Indicators of Physical Abuse & Neglect

Physical Abuse Indicators

There are several variables that will affect the child's response to abuse, and the effects of abuse on the child's development. They will also determine the behavioral indicators of maltreatment in children.

• The age of the child when the abuse begins. The younger the child when first abused, the more likely the child will have serious developmental problems from the abuse.
  
• The length of time the child has been abused. The greater the period of time the child has been abused, the more severe the developmental outcomes will be.
  
• The frequency of the abuse. The more often the child is abused, the more pervasive the effects will be.
  
• The nature of the child's relationship with the abuser. The closer the relationship of the abuser to the child, the more likely the child will be negatively affected. Abuse by a parent has the most serious conse­quences.
  
• The type of abuse. The more severe the pain and the greater the injury inflicted on the child, the more negative the psychological, as well as physical, outcomes will be.
  
• The availability to the child of support. The presence of other, non-­abusing adults who can provide proper care and nurturance, either in the home or easily available to the child, can partially mediate the negative affects of abuse.
  
• Constitutional factors. The child's basic personality and temperament can affect the outcomes of abusive treatment. Some children are more resilient than others and have unusual coping strengths. Other children are more vulnerable.

Young children who have been abused severely and at an early age may display pervasive indicators of developmental delay and abnormal developmental patterns.

• The child may be remote, withdrawn, lacking in curiosity, compliant, or detached. The child may not relate to other people.
  
• The child may whine, whimper, or cry, with no expectation that he will be comforted. The child may not look to adults for help.
  
• A state of “ frozen watchfulness ” has been noted in severely abused children. They remain emotionally withdrawn and uninvolved, but watch carefully what is going on around them.
  
• The child may exhibit discomfort with or fear of physical contact .
  
• Severely abused children may appear to be autistic. Many do not relate in normal ways to the people and objects in their environment. Most seriously abused infants show serious delays in all areas of development.
  
• The child may display a forlorn, clinging dependency , but may be lacking in healthy attachment to any adult, and appear unable to attach in healthy ways.
  
• The child may appear depressed, or display flat affect and lack of emotion . He may not cry or respond when in pain or when injured, and shows no enjoyment. He may not smile or play.

Preschool-age children who have been abused may display the following characteristics.

• The child may be timid and easily frightened . He may duck, cringe, flinch, withdraw, attempt to get out of the way, or otherwise exhibit fear of the parent.
  
• The child may be very eager to please , may crave affection, and may show indiscriminate attachment by becoming affectionate with any­one, including strangers.
  
• Early signs of role reversal may be present. The child may try hard to meet the parent's needs. The child may also demonstrate a clingy attachment and verbalize love for the abusing parent.
  
• The child may show physical signs of stress and anxiety, including physical illness and regressive behaviors.
  
• The child may be aggressive with other children , have temper tan­trums, may be "touchy."

The school-age child shows many of the same characteristics as the preschool child. Problems in relationships and developmental delays will be more pro­nounced the longer the maltreatment has been occurring.

• The child may assume the "adult" role in his relationship with the parent. The child is often a " little helper ," who cares for the parent, demonstrates excessive concern when the parent is distressed, and is unusually compliant.
  
• The child has difficulty in relating to other children and to adults. He may be manipulative, or withdrawn and distant. He may have angry, aggressive outbursts and temper tantrums.
  
• Some abused children appear to be "hyperactive," including having an unusually short attention span, an inability to concentrate, and other symptoms of chronic anxiety . They often do not do well in school, and may appear to be "preoccupied."
  
• The child may demonstrate a fear of the parents or, in some cases, an absence of fear or concern in the face of parental or adult authority.
  
• Some children wear unseasonable or unnecessary clothing , in an ap­parent attempt to hide themselves or their injuries.

The abused adolescent may show behavior problems including:

• Lying, stealing, acting out, and other aggressive behaviors.
• Abuse of alcohol or drugs.
• Truancy, including repeatedly running away and refusing to go home.
• Generalized difficulty in entering into and sustaining interpersonal relationships.
  
  

Neglect Indicators

Behavioral and emotional indicators can alert a caseworker to the presence of neglect in a family when there are no clear physical indicators of illness or injury.

• A very large percentage of neglected children are developmentally delayed in all developmental domains. One can determine the degree of delay by comparing the child's developmental level with expected developmental achievements for the child's chronological age. Ne­glected children may display mild to serious delays in physical/motor development, cognitive ability and school achievement, social skills, interpersonal relationships, and emotional development. Severely neglected children may develop mental retardation as a result.
  
• Neglected children are often characterized as unresponsive , placid, apathetic, dull, lacking in curiosity, and uninterested in their surround­ings. They may not approach other people, nor do they exhibit a normal degree of exuberance in their interactions. They may not play, or they may play halfheartedly. In cases of serious neglect, ''the' child may exhibit signs of depression.
  
• The child may appear to be hungry or always tired. Some older children who are inadequately fed use their own resources by scrounging for or stealing food.
  
• Some neglected children may be " out of control " due to an absence of limits from adult caretakers. They may exhibit a variety of behavior problems, anxiety, and other signs of emotional distress. At times a false bravado can be seen.
  
• School failure may be an indicator of neglect, particularly when com­bined with an inability to concentrate, falling a sleep in class, and a lack of interest in the school environment. School failure by itself cannot be considered the result of neglect, but can support a diagnosis of neglect when other indicators are also present.