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Not all bad treatment is psychological maltreatment
Child Abuse & Neglect 35 (2011) 797–801
Contents lists available at SciVerse ScienceDirect
Child Abuse & Neglect
Not all bad treatment is psychological maltreatment James Garbarino Humanistic Psychology, Center for the Human Rights of Children, Loyola University Chicago, USA
a r t i c l e
i n f o
Article history: Received 22 October 2010 Received in revised form 9 May 2011 Accepted 12 May 2011 Available online 24 October 2011 Keyword: Psychological maltreatment
a b s t r a c t One of the conceptual and definitional issues that has plagued the study of child maltreatment is the relationship between intention and outcome. This paper flows from the finding that the common developmentally destructive element in all forms of child maltreatment is psychological maltreatment, that the study of child abuse and neglect is the study of child maltreatment in a fundamental way. The key is to find a way to embrace the dynamic character of defining “psychological maltreatment,” by creating and sustaining a model that locates that dynamic in the conceptual space between science and professional practice on the one hand, and culture and community norms on the other. © 2011 Elsevier Ltd. All rights reserved.
The more things change the more they remain the same? “It is significant that at this stage of the development of child protective services attention is being focused nationally on emotional neglect of children.” Robert M. Mulford Mulford’s comment seems both reasonable and contemporary. It is reasonable because research from diverse sources has demonstrated the central role of psychological maltreatment as a risk factor in child development. That it seems current is evidenced by the fact of this special issue devoted to “Emotional Maltreatment,” and the fact that the editors had a wide range of researchers to invite to participate. All this is true. However, Mulford made his comment more than half a century ago! Mulford’s comment appeared in the journal Child Welfare in 1958; I first cited it 28 years later—26 years ago (Garbarino, 1986). At that time it seemed the topic of psychological maltreatment was beginning to take hold in the field of child protection and research on child abuse and neglect. Twenty five years ago there were many conferences and workshops being devoted to the topic, and the Advisory Committee for the American Humane Association’s National Study of Child Abuse and Neglect Reporting had recommended “emotional maltreatment” as one of four principal reporting categories. In 1978, two prominent researcher/clinicians wrote that, “Mental health professionals have avoided the topic of emotional abuse” (Lurie & Stefano, 1978). All that was supposed to change, and in many ways it did. For example, in 1986, my colleagues and I offered a comprehensive review in a book entitled, “The Psychologically Battered Child (Garbarino, Guttmann, & Seeley, 1986), in 1987, Brassard, Germain, Hart, and Cohn complied a wide ranging review of the issue (Brassard, Germain, Hart, & Cohn, 1987), and by 1991 an empirical analysis by Claussen and Critenden (1991) established that psychological maltreatment was indeed the common destructive theme across all forms of child abuse and neglect. In the last three decades research and practice have proliferated. Yet some core issues remain. In this article I will attempt to explore some of them, with the unifying theme being this: not all bad outcomes are the result of (psychological) maltreatment. Pursuing this idea begins with a review of two principal topics, the complex nature of the relationship between cause and effect in child development, and, the fundamental impossibility of a final fixed definition of child maltreatment. First, let me address the issue of causality in child development. Rarely does the process of cause and effect work universally in matters of human development. Rather, it operates in the context established by family as family itself operates within the context of neighborhoods and community, of socioeconomic systems, of culture, of gender and ethnicity, of prior 0145-2134/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.chiabu.2011.05.014
798
J. Garbarino / Child Abuse & Neglect 35 (2011) 797–801
experience, and of historical circumstance. This is the fundamental lesson we learn from scientific research on human development. When we look at the development of children and ask, “does x cause y?” the best scientific answer is almost always “it depends.” It depends. That is one of the most important messages from modern developmental science, and it provides the foundation for an ecological perspective as laid out by developmental psychologist Urie Bronfenbrenner beginning in the 1960s. Bronfenbrenner’s books Two Worlds of Childhood (1970) and The Ecology of Human Development (1979) pioneered in making the case for the paramount importance of context in shaping the workings of developmental influences, influences that are found in the child’s biology, the child’s psychology, the child’s family, the child’s schools, the child’s community, the child’s society, and the child’s culture. A direct implication of this ecological perspective is the fact that rarely if ever does a single influence determine the course of a child’s life, for better or for worse. Of course, there may be exceptions, as in the case of horrendously traumatic single events that catastrophically alter the course of development. But in general, whether these influences be negative—“risk factors”—or positive—“developmental assets”—it is extremely rare that a single influence is decisive (Garbarino, 2008). Rather, it is the accumulation of risk factors and the accumulation of developmental assets that generally describe the level of social toxicity and social robustness, which when coupled with the forces of human biology tell the story of a child’s development. All child maltreatment is psychological maltreatment, but not all bad developmental outcomes are the result of child maltreatment. And, child maltreatment does not always result in bad outcomes. This is one implication of this perspective on human development. There are pathogenic influences of child development that derive from the accumulation of risk factors other than child maltreatment. For example, in research conducted by Sameroff, Seifer, Barocas, Zax, and Greenspan (1987) seven other risk factors were identified, each of which contributed to negative outcomes in the form of below average intellectual functioning and disruptive behavioral problems. These were poverty, maternal mental illness, absence of a parent, low educational attainment of the mother, large number of children in the family, exposure to racism, and substance abuse in a parent. The accumulation of any four factors (with the eighth factor being “rigid and punitive child rearing style,” which can be taken as the code word for maltreatment in a way consistent with Claussen and Crittenden’s conclusion that it is the psychological dimensions of all maltreatment that are the principal culprit in the negative developmental effects of child abuse and neglect) was associated with significantly below average intellectual functioning and disruptive behavioral problems. Not all bad outcomes are the result of child maltreatment. And, whether child maltreatment “causes” bad outcomes depends to a significant degree upon the context in which it occurs. If it is a single risk factor it is much less likely to have a significant effect on critical developmental phenomena such as cognitive development and the development of pro-social behavior. When it occurs in a context infused with other risk factors it is likely to cause problems (i.e. when it is the fourth rather than the only risk factor). Does maltreatment cause impaired development? As always, the best answer is “it depends.” Having looked at the issue of causation in child development, let me turn to the topic of defining child maltreatment. I have learned that the task of defining child maltreatment is not simply one of listing specific behaviors that fall within the boundaries of the term or outside it. No simple list will be of much use because there are complex issues of intention (if you hurt a child unintentionally but should have known what you were doing was dangerous or damaging is it still child maltreatment?) and consequence (if you have sex with a child, terrorize a child or throw a child against a wall and the child is unhurt that does not make it any the less child maltreatment?). After considering this issue for many years, I came to the conclusion that the best definition of child maltreatment is “acts of omission or commission by a parent or guardian that are judged by a mixture of community values and professional expertise to be inappropriate and damaging” (Garbarino, 2008). This approach lodges child maltreatment solidly within a human rights framework. It recognizes that protecting children is an on-going effort to raise the standards for how children are treated as knowledge and awareness of what children are entitled to advance and how that entitlement influences positive and negative development increases. Thus, at any particular time and in any particular place, to label something as “child maltreatment” is to recognize that the institutions of a community have come to understand that the minimal standards of child care are being violated in ways that put the child at risk. In a sense, the UN Convention on the Rights of the Child is at its heart a compilation of this process in the sense that it represents a global consensus of what it should mean to be a child and what the adult world should feel compelled to do about it. Many people find this approach to defining child maltreatment frustrating, of course. They would like a final list of what is and what isn’t child abuse and neglect. But I am convinced that there is no such list. There is only a commitment to keep at the task of bringing social and cultural realities in line with our developing understanding of the basic needs—and thus human rights—of children, to bodily integrity, to emotional and psychological safety, and to being nurtured. I think of what Michelangelo said when asked how he went about sculpting. Rather than having a precise algorithm, recipe, a set of pre-specified actions, he had a guiding concept and vision. He said words to the effect that, “if asked to sculpt an angel I take my hammer and chisel, approach the block of stone and chip away anything that does not look like an angel.” Like it or not, that is how we must approach psychological maltreatment, indeed all child maltreatment. In a manner consistent with Michelangelo, we take up our concepts of the human rights of children and our understanding of child development and we approach the lives of children to chip away at anything that is inconsistent with the human right to have their basic developmental needs met. One of the most important consequences of approaching children this way is that we find ourselves drawn to the ways in which the experience of being maltreated can set children off on a negative developmental pathway. It is important to
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note that the link between child maltreatment is no different than most of the causal links in child development. It is not simple and invariant. Some children do exhibit resilience, in the sense that they are not crushed developmentally by the experience of being maltreated in childhood. Of course, even among those who are functionally resilient there may be great sadness and even barriers to a positive inner life and intimate relationships. Indeed, Michael Rutter’s recent review of four studies looking at the consequences of child maltreatment concludes that “a substantial proportion (about half) of all individuals suffering physical or sexual abuse in childhood nevertheless shows unremarkable positive psychosocial functioning afterwards.” It doesn’t make the violation of the human rights of the maltreated children any less a violation (harm is not the sole criterion for judging maltreatment, after all). But it is good news for victimized children—indeed for the whole human community. But what about the children whose development is impaired severely by the experience of child maltreatment. What about them? While there are many deleterious outcomes we might consider—depression, sexual dysfunction, economic failure, learning disabilities, physical injury and death—I am drawn to the role of child maltreatment in setting off a chain of events that leads to problems with anti-social violence and aggression in childhood that become the basis for life-long problems with anti-social and criminal behavior, with what in the psychiatric field is called “conduct disorder” because this particular outcome is extremely costly to communities, families, and individuals. Individuals who develop a deeply embedded pattern of conduct disorder that continues into adulthood (when it my be renamed “anti-social personality disorder”) account for a highly disproportionate share of public funds in the forms of incarceration and health services (for perpetrators and victims alike). Anti-social aggressive behavior forms the foundation for the diagnosis of conduct disorder—which is just a label recognizing that a child is exhibiting a chronic pattern of aggression, bad behavior, acting out, and violating the rights of others. Thus, the violation of human rights that is child maltreatment becomes the basis for perpetuating and extending human rights violation to others. This on-going pattern of human rights violations starts with the skewed way in which (psychologically) maltreated children see the world. What is it about the way some abused kids see the world that leads them to develop conduct disorder? Generally it starts with the fact that they are negative and unrealistic about the social environment. The social environment is always broadcasting messages, some positive, some negative, some neutral or ambiguous. Children filter all these “data” through the basic ideas and knowledge they have about attachment and acceptance, and then digest them through their thinking processes (“social cognition”). Psychologist Kenneth Dodge and his colleagues (1997) have found that children differ in how they receive and organize social information, and the results of these differences go a long way toward explaining how conduct disorder arises and flourishes in some children—particularly abused children—and not in others. Dodge and his colleagues found that the odds that abused children will develop conduct disorder increase if their thinking about social information is characterized by four distinct patterns in the way they “map” this information: being hypersensitive to negative social cues, being oblivious to positive social cues, having a narrow repertoire of aggressive responses to being aroused, and drawing the conclusion that aggression is successful in social relations. Note that this research tells us that the pathway from abuse to conduct disorder is to be found in the psychological effects of maltreatment, which is not surprising given that above all material realities, human beings develop first and foremost through their minds and spirits. The first two patterns push a child’s social map toward negativity. Under normal circumstances most of us receive both positive and negative social information, and this keeps our social maps balanced, a realistic mix of the positive and the negative. This person is smiling, but that one is frowning. This one has a positive tone of voice, but that one has a threatening tone. This one is kind, but that one is mean. Some kids receive only the positive input, and this skews their social map in an unrealistically positive direction—what might be called “Pollyana Syndrome”—but this is actually more functional and socially desirable than its opposite. The kids Dodge was concerned about suffer from this opposite problem: They receive only the negative and thus see the world in increasingly negative terms. They experience an unrelentingly negative pattern that we might call the “war zone mentality,” in which the perception of threat increases and the defensive inclination to hit first and ask questions later arises. What is more, some of these children are at heightened risk for translating the experience of being the victim of child abuse into the experience of being the perpetrator of conduct disorder because their understanding of how the world works is also unrealistically skewed. Mark Twain wrote that “if the only tool you have is hammer, you are likely to define every problem as a nail.” I would say that the reverse is true as well: “If you define every problem as a nail, the only tool you need is a hammer.” Kids at risk for problems with aggression suffer from a similar limitation. Their answer to every question is aggression. What to do if afraid? Hit. What to do if confused? Hit. What to do if frustrated? Hit. It is as if they had road map that had only North on it. All roads lead to aggression; it is the only direction they recognize. There is more. These kids have gone beyond simply possessing and demonstrating a narrow range of responses to being angry, afraid, frustrated, and covetous (namely aggression). They have taken the next step, and actually believe that aggression is successful. It is not surprising that this is a tempting possibility for a child living in an abusive family. Like a little anthropologist, the child observes and records in the notebook of the social map: Mom and Dad are arguing, Dad hits Mom in the face, and she shuts up. Note to self: Hitting works (at least if you can identify with the aggressor). Baby brother is whining for ice cream. Mom slaps him, and he stops asking. Note to self: Slapping is effective (particularly if you are bigger and more powerful than the target of your aggression). I take Billy’s toy. He starts to complain to the teacher. I hit him in the
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stomach, and he shuts up. Note to self: Hitting stops kids from complaining to the teacher if you hit hard enough (and don’t get caught). The bottom line in all this? Dodge reports that if, by age six, abused children develop the four risky patterns of thinking (that is, focusing on the negative, ignoring the positive, being limited to aggressive responses, and believing aggression is successful), they are eight times more likely to develop conduct disorder than abused children who don’t. Abused children who don’t develop these risky patterns of thinking are no more likely that non-abused children to develop conduct disorder. But of course that raises some very important questions. Why do some abused children develop risky thinking while others don’t? Why do non-abused children develop conduct disorder at all? Both invite answers that involve the human biology within the child as well as social conditions around the child. Both hinge on our understanding of cause and effect in child development. The question of which abused children develop risky thinking and why finds one provocative and illustrative answer in the work of Avshalom Caspi et al. (2002). Their study grew out of research with animals showing that when there was a deficiency of certain chemicals in the brain (neurotransmitters), the affected animals were more aggressive, particular when put in stressful situations. Why? Because the chemicals involved affect the brains’ response to threat and stress. When there is a deficiency of these chemicals, the brain has trouble processing social information effective in ways that are the animal equivalent of what Dodge and his colleagues demonstrated with children, and these problems lead to more aggressive responses. The neurotransmitters are under the control of an enzyme linked to a specific gene (monoamine oxidase A—the MAOA gene), and Caspi and Moffitt set out to trace the impact of all this on child development. Through its effect on the enzyme, the gene can turn the important neurotransmitters “off,” causing the deficiency, or “on,” leading to the normal levels of these chemicals. When the MAOA gene is turned off, the child does not have the same level of activity in the important neurotransmitters of norepinephrine, serotonin, and dopamine than when it is on. The result is that the children with MAOA gene off are less able to deal with stressful information and more prone to overreact to potentially dangerous situations? Does this sound familiar? It should. These are exactly the issues Dodge identified in his study of why some abused children develop conduct disorder while others do not do so. Sure enough, the results of Caspi and Moffitt’s research shed light on the unanswered question in Dodge’s research—namely, why do some abused kids develop risky thinking (and thus become prone to conduct disorder) while others do not? If abused children have the MAOA gene turned off, about 85 percent develop conduct disorder. If they are abused and have the gene turned on, the figure is about 40 percent. If the MAOA gene is turned off and the child is not abused, the rate of conduct disorder is about 20 percent. And the rate is 20 percent if the gene is on and there is not abuse. Although this is only one study, it is consistent with the research on animals mentioned before. And, it is consistent with the body of research demonstrating that the developmental pathways for aggression start with a nearly universal capacity and inclination to behave aggressively during infancy and early childhood (as demonstrated by the research of Richard Tremblay, 2000) but that the processes controlling whether aggression waxes or wanes thereafter are the child’s thinking about aggression (“cognitive structuring”) and the child’s experience with aggression (“behavioral rehearsal”) (Tolan & Guerra, 1996). I think the important conclusion from looking at the intersection of Dodge’s research, the findings of Caspi and Moffitt’s study, and the perspective brought by Tremblay (2000), and Tolan and Guerra (1996) is that the consequences of violating the child’s basic human right to live free of abuse are often dreadful, for the child and for the larger community. The development of conduct disorder in childhood puts children on the fast track for becoming seriously violent delinquents, and eventually adult criminals. About 30% of kids with conduct disorder in childhood end up as seriously violent delinquents in adolescence. Among kids living in violent and anti-social neighborhoods that figure is 60%. Among kids with the MAOA gene turned off (i.e. when the form of the gene that a child has does not lead to a normal production of the critical neurotransmitter) that figure is 90%! This is why the child’s right to protection from abuse is one of the most important rights there is, because when it is violated the damage done can reverberate through the lives of individual children to reach the community around them and the next generation of children. We must remember that if we prevent child abuse we can neutralize the relevance of the MAOA gene (that is, non-abused kids with the MAOA gene turned off have no higher rate of conduct disorder than non-abused kids with the gene turned on). Because it is the mental and spiritual development of children that is most central to their overall human development, anything that inhibits or distorts these dimensions of development is a core concern of those who care for children and their human rights to thrive. Where minimal standards can be set for the psychological treatment of children a domain of psychological maltreatment can be identified. We know that terrorizing, ignoring, isolating, corrupting, and rejecting children can undermine their mental functioning, their personality development, their moral reasoning, and their ability and motivation to behave pro-socially (Garbarino et al., 1986). This returns to our central concern (that is, psychological maltreatment). We can recognize that even when the immediate violation of the child is in the form of physical or sexual abuse, the most pervasive consequences are psychological (as Claussen and Crittenden demonstrated in 1991). Children develop as their minds and spirits develop. As personalities they can survive (and even thrive) if they confront physical injury, so long as that injury does not have psychological implications of rejection and shame. Decades of research by Ronald Rohner, Khaleque, and Cournoyer (2005) have demonstrated that parental rejection is associated with problematic development (accounting
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for about 25% of the variance across cultures and societies). Research by James Gilligan (1996) pinpoints shame as a primary mental health toxin, linked to violent behavior by those who experience it. A child whose leg is broken playing football is not an abuse victim; a child whose leg is broken by being beaten is. It is not the injury but the message it conveys, the meaning of the injury that matters. Psychological maltreatment is about that meaning, and this is why it is the core issue in the larger domain of child maltreatment. And defining it is an on-going dialogue about how to raise the standards of care for how children are treated, standards of care that are tied to the basic human rights of children. References Brassard, M., Germain, R., Hart, S. & Cohn, A. (1987). Psychological maltreatment of children and youth. NY: Pergamon. Bronfenbrenner, U. (1970). Two worlds of childhood. NY: Sage. Bronfenbrenner, U. (1979). The ecology of human development. Harvard University Press: Cambridge, MA. Caspi, A., McClay, J., Moffit, T., Mill, J., Martin, J., Craig, I., Taylor, A. & Poulton, R. (2002). The role of genotype in the cycle of violence in maltreated children. Science, 297, 851–854. Claussen, A. & Critenden, P. (1991). Physical and psychological maltreatment. Relations among types of maltreatment. Child Abuse and Neglect, 15, 5–18. Dodge, K., Pettit, G. & Bates, J. (1997). How the experience of early physical abuse leads children to become chronically aggressive. In C. Cicchetti, & S. L. Toth (Eds.), Theory, research, and intervention Developmental psychopathology: Developmental perspectives on trauma (pp. 263–288). Rochester, NY: University of Rochester. Garbarino, J. (2008). Children and the dark side of human experience. NY: Springer. Garbarino, J., Guttmann, E. & Seeley, J. (1986). The psychologically battered child. San Francisco: Jossey-Bass. Gilligan, J. (1996). Violence: Our deadly epidemic and its cause. NY: Putnam. Lurie, I. & Stefano, L. (1978). On defining emotional abuse. In Proceedings of the Second Annual National Conference on Child Abuse and Neglect. Washington, DC: U.S. Government Printing Office. Mulford, R. (1958). Emotional neglect of children. Child Welfare, 37, 19–24. Rohner, R., Khaleque, A. & Cournoyer, D. (2005). Parental-acceptance-rejection: Theory, methods, cross-cultural evidence and implications. Ethos, 33, 299–334. Sameroff, A., Seifer, R., Barocas, R., Zax, M. & Greenspan, S. (1987). Intelligence quotient scores of 4-year-old children: Socio-environmental risk factors. Pediatrics, 779, 343–350. Tolan, P. & Guerra, N. (1996). Youth violence prevention: Descriptions of baseline data from thirteen evaluation projects. American Journal of Preventative Medicine, 12(5), 1–134. Tremblay, R. (2000). The development of aggressive behaviour in childhood: What have we learned in the past century? International Journal of Behavioural Development, 24, 129–141.
Contents lists available at SciVerse ScienceDirect
Child Abuse & Neglect
Not all bad treatment is psychological maltreatment James Garbarino Humanistic Psychology, Center for the Human Rights of Children, Loyola University Chicago, USA
a r t i c l e
i n f o
Article history: Received 22 October 2010 Received in revised form 9 May 2011 Accepted 12 May 2011 Available online 24 October 2011 Keyword: Psychological maltreatment
a b s t r a c t One of the conceptual and definitional issues that has plagued the study of child maltreatment is the relationship between intention and outcome. This paper flows from the finding that the common developmentally destructive element in all forms of child maltreatment is psychological maltreatment, that the study of child abuse and neglect is the study of child maltreatment in a fundamental way. The key is to find a way to embrace the dynamic character of defining “psychological maltreatment,” by creating and sustaining a model that locates that dynamic in the conceptual space between science and professional practice on the one hand, and culture and community norms on the other. © 2011 Elsevier Ltd. All rights reserved.
The more things change the more they remain the same? “It is significant that at this stage of the development of child protective services attention is being focused nationally on emotional neglect of children.” Robert M. Mulford Mulford’s comment seems both reasonable and contemporary. It is reasonable because research from diverse sources has demonstrated the central role of psychological maltreatment as a risk factor in child development. That it seems current is evidenced by the fact of this special issue devoted to “Emotional Maltreatment,” and the fact that the editors had a wide range of researchers to invite to participate. All this is true. However, Mulford made his comment more than half a century ago! Mulford’s comment appeared in the journal Child Welfare in 1958; I first cited it 28 years later—26 years ago (Garbarino, 1986). At that time it seemed the topic of psychological maltreatment was beginning to take hold in the field of child protection and research on child abuse and neglect. Twenty five years ago there were many conferences and workshops being devoted to the topic, and the Advisory Committee for the American Humane Association’s National Study of Child Abuse and Neglect Reporting had recommended “emotional maltreatment” as one of four principal reporting categories. In 1978, two prominent researcher/clinicians wrote that, “Mental health professionals have avoided the topic of emotional abuse” (Lurie & Stefano, 1978). All that was supposed to change, and in many ways it did. For example, in 1986, my colleagues and I offered a comprehensive review in a book entitled, “The Psychologically Battered Child (Garbarino, Guttmann, & Seeley, 1986), in 1987, Brassard, Germain, Hart, and Cohn complied a wide ranging review of the issue (Brassard, Germain, Hart, & Cohn, 1987), and by 1991 an empirical analysis by Claussen and Critenden (1991) established that psychological maltreatment was indeed the common destructive theme across all forms of child abuse and neglect. In the last three decades research and practice have proliferated. Yet some core issues remain. In this article I will attempt to explore some of them, with the unifying theme being this: not all bad outcomes are the result of (psychological) maltreatment. Pursuing this idea begins with a review of two principal topics, the complex nature of the relationship between cause and effect in child development, and, the fundamental impossibility of a final fixed definition of child maltreatment. First, let me address the issue of causality in child development. Rarely does the process of cause and effect work universally in matters of human development. Rather, it operates in the context established by family as family itself operates within the context of neighborhoods and community, of socioeconomic systems, of culture, of gender and ethnicity, of prior 0145-2134/$ – see front matter © 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.chiabu.2011.05.014
798
J. Garbarino / Child Abuse & Neglect 35 (2011) 797–801
experience, and of historical circumstance. This is the fundamental lesson we learn from scientific research on human development. When we look at the development of children and ask, “does x cause y?” the best scientific answer is almost always “it depends.” It depends. That is one of the most important messages from modern developmental science, and it provides the foundation for an ecological perspective as laid out by developmental psychologist Urie Bronfenbrenner beginning in the 1960s. Bronfenbrenner’s books Two Worlds of Childhood (1970) and The Ecology of Human Development (1979) pioneered in making the case for the paramount importance of context in shaping the workings of developmental influences, influences that are found in the child’s biology, the child’s psychology, the child’s family, the child’s schools, the child’s community, the child’s society, and the child’s culture. A direct implication of this ecological perspective is the fact that rarely if ever does a single influence determine the course of a child’s life, for better or for worse. Of course, there may be exceptions, as in the case of horrendously traumatic single events that catastrophically alter the course of development. But in general, whether these influences be negative—“risk factors”—or positive—“developmental assets”—it is extremely rare that a single influence is decisive (Garbarino, 2008). Rather, it is the accumulation of risk factors and the accumulation of developmental assets that generally describe the level of social toxicity and social robustness, which when coupled with the forces of human biology tell the story of a child’s development. All child maltreatment is psychological maltreatment, but not all bad developmental outcomes are the result of child maltreatment. And, child maltreatment does not always result in bad outcomes. This is one implication of this perspective on human development. There are pathogenic influences of child development that derive from the accumulation of risk factors other than child maltreatment. For example, in research conducted by Sameroff, Seifer, Barocas, Zax, and Greenspan (1987) seven other risk factors were identified, each of which contributed to negative outcomes in the form of below average intellectual functioning and disruptive behavioral problems. These were poverty, maternal mental illness, absence of a parent, low educational attainment of the mother, large number of children in the family, exposure to racism, and substance abuse in a parent. The accumulation of any four factors (with the eighth factor being “rigid and punitive child rearing style,” which can be taken as the code word for maltreatment in a way consistent with Claussen and Crittenden’s conclusion that it is the psychological dimensions of all maltreatment that are the principal culprit in the negative developmental effects of child abuse and neglect) was associated with significantly below average intellectual functioning and disruptive behavioral problems. Not all bad outcomes are the result of child maltreatment. And, whether child maltreatment “causes” bad outcomes depends to a significant degree upon the context in which it occurs. If it is a single risk factor it is much less likely to have a significant effect on critical developmental phenomena such as cognitive development and the development of pro-social behavior. When it occurs in a context infused with other risk factors it is likely to cause problems (i.e. when it is the fourth rather than the only risk factor). Does maltreatment cause impaired development? As always, the best answer is “it depends.” Having looked at the issue of causation in child development, let me turn to the topic of defining child maltreatment. I have learned that the task of defining child maltreatment is not simply one of listing specific behaviors that fall within the boundaries of the term or outside it. No simple list will be of much use because there are complex issues of intention (if you hurt a child unintentionally but should have known what you were doing was dangerous or damaging is it still child maltreatment?) and consequence (if you have sex with a child, terrorize a child or throw a child against a wall and the child is unhurt that does not make it any the less child maltreatment?). After considering this issue for many years, I came to the conclusion that the best definition of child maltreatment is “acts of omission or commission by a parent or guardian that are judged by a mixture of community values and professional expertise to be inappropriate and damaging” (Garbarino, 2008). This approach lodges child maltreatment solidly within a human rights framework. It recognizes that protecting children is an on-going effort to raise the standards for how children are treated as knowledge and awareness of what children are entitled to advance and how that entitlement influences positive and negative development increases. Thus, at any particular time and in any particular place, to label something as “child maltreatment” is to recognize that the institutions of a community have come to understand that the minimal standards of child care are being violated in ways that put the child at risk. In a sense, the UN Convention on the Rights of the Child is at its heart a compilation of this process in the sense that it represents a global consensus of what it should mean to be a child and what the adult world should feel compelled to do about it. Many people find this approach to defining child maltreatment frustrating, of course. They would like a final list of what is and what isn’t child abuse and neglect. But I am convinced that there is no such list. There is only a commitment to keep at the task of bringing social and cultural realities in line with our developing understanding of the basic needs—and thus human rights—of children, to bodily integrity, to emotional and psychological safety, and to being nurtured. I think of what Michelangelo said when asked how he went about sculpting. Rather than having a precise algorithm, recipe, a set of pre-specified actions, he had a guiding concept and vision. He said words to the effect that, “if asked to sculpt an angel I take my hammer and chisel, approach the block of stone and chip away anything that does not look like an angel.” Like it or not, that is how we must approach psychological maltreatment, indeed all child maltreatment. In a manner consistent with Michelangelo, we take up our concepts of the human rights of children and our understanding of child development and we approach the lives of children to chip away at anything that is inconsistent with the human right to have their basic developmental needs met. One of the most important consequences of approaching children this way is that we find ourselves drawn to the ways in which the experience of being maltreated can set children off on a negative developmental pathway. It is important to
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note that the link between child maltreatment is no different than most of the causal links in child development. It is not simple and invariant. Some children do exhibit resilience, in the sense that they are not crushed developmentally by the experience of being maltreated in childhood. Of course, even among those who are functionally resilient there may be great sadness and even barriers to a positive inner life and intimate relationships. Indeed, Michael Rutter’s recent review of four studies looking at the consequences of child maltreatment concludes that “a substantial proportion (about half) of all individuals suffering physical or sexual abuse in childhood nevertheless shows unremarkable positive psychosocial functioning afterwards.” It doesn’t make the violation of the human rights of the maltreated children any less a violation (harm is not the sole criterion for judging maltreatment, after all). But it is good news for victimized children—indeed for the whole human community. But what about the children whose development is impaired severely by the experience of child maltreatment. What about them? While there are many deleterious outcomes we might consider—depression, sexual dysfunction, economic failure, learning disabilities, physical injury and death—I am drawn to the role of child maltreatment in setting off a chain of events that leads to problems with anti-social violence and aggression in childhood that become the basis for life-long problems with anti-social and criminal behavior, with what in the psychiatric field is called “conduct disorder” because this particular outcome is extremely costly to communities, families, and individuals. Individuals who develop a deeply embedded pattern of conduct disorder that continues into adulthood (when it my be renamed “anti-social personality disorder”) account for a highly disproportionate share of public funds in the forms of incarceration and health services (for perpetrators and victims alike). Anti-social aggressive behavior forms the foundation for the diagnosis of conduct disorder—which is just a label recognizing that a child is exhibiting a chronic pattern of aggression, bad behavior, acting out, and violating the rights of others. Thus, the violation of human rights that is child maltreatment becomes the basis for perpetuating and extending human rights violation to others. This on-going pattern of human rights violations starts with the skewed way in which (psychologically) maltreated children see the world. What is it about the way some abused kids see the world that leads them to develop conduct disorder? Generally it starts with the fact that they are negative and unrealistic about the social environment. The social environment is always broadcasting messages, some positive, some negative, some neutral or ambiguous. Children filter all these “data” through the basic ideas and knowledge they have about attachment and acceptance, and then digest them through their thinking processes (“social cognition”). Psychologist Kenneth Dodge and his colleagues (1997) have found that children differ in how they receive and organize social information, and the results of these differences go a long way toward explaining how conduct disorder arises and flourishes in some children—particularly abused children—and not in others. Dodge and his colleagues found that the odds that abused children will develop conduct disorder increase if their thinking about social information is characterized by four distinct patterns in the way they “map” this information: being hypersensitive to negative social cues, being oblivious to positive social cues, having a narrow repertoire of aggressive responses to being aroused, and drawing the conclusion that aggression is successful in social relations. Note that this research tells us that the pathway from abuse to conduct disorder is to be found in the psychological effects of maltreatment, which is not surprising given that above all material realities, human beings develop first and foremost through their minds and spirits. The first two patterns push a child’s social map toward negativity. Under normal circumstances most of us receive both positive and negative social information, and this keeps our social maps balanced, a realistic mix of the positive and the negative. This person is smiling, but that one is frowning. This one has a positive tone of voice, but that one has a threatening tone. This one is kind, but that one is mean. Some kids receive only the positive input, and this skews their social map in an unrealistically positive direction—what might be called “Pollyana Syndrome”—but this is actually more functional and socially desirable than its opposite. The kids Dodge was concerned about suffer from this opposite problem: They receive only the negative and thus see the world in increasingly negative terms. They experience an unrelentingly negative pattern that we might call the “war zone mentality,” in which the perception of threat increases and the defensive inclination to hit first and ask questions later arises. What is more, some of these children are at heightened risk for translating the experience of being the victim of child abuse into the experience of being the perpetrator of conduct disorder because their understanding of how the world works is also unrealistically skewed. Mark Twain wrote that “if the only tool you have is hammer, you are likely to define every problem as a nail.” I would say that the reverse is true as well: “If you define every problem as a nail, the only tool you need is a hammer.” Kids at risk for problems with aggression suffer from a similar limitation. Their answer to every question is aggression. What to do if afraid? Hit. What to do if confused? Hit. What to do if frustrated? Hit. It is as if they had road map that had only North on it. All roads lead to aggression; it is the only direction they recognize. There is more. These kids have gone beyond simply possessing and demonstrating a narrow range of responses to being angry, afraid, frustrated, and covetous (namely aggression). They have taken the next step, and actually believe that aggression is successful. It is not surprising that this is a tempting possibility for a child living in an abusive family. Like a little anthropologist, the child observes and records in the notebook of the social map: Mom and Dad are arguing, Dad hits Mom in the face, and she shuts up. Note to self: Hitting works (at least if you can identify with the aggressor). Baby brother is whining for ice cream. Mom slaps him, and he stops asking. Note to self: Slapping is effective (particularly if you are bigger and more powerful than the target of your aggression). I take Billy’s toy. He starts to complain to the teacher. I hit him in the
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stomach, and he shuts up. Note to self: Hitting stops kids from complaining to the teacher if you hit hard enough (and don’t get caught). The bottom line in all this? Dodge reports that if, by age six, abused children develop the four risky patterns of thinking (that is, focusing on the negative, ignoring the positive, being limited to aggressive responses, and believing aggression is successful), they are eight times more likely to develop conduct disorder than abused children who don’t. Abused children who don’t develop these risky patterns of thinking are no more likely that non-abused children to develop conduct disorder. But of course that raises some very important questions. Why do some abused children develop risky thinking while others don’t? Why do non-abused children develop conduct disorder at all? Both invite answers that involve the human biology within the child as well as social conditions around the child. Both hinge on our understanding of cause and effect in child development. The question of which abused children develop risky thinking and why finds one provocative and illustrative answer in the work of Avshalom Caspi et al. (2002). Their study grew out of research with animals showing that when there was a deficiency of certain chemicals in the brain (neurotransmitters), the affected animals were more aggressive, particular when put in stressful situations. Why? Because the chemicals involved affect the brains’ response to threat and stress. When there is a deficiency of these chemicals, the brain has trouble processing social information effective in ways that are the animal equivalent of what Dodge and his colleagues demonstrated with children, and these problems lead to more aggressive responses. The neurotransmitters are under the control of an enzyme linked to a specific gene (monoamine oxidase A—the MAOA gene), and Caspi and Moffitt set out to trace the impact of all this on child development. Through its effect on the enzyme, the gene can turn the important neurotransmitters “off,” causing the deficiency, or “on,” leading to the normal levels of these chemicals. When the MAOA gene is turned off, the child does not have the same level of activity in the important neurotransmitters of norepinephrine, serotonin, and dopamine than when it is on. The result is that the children with MAOA gene off are less able to deal with stressful information and more prone to overreact to potentially dangerous situations? Does this sound familiar? It should. These are exactly the issues Dodge identified in his study of why some abused children develop conduct disorder while others do not do so. Sure enough, the results of Caspi and Moffitt’s research shed light on the unanswered question in Dodge’s research—namely, why do some abused kids develop risky thinking (and thus become prone to conduct disorder) while others do not? If abused children have the MAOA gene turned off, about 85 percent develop conduct disorder. If they are abused and have the gene turned on, the figure is about 40 percent. If the MAOA gene is turned off and the child is not abused, the rate of conduct disorder is about 20 percent. And the rate is 20 percent if the gene is on and there is not abuse. Although this is only one study, it is consistent with the research on animals mentioned before. And, it is consistent with the body of research demonstrating that the developmental pathways for aggression start with a nearly universal capacity and inclination to behave aggressively during infancy and early childhood (as demonstrated by the research of Richard Tremblay, 2000) but that the processes controlling whether aggression waxes or wanes thereafter are the child’s thinking about aggression (“cognitive structuring”) and the child’s experience with aggression (“behavioral rehearsal”) (Tolan & Guerra, 1996). I think the important conclusion from looking at the intersection of Dodge’s research, the findings of Caspi and Moffitt’s study, and the perspective brought by Tremblay (2000), and Tolan and Guerra (1996) is that the consequences of violating the child’s basic human right to live free of abuse are often dreadful, for the child and for the larger community. The development of conduct disorder in childhood puts children on the fast track for becoming seriously violent delinquents, and eventually adult criminals. About 30% of kids with conduct disorder in childhood end up as seriously violent delinquents in adolescence. Among kids living in violent and anti-social neighborhoods that figure is 60%. Among kids with the MAOA gene turned off (i.e. when the form of the gene that a child has does not lead to a normal production of the critical neurotransmitter) that figure is 90%! This is why the child’s right to protection from abuse is one of the most important rights there is, because when it is violated the damage done can reverberate through the lives of individual children to reach the community around them and the next generation of children. We must remember that if we prevent child abuse we can neutralize the relevance of the MAOA gene (that is, non-abused kids with the MAOA gene turned off have no higher rate of conduct disorder than non-abused kids with the gene turned on). Because it is the mental and spiritual development of children that is most central to their overall human development, anything that inhibits or distorts these dimensions of development is a core concern of those who care for children and their human rights to thrive. Where minimal standards can be set for the psychological treatment of children a domain of psychological maltreatment can be identified. We know that terrorizing, ignoring, isolating, corrupting, and rejecting children can undermine their mental functioning, their personality development, their moral reasoning, and their ability and motivation to behave pro-socially (Garbarino et al., 1986). This returns to our central concern (that is, psychological maltreatment). We can recognize that even when the immediate violation of the child is in the form of physical or sexual abuse, the most pervasive consequences are psychological (as Claussen and Crittenden demonstrated in 1991). Children develop as their minds and spirits develop. As personalities they can survive (and even thrive) if they confront physical injury, so long as that injury does not have psychological implications of rejection and shame. Decades of research by Ronald Rohner, Khaleque, and Cournoyer (2005) have demonstrated that parental rejection is associated with problematic development (accounting
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for about 25% of the variance across cultures and societies). Research by James Gilligan (1996) pinpoints shame as a primary mental health toxin, linked to violent behavior by those who experience it. A child whose leg is broken playing football is not an abuse victim; a child whose leg is broken by being beaten is. It is not the injury but the message it conveys, the meaning of the injury that matters. Psychological maltreatment is about that meaning, and this is why it is the core issue in the larger domain of child maltreatment. And defining it is an on-going dialogue about how to raise the standards of care for how children are treated, standards of care that are tied to the basic human rights of children. References Brassard, M., Germain, R., Hart, S. & Cohn, A. (1987). Psychological maltreatment of children and youth. NY: Pergamon. Bronfenbrenner, U. (1970). Two worlds of childhood. NY: Sage. Bronfenbrenner, U. (1979). The ecology of human development. Harvard University Press: Cambridge, MA. Caspi, A., McClay, J., Moffit, T., Mill, J., Martin, J., Craig, I., Taylor, A. & Poulton, R. (2002). The role of genotype in the cycle of violence in maltreated children. Science, 297, 851–854. Claussen, A. & Critenden, P. (1991). Physical and psychological maltreatment. Relations among types of maltreatment. Child Abuse and Neglect, 15, 5–18. Dodge, K., Pettit, G. & Bates, J. (1997). How the experience of early physical abuse leads children to become chronically aggressive. In C. Cicchetti, & S. L. Toth (Eds.), Theory, research, and intervention Developmental psychopathology: Developmental perspectives on trauma (pp. 263–288). Rochester, NY: University of Rochester. Garbarino, J. (2008). Children and the dark side of human experience. NY: Springer. Garbarino, J., Guttmann, E. & Seeley, J. (1986). The psychologically battered child. San Francisco: Jossey-Bass. Gilligan, J. (1996). Violence: Our deadly epidemic and its cause. NY: Putnam. Lurie, I. & Stefano, L. (1978). On defining emotional abuse. In Proceedings of the Second Annual National Conference on Child Abuse and Neglect. Washington, DC: U.S. Government Printing Office. Mulford, R. (1958). Emotional neglect of children. Child Welfare, 37, 19–24. Rohner, R., Khaleque, A. & Cournoyer, D. (2005). Parental-acceptance-rejection: Theory, methods, cross-cultural evidence and implications. Ethos, 33, 299–334. Sameroff, A., Seifer, R., Barocas, R., Zax, M. & Greenspan, S. (1987). Intelligence quotient scores of 4-year-old children: Socio-environmental risk factors. Pediatrics, 779, 343–350. Tolan, P. & Guerra, N. (1996). Youth violence prevention: Descriptions of baseline data from thirteen evaluation projects. American Journal of Preventative Medicine, 12(5), 1–134. Tremblay, R. (2000). The development of aggressive behaviour in childhood: What have we learned in the past century? International Journal of Behavioural Development, 24, 129–141.