Behavioural consequences of child abuse

Effects of violence and neglect on attachment and brain development

A strong and secure attachment bond with a primary caregiver is the core of developing resilience and a healthy personality.^7,8 It strengthens a child’s ability to cope with stress, regulates emotions, provides social support, and forms nurturing relationships.⁹ The world is experienced as a safe place in which to explore and develop independence. The child finds comfort and support from his or her caregiver when under stress. When children are abused, they might display disturbed forms of attachment and abnormal patterns of emotional response toward their caregivers. This might subsequently lead to a serious attachment disorder with symptoms such as those shown in Box 1.^5–8

The Early Years Study 2 summarized the research on the effects of violence and neglect on early brain development.⁵ Poor caregiver-infant interactions compromise the formation of neural circuits and pathways. A series of studies spanning 2 decades shows that neglect, abuse, or parenting compromised by depression or substance abuse influence the development of the child’s brain and biologic pathways.¹⁰

Research has shown that the quality of exchanges between caregiver and infant serves as the foundation for the infant’s signaling system and influences the child’s subsequent mental and physical health, especially the child’s capacity to interact with others and the development of neural pathways for language and higher cognitive functions.⁷ Children are more likely to have learning and behaviour problems when living with parents who struggle with mental health or substance abuse problems. Maternal depression is a key determinant of poor early child development; it is related to and as important as family functioning, parenting style, and engagement.

Young children are highly sensitive to other people’s emotions, particularly those of their family members. Witnessing scenes of verbal or physical violence and discord has direct negative effects with long-lasting consequences. Similarly, children who experience parental abuse or neglect are more likely to show negative outcomes that carry forward into adult life, with ongoing problems with emotional regulation, self-concept, social skills, and academic motivation, as well as serious learning and adjustment problems, including academic failure, severe depression, aggressive behaviour, peer difficulties, substance abuse, and delinquency.^11–13

Types of child abuse

The current literature discusses many kinds of child abuse, each with implications that have been shown to harm child development. An abused child often suffers from more than one type of abuse; however, some types of abuse are more frequently seen than others.^1–5

Effect of child abuse on the stages of behavioural development

Common behavioural indicators of abuse

Identifying indicators of child abuse is usually challenging. Family members and family physicians should be very watchful of children who have unusual psychosomatic complaints or behavioural changes. In such cases, more in-depth assessment of the child and family might be indicated.²⁵ It should be noted that not all maladaptive behaviour is an indication of abuse, and the indicators listed in Box 2 are not indicative of abuse only.

Physically abused children might have unusual injuries to particular sites on their bodies that are not usually subject to injury, such as wounds on the genitals, on the thighs, or around the eyes. Physical abuse might even manifest as serious trauma without adequate justification, such as fracture with minimal trauma. In clinical practice, physically abused children might stare at their parents or caregivers and appear apprehensive, as if they are waiting for the next abusive event to occur.²³ In addition, the way clothing is worn can indicate physical abuse; for example, a child wearing a long-sleeve dress or clothing that covers parts of the body that are not normally covered—ie, hands, legs, and neck—especially in hot weather.

Emotional effects of abuse often stem from insecure relationships with caregivers and affect child attachment development (Box 3). Such effects might be destructive to their confidence and self-esteem and to relationships with peers or partners later in life. Emotionally abused children might also persist with age-inappropriate habits and repetitive behaviour such as rocking and thumb-sucking.¹⁸ When emotional abuse is chronic and persistent, it can result in emotional harm to the child. Under the Child and Family Services Act, a child is defined as emotionally harmed if he or she demonstrates severe anxiety, depression, withdrawal, or self-destructive or aggressive behaviour.²⁶

The child’s condition and behaviour in general might indicate abuse. The history might reveal multiple emergency admissions and multiple visits to different physicians. Also, undue delay in obtaining treatment of injury should raise concern.

In the case of neglect, a child might exhibit poor hygiene such as an unwashed body or hair, or an unpleasant body odour. He or she might live in unhealthy conditions, be left unsupervised, or be allowed to play in unsafe situations. Such children are frequently late for or absent from school (Box 4).

Sexual abuse also has serious negative effects throughout children’s lives, ranging from physical injuries to emotional destruction.¹⁷ Indicators of sexual abuse are outlined in Box 5. Sexually abused children might have trouble walking or sitting because of disabling pain or injuries. Additionally, they might be afraid to change their clothes in front of other people because they do not want others seeing their bodies. They might also avoid sitting with peers or engaging in physical exercises that could lead to being touched. Sometimes, they behave in a seductive manner, which shows knowledge about sexual relationships. Teen pregnancy and a history of sexually transmitted diseases might be signs of ongoing sexual abuse.