Long-Term Consequences of Child Abuse and Neglect

An estimated 905,000 children were victims of child abuse or neglect in 2006 (U.S. Department of Health and Human Services, 2008). While physical injuries may or may not be immediately visible, abuse and neglect can have consequences for children, families, and society that last lifetimes, if not generations.

The impact of child abuse and neglect is often discussed in terms of physical, psychological, behavioral, and societal consequences. In reality, however, it is impossible to separate them completely. Physical consequences, such as damage to a child's growing brain, can have psychological implications such as cognitive delays or emotional difficulties. Psychological problems often manifest as high-risk behaviors. Depression and anxiety, for example, may make a person more likely to smoke, abuse alcohol or illicit drugs, or overeat. High-risk behaviors, in turn, can lead to long-term physical health problems such as sexually transmitted diseases, cancer, and obesity.

This fact sheet provides an overview of some of the most common physical, psychological, behavioral, and societal consequences of child abuse and neglect, while acknowledging that much crossover among categories exists.

Factors Affecting the Consequences of Child Abuse and Neglect

Not all abused and neglected children will experience long-term consequences. Outcomes of individual cases vary widely and are affected by a combination of factors, including:

• The child's age and developmental status when the abuse or neglect occurred
• The type of abuse (physical abuse, neglect, sexual abuse, etc.)
• The frequency, duration, and severity of abuse
• The relationship between the victim and his or her abuser (English et al., 2005; Chalk, Gibbons, & Scarupa, 2002)

Researchers also have begun to explore why, given similar conditions, some children experience long-term consequences of abuse and neglect while others emerge relatively unscathed. The ability to cope, and even thrive, following a negative experience is sometimes referred to as "resilience." A number of protective and promotive factors may contribute to an abused or neglected child’s resilience. These include individual characteristics, such as optimism, self-esteem, intelligence, creativity, humor, and independence, as well as the acceptance of peers and positive individual influences such as teachers, mentors, and role models. Other factors can include the child's social environment and the family’s access to social supports. Community well-being, including neighborhood stability and access to safe schools and adequate health care, are other protective and promotive factors (Fraser & Terzian, 2005).

Physical Health Consequences

The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or severe (broken bones, hemorrhage, or even death). In some cases the physical effects are temporary; however, the pain and suffering they cause a child should not be discounted. Meanwhile, the long-term impact of child abuse and neglect on physical health is just beginning to be explored. According to the National Survey of Child and Adolescent Well-Being (NSCAW), more than one-quarter of children who had been in foster care for longer than 12 months had some lasting or recurring health problem (Administration for Children and Families, Office of Planning, Research, and Evaluation [ACF/OPRE], 2004a). Below are some outcomes researchers have identified:

Shaken baby syndrome. Shaking a baby is a common form of child abuse. The injuries caused by shaking a baby may not be immediately noticeable and may include bleeding in the eye or brain, damage to the spinal cord and neck, and rib or bone fractures (National Institute of Neurological Disorders and Stroke, 2007).

Impaired brain development. Child abuse and neglect have been shown, in some cases, to cause important regions of the brain to fail to form or grow properly, resulting in impaired development (De Bellis & Thomas, 2003). These alterations in brain maturation have long-term consequences for cognitive, language, and academic abilities (Watts-English, Fortson, Gibler, Hooper, & De Bellis, 2006). NSCAW found more than three-quarters of foster children between 1 and 2 years of age to be at medium to high risk for problems with brain development, as opposed to less than half of children in a control sample (ACF/OPRE, 2004a).

Poor physical health. Several studies have shown a relationship between various forms of household dysfunction (including childhood abuse) and poor health (Flaherty et al., 2006; Felitti, 2002). Adults who experienced abuse or neglect during childhood are more likely to suffer from physical ailments such as allergies, arthritis, asthma, bronchitis, high blood pressure, and ulcers (Springer, Sheridan, Kuo, & Carnes, 2007).

Psychological Consequences

The immediate emotional effects of abuse and neglect—isolation, fear, and an inability to trust—can translate into lifelong consequences, including low self-esteem, depression, and relationship difficulties. Researchers have identified links between child abuse and neglect and the following:

Difficulties during infancy. Depression and withdrawal symptoms were common among children as young as 3 who experienced emotional, physical, or environmental neglect. (Dubowitz, Papas, Black, & Starr, 2002).

Poor mental and emotional health. In one long-term study, as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21. These young adults exhibited many problems, including depression, anxiety, eating disorders, and suicide attempts (Silverman, Reinherz, & Giaconia, 1996). Other psychological and emotional conditions associated with abuse and neglect include panic disorder, dissociative disorders, attention-deficit/hyperactivity disorder, depression, anger, posttraumatic stress disorder, and reactive attachment disorder (Teicher, 2000; De Bellis & Thomas, 2003; Springer, Sheridan, Kuo, & Carnes, 2007).

Cognitive difficulties. NSCAW found that children placed in out-of-home care due to abuse or neglect tended to score lower than the general population on measures of cognitive capacity, language development, and academic achievement (U.S. Department of Health and Human Services, 2003). A 1999 LONGSCAN study also found a relationship between substantiated child maltreatment and poor academic performance and classroom functioning for school-age children (Zolotor, Kotch, Dufort, Winsor, & Catellier, 1999).

Social difficulties. Children who experience rejection or neglect are more likely to develop antisocial traits as they grow up. Parental neglect is also associated with borderline personality disorders and violent behavior (Schore, 2003).

Behavioral Consequences

Not all victims of child abuse and neglect will experience behavioral consequences. However, behavioral problems appear to be more likely among this group, even at a young age. An NSCAW survey of children ages 3 to 5 in foster care found these children displayed clinical or borderline levels of behavioral problems at a rate of more than twice that of the general population (ACF, 2004b). Later in life, child abuse and neglect appear to make the following more likely:

Difficulties during adolescence. Studies have found abused and neglected children to be at least 25 percent more likely to experience problems such as delinquency, teen pregnancy, low academic achievement, drug use, and mental health problems (Kelley, Thornberry, & Smith, 1997). Other studies suggest that abused or neglected children are more likely to engage in sexual risk-taking as they reach adolescence, thereby increasing their chances of contracting a sexually transmitted disease (Johnson, Rew, & Sternglanz, 2006).

Juvenile delinquency and adult criminality. According to a National Institute of Justice study, abused and neglected children were 11 times more likely to be arrested for criminal behavior as a juvenile, 2.7 times more likely to be arrested for violent and criminal behavior as an adult, and 3.1 times more likely to be arrested for one of many forms of violent crime (juvenile or adult) (English, Widom, & Brandford, 2004).

Alcohol and other drug abuse. Research consistently reflects an increased likelihood that abused and neglected children will smoke cigarettes, abuse alcohol, or take illicit drugs during their lifetime (Dube et al., 2001). According to a report from the National Institute on Drug Abuse, as many as two-thirds of people in drug treatment programs reported being abused as children (Swan, 1998).

Abusive behavior. Abusive parents often have experienced abuse during their own childhoods. It is estimated approximately one-third of abused and neglected children will eventually victimize their own children (Prevent Child Abuse New York, 2003).

Societal Consequences

While child abuse and neglect almost always occur within the family, the impact does not end there. Society as a whole pays a price for child abuse and neglect, in terms of both direct and indirect costs.

Direct costs. Direct costs include those associated with maintaining a child welfare system to investigate and respond to allegations of child abuse and neglect, as well as expenditures by the judicial, law enforcement, health, and mental health systems. A 2001 report by Prevent Child Abuse America estimates these costs at $24 billion per year.

Indirect costs. Indirect costs represent the long-term economic consequences of child abuse and neglect. These include costs associated with juvenile and adult criminal activity, mental illness, substance abuse, and domestic violence. They can also include loss of productivity due to unemployment and underemployment, the cost of special education services, and increased use of the health care system. Prevent Child Abuse America estimated these costs at more than $69 billion per year (2001).

Summary

Much research has been done about the possible consequences of child abuse and neglect. The effects vary depending on the circumstances of the abuse or neglect, personal characteristics of the child, and the child’s environment. Consequences may be mild or severe; disappear after a short period or last a lifetime; and affect the child physically, psychologically, behaviorally, or in some combination of all three ways. Ultimately, due to related costs to public entities such as the health care, human services, and educational systems, abuse and neglect impact not just the child and family, but society as a whole.

Resources on the Child Welfare Information Gateway Website

Child Abuse and Neglect
http://www.childwelfare.gov/can/

Defining Child Abuse and Neglect
http://www.childwelfare.gov/can/defining/

Preventing Child Abuse and Neglect
http://www.childwelfare.gov/preventing/

Reporting Child Abuse and Neglect
http://www.childwelfare.gov/responding/reporting.cfm

References

Administration for Children and Families, Office of Planning, Research and Evaluation. (2004a). Who are the children in foster care? NSCAW Research Brief No. 1. Retrieved August 9, 2007, from the National Data Archive on Child Abuse and Neglect website: www.ndacan.cornell.edu/NDACAN/Datasets/Related_Docs/NSCAW_Research_Brief_1.pdf (PDF - 221 KB)

Administration for Children and Families, Office of Planning, Research and Evaluation. (2004b). Children ages 3 to 5 in the child welfare system. NSCAW Research Brief No. 5. Washington, DC: Author.

Chalk, R., Gibbons, A., & Scarupa, H. J. (2002). The multiple dimensions of child abuse and neglect: New insights into an old problem. Washington, DC: Child Trends. Retrieved April 27, 2006, from www.childtrends.org/Files/ChildAbuseRB.pdf (PDF - 82 KB)

De Bellis, M., & Thomas, L. (2003). Biologic findings of post-traumatic stress disorder and child maltreatment. Current Psychiatry Repots, 5, 108-117.

Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences Study. Journal of the American Medical Association, 286, 3089-3096.

Dubowitz, H., Papas, M. A., Black, M. M., & Starr, R. H., Jr. (2002). Child neglect: Outcomes in high-risk urban preschoolers. Pediatrics, 109, 1100-1107.

English, D. J., Upadhyaya, M. P., Litrownik, A. J., Marshall, J. M., Runyan, D. K., Graham, J. C., & Dubowitz, H. (2005). Maltreatment’s wake: The relationship of maltreatment dimensions to child outcomes. Child Abuse and Neglect, 29, 597-619.

English, D. J., Widom, C. S., & Brandford, C. (2004). Another look at the effects of child abuse. NIJ journal, 251, 23-24.

Felitti, V. J. (2002). The relationship of adverse childhood experiences to adult health: Turning gold into lead. Zeitschrift für Psychosomatische Medizin und Psychotherapie 48(4), 359-369. Retrieved June 18, 2007, from www.acestudy.org/docs/GoldintoLead.pdf

Flaherty, E. G., et al. (2006). Effect of early childhood adversity on health. Archives of Pediatrics and Adolescent Medicine, 160, 1232-1238.

Fraser, M. W., & Terzian, M. A. (2005). Risk and resilience in child development: principles and strategies of practice. In G. P. Mallon & P. M. Hess (Eds.), Child welfare for the 21st century: A handbook of practices, policies, and programs (pp. 55-71). New York, NY: Columbia University Press.

Johnson, R., Rew, L., & Sternglanz, R. W. (2006). The relationship between childhood sexual abuse and sexual health practices of homeless adolescents. Adolescence, 41(162), 221-234.

Kelley, B. T., Thornberry, T. P., & Smith, C. A. (1997). In the wake of childhood maltreatment. Washington, DC: National Institute of Justice. Retrieved April 27, 2006, from www.ncjrs.gov/pdffiles1/165257.pdf (PDF - 221 KB)

National Institute of Neurological Disorders and Stroke. (2007). Shaken baby syndrome. Retrieved June 4, 2007, from www.ninds.nih.gov/disorders/shakenbaby/shakenbaby.htm

Prevent Child Abuse America. (2001). Total estimated cost of child abuse and neglect in the United States. Retrieved April 27, 2006, from http://member.preventchildabuse.org/site/DocServer/cost_analysis.pdf?docID=144 (PDF - 44 KB) - NOTE: must register to view document

Prevent Child Abuse New York. (2003). The costs of child abuse and the urgent need for prevention. Retrieved April 27, 2006, from http://pca-ny.org/pdf/cancost.pdf (PDF - 146 KB)

Schore, A. N. (2003). Early relational trauma, disorganized attachment, and the development of a predisposition to violence. In M. F. Solomon & D. J. Siegel (Eds.), Healing trauma: Attachment, mind, body, and brain. New York, NY: Norton.

Silverman, A. B., Reinherz, H. Z., & Giaconia, R. M. (1996). The long-term sequelae of child and adolescent abuse: A longitudinal community study. Child Abuse and Neglect, 20(8), 709-723.

Springer, K. W., Sheridan, J., Kuo, D., & Carnes, M. (2007). Long-term physical and mental health consequences of childhood physical abuse: Results from a large population-based sample of men and women. Child Abuse & Neglect, 31, 517-530.

Swan, N. (1998). Exploring the role of child abuse on later drug abuse: Researchers face broad gaps in information. NIDA Notes, 13(2). Retrieved April 27, 2006, from the National Institute on Drug Abuse website: www.nida.nih.gov/NIDA_Notes/NNVol13N2/exploring.html

Teicher, M. D. (2000). Wounds that time won’t heal: The neurobiology of child abuse. Cerebrum: The Dana Forum on brain science, 2(4), 50-67.

U.S. Department of Health and Human Services. (2003). National Survey of Child and Adolescent Well-Being: One year in foster care wave 1 data analysis report. Retrieved April 27, 2006, from www.acf.hhs.gov/programs/opre/abuse_neglect/nscaw/reports/nscaw_oyfc/oyfc_title.html

U.S. Department of Health and Human Services. (2008). Child maltreatment 2006. Washington, DC: Government Printing Office. Retrieved April 1, 2008, from www.acf.hhs.gov/programs/cb/pubs/cm06/index.htm

Watts-English, T., Fortson, B. L., Gibler, N., Hooper, S. R., & De Bellis, M. (2006). The psychobiology of maltreatment in childhood. Journal of Social Sciences 62(4) 717-736.

Zolotor, A., Kotch, J., Dufort, V., Winsor, J., Catellier, D., & Bou-Saada I. (1999). School performance in a longitudinal cohort of children at risk of maltreatment. Maternal and Child Health Journal, 3(1), 19-27