes accustomed to severe emotional abuse in everyday life? I wonder whether the moderate emotional abuse is a kind of threshold for a child that if the emotional abuse is over that threshold (severe), the child becomes less able to react since severe emotional abuse becomes a part of one’s life. In this study, all children lived either with their own parent(s), or their grandparent(s), and most offenders were the children’s primary caregivers at home. There have been strong debates whether less severe forms of physical punishment, emotional abuse, and neglect are to be considered as child maltreatment in the cultural context of South Korea. For example, corporal punishment by the parents, or leaving primary school children at home without adult supervision until it becomes dark, is often regarded as a private family matter, perhaps harsh, but not abusive. However, in this study, these acts were counted as maltreatment in accordance with the U.N. definition of the Rights of The Child (United Nation, 2011) and recent Article 2 of the Korean Child Welfare Law. Many abused children in Korea tend to attribute the cause of abuse to themselves (Ju & Lee, 2010; Kim, 2009; Korean Association for the Prevention of Child Abuse and Neglect, 2000; Korean Ministry of Health and Welfare, 2000). Lee and Kim (2011) pointed out that such cultural acceptance and tolerance of abusive acts by the primary caregivers at home may have influenced children to not remember the events. Therefore, a cultural context should be taken into account when interpreting such results. There was a lack of significant group differences (children without adversities; abused children; poor and abused children) regarding demographic information. This might be due to the fact that the study was conducted through local CCCs in the economically deprived areas of Jeollabukdo, South Korea. Most children were from below middle class, which is generally considered as poor compared to the general public in South Korea, although only two third (n = 202) of the children were identified as coming from families below the poverty line. Therefore, a future study should include children outside the deprived areas in order to compare poor children with children from middle class families. The majority of the children who were exposed to abuse and poverty were male (60.4%) while there was not much difference in boy and girl ratios (50.8: 49.2) among total participants. Previous studies in South Korea (Kim, 2009; Lee & Kim, 2011) reported that males were more subjected to physical abuse, while females emotional and sexual abuse. It would have been relevant to find out effects of gender differences in child abuse and poverty, however it was beyond the scope of this study. The results on the preferred music genre of children will be useful when planning effective treatment programs for music therapy. Children’s most preferred music genre was Korean pop music followed by children’s songs, and drama/movie music. It is also understandable that poor and abused children had fewer opportunities for music lessons compared to other groups of children. The effects of music and arts therapy related experiences on the behavior of the children who were exposed to abuse and poverty were analyzed, which may be clinically relevant for the professionals working with this population. The results of teachers’ ratings indicated that children who played instruments and had arts therapies, displayed less externalized behavioral problems (aggressive and delinquent behavior); children who listened to songs when feeling bad, were less withdrawn than children who did not have such experiences. Music can evoke a great range of intense emotion (Baker & Bor, 2008; North & Hargreaves, 2005; Scheel & Westerfeld, 1999). As Korean pop music is very popular among primary school children in Korea, listening to favorite songs may have provided a means for self-expression and exploration of wide range of emotions otherwise difficult to express and explore for these children. This may be the reason why the children who listened to songs when feeling bad appeared to be less withdrawn. Dunbar et al. (2012) claimed that playing music appeared to produce positive affects with ready endorphin release, and also enhances social bonding between players, creating a sense of community, which may have buffering effects on children’s externalized behavioral problems. Although statistically not significant, there was a conspicuous clinical tendency in the mean scores of the teachers’ and children’s ratings regarding musical experiences (ability to play instruments, songs to listen to when feeling bad, music lessons). While teachers’ mean scores indicated that children with musical experiences scored lower in almost every scale (except a few) than the children did not have such experiences, the children’s mean scores indicated otherwise. When considering the general effects of musical experiences as discussed above, it would not be difficult to understand. The children with more musical experiences may have had more chances of expressing and exploring their own feelings that they might be more in touch with their feelings, and therefore more able to express negative feelings associated with abuse experiences since music is highly related with emotional responses, and emotional self-expression. Kim (2013) also reported that some abused children were less able to recognize negative aspects of their feeling states during the pre-test period, but more able to report their feeling state after the completion of music therapy, resulting in worsening behavioral problems at the post-test period, whereas teachers’ report indicated exactly the opposite direction. Musical experiences routinely involve emotional expression, emotional release, emotional communication and social bonding, which may have either channeling or sublimating effects on the negative feelings associated with childhood adversities (Lindberg, 1995; Pavlicevic, 1994; Rogers, 1995; Kim, 2013). Therefore, the teachers may report less behavioral problems on children with musical

Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model CHIABU-2750; No. of Pages 10

ARTICLE IN PRESS J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

9

experiences than children without such experiences. Kim (2013) and Lindberg (1995) also reported similar situation in their study. As this survey utilized both self-reporting and informant-based rating scales, the possibility of a personal bias could be the limitation of this study. Therefore it might also be premature to establish causal relations between predictors and outcomes based on survey data. The cultural context as discussed earlier should be carefully considered when interpreting the results. Community-based intervention, working closely with child social services, schools and parents will be needed in the future. As this is a preliminary survey, it is not certain whether the findings are generalizable to other children in similar situations. Therefore further investigation is needed. Acknowledgments I thank children, their families, and the teachers at the local CCC. References Achenbach, T. M. (1991). Integrative guide to the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington, VT: University of Vermont, Department of Psychology. Afifi, T. C., Brownridge, D. A., Cox, B. J., & Sareen, J. (2006). Physical punishment, childhood abuse and psychiatric disorders. Child Abuse & Neglect, 30, 1093–1103. http://dx.doi.org/10.1016/j.chiabu.2006.04.006 Baker, F., & Bor, W. (2008). Can music preference indicate mental health status in young people? Australian Journal of Psychiatry, 16(4), 284–288. Chang, J., Rhee, S., & Weaver, D. (2006). Characteristics of child abuse in immigrant Korean families and correlates of placement decisions. Child Abuse & Neglect, 30, 881–891. http://dx.doi.org/10.1016/j.chiabu.2006.03.002 Costa-Giomi, E. (2004). Effects of three years of piano instruction on children’s academic achievement, school performance and self-esteem. Psychology of Music, 32(2), 139–152. Coulter, S. J. (2000). Effect of Song Writing Versus Recreational Music on Posttraumatic Stress Disorder (PTSD) symptoms and abuse attribution in abused children. Journal of Poetry Therapy, 13(4), 89–208. Coulton, C., Korbin, J. E., & Su, M. (1999). Neighbourhoods and child maltreatment: A multi-level study. Child Abuse & Neglect, 23(11), 1019–1040. http://dx.doi.org/10.1016/S0145-2134(99)00076-9 Drake, S., & Pandey, S. (1996). Understanding the relationship between neighbourhood poverty and specific types of child maltreatment. Child Abuse & Neglect, 20(1), 1003–1018. http://dx.doi.org/10.1016/0145-2134(96)00091-9 Dunbar, R. I., Kaskatis, K., MacDonald, I., & Barra, V. (2012). Performance of music elevates pain threshold and positive affect: Implications for the evolutionary function of music. Evolutionary Psychology, 10(4), 688–702. Retrieved from www.epjournal.net/wp-content/uploads/EP10688702.pdf Gelles, R. (1992). Poverty and violence towards children. American Behavioral Scientist, 35(3), 258–274. Retrieved from http://abs.sagepub.com/content/35/3/258.full.pdf+html Gillham, B., Tanner, G., Cheyne, B., Freeman, I., Rooney, M., & Lambie, A. (1998). Unemployment rates, single parent density, and indices of child poverty: Their relationship to different categories of child abuse and neglect. Child Abuse & Neglect, 22(2), 79–90. http://dx.doi.org/10.1016/S0145-2134(97)00134-8 Hallam, S. (2010). The power of music: Its impact on the intellectual, social and personal development of children and young people. International Journal of Music Education, 28(3), 269–289. Retrieved from http://ijm.sagepub.com/content/28/3/269.full.pdf+html Hogan, D. E., & Huesman, T. (2008). Music training and semantic clustering in college students. Journal of Genetic Psychology, 169(4), 322–331. http://dx.doi.org/10.3200/GNTP.169.4.322-331 Kim, H. (2010). Effects of social support to school adjustment of the poor children in using community child centers. Korean Journal of Youth Studies, 17(2), 211–233. Ju, S., & Lee, Y. (2010). Experiences of family maltreatment by Korean children in Korean National Protective Services. Child Abuse & Neglect, 34, 18–27. http://dx.doi.org/10.1016/j.chiabu.2009.09.009 Kim, D. (1995). Pre-school teacher’s perception on child abuse and neglect in poor neighbourhood. In Paper presented at the child abuse and neglect seminar Korean Association for the Prevention of Child Abuse and Neglect, Seoul. Kim, J. (2013). Music therapy with children who have been exposed to ongoing child abuse and poverty: A pilot study. Nordic Journal of Music Therapy (in press). http://dx.doi.org/10.1080/08098131.2013.872696 Kim, K. (2009). Effects of child abuse and neglect on child development. Korean Journal of Social Sciences, 24(2), 27–46. Kim, K. (2010). Effects of poverty on children’s levels of anxiety and depression according to the duration and severity of poverty. Korean Journal of National Youth, 21(1), 1–20. Retrieved from http://www.nypi.re.kr/paper/aidsView.np?y idx=599 Kim, K., & Ko, B. (1990). An incidence survey of battered children in two elementary schools of Seoul. Child Abuse & Neglect, 14, 273–276. http://dx.doi.org/10.1016/0145-2134(90)90038-U Kim, S., Lee, J., Kim, H., Lee, H., Jang, H., Song, S., Lee, K., & Yoon, Y. (2003). The Development and Research on Child abuse screening checklist. Seoul: The Korean Institute of Social Health. Korean Association for the Prevention of Child Abuse and Neglect. (2000). Child abuse and its effects in Korea. In Proceedings from 23rd seminar on prevention of child abuse and neglect. Korean Association for the Prevention of Child Abuse and Neglect, Seoul. Korean Ministry of Health and Welfare. (2000). Study on child abuse and its impact. Seoul: Ministry of Health and Welfare. Korean Ministry of Health and Welfare. (2010). The review of the state of child abuse. Seoul: Ministry of Health and Welfare. Lee, B. J., & Kim, S. W. (2005). Societal factors of children maltreatment: Focusing on the role of neighborhood poverty. Journal of Korean Council for Children & Rights, 9(3), 347–373. Retrieved from http://www.kccr.or.kr/sub2 3.html Lee, B. J., & Kim, K. H. (2007). Effects of Family Poverty and Family Structure on Physical Abuse and Neglect of Children. Journal of Korean Council for Children & Rights, 11(3), 333–359. Retrieved from http://www.kccr.or.kr/sub2 3.html Lee, B. J., & Kim, K. H. (2009). The process of the influence of the unemployment on the child abuse and neglect. Journal of Korean Council for Children & Rights, 13(2), 177–201. Retrieved from http://www.kccr.or.kr/sub2 3.html Lee, Y., & Kim, S. (2011). Childhood maltreatment in South Korea: Retrospective study. Child Abuse & Neglect, 35, 1037–1044. Retrieved from http://www.kccr.or.kr/sub2 3.html Lee, T., Kim, S., Lee, K., & Lee, H. (2009). Community Child Centers in 2008. Seoul: Community Publication. Lindberg, K. A. (1995). Songs of healing: Song writing with an abused adolescent. Music Therapy, 13(1), 93–108. North, A. C., & Hargreaves, D. J. (2005). Brief report: Labelling effects on the perceived deleterious consequences of pop music listening. Journal of Adolescence, 28, 433–440. http://dx.doi.org/10.1016/j.adolescence.2004.09.003 Nunnally, J. C. (1978). Psychometric theory (2nd ed.). NewYork: McGraw Hill. Oh, K., Ha, E., Lee, H., & Hong, K. (2007). Korean-Child Behavior Checklist. Seoul: Central Institute of Aptitude. Park, M. S. (2001). The factors of child physical abuse in Korean immigrant families. Child Abuse & Neglect, 25, 945–958. http://dx.doi.org/10.1016/S0145-2134(01)00248-4 Pavlicevic, M. (1994). Between chaos and creativity: Music therapy with ‘traumatised’ children in South Africa. Journal of British Music Therapy, 8(2), 4–9.

Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005

G Model CHIABU-2750; No. of Pages 10

10

ARTICLE IN PRESS J. Kim, K. Kim / Child Abuse & Neglect xxx (2014) xxx–xxx

Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press. Rogers, P. (1995). Childhood sexual abuse: Dilemmas in therapeutic practice. Music Therapy Perspectives, 13(1), 24–30. http://dx.doi.org/10.1093/mtp/13.1.24 Scheel, K. R., & Westerfeld, J. S. (1999). Heavy metal music and adolescence suicidality: An empirical investigation. Adolescence, 34(134), 253–273. Schellenberg, E. G. (2006). Long-term positive associations between music lessons and IQ. Journal of Educational Psychology, 98(2), 457–468. Straus, M. A. (1979). Measuring intra family conflict and violence: The conflict tactics (CT) scales. Journal of Marriage and the Family, 41(1), 75–88. Van der Kolk, B. A. (2005). Developmental trauma disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric Annals, 35(5), 401–408. United Nation. (2011). Ceneral Comment to the CRC No. 13 on the rights of the child to freedom from all forms of violence. http://www2.ohchr.org/english/bodies/crc/dpcs/CRC.C.GC.13 en.doc Wetter, O., Koerner, F., & Schwaninger, A. (2009). Does music training improve school performance? Instructional Science, 37(4), 365–374. http://dx.doi.org/10.1007/s11251-008-9052-y

Please cite this article in press as: Kim, J., & Kim, K. Behavioral and musical characteristics of the children who are exposed to child maltreatment and poverty in South Korea: A survey. Child Abuse & Neglect (2014), http://dx.doi.org/10.1016/j.chiabu.2014.03.005