Article Type : Research Article
Authors : Tomasello L and Ranno M
Keywords : Child mistreatment; Abuse; Resilience
The issue on family maltreatment of
children, is increasingly being paid attention to and is the result of a
different consideration than in the past of what is defined as maltreatment,
the phenomenon, both socially and clinically, has given rise to a set of
studies that highlight how the public is less clueless and more sensitive, even
those forms of mistreatment and abuse that are less obvious, but nevertheless
devastating to the psychosocial balance of the child, are also examined, his
awareness has come about, thanks to the psychological and social sciences,
which have helped to create a vision within the family and society, as a bearer
of rights. In this article, the effects of maltreatment and abuse on child development
will be examined.
Advances in psychological and social sciences have
helped create a new view of the child within the family and society. The path
to recognition has been long and tortuous; before the Constitution, the minor
was considered as an object subject to the will of adults who could decide on
his or her own life and death. With the passage of time, there have been
important legislative interventions, which have recognized the minor's rights,
his or her own autonomy and ability to establish relationships freely. Among
the most relevant legislative initiatives, we can mention: the Declaration of
the Rights of the Child, approved by the U.N. General Assembly on November 20,
1959. This document reaffirms the same principles as the Geneva Declaration,
further calling on states both to recognize these principles and to apply and
provide for their dissemination [1]. The International Convention on the Rights
of the Child, stipulated by the UN in 1989, which establishes the obligation to
protect children from violations of the rights set forth in the 1959
Declaration, and finally the Optional Protocol to the Convention on the Rights
of the Child on the Sale, Prostitution of Children and Representative
Pornography of Children, stipulated on September 6, 2000, and ratified by Italy
through Law No. 46 of March 11, 2002 [2], articles 2 and 3 of the Constitution,
state that “The Republic recognizes and guarantees the inviolable rights of
man, both as an individual and in the social formations where his personality
takes place...” “It is the duty of the Republic to remove obstacles of an
economic and social order, which, by effectively limiting the freedom and
equality of citizens, prevent the full development of the human person...” [3],
also emphasize the child's right to education, which may include a set of other
important rights such as: that to life, autonomy, equality and socialization.
Also deserving of attention are Articles 29, 30 and 31 of the Italian
Constitution, which recognize the family as a natural society founded on marriage
and “the centrality of the person of the child, who has the right with respect
to the parent to be maintained, instructed and educated” [4]. It is also stated
in these articles, that in the case of incapacity, the state has an obligation
to provide for the fulfillment of their duties, again emphasizing the need to
consider and respond to the multiple needs of the child, to recognize the
child's rights and respond to the guardianship function. Kempe introduced the
expression “child abuse and neglect,” which is still in use today” [5] to
describe the maltreatment scenario, and given the interest in the phenomenon,
important changes have been introduced, such as the increasing number of
professions interested in the study of this issue, the broadening of the
operational modalities considered appropriate to deal with it, and a greater
sensitivity no longer only on physical maltreatment, but also on other forms of
abuse such as psychological and sexual abuse that significantly affect, the
psycho-physical growth of the child.
In the 4th Criminological Colloquium of the Council of
Europe, Strasbourg, 1978, child maltreatment is defined as “the set of acts and
failures which seriously disturb the child, affect his bodily integrity,
physical, affective, intellectual and moral development, the manifestations of
which are neglect and/or injury of a physical and/or psychological and/or
sexual nature by a family member or others who care for the child” [6]. The
National Center of Child Abuse and Neglect in 1981 defined child maltreatment
as “[...] that situation in which, through intentional acts or gross
inattention to the child's basic needs, the behavior of a parent or substitute
or other adult caring for the child has caused harm or impairment that could
have been foreseen and avoided or has materially contributed to the
prolongation of an existing harm or impairment” [7]. The Fifth International
Congress on Abused and Neglected Children (Montreal 1984) defined abuse as “any
act of omission or authoritarianism that endangers or impairs the health or
emotional development of a child, including physical violence and unreasonably
severe corporal punishment, sexual acts, exploitation in the work environment,
and disregard for the child's emotionality” [8]. WHO stated in 1999 that “child
abuse or maltreatment is defined as all forms of physical and emotional ill
care (ill treatment), sexual abuse, neglect or negligent treatment, commercial
or other exploitation, which result in actual or potential harm to a child's
health, survival, development or dignity in the context of a relationship of
responsibility, trust or power” [9]. Childhood abuse, takes many forms and is
divided into: maltreatment, treatment pathology, sexual abuse and witnessing
violence.
Maltreatment can be
distinguished into physical and psychological
Physical maltreatment is a form of visible violence in
which parents or caregivers cause him physical injury or expose him to serious
risk of being physically abused. Physical mistreatment is related to
psychological mistreatment, to which generally adults (parents or other
figures) instead of protecting the child humiliate, devalue, and ignore him or
her disregard his or her emotional needs by neglecting the empathic
relationship that should be established between parents and children, and
subject him or her to psychological violence in a repetitive and constant
manner over time. This type of violence causes damage to the child's
personality, incentivizes the child to adopt aggressive modes in problem
solving and interactions with others, has low self-esteem, on his perception of
the world [10,11].
Pathology of care
Pathology of care is “the inadequacy or insufficiency of physical and/or psychological care provided to the child, in relation to his or her developmental moment, by those who are legally responsible for it” Montecchi) [2]. Parents, are incapable of responding to the physical and psychological needs of the child negatively affecting his or her growth path, are unable to assist them, protect them, stimulate them, give them affection and preserve them from dangerous situations. The juvenile is exposed to malnutrition, school difficulties, failure to educate them to respect the rules of behavior and peaceful coexistence, inability to establish lasting bonds and take on deviant attitudes. Modalities of care pathology include: neglect, dysuria and overcare. “Physical neglect” refers to deficient physical care with respect to a child's age and developmental needs. “Psychological neglect” refers to a failure to pay attention to the child's emotional and emotional needs with respect to his or her developmental needs.
Sexual abuse
Sexual abuse “refers to the involvement of children in
sexual activities that include not only heterosexual and full homosexual
relationships, but also sex games, pornography, prostitution, and acts that use
the child to procure sexual pleasure for self or eventual partner” [13].
Three types of abuse can be distinguished based on the relationship between victim and abuser:
The CISMAI (Italian coordination of services against
child maltreatment and abuse ) in 2005 defined intra-familial witnessing
violence as “the experience by the child of any form of maltreatment carried
out through acts of physical, verbal, psychological, sexual, and economic
violence on reference figures or other affectively significant adult or minor
figures. The child may experience this directly or indirectly, including
witnessing violence by minors on other minors and/or other family members and
abandonment and mistreatment of domestic animals” [14]. This type of abuse, has
only recently been considered, affects all minors who witness family violence.
Although not directly victims of abuse, the minors concerned, living in an
atmosphere filled with hatred and violence, may grow up with serious
psychological and physical problems (such as anxiety, fear, shame, depression,
passivity, difficulty relating, cruelty to animals, hyperactivity) [15]. In the
case of separation, the child, a victim of the situation, “is denied the
opportunity to retain both parents, but in addition is forced to act the active
exclusion of one of them, as if this were his or her spontaneous and autonomous
choice” [16]. Children, experience separation and conflict as a trauma and may
suffer consequences on the psychic sphere; blaming themselves for the situation
they are experiencing, they may find it difficult to develop intimate
relationships, take on deviant behaviours and in some cases take on the role of
“parenting their parents” [16], they become the container of the confidences
and fears of both parents. The consequences, may be, on the physical sphere and
manifest eating and sleeping disorders, poor school performance, low
self-esteem, behavioural and learning disorders, to prevent these serious
consequences parents, must recognize the suffering of their child and taking
care of him, despite the difficult situation [17].
The consequences of maltreatment on the child's mental
and physical development. Maltreatment is a traumatic experience for a child's
growth. The various research conducted in recent years has recognized a wide
variety of disorders related to childhood experiences of abuse and
maltreatment, which can vary in severity. “The different forms of maltreatment
to which children may be exposed can produce a negative impact on development
in both the short and long term, to the extent that they represent real
traumatic events that, depending on the case, may take on the characteristics
of acute or chronic trauma and whose effects may persist over time and manifest
late consequences even in adolescence and adulthood” [18]. Children who are
victims or witnesses of maltreatment situations, face repeated experiences of
rejection or hostility with their attachment figure, the latter plays a major
role in influencing the child's beliefs and expectations, towards themselves,
others and the world, they develop a negative self-image characterized by: low
self-esteem, distorted perception of their own social skills, difficulty in
expressing discomfort and suffering, poor social adjustment, they perceive a
lack of love from their parents and hold themselves primarily responsible for
the condition they are experiencing caused by their behaviour or their being in
totality [19]. Feeling guilty is a common reaction experienced by those who
have experienced violence, and, feeling responsible for what has happened
“relieves the child of the feeling of feeling totally passive and powerless,
that is, it allows him or her to attempt to master the suffering due to
abandonment, loss or an otherwise traumatic situation” [20].
"Post-traumatic stress disorder (PTSD) is a
psychopathological condition classified in the DSM V. Post-traumatic stress
disorder is a disorder that typically develops after a particularly traumatic
event, an event that has endangered the health and physical or psychological
integrity of the individual. It is characterized by particularly disabling
symptoms, such as very intense and frequent anxiety, decreased mood, intrusive
thoughts, images, or memories of the traumatic event, and often a very intense
emotional experience, as if one were reliving the traumatic episode [21].
Post-traumatic stress disorder manifests in different ways, but the main
characteristic is the development of a range of anxiety-depressive symptoms
following a traumatic event. In some patients the prevailing symptoms, are
fear, avoidance and anxiety, a decline in mood and anhedonia are also observed,
other people, may have dissociative symptoms, often a combination of these
symptoms is observed in PTSD patients. The symptoms of post-traumatic stress
disorder can be divided, into four categories: intrusive symptoms, avoidance
strategies, alterations in mood and thoughts, and increased psychomotor
activation state. These four categories represent 4 of the criteria defined by
the DSM-5 for the diagnosis of PTSD [22].
Intrusive symptoms in
PTSD
Intrusive symptoms involve memories of the traumatic
event. They are defined as intrusive because the subject feels that he or she
is not in control and is powerless; they present themselves to the subject's
consciousness in a disturbing and involuntary manner [23]. They may occur,
during the day or even at night, in the form of dreams or nightmares;
psychological distress symptoms may be present in the presence of a stimulus
that recalls the traumatic episode (such as an image or sound). Another symptom
of post-traumatic stress disorder is the use of avoidance strategies to avoid
coming into contact with any stimulus reminiscent of the trauma. Subjects tend
to avoid places, situations, or people that remind them of the traumatic event
[24]. This avoidance can reduce the subject's attendance and avoidance of
places that are particularly important to him or her (e.g., places that remind
him or her of the traumatic event), progressively reducing his or her quality
of life [25].
Alterations in thinking
or mood
Patients with PTSD may have no recollection of the
traumatic event (post traumatic amnesia) [26] or may develop negative ideas
about themselves, others and the world, the consequence being a decline in
mood, or feeling emotionally distant from everyone or no longer being able to
experience positive emotions. These patients, may show symptoms of hyperarousal
and heightened reactivity, may show themselves to be angry and irritable, to
the point of violent and destructive behaviour, live in a constant state of
anxiety, sleep problems, and alterations in attention and memory [27]. These
symptoms can be particularly disturbing and negatively affect the quality of
life of individuals it is therefore desirable that the traumatic event, be
addressed within a psychotherapeutic setting. Therefore, it is important to
address the traumatic event within a psychotherapeutic setting. In order to
make a diagnosis of post-traumatic stress disorder, the DSM-5, the Diagnostic
and Statistical Manual of Mental Disorders (source, Diagnostic and Statistical
Manual of Mental Disorders, V edition), proposes certain criteria to guide the
clinician in making the diagnosis. The DSM-5 criteria for PTSD cover adults as
well as adolescents and children over 6 years of age. Below 6 years of age, the
diagnostic criteria change.
Several studies, have found it to be the disorder with
a higher prevalence among children and adolescents who have suffered adverse
childhood experiences [28]. The negative effects, affect the immune system and
the regulation of sleep-wake rhythms, and may increase the risk of heart
problems [29]. In some cases, depression results in suicide or suicide
attempts; Plunkett [30] through interviews with 183 young victims of sexual
abuse found a frequency of suicide attempts 13 times higher than the frequency relative
to the population of the same age (32% of abused attempted suicide) and an even
higher frequency of suicidal thinking (43% of abused).
Substance abuse
From the studies of several authors [31], Fergusson
and Lynskey; [32,33] Miller and Downs; [34] Nelson [35], Wilsnack [36], found
that individuals who report episodes of childhood abuse are the most likely to
abuse alcohol. “Abuse is defined as a pathological pattern of substance use
that gives rise to recurrent and significant harmful consequences, leads to
impairment and/or clinically significant distress” [37]. Mistreatment also has
negative consequences on cognition and school performance from early childhood
and as an adult, job failure as evidenced by the studies of Eckenrode [38] and
Wodarski [39] who reported that the consequences, affect not only abused
children, but also neglected children, the results, are also confirmed by the
research of Trickett and McBride-Chang, [40] and Shonk and Cicchetti [41],
state that the cause of school failure and behavioural problems is due to the
family environment in which children live, who as adults, by virtue of the
deficiencies suffered will lack the skills needed to cope with the difficulties
of life. According to their assumption is ascribable to the negative influence
exerted by maltreatment on the development of individual skills, therefore, the
family environment in which the child lives is primarily responsible for the
child's failures at school. Based on this assumption, it is necessary not
according to their assumption is attributable to the negative influence exerted
by maltreatment on the development of individual skills, so the family
environment in which the child lives is primarily responsible for the child's
failures in school. Based on this assumption, it is necessary not to
underestimate this risk factor since children who suffer such situations may
find themselves as adults lacking the skills necessary to cope with the
difficulties of life.
Consequences on the
social and behavioural spheres
Research shows that maltreated children are at greater
risk of developing behavioural disorders, embarking on a career of deviance,
and inflicting violence on others, both in adolescence and adulthood.
Maltreated children show higher levels of aggression and social isolation than
non-maltreated children (Herrenkohl and Herrenkohl, [42] Sternberg [43] Rogosch
and Cicchetti) [44]. To elaborate on the effects that maltreatment causes on
the social and behavioral spheres, I think it is appropriate to report below
the analyses made on this topic and that child neuropsychiatrist M. Malacrea
has well highlighted in her article “Adverse Childhood Experiences (ESI):
theoretical premises” [45]. Haskett e Kistner, [46] Darwish, Esquivel, Houtz e
Alfonso [47] have shown how maltreatment has an effect on preschoolers'
interactions, maltreated individuals prefer to isolate themselves, have poor
skills in establishing relationships with peers, have difficulty maintaining
self-control, and exhibit behavior problems. Kim and Cicchetti [48] found that
when abused children have difficulty managing their emotions, they are more at
risk of developing problematic relationships with peers. For these very
reasons, peers consider them undesirable as playmates. This rejection is felt by
children very early, from their earliest interactions, and in most cases will
be repeated throughout their infliction of violence on others, both in
adolescence and adulthood. Bolger and Patterson, [49] in their study identified
a link between rejection and chronicity of maltreatment: the longer the
maltreatment persists over the years, the greater the likelihood that children
will be rejected by peers, which would be traced to the presence of behavioural
problems such as aggression or antisocial behaviour and consequently lead to
exclusion. Hoffman-Plotkin and Twentyman's studies [50] have attentuated
neglect and highlighted that neglected children are, characterized by a lower
number of social interactions than individuals who have experienced other forms
of maltreatment, Kendall-Tackett and Eckenrode's studies [51] show the result
that neglected children exhibit poor academic performance and that their
disciplinary and interpersonal problems steadily increase throughout the school
years. Maltreatment on aggressive behaviours are much more pronounced in male
subjects. The study by Alessandri and Lewis [52] has, shown how abused girls
express more shame in cases of failure and less pride in cases of success,
unlike boys who demonstrate lower levels of both shame and pride, from this it
is possible to draw the conclusions that the negative outcomes of maltreatment
affect the behavioural system more in males, compared to the emotional system
in females.
Consequences for
psychophysical health
Early studies of physically abused children revealed
significant neuropsychological disabilities, including growth retardation,
damage to the central nervous system, mental retardation, speech and learning
disorders, and poor school performance. Various forms of ill-treatment have
been linked to an increase in body mass index and increased eating disorders
(obesity, anorexia, bulimia) during childhood, adolescence and adulthood [53].
Lack of treatment (defined as inattention to things like adequate food and
clothing) predicts body mass index at younger age, while lack of alertness
(defined as lack of parental availability) predicts body mass index at older
age. The results of the study by Widom and colleagues [54] showed that abused
children risk contracting diseases such as diabetes, hepatitis, kidney
problems, poor functioning of the lungs, and higher-than-average vision
problems. In addition, studies of sexual abuse show that abused children are
more likely to contract diseases such as hepatitis C and venereal. In conclusion,
these findings provide clear evidence that the abuse and early abandonment of
children affects their state of health and well-being, thus increasing their
risk of developing serious diseases [55] Koenig and Clark; [56] Senn [57]. All
these consequences, evident already in childhood, persist most of the time,
throughout the course of life causing serious problems in the ability to adapt
and social interaction of the individual.
The research highlights cases of children who live in
unfavourable family and social conditions or who have experienced particularly
stressful events, but who are still able to adapt to such contexts without
developing any pathology [58]. The researchers investigated possible protective
factors and focused on the characteristics of the child or the environment,
Garmezy, called these factors "protective" (e.g. individual
endowment, environmental conditions, biological predispositions and positive
events), factors that protect the child and reduce the harmful effects that critical
events could cause [59]. What allows any individual to adapt to the adverse
events of life is called resilience. It comes from the Latin resilire which
means "jump back, bounce" in psychology, indicates the ability of
some people not to succumb to the traumatic, harmful, stressful events to which
they are subjected, but to move forward with courage and serenity until you
reach an optimal level of adaptation, Cyrulnik and Malaguti, [60] define
resilience as the «ability to return with elasticity to an initial situation in
order to deal with and overcome a high trauma and, subsequently, absorb it»,
Thomsen, considers it as the competence of a person to remain constant or
recover despite adversity, strong people draw strength both internally and from
the environment to overcome challenges» [61], people with a high level of
resilience successfully manage adverse situations, overcome difficulties that
arise in the course of life, facing adversities, which become a strengthening
element, rather than weakening, in literature are reported cases of resilient
people endowed with a docile and confident temperament of the individual that
allows him to be well-liked is a person, who accepts the help that is offered
to him from outside, has a good foundation of self-esteem, addresses problems
with self-awareness and in controlling the management of emotions, has a good
ability to interact, good intelligence
and excellent creative abilities [62]. All supported by factors such as family
factors (for example, the presence of a reassuring environment or a safe
attachment figure in childhood) factors related to the context (for example to
have significant ties with people outside their core such as teachers, the
group of peers, friends, who with their being affectionate and caring allow
them to grow in a healthy way by offering a peaceful and stable relationship.
In the light of the foregoing and the above, and being
aware to date of the negative and complex consequences of abuse, we can say
that prevention is an activity that can be useful and effective, but at the
same time, requires the shared commitment of several actors working in the
interinstitutional framework. When we talk about prevention in cases of child
abuse and/or adolescence, one of the services that has greater relevance is
undoubtedly the school context. In fact, school is an institution that, after
the family unit, plays a fundamental role in the life of the child and at the
same time represents the environment in which the child spends most of his
time. This institution, in addition to having an educational function,
represents an agency of socialization and has always been considered a
privileged observatory for the detection of children at risk. School workers
have a better chance of detecting attitudes and behaviours, or by the stories
that the child himself reports, 'the presence in the family of risky
educational habits and styles for its development». The teacher is the main
interlocutor of the family and at the same time of the child and therefore it
is essential that he has adequate empathic skills strong preventive potential,
enhancing the kindergarten. This means improving the attention of educators
towards children, avoiding disqualifying attitudes towards parents and
children, and encouraging the establishment of relations between family and
school, based as much as possible on mutual relationships of trust and
collaboration. This is due to the fact that the educators of kindergartens and
kindergartens have a privileged relationship with families, because in the
first years of the child’s life parents are often insecure in the management of
their parental functions and uncertain about what educational modality to
implement towards the child; educators can carry out an important preventive
action.
It is essential to support the school in this
important work of prevention, so that, by establishing a good relationship with
the family, it ensures that the damage to which the child is exposed is limited
or, if this does not happen, signals the situation to the judicial authority. A
further step towards making prevention the common objective of the whole
community is «the widespread dissemination of more rigorous information and
less anecdotal and chronicle on the issue of child abuse at the level of public
opinion». Building an opinion must be promoted public that is not limited to
being alarmed by the scandals and family crimes told by the mass media, public
opinion must acquire 'a social awareness and policy of the heavy consequences
that job loss, housing insecurity, the inclusion of the family in a foreign
culture, may have for the children». A greater amount of resources should be
invested mainly in prevention activities, since they are «potentially able to
generate future savings» and have the advantage of intervening preventively on
defined risk cases. However, it is necessary for adults to become aware of
their responsibility towards children, because otherwise preventive activities
«Specifically planned they risk to see compromised their effectiveness or not
to find a fabric of shared thoughts on which to graft».