More Research Needed on Child Abuse and Neglect

From the WebMD Archives

Oct. 15, 1999 (Atlanta) -- More attention needs to be paid to the prevention and intervention of child abuse, and that attention should come in the forms of more money and more research, according to a new study.

The study, published in this month's edition of the Journal of the American Academy of Child and Adolescent Psychiatry, reviews available research into child and adolescent abuse and neglect during the decade from 1988 to 1998.

According to the researchers, child abuse has been on the rise since 1980. During the last decade, there has been "substantial progress in understanding" and defining child abuse, and there has been great emphasis "on determining a child's risk for continued maltreatment," write Sandra J. Kaplan and colleagues from the North Shore University Hospital in New York and the New York University School of Medicine.

But looking ahead, investigation needs to focus more on specific types of child abuse, their effect on the child, and what can be done about them. "Child maltreatment research in the next decade needs to focus on understanding factors leading to resilient outcomes and on assessing the effectiveness of psychotherapeutic and psychopharmacological treatment strategies. Increased resources are needed to support child maltreatment research studies and investigators," according to the researchers.

They write that research into preventing parents from victimizing children has "increased greatly." But not enough is done for the victims. This has a twofold effect -- on the child, and on society. Ultimately, the study makes clear, large numbers of those abused in one generation become the next generation's abusers.

Kaplan finds many areas lacking in research and funds -- for instance, emotional abuse and neglect. The study shows most research focuses on physical abuse, because it's assumed to be more damaging, and it's also more obvious. But "there is some evidence that neglect results in greater deficits than abuse," Kaplan and her colleagues write.

Beyond the emotional damage wrought by abuse, the researchers find a lack of study on the actual biological changes brought on by abuse. This could be hormonal changes or changes in the brain. More could also be done to test the effectiveness of drugs for traumatized children.

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Kaplan also proposes more long-term studies. But the complications of carrying out such research may be an integral part of the problem, says David A. Wolfe, PhD, from the University of Western Ontario in London, Ontario. "It's tough stuff to follow people over long periods to see the long-term effects of intervention. Politicians don't want to wait that long to see results."

Wolfe, who has been part of the National Institute of Mental Health (NIMH) panel that reviews research applications on neglect and abuse, finds that few applications are actually received and most are rarely funded. "No one goes into this anymore. It's difficult to meet the high standards of an NIMH clinical trial," Wolfe tells WebMD.

"Researchers like myself are doing what they can given small budgets available," says Wolfe. Wolfe currently gives foundations more credit than government sources in supporting research for the prevention of child abuse. "It's a frustrating situation. Child abuse is everyone's distant cousin and no one's baby."

The researchers also highlight that there are many definitions of abuse and neglect, and this can lead to failure in identifying the exact type of abuse the child experienced. Sherryl S. Heller, PhD, a researcher in child abuse at Tulane University Medical Center in New Orleans, agrees with Kaplan. "After reviewing the literature, we found it's a pretty big problem. Until we can define things the same way, the conclusions we draw are going to be somewhat questionable because we don't have consistent classifications," Heller tells WebMD.

Heller finds that, due to legal reasons, physically abused children are in some cases classified as neglected. She has also observed that children may be classified in different categories depending on who reports the abuse, be it parent, teacher, or physician. And if there's more than one report, that's important, says Heller.

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