Fragile Families, Troubled Children. The Aftermath of Infant Trauma

I was becoming rather fed-up with the flood of books detailing theories, researches, or symposia on battered and abused children. This one makes a change, and is stimulating, if only because its conclusions are so much at variance with the others. Doubts have recently been expressed on whether the underlying attitudes of battering parents can be changed. Perhaps the ultimate test of the effectiveness of medical intervention would be the study of how individuals, who have themselves been battered early in life, in their turn behave and feel towards their own children. Standards for comparison are necessary, and this too entails continuing observation. How could one avoid the problems of observer-altered experiments ? How could one refrain from intervening in a control series? Indeed, is it really possible to obtain a truly matched control series? An American social worker and her coworkers have now reported what is claimed to be the first controlled, longterm follow-up study of child abuse; and they plan to follow the children into adult life. Traumatised infants were divided in 2 groups, according to their assessment as deliberately or accidentally injured. Eight years later some of these judged to have been abused were matched against others classed as accidentally injured. At this later stage, too, an additional group of uninjured children was brought in as a further control. It is generally accepted that child abuse can harm not only physical but intellectual emotional, and social development. The author here concludes that the abuse of children made no appreciable difference to the comprehensive development of her cases. The decisive factor, it is claimed, is low social class, associated with poverty. It is, of course, nothing new to affirm that poverty reinforces and perpetuates itself from one generation to another, and long ago Bernard Shaw put it neatly: 'Poverty is the most chronic disease of the poor'. But the absence from this study of evidence incriminating battering and illtreatment in developmental impairment is so surprising-as the author candidly admits-that one looks suspiciously at the controls. The crux, surely, is this. Poverty can certainly impair the development of children; but it seems to me that poverty plus abuse would impair it even more, and the differences should be assessable. In the present study the investigators went to considerable lengths to safeguard and validate their basic data, but sophisticated statisticians are likely to detect flaws (they usually do! ). I mention only one of the items that disquiet me. Five families, originally classified under the category of accidental injury, were later transferred to the other category, abuse. I would go further. The entire accident group, to my eye, looks suspect. Some among them may well have been injured deliberately; but, in any event, the disturbed emotional climate in families whose children suffer accidents (as distinct from abuse) can itself influence their development adversely. Although I am reluctant to accept the author's conclusions, I find the book well written and deserving of serious attention. I know from my own experience that, for those involved with battered babies, the passion may be more persuasive than the statistics.