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Youth at risk
Youth at Risk: Adolescents
and Maltreatment
Lenore J. Olsen Rhode Island College William M. Holmes University Northeastern
Data from the National Incidence Study of Child Abuse and Neglect are used to examine the maltreatment of adolescents. The discussion considers the type of maltreatment adolescents experience and the response of service agencies. Adolescents are compared with younger children to identify differences in the form of abuse and neglect they experience and the reporting of that mistreatment. Implications of the results are noted for programs serving youth who have been abused and neglected.
Relatively little of the current literature on child abuse and neglect addresses the issue of adolescent maltreatment. It is only within the last several years that investigators have begun to focus on the problems of maltreatment among adolescents. However, studies Funding for this study was provided by the National Center for Child .L\buse and Seglect grant 90CA843/01 to the Center for Applied Social Research, Northeastern University. Opinions expressed in the paper are not those of the National Center on Child Abuse and Neglect, nor its employees. The authors wish to acknowledge the research assistance of Teresa Llayors. An earlier version of this paper was presented at the American Orthopsychiatric Assoctation annual meeting, Boston Massachusetts, 1983. Requests for reprints should be sent to Lt’illiam XI. Holmes, Center for Applied Social Research, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, 13
14
Olsen and Holmes
which have examined these problems have indicated that at least one out of every four child abuse cases involves an adolescent (American Humane Association, 1984; Lourie, 1977; National Center on Child Abuse and Neglect, 1981). Moreover, the National Incidence Study (National Center on Child Abuse and Neglect, 1981) pointed to an incidence rate which was twice as great among adolescents (12.9 per 1,000 teens) as among younger children (6.3 per 1,000 children). These studies point to a large number of adolescents who are abused or neglected by their parents or caretakers. Holmes and Olsen (1982) found that adolescents made up 42% of all confirmed cases in the National Incidence Study of Child Abuse and Neglect. Applied to an estimated half million known cases of abuse and neglect annually (National Center on Child Abuse and Neglect, 1981), this suggests that there are at least 200,000 teens who are abused or neglected each year. These studies raise questions about the risks adolescents face. What types of maltreatment do the victims suffer? How severe is it when it does occur? How does it get reported and to whom? Adolescence and Family Conflict The many task and role changes involved in the transition from childhood to adulthood pose a continuous series of challenges for adolescents and the adults who must deaI with them. The development of an adult identity, the growth of aLitonollly, and the acquisition of new roles by the adolescent are all processes that may lead to conflict with parents (Blos, 1972; Erikson, 1963, 1968; Freud, 1978; Cordon, 1972). Teenage girls attempting to establish their autonomy may be particuIarIy vulnerable to parents who are more autocratic or authoritarian and expect their daughters to be compliant (Enright, Lapsky, Drivas & Fehr, 1980). Such conflict can be intensified by pre-existent stresses in the family, new stresses, and changes associated with the family’s life cycle (Garbarino & Gilliam, 1980; Lourie, 1979). Because of childrearing patterns, parents may be undergoing a mid-Iife crisis of their own as their children enter adolescence. M’hen children are in their teens, parents tend to be in their mid-thirties to mid-forties. The self-examination of the teen may strike a particularly sensitive issue with parents facing their own crisis of identity (Fisher, Berdie, Cook & Day, 1980; Justice &Justice, 1976; Ziefert, 1981). This may also coincide with other crises in the family, such as divorce, death of grandparents, or e~lp~oyment change. Such change may stress the f-amily so severely that abuse or neglect of the adolescent results (Elmer, 1979). In remarried families, for
Youth at Risk
15
example, interpersonal difficulties between step-parents and adolescent step-children are quite common, a phenomenon referred to by Burgess, Anderson, Schellenbach and Conger (1981) as the “Cinderella Effect.” These difficulties may arise from conflicts between step-parents and their adolescent step-children over their relative power within the family (Biller, 197 1; Halperin & Smith, 1983; Visher & Visher, 1979), and from the lower investment that step-parents may have in their step-children(Burgess et al., 1981; Daly 8c Wilson, 1981). Coupled with the challenges presented by adolescents as they make the transition to adulthood, it is, therefore, not surprising to find an increased risk of abuse in families where there is a step-parent (Daly SC Wilson, 1981; Garbarino, Sebes & Schellenbach, 1984). Cicchetti and Rizley (198 1) have classified these problems as potentiating and compensatory factors. Potentiating factors increase the likelihood of maltreatment, while compensatory factors decrease that risk. Other potentiating factors which may influence the ways in which conflicts between adolescents and their families are handled include: (1) the employment status of the caretaker, (2) the educational status of the caretaker, (3) the number of children in the household, (4) the income level of the family, and (5) ethnicity of the family (Burgess et. al., 1981; Justice & Justice, 1976; Martin & Walters, 1982; Straus, Gelles & Steinmetz, 1980). Forms of Maltreatment
Such diverse problems as economic stress and problems in role functioning may lead to different forms of maltreatment, different agency involvement, and different service needs (Garbarino & Gilliam, 1980; Martin & Walters, 1982). For example, neglect is known to be associated with economic stress, while emotional abuse is more often associated with interpersonal stress (Garbarino & Gilliam; Martin & Walters). The type of maltreatment experienced also varies by the developmental phase of the child and the life cycle of the family (Garbarino, 1984; Garbarino & Gilliam, 1980; Lourie, 1979). For example, physical neglect is more common for younger children and their families, while sexual abuse is more frequent among families with adolescents (Finkelhor SC Hotaling, 1984; Garbarino & Gilliam). Families with teens are also likely to face an increased risk of emotional abuse and neglect because of the increased interpersonal stresses with which they are faced (Garbarino 8c Gilliam). In order to adequately serve these teens and their families, it is important for us to understand the specific types of harm these youth are likely to experience and the severity of that harm.
Olsen and Holmes
16 Reporting Maltreatment
Reacting to these stresses, problems, and conflicts can lead to youth behaving in ways that are labeled by adults as disruptive and uncontrollable, thus obscuring the fact of maltreatment. As a result, adolescent abuse is often hidden within such other problems as parent-child conflict, running away, and delinquency (Farber, McCoard, Kinart & Falkner 1984; Fisher et. al., 1980; Garbarino, 1980; Guiterres 8c Reich, 1981). Their reaction to the maltreatment may be glossed over as an “adolescent adjustment reaction,” as criminality, or as immoral behavior. Such behavior tends to involve adolescents with the courts, and with alternative service networks. The ambiguous status of adolescents’ legal rights which results in a lack of clarity as to whether they should be treated as adults or as children further clouds the issue (Caldwell, 1980; Zimring, 1982). Because of these difficulties, it is important for us to understand how adolescent abuse cases are identified and to determine the extent to which organizations other than child pi-otection agencies are involved with teens who have been abused and neglected. It is particularly important to examine whether trends that point to under-reporting of higher status families further complicate the recognition and investigation of adolescent maltreatment (Mrazek, 1981; Straus et. al., 1980). Study Questions. The issues raised by prior research lead to three broad questions that are addressed in this study: (1) What are the characteristics of the maltreated adolescents and their families? (2) What forms of maltreatment do the teens experience? (3) How do service organizations respond to the victims and their families? As each question is examined, the ways in which adolescents maltreatment differs from the experience of younger children will also be looked at. Methodology This study of adolescent maltreatment used information from the 1980 National Study of the Incidence and Severity of Child Abuse and Neglect (National Center on Child Abuse and Neglect, 19SI). Data from that study were re-analyzed with a focus specilitally on adolescents. These data have provided the basis for analysis of other significant problems, including sexual abuse and abuse by teen parents (Finkeihor & Hotaling, 1984; Miller, 1984). Some information desirable to have was not present in the data (such as, whether the parents had been maltreated when they were chii-
Youth at Risk
17
dren). Nevertheless, the National Incidence Study is the most comprehensive and reliable information available on the incidence and severity of child abuse and neglect. Measurement. Following the precedent of other studies, adolescents were defined in this study as ranging from 12 to 17 years of Center on Child Abuse and Neage (Fisher et al., 1980; National glect, 198 1). Maltreatment was examined using survey questions on the nature of abuse and neglect, its severity, and the source of information for the report. Maltreatment was defined as a situation where, through purposive acts of marked inattention to the child’s basic needs, behavior of a parent/substitute or other adult caretaker caused forseeable and avoidable injury or impairment to a child or materially contributed to unreasonable prolongation or worsening of an existing injury or impairment. (National Center on Child Abuse and Neglect, 1981, pp. 11-12) Physical maltreatment required evidence of a visible injury for a 48 hour period. Sexual maltreatment required evidence that the act had occurred, but did not require physical evidence of the action. Emotional maltreatment required evidence of emotional or mental health impairment of the child resulting from verbal assault, rejection, withholding affection, or inattention to the child’s emotional needs. Evidence of emotional or mental health impairment included: attempted suicide, running away, stuttering with sudden onset, a drop in the child’s academic performance, sudden and persistent loss of emotional control, or severe withdrawal, anxiety, or depression. For detailed definitions of each type of abuse or neglect, the reader is referred to the technical report of the National Incidence Study (National Center on Child Abuse and Neglect, 198 1). Sampling. The National Incidence Study of Child Abuse and Neglect included a nationally representative sample of cases of child abuse and neglect. The total sample included both alleged and confirmed cases. Reports were gathered from Child Protective Services (CPS) agencies, hospitals, schools, police and other social service agencies. For purposes of identifying the highest level at which cases had been recognized, these reports were classified with those known to CPS agencies, those known to other investigatory agency (for example, law enforcement agencies and public health departments), and those known only to other agencies included in this study (for example, schools, hospitals, mental health clinics,
18
Olsen and Holmes
and private child welfare agencies) (National Center on Child Abuse and Neglect, 1981). The sample does not include cases of abuse by anonymous strangers. However, such abuse is believed to be a small portion of the total number of mistreated youth. These sampling procedures resulted in a broader and more encompassing data base than that contained in the official report of CPS agencies alone. It is the broadest sample available of clearly identifiable cases of maltreatment. In order to focus our analysis upon clear cases of abuse and neglect, all non-confirmed cases are eliminated. These were cases which a CPS investigation rejected as “not substantiated,” or cases in which a project case reviewer found the allegations to be unsL~pported by the evidence. Including the unsubstantiated cases would raise serious questions about the reliability of the findings when examining correlates of each type of abuse. Children for whom the only form of maltreatment reported was that of educational neglect were also excluded from the analysis in order to make the findings more compatible with other studies of abuse and neglect. Data Analpi. Differences reported by the National Center on Child Abuse and Neglect in the type of severity of maltreatment experienced by adolescents were elaborated upon in this study. As in the report of the National Incidence Study, the data selected for analvsis were weighted to better represent the national populat~t~n of children under 18 years of age using weights contained in the data set.’ Questions were examined by means of frequency distributions, bivariate crosstabulations and Pearson’s correlations, and Ioglinear analysis. The presence of a relatio~lship was judged according to statistical as well as substantive criteria. The alpha levels for significance tests were set at .Ol because the sample size is large and we wished to eliminate very weak, but statistically unlikely, findings. In addition, to emphasize the stronger findings all standardized measures of association were required to be greater than . IO or Iess than - .LO. In most cases, bivariate relatiollsIlips were strong enough that they did not disappear when controlling for other correlates. Thus, the log-linear analysis results are not discussed separately from the results of the bivariate analysis. ‘These weights tvere divided by 100 in order to avoid infiating the statistical significance ctf the results while maintaining the representativeness of the sample (see Olsen and Holmes, 1980, for details of’ this procedure).
Youth at Risk
19 Findings
Profile of the Adolescents and their Families. A total of 192,000 youths between the ages of 12 and 17 were known to be abused or neglected in 1980. They represented 42% of all substantiated cases of abuse and neglect reported by child protective service agencies, agenother investigating agencies, and various non-investigatory cies included in this study. Characteristics of these children and their families are reported in Table 1. In Table 1 we see that most maltreated adolescents were white. In addition, the contrast between the adolescents and younger children suggests that white youth face a greater risk of maltreatment once they enter adolescence, while the risk for minority youth tends to decline. The data in Table 1 also indicate that adolescent girls face a far greater risk of abuse and neglect that do adolescent boys. The comparison between teens and pre-teens further suggests that girls face a greater risk of abuse once they enter the teen years, whereas the risk for boys declines. Eighty-five percent of these youths’ mothers and 95% of their fathers were identified as perpetrators. In Table 1, it is shown that nearly all these adolescents were related to their mothers through birth, but that a sizable proportion of their fathers were stepparents. The relationship between teenaged children and their stepparents is an important element in the maltreatment they experience. A comparison of these findings with the pre-teen group indicates that one third of the adolescents were stepchildren, in contrast with one fourth of the children under 12 years. Data in Table 1 further indicate that the abused and neglected youth included in this study tended to be the only victim within the household. The findings also show that adolescents, particularly older adolescents, were more often singled out for abuse and neglect than were their younger counterparts. In looking at family size, it is found that maltreated adolescents were in families having an average of two children in the household. One fourth were only children, and 10% were in homes having five or more children, with the number of children ranging up to nine (less than 1%). The number of children in the household did not differ significantly for pre-adolescents and adolescents. The study included a variety of questions about the parents’ education, employment, and income. In Table 1, it is shown that parents of maltreated adolescents tended to be better educated and to have a higher family income than parents of younger children.
20
Olsen TABLE
Characteristics
and Holmes
1
of Abused and Neglected Youth By Age* Under 12 years
12 Years 12-14
(266,100),
c/c(SO,SOo),
yrs
and Older
15-17
% (111,200),
yrs
‘l‘otal
%(lun,ooo),
Ethnicit) White Black Hispanic other
79.4 13.6 5.5 1.5
81.7 14.9 2.6 0.8
91.0 7.2 1.5 0.3
87.0 10.5 2.0 0.5
Sex !vTale Female
53.5 46.5
40.4 59.6
34.8 65.2
37.1 62.9
Relationship to Mother Natural Child Stepchild other
92.1 4.0 3.9
86.7 8.4 4.9
X8.8 7.3 3.9
87.9 7.7 4.4
Relationship to Father Natural Child Stepchild other
71.1 21.7 6.6
69.2 21.1 9.7
69.5 26.2 4.3
69.4 24.1 6.5
Number of Victims in Household Single Victim Multiple Victims
61.6 38.4
62.2 37.8
72.3 27.7
68.1 3 1.9
Father’s Education Less than 9 years Some High School High School Graduate Post High School
8.1 39.9 37.2 14.8
9.0 35.0 39.0 18.0
10.0 23.0 36.0 32.0
9.3 27.4 37.4 25.9
Mother’s Education Less than 9 years Some High School High School Graduate Post High School
15.1 47.5 29.0 8.4
12.0 38.5 33.0 16.5
12.2 28.9 43.2 15.7
12.1 33.1 38.7 16.1
Father’s Employment Full-time Part-time Unemployed Not in Labor Force
71.5 7.6 7.0 13.8
79.8 3.5 5.6 11.2
85.4 2.0 3.0 9.6
83.1 2.6 4.1 10.2
‘/c
Youth at Risk
21 TABLE 1 Continued Under 12 years (266,100),
Mother’s Employment Full-time Part-time Unemployed Not in Labor Force Family Income Under $7,000 $7,000-$14,999 $15,000 or more *Numbers
in Parentheses
12 Years
and
Older
Total 12-14 yrs 15-17 yrs % (80,800), % (111,200), %(le,ooo),
26.4 6.4 5.3 63.2
48.0 5.3 3.3 43.5
41.7 8.1 2.5 47.5
44.4 6.9 2.8 45.9
49.3 39.8 10.9
29.3 45.1 25.6
20.6 40.0 39.3
24.1 42.1 33.8
are National
7~
estimates.
The employment picture for parents of maltreated teens was quite similar to that reported for men and women nationally (U.S. Bureau of the Census, 1980). In contrast with the parents of younger children, these parents were more often active participants in the labor force. Because families of adolescents were better off economically, they were not very often receiving Aid for Dependent Children (AFDC), nor were they likely to be eligible for Medicaid. Approximately one out of every six families with a maltreated adolescent were reported as beneficiaries, in contrast with one out of every three families with children under 12 years.
Forms of Maltreatment. Three out of every four (145,079) adolescents included in this study were abused. Physical assault was the most frequent form of abuse (involving 79,600 adolescents), followed by emotional abuse (61,700) and sexual abuse (23,400). Adolescents were less likely to have been physically assaulted than younger children. Instead, they were more often the victims of both emotional and sexual abuse. Figure 1 demonstrates several significant trends in the occurrence of abuse. While physical abuse insignificantly once creased during the early teen years, it declined the youth turned 15 years of age. The risk of sexual abuse doubled once the youth reached the age of puberty, and then increased slightly during the early teen years. Incidences of emotional abuse were reported with increasing frequency until the youth reached adolescence and peaked during the later teen years. One in four (54,420) adolescents experienced some form of
Olsen and Holmes
22
Percent
10
FIGURE 1 Abuse by Age of the Children
: .-__---_ : 1 */-
OWinul~~ t
_--
pJjvlcD=”
.’
I
6
it
<
(Age) Physical Abuse Sexual Abuse-----------Emotional
Abuse...-........
neglect. One out of seven (27,863) were subject to emotional neglect, and another one out of every seven (27,052) experienced physical neglect. While these youth were less likely to be physically neglected than children under 12 years, they were more often subject to emotional neglect. In Figure 2, it is shown that physical neglect tended to decrease in frequency as children got older. There was little fluctuation in the frequency with which youth experienced emotional neglect until they turned 15 years of age, when the risk of emotional neglect increased substantially.
Types of Allegations. The specific types of allegations reported in cases of adolescent maltreatment speak to the difficu!ty of the adolescent period and to the special tensions this transmonal period presents to family relations. In Table 2, two kinds of abuse-verbalemotional abuse and direct striking of the youth without an object or implement-are shown to account for half of all adolescent maltreatment cases reported. These two types of abuse, along with sexual intrusion, refusal of custody, and permission of maladaptive behavior were all more likely to be reported in cases of adolescent maltreatment than in cases involving younger children.
Youth at Risk
23 FIGURE 2 Percent Neglect by Age of the Children
;
60
z gi
50
=
40
0
wrnu3,g 0
I;Lnm;
I;
*
7
(Age) Physical Neglect Emotionol Neglect--------
Table 3 shows that the severity of the Severity of Maltreatment. cases reported tended to be moderate, pointing to behavioral problems, as well as physical, mental, and emotional conditions with observable symptoms lasting at least 48 hours. A majority of the adolescent cases were classified in this way, with another quarter classified as involving serious injuries. Serious injuries were defined as conditions needing professional treatment to alleviate acute, current suffering or to prevent significant long-term impairment (National Center on Child Abuse and Neglect, 1981). Only a small minority of the cases (4,800) involved life-threatening (4,545) or fatal (255) injuries. It is important to note that teens between the ages of 15 and 17 years sustained a greater percentage of the fatal, life threatening, and serious injuries than did the younger teens. Comparisons with children under 12 years also show that although younger children faced a greater risk of serious injury than adolescents, their chances of sustaining a life threatening or fatal injury were only half as great as those faced by older teens. Thus, for adolescents, particularly for those who are older, maltreatment can involve a serious threat to their health and well-being.
Olsen
24 TABLE Allegations
2
of Abuse and Neglect by Age* Under 12 Years
12 Years and Older
12-14 yrs (266,100), 70 (80,800), % Direct Injury Without Implement With Implement Verbal-emotional Sexual Intrusion Refusal of Custody Permitted Maladaptive Behavior Other ‘Numbers
in parentheses
and Holmes
15-17 yrs Total (111,200) (192,000),
23.7 19.8 14.3 2.4 0.7
28.4 16.7 18.8 6.1 3.2
25.4 7.6 25.9 5.3 8.5
26.7 11.5 22.9 5.6 6.3
0.4 38.6
1.6 25.2
5.6 21.7
3.9 23.1
are National
estimates
TABLE
3
Severity of Maltreatment Under 12 Years
by Age* 12 Years and Older
12-14 yrs 15-17 yrs (266,100), 5%(SO,SOO), 5%(111,200), %( Probable Injury Moderate Serious Life Threatening/ Fatal *Numbers
in parentheses
Total
192,ooo). %
14.7 57.8 25.7
11.4 71.4 15.8
2.6 67.7 25.9
6.4 69.3 21.5
1.8
1.4
3.8
2.8
are National
c/c
estimates.
maltreatIdent$cation of Maltreatment. By whom is teenage ment first seen? In Table 4 it is shown that the majority of cases involving adolescent maltreatment were first identified by the schools. A comparison of these cases with those involving pre-teens further indicates that both law enforcement agencies and schools were more often the first source of report for cases involving adoIn contrast, other agencies (including lescent abuse and neglect. medical authorities and other social service agencies) and other individuals were less often involved in the initial identification of adolescent maltreatment. When maltreatment was first identified by the schools and by
Youth at Risk
25 TABLE Identification
4
of Maltreatment
Under 12 Years
12 Years and Older
12-14 (266,100),%(80,800), Initial Report Schools Law Enforcement Other Agencies Other Individuals Level of Recognition Child Protective Services Other Investigatory Agency Other Agency *Numbers
in parentheses
law enforcement
by Age*
yrs 15-17 yrs Total %(111,200),%(192,ooo),%
41.7 12.1 30.8 15.4
46.4 19.7 20.1 13.8
57.2 24.1 9.0 9.7
52.7 22.1 13.7 11.4
47.5
40.0
25.8
31.8
7.8 44.7
14.9 45.1
18.3 55.8
16.9 51.3
are national estimates.
there agencies, they encountered.
were
several
differences
in
the
In Table 5, law enforcement agencies (which included both the police and the courts) are revealed to be more likely to identify cases of sexual abuse, while schools were most likely to encounter instances of physical and emotional maltreatment. Agencies also differed in the kinds of families they identified in these initial reports. Families identified by law enforcement agencies tended to include fathers who were less educated with less income than those identified by the schools. types
of situations
Level of Recognition. To study the process by which cases were recognized, agencies were divided into three categories representing the highest level at which cases were known: CPS agencies, other investigatory agencies, and other sources. Other investigatory agencies included law enforcement agencies and public health departments. Other sources included hospitals, schools, clinics, mental health agencies, child development centers, and all other agencies from which data were collected. Most cases of adolescent maltreatment had not been reported to CPS agencies. The data reported earlier in Table 4 indicated that one half of the cases involving 12 to 17 years old youth were identified only by non-investigatory agencies such as public schools, hospitals, mental health facilities, and other social service agencies. Only one third of the adolescents were reported to CPS agencies,
‘Type of Xistreatment Physical Abuse Sexual Abuse Emotional Abuse Physica Neglect Emotional Neglect Father’s Education Cnder 9 Years Some High School High School Graduate Post High School Income Cnder $7,000 si,ooo-$14,999 $15,000 or more
Correlates
33.x 53.3 39.4 ‘73.2
41.7 Ii.3 17.2 9.0 33.2 li.1 23. I
5i.Y 20.2 61.9 41.0 54.6
5% Schools,
%
Type oE Agenq
24.5 29.2 43.4 17.8
25.9 34.4 19.6 2f.6 15.5
Other Agencies,
TABLE 5 Adolescent Maltreatment
16.2 45.4 18.5 31.4 29.9
Law Enforcement,
Agency First Identifying
c/c 100.0 100.0 100.0 1no.0 100.0
Percent
Total
by Selected Correlates*
(5 1,700)
(4ti,OOO)
(~~7,000)
(8,300) (23,~O~) (32,000) (22,100)
(79,600) (23,300) (61,700) (27,100) (27,800)
Number
Youth at Risk
27
in comparison with nearly half of the children under 12 years. It is important to note, however, that reports to CPS agencies decreased once the child reached school age, and that the smaller percentage of adolescent cases was a continuation of this trend. The data in Table 6 point to several differences in how cases were handled. These data suggest that the type of maltreating family that came to be recognized by protective agencies tended to have less income and to include fathers who had less education. Families were also reported to CPS agencies more often when they were larger or when they were non-white. In the case of white families, a majority were not even referred to an investigatory agency. Agencies also differed in the rate with which they reported allegations of abuse and neglect. A third of the cases identified by the police were reported to protective service agencies. In contrast, the schools reported only 14c% of their cases to CPS agencies. Reporting to CPS agencies also varied considerably with the type of maltreatment. Sexual abuse was most often reported, while emotional abuse and neglect were the least frequently recognized. This finding concerning emotional maltreatment is, no doubt, related to the fact that criteria for reporting contained in the mandatory reporting. laws are more clear for physical and sexual abuse than for emotional maltreatment. Some states do not even require reporting emotional abuse. It should be noted, however, that substantial under-reporting occurred irrespective of the form of mistreatment involved. With the exception of sexual abuse, a large percentage of these cases never came to the attention of agencies with investigatory responsibility. These findings imply that a considerable amount of abuse and neglect of teenagers is never reported by agencies required to report these incidents. The severity of nlaltreatment also was related to its recognition by CPS agencies. Contrary to expectations, more severe cases were less likely to be reported to CPS agencies. Only 20% of the life threatening cases were known to CPS agencies. Most were known, but not reported by the other non-investigatory agencies. This suggests that the number of teenagers in life threatening circumstances may be more than five times the number known to CPS agencies. by CPS Agencies. Of the cases reported to CPS 45% of those involving adolescents were substantiated.’
Substantiation
agencies,
*For the purpose cluded.
of this analvsis,
both
substantiated
and
non-substantiated
cases were in-
28
Olsen and Holmes
__hh
OUOO 2000 i-.~C3~--
.$0-Y c4 2 iyj--_i-
*Numbers
in parentheses
are national
Initial Report Schools Law Enforcement Other Agencies Type of Mistreatment Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect Severity of Maltreatment Life Threatening Severe Moderate Probable in percentages
14.5 26.2 12.5 15.9
19.6 16.6 30.3 45.3 Differences
8.5 33.3 19.0 18.5 28.9
36.7 53.6 18.7 37.9 Il.5
estimates.
2.0 69.5 2.8
14.0 30.5 41.9
bet\reen
at .Ol alpha
100.0 100.0 100.0 100.0
65.9 57.2 57.2 38.8 ro~vs are significant
100.0 100.0 100.0 100.0 100.0
100.0 100.0 100.0
54.8 13.1 62.4 43.6 60.1
0.0 55.3
83.9
leyel.
(1,920) (37,300) (58,150) (11,100)
(79,600) (23,400) (61,700) (27,100) (37,800)
(101,100) (42,700) (24,600)
f cc 56 E
30
Olsen and Holmes
Cases of adolescent abuse and neglect were more likely to be substantiated than those involving younger children where 40% of the cases were confirmed. Moreover, the likelihood of subs~ntiation increased as the youths got older, with half of the cases involving youths over 14 years of age being substantiated. Data in Table 7 showed that confirmation varied by the type of abuse. Cases involving physical and sexual maltreatment. were more likelv to be substantiated. Sexual abuse was three times as likely, and phy&al abuse twice as likely, to be confirmed as emotional abuse. Physical neglect was nearly four times as likely to be substantiated as emotional neglect. This does not mean t,hat reports of emotional
TABLE 7 Substantiation of Adolescent Cases by Selected Correlates* Subst.anNot Subtiated, ‘3 stantiated, 5’~ Percent
Correlates
Type of Maltreatment Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect Father’s Education Less than 9 years Some High School High School Graduate Post High School Father’s Employment Full time Part time Unemployed Not in Labor Force Income IJnder $7,000 $7,000-$14,999 $15,000 or more Ethnicity White Black Hispanic Other *Numbers in parentheses are significant at .O 1 alpha
Total Number
32.4 49.9 16.5 36.2 9.9
67.6 50.1 83.3 63.8 90.1
100.0 100.0 100.0 100.0 100.0
(79,600) (23,400) (61,700) (27,100) (27,900)
36.8 36.2 46.3 13.4
63.2 63.8 53.7 86.6
100.0 100.0 100.0 100.0
(7,900) (23,400) (3 1,900) (22,200)
29.2 64.0 34.7 42.2
70.8 36.0 65.3 57.8
100.0 100.0 100.0 100.0
(103,60(1) (3.3~0) (5,100) (12,800)
38.8 42.4 23.1
61.2 57.6 76.9
100.0 100.0 100.0
(36,900) (64,400) (51,600)
26.5 45.1 63.7 56.0
73.5 54.9 36.3 44.0
100.0 100.0 100.0 100.0
(164,600) (19,800) (3,700) (1,100)
are national level.
estimates.
Differences
in percentages
between
rows
Youth at Risk
31
maltreatment were necessarily less valid than physical or sexual maltreatment. It could easily be that criteria for recognizing and reporting such cases need to be more reliable and verifiable. It is important to note that cases involving families with lower social status were substantiated more frequently than those with higher social status. Families where the father had no education past high school or was employed part-time, as well as families with incomes below $15,000, had greater chances of having maltreatment substantiated. The effect of lower social status on substantiation is also revealed in the ethnic background of substantiated cases. Just as non-white families were more often reported to CPS agencies, so also did CPS agencies more often confirm reports involving these families. Discussion Adolescents are very clearly a high-risk group. They make up nearly half of all reported cases of abuse and neglect and are particularly vulnerable to emotional and sexual forms of abuse. Many of these teens are in situations having medically serious consequences. In this concluding discussion, the problems experienced by these youth will be summarized and implications for practice will be suggested. C~.ur~cte~ist~cs of the A~oZ@scentsand their F~~~~i~s. The dynamics of stress in families having adolescents is an important issue. One of the most striking aspects of adolescent maltreatment is that it is very much a function of interpersonal stresses between family members. While many of these stresses result from the special strains of the adolescent transition period, another source of stress appears to come from the reconstitution of family units. Teenagers were more often living with stepparents than were younger children. As a consequence, they were more often maltreated by a stepparent. Professionals working with these families must be prepared to help them with the tensions and strains of creating a new family, as well as the special stresses that accompany their children’s transition into adulthood. Coping with the problems of adolescent role transition and family disruption requires working with parents and children to identify new roles appropriate to the changed circumstance of divorce or remarriage and maturation of the child. To aid in role transition, teenagers must be helped in the tasks of individuation, separation from the family, and development of autonomous control over decision making. Parents must be encouraged to acknowledge these changes as appropriate and
32
Olsen and Holmes
desirable for their children, even when they disagree with the choices made by them. Divorce or remarriage pose difficult questions regarding changes in the locus of power in a family and responsibility for decision making. Stepparents must be encouraged to share with adolescents some responsibility for decision making in the family. They must also understand that, even though they are not the natural parents, they have a responsibility to encourage these youth in their maturation. Forms of Maltreatment. This study clearly demonstrates that the risk to adolescents is far greater than has been generally thought. Adolescent maltreatment is a problem that can result in serious injury. Contrary to the popular belief that adolescents can defend themselves, this study shows that older adolescents are even more likely to sustain serious injury than younger teens. Emotional abuse and neglect also increase in intensity as these youth become older, underscoring the need for intervention during the early stages of adolescence to resolve family conflicts. In some cases the abuse and neglect may not, occur until the youth is older and struggling more actively to establish his or her independence from the family unit. In these situations, families need support that will help them to provide their children with guidance while also accepting their children’s need to separate from the family. Services provided for teens need to focus on identification and treatment of problems for which they are most at risk-physical and sexual abuse and emotional maltreatment. Because the problem of emotional abuse and neglect is so under-recognized, hot lines, runaway shelters and other providers likely to come into contact with the teens (especially schools and law enforcement agencies) need further training to better identify emotional abuse and neglect. Options for teenagers at risk need to be significantly increased. In particular, significant resources need to be directed toward our already overburdened child welfare system to handle the increased demand that identification of such cases will place on the system. Re~or~~r~g of ~~~~t~e~tm~nt. Cases of adolescent abuse and neglect were far less likely to be reported to CPS agencies than cases involving younger children. Part of the reason for this can be found in the fact that there was greater willingness to report and substantiate allegations involving families with lower socio-economic status. Families with higher incomes and in which the parents were better educated, as well as white families, were all less
33
Youth at Risk
likely to be reported to protective service agencies and to have allegations of maltreatment confirmed. Because maltreated adolescents more often come from these types of families, they are more likely to be hidden from the protective service system. Protective services for these youth will depend in part upon more equitable implementation of our reporting laws. Specialized training in identifying emotional maltreatment is also needed. Emotional abuse and neglect were the least likely to be reported of the various forms of maltreatment. Problems, such as extreme anger or delinquency, suicide attempts, self-mutilation, depression, need greater recognition as potential symptoms of emotional maltreatment. Such behavior should not be automaticatly labeled as “adolescent adjustment syndrome.” Workers should be taught to evaluate it in light of the parent/child relationshipespecially if parents are extremely critical and denigrating of the child or threaten the child with physical or sexual abuse. between schools, police, and CPS Improved coordination agencies may also increase the recognition of adolescent maltreatment. Appointing particular individuals, who will deal with teenagers as contact persons with whom one can discuss a possibIe case, may overcome reluctance to report and enhance the awareness of co-workers about the special problems of adolescents. The legal status of adolescents is particularly ambiguous. Court officers and service workers may have few options when the law favors the wishes of the parents over those of the adolescent. Giving more legal weight to the desires of the teenager would be beneficial for the adolescent’s sense of individual worth, autonomy, and ability to make responsible decisions. Working in these ways, efforts and services to address the problem of abuse and neglect can be better targeted to support these youth in their struggle to become emotionally healthy adults. Failure to respond to the needs of these adolescents will deprive us of their full contribution to our society. References American
Humane Association. (I 984). Trends in child abuse and neglect: A ~~ational Denver, Colorado: American Humane Association. Biller, H. B. (1971). Father, child, and sex role. Lexington, Massachusetts: Lexington Books. BIOS, P. (1972). The child analyst looks at the young adolescent. In J. Kagan & R. Coles (Eds.), Twelve to sixteen: Early adolescence (pp. 5?5-72). New York: W. W. Norton. Burgess, R. L., Anderson, E. A., Schellenbach, C. J., & Conger, R. D. (1981). A social interactional approach to the study of abusive Families. In J. P. Vincent ~ers~ectiue.
Olsen and Holmes (Ed.),
Aduunces in family intervention, assessment and theory, Volume 2 (pp. l-46). Sew York: JAI Press. Caldwell, B. (1980). Balancing children’s rights and parents’ rights. In R. Haskins 8c J. Gallagher (Eds.), Cure and educution ofyoung child?-en in Ameriru (pp. 27-X). Not-wood, NJ: Ablex. Cicchetti, D., & Rizley, R. (1981). Developmental perspectives on the etiolog!, intergenerational transmission, and sequelae of child maltreatment. In R. Rizle)- 8c D. Cicchetti (Eds.), Developmental perspectives on child maltreatment (Se!\ Directions for Child Development, number 11) (pp. 31-55). San Francisco: Jossey-Bass. Daly, M., & Wilson, M. (198 1). Child maltreatment from a sociobiological perspective. In R. Rizley & D. Cicchetti (Eds.), Developmentul per.spe&~ on child multreatment (h’ew Directions for Child Development, number 1 I) (pp. 93-l 12). San Francisco: Jossey-Bass. Elmer, E. (1979). Child abuse and family stress. Journul o{ Social Is~ue.r, 35, 60-7 I. Enright, R. D., Lapsky, D. K., Drivas, I. E., & Fehr, L. A. (1980). Parental influences on the development of adolescent autonomy and identity. Journal of Youth and Adolexence,
9, S29-S4;.
Erikson, E. (1963). Childhood nnd society (2nd ed.). New Y’ork: Norton. Erikson, E. (1968). Identity, youth und cri.sis. Ne\v York: Norton. Farber, E., McCoard, W. D., Kinart, C.. & Falkner, D. (1984). C’iolence in the families of adolescent runaways. Child Abuse and Neglect, 8, 295-300. Finkelhor, D., & Hotaling, G. (1984). Sexual abuse in the national incidence stud?, of child abuse and neglect. Child Abuse and ;Veglect, 8, 23-33. Fisher, B., Berdie, J., Cook, J.. & Day, N. (1980). Adolescent ubxe and neglert. Intervention strutegies. Washington, D.C.: National Center on Child Abuse and Neglect. Freud, A. (1978). Adolescence as a developmental disturbance. In I‘. Cottle (Ed.), Readings in adolescent psychology (pp. 52-56). New York: Harper 8c Row. Carbarino, J. (1980). Meeting the needs of mistreated youth. Social FI’ork, 25, 122-126. Carbarino, J. (1984). Adolescent maltreatment, a guide for practice and polic!. Practice Applications, 2, 1- 1 1. Carbarino, J., & Cilliam, G. (1980). Understanding abusive fumi1ie.r. Lexington, Massachusetts: D.C. Heath. Garbarino, J., Sebes, J., & Schellenbach, C. (1984). Families at risk of destructive parent-child relations in adolescence. Child Development, 55, 174-183. Gordon, C. (1972). Social characteristics of early adolescence. In J. Kagan & K. Coles (Eds.), Twelve to .&teen: Earb adoletcence (pp. 25-54). New York: W. \V. Norton. Guiterres, S. E., & Reich, J. W. (1981). A developmental perspective on runaway behavior: Its relationship to child abuse. Child We&?-e, 60, 89-94. Halperin, S. M., & Smith, I’. A. (1983). Differences in stepchildren’s perceptions of their stepfathers and natural fathers: Implications for family therapy. Journal of Divorce,
7, 19-30.
Incidence Holmes, MT., & Olsen, L. (1982). Ad o 1escent maltreatment: Massachusetts: Northeastern University, Center for Applied
and riJk. Boston, Social Research.
Youth at Risk
35
Justice, B., & Justice, R. (1976). The abusingfamil3 New York: Human Sciences Press. Lourie, I. S. (1977). The phenomenon of the abused adolescent: A clinical study. Victimology, 4, 268-276.
Lourie, I. S. (1979). Family dynamics and abuse of adolescents: ,4 case for a developmental phase specific model of child abuse. Child Abuse and ll:eglect, 3, 967- 1174. Martin, M., & Walters, J. (1982). Familial correlates of selected types of child abuse and neglect. Journal of Marriage and the Family, 44, 267-286. Miller, S. H. (1984). The influence of adolescent childbearing on the incidence, type, and severity of child maltreatment. Child Welfare, 22, 34-39. Mrazek, P. (198 1). Definition and recognition of sexual child abuse: Historical and cultural perspectives. In P. Mrazek & H. Kempe (Eds.), Sexuully abused children and their families (pp. 45-62). ?
and Maltreatment
Lenore J. Olsen Rhode Island College William M. Holmes University Northeastern
Data from the National Incidence Study of Child Abuse and Neglect are used to examine the maltreatment of adolescents. The discussion considers the type of maltreatment adolescents experience and the response of service agencies. Adolescents are compared with younger children to identify differences in the form of abuse and neglect they experience and the reporting of that mistreatment. Implications of the results are noted for programs serving youth who have been abused and neglected.
Relatively little of the current literature on child abuse and neglect addresses the issue of adolescent maltreatment. It is only within the last several years that investigators have begun to focus on the problems of maltreatment among adolescents. However, studies Funding for this study was provided by the National Center for Child .L\buse and Seglect grant 90CA843/01 to the Center for Applied Social Research, Northeastern University. Opinions expressed in the paper are not those of the National Center on Child Abuse and Neglect, nor its employees. The authors wish to acknowledge the research assistance of Teresa Llayors. An earlier version of this paper was presented at the American Orthopsychiatric Assoctation annual meeting, Boston Massachusetts, 1983. Requests for reprints should be sent to Lt’illiam XI. Holmes, Center for Applied Social Research, Northeastern University, 360 Huntington Avenue, Boston, MA 02115, 13
14
Olsen and Holmes
which have examined these problems have indicated that at least one out of every four child abuse cases involves an adolescent (American Humane Association, 1984; Lourie, 1977; National Center on Child Abuse and Neglect, 1981). Moreover, the National Incidence Study (National Center on Child Abuse and Neglect, 1981) pointed to an incidence rate which was twice as great among adolescents (12.9 per 1,000 teens) as among younger children (6.3 per 1,000 children). These studies point to a large number of adolescents who are abused or neglected by their parents or caretakers. Holmes and Olsen (1982) found that adolescents made up 42% of all confirmed cases in the National Incidence Study of Child Abuse and Neglect. Applied to an estimated half million known cases of abuse and neglect annually (National Center on Child Abuse and Neglect, 1981), this suggests that there are at least 200,000 teens who are abused or neglected each year. These studies raise questions about the risks adolescents face. What types of maltreatment do the victims suffer? How severe is it when it does occur? How does it get reported and to whom? Adolescence and Family Conflict The many task and role changes involved in the transition from childhood to adulthood pose a continuous series of challenges for adolescents and the adults who must deaI with them. The development of an adult identity, the growth of aLitonollly, and the acquisition of new roles by the adolescent are all processes that may lead to conflict with parents (Blos, 1972; Erikson, 1963, 1968; Freud, 1978; Cordon, 1972). Teenage girls attempting to establish their autonomy may be particuIarIy vulnerable to parents who are more autocratic or authoritarian and expect their daughters to be compliant (Enright, Lapsky, Drivas & Fehr, 1980). Such conflict can be intensified by pre-existent stresses in the family, new stresses, and changes associated with the family’s life cycle (Garbarino & Gilliam, 1980; Lourie, 1979). Because of childrearing patterns, parents may be undergoing a mid-Iife crisis of their own as their children enter adolescence. M’hen children are in their teens, parents tend to be in their mid-thirties to mid-forties. The self-examination of the teen may strike a particularly sensitive issue with parents facing their own crisis of identity (Fisher, Berdie, Cook & Day, 1980; Justice &Justice, 1976; Ziefert, 1981). This may also coincide with other crises in the family, such as divorce, death of grandparents, or e~lp~oyment change. Such change may stress the f-amily so severely that abuse or neglect of the adolescent results (Elmer, 1979). In remarried families, for
Youth at Risk
15
example, interpersonal difficulties between step-parents and adolescent step-children are quite common, a phenomenon referred to by Burgess, Anderson, Schellenbach and Conger (1981) as the “Cinderella Effect.” These difficulties may arise from conflicts between step-parents and their adolescent step-children over their relative power within the family (Biller, 197 1; Halperin & Smith, 1983; Visher & Visher, 1979), and from the lower investment that step-parents may have in their step-children(Burgess et al., 1981; Daly 8c Wilson, 1981). Coupled with the challenges presented by adolescents as they make the transition to adulthood, it is, therefore, not surprising to find an increased risk of abuse in families where there is a step-parent (Daly SC Wilson, 1981; Garbarino, Sebes & Schellenbach, 1984). Cicchetti and Rizley (198 1) have classified these problems as potentiating and compensatory factors. Potentiating factors increase the likelihood of maltreatment, while compensatory factors decrease that risk. Other potentiating factors which may influence the ways in which conflicts between adolescents and their families are handled include: (1) the employment status of the caretaker, (2) the educational status of the caretaker, (3) the number of children in the household, (4) the income level of the family, and (5) ethnicity of the family (Burgess et. al., 1981; Justice & Justice, 1976; Martin & Walters, 1982; Straus, Gelles & Steinmetz, 1980). Forms of Maltreatment
Such diverse problems as economic stress and problems in role functioning may lead to different forms of maltreatment, different agency involvement, and different service needs (Garbarino & Gilliam, 1980; Martin & Walters, 1982). For example, neglect is known to be associated with economic stress, while emotional abuse is more often associated with interpersonal stress (Garbarino & Gilliam; Martin & Walters). The type of maltreatment experienced also varies by the developmental phase of the child and the life cycle of the family (Garbarino, 1984; Garbarino & Gilliam, 1980; Lourie, 1979). For example, physical neglect is more common for younger children and their families, while sexual abuse is more frequent among families with adolescents (Finkelhor SC Hotaling, 1984; Garbarino & Gilliam). Families with teens are also likely to face an increased risk of emotional abuse and neglect because of the increased interpersonal stresses with which they are faced (Garbarino 8c Gilliam). In order to adequately serve these teens and their families, it is important for us to understand the specific types of harm these youth are likely to experience and the severity of that harm.
Olsen and Holmes
16 Reporting Maltreatment
Reacting to these stresses, problems, and conflicts can lead to youth behaving in ways that are labeled by adults as disruptive and uncontrollable, thus obscuring the fact of maltreatment. As a result, adolescent abuse is often hidden within such other problems as parent-child conflict, running away, and delinquency (Farber, McCoard, Kinart & Falkner 1984; Fisher et. al., 1980; Garbarino, 1980; Guiterres 8c Reich, 1981). Their reaction to the maltreatment may be glossed over as an “adolescent adjustment reaction,” as criminality, or as immoral behavior. Such behavior tends to involve adolescents with the courts, and with alternative service networks. The ambiguous status of adolescents’ legal rights which results in a lack of clarity as to whether they should be treated as adults or as children further clouds the issue (Caldwell, 1980; Zimring, 1982). Because of these difficulties, it is important for us to understand how adolescent abuse cases are identified and to determine the extent to which organizations other than child pi-otection agencies are involved with teens who have been abused and neglected. It is particularly important to examine whether trends that point to under-reporting of higher status families further complicate the recognition and investigation of adolescent maltreatment (Mrazek, 1981; Straus et. al., 1980). Study Questions. The issues raised by prior research lead to three broad questions that are addressed in this study: (1) What are the characteristics of the maltreated adolescents and their families? (2) What forms of maltreatment do the teens experience? (3) How do service organizations respond to the victims and their families? As each question is examined, the ways in which adolescents maltreatment differs from the experience of younger children will also be looked at. Methodology This study of adolescent maltreatment used information from the 1980 National Study of the Incidence and Severity of Child Abuse and Neglect (National Center on Child Abuse and Neglect, 19SI). Data from that study were re-analyzed with a focus specilitally on adolescents. These data have provided the basis for analysis of other significant problems, including sexual abuse and abuse by teen parents (Finkeihor & Hotaling, 1984; Miller, 1984). Some information desirable to have was not present in the data (such as, whether the parents had been maltreated when they were chii-
Youth at Risk
17
dren). Nevertheless, the National Incidence Study is the most comprehensive and reliable information available on the incidence and severity of child abuse and neglect. Measurement. Following the precedent of other studies, adolescents were defined in this study as ranging from 12 to 17 years of Center on Child Abuse and Neage (Fisher et al., 1980; National glect, 198 1). Maltreatment was examined using survey questions on the nature of abuse and neglect, its severity, and the source of information for the report. Maltreatment was defined as a situation where, through purposive acts of marked inattention to the child’s basic needs, behavior of a parent/substitute or other adult caretaker caused forseeable and avoidable injury or impairment to a child or materially contributed to unreasonable prolongation or worsening of an existing injury or impairment. (National Center on Child Abuse and Neglect, 1981, pp. 11-12) Physical maltreatment required evidence of a visible injury for a 48 hour period. Sexual maltreatment required evidence that the act had occurred, but did not require physical evidence of the action. Emotional maltreatment required evidence of emotional or mental health impairment of the child resulting from verbal assault, rejection, withholding affection, or inattention to the child’s emotional needs. Evidence of emotional or mental health impairment included: attempted suicide, running away, stuttering with sudden onset, a drop in the child’s academic performance, sudden and persistent loss of emotional control, or severe withdrawal, anxiety, or depression. For detailed definitions of each type of abuse or neglect, the reader is referred to the technical report of the National Incidence Study (National Center on Child Abuse and Neglect, 198 1). Sampling. The National Incidence Study of Child Abuse and Neglect included a nationally representative sample of cases of child abuse and neglect. The total sample included both alleged and confirmed cases. Reports were gathered from Child Protective Services (CPS) agencies, hospitals, schools, police and other social service agencies. For purposes of identifying the highest level at which cases had been recognized, these reports were classified with those known to CPS agencies, those known to other investigatory agency (for example, law enforcement agencies and public health departments), and those known only to other agencies included in this study (for example, schools, hospitals, mental health clinics,
18
Olsen and Holmes
and private child welfare agencies) (National Center on Child Abuse and Neglect, 1981). The sample does not include cases of abuse by anonymous strangers. However, such abuse is believed to be a small portion of the total number of mistreated youth. These sampling procedures resulted in a broader and more encompassing data base than that contained in the official report of CPS agencies alone. It is the broadest sample available of clearly identifiable cases of maltreatment. In order to focus our analysis upon clear cases of abuse and neglect, all non-confirmed cases are eliminated. These were cases which a CPS investigation rejected as “not substantiated,” or cases in which a project case reviewer found the allegations to be unsL~pported by the evidence. Including the unsubstantiated cases would raise serious questions about the reliability of the findings when examining correlates of each type of abuse. Children for whom the only form of maltreatment reported was that of educational neglect were also excluded from the analysis in order to make the findings more compatible with other studies of abuse and neglect. Data Analpi. Differences reported by the National Center on Child Abuse and Neglect in the type of severity of maltreatment experienced by adolescents were elaborated upon in this study. As in the report of the National Incidence Study, the data selected for analvsis were weighted to better represent the national populat~t~n of children under 18 years of age using weights contained in the data set.’ Questions were examined by means of frequency distributions, bivariate crosstabulations and Pearson’s correlations, and Ioglinear analysis. The presence of a relatio~lship was judged according to statistical as well as substantive criteria. The alpha levels for significance tests were set at .Ol because the sample size is large and we wished to eliminate very weak, but statistically unlikely, findings. In addition, to emphasize the stronger findings all standardized measures of association were required to be greater than . IO or Iess than - .LO. In most cases, bivariate relatiollsIlips were strong enough that they did not disappear when controlling for other correlates. Thus, the log-linear analysis results are not discussed separately from the results of the bivariate analysis. ‘These weights tvere divided by 100 in order to avoid infiating the statistical significance ctf the results while maintaining the representativeness of the sample (see Olsen and Holmes, 1980, for details of’ this procedure).
Youth at Risk
19 Findings
Profile of the Adolescents and their Families. A total of 192,000 youths between the ages of 12 and 17 were known to be abused or neglected in 1980. They represented 42% of all substantiated cases of abuse and neglect reported by child protective service agencies, agenother investigating agencies, and various non-investigatory cies included in this study. Characteristics of these children and their families are reported in Table 1. In Table 1 we see that most maltreated adolescents were white. In addition, the contrast between the adolescents and younger children suggests that white youth face a greater risk of maltreatment once they enter adolescence, while the risk for minority youth tends to decline. The data in Table 1 also indicate that adolescent girls face a far greater risk of abuse and neglect that do adolescent boys. The comparison between teens and pre-teens further suggests that girls face a greater risk of abuse once they enter the teen years, whereas the risk for boys declines. Eighty-five percent of these youths’ mothers and 95% of their fathers were identified as perpetrators. In Table 1, it is shown that nearly all these adolescents were related to their mothers through birth, but that a sizable proportion of their fathers were stepparents. The relationship between teenaged children and their stepparents is an important element in the maltreatment they experience. A comparison of these findings with the pre-teen group indicates that one third of the adolescents were stepchildren, in contrast with one fourth of the children under 12 years. Data in Table 1 further indicate that the abused and neglected youth included in this study tended to be the only victim within the household. The findings also show that adolescents, particularly older adolescents, were more often singled out for abuse and neglect than were their younger counterparts. In looking at family size, it is found that maltreated adolescents were in families having an average of two children in the household. One fourth were only children, and 10% were in homes having five or more children, with the number of children ranging up to nine (less than 1%). The number of children in the household did not differ significantly for pre-adolescents and adolescents. The study included a variety of questions about the parents’ education, employment, and income. In Table 1, it is shown that parents of maltreated adolescents tended to be better educated and to have a higher family income than parents of younger children.
20
Olsen TABLE
Characteristics
and Holmes
1
of Abused and Neglected Youth By Age* Under 12 years
12 Years 12-14
(266,100),
c/c(SO,SOo),
yrs
and Older
15-17
% (111,200),
yrs
‘l‘otal
%(lun,ooo),
Ethnicit) White Black Hispanic other
79.4 13.6 5.5 1.5
81.7 14.9 2.6 0.8
91.0 7.2 1.5 0.3
87.0 10.5 2.0 0.5
Sex !vTale Female
53.5 46.5
40.4 59.6
34.8 65.2
37.1 62.9
Relationship to Mother Natural Child Stepchild other
92.1 4.0 3.9
86.7 8.4 4.9
X8.8 7.3 3.9
87.9 7.7 4.4
Relationship to Father Natural Child Stepchild other
71.1 21.7 6.6
69.2 21.1 9.7
69.5 26.2 4.3
69.4 24.1 6.5
Number of Victims in Household Single Victim Multiple Victims
61.6 38.4
62.2 37.8
72.3 27.7
68.1 3 1.9
Father’s Education Less than 9 years Some High School High School Graduate Post High School
8.1 39.9 37.2 14.8
9.0 35.0 39.0 18.0
10.0 23.0 36.0 32.0
9.3 27.4 37.4 25.9
Mother’s Education Less than 9 years Some High School High School Graduate Post High School
15.1 47.5 29.0 8.4
12.0 38.5 33.0 16.5
12.2 28.9 43.2 15.7
12.1 33.1 38.7 16.1
Father’s Employment Full-time Part-time Unemployed Not in Labor Force
71.5 7.6 7.0 13.8
79.8 3.5 5.6 11.2
85.4 2.0 3.0 9.6
83.1 2.6 4.1 10.2
‘/c
Youth at Risk
21 TABLE 1 Continued Under 12 years (266,100),
Mother’s Employment Full-time Part-time Unemployed Not in Labor Force Family Income Under $7,000 $7,000-$14,999 $15,000 or more *Numbers
in Parentheses
12 Years
and
Older
Total 12-14 yrs 15-17 yrs % (80,800), % (111,200), %(le,ooo),
26.4 6.4 5.3 63.2
48.0 5.3 3.3 43.5
41.7 8.1 2.5 47.5
44.4 6.9 2.8 45.9
49.3 39.8 10.9
29.3 45.1 25.6
20.6 40.0 39.3
24.1 42.1 33.8
are National
7~
estimates.
The employment picture for parents of maltreated teens was quite similar to that reported for men and women nationally (U.S. Bureau of the Census, 1980). In contrast with the parents of younger children, these parents were more often active participants in the labor force. Because families of adolescents were better off economically, they were not very often receiving Aid for Dependent Children (AFDC), nor were they likely to be eligible for Medicaid. Approximately one out of every six families with a maltreated adolescent were reported as beneficiaries, in contrast with one out of every three families with children under 12 years.
Forms of Maltreatment. Three out of every four (145,079) adolescents included in this study were abused. Physical assault was the most frequent form of abuse (involving 79,600 adolescents), followed by emotional abuse (61,700) and sexual abuse (23,400). Adolescents were less likely to have been physically assaulted than younger children. Instead, they were more often the victims of both emotional and sexual abuse. Figure 1 demonstrates several significant trends in the occurrence of abuse. While physical abuse insignificantly once creased during the early teen years, it declined the youth turned 15 years of age. The risk of sexual abuse doubled once the youth reached the age of puberty, and then increased slightly during the early teen years. Incidences of emotional abuse were reported with increasing frequency until the youth reached adolescence and peaked during the later teen years. One in four (54,420) adolescents experienced some form of
Olsen and Holmes
22
Percent
10
FIGURE 1 Abuse by Age of the Children
: .-__---_ : 1 */-
OWinul~~ t
_--
pJjvlcD=”
.’
I
6
it
<
(Age) Physical Abuse Sexual Abuse-----------Emotional
Abuse...-........
neglect. One out of seven (27,863) were subject to emotional neglect, and another one out of every seven (27,052) experienced physical neglect. While these youth were less likely to be physically neglected than children under 12 years, they were more often subject to emotional neglect. In Figure 2, it is shown that physical neglect tended to decrease in frequency as children got older. There was little fluctuation in the frequency with which youth experienced emotional neglect until they turned 15 years of age, when the risk of emotional neglect increased substantially.
Types of Allegations. The specific types of allegations reported in cases of adolescent maltreatment speak to the difficu!ty of the adolescent period and to the special tensions this transmonal period presents to family relations. In Table 2, two kinds of abuse-verbalemotional abuse and direct striking of the youth without an object or implement-are shown to account for half of all adolescent maltreatment cases reported. These two types of abuse, along with sexual intrusion, refusal of custody, and permission of maladaptive behavior were all more likely to be reported in cases of adolescent maltreatment than in cases involving younger children.
Youth at Risk
23 FIGURE 2 Percent Neglect by Age of the Children
;
60
z gi
50
=
40
0
wrnu3,g 0
I;Lnm;
I;
*
7
(Age) Physical Neglect Emotionol Neglect--------
Table 3 shows that the severity of the Severity of Maltreatment. cases reported tended to be moderate, pointing to behavioral problems, as well as physical, mental, and emotional conditions with observable symptoms lasting at least 48 hours. A majority of the adolescent cases were classified in this way, with another quarter classified as involving serious injuries. Serious injuries were defined as conditions needing professional treatment to alleviate acute, current suffering or to prevent significant long-term impairment (National Center on Child Abuse and Neglect, 1981). Only a small minority of the cases (4,800) involved life-threatening (4,545) or fatal (255) injuries. It is important to note that teens between the ages of 15 and 17 years sustained a greater percentage of the fatal, life threatening, and serious injuries than did the younger teens. Comparisons with children under 12 years also show that although younger children faced a greater risk of serious injury than adolescents, their chances of sustaining a life threatening or fatal injury were only half as great as those faced by older teens. Thus, for adolescents, particularly for those who are older, maltreatment can involve a serious threat to their health and well-being.
Olsen
24 TABLE Allegations
2
of Abuse and Neglect by Age* Under 12 Years
12 Years and Older
12-14 yrs (266,100), 70 (80,800), % Direct Injury Without Implement With Implement Verbal-emotional Sexual Intrusion Refusal of Custody Permitted Maladaptive Behavior Other ‘Numbers
in parentheses
and Holmes
15-17 yrs Total (111,200) (192,000),
23.7 19.8 14.3 2.4 0.7
28.4 16.7 18.8 6.1 3.2
25.4 7.6 25.9 5.3 8.5
26.7 11.5 22.9 5.6 6.3
0.4 38.6
1.6 25.2
5.6 21.7
3.9 23.1
are National
estimates
TABLE
3
Severity of Maltreatment Under 12 Years
by Age* 12 Years and Older
12-14 yrs 15-17 yrs (266,100), 5%(SO,SOO), 5%(111,200), %( Probable Injury Moderate Serious Life Threatening/ Fatal *Numbers
in parentheses
Total
192,ooo). %
14.7 57.8 25.7
11.4 71.4 15.8
2.6 67.7 25.9
6.4 69.3 21.5
1.8
1.4
3.8
2.8
are National
c/c
estimates.
maltreatIdent$cation of Maltreatment. By whom is teenage ment first seen? In Table 4 it is shown that the majority of cases involving adolescent maltreatment were first identified by the schools. A comparison of these cases with those involving pre-teens further indicates that both law enforcement agencies and schools were more often the first source of report for cases involving adoIn contrast, other agencies (including lescent abuse and neglect. medical authorities and other social service agencies) and other individuals were less often involved in the initial identification of adolescent maltreatment. When maltreatment was first identified by the schools and by
Youth at Risk
25 TABLE Identification
4
of Maltreatment
Under 12 Years
12 Years and Older
12-14 (266,100),%(80,800), Initial Report Schools Law Enforcement Other Agencies Other Individuals Level of Recognition Child Protective Services Other Investigatory Agency Other Agency *Numbers
in parentheses
law enforcement
by Age*
yrs 15-17 yrs Total %(111,200),%(192,ooo),%
41.7 12.1 30.8 15.4
46.4 19.7 20.1 13.8
57.2 24.1 9.0 9.7
52.7 22.1 13.7 11.4
47.5
40.0
25.8
31.8
7.8 44.7
14.9 45.1
18.3 55.8
16.9 51.3
are national estimates.
there agencies, they encountered.
were
several
differences
in
the
In Table 5, law enforcement agencies (which included both the police and the courts) are revealed to be more likely to identify cases of sexual abuse, while schools were most likely to encounter instances of physical and emotional maltreatment. Agencies also differed in the kinds of families they identified in these initial reports. Families identified by law enforcement agencies tended to include fathers who were less educated with less income than those identified by the schools. types
of situations
Level of Recognition. To study the process by which cases were recognized, agencies were divided into three categories representing the highest level at which cases were known: CPS agencies, other investigatory agencies, and other sources. Other investigatory agencies included law enforcement agencies and public health departments. Other sources included hospitals, schools, clinics, mental health agencies, child development centers, and all other agencies from which data were collected. Most cases of adolescent maltreatment had not been reported to CPS agencies. The data reported earlier in Table 4 indicated that one half of the cases involving 12 to 17 years old youth were identified only by non-investigatory agencies such as public schools, hospitals, mental health facilities, and other social service agencies. Only one third of the adolescents were reported to CPS agencies,
‘Type of Xistreatment Physical Abuse Sexual Abuse Emotional Abuse Physica Neglect Emotional Neglect Father’s Education Cnder 9 Years Some High School High School Graduate Post High School Income Cnder $7,000 si,ooo-$14,999 $15,000 or more
Correlates
33.x 53.3 39.4 ‘73.2
41.7 Ii.3 17.2 9.0 33.2 li.1 23. I
5i.Y 20.2 61.9 41.0 54.6
5% Schools,
%
Type oE Agenq
24.5 29.2 43.4 17.8
25.9 34.4 19.6 2f.6 15.5
Other Agencies,
TABLE 5 Adolescent Maltreatment
16.2 45.4 18.5 31.4 29.9
Law Enforcement,
Agency First Identifying
c/c 100.0 100.0 100.0 1no.0 100.0
Percent
Total
by Selected Correlates*
(5 1,700)
(4ti,OOO)
(~~7,000)
(8,300) (23,~O~) (32,000) (22,100)
(79,600) (23,300) (61,700) (27,100) (27,800)
Number
Youth at Risk
27
in comparison with nearly half of the children under 12 years. It is important to note, however, that reports to CPS agencies decreased once the child reached school age, and that the smaller percentage of adolescent cases was a continuation of this trend. The data in Table 6 point to several differences in how cases were handled. These data suggest that the type of maltreating family that came to be recognized by protective agencies tended to have less income and to include fathers who had less education. Families were also reported to CPS agencies more often when they were larger or when they were non-white. In the case of white families, a majority were not even referred to an investigatory agency. Agencies also differed in the rate with which they reported allegations of abuse and neglect. A third of the cases identified by the police were reported to protective service agencies. In contrast, the schools reported only 14c% of their cases to CPS agencies. Reporting to CPS agencies also varied considerably with the type of maltreatment. Sexual abuse was most often reported, while emotional abuse and neglect were the least frequently recognized. This finding concerning emotional maltreatment is, no doubt, related to the fact that criteria for reporting contained in the mandatory reporting. laws are more clear for physical and sexual abuse than for emotional maltreatment. Some states do not even require reporting emotional abuse. It should be noted, however, that substantial under-reporting occurred irrespective of the form of mistreatment involved. With the exception of sexual abuse, a large percentage of these cases never came to the attention of agencies with investigatory responsibility. These findings imply that a considerable amount of abuse and neglect of teenagers is never reported by agencies required to report these incidents. The severity of nlaltreatment also was related to its recognition by CPS agencies. Contrary to expectations, more severe cases were less likely to be reported to CPS agencies. Only 20% of the life threatening cases were known to CPS agencies. Most were known, but not reported by the other non-investigatory agencies. This suggests that the number of teenagers in life threatening circumstances may be more than five times the number known to CPS agencies. by CPS Agencies. Of the cases reported to CPS 45% of those involving adolescents were substantiated.’
Substantiation
agencies,
*For the purpose cluded.
of this analvsis,
both
substantiated
and
non-substantiated
cases were in-
28
Olsen and Holmes
__hh
OUOO 2000 i-.~C3~--
.$0-Y c4 2 iyj--_i-
*Numbers
in parentheses
are national
Initial Report Schools Law Enforcement Other Agencies Type of Mistreatment Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect Severity of Maltreatment Life Threatening Severe Moderate Probable in percentages
14.5 26.2 12.5 15.9
19.6 16.6 30.3 45.3 Differences
8.5 33.3 19.0 18.5 28.9
36.7 53.6 18.7 37.9 Il.5
estimates.
2.0 69.5 2.8
14.0 30.5 41.9
bet\reen
at .Ol alpha
100.0 100.0 100.0 100.0
65.9 57.2 57.2 38.8 ro~vs are significant
100.0 100.0 100.0 100.0 100.0
100.0 100.0 100.0
54.8 13.1 62.4 43.6 60.1
0.0 55.3
83.9
leyel.
(1,920) (37,300) (58,150) (11,100)
(79,600) (23,400) (61,700) (27,100) (37,800)
(101,100) (42,700) (24,600)
f cc 56 E
30
Olsen and Holmes
Cases of adolescent abuse and neglect were more likely to be substantiated than those involving younger children where 40% of the cases were confirmed. Moreover, the likelihood of subs~ntiation increased as the youths got older, with half of the cases involving youths over 14 years of age being substantiated. Data in Table 7 showed that confirmation varied by the type of abuse. Cases involving physical and sexual maltreatment. were more likelv to be substantiated. Sexual abuse was three times as likely, and phy&al abuse twice as likely, to be confirmed as emotional abuse. Physical neglect was nearly four times as likely to be substantiated as emotional neglect. This does not mean t,hat reports of emotional
TABLE 7 Substantiation of Adolescent Cases by Selected Correlates* Subst.anNot Subtiated, ‘3 stantiated, 5’~ Percent
Correlates
Type of Maltreatment Physical Abuse Sexual Abuse Emotional Abuse Physical Neglect Emotional Neglect Father’s Education Less than 9 years Some High School High School Graduate Post High School Father’s Employment Full time Part time Unemployed Not in Labor Force Income IJnder $7,000 $7,000-$14,999 $15,000 or more Ethnicity White Black Hispanic Other *Numbers in parentheses are significant at .O 1 alpha
Total Number
32.4 49.9 16.5 36.2 9.9
67.6 50.1 83.3 63.8 90.1
100.0 100.0 100.0 100.0 100.0
(79,600) (23,400) (61,700) (27,100) (27,900)
36.8 36.2 46.3 13.4
63.2 63.8 53.7 86.6
100.0 100.0 100.0 100.0
(7,900) (23,400) (3 1,900) (22,200)
29.2 64.0 34.7 42.2
70.8 36.0 65.3 57.8
100.0 100.0 100.0 100.0
(103,60(1) (3.3~0) (5,100) (12,800)
38.8 42.4 23.1
61.2 57.6 76.9
100.0 100.0 100.0
(36,900) (64,400) (51,600)
26.5 45.1 63.7 56.0
73.5 54.9 36.3 44.0
100.0 100.0 100.0 100.0
(164,600) (19,800) (3,700) (1,100)
are national level.
estimates.
Differences
in percentages
between
rows
Youth at Risk
31
maltreatment were necessarily less valid than physical or sexual maltreatment. It could easily be that criteria for recognizing and reporting such cases need to be more reliable and verifiable. It is important to note that cases involving families with lower social status were substantiated more frequently than those with higher social status. Families where the father had no education past high school or was employed part-time, as well as families with incomes below $15,000, had greater chances of having maltreatment substantiated. The effect of lower social status on substantiation is also revealed in the ethnic background of substantiated cases. Just as non-white families were more often reported to CPS agencies, so also did CPS agencies more often confirm reports involving these families. Discussion Adolescents are very clearly a high-risk group. They make up nearly half of all reported cases of abuse and neglect and are particularly vulnerable to emotional and sexual forms of abuse. Many of these teens are in situations having medically serious consequences. In this concluding discussion, the problems experienced by these youth will be summarized and implications for practice will be suggested. C~.ur~cte~ist~cs of the A~oZ@scentsand their F~~~~i~s. The dynamics of stress in families having adolescents is an important issue. One of the most striking aspects of adolescent maltreatment is that it is very much a function of interpersonal stresses between family members. While many of these stresses result from the special strains of the adolescent transition period, another source of stress appears to come from the reconstitution of family units. Teenagers were more often living with stepparents than were younger children. As a consequence, they were more often maltreated by a stepparent. Professionals working with these families must be prepared to help them with the tensions and strains of creating a new family, as well as the special stresses that accompany their children’s transition into adulthood. Coping with the problems of adolescent role transition and family disruption requires working with parents and children to identify new roles appropriate to the changed circumstance of divorce or remarriage and maturation of the child. To aid in role transition, teenagers must be helped in the tasks of individuation, separation from the family, and development of autonomous control over decision making. Parents must be encouraged to acknowledge these changes as appropriate and
32
Olsen and Holmes
desirable for their children, even when they disagree with the choices made by them. Divorce or remarriage pose difficult questions regarding changes in the locus of power in a family and responsibility for decision making. Stepparents must be encouraged to share with adolescents some responsibility for decision making in the family. They must also understand that, even though they are not the natural parents, they have a responsibility to encourage these youth in their maturation. Forms of Maltreatment. This study clearly demonstrates that the risk to adolescents is far greater than has been generally thought. Adolescent maltreatment is a problem that can result in serious injury. Contrary to the popular belief that adolescents can defend themselves, this study shows that older adolescents are even more likely to sustain serious injury than younger teens. Emotional abuse and neglect also increase in intensity as these youth become older, underscoring the need for intervention during the early stages of adolescence to resolve family conflicts. In some cases the abuse and neglect may not, occur until the youth is older and struggling more actively to establish his or her independence from the family unit. In these situations, families need support that will help them to provide their children with guidance while also accepting their children’s need to separate from the family. Services provided for teens need to focus on identification and treatment of problems for which they are most at risk-physical and sexual abuse and emotional maltreatment. Because the problem of emotional abuse and neglect is so under-recognized, hot lines, runaway shelters and other providers likely to come into contact with the teens (especially schools and law enforcement agencies) need further training to better identify emotional abuse and neglect. Options for teenagers at risk need to be significantly increased. In particular, significant resources need to be directed toward our already overburdened child welfare system to handle the increased demand that identification of such cases will place on the system. Re~or~~r~g of ~~~~t~e~tm~nt. Cases of adolescent abuse and neglect were far less likely to be reported to CPS agencies than cases involving younger children. Part of the reason for this can be found in the fact that there was greater willingness to report and substantiate allegations involving families with lower socio-economic status. Families with higher incomes and in which the parents were better educated, as well as white families, were all less
33
Youth at Risk
likely to be reported to protective service agencies and to have allegations of maltreatment confirmed. Because maltreated adolescents more often come from these types of families, they are more likely to be hidden from the protective service system. Protective services for these youth will depend in part upon more equitable implementation of our reporting laws. Specialized training in identifying emotional maltreatment is also needed. Emotional abuse and neglect were the least likely to be reported of the various forms of maltreatment. Problems, such as extreme anger or delinquency, suicide attempts, self-mutilation, depression, need greater recognition as potential symptoms of emotional maltreatment. Such behavior should not be automaticatly labeled as “adolescent adjustment syndrome.” Workers should be taught to evaluate it in light of the parent/child relationshipespecially if parents are extremely critical and denigrating of the child or threaten the child with physical or sexual abuse. between schools, police, and CPS Improved coordination agencies may also increase the recognition of adolescent maltreatment. Appointing particular individuals, who will deal with teenagers as contact persons with whom one can discuss a possibIe case, may overcome reluctance to report and enhance the awareness of co-workers about the special problems of adolescents. The legal status of adolescents is particularly ambiguous. Court officers and service workers may have few options when the law favors the wishes of the parents over those of the adolescent. Giving more legal weight to the desires of the teenager would be beneficial for the adolescent’s sense of individual worth, autonomy, and ability to make responsible decisions. Working in these ways, efforts and services to address the problem of abuse and neglect can be better targeted to support these youth in their struggle to become emotionally healthy adults. Failure to respond to the needs of these adolescents will deprive us of their full contribution to our society. References American
Humane Association. (I 984). Trends in child abuse and neglect: A ~~ational Denver, Colorado: American Humane Association. Biller, H. B. (1971). Father, child, and sex role. Lexington, Massachusetts: Lexington Books. BIOS, P. (1972). The child analyst looks at the young adolescent. In J. Kagan & R. Coles (Eds.), Twelve to sixteen: Early adolescence (pp. 5?5-72). New York: W. W. Norton. Burgess, R. L., Anderson, E. A., Schellenbach, C. J., & Conger, R. D. (1981). A social interactional approach to the study of abusive Families. In J. P. Vincent ~ers~ectiue.
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Aduunces in family intervention, assessment and theory, Volume 2 (pp. l-46). Sew York: JAI Press. Caldwell, B. (1980). Balancing children’s rights and parents’ rights. In R. Haskins 8c J. Gallagher (Eds.), Cure and educution ofyoung child?-en in Ameriru (pp. 27-X). Not-wood, NJ: Ablex. Cicchetti, D., & Rizley, R. (1981). Developmental perspectives on the etiolog!, intergenerational transmission, and sequelae of child maltreatment. In R. Rizle)- 8c D. Cicchetti (Eds.), Developmental perspectives on child maltreatment (Se!\ Directions for Child Development, number 11) (pp. 31-55). San Francisco: Jossey-Bass. Daly, M., & Wilson, M. (198 1). Child maltreatment from a sociobiological perspective. In R. Rizley & D. Cicchetti (Eds.), Developmentul per.spe&~ on child multreatment (h’ew Directions for Child Development, number 1 I) (pp. 93-l 12). San Francisco: Jossey-Bass. Elmer, E. (1979). Child abuse and family stress. Journul o{ Social Is~ue.r, 35, 60-7 I. Enright, R. D., Lapsky, D. K., Drivas, I. E., & Fehr, L. A. (1980). Parental influences on the development of adolescent autonomy and identity. Journal of Youth and Adolexence,
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Erikson, E. (1963). Childhood nnd society (2nd ed.). New Y’ork: Norton. Erikson, E. (1968). Identity, youth und cri.sis. Ne\v York: Norton. Farber, E., McCoard, W. D., Kinart, C.. & Falkner, D. (1984). C’iolence in the families of adolescent runaways. Child Abuse and Neglect, 8, 295-300. Finkelhor, D., & Hotaling, G. (1984). Sexual abuse in the national incidence stud?, of child abuse and neglect. Child Abuse and ;Veglect, 8, 23-33. Fisher, B., Berdie, J., Cook, J.. & Day, N. (1980). Adolescent ubxe and neglert. Intervention strutegies. Washington, D.C.: National Center on Child Abuse and Neglect. Freud, A. (1978). Adolescence as a developmental disturbance. In I‘. Cottle (Ed.), Readings in adolescent psychology (pp. 52-56). New York: Harper 8c Row. Carbarino, J. (1980). Meeting the needs of mistreated youth. Social FI’ork, 25, 122-126. Carbarino, J. (1984). Adolescent maltreatment, a guide for practice and polic!. Practice Applications, 2, 1- 1 1. Carbarino, J., & Cilliam, G. (1980). Understanding abusive fumi1ie.r. Lexington, Massachusetts: D.C. Heath. Garbarino, J., Sebes, J., & Schellenbach, C. (1984). Families at risk of destructive parent-child relations in adolescence. Child Development, 55, 174-183. Gordon, C. (1972). Social characteristics of early adolescence. In J. Kagan & K. Coles (Eds.), Twelve to .&teen: Earb adoletcence (pp. 25-54). New York: W. \V. Norton. Guiterres, S. E., & Reich, J. W. (1981). A developmental perspective on runaway behavior: Its relationship to child abuse. Child We&?-e, 60, 89-94. Halperin, S. M., & Smith, I’. A. (1983). Differences in stepchildren’s perceptions of their stepfathers and natural fathers: Implications for family therapy. Journal of Divorce,
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Incidence Holmes, MT., & Olsen, L. (1982). Ad o 1escent maltreatment: Massachusetts: Northeastern University, Center for Applied
and riJk. Boston, Social Research.
Youth at Risk
35
Justice, B., & Justice, R. (1976). The abusingfamil3 New York: Human Sciences Press. Lourie, I. S. (1977). The phenomenon of the abused adolescent: A clinical study. Victimology, 4, 268-276.
Lourie, I. S. (1979). Family dynamics and abuse of adolescents: ,4 case for a developmental phase specific model of child abuse. Child Abuse and ll:eglect, 3, 967- 1174. Martin, M., & Walters, J. (1982). Familial correlates of selected types of child abuse and neglect. Journal of Marriage and the Family, 44, 267-286. Miller, S. H. (1984). The influence of adolescent childbearing on the incidence, type, and severity of child maltreatment. Child Welfare, 22, 34-39. Mrazek, P. (198 1). Definition and recognition of sexual child abuse: Historical and cultural perspectives. In P. Mrazek & H. Kempe (Eds.), Sexuully abused children and their families (pp. 45-62). ?