There is no single known cause of child maltreatment. Nor is there any single description that captures all families in which children are victims of abuse and neglect. Child maltreatment occurs across socio-economic, religious, cultural, racial, and ethnic groups.
While no specific causes definitively have been identified that lead a parent or other caregiver to abuse or neglect a child, research has recognized a number of risk factors or attributes commonly associated with maltreatment. Children within families and environments in which these factors exist have a higher probability of experiencing maltreatment.
It must be emphasized, however, that while certain factors often are present among families where maltreatment occurs, this does not mean that the presence of these factors will always result in child abuse and neglect.
The factors that may contribute to maltreatment in one family may not result in child abuse and neglect in another family. For example, several researchers note the relation between poverty and maltreatment, yet it must be noted that most people living in poverty do not harm their children. Professionals who intervene in cases of child maltreatment must recognize the multiple, complex causes of the problem and must tailor their assessment and treatment of children and families to meet the specific needs and circumstances of the family.
Risk factors associated with child maltreatment can be grouped in four domains:
Parent or caregiver factors
It is increasingly recognized that child maltreatment arises from the interaction of multiple factors across these four domains. The sections that follow examine risk factors in each category. Available research suggests that different factors may play varying roles in accounting for different forms of child maltreatment (physical abuse, sexual abuse, neglect, and psychological or emotional abuse).
A greater understanding of risk factors can help professionals working with children and families both to identify maltreatment and high-risk situations and to intervene appropriately. Assessment of the specific risk factors that affect a family may influence the prioritization of intervention services for that family (e.g., substance abuse treatment). Moreover, addressing risk and protective factors can help to prevent child abuse and neglect. For example, prevention programs may focus on increasing social supports for families (thereby reducing the risk of social isolation) or providing parent education to improve parent's age-appropriate expectations for their children.
Parent or Caregiver Factors
Parent or caregiver factors potentially contributing to maltreatment relate to:
Personality characteristics and psychological well-being
History of maltreatment
Attitudes and knowledge
Personality Characteristics and Psychological Well-Being
No consistent set of characteristics or personality traits has been associated with maltreating parents or caregivers. Some characteristics frequently identified in those who are physically abusive or neglectful include low self-esteem, an external locus of control (i.e., belief that events are determined by chance or outside forces beyond one's personal control), poor impulse control, depression, anxiety, and antisocial behavior. While some maltreating parents or caregivers experience behavioral and emotional difficulties, severe mental disorders are not common.
Parental Histories and the Cycle of Abuse
A parent's childhood history plays a large part in how he or she may behave as a parent. Individuals with poor parental role models or those who did not have their own needs met may find it very difficult to meet the needs of their children.
While the estimated number varies, child maltreatment literature commonly supports the finding that some maltreating parents or caregivers were victims of abuse and neglect themselves as children. One review of the relevant research suggested that about one-third of all individuals who were maltreated will subject their children to maltreatment. Children who either experienced maltreatment or witnessed violence between their parents or caregivers may learn violent behavior and may also learn to justify violent behavior as appropriate.
An incorrect conclusion from this finding, however, is that a maltreated child will always grow up to become a maltreating parent. There are individuals who have not been abused as children who become abusive, as well as individuals who have been abused as children and do not subsequently abuse their own children. In the research review noted above, approximately two-thirds of all individuals who were maltreated did not subject their children to abuse or neglect.
It is not known why some parents or caregivers who were maltreated as children abuse or neglect their own children and others with a similar history do not. While every individual is responsible for his or her actions, research suggests the presence of emotionally supportive relationships may help lessen the risk of the intergenerational cycle of abuse.
Parental substance abuse is reported to be a contributing factor for between one- and two-thirds of maltreated children in the child welfare system. Research supports the association between substance abuse and child maltreatment. For example:
A retrospective study of maltreatment experience in Chicago found children whose parents abused alcohol and other drugs were almost three times likelier to be abused and more than four times likelier to be neglected than children of parents who were not substance abusers.
A Department of Health and Human Services study found all types of maltreatment, and particularly neglect, to be more likely in alcohol-abusing families than in nonalcoholic-abusing families.
Substance abuse can interfere with a parent's mental functioning, judgment, inhibitions, and protective capacity. Parents significantly affected by the use of drugs and alcohol may neglect the needs of their children, spend money on drugs instead of household expenses, or get involved in criminal activities that jeopardize their children's health or safety. Also, studies suggest that substance abuse can influence parental discipline choices and child-rearing styles.
Over the past decade, prenatal exposure of children to drugs and alcohol during their mother's pregnancy and its potentially negative, developmental consequences has been an issue of particular concern. The number of children born each year exposed to drugs or alcohol is estimated to be between 550,000 and 750,000. While this issue has received much attention, children who are exposed prenatally represent only a small proportion of children negatively affected by parental substance abuse.
The number and complexity of co-occurring family problems often makes it difficult to understand the full impact of substance abuse on child maltreatment. Substance abuse and child maltreatment often co-occur with other problems, including mental illness, HIV/AIDS or other health problems, domestic violence, poverty, and prior child maltreatment. These co-occurring problems produce extremely complex situations that can be difficult to resolve. Because many of the problems may be important and urgent, it can be difficult to prioritize what services to provide. Additionally, identifying and obtaining appropriate resources to address these needs is a challenge in many communities.
Attitudes and Knowledge
Negative attitudes and attributions about a child's behavior and inaccurate knowledge about child development may play a contributing role in child maltreatment. For example, some studies have found that mothers who physically abuse their children have both more negative and higher than normal expectations of their children, as well as less understanding of appropriate developmental norms. Not all research, however, has found differences in parental expectations.
A parent's lack of knowledge about normal child development may result in unrealistic expectations. Unmet expectations can culminate in inappropriate punishment (e.g., a parent hitting a one-year-old for soiling his pants). Other parents may become frustrated with not knowing how to manage a child's behavior and may lash out at the child. Still others may have attitudes that devalue children or view them as property.
Caretaker age may be a risk factor for some forms of maltreatment, although research findings are inconsistent. Some studies of physical abuse, in particular, have found that mothers who were younger at the birth of their child exhibited higher rates of child abuse than did older mothers. Other contributing factors, such as lower economic status, lack of social support, and high stress levels may influence the link between younger childbirth-particularly teenage parenthood-and child abuse.
Specific life situations of some families-such as marital conflict, domestic violence, single parenthood, unemployment, financial stress, and social isolation-may increase the likelihood of maltreatment. While these factors by themselves may not cause maltreatment, they frequently contribute to negative patterns of family functioning.
Children living with single parents may be at higher risk of experiencing physical and sexual abuse and neglect than children living with two biological parents. Single parent households are substantially more likely to have incomes below the poverty line. Lower income, the increased stress associated with the sole burden of family responsibilities, and fewer supports are thought to contribute to the risk of single parents maltreating their children. In 1998, 23 percent of children lived in households with a single mother, and 4 percent lived in households with a single father. A strong, positive relationship between the child and the father, whether he resides in the home or not, contributes to the child's development and may lessen the risk of abuse.
In addition, studies have found that compared to similar non-neglecting families, neglectful families tend to have more children or greater numbers of people living in the household. Chronically neglecting families often are characterized by a chaotic household with changing constellations of adult and child figures (e.g., a mother and her children who live on and off with various others, such as the mother's mother, the mother's sister, or a boyfriend).
The Child Abuse and Father Absence Connection
The rate of child abuse in single parent households is 27.3 children per 1,000, which is nearly twice the rate of child abuse in two parent households (15.5 children per 1,000).
An analysis of child abuse cases in a nationally representative sample of 42 counties found that children from single parent families are more likely to be victims of physical and sexual abuse than children who live with both biological parents. Compared to their peers living with both parents, children in single parent homes had:
- 77 percent greater risk of being physically abused - 87 percent greater risk of being harmed by physical neglect - 165 percent greater risk of experiencing notable physical neglect - 74 percent greater risk of suffering from emotional neglect - 80 percent greater risk of suffering serious injury as a result of abuse - 120 percent greater risk of experiencing some type of maltreatment overall.
A national survey of nearly 1,000 parents found that 7.4 percent of children who lived with one parent had been sexually abused, compared to only 4.2 percent of children who lived with both biological parents.
Using data from 1,000 students tracked from seventh or eighth grade in 1988 through high school in 1992 in the US, researchers determined that only 3.2 percent of the boys and girls who were raised with both biological parents had a history of maltreatment. However, a full 18.6 percent of those in other family situations had been maltreated.
A study of 156 victims of child sexual abuse found that the majority of the children came from disrupted or single-parent homes; only 31 percent of the children lived with both biological parents. Although stepfamilies make up only about 10 percent of all families, 27 percent of the abused children in this study lived with either a stepfather or the mother's boyfriend. Marital Conflict and Domestic Violence
According to published studies, in 30 to 60 percent of families where spouse abuse takes place, child maltreatment also occurs. Children in violent homes may witness parental violence, may be victims of physical abuse themselves, and may be neglected by parents who are focused on their partners or unresponsive to their children due to their own fears. A child who witnesses parental violence is at risk for also being maltreated, but, even if the child is not maltreated, he or she may experience harmful emotional consequences from witnessing the parental violence.
Stress is also thought to play a significant role in family functioning, although its exact relationship with maltreatment is not fully understood. Physical abuse has been associated with stressful life events, parenting stress, and emotional distress in various studies. Similarly, some studies have found that neglectful families report more day-to-day stress than non-neglectful families. It is not clear, however, whether maltreating parents actually experience more life stress or, rather, perceive more events and life experiences as being stressful. In addition, specific stressful situations (e.g., losing a job, physical illness, marital problems, or the death of a family member) may exacerbate certain characteristics of the family members affected, such as hostility, anxiety, or depression, and that may also aggravate the level of family conflict and maltreatment.
Families involved in child maltreatment seldom recognize or reward their child's positive behaviors, while having strong responses to their child's negative behaviors. Maltreating parents have been found to be less supportive, affectionate, playful, and responsive with their children than parents who do not abuse their children. Research on maltreating parents, particularly physically abusive mothers, found that these parents were more likely to use harsh discipline strategies (e.g., hitting, prolonged isolation) and verbal aggression and less likely to use positive parenting strategies (e.g., using time outs, reasoning, and recognizing and encouraging the child's successes).
Children are not responsible for being victims of maltreatment. Certain factors, however, can make some children more vulnerable to maltreating behavior. The child's age and development-physical, mental, emotional, and social-may increase the child's vulnerability to maltreatment, depending on the interactions of these characteristics with the parental factors previously discussed.
The relationship between a child's age and maltreatment is not clear cut and may differ by type of maltreatment. In 2000, for example, the rate of documented maltreatment was highest for children between birth and 3 years of age (15.7 victims per 1,000 children of this age in the population) and declined as age increased. The inverse relationship between age and maltreatment is particularly strong for neglect, but not as evident for other types of maltreatment (physical, emotional, or sexual abuse).
Infants and young children, due to their small physical size, early developmental status, and need for constant care, can be particularly vulnerable to child maltreatment. Very young children are more likely to experience certain forms of maltreatment, such as shaken baby syndrome and nonorganic failure to thrive. Teenagers, on the other hand, are at greater risk for sexual abuse.
Children with physical, cognitive, and emotional disabilities appear to experience higher rates of maltreatment than do other children. A national study, completed in 1993, found that children with disabilities were 1.7 times more likely to be maltreated than children without disabilities. To date, the full degree to which disabilities precede or are a result of maltreatment is unclear.
In general, children who are perceived by their parents as "different" or who have special needs-including children with disabilities, as well as children with chronic illnesses or children with difficult temperaments-may be at greater risk of maltreatment. The demands of caring for these children may overwhelm their parents. Disruptions may occur in the bonding or attachment processes, particularly if children are unresponsive to affection or if children are separated by frequent hospitalizations. Children with disabilities also may be vulnerable to repeated maltreatment because they may not understand that the abusive behaviors are inappropriate, and they may be unable to escape or defend themselves in abusive situations. Some researchers and advocates have suggested that some societal attitudes, practices, and beliefs that devalue and depersonalize children with disabilities sanction abusive behavior and contribute to their higher risk of maltreatment. For instance, there may be greater tolerance of a caregiver verbally berating or physically responding to a disabled child's inability to accomplish a task or act in an expected way than there would be if similar behavior was directed at a normally able child.
Other Child Characteristics
While some studies suggest that infants born prematurely or with low birth-weight may be at increased risk for maltreatment, other studies do not. The relationship between low birth-weight and maltreatment may be attributable to higher maternal stress heightened by high caregiver demands, but it also may be related to poor parental education about low birth-weight, lack of accessible prenatal care, and other factors, such as substance abuse or domestic violence.
Child factors such as aggression, attention deficits, difficult temperaments, and behavior problems-or the parental perceptions of such problems-have been associated with increased risk for all types of child maltreatment. These factors may contribute indirectly to child maltreatment when interacting with certain parental characteristics, such as poor coping skills, poor ability to empathize with the child, or difficulty controlling emotions. In addition, these same child characteristics may be reinforced by the maltreatment (e.g., a physically abused child may develop aggressive behaviors that elicit harsh reactions from others) and create conditions that can lead to recurring maltreatment.
Environmental factors are often found in combination with parent, family, and child factors, as highlighted in previous sections of this chapter. Environmental factors include poverty and unemployment, social isolation, and community characteristics. It is important to reiterate that most parents or caregivers who live in these types of environments are not abusive.
Poverty and Unemployment
Poverty and unemployment show strong associations with child maltreatment, particularly neglect. The NIS-3 study, for example, found that children from families with annual incomes below $15,000 in 1993 were more than 22 times more likely to be harmed by child abuse and neglect as compared to children from families with annual incomes above $30,000. It is important to underscore that most poor people do not maltreat their children. However, poverty-particularly when interacting with other risk factors such as depression, substance abuse, and social isolation-can increase the likelihood of maltreatment. In 1999, 85 percent of States identified poverty and substance abuse as the top two problems challenging families reported to child protective service (CPS) agencies.
Rod Plotnik, emeritus professor, Department of Psychology, San Diego State University, describes several theories related to the association between poverty and maltreatment, all of which may hold some truth. One theory is that low income creates greater family stress, which, in turn, leads to higher chances of maltreatment. A second theory is that parents with low incomes, despite good intentions, may be unable to provide adequate care while raising children in high-risk neighborhoods with unsafe or crowded housing and inadequate daycare. A third theory is that some other characteristics may make parents more likely to be both poor and abusive. For example, a parent may have a substance abuse problem that impedes the parent's ability to obtain and maintain a job, which also may contribute to abusive behavior. A final theory is that poor families may experience maltreatment at rates similar to other families, but that maltreatment in poor families is reported to CPS more frequently, in part because they have more contact with and are under greater scrutiny from individuals who are legally mandated to report suspected child maltreatment.
Social Isolation and Social Support
Some studies indicate that compared to other parents, parents who maltreat their children report experiencing greater isolation, more loneliness, and less social support. Social isolation may contribute to maltreatment because parents have less material and emotional support, do not have positive parenting role models, and feel less pressure to conform to conventional standards of parenting behaviors. It is not clear, however, whether social isolation in some cases precedes and serves as a contributing factor to maltreatment or whether it is a consequence of the behavioral dynamics of maltreatment.
Children living in dangerous neighborhoods have been found to be at higher risk than children from safer neighborhoods for severe neglect and physical abuse, as well as child sexual victimization. Some risk may be associated with the poverty found in dangerous neighborhoods, however, concerns remain that violence may seem an acceptable response or behavior to individuals who witness it more frequently.
Societal attitudes and the promotion of violence in cultural norms and the media have been suggested as risk factors for physical abuse. In addition, while the research is controversial, some studies show a positive relationship between televised violence and aggressive behaviors, particularly for individuals who watch substantial amounts of television.
Just as there are factors that place families at risk for maltreating their children, there are other factors that may protect them from vulnerabilities-factors that promote resilience. In general, research has found that supportive, emotionally satisfying relationships with a network of relatives or friends can help minimize the risk of parents maltreating children, especially during stressful life events. For example, parents who were abused as children are less likely to abuse their own children if they have resolved internal conflicts and pain related to their history of abuse and if they have an intact, stable, supportive, and no abusive relationship with their partner. Additionally, programs on marriage education and enhancement may provide a roadmap of expected challenges such as the birth of the first child, parenting adolescents, and common gender differences which may act as a protective factor by strengthening families.
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