Long-Term Consequences Of Child Abuse And Neglect

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FACTSHEETApril 2019Long-Term Consequences ofChild Abuse and NeglectAside from the immediate physical injuries childrencan experience through maltreatment, a child’sreactions to abuse or neglect can have lifelongand even intergenerational impacts. Childhoodmaltreatment can be linked to later physical,psychological, and behavioral consequences as wellas costs to society as a whole. These consequencesmay be independent of each other, but they also maybe interrelated. For example, abuse or neglect maystunt physical development of the child’s brain andlead to psychological problems, such as low self-esteem, which could later lead to high-risk behaviors,such as substance use. The outcomes for each childmay vary widely and are affected by a combination offactors, including the child’s age and developmentalstatus when the maltreatment occurred; the type,frequency, duration, and severity of the maltreatment;and the relationship between the child and theperpetrator. Additionally, children who experiencemaltreatment often are affected by other adverseexperiences (e.g., parental substance use, domesticviolence, poverty), which can make it difficultto separate the unique effects of maltreatment(Rosen, Handley, Cicchetti, & Rogosch, 2018).Children’s Bureau/ACYF/ACF/HHS800.394.3366 Email: info@childwelfare.gov https://www.childwelfare.govWHAT’S INSIDEPhysical ralconsequencesSocietalconsequencesFederal research onadverse childhoodexperiencesPreventing andreducing the longterm consequencesof maltreatmentConclusionReferences

https://www.childwelfare.govLong-Term Consequences of Child Abuse and NeglectThis factsheet explains the long-term physical,psychological, behavioral, and societal consequences ofchild abuse and neglect and provides an overview ofadverse childhood experiences (ACEs). It also discussesthe importance of prevention and intervention efforts andpromoting protective relationships and environments. Migraine headaches Chronic bronchitis/emphysema/chronic obstructivepulmonary disease Cancer Stroke Bowel disease Chronic fatigue syndromeFor more information on abuse and neglect, readChild Welfare Information Gateway’s What Is ChildAbuse and Neglect? Recognizing the Signs andSymptoms, which is available at scan, andDefinitions of Child Abuse and Neglect, which isavailable at s-policies/statutes/define/.Child abuse and neglect also has been associated withcertain regions of the brain failing to form, function, orgrow properly. For example, a history of maltreatmentmay be correlated with reduced volume in overall brainsize and may affect the size and/or functioning of thefollowing brain regions (Bick & Nelson, 2016): The amygdala, which is key to processing emotions The hippocampus, which is central to learning andmemoryPhysical Health ConsequencesSome long-term physical effects of abuse or neglect mayoccur immediately (e.g., brain damage caused by headtrauma), but others can take months or years to emerge orbe detectable. There is a straightforward link betweenphysical abuse and physical health, but it is also importantto recognize that maltreatment of any type can causelong-term physical consequences.Childhood maltreatment has been linked to higher risk fora wide range of long-term and/or future health problems,including—but not limited to—the following (Widom,Czaja, Bentley, & Johnson, 2012; Monnat & Chandler,2015; Afifi et al., 2016): Diabetes The orbitofrontal cortex, which is responsible forreinforcement-based decision-making and emotionregulation The cerebellum, which helps coordinate motorbehavior and executive functioning The corpus callosum, which is responsible for leftbrain/right brain communication and other processes(e.g., arousal, emotion, higher cognitive abilities)Fortunately, however, there is promising evidence thatchildren’s brains may be able to recover with the help ofappropriate interventions (Bick & Nelson, 2016). Foradditional information about these impacts, refer toInformation Gateway’s Understanding the Effects ofMaltreatment on Brain Development ain-development/). Lung disease Malnutrition Vision problems Functional limitations (i.e., being limited in activities) Heart attack Arthritis Back problems High blood pressureAdditionally, the type of maltreatment a child experiencescan increase the risk for specific physical healthconditions. For example, one study found that childrenwho experienced neglect were at increased risk fordiabetes, poorer lung functioning, and vision and oralhealth problems. Children who had been physicallyabused were at higher risk for diabetes and malnutrition.Children who were victims of sexual abuse were morelikely to contract hepatitis C and HIV (Widom et al., 2012). Brain damageThis material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.This publication is available online at term-consequences/.2

Long-Term Consequences of Child Abuse and NeglectEpigeneticsEpigenetics refers to changes in how anindividual’s genes are expressed and used, whichmay be temporary or permanent (NationalScientific Council on the Developing Child, 2010).These changes can even be passed on to theperson’s children. An epigenetic change can becaused by life experiences, such as childmaltreatment or substance exposure. Forexample, one study found that children who hadbeen maltreated exhibited changes in genesassociated with various physical and psychologicaldisorders, such as cancer, cardiovascular disease,immune disorders, schizophrenia, bipolardisorder, and depression (Cicchetti et al., 2016).Psychological ConsequencesChild abuse and neglect can cause a variety ofpsychological problems. Maltreatment can cause victimsto feel isolation, fear, and distrust, which can translate intolifelong psychological consequences that can manifest aseducational difficulties, low self-esteem, depression, andtrouble forming and maintaining relationships. Researchershave identified links between child abuse and neglect andthe following psychological outcomes.Diminished executive functioning and cognitive skills.Disrupted brain development as a result of maltreatmentcan cause impairments to the brain’s executive functions:working memory, self-control, and cognitive flexibility (i.e.,the ability to look at things and situations from differentperspectives) (Kavanaugh, Dupont-Frechette, Jerskey, &Holler, 2016). Children who were maltreated also are at riskfor other cognitive problems, including difficultieslearning and paying attention (Bick & Nelson, 2016).https://www.childwelfare.govPoor mental and emotional health. Experiencingchildhood maltreatment is a risk factor for depression,anxiety, and other psychiatric disorders throughoutadulthood. Studies have found that adults with a historyof ACEs had a higher prevalence of suicide attempts thenthose who did not (Choi, DiNitto, Marti, & Segal, 2017;Fuller-Thomson, Baird, Dhrodia, & Brennenstuhl, 2016).(For additional information about ACEs, see the FederalResearch on Adverse Childhood Experiences section laterin this factsheet.) Further, adults with major depressionwho experienced abuse as children had poorer responseoutcomes to antidepressant treatment, especially if themaltreatment occurred when they were aged 7 or younger(Williams, Debattista, Duchemin, Schatzberg, & Nemeroff,2016).Attachment and social difficulties. Infants in foster carewho have experienced maltreatment followed bydisruptions in early caregiving can develop attachmentdisorders. Attachment disorders can negatively affect achild’s ability to form positive peer, social, and romanticrelationships later in life (Doyle & Cicchetti, 2017).Additionally, children who experience abuse or neglectare more likely to develop antisocial traits as they growup, which can lead to criminal behavior in adulthood (U.S.Department of Justice, Office of Justice Programs,National Institute of Justice, 2017).Posttraumatic stress. Children who experienced abuseor neglect can develop posttraumatic stress disorder(PTSD), which is characterized by symptoms such aspersistent re-experiencing of the traumatic events relatedto the abuse; avoiding people, places, and events that areassociated with their maltreatment; feeling fear, horror,anger, guilt, or shame; startling easily; and exhibitinghypervigilance, irritability, or other changes in mood(Sege et al., 2017). PTSD in children can lead todepression, suicidal behavior, substance use, andoppositional or defiant behaviors well into adulthood,which can affect their ability to succeed in school, andcreate and nurture important relationships.This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.This publication is available online at term-consequences/.3

Long-Term Consequences of Child Abuse and NeglectToxic StressStrong, frequent, or prolonged activation of aperson’s stress response system, often referred toas toxic stress, can have long-lasting damagingeffects on an individual’s health, behavior, andability to learn (National Scientific Council on theDeveloping Child, 2014). Toxic stress can becaused by experiencing ACEs, including childmaltreatment. It can change an individual’s brainarchitecture, which can cause the person’s stressresponse system to be triggered more frequentlyand for longer periods of time and place him orher at an increased risk for a variety of physical andmental health problems, including cardiovasculardisease, depression, and anxiety (NationalScientific Council on the Developing Child, 2014).Trauma-informed approaches, however, can helpimprove outcomes for individuals affected by toxicstress, and there is evidence that social andemotional support (e.g., consistent parentingpractices, community supports) can alleviate itseffects (U.S. Department of Health and HumanServices [HHS], Administration for Children andFamilies [ACF], 2017).For more information about toxic stress, visit theCenter on the Developing Child at HarvardUniversity at to-toxic-stress/.Behavioral ConsequencesVictims of child abuse and neglect often exhibitbehavioral difficulties even after the maltreatment ends.The following are examples of how maltreatment canaffect individuals’ behaviors as adolescents and adults.Unhealthy sexual practices. Studies suggest that abusedor neglected children are more likely to engage in sexualrisk-taking as they reach adolescence, including a highernumber of sexual partners, earlier initiation of sexualhttps://www.childwelfare.govbehavior, and transactional sex (i.e., sex exchanged formoney, gifts, or other material support) (Thompson et al.,2017), which increases their chances of contracting asexually transmitted disease.Juvenile delinquency leading to adult criminality.Several studies have documented the correlationbetween child maltreatment and future juveniledelinquency and criminal activities (Herrenkohl, Jung, Lee,& Kim, 2017). According to research funded by theNational Institute of Justice within the U.S. Department ofJustice, Office of Justice Programs, children whoexperience maltreatment in the form of physical andemotional abuse are more likely to develop antisocialbehaviors and form relationships with other antisocialpeople (U.S. Department of Justice, Office of JusticePrograms, National Institute of Justice, 2017).Furthermore, there is a difference between girls and boysin the way child maltreatment influences delinquentbehavior. In the study, girls tended to express internalizingbehaviors (e.g., depression, social withdrawal, anxiety),while boys tended to express externalizing behaviors (e.g.,bullying, aggression, hostility) leading up to adult criminalbehavior (Herrenkohl et al., 2017).Alcohol and other drug use. Adults who had beenmaltreated as children are at a significantly higher risk ofsubstance use disorders than adults who have not beenmaltreated (LeTendre & Reed, 2017; (Choi, DiNitto, Marti,& Choi, 2017).Future perpetration of maltreatment. Although mostchildren who have experienced abuse and neglect do notgo on to abuse or neglect their own children, researchsuggests they are more likely to do so compared tochildren who were not maltreated (Yang, Font, Ketchum,& Kim, 2018). This cycle of maltreatment can be a result ofchildren learning early on that physical abuse or neglect isan appropriate way to parent (Child Welfare InformationGateway, 2018). To learn more, read Information Gateway’sIntergenerational Patterns of Child Maltreatment: Whatthe Evidence Shows, available at ergenerational/.This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.This publication is available online at term-consequences/.4

https://www.childwelfare.govLong-Term Consequences of Child Abuse and NeglectSocietal ConsequencesAlthough the physical, psychological, and behavioralconsequences of child abuse and neglect weigh heavilyon the shoulders of the children who experience it, theimpact of maltreatment does not end there. Society paysa price for child abuse and neglect in both direct costs(e.g., hospitalizations, foster care payments) and indirectcosts (e.g., long-term care, lost productivity at school,juvenile and criminal justice systems costs).A study by researchers from the Centers for DiseaseControl and Prevention (CDC) developed estimates using2015 data for the cost of child maltreatment in the UnitedStates. For nonfatal incidents of child maltreatment, theresearchers estimated a lifetime cost of 831,000 perchild, and for fatal incidents of child maltreatment, itestimated a lifetime cost of 16.6 million per child(Peterson, Florence, & Klevens, 2018). It appraised theannual cost of nonfatal child maltreatment in the UnitedStates to be 428 billion (based on the number ofsubstantiated cases of nonfatal maltreatment) or 2 trillion(based on the number of investigated instances ofnonfatal maltreatment). The costs in this study includeboth tangible costs (e.g., child welfare, health care,juvenile justice) and intangible costs (e.g., pain, suffering,grief).Federal Research on AdverseChildhood ExperiencesACEs refers to a group of traumatic experiences inchildhood, including maltreatment, that can cause toxicstress and affect an individual’s physical, psychological,and behavioral well-being.1 (See figure 1 for arepresentation of how ACEs affect an individualthroughout his or her life.) Between 1995 and 1997, theCDC, in collaboration with Kaiser Permanente’s HealthAppraisal Clinic, conducted the landmark ACEs study,which examined the correlation between childhoodtrauma and adult health and well-being outcomes.Research that explores ACEs and how to respond to themis still ongoing. Findings from a subsequent study showedthat nearly half of children in the United Statesexperienced at least one ACE and that about 1 in 10 hadexperienced three or more ACEs (Sacks & Murphey, 2018).For more information about the study, visit igure 1. ACEs PyramidFor more information on the economic and societal costsof child abuse and neglect, see the following InformationGateway webpages: Cost-of-Injury Analysis veloping/economic/cost-injury/) and Social and Economic Consequences ofChild Abuse and Neglect nsequences/).Source: U.S. Department of Health and Human Services, Centers for Disease Control andPrevention. (n.d.). Adverse childhood experiences presentation graphics: The ACE pyramid.Retrieved from E graphics.htmlThe following are the 10 ACEs generally studied: physical abuse, sexualabuse, emotional abuse, physical neglect, emotional neglect, intimate partnerviolence within the household, substance misuse within the household, mentalillness within the household, parental separation or divorce, and incarceratedhousehold member.1This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway.This publication is available online at term-consequences/.5

Long-Term Consequences of Child Abuse and Neglecthttps://www.childwelfare.govTwo additional Federal research initiatives regardingACES are the National Survey of Child and AdolescentWell-Being (NSCAW) and the Behavioral Risk FactorSurveillance System (BRFSS):For more information on ACEs, including related research,refer to the following: NSCAW is a project of the Administration on Children,Youth and Families within HHS/ACF. It seeks todescribe the child welfare system and the experiencesof children and families who come into contact with it.Survey data are collected firsthand from children,parents, other caregivers, caseworkers, and teachers aswell as administrative records. As a longitudinal study,NSCAW follows the life course of these children togather data about service receipt, child well-being,and other outcomes. This information will provide aclearer understanding of the life outcomes of childrenand families involved with child welfare. For moreinformation, visit w. ACEs Resource Packet: Adverse Childhood Experiences(ACEs) Basics: i/aces-resource-packet all-pages 12 0616112336f3c0266255aab2ff00001023b1.pdf?sfvrsn 2 BRFSS is an annual national telephone survey thatcollects State data on U.S. residents ages 18 years orolder regarding their health-related risk behaviors,chronic health conditions, and use of preventativeservices. BRFSS consists of a core module as well asoptional modules that States can incorporate. Inaddition, many States develop their own questions tomeet their needs. The HHS CDC developed anoptional ACEs module that was available from 2009 to2011. Since 2011, many States have continued to addthe ACEs module to their surveys as State-addedquestions. For more information, visit the CDC websiteat https://www.cdc.gov/brfss/index.html. The Prevalence of Adverse Childhood Experiences,Nationally, by State, and by Race or ystate-race-ethnicityPromising evidence-based strategies have emerged tohelp combat the effects of ACEs on future outcomes andwell-being. These include enlisting communities topromote stable, safe, and nurturing environments forchildren; using data to inform programs and services forpreventing child maltreatment; and implementingcommunity efforts that support parenting programs andpositive parenting behaviors (HHS, CDC, National Centerfor Injury Prevention and Control, Division of ViolencePrevention, 2014). ACEs Connection [website]:https://www.acesconnection.com/ Adverse Childhood Experiences estudy/index.html Childhood Trauma and Positive Health ldhood-experiences-aces/ A National and Across-State Profile on AdverseChildhood Experiences Among U.S. Children andPossibilities to Heal and /05/aces brief final.pdfPreventing and Reducing the LongTerm Consequences of MaltreatmentBy reducing the incidence of child abuse and neglectthrough primary prevention approaches and providingcomprehensive, trauma-

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