Understanding Child Abuse and Neglect (1993) / Chapter Skim
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2 IDENTIFICATION AND DEFINITIONS
2 IDENTIFICATION AND DEFINITIONS
Pages 57-77
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From page 57... ...
lack of social consensus over what constitutes dangerous or unacceptable forms of parenting. · uncertainty about whether to define maltreatment based on adult characteristics, adult behavior, child outcome, environmental context, or some combination.
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From page 58... ...
, has played a major role in modern advances in psychiatric research, despite its limitations. Research on child maltreatment could benefit greatly from the development of an analogous diagnostic system for child abuse and neglect.
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In particular, issues of definition obscure comparisons of incidence rates from two governmental national incidence studies that rely heavily on administrative reports of child abuse and neglect (commonly referred to as NIS-1 and NIS-2) (National Center for Abuse and Neglect, 1981; 1988b)
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It formulated broader legal definitions of child abuse that encompass emotional injury, neglect, parental deprivation of medical services, and factors deleterious to children's moral development (Cicchetti and Barnett, 1991~. Legal definitions in the Juvenile Justice Standards Project (Wald, 1977)
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Emotional damage is evidenced by "severe anxiety, depression or withdrawal, or untoward aggressive behavior towards self or others, and the child's parents are unwilling to provide treatment for him/her." · Sexual abuse is limited to those cases in which the child is "seriously harmed physically or emotionally thereby." Such a definition excludes many cases in which consequences are not immediately apparent but emerge at later points in the developmental cycle. In these legal definitions, coercive state intervention on behalf of the child is weighed against the potential harm of separation from the caregiver and the problems of state intrusion into family autonomy.
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suggested four general principles for formulating research definitions of child abuse: Formulation of the specific objectives the definition must serve. Ross and Zigler (1980:294)
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The panel believes strongly that progress on child maltreatment research requires not only the development of intelligent classification schemes, but also the development of standardized field instruments, such as clinical checklists or structured survey questionnaires, with documented psychometric properties. In other words, instruments need to be developed, together with associated documentation such as training manuals; interrater reliability studies need to be conducted to document consistency together with studies of construct validity and (in the longer term)
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From page 64... ...
of 1986 provides an example of an endangerment definition: "Child abuse is physical assault with or without a weapon by a parent or temporary caretaker. It includes hitting with a stick, strap, or other hard object, as well as scalding, burning, poisoning, suffocating, and drowning.
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With child abuse, no consensus appears to exist as to how broadly the set of potential perpetrators should be defined.
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Documentation needs to be supplied to ensure that instruments are not administered to inappropriate age groups. Culturally Informed Definitions Although definitions of child abuse and neglect vary across time and across cultures, consensus exists around definitions of severe forms of child maltreatment for example, all members of society would probably agree that battering a child to death is morally repugnant.
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. IDENTIFICATION OF CHILD MALTREATMENT Detection in Medical Settings Spurred by pediatric advocacy, reporting laws adopted in the mid-1960s were narrowly focused on encouraging physicians to recognize and initiate protective action for children who were victims of physical abuse inflicted by their caretakers.
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Documenting physical evidence of sexual abuse is complicated by variations in observations and descriptions of normal and abnormal genital appearance (Paradise, 1990~.5 Accurate diagnosis of sexual abuse in children is hindered by frequent delays between alleged molestations, disclosure, and medical examinations. Currently, physicians retrospectively interpret changes in anogenital anatomy without the benefit of clinical research describing the healing chronology of acute genital and anal trauma (Finkel, 19891.
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From page 69... ...
In the absence of specific definitive physical manifestations, diagnoses often depend on the value judgments of individual physicians (Ludwig, 1983; Bross, 1982~.6 Although the medical diagnosis of child abuse has improved (particularly in the area of physical abuse) , most medical research in child maltreatment has been retrospective and clinical, consisting primarily of observations of patients at one institution.
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RESEARCH RECOMMENDATIONS 2-1. Research Recommendation: Recognizing that the absence of consistent research definitions seriously impedes the development of an integrated research base in child abuse and neglect, a series of expert multidisciplinary panels should be convened to review existing work and to develop a consensus on research definitions of each form of abuse and neglect.
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2-4. Research Recommendation: Empirical research that builds on existing medical knowledge of the physical indicators of child sexual and physical abuse would assist physicians in the identification of child maltreatment.
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. The American Medical Association's Diagnostic and Treatment Guidelines Concerning Child Abuse and Neglect (1985)
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American Academy of Pediatrics 1991 Committee on Child Abuse and Neglect. Guidelines for the Evaluation of Sexual Abuse of Children.
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Carlson, eds., Child Maltreatment: Theory and Research on the Causes and Consequences of Child Abuse and Neglect. New York: Cambridge University Press.
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1980 The cultural context of child abuse and neglect. Child Abuse and Neglect 4:3-13.
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1988b Study Findings: Study of National Incidence and Prevalence of Child Abuse and Neglect. Washington, D.C.: U.S.
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Peters 1986 Issues in the definition of child sexual abuse in prevalence research. Child Abuse and Neglect 10:231-240.
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