Entropy Rules

What's Wrong With This Picture:

The Impact Of Child Maltreatment

    Child maltreatment is a significant societal problem. A 2013 United Nation report ranks the US 26th out of 29 countries in child well-being (UNICEF, 2015). In 2015, approximately 3,358,000 cases of child abuse and neglect were investigated in the U.S., a nine percent increase since 2011. That same year, an estimated 1,670 children died from abuse and neglect in the U.S. Approximately 91% of perpetrators were parents of the victims (U.S. Department of Health & Human Services, Administration on Children, Youth, and Families, Children's Bureau, 2017). These numbers are likely to be gross underestimations due to many unsubstantiated reports and the likelihood of underreporting. Additionally, there are no legal consequences for (and thus no recourse for consistently reporting) emotional and psychological abuse and neglect when it occurs in the absence of substantiated physical abuse or neglect, or sexual abuse. However, mounting evidence suggests various forms of child neglect can have an even greater negative impact on development than overt abuse (Ben-David, 2016; Davidson-Arad et al., 2010; Hildyard & Wolfe, 2002) Approximately 75% of cases investigated by DHHS in 2015 were cases of child neglect (U.S. Department of Health & Human Services, Administration on Children, Youth, and Families, Children's Bureau, 2017).
    In addition to the deleterious effects on psychological and interpersonal functioning discussed in detail later in this review, child maltreatment has also been linked to a variety of physical maladies including irritable bowel syndrome, autoimmune diseases, ischemic heart disease, metabolic syndrome, diabetes, and obesity (Shonkoff et al., 2011; Palasznski & Nemeroff, 2009; Norman et al., 2012). Maltreated people have lifelong difficulties in regulation of physiological stress (Cichetti, Rogosh, Gunner & Toth, 2010), and experience diminishing cognitive and socio-emotional capacities based on deprivation, trauma, and high levels of stress (Cicchetti, 2013). Consequently, child maltreatment is a major early life contributor to unhealthy lifestyles that result in staggering physical and mental healthcare costs. Analysis of statistics collected by the Centers for Disease Control (CDC) yielded an estimated total lifetime economic burden of maltreatment to be $585 billion per generation of maltreated children. The estimated lifetime public health cost per maltreated person is estimated to be greater than $210,000 per lifetime as of 2010 (Fang, Brown, Florence & Mercy, 2012). Child maltreatment, then, may be one of the most important prevention targets in addressing overall public health costs (Palaszynski & Nemeroff, 2009).
    The chronic stress associated with maltreatment during critical periods of brain development results in persistent neurobiological and psychophysiological effects that play a role in the development of poor health in adulthood (Palaszynski & Nemeroff, 2009). Exposure to toxic stress early in life is especially problematic because it can interfere with optimal development of psychobiological regulatory capacities, impacting multiple biological systems, including the immune system, autonomic nervous system, and endocrine system, leading to a variety of health problems (Palaszynski & Nemeroff, 2009). In a predicament that adds insult to injury, chronic exposure to stress compromises developing abilities to cope with stress. Considering that child maltreatment usually co-occurs with low SES, parental substance abuse, and other forms of environmental stress, the maltreated child is left ill-equipped to cope with an exceptionally stressful environment. Exposure to maltreatment in childhood is associated with psychosocial risk, difficulty regulating emotion, impaired perspective taking, psychopathology, depression, PTSD, and compromised parenting (Cicchetti & Valentino, 2006; Heim, Shugart, Craighead, & Nemeroff, 2010; Hildyard & Wolfe, 2002; Koren-Karie, Oppenheim, & Getzler-Yosef, 2004; Lyons-Ruth & Block, 1996; McCauley et al., 1997; Rowan & Foy, 1993). Of central interest in the current paper is the risk that maltreated children may go on to maltreat their own children, resulting in a cumulative cost to society over time.
    Research suggests that maltreatment leads to suboptimal attachment, compromising the foundational context within which many relational skills and competencies are fostered (DeKlyen & Greenberg, 2008; Dozier, Stovall-McClough, & Albus, 2008; Kobak & Madsen, 2008). Theory dictates and evidence supports that the quality of attachment between parent and child is a powerful predictor of multiple factors that affect later parenting. A healthy and responsive parent-child bond supports psychological adjustment, the development of autonomy and self-reliance, regulation of levels of negative affect such as anger and anxiety, and the development of empathic capacities and interpersonal competence (e.g., Berlin et al., 2008; Mikulincer & Shaver, 2008; Weinfield, Sroufe, Egeland, & Carlson, 2008). Secure attachment fosters pro-social qualities such as self-confidence, self-efficacy, self-esteem, and social skills that support competent exploration of environments (Siegel & Hartzell, 2014). Thus, securely attached children are more likely to develop into adults with skills that support effective parenting, such as relational competence, desirable personality traits, stronger emotion regulation skills, better self-concept, more nuanced and functional social cognition, and greater emotional intelligence (Siegel, 2011; Thompson, 2008; Weinfield, Sroufe, Egeland, & Carlson, 2008). These many traits and capacities, which influence the degree of success of future relationships, including future parent-child relationships, tend to be compromised in individuals who were maltreated as children (e.g., Raby et al., 2015).
    Although maltreatment related attachment styles are often transmitted intergenerationally, it is possible for attachment style to change from one generation to the next (Conger, Belsky, & Capaldi, 2009; Ehrensaft, Knous-Westfall, Cohen & Chen, 2015; Putallaz, Costanzo, Grimes, & Sherman, 1998). Attachment is based, primarily, on the quality of contingent communication and interaction between the parent and child. Thus, changing the quality of parent-child interactions can interrupt the process of intergenerational transmission (Kobak & Madsen, 2008). Research has shown that quality of caregiving predicts individual differences in attachment security over and above genetic factors (Vaughn, Bost, & Van Ijzendoorn, 2008). Although genetic factors do affect temperament and can influence the development of psychopathology, attachment has emerged as more influential than genetics in predicting later functioning, implying that healthy parent-child attachment relationships are foundational to human thriving, which is not predetermined by genetics (Vaughn, Bost, & Van Ijzendoorn, 2008). This paper responds to a call for more research elucidating the conditions under which compromised attachment and its problematic sequelae can change (Berlin, Appleyard & Dodge, 2011).

⇲ About The Author

Robin Hertz, MA is currently in the process of completing a PhD in Clinical Psychology at the University of Oregon.