Understanding and Treating Children Who Experience Interpersonal Maltreatment: Empirical Findings

Since the early 1970s, legal and scholarly interest in child maltreatment (CM; includes children and adolescents) has increased dramatically, largely due to the Child Abuse Prevention and Treatment Act of 1974 (CAPTA). Prior to this time, CM was viewed as a family problem and most outside involvement was considered intrusive. CAPTA required states to develop criteria for mandated reporting and gave states the fight to remove children from homes if they were viewed as being in danger. CM is defined by CAPTA and amended by the Keeping Children and Families Safe Act of 2003 as any act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or An act or failure to act which presents an imminent risk of serious harm. (National Clearinghouse on Child Abuse and Neglect Information, 2004b) The U.S. Department of Health and Human Services (DHHS; 2006) identifies four types of CM: neglect, physical abuse, sexual abuse, and psychological abuse. Although they are defined as distinct forms of maltreatment, in reality, they often co-occur (Cohen, Mannarino, Murray, & Igelman, 2006). In 2004, DHHS (2006) substantiated 872,000 reported cases of CM. However, retrospective reports of child abuse indicated that when asked, approximately 25% to 35% of women and 10% to 25% of men in the general U.S. population had experienced some form of child sexual abuse and 10% to 20% of these adults also reported incidences of physical abuse as a child (Briere & Elliott, 2003; Finkelhor, Hotaling, Lewis, & Smith, 1990). Furthermore, studies estimate that between 3.3 and 10 million children witness interparental violence in the United States, resulting in effects that are similar to those experienced by victims of physical and emotional abuse (Straus, 1992). The majority of child abusers are family members. CM causes serious problems that can have a negative impact on a child's overall physical health as well as on psychological, emotional, behavioral, cognitive, and neurological functioning (Berliner & Elliott, 2002). Children who experience severe and prolonged maltreatment and fail to receive adequate treatment often experience symptoms well into adulthood (Cloitre, Stoval-McClough, Miranda, & Chemtob, 2004). In particular, the longer the period between the occurrence of maltreatment and treatment, the more time and effort are necessary to alter the negative effects of that maltreatment (Perry, 2006). Conversely, early intervention results in healthier children as well as fewer economic and human resources. A thorough knowledge of CM is critical for all counselors but especially those who work with children. In this article, I review the empirical literature on major aspects of CM. The first part of the article is focused on the consequences of, symptoms of, and the context for maltreatment; the latter part of the article is a review of the literature on effective treatment of CM. * Consequences of CM Maltreated children are at risk for significant psychological and physical symptoms. These include anxiety, depression, somatic complaints, suicide, impulsivity, hyperactivity, interpersonal problems, intrusive thoughts, hyperarousal, and dissociation (Berliner & Elliott, 2002; Kolko, 2002). Maltreated children develop posttraumatic stress disorder (PTSD) at rates ranging from 20% to 63% (Kendall-Tackett, Williams, & Finkelhor, 1993; Spinazzola et al., 2005). Furthermore, up to 70% of sexually abused children meet partial or full criteria for PTSD (Wolfe, Sas, & Wekerle, 1993). Research has identified several characteristics associated with increased risk of PTSD after exposure to traumatic stress (see Briere & Scott, 2006): (a) little or no positive attachment and support by caregivers; (b) being female; (c) being younger; (d) race, with African Americans, Hispanics, and Native Americans at higher risk than Caucasians; (e) physical and emotional proximity; (f) lower socioeconomic status; (g) previous psychological problems; (h) subfunctional coping skills; (i) history of family dysfunction; and (j) prior history of trauma. …