Child abuse and neglect continues to be a major concern in the United States. Reports of child maltreatment have increased dramatically over the last decades of the twentieth century, in part because of better reporting. During 2003, 2.9 million referrals regarding over 5 million children were made to child protective services. Approximately 30 percent of these reports were subsequently substantiated (United States Department of Health and Human Services [USDHHS] 2005). Given the staggering number of child maltreatment reports, it is not surprising that the U.S. Advisory Board on Child Abuse and Neglect (1990) characterized child maltreatment in America as a ‘‘national emergency.’’ Fortunately, it appears that the incidence of actual child victimization has dropped slightly, from 14.7 per 1,000 children in 1996 to 12.4 per 1,000 children in 2003 (USDHHS 2005). This research paper provides a brief overview of the history and prevalence of child abuse in America as well as federal laws regarding abuse.
I. Background on Child Abuse and Neglect in the United States
II. Prevalence of Abuse in the United States
III. Risk Factors of Abuse and Neglect in the United States
IV. Investigating Abuse in the United States
V. Children Who Testify
VII. Perpetrators of Abuse
Background on Child Abuse and Neglect in the United States
During the late eighteenth and early nineteenth centuries, there was little focus on physical or sexual abuse of children in the United States, and no focus on emotional abuse. The typical societal response to child abuse and neglect at this time involved either ignoring the abuse or, in some instances, removing the child from the family, with indigent children being placed in institutions, foster homes, or situations working as apprentices in factories or on farms (Giovannoni 1989; Schene 1996). Legislation specifically designed to protect children from physical maltreatment was limited. One of the earliest cases of physical abuse in the United States to receive widespread attention was the 1874 case of Mary Ellen, a young girl who was seriously abused by her adoptive parents. Although the little girl had been repeatedly beaten and malnourished, existing laws made it difficult for the state to remove the child from her home. The case generated significant media attention and led to the establishment of the Society for the Prevention of Cruelty to Children in 1875 (Zigler and Hall 1989).
Sexual abuse was rarely identified during this period, even though it clearly occurred, as numerous articles published in American medical journals during the nineteenth century discussed children with venereal diseases—usually syphilis and gonorrhea. As late as 1889, some professionals suggested that children had contracted these diseases through nonsexual contact, such as breastfeeding, hugging, or the sharing of eating utensils and bedding (Taylor 1985). This assumption allowed doctors to diagnose and treat children with venereal diseases without acknowledging a violation of society’s incest taboo.
The first federal legislation to protect children was passed in 1935 as part of the Social Security Act, marking the first time the federal government provided funding for child welfare services (USDHHS 1988). Under the Social Security Act, suspected child abuse could be reported to child protection agencies. Mandatory reporting requirements and widespread social awareness of the problem, however, still did not emerge until the 1960s, when Kempe, Silverman, Steele, Droegemueller, and Silver (1962) identified the ‘‘battered child syndrome.’’ This research provided working medical definitions for physical abuse and encouraged the medical community to report physical examinations that suggested abuse (see also Bain 1963; Fontana, Donovan, and Wong 1963). This work, along with other studies during this period, resulted in swift changes. By 1966, all states had enacted laws requiring physicians to report suspected abuse (Kalichman 1993). Soon thereafter, the types of abuse that required mandatory reporting expanded to include emotional and nutritional maltreatment, as well as suspected sexual abuse. Concurrently, the number of professionals identified as mandatory reporters broadened beyond just doctors to include human service professionals such as teachers, therapists, and social workers (Giovannoni 1989).
With the Child Abuse Prevention and Treatment Act of 1974 (CAPTA) the United States created a federal definition of child abuse and neglect with guidelines and standards for mandatory reporting. CAPTA defined child abuse and neglect as:
The physical or mental injury, sexual abuse, negligent treatment, or maltreatment of a child under the age of 18 by a person who is responsible for the child’s welfare under the circumstances which indicate the child’s health or welfare is harmed or threatened thereby as determined in accordance with regulations prescribed [Child Abuse Prevention and Treatment Act of 1974, 42 U.S.C. § 5106g (4) (1974)].
This broad definition provided a comprehensive view of child abuse that increased governmental and public awareness and response. In 1996, Congress changed the federal definition of ‘‘child abuse and neglect’’ to read as follows:
The term ‘‘child abuse and neglect’’ means, at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm [42 U.S.C. §5106g(2) (1999)].
Prevalence of Abuse in the United States
Compared with many other countries, the United States has good data on the incidence of child maltreatment, particularly after 1990. This is in part due to the 1988 amendments to CAPTA, which mandated that the Department of Health and Human Services (DHHS) acquire and maintain data on the prevalence and types of abuse. To this end, the United States seeks to collect information about every case of child maltreatment reported to child protective services, which in 2003 amounted to approximately 2.9 million referrals. Of these, approximately one-third of the cases were substantiated, resulting in the victimization of approximately 960,000 children, of whom approximately 1,500 died from the maltreatment. The majority (60.9 percent) of cases of child maltreatment in the United States in 2003 were of neglect. However, physical abuse accounted for 18.9 percent of child victims, sexual abuse 9.9 percent, and emotional abuse 4.9 percent. Because each state has slightly different laws, 17 percent of the cases are identified as ‘‘other’’ in the federal records (USDHHS 2005).
Although the data in the United States are much better than in many other countries, the exact number of children affected each year is difficult to determine. The prevalence numbers provided by DHHS are not exact, in part because a particular child may have experienced multiple types of abuse, all accounted for in a single incident report. Additionally, a particular child may be the subject of multiple investigations in a year. Scholars have repeatedly suggested that these rates underestimate the actual incidence of maltreatment, with some arguing that perhaps half of all cases are not reported. Additional support for this view comes from national research surveys which have asked adults to retrospectively report whether they were abused as children. These surveys reveal much higher levels of abuse than those reported by DHHS. In particular, childhood sexual victimization is reported by approximately one in four women and by approximately one in ten men (e.g., Elliot and Briere 1995; Epstein and Bottoms 1998).
Risk Factors of Abuse and Neglect in the United States
Although abuse in the United States occurs across all levels of parental class, income, and education, there are several factors related to increased risk of victimization. Experiences of abuse tend to be related to parental class and family income, or socioeconomic status (SES), with violence occurring more often in homes with lower SES (e.g., Pelton 1981; Sedlack and Broadhurst 1996; Straus 1994; Straus, Gelles, and Steinmetz 1980) and in single-parent homes. Although the overall rate of child victimization in the general population is low (1.2 percent of children), the rate is almost twice that for African American, Pacific Islander, and American Indian children (2.04 percent, 2.14 percent, and 2.13 percent, respectively) compared with white children (1.1 percent). It is difficult to know how this latter finding should be interpreted. Minority status is correlated with SES, thus it is possible that these findings are being driven by the fact that a large percentage of minority children live in lower-SES homes. Additionally, it is possible that there is bias such that maltreatment occurring in minority families is more likely to be brought to the attention of child protective services than the same treatment occurring in white families.
Also related to prevalence of victimization is a child’s age and gender. Specifically, children in their first three years of life have the highest rates of victimization. Further, three-quarters of the children killed by abuse were under age four (USDHHS 2005). In addition, girls are more likely to experience abuse than boys, but boys are more likely to receive particularly serious injuries (Sedlack and Broadhurst 1996).
Investigating Abuse in the United States
Throughout the United States, child protective services receive approximately 50,000 calls a week alleging abuse. Approximately one-third of these referrals are dismissed immediately without investigation, and the remaining two-thirds are investigated. It is estimated that, on average, each investigation worker will handle sixty-one investigations per year. However, this number is based on reports from only twenty-eight states and does not take into account the wide variability between urban and rural populations as well as different resources available at different locations (USDHHS 2005).
Mandated federal reporters, such as child care providers, medical personnel, teachers, and mental health/social service professionals, submit the majority of referrals (USDHHS 2005). In 2003, the largest number, over 17 percent, came from educational personnel and child care providers. In the United States, individual states may define aspects of abuse and neglect slightly differently. Thus, once a referral is made, the exact investigation progresses as a function of the particular state guidelines. Typically, after a referral is made and determined to be worthy of an investigation, an investigator will visit the alleged victim at home or in school to interview the child. In addition, siblings, parents, and others who have considerable contact with the child or family (e.g., teachers) might be interviewed to provide information about the child’s situation and level of risk. Additional in-depth assessments including medical examinations may be conducted if the investigator believes the situation warrants this (Pecora 1991).
An abuse investigation may produce a variety of outcomes, but the three main outcomes are substantiated, unsubstantiated, and indicated. Substantiation means that the abuse has occurred, the family is in need of assistance, and the child requires protection. Typically, in substantiated cases, either the identified perpetrator or the child victim is removed from the home, and additional social services are provided to the family. In 2003, of the investigated cases, 26.4 percent were substantiated (USDHHS 2005). If investigators did not find enough evidence to support child maltreatment charges, the case is considered unsubstantiated. The majority (57 percent) of cases investigated in 2003 fell into this category. However, even in unsubstantiated cases, the agency may refer the family for education and prevention counseling. Finally, in some states, the child protective services may return an indicated finding. This states that although there was not enough evidence for substantiation, there is reason to believe that the child may have been, or is, at risk for maltreatment. Approximately 4 percent of investigated cases resulted in an indication finding in 2003. Notably, under this system, the closest an alleged perpetrator can come to being ‘‘cleared’’ is to have the case classified as unsubstantiated; investigators rarely, if ever, conclude or report that abuse has not, in fact, occurred.
Children Who Testify
When a case goes to court, a child’s testimony may be critical, because the child is often the sole witness to the events in question. In the United States, it is necessary for a witness to be deemed competent to take the stand. Although the majority of states have adopted the Federal Rules of Evidence Rule 601, which presumes that all persons are competent to testify regardless of age, it is always possible that a child’s competence will be challenged. In states that have not adopted Rule 601’s presumption, the competence of a child witness will be determined during a pretrial hearing. State laws differ with regard to the age at which a child no longer requires such a hearing. However, generally beginning at ten to fourteen years of age, a hearing is no longer required for a child. During a competency hearing, the child witness’s understanding of the truth and what a lie is will be assessed. Historically, the court has found children competent when they demonstrate an understanding of the difference between a truth and a lie.
In the last two decades, a number of reforms have been proposed and implemented to accommodate child witnesses. These reforms are designed to obtain accurate information from potentially abused children. For example, many states have created community-based ‘‘Children’s Advocacy Centers’’ in which experts in many fields (e.g., law, mental health, child protection) work together in making decisions about the investigation, treatment, and prosecution of child abuse cases (National Children’s Advocacy Center 1999). These programs are focused on helping children through the process of a trial. In addition to ensuring that the best investigative procedures are followed, these professionals facilitate medical and mental health referrals for child victims. The interviewers at these centers are specially trained to use the most recent research in child psychology to increase a child’s recall without being coercive or misleading. Often, the use of such a center results in fewer total number of interviews for the child. This is important because research has found that repeated interviews increase the chances of a child reporting inaccurate information.
Other suggested innovations for use with child abuse victims include allowing a child to testify using closed-circuit television and one-way mirrors so she or he does not have to be in the presence of the alleged perpetrator. This suggestion is controversial given that in the United States, a defendant has a constitutional right to face her or his accuser. However, in Maryland v. Craig (1990) the U.S. Supreme Court suggested that the use of this type of intervention may be considered appropriate on a case-by-case basis when a child would not be able to provide credible testimony without it. Additionally, given the anxiety that can be produced by the experience of being in court, some communities have established ‘‘court schools,’’ or programs that educate a child victim about the trial process ahead of time (e.g., Doueck, Weston, Filbert, Beekhuis, and Redlich 1997). Other communities have excluded spectators from the courtroom and/ or allowed a parent or loved one to be next to the child for social/moral support while he or she testifies (see Goodman et al. 1992).
Child protective services offer many different types of responses for families and children after abuse has occurred. Remedial services include family and individual counseling and foster care. In 2003, approximately 57 percent of child victims—over 500,000 children and their families—received some type of post-event remedial services. A number of factors predict whether a child will receive post-event services. Children who have been prior victims of maltreatment, are victims of multiple types of maltreatment, or are disabled are more likely to receive services than those without such experiences. Race was also an important predictor of the provision of services in 2003. White children were less likely than African American and Hispanic children to be referred for post-event services. In addition, children abused or maltreated by their mothers are more likely to receive service than those maltreated by their fathers (USDHHS 2005).
In addition, over 200,000 children were placed in foster care in 2003. There are a number of factors related to the decision to remove a child from his or her home. Similar to other services, children who had been prior victims of maltreatment were more likely to be placed in foster care compared with children for whom this was a first finding of maltreatment. Child victims who were disabled were more likely to be placed in foster care than nondisabled children. Again, race played an important role in this situation, with African American children 36 percent more likely to be placed in foster care than white children. Finally, children abused or maltreated by their mothers, compared with those maltreated by their fathers, were more likely to be placed in foster care (USDHHS 2005). In addition to those children who were removed from their homes because of maltreatment, approximately 70,000 children, later determined to not be victims, were placed in foster care during the process of investigating their cases.
Child protective services also provided educational services to prevent child abuse and neglect. In 2003 it is estimated that almost two million children and families received preventative services. These services are typically provided to families deemed at risk for abuse or neglect. They include education about child development and child rearing practices, substance abuse treatment, respite care, housing assistance, and counseling (USDHHS 2005).
Perpetrators of Abuse
When all types of maltreatment (neglect and abuse) are considered, perpetrators are more likely to be female (58.2 percent) than male (41.8 percent). Additionally, the female perpetrators are on average slightly younger (average age of thirty-one years) compared with male perpetrators (average age of thirty-four years). In general, the majority of the perpetrators were parents (80 percent). The fact that parents are the most common perpetrators is in part related to the fact that neglect is the most common form of child maltreatment in the United States. In 2003, neglect accounted for 69 percent of all maltreatment, and parents are responsible for the majority of neglect (62 percent) that occurs. Relatives and unmarried partners were the next most frequent perpetrators of overall maltreatment (6 percent and 4 percent, respectively). However, when physical and sexual abuse are evaluated apart from neglect, parents are not the primary perpetrators. Only 11 percent of physical abuse and less than 3 percent of sexual abuse involved parents. The perpetrators in these cases were likely to be familiar others in the child’s life (USDHHS 2005).
Legal Ramifications for Convicted Perpetrators of Child Abuse
Often cases of child abuse are not taken to criminal court but are decided instead in family or civil court. If a case goes to criminal court and the perpetrator is convicted, sentencing will differ from state to state. The sanction will be based on the act or type of violation and the age of the child victim. For example, in Vermont the criminal code states that a person convicted of sexual assault of a minor younger than sixteen years of age ‘‘shall be imprisoned for not more than 20 years, or fined not more than $10,000, or both’’ [13 V.S.A. § 3253(a) (3)]. The Arizona criminal code draws finer age distinctions by providing that sexual assault of a minor who is fifteen years of age or older is punishable by a presumptive sentence of seven years imprisonment, while the sexual assault of a minor between the ages of twelve and fifteen is punishable by a presumptive sentence of twenty years imprisonment, and sexual assault of a minor younger than twelve years of age is punishable by life imprisonment without hope of parole until at least thirty-five years of the sentence have been served [Ariz. Rev. Stat. §§ 13-1406(B), 13-604.01(C), and 13-604.01(A)]. Each state differs with regard to the mandatory minimum sentencing for sexual abuse, but most require that a convicted perpetrator serve a minimum number of years prior to gaining eligibility for parole (Bulkley et al. 1996).
Edward Zigler at Yale University’s Child Study Center has suggested that to prevent child abuse and neglect, it is necessary to focus resources on family education and support to alleviate family stressors such as poverty (McCauley, Schwartz- Kenney, and Epstein 2001). For example, unemployment and job loss have been repeatedly linked to increases in child abuse (Scannapieco and Connell- Carrick 2005). Perhaps because of the additional financial stressors, children in single-parent households are more likely to experience abuse. It is not clear how society can help families reduce these stressors, but it is clear that doing so would be helpful in preventing child maltreatment.
National agencies and corporations often sponsor outreach programs aimed at preventing child abuse. For example, the Freddie Mac Foundation, Doris Duke Charitable Foundation, and Ronald McDonald House Charities each donated over $250,000 last year to the Healthy Families America Program. This program, and others like it, focus efforts on home visits for families with young children and educational outreach. Healthy Families America (2006) is involved in over 450 communities in the United States and Canada. They report that over 90 percent of families contacted accept their services. Programs like this seek to foster a supportive environment for families with newborns by enlisting the help of professionals and neighbors (Rabasca 1999). Getting the community involved may be key to the success of a prevention program. Parents view community-based programs as less threatening and less stigmatizing than government-sponsored programs. Healthy neighborhoods are also related to a reduction in child maltreatment. Children in families who interact with their neighbors and experience strong informal social support from the neighborhood are less at risk for abuse and neglect (Scannapieco and Connell-Carrick 2005).
In addition to family-focused prevention, school-based child sexual abuse prevention programs educate children about personal safety. These programs teach children about personal safety, appropriate and inappropriate touching, and saying no, as well as how to resist if abuse against them is attempted. Finally, these programs inform children of where they can get support if needed. It is hoped that children who receive this type of training will be empowered to resist abuse. Training has also been used to decrease the chances that a child will abuse others. To this end, some prevention programs have included empathy training, problem solving, and anger management. The type of programs and topics included in the training will depend on the age of the children involved. Training programs for younger children use puppets and dolls, while those targeting older children may use lectures and role-playing (Kohl 1993). It is unclear the extent to which these interventions and programs are effective in reducing the incidence of child maltreatment. It does appear that children learn about prevention from the different training approaches (Finkelhor and Strapko 1987).
Conclusions Child abuse remains a large problem in the United States. The positive news is that although the number of reports made each year has increased, the number of substantiations has decreased. In addition, many communities are becoming involved in proactive programs for parents and children to help reduce the chances of abuse. One can hope that the recent decline in maltreatment and increase in prevention mark the beginning of a permanent trend.
- Ariz. Rev. Stat. §§ 13-1406(B), 13-604.01(C), and 13-604.01(A) (1999).
- Bain, K. ‘‘The Physically Abused Child.’’ Pediatrics 31 (1963): 895–898.
- Child Abuse Prevention and Treatment Act, 42 U.S.C. §5106g(4) (1974).
- Child Abuse Prevention and Treatment Act, 42 U.S.C. § 5101 et seq (1974).
- Child Abuse Prevention and Treatment Act, 42 U.S.C. §5106g(2) (1999).
- Child Abuse Prevention and Treatment Act Amendments of 1995, 104 S.Rpt 117 (July 20, 1995).
- Doueck, H. J., E. A. Weston, L. Filbert, R. Beekhuis, and H. F. Redlich. ‘‘A Child Witness Advocacy Program: Caretakers’ and Professionals’ Views.’’ Journal of Sexual Abuse 6 (1997): 113–132.
- Epstein, M. A., and B. L. Bottoms. ‘‘Memories of Childhood Sexual Abuse: A Survey of Young Adults.’’ Child Abuse and Neglect 22 (1998): 1217–1238.
- Fontana, V. J., D. Donovan, and R. J. Wong. ‘‘The ‘Maltreatment Syndrome’ in Children.’’ New England Journal of Medicine 269 (1963): 1389–1394.
- Giovannoni, J. ‘‘Definitional Issues in Child Maltreatment.’’ In Child Maltreatment, edited by D. Cicchetti and V. Carlson. Cambridge, England: Cambridge University Press, 1989, pp. 3–37.
- Goodman, G. S., E. P. Pyle-Taub, D. P. H. Hones, P. England, L. K. Port, L. Rudy, and L. Prado. ‘‘The Effects of Criminal Court Testimony on Child Sexual Assault Victims.’’ Monographs of the Society for Research in Child Development 57 (1992) (Serial No. 229): 1–163.
- Healthy Families America website, 2006. http://www.healthyfamiliesamerica.org/about_us/index.shtml (accessed August 26, 2013).
- Kalichman, S. C. Mandated Reporting of Suspected Child Abuse: Ethics, Law, and Policy. Washington, DC: American Psychological Association, 1993.
- Kempe, C., F. Silverman, B. Steele, W. Droegemueller, and H. Silver. ‘‘The Battered-Child Syndrome.’’ Journal of American Medical Association 181 (1962): 17–24.
- Kohl, J. ‘‘School-Based Child Sexual Abuse Prevention Program.’’ Journal of Family Violence 8 (1993): 137–150.
- Maryland v. Craig, 110 S. Ct. 3157 (1990).
- Pecora, P. J. ‘‘Investigating Allegations of Child Maltreatment: The Strengths and Limitation of Current Risk Assessment Systems.’’ Child and Youth Services 15 (1991): 73–92.
- Pelton, L. H., ed. The Social Context of Child Abuse and Neglect. New York: Human Sciences Press, 1981.
- Rabasca, L. ‘‘Child-Abuse Prevention Efforts Still Too Few.’’ APA Monitor. Washington, DC: American Psychological Association, 1999, p. 30.
- Scannapieco, M., and K. Connell-Carrick. Understanding Child Maltreatment: An Ecological and Developmental Perspective. New York: Oxford University Press, 2005.
- Schene, P. ‘‘Child Abuse and Neglect Policy: History, Models, and Future Directions.’’ In The APSAC Handbook on Child Maltreatment, edited by J. Briere, L. Berliner, J. A. Bulkley, C. Jenny, and T. Reid. Thousand Oaks, CA: Sage, 1996, pp. 385–397.
- Sedlack, A. J., and D. D. Broadhurst. The Third National Incidence Study of Child Abuse and Neglect. U.S. Department of Health and Human Services. Washington, DC: U.S. Government Printing Office, 1996.
- Straus, M. A. Beating the Devil Out of Them: Corporal Punishment in American Families. New York: Lexington Books, 1994.
- Straus, M. A., R. Gelles, and S. Steinmetz. Behind Closed Doors: Violence in the American Family. Garden City, NY: Doubleday, 1980.
- Taylor, K. J. ‘‘Venereal Disease in Nineteenth-Century Children.’’ Journal of Psychohistory 12 (1985): 431–463.
- U.S. Advisory Board on Child Abuse and Neglect. Child Abuse and Neglect: Critical First Steps in Response to a National Emergency. Washington, DC: Government Printing Office, 1990.
- U.S. Department of Health and Human Services. Child Maltreatment 2003. Washington, DC: U.S. Government Printing Office, 2005.
- 13 V.S.A. § 3253(a)(3) (1999).
- Zigler, E., and N. W. Hall. ‘‘Child Abuse in America.’’ In Child Maltreatment, edited by D. Cicchetti and V. Carlson. Cambridge, England: Cambridge University Press, 1989, pp. 38–75.