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How the Government and Society have a Responsibility to Help Child Abuse Victims

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Child maltreatment is a problem that society as a whole must face in all corners of the globe. Although the definition of child abuse and neglect may vary from culture to culture, the problem remains the same – and so do its effects. As technology progresses, researchers have been discovering just exactly how the brain of a child is affected following mistreatment, and more importantly, how we can help these children in need.

According to the World Health Organization, or WHO, child maltreatment is defined as “all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that results in actual or potential harm to the child’s health, development or dignity” (who.int). There are two types of maltreatment. These are known as acts of commission, and acts of omission. An act of commission, otherwise known as child abuse, is when a caregiver uses “words or overt actions that cause harm, potential harm, or threat of harm to a child” (who.int). This is even broken down further into three subcategories; these are physical abuse, sexual abuse, and psychological abuse. Acts of omission, otherwise known as child neglect, is “the failure to provide for a child’s basic physical, emotional, or educational needs or to protect a child from harm or potential harm”(who.int). Like acts of commission, this is also separated into several subcategories. These are physical, emotional, medical/dental, and educational neglect (failure to provide), and inadequate supervision/exposure to violent environments (failure to supervise). However, unlike child abuse, neglect is not always intentionally meant to harm a child. However, in each type of abuse, the child is still the victim and still does suffer, whether the abuse is intentional or not.

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Although children are never responsible nor in control of the damage they are subjected to, there are certain factors and traits that may increase the probability of abuse. Statistics show that children under the age of four are most likely to fall victim to abuse. Also, children that suffer from special needs that increase the amount of attention or energy required to care for them are far more susceptible to abuse. Children with mental health issues or chronic physical disabilities, such as Down Syndrome, are at the highest risk of becoming victims of abuse or neglect (cdc.gov).

Victims are not the only group with risk factors. Often, it is the caregiver who possesses a trait that raises the risk of them becoming abusers. The CDC states that, often in cases of child maltreatment, the parents or guardians of the child do not fully understand the needs of a child or how a child develops. Incompetent parenting skills may very well be to blame for a large number of cases of abuse or neglect. Substance abuse and mental health issues are also two of the more common risk factors in caregivers. Finally, “parental characteristics such as young age, low education, single parenthood, large number of dependent children, and low income” also plays a huge role and increases the risk of abuse or neglect by the caregiver (cdc.gov).

Abuse or neglect can affect a child in several unique ways. It has been known to cause: improper brain development, impaired socio-emotional skills, a higher risk for heart, lung and liver diseases, obesity, cancer, high blood pressure and cholesterol, anxiety, alcoholism and substance abuse. In some severe cases, abuse or neglect of a child could result in death. In fact, “In 2011, approximately 1,570 children died from abuse and neglect across the country—a rate of 2.10 deaths per 100,000 children” (cdc.gov).

It is not only the abusive environment that can affect a child. Recent studies have shown that not only does child maltreatment have a severe psychological effect on children, but a physical one as well. In 2013, a study was performed by several experts, among them Dr. Christine M. Heim of Emory University in Atlanta, to test the hypothesis that early child abuse will leave scars on the brain that will remain for the rest of the victims’ lives. Dr. Heim hypothesized that, because sexual dysfunction was a common clinical symptom of child abuse victims, there must be a mechanism in the brain that constituted this. Her and her partners “used MRI-based cortical thickness analysis in fifty-one medically healthy adult women to test whether different forms of childhood abuse were associated with cortical thinning in areas critical to the perception and processing of specific behavior implicated in the type of abuse.” The results of her experiment was that abuse was associated with “pronounced cortical thinning in the genital representation field of the primary somatosensory cortex.” In other words, in victims of sexual abuse, areas of the brain that are associated with genital sensitivity became significantly thinner (ajp.psychiatryonline.org).

However, perhaps the most admirable aspect of this experiment was Heim’s insight as to why this occurs. Her conclusion was that “neural plasticity during development appears to result in cortical adaptation that may shield a child from the sensory processing of the specific abusive experience by altering cortical representation fields in a regionally highly specific manner.” In a sense, this is a child’s defense mechanism. In order to prevent further emotional scaring each time abuse occurs, the brain slowly begins to desensitize the child from the specific form of violence or abuse they are subjected to. Although this may prevent the child from suffering a certain degree of damage in early childhood, multiple studies have shown that an effect of this ‘desensitization’ also has its consequences. It dramatically increases the chances of disorders, such as sexual dysfunction, later on in life (ajp.psychiatryonline.org) (healthland.time.com).

Although this experiment was specifically aimed at testing sexual abuse, it did give insight to other types of abuse as well. As previously stated, sexual abuse frequently affected the somatosensory cortex. However, emotional abuse leaves the brain with another kind of alteration. Emotional abuse had a severe impact on the social aspects of a child’s life. “Here, the changes were seen in regions associated with understanding and controlling emotions and recognizing and responding to the feelings of others.” The prefrontal cortex and the medial temporal lobe were affected the most with this type of maltreatment. These areas are responsible for self-awareness and emotional regulation. The long term effects of emotional abuse were that it commonly left victims “prone to depression, moodiness and extreme or dulled emotional responsiveness.” Jens Pruessner, an associate professor of psychiatry at McGill University in Montreal, says that “As adults, [victims of this type of emotional abuse have difficulty] reflecting on themselves and finding the right way to deal with emotions.” However, although the effects may be more visible as children reach adulthood, the foundation for this type of behavior is already present after the first abusive encounter (healthland.time.com).

Pruessner also adds that the changes of cortical thickness in the brain are not small. On average, the areas of the cortex that are affected by abuse are 5mm thick. In victims of abuse, the average is somewhere between 3 and 4mm thick – that is a 20-40% decrease in size. This decrease in size happens because the brain, just like all muscles, grows the more it is used. However, in order to prevent psychological scarring, the brain decreases connections to certain areas of the cortex that it feels are the most susceptible to damage during abuse, leaving these areas of the brain ‘underdeveloped.’ This research also supports the hypothesis that a thinning in these areas of the brain is associated with a higher pain threshold (healthland.time.com).

This type of damage to the brain, however, is not irreversible, Pruessner explains. “Most abuse survivors do not develop symptoms, in fact, and research shows increasingly that the brain can change dramatically when provided with the right type of support and emotional nourishment.” The key to recovery is for the child to remain in the care of someone who is able to emotionally support them, which often times, may be difficult depending on the severity of the previous abuse (healthland.time.com).

Child neglect can also affect the brain of a victim just as critically. Dr. Bruce Perry, Professor of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine in Chicago, explains how this works:

“Huge portions of the human brain are devoted to social functions and communication including establishing and maintaining eye contact, reading faces, judgments and more. When a baby is born, his brain houses over one hundred billion neurons that will chart paths and make connections based on the social experiences they encounter. By the age of two and a half, approximately 85 percent of the baby’s neurological growth is complete, meaning the foundation of their brain’s capacity is in place. By age three, the child’s brain is 90 percent of its completed adult size.” (acrf.org).

Although a child is born with over one hundred billion neurons in the brain, if these neurons are not given a chance to make connections with each other through the use of social interactions, they will not grow. Instead of the brain being used at full potential, it will develop in a “compromised state.” (acrf.org)

In order for a brain to grow at it’s fullest potential, certain areas of the brain must grow proportionally. The combined brainstem and midbrain areas, which are responsible for reactive and reflexive functions, such as breathing, heartbeat, and safety responsiveness, must be half the size of limbic and cortical systems. The limbic and cortical systems control one’s higher reasoning skills, including: feelings, emotions, predicting, analyzing, and reasoning

Dr. Perry’s research has led him to believe that, in children who have experienced severe trauma such as child abuse, “the Brainstem and Midbrain portion of the brain seems to overdevelop, meaning children will have overdeveloped safety and stress responses and act more impulsively, even though the thinking and feeling part of the brain (the Cortical/Limbic systems) may be normally sized.” (acrf.org).

Child neglect, however, has an inverse effect. In this case, the Cortical and Limbic systems become underdeveloped, because the child does not have the capability to expand the higher reasoning skills associated with these parts of the brain. Finally, in the worst case scenario, a child that has been both abused and neglected in the past will have both an overdeveloped brainstem and midbrain, as well as underdeveloped Limbic and Cortical systems. “When neglect is combined with trauma, a child’s brain develops in a survival style to help him stay safe. This may result in a child being initially “wired” for survival—being impulsive, anxious, acting from instinct instead of reason, and not able to understand or identify his feelings easily.” (acrf.org)

A recent study published by the NSPCC, or The National Society for the Prevention of Cruelty to Children located in the United Kingdom, suggests that, “children who are abused and neglected at home are more likely than their peers to do badly at school, to have behaviour problems and to become victims of bullying.” (www.theguardian.com)

In fact, the study concluded that children who are abused within the first five years of life are three times more likely to suffer from complications from the abuse, such as “having multiple physiological, behavioural and academic problems at school.” Furthermore, children with severe disabilities are “more than seven times more likely” to suffer from abuse at home, and have the same chances of being neglected despite the fact that they are far less capable of being self-sufficient compared to a child without disabilities. (www.theguardian.com)

Children who have spent at least one year in foster care in England are far less likely to achieve five GCSEs* than children that were never in foster care. A GSCE is an academic qualification awarded in a specific subject, generally taken in a number of subjects by students in secondary education in the United Kingdom. These tests are comparable to MCAS and other state distributed exams. Statistically, only 8% of children in care receive high marks on their GCSE exams compared to the national average of 50% (www.theguardian.com).

This is not the only study conducted that demonstrates the link between child maltreatment and poor school performance. In 1984, a study conducted by Dr. Hoffman-Plotkin and Dr. Twentyman exhibited that abused and neglected children displayed a multitude of behaviour and cognitive issues while with their peers. The conductors of this experiment divided the 42 children into three groups; one group consisted of children with a history of physical abuse, one group with a history of neglect, and one group with no history of abuse or neglect. The doctors found that the group of neglected children had the least number of interactions with each other, and the group of children with a history of physical abuse were far more aggressive whilst interacting with each other. The group of children with a history of abuse were also displaying more instances of immaturity and were less responsive to adults, and also, less ready to learn. In general, the abused kids received more discipline from adult care compared to the other two groups. (www.pupilbay.com) (https://www.ncbi.nlm.nih.gov/)

One study conducted in 1982 hypothesizes that neglect perhaps has more of an effect on children and their educational career than physical abuse. Dr. Rebecca Oliver experimented with “auditory comprehension and verbal ability in maltreated [preschool aged] children.” She compared her results with non-maltreated children. Her conclusion was that, “Child neglect is a significant negative predictor of both auditory comprehension and verbal ability” (King 74). In other words, child neglect resulted in extreme underdevelopment of a child’s communication skills, therefor creating difficulty in school.

There are hundreds of other experiments that have been performed regarding how abuse and neglect can affect a child’s educational performance, all of which have the same conclusion. Child maltreatment constitutes huge consequences and critically damages a child’s ability to perform well at school. These negative effects disturb not only a child’s brain but their psyche as well. It is crucial that these children get the help they need as early as possible so they may be able to continue normal, healthy lives.

The article, “Effects of Complex Trauma,” written by the NTCSN, provides an extensive amount of information regarding the socio-psychological influence of several factors of a human relationship. It discusses the science behind the brain and how it affects relationships, behavior, cognition, self-concept, future orientation, and dissociation, among several other topics. It describes how complex trauma can affect children in a multitude of ways.

This information will help give a basis of how a normal, non-abusive relationship between two people works. It can be used as a comparison to people that are abused and how they function in each of their respective relationships. Although no specific author was found, the NCTSN is an organization coordinated by the UCLA and Duke University, and funded by the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health

The article, “Childhood Maltreatment Can Leave Scars In The Brain,” by Jon Hamilton reveals a new piece of information – that females may be more vulnerable to brain changes caused by stress or trauma. It also describes how “brain scans of teenagers revealed weaker connections between the prefrontal cortex and the hippocampus in both boys and girls who had been maltreated as children.” It also offers the results of a study that the NPR had been performing since 1994 – where 500 abuse victims around the age of 18 were surveyed about their childhood abuse.

This information will be very crucial to the original research question because it offers new data involving the difference in brain growth between male and female abuse victims. Jon Hamilton, the athor of the article, is a correspondent for the NPR (National Public Radio), who focuses his writings on neuroscience and health risks. He graduated with a masters degree in an honors program from Columbia University and has won several awards, such as the Baker Prize and the Michael E. Debakey Journalism award for his research

Dr. Charles Nemeroff’s article, “Changes in Brain Structure Found After Child Abuse,” describes exactly how different forms of childhood abuse increase the risk for mental illness and sexual dysfunction in adulthood. He, along with several other doctors from the University of Miami and Emory University in Atlanta, studied 51 MRI scans, each on different women, and found that there is “a correlation between specific forms of maltreatment and thinning of the cortex in precisely the regions of the brain that are involved in the perception or processing of the type of abuse. Specifically, the somatosensory cortex in the area in which the female genitals are represented was significantly thinner in women who were victims of sexual abuse in their childhood.”

The information provided by Dr. Nemeroff will help tremendously because it connects certain forms of sexual abuse to the thinning of certain areas of the prefrontal cortex in the brain, which could alter a person’s response to certain stimuli that provoke fear and stress. Dr. Nemeroff is a highly accredited professor who received his M.D. and Ph.D. for neurobiology at the University of North Carolina. Since then, he has earned numerous awards and accolades involving his research in the field.

The article, “The Impact of Abuse and Neglect on the Developing Brain,” by Dr. Bruce Perry discusses critical points of brain development, starting at infancy and working its way up to early adolescence. It describes how the brain “first develops the most bottom, regulatory regions of the brain,” and then it continues to develop “adjacent, but more higher up and complex regions of the brain.” It discusses that, depending on the starting time of abuse or neglect, which regions of the brain could be affected most. It also further discusses

This piece of information is very important because it gives a sense of a ‘timeline’ regarding which parts of the brain are affected from child maltreatment. Depending on the age of the child at the first signs of the abuse, the physical brain damage as well as psychological damage to a child could be completely different. “Dr. Bruce D. Perry, M.D., Ph.D., is an internationally recognized authority on brain development and children in crisis. His clinical research and practice focuses on traumatized children-examining the long-term effects of trauma in children, adolescents and adults. Dr. Perry’s work has been instrumental in describing how traumatic events in childhood change the biology of the brain. ”

Maia Szalavitz’ article, “Sexual and Emotional Abuse Scar The Brain in Specific Ways,” describes the distinct brain patterns involving people- mainly women and children- when there has been a history of abuse. She describes the different areas of the brain that have abnormal levels of activity, as well as how the brain physically changes after traumatic events. She also provides results to a survey given to several abuse victims.

This article is extremely relevant to my research question because Szalavitz describes specifically how abuse can affect the brain of a child, which would obviously have a tremendous impact on a child’s education in the future. The author, Maia Szalavitz, is a well-known neuroscience journalist that has written several books and has been involved in many publications including but not limited to TIME magazine, the New York Times, and the Washington Post. She graduated cum laude from Brooklyn College and is considered a very credible source amongst her peers.

Maia Szalavitz’ article, “How Child Abuse Primes the Brain for Future Mental Illness,” discusses how abuse, especially as a child, can tremendously raise the risk of depression, post-traumatic stress disorder (PTSD), and addiction later on in life. She continues to write about how child abuse affects the hippocampus area of the brain, and how stress related hormones associated with child maltreatment can actually physically alter certain parts of the brain.

Szalavitz describes specifically how child maltreatment can psychologically affect children by raising the risk of certain mental disorders. The author, Maia Szalavitz, is a well-known neuroscience journalist that has written several books and has been involved in several publications including but not limited to TIME magazine, the New York Times, and the Washington Post. She graduated cum laude from Brooklyn College and is considered a very credible source amongst her peers.

“Understanding the Effects of Maltreatment on Brain Development,” an article written and sponsored by the Child Welfare Information Gateway, describes how a recent surge of research on brain development through the use of magnetic resonance imaging (MRI) has proven that certain brain functions and process are altered as a result of early abuse and neglect. The article goes into detail about each type of abuse (emotional, physical, and sexual) as well as neglect (lack of stimulation, malnutrition, and how each affects a child’s response to sensory stimulation. This article also provides images of MRIs comparing the brain of an ‘average’ child to one of a child that has suffered from ‘extreme neglect.’

This article relates to the research question because it describes how early abuse can “damage [a child’s ability to] learn, form healthy relationships, and lead healthy, positive lives. This article is extremely credible as it was written and sponsored by a government agency that has done extensive research on the brains of abused and neglected children over many years.

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