Differences between victims of different types of child
maltreatment (physical abuse, sexual abuse or neglect) in later
mental health problems.
Name: Esther Schoofs Student Number: 10419357
Thesis supervisor: Claudia van der Put Supervisor 2: Jessica Asscher
Preface
In order to complete the master Forensic behavioural science, students are expected to write a thesis about a topic related to their master. The topic child abuse and mental health problems, is chosen because of my personal interest in the effects of child abuse. During my study I was surprised that there is very little to almost no attention to this topic. In my environment, a lot of people work with children and discus the concerns about child abuse in their classes or groups. The little attention, and the great demand of professionals for this theme made me think and decide to not only do my
internship at a foundation that tries to put child abuse on everybody’s agenda, but also develop myself on this theme and write my thesis about child abuse and mental health problems.
I would like to take a moment to look back at my days as a student. Honestly, it was a long way to get myself where I am right now. Starting as a average student on the “MAVO” I’d never thought I would ever carry the title master of science. After I finished the MAVO I had to orientate on my future and found out that I wanted to work with children with behavioural problems. I had a special interest in children who were involved with the justice system as perpetrator as well as as victims. I’d found studies that I liked, but for those studies I had to go to university. So my journey started. I went to the HAVO, got my “p” in psychology and started at the University in Belgium (Criminology). After a year of hard work I wasn’t able to finish the first year successfully and I came back to Holland to start over at the university of Leiden, behavioural sciences. I worked really hard to prove I could do it. During my bachelor Professor Stams gave a lecture about the master forensic behavioural science in Amsterdam and he won me over. That was what I was gonna do. A long way, hard work and a lot of perseverance have made me master of behavioural science. I did it, Form average MAVO student to behavioural scientist.
I’d like to thank the people who have contribute to this Master Thesis. First a word of thanks for Claudia van der Put, who provided me with feedback that made me think about the thesis and the theme. It was a very pleasant guidance throughout the process. Also a word of thanks to my second supervisor, Jessica Asscher, which has provided good feedback to me and took the time to help me through the process. At least a word of thanks to Judy Hooymeyer who took the time to read my thesis
and asked critical questions and helped me out with my English.
Further, I would like to thank Channa Al for her guidance during my internship at Augeo foundation, She made my even more interested about the subject and I’ve learned a lot about child abuse, the effects, policy and everything in between, that I could use in this thesis.
Last but not least I’d like to take a moment to thank my mom, dad and the rest of my close family, Remco Janssen and his family for the support all the way from MAVO to University. The support varies from financially to emotionally to practically reading my thesis and helping me out with making it better. I've had a lot of stress and I was therefore not always fun to be around of. But without these people as wailing wall I would have never reached the finish line.
I hope everybody is just as proud of the result as I am. Esther Schoofs
Bladel, March 2014
Abstract:
Child maltreatment is associated with numerous negative mental health outcomes. Until now, it is unclear whether different types of child maltreatment (e.g. physical abuse, sexual abuse or neglect) are associated with different types of mental health problems. Therefore, this study examined differences between juvenile offenders who were a victim of sexual abuse (n = 231), physical abuse (n = 1.568), neglect (n = 1.555) or exposed to multiple forms of child maltreatment (n = 1.767) and offenders who were nonvictimized (n = 8.492), in the prevalence of mental health problems. Secondary data from the Washington State Juvenile Court Assessment validation study were used. Results showed relatively high rates of internalising problems, including suicidal ideation, among victims of sexual abuse, while victims of physical abuse and neglect had relatively high rates of externalising problems. This knowledge is important for the assessment of problems and to improve intervention programs for juvenile offenders who are victims of child abuse.
Introduction
Childhood abuse is a serious public health problem that is associated with numerous negative mental health outcomes (Swogger, Conner, Walsh, Stephen, & Maisto, 2011; Mills, Scott, Alati, O’Callaghan, Najman, & Strathearn, 2013; Cicchetti, Rogosch, Gunnar, Toth, 2010; Spataro, Mullen, Burgess, Wells, and Moss, 2004; Cyr, Euser, Bakermans-Kranenburg, & Van IJzendoorn, 2010). The extent to which early physical abuse leads to later aggression and violence is of particular concern (Lansford, Miller-Johnson, Berlin, Dodge, Bates, & Pettit, 2007). Several studies have linked early maltreatment to later aggression and delinquency (Lansford, et al., 2007). Smith and Thornberry (1995) founda significant relation between child maltreatment and self-reported and official delinquency, especially for more serious forms of delinquency. The results suggest that more extensive maltreatment is related to higher rates of delinquency (Smith & Thornberry, 1995). Three pathways have been found, related to maltreatment, leading to disruptive and delinquent behaviour: authority conflict pathway, overt pathway, and covert pathway (Stouthamer- Loeber, Loeber, Homisch, & Wei, 2001). Abuse victims were more likely to have engaged in behaviours characteristic of the authority conflict and the overt pathways but less strongly engaged in behaviours associated with the covert pathway than matched controls (Stouthamer, et al., 2001).
Many thousands of children in the Netherlands get beaten, neglected, abused, humiliated or ignored, or are witness to violence in their homes against one of their parents (Van IJzendoorn, & Bakermans-Kranenburg, 2009).The estimated prevalence of child abuse in 2010, based on informants of AMK (general hotline child abuse), is about 34 cases of child abuse on every 1000 children (Alink, Van IJzendoorn, & Bakermans-Kranenburg, 2009).
Besides delinquency, child abuse victimization is associated with problems at school, work, in relationships, health problems and severe personal and social damage (van Dantzig, Tromp, Heyman, Meuwese, & Willems, 2000; Van IJzendoorn, & Bakermans-Kranenburg, 2009). According to Hooymeyer (1990), the lack of a healthy and safe environment during the early childhood does not evoke development disorders on the short term, but can be seen as the primary cause of personality disorders such as borderline, auto mutilation and eating disorders. On the long term child abuse and
neglect can lead to psychiatric symptoms, cognitive and neurobiological changes (Hooymeyer, 1990).
Furthermore, Spataro, Mullen, Burgess, Wells, and Moss (2004) found that both male and female victims of abuse had significantly higher rates of psychiatric treatment during the study period than general population. Rates were higher for childhood mental disorders, personality disorders, anxiety disorders and major affective disorders, except for schizophrenia. This prospective study demonstrated an association between child sexual abuse and a subsequent increase in rates of childhood and adult mental disorders. Herrenkohl, Hong, Klika, Herrenkohl and Russo (2013) reported comparable findings: victims of childhood maltreatment reported more symptoms of depression, anxiety, and more impairment due to mental and physical health problems during adulthood than non-victims. Abuse victims also reported a higher rate of lifetime alcohol problems and a greater risk for substance abuse.
Schneider, Baumrind, and Kimerling (2007) found that child sexual, physical, and emotional abuse were independently associated with increased risk for mental health problems in women. A history of multiple types of child abuse was associated with elevated risk for mental health problems. Exposure to all three types of child abuse was linked to a 23- fold increase in risk for posttraumatic stress disorder (PTSD) (Schneider, Baumrind, & Kimerling, 2007). Fergusson, Boden, and Horwood (2008) concluded that sexual abuse and childhood psychical abuse increases risk of later mental disorders as well. Fergusson and colleagues (2008) referred to mental health disorders as depression, anxiety disorder, conduct/anti-social personality disorder, substance dependence, suicidal ideation, and suicide attempts. In addition, child abuse leads to an increased risk of developing a depression and poor functioning of the working memory (Cyr, et al., 2010; Van IJzendoorn & Bakermans-Kranenburg, 2009).
The comorbidity in exposure to different types of child abuse is high. Ney, Fung, and Wickett (1994) reported that more than 95% of victims experience more than one type of maltreatment. Similarly, in a study of college students, Arata, Langhinrichsen-Rohling, Bowers, and O’Farrill-Swails (2005) found that 60% of individuals reporting a history of childhood maltreatment also reported more than one type of maltreatment (Arata, et al., 2007). Therefore, there is little known
about whether the relation between child abuse and mental health problems depends on the type of abuse experienced. According to the NJi (Dutch Youth Institute) more severe child abuse, for
example when the child was victim of sexual abuse as well as physical abuse, leads to more problems (Wolzak & ten Berge, 2008). Hart and Bassard (1987) assume that psychological maltreatment is more prevalent and potentially more destructive than other forms of child abuse and neglect. The aim of this study is to examine whether there are differences between juveniles that suffered from different types of abuse (sexual, physical, or neglect) or multiple types of abuse, in the prevalence of mental health problems.
Trickett and McBride Chang (1995) reviewed and integrated research knowledge about the impact of different forms of child maltreatment-physical abuse, sexual abuse, and neglect. Sexual abused and neglected children are most likely to show problems of withdrawal and isolation (Trickett & McBride Chang, 1995). Physically abused children also show these problems as well as problems with aggressive, disruptive interpersonal behaviour (Trickett & McBride Chang, 1995). In the cognitive/academic domain, physical abused and neglected children show poorer cognitive development and poorer school performances (Trickett & McBride Chang, 1995). Tickett and McBride Chang concluded that “it may be that physically abused juveniles show more externalising problems, relative to sexually abused juveniles who show more internalising problems, although the evidence is not completely consistent” (Trickett & McBride Chang, p. 325, 1995). Females are overrepresented in samples of sexual abuse victimization studies and therefore it is possible that the differences found between physically and sexually abused victims rather result from the higher prevalence of internalising problems in females than the type of abuse experienced (Trickett & McBride Chang, 1995).
More recently, Bedi and colleagues found that a history of childhood sexual abuse is
associated with increased risk of Major Depressive Disorder, suicidal thoughts and suicidal behaviour including suicidal ideation, persistent suicidal thoughts, suicide plan, and suicide attempt (Bedi, Nelson, Lynskey, McCutcheon, Heath, Madden, & Martin, 2011). However, no comparison with other types of abuse was made in this study.
On physical abuse we found several studies (Springer, Sheridan, Kuo, & Carnes, 2007; Sugaya, Hasin, Olfson, Lin, Grant, & Blanco, 2012). These studies, again, did not compare the outcome of mental health problems of physical abuse with other types of abuse. Child physical abuse was associated with increased adjusted odds ratios of a broad range of DSM-IV, psychiatric disorders, especially attention-deficit hyperactivity disorder, posttraumatic stress disorder, and bipolar disorder (Sugaya, et al., 2012). Springer and colleagues (2007) found that physical abuse predicted an increase in depression, anxiety, anger, physical symptoms, and medical (psycho somatic) diagnoses. The present study aimed to contribute to the knowledge on mental health outcomes as a result of different types of abuse.
In the present study, differences in prevalence of mental health problems between juveniles who were victim of physical abuse, sexual abuse, neglect, multiple types of abuse and non-victims will be examined. As it is unclear whether the differences between different types of abuse found in earlier studies are in fact gender differences, interaction effects between type of abuse and gender will be examined. The present study will focus on the following mental health problems; special education needs, such as mental retardation, ADHD, behaviour problems and other learning problems, suicidal ideation, ADHD/ADD diagnosis, alcohol and drugs problems, internalising mental health problems such as schizophrenia, bi-polar-, mood-, thought-, personality- and adjustment- disorders. It is important to determine what type of abuse is associated with which mental health problems, in order to improve prevention or intervention programs for abuse victims.
Methods Sample
The sample of this study consisted of N = 13.613 American juveniles aged 12 to 18, who were placed on probation for committing a criminal offense and for whom the Washington State Juvenile Court Assessment (WSJCA; full assessment) was completed. This study uses secondary data from the Washington State Juvenile Court Assessment (WSJCA) validation study (Barnoski, 2004). These juveniles scored medium to high on the Washington State Juvenile Court Pre-Screen Assessment (WSJCPA; pre-screen assessment). Because many enter the juvenile justice system on multiple occasions, the current study utilized only the first full assessment for each individual in the sample, so the 13.613 represent unique individuals. From this dataset the following groups were selected:
A) Juvenile offenders with a history of sexual abuse by a family member:
All juvenile offenders with a history of sexual abuse by a family member but without a history of physical abuse by a family member and/or neglect.
B) Juvenile offenders with a history of physical abuse by a family member:
All juvenile offenders with a history of sexual abuse by a family member but without a history of physical abuse by a family member and/or neglect.
C) Juvenile offenders with a history of neglect:
All juvenile offenders with a history of neglect but without a history of physical and/or sexual abuse by a family member.
In addition to these characteristics and groups, there were also youth that suffered from a combination of different forms of maltreatment. The prevalence of the combination of victims of physical abuse and neglect is 64,4%, Victims of sexual abuse and neglect is 6,3% and victims of physical abuse and sexual abuse is 10,5%.
Table 1 presents the sample characteristics Table 1; Sample characteristics
Comparison group (n= 8.492) Victim of physical abuse (n= 1.568) Victim of sexual abuse (n= 231) Victim of neglect (n= 1.555) Victim of multiple types of abuse (n=1.767) χ² Male gender 79%a 70%b 40%c 70%b 62%d 429,15a*** Ethnicity European Americans 57%a 63%b 65%b 56%a 61%b 30,46a*** African Americans 9%a 8%a 8%ab 11%b 8%a 13,38a** Hispanic 12%a 7%b 10%ab 7%b 6%b 88,54a*** Other 7%a 6%a 6%ab 9%b 8%ab 11,88a* Age at time of the assessment 105a*** 12-13 9,2%a 10,5%a 8,7%ab 12,9%b 15,8%c 14-15 35,9%a 38,7%bc 41%abc 40,3%c 36,6%ab 16-17 54,9%a 50,8%b 50%abc 46,9%c 47,7bc * p < 0,05 ** p <0,01 *** p < 0,001
Each subscript letter denotes a subset of categories whose column proportions do not differ significantly from each other at the 0.05 level.
Juveniles were asked to report on the histories of physical abuse, sexual abuse and history of being a neglect victim. The self-reported information was checked with child protective services, community mental health organizations, and other sources of information. Any history of being a victim of physical or sexual abuse or neglect that was suspected, whether or not substantiated, was included. False reports of abuse or neglect were excluded (Barnoski, 2004b). Physical abuse, sexual
abuse and neglect were operationalized following Child Protective Services (CPS) definitions (Barnoski, 2004b):
Physical abuse included any non-accidental physical injury, such as bruises, burns, fractures, bites, or internal injuries. Physical abuse was scored as follows: “Being a victim of physical abuse”, yes or no; “Physically abused by a family member”, yes or no; and “Physically abused outside the family”, yes or no.
Sexual abuse included acts such as indecent liberties, communication with a minor for immoral purposes, sexual exploitation of a child, child molestation, sexual misconduct with a minor, rape of a child, and rape. Like physical abuse, sexual abuse was scored as “Being a victim of sexual abuse”, yes or no; “Sexually abused by a family member”, yes or no; and “Sexually abused outside the family”, yes or no.
Neglect included negligent or maltreatment (dangerous act) or omission that constitutes a clear and present danger to the child’s health, welfare, and safety, such as: a) failure to provide adequate food, clothing, shelter, emotional nurturing, or health care, b) failure to provide adequate supervision given the child’s level of development, c) an act of abandonment with the intent to forego parental responsibilities despite an ability to do so, d) an act of exploitation, such as requiring the child to be involved in criminal activity, imposing unreasonable work standards, etc., e) an act of reckless endangerment, such as a parent driving under the influence of alcohol or drugs with children present, f) other dangerous acts, such as hitting, kicking, throwing, choking a child, or shaking an infant. Neglect was assessed by a “Being a victim of neglect” score, yes or no.
Instruments and Procedure
The WSJCA is a screening and risk assessment instrument, which was developed in Washington State. The WSJCA maps out the most important risk and protective factors on a large number of domains. The selection of domains and items took place on the basis of a review of the juvenile delinquency research literature and then was modified, based on feedback from an international team of experts.
The WSJCA comprises two parts: a pre-screen and a full assessment. The pre-screen is a shortened version of the full assessment that quickly indicates whether a youngster is at low,
moderate, or high risk for re-offending. This version is administered to all youth on probation and the full assessment is required only for youth who are assessed as having moderate or high risk on the pre-screen (71% of the juvenile offenders). The full assessment identifies a youth’s risk and protective factor profile to guide rehabilitative efforts.
The full assessment includes 132 items, divided into 13 domains such as relationships, employment, school, attitudes, and aggression. Probation officers perform the full assessments on the basis of information from a structured motivational interview with the youth and youth’s family. Probation officers are trained in conducting the assessment. This training includes reviewing videotaped interviews and the resulting assessment to ensure the probation counsellor has mastered the assessment skills. There is a manual available for the full assessment and quality assurance is an important part of the assessment structure and organization in Washington State (Barnoski, 2004). The following variables were examined in this study: suicidal ideation, ADD/ADHD, alcohol and drugs problems, special needs education and internalising mental health issues.
Suicidal ideation: 0 = Does not have thoughts about suicide; 1 = Has serious thoughts about suicide, has recently made a plan to commit suicide or has recently attempted to commit suicide.
ADD/ADHD (confirmed by a professional in the social service/healthcare field): 0 = No ADD/ADHD diagnosis; 1 = ADD/ADHD diagnose
Current Alcohol and drugs problems: alcohol use: 0 = No current alcohol use; 1 = Alcohol causing family conflict and/or disrupting education and/or causing health problems and/or alcohol interfering with keeping pro-social friends and/or an Alcohol contributing to criminal behaviour. Drugs: 0= No current drug use; 1= Drugs causing family conflict and/or disrupting education and/or causing health problems and/or interfering with keeping pro-social friends and/or contributing to criminal behaviour.
Special needs education: mental retardation, 0 = no special education student; 1 = special education students or juveniles who have a formal diagnosis of a special education need because of ID. All juveniles in this group have a formal diagnosis of ID, which means a full scale IQ of less than 70, coupled with a significant deficit in adaptive behavior, with childhood onset. The diagnosis of ID was made by a professional in the social service/healthcare field (for example a child psychiatrist, child psychologist or developmental/behavioral pediatrician).
Mental health issues: such as schizophrenia, bi-polar, mood, thought, personality, and adjustment disorders. Confirmed by a professional in the social service/healthcare field: 0 = No history of mental health problem(s); 1 = Diagnosed with mental health problem(s).
Analyses
The data are analyzed with SPSS. A Chi-square test will answer the question whether there are differences between the different types of abuse and mental health problems.
Type of abuse (Physical abuse, sexual abuse or neglect) is the independent variable. The dependent variable in this study are suicidal ideation, ADD/ADHD, alcohol and drugs problems, special needs education and internalising mental health issues.
To exclude possible gender influences we added another step in the analysis. We calculated the total number of externalising problems by adding the risk factors ADD/ADHD, substance abuse and behavioral problems. We also calculated the total number of internalising problems by adding the risk factors internalising mental health problems and suicidal thoughts. In addition, we calculated the total number of developmental problems by adding the risk factors learning problems and low IQ. We then performed two-way ANOVA analyses to examine: (a) the main effect of type of child
maltreatment, (b) the main effect of gender, and (c) the interaction effect between type of child maltreatment and gender on the total number internalising problems, externalising problems and developmental problems.Then, we calculated Z-scores of the variables to be able to compare them. Finally, we calculated the total number of problems by adding the Z-scores of the total number of externalising problems, the total number of internalising problems and the total number of developmental problems.
Results
Table 2 shows the rate by type of abuse in relation to mental health problems. Comparison Group Physical abuse Sexual abuse neglect Multiple types of abuse χ² Suicidal ideation 4,7%a 10,7%b 17,7%c 5,7%a 14,5%c 302,55a*** ADD/ADHD 14,6%a 20,5%b 16%abc 17,1%c 23,8%d 105,64a*** Substance abuse Alcohol 33,3%a 37,6%b 31,6%ab 36,1%b 35,2%ab 15,35a** Drugs 45,6%a 49,2%b 45,0%ab 50,9%ab 45,1%a 21,06a*** Special education needs Behavioral problems 15,2%a 20,7%bc 15,2%ac 21,9%b 31,7%d 278,00a*** Learning problems 19,9%a 21,2%a 23,9%ab 26,7%b 29,3%b 96,89a*** Low IQ 0,4%a 0,7%ab 2,2%cd 1,0%bd 2,2%c 68,79a***
Internalising mental health problems
18,8%a 34,6%b 45,9%c 25,3%d 43,0%c 607,98a***
* p < 0,05 ** p <0,01 *** p < 0,001
Each subscript letter denotes a subset of categories whose column proportions do not differ significantly from each other at the 0.05 level.
There were differences between the groups in the prevalence of the different types of mental health problems. Suicidal ideation was most common in victims of sexual abuse and victims of multiple types of abuse, followed by victims of physical abuse, and least common in victims of neglect and non-victims.
ADD/ADHD was most common in victims of multiple types of abuse, followed by victims of physical abuse and least common in victims of neglect, sexual abuse and non-victims.
Alcohol problems are significantly higher among victims of neglect and physical abuse than among victims of sexual abuse. Drugs problems are significantly higher among victims of neglect than among victims of sexual abuse. There is no significant difference found between victims of physical abuse and victims of sexual abuse or victims of neglect in substance abuse.
Behavioural problems were significantly more often present among victims of multiple types of abuse than among non-victims or victims of a single type of abuse. In addition, behavioural problems were more common in victims of neglect and physical abuse than in victims of sexual abuse. Behavioural problems are the most common among victims of multiple types of abuse, followed by neglect and physical abuse and is the least common among non-victims of victims of sexual abuse. Learning problems are the most common among victims of multiple types of abuse, followed by neglect and are the least common in victims of non-victims, victims of physical abuse and victims of sexual abuse.
Low IQ is most common in non-victims and in victims of multiple types of abuse, followed by victims of neglect, and least common in victims of physical abuse and victims of sexual abuse.
Internalising health problems are the most common among victims of sexual abuse and victims of multiple types of abuse, followed by physical abuse and neglect. Internalising problems are the least common in non-victims.
In order to exclude the influence of gender differences Table 3 is showing the results of tests of significance for main and interaction effects.
Table 3: Tests of significance for main and interaction effects
Problems in the domains: Type of abuse(main effect) Gender (main effect) Gender*Type of abuse (interaction effect)
Externalising problems
52.63
***60.46
***1.54
Internalising problems
132.87
***24.19
***.62
Developmental problems 29.45
***60.81
***2.19
Notes: *** p < .001The interaction effect of gender and type of abuse is not significant for all three
variables. So the relation between type of abuse and externalising, internalising and
developmental problems is not influenced by gender. Both the main effect of abuse and the
main effect of gender are significant for all three variables.
Figure 1 Z-scores of the Number of Internalising and Externalising Problems and the Total Number of Problems for Each Subgroup
Figure 1 is showing Z-scores of the number of internalising, externalising problems, developmental problems and the total number of problems for each subgroup. First of all the figure is showing a high number of problems among victims of multiple types of abuse. Second, internalising problems are more common among victims of sexual abuse, while externalising problems show higher numbers on physical abuse and neglect than sexual abuse.
When we show these results in different graphs, with separate lines for boys and girls, we can conclude that the differences in later mental health problems between the different subgroups is not a result of gender differences (see Figure 2, 3 and 4).
Figure 2 Z-scores of boys and girls for internalising problems
Figure 3 Z-scores of boys and girls for externalising problems
Figure 4 Z-scores of boys and girls for developmental problems
When we look at Figure 2, 3 and 4, we see that the lines of boys and girls are about equal. The graphs do show that internalising problems are more common among girls and externalising- and
developmental problems are more common among boys.
Discussion
This study examined differences between juvenile offenders who were a victim of sexual abuse, physical abuse, neglect or exposed to multiple forms of child maltreatment and offenders who were non-victimized, in the prevalence of mental health problems.
First, results showed that the differences on externalising problems were very small between victims of sexual abuse and non-victims, which is also found by Swogger et al. (2011), Mills et al. (2013), Cicchetti et al. (2010), Spataro et al. (2004) and Cyr et al. (2010). They found higher rates of internalising problems as well as externalising problems among sexual abused children, but the differences were really small.
Second, the present study showed that suicidal ideation was higher among victims of
physical and sexual abuse than among neglect. Mullen and colleagues (1993) and Bedi and colleagues (2011) found more suicidal thoughts and suicidal behavior among victims of child maltreatment. The present study adds to these results by making a distinction between the different types of child abuse. Suicidal ideation is more common among victims of sexual abuse in comparison with victims of physical abuse, neglect or victims of multiple types of abuse. Among victims of neglect and non-victims is no notable difference of suicidal ideation.
Third, we found no significant difference between victims of child abuse and non-victims on alcohol and drugs abuse. This is not in line with results of Herrenkohl and colleagues (2013), they describe higher rates of alcohol and drugs abuse among victims of child abuse in comparison with non-victims.
Fourth, the domain special education needs showed varying results. Notable is that no significant differences were found between the groups on learning problems. Special education needs as a result of a low IQ were more common among victims of multiple types of abuse and non-victims than among victims of sexual abuse, physical abuse or neglect. This could be accounted by the fact that the prevalence is low and because of that the power of the present study is too low to find any significant effects. This is in contradiction with the results of the studies of Cyr and colleaues (2010), and Van IJzendoorn & Bakermans-Kranenburg (2009) who found that child abuse results in a poorer
working memory and learning problems. Tricket and McBride Chang (1995) found that victims of physical abuse and neglect seem to have a poorer cognitive development and poorer school performance, which is in contradiction with the results of this study. We did find some differences between victims of physical abuse, neglect and sexual abuse, but these differences are not significant. At last, ADD/ADHD was most common among victims of multiple types of abuse, followed by victims of physical abuse and least common in victims of sexual abuse and non-victims. The outcomes at ADD/ADHD are as we expected, based on research of Lamet & Wittebrood (2009). In line with our expectations, behavioral problems showed, just like ADD/ADHD higher rates among victims of multiple types of abuse in comparison with single types of abuse or non-victims.
To summarize, results showed that externalizing problems were most common in victims of physical abuse, neglect or multiple forms of maltreatment, whereas internalizing problems were most common in victims of sexual abuse and multiple forms of maltreatment. Because there has been performed a two-way ANOVA to exclude possible gender influences, we can conclude that the differences that are found in this study are no result of gender differences.
This study has some limitations that should be mentioned. First of all, this study is no experimental study which means we can’t say anything about cause and related effects. Second, the severity of the abuse, which could influence later mental health problems, is not taking into account in this study. For ethical reasons we can’t avoid the first limitation. The second limitation is something to into account in future research, but we have to be careful to mark some types of abuse or abusing behaviour as less severe than others.
Interesting would be to see future research focus on differences in duration and severity of the types of abuse. Does this affect the problems that arise? And the intensity of the problems?
Furthermore, future study could focus on the perpetrator. It would be interesting to look at the differences in outcomes when the perpetrator was somebody from outside the family in comparison with being abused by somebody within the family. This could influence the problems. Being abused by somebody within the family is most of the time somebody you trust and should give you safety. This leads to a negative attachment relationship, that could lead to more problems or more severe
problems.
What does this results mean for treatment or the working field? If different types of abuse lead to different mental health problems it can influence the treatment that should be given. We should be more alert at the problems that are most common at a specific type of abuse. When we know that children suffered from a specific kind of abuse have more chance to develop a specific kind of problem we can start preventive treatment for a select group of problems.
Our results add to the understanding of the relation between child maltreatment and mental health problems by showing that, for both male and female adolescent offenders, externalising problems were most common among victims of physical abuse, neglect or multiple forms of
maltreatment, whereas internalising problems were most common among victims of sexual abuse and multiple forms of maltreatment
.
This knowledge is important for the assessment of problems and to improve intervention programs for juvenile offenders who are victims of child abuse. Preventive intervention programs can focus on the more common later mental health problems if we know which type of abuse leads to what kind of mental health problems.References
Alink, A., van IJzendoorn, L., Bakermans- Kranenburg, M., Pannebakker, F., Vogels, T., & Euser S. (2011). De Tweede Nationale Prevalentiestudie Mishandeling van Kinderen en Jeugdigen (NPM-2010). Leiden: Drukkerij van der Linden.
Arata, C. M., Langhinrichsen-Rohling, J., Bowers, D., & O’Brien, N. (2007) Differential correlates of multi-type maltreatment among urban youth. Child Abuse & Neglect, 31, 393–415
Barnoski, R. (2004). Assessing risk for re-offense: Validating the Washington State juvenile court assessment. Olympia: Washington State Institute for Public Policy, 2004.
Bedi, S., Nelson, E. C., Lynskey, M. T., McCutcheon, V. V., Heath, A. C., Madden, P. A. F., & Martin, N. G. (2011) Risk for suicidal thoughts and behavior after childhood sexual abuse in women and men. Suicide and Life-Threatening Behavior, 41(4), 406–415.
Cicchetti, D., Rogosch F. A., Gunnar, M. R. & Toth, S. L. (2010) The differential impacts of early physical and sexual abuse and internalizing problems on daytime cortisol rhythm in school- aged children. Child Development, 81(1), 252-269.
Cyr, C., Euser, E. M., Bakermans- Kranenburg, M. J., & van IJzendoorn, M. H. (2010). Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyse. Development and Psychopathology, 22, 87–108.
Fergusson, D. M., Boden, J. M., & Horwood, L. M. (2008). Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse & Neglect, 32 (6), 607- 619. Hart, S. N., Brassard, M. R. (1987). A Major Threat to Children’s Mental health: Psychological Maltreatment. American Psychologist, 42 (2), 160 – 165.
Hayes, S. C. (1997). Prevalence of intellectual disability in local courts. Journal of Intellectual & Developmental Disabilities, 22(2), 71-85.
Herrenkohl, T., Seunghye, H., Klika, J., Herrenkohl, R., & Russo, M. ( 2013) Developmental Impacts of Child Abuse and Neglect Related to Adult Mental Health, Substance Use, and Physical Health. Journal of Family Violence, 28(2), 191-199.
Kaplow, J. B., & Widom, C. S. (2007) Age of onset of child maltreatment predicts long-term mental health outcomes. Journal of abnormal psychology, 116 (1), 176- 187.
Lamet, W., & Wittebrood, K. (2009) Nooit meer dezelfde. Gevolgen vanmisdrijven voor slachtoffers. Den Haag: CPB-publicatie.
Lansford, J. E., Miller-Johnson, S., Berlin, L. J., Dodge, K. A., Bates, J. E., & Pettit, G. S. (2007) Early Physical Abuse and Later Violent Delinquency: A Prospective Longitudinal Study. Child Maltreatment, 12(3), 233-245.
Mills, R., Scott, J., Alati, R., O’Callaghan, M., Najman, J. M., & Strathearn, L. (2013) Child maltreatment and adolescent mental health problems in a large birth cohort. Child Abuse & Neglect, Article in Press.
Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E., & Herbison, G. P. (1993) Childhood sexual abuse and mental health in adult life. The British Journal of Psychiatry, 163, 721-732. Ney, P., Fung, T., & Wickett, A. (1994). The worst combinations of child abuse and neglect. Child Abuse & Neglect, 18, 705–715
Schneider, R., Baumrind, N., Kimerling, R. (2007) Exposure to child abuse and risk for mental health problems in women. Violence and Victims, 22(5), 620 – 631.
Smith, C., & Thornberry, T. P. (1995). The relationship between child maltreatment and adolescent involvement in delinquency. Criminology, 33, 451-481.
Spataro, J., Mullen, P. E., Burgess, P. M., Wells, D. L., & Moss, S. A. (2004) Impact of child sexual abuse on mental health : Prospective study in males en females. The Britisch Journal of Psychiatry, 184, 416-421.
Springer, K. W., Sheridan, J., Kuo, D., & Carnes, M. (2007) Long-term physical and mental health consequences of childhood physical abuse: Results from a large population-based sample of men and women. Child Abuse & Neglect, 31(5), 517-530.
Stouthamer-Loeber, M., Loeber, R., Homish, D. L., & Wei, E. (2001). Maltreatment of boys and the development of disruptive and delinquent behavior. Development and Psychopathology, 13, 941-955.
Sugaya, L., Hasin, D., Olfson, M., Lin, K., Grant, B. F., & Blanco, C. (2012) Childhood Physical abuse and adult mental health: a national study. Journal of traumatic stress, 25(4), 384-392 Swogger, M. T., Conner, K. R., Walsh, Z., & Maisto, S. A. (2011) Childhood abuse and harmful substance use among criminal offenders. Addictive Behaviors, 36(12), 1205-1212.
Trickett, P. K., & McBride-Chang, C. (1995) The Developmental Impact of Different Froms of Child Abuse and Neglect. Developmental Review, 15(3), 311-337
Van Dantzig, A., Tromp, C., Heyman, T. H., Meuwese, S., & Willems, J. (2000). Kindermishandeling. Een zaak van volwassenen. Manifest over de aanpak van
kindermishandeling en voor een kindvriendelijke samenleving. Amsterdam: Defence for Children International Nederland.
Van IJzendoorn, M. H., & Bakermans- Kranenburg, M. J. (2009). Attachment Security and Disorganization in Maltreating Families and Orphanages. Leiden: Centre for Child and Family Studies, Leiden University.
Wolzak, A, & ten Berge, I. (2008) Gevolgen van kindermishandeling. Utrecht: Nederlands Jeugd Instituut.
