Current Psychiatry Reports

, Volume 5, Issue 2, pp 87–94 | Cite as

Child physical abuse: Risk for psychopathology and efficacy of interventions

  • Elissa J. Brown


The emerging research on child physical abuse (CPA) is reviewed herewith. Incidence of CPA may be as high as 11% for adolescents in the US. Child physical abuse survivors vary in their symptom picture of severity and type. Children who have been physically abused may experience symptoms of post-traumatic stress disorder, anxiety disorders, depressive disorders, or disruptive behavior disorders. Additionally, developmental disturbances include problems with attachment, social skills, and affect regulation. Chronic abuse is associated with more severe psychopathology. Cognitive processing of the abuse may mediate the impact of CPA on development. Service delivery studies indicate that as many as half of children with substantiated cases of CPA do not receive mental health services. Emerging treatment outcome research reveals the potential efficacy of cognitive behavioral treatment for CPA. Reactions to existing literature and recommendations for future work are presented.


Child Abuse Physical Abuse Parent Training Disruptive Behavior Disorder Child Protective Service 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Courtney ME: The economics. Child Abuse Negl 1999, 23:975–986.PubMedCrossRefGoogle Scholar
  2. 2.
    Starr RH, Dubowitz H, Bush BA: The epidemiology of child maltreatment. In Children at Risk: An Evaluation of Factors Contributing to Child Abuse and Neglect. Edited by Ammerman RT, Hersen M. New York: Plenum; 1990:23–53.Google Scholar
  3. 3.
    Brown EJ, Swenson CC, Saunders BE, Kilpatrick DG: An evaluation of a multifactorial predictive model of child physical abuse. Paper presented at the Annual Meeting of the International Family Violence Research Conference. Durham, NH; June 1997.Google Scholar
  4. 4.
    Gelles RJ, Straus MA: Is violence toward children increasing? A comparison of 1975 and 1985 national survey rates. J Interpersonal Violence 1987, 2:212–222.CrossRefGoogle Scholar
  5. 5.
    Wolfner GD, Gelles RJ: A profile of violence toward children: a national study. Child Abuse Negl 1993, 17:197–212.PubMedCrossRefGoogle Scholar
  6. 6.
    National Center for Child Abuse and Neglect: Study Findings: Study of National Incidence and Prevalence of Child Abuse and Neglect. Washington, DC: Office of Human Development Services, Department of Health and Human Services; 1996.Google Scholar
  7. 7.
    National Child Abuse and Neglect Data System: Child Maltreatment 1997: Reports from the States to the National Child Abuse and Neglect Data System. Washington, DC; Office of Human Development Services, Department of Health and Human Services; 1997.Google Scholar
  8. 8.
    Kolko DJ: Child physical abuse. In The APSAC Handbook on Child Maltreatment, edn 2. Edited by Myers JEB, Berliner L, Briere J, et al. Thousand Oaks: Sage Publications; 2002:21–54. This book is a comprehensive overview of a variety of forms of child abuse and neglect. Kolko’s chapter specifically highlights up-to-date knowledge of predictors of CPA, clinical correlates, treatment, and service delivery issues.Google Scholar
  9. 9.
    Kaplan SJ, Pelcovitz D, LaBruna V: Child and adolescent abuse and neglect research: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1999, 38:1214–1222. Kaplan et al. have produced an excellent review of CPA and neglect. Fifty percent of children experiencing CPA are living in neglectful homes. They highlight this relationship and the contextual factors typifying these families. Psychiatric sequelae and treatment are also discussed.PubMedCrossRefGoogle Scholar
  10. 10.
    Deblinger E, McLeer SV, Atkins MS, et al.: Post-traumatic stress in sexually abused, physically abused, and nonabused children. Child Abuse Negl 1989, 13:403–408.PubMedCrossRefGoogle Scholar
  11. 11.
    Dykman RA, McPherson B, Ackerman PT, et al.: Internalizing and externalizing characteristics of sexually and/or physically abused children. Integrative Physiological and Behavioral Science 1997, 32:62–74.PubMedGoogle Scholar
  12. 12.
    Famularo R, Fenton T, Kinscherff R: Child maltreatment and the development of posttraumatic stress disorder. Am J Dis Child 1993, 147:755–760.PubMedGoogle Scholar
  13. 13.
    Kiser LJ, Heston J, Millsap PA, Pruitt DB: Physical and sexual abuse in childhood: relationship with post-traumatic stress disorder. J Am Acad Child Adolesc Psychiatry 1991, 30:776–783.PubMedCrossRefGoogle Scholar
  14. 14.
    Pelcovitz D, Kaplan S: Post-traumatic stress disorder in children and adolescents. Child Adolesc Psychiatr Clin North Am 1994, 5:449–469.Google Scholar
  15. 15.
    Pfferbaum B: Posttraumatic stress disorder in children: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1997, 36:1503–1511.CrossRefGoogle Scholar
  16. 16.
    Wolfe D: Child Abuse: Implications for Child Development and Psychopathology, edn 2. Thousand Oaks: Sage; 1999.Google Scholar
  17. 17.
    Brown EJ, Swenson CC, Saunders BE, Kirk LC: The impact of physical abuse on children. Paper presented at the Annual Meeting of the American Professional Society on the Abuse of Children. Chicago, IL; June 1996.Google Scholar
  18. 18.
    Kaplan SJ, Pelcovitz D, Salzinger S, et al.: Adolescent physical abuse: risk for adolescent psychiatric disorders. Am J Psychiatry 1998, 155:954–959.PubMedGoogle Scholar
  19. 19.
    Barnett D, Ganiban J, Cicchetti D: Maltreatment, negative expressivity, and the development of type D attachments from 12 to 24 months of age. Monogr Soc Res Child Dev 1999, 64:97–118.PubMedCrossRefGoogle Scholar
  20. 20.
    Fantuzzo JW, Weiss AD, Atkins M, et al.: A contextually relevant assessment of the impact of child maltreatment on the social competencies of low-income urban children. J Am Acad Child Adolesc Psychiatry 1998, 37:1201–1208.PubMedCrossRefGoogle Scholar
  21. 21.
    Feldman RS, Salzinger S, Rosario M, et al.: Parent, teacher, and peer ratings of physically abused and nonmaltreated children’s behavior. J Abnorm Child Psychol 1995, 23:317–334.PubMedCrossRefGoogle Scholar
  22. 22.
    Salzinger S, Feldman RS, Hammer M, Rosario M: The effects of physical abuse on children’s social relationships. Child Dev 1993, 64:169–187.PubMedCrossRefGoogle Scholar
  23. 23.
    Dodge KA, Pettit GS, Bates JE, Valente E: Social informationprocessing patterns partially mediate the effect of early physical abuse on later conduct problems. J Abnorm Psychol 1995, 104:632–643.PubMedCrossRefGoogle Scholar
  24. 24.
    Wolfe DA, Wekerle C, Reitzel-Jaffe D, Lefebvre L: Factors associated with abusive relationships among maltreated and nonmaltreated youth. Dev Psychopathol 1998, 10:61–85.PubMedCrossRefGoogle Scholar
  25. 25.
    Pollak SD, Cicchetti D, Hornung K, Reed A: Recognizing emotion in faces: developmental effects of child abuse and neglect. Dev Psychol 2000, 36:679–688. Pollak et al. are producing some of the most innovative work regarding affect regulation in maltreated children. In this article, as in the others quoted in this paper, Pollak et al. describe technology-based methods of assessing affect regulations and the sensitivity of CPA survivors to anger.PubMedCrossRefGoogle Scholar
  26. 26.
    Pollak SD, Kistler DJ: Early experience is associated with the development of categorical representations for facial expressions of emotions. Proc Natl Acad Sci U S A 2002, 99:9072–9076.PubMedCrossRefGoogle Scholar
  27. 27.
    Pollak SD, Klorman R, Thatcher JE, Cicchetti D: P3b reflects maltreated children’s reactions to facial displays of emotion. Psychophysiology 2001, 38:267–274.PubMedCrossRefGoogle Scholar
  28. 28.
    Duncan RD, Saunders BE, Kilpatrick DG, et al.: Childhood physical assault as a risk factor for PTSD, depression, and substance abuse: findings from a national survey. Am J Orthopsychiatry 1996, 66:437–448.PubMedCrossRefGoogle Scholar
  29. 29.
    Malinosky-Rummell R, Hansen DJ: Long-term consequences of childhood physical abuse. Psychol Bull 1993, 114:68–79.PubMedCrossRefGoogle Scholar
  30. 30.
    McCord J: A forty-year perspective on effects of child abuse and neglect. Child Abuse Negl 1988, 7:265–270.CrossRefGoogle Scholar
  31. 31.
    Widom CS: Posttraumatic stress disorder in abused and neglect children grown up. Am J Psychiatry 1999, 156:1223–1229.PubMedGoogle Scholar
  32. 32.
    Widom CS, Weiler BL, Cottler LB: Childhood victimization and drug abuse: a comparison of prospective and retrospective findings. J Consult Clin Psychol 1999, 67:867–880.PubMedCrossRefGoogle Scholar
  33. 33.
    English DJ, Marshall DB, Brummel S, Orme M: Characteristics of repeated referrals to Child Protective Services in Washington State. Child Maltreatment 1999, 4:297–307.CrossRefGoogle Scholar
  34. 34.
    Marshall DB, English DJ: Survival analysis of risk factors for recidivism in child abuse and neglect. Child Maltreatment 1999, 4:287–296.CrossRefGoogle Scholar
  35. 35.
    Brown EJ, Kolko DJ: Child victims’ attributions about being physically abused: an examination of factors associated with symptom severity. J Abnorm Child Psychol 1999, 27:311–322.PubMedCrossRefGoogle Scholar
  36. 36.
    Keiley MK, Howe TR, Dodge KA, et al.: The timing of child physical maltreatment: a cross-domain growth analysis of impact on adolescent externalizing and internalizing problems. Dev Psychopathol 2001, 13:891–912.PubMedGoogle Scholar
  37. 37.
    Walker EA, Unutzer J, Rutter C, et al.: Costs of health care use by women HMO members with a history of childhood abuse and neglect. Arch Gen Psychiatry 1999, 56:609–613.PubMedCrossRefGoogle Scholar
  38. 38.
    Straus MA, Kantor GK: Corporal punishment of adolescents by parents: a risk factor in the epidemiology of depression, suicide, alcohol abuse, child abuse, and wife beating. Adolescence 1994, 29:543–561.PubMedGoogle Scholar
  39. 39.
    Finkelhor D, Berliner L: Research on the treatment of sexually abused children: a review and recommendations. J Am Acad Child Adolesc Psychiatry 1995, 34:1408–1423.PubMedCrossRefGoogle Scholar
  40. 40.
    Appel AE, Holden GW: The co-occurrence of spouse and physical child abuse: a review and appraisal. J Fam Psychol 1998, 12:578–599.CrossRefGoogle Scholar
  41. 41.
    Christmas AL, Wodarski JS, Smokowski PR: Risk factors for physical child abuse: a practice theoretical paradigm. Fam Ther 1996, 23:233–248.Google Scholar
  42. 42.
    Cohen T: Risk factors and determinants of child maltreatment. In The Link: The Official Newsletter of the International Society for Prevention of Child Abuse and Neglect, vol 9. Chicago: ISPCAN; 2000:1–3.Google Scholar
  43. 43.
    Gillham B, Tanner G, Cheyne B, et al.: Unemployment rates, single parent density and indices of child poverty: their relationship in different categories of child abuse and neglect. Child Abuse Negl 1998, 22:79–90.PubMedCrossRefGoogle Scholar
  44. 44.
    Milner JS: Individuals and family characteristics associated with intrafamilial child physical and sexual abuse. In Violence Against Children in the Family and Community. Edited by Trickett PK, Schellenback CJ. Washington, DC: American Psychological Association; 1999:147–170.Google Scholar
  45. 45.
    Kelleher K, Chaffin M, Hollenberg J, Fischer E: Alcohol and drug disorders among physically abusive and neglectful parents in a community-based sample. Am J Public Health 1994, 84:1586–1590.PubMedCrossRefGoogle Scholar
  46. 46.
    Peterson L, Gable S: Holistic injury prevention. In Handbook of Child Abuse Research and Treatment. Edited by Lutzker JR. New York: Plenum Press; 1998:291–318.Google Scholar
  47. 47.
    Kolko DJ, Brown EJ: Individual cognitive behavioral therapy and family therapy for physical abuse: what characteristics influence clinical outcome? Seminar presented at the Annual Meeting of the American Professional Society on the Abuse of Children. Chicago, IL; July 1998.Google Scholar
  48. 48.
    Kolko DJ, Selelyo J, Brown EJ: The treatment histories and service involvement of physically and sexually abusive families: description, correspondence, and clinical correlates. Child Abuse Negl 1999, 23:459–476.PubMedCrossRefGoogle Scholar
  49. 49.
    Kolko DJ: Individual cognitive behavioral treatment and family therapy for physically abused children and their offending parents: a comparison of clinical outcomes. Child Maltreatment 1996, 1:322–342.CrossRefGoogle Scholar
  50. 50.
    Oates RK, Bross DC: What have we learned about treating child physical abuse? A literature review of the last decade. Child Abuse Negl 1995, 19:463–473.PubMedCrossRefGoogle Scholar
  51. 51.
    Greenwalt BC, Sklare G, Portes P: The therapeutic treatment provided in cases involving physical child abuse: a description of current practices. Child Abuse Negl 1998, 22:71–78.PubMedCrossRefGoogle Scholar
  52. 52.
    Schellenbach CJ: Child maltreatment: a critical review of research on treatment for physically abusive parents. In Violence Against Children in the Family and the Community. Edited by Tricket PK, Schellenback CJ. Washington, DC: American Psychological Association; 1998:251–268.CrossRefGoogle Scholar
  53. 53.
    Patterson GR, Reid JB, Jones RR, Conger RW: A Social Learning Approach to Family Intervention, vol 1. Eugene: Castalia; 1975.Google Scholar
  54. 54.
    Forehand RL, McMahon RJ: Helping the Noncompliant Child: A Clinician’s Guide to Parent Training. New York: Guilford; 1981.Google Scholar
  55. 55.
    Kazdin AE: Parent management training: evidence, outcomes, and issues. J Am Acad Child Adolesc Psychiatry 1997, 36:1349–1356.PubMedCrossRefGoogle Scholar
  56. 56.
    Webster-Stratton C: Parents and Children: A 10 Program Videotape Parent Training Series with Manuals. Eugene,: Castalia Press; 1987.Google Scholar
  57. 57.
    Webster-Stratton C: Preventing conduct problems in Head Start children: strengthening parenting competencies. J Consult Clin Psychol 1998, 66:715–730.PubMedCrossRefGoogle Scholar
  58. 58.
    Wolfe DA, Wekerle C: Treatment strategies for child physical abuse and neglect: a critical progress report. Clin Psychol Rev 1993, 13:473–500.CrossRefGoogle Scholar
  59. 59.
    Kolko DJ, Brown EJ: CPS risk assessment and clinical evaluation in child abuse: risky business? Paper presented at the Annual Meeting of the Family Violence Research Conference. Durham, NH; July 1997.Google Scholar
  60. 60.
    Swenson CC, Brown EJ, Sheidow AJ: Medical, mental health, and legal service utilization by physically abused children and their caregivers. Child Maltreatment 2002, In press.Google Scholar
  61. 61.
    Fantuzzo JW, Stovall A, Schachtel D, et al.: The effects of peer social initiations on the social behavior of withdrawn maltreated preschool children. J Behav Ther Exp Psychiatry 1987, 18:357–363.PubMedCrossRefGoogle Scholar
  62. 62.
    Fantuzzo JW, Jurecic L, Stovall A, et al.: Effects of adult and peer social initiations on the social behavior of withdrawn, maltreated preschool children. J Consult Clin Psychol 1988, 56:34–39.PubMedCrossRefGoogle Scholar
  63. 63.
    Culp RE, Little V, Letts D, Lawrence H: Maltreated children’s self-concept: effects of a comprehensive treatment program. Am J Orthopsychiatry 1991, 61:114–121.PubMedCrossRefGoogle Scholar
  64. 64.
    Culp RE, Richardson MT, Heide JS: Differential developmental progress of maltreated children in day treatment. Social Work 1987, 6:497–499.Google Scholar
  65. 65.
    Gabel S, Swanson AJ, Shindledecker R: Aggressive children in a day treatment program: changed outcome and possible explanations. Child Abuse Negl 1990, 14:515–523.PubMedCrossRefGoogle Scholar
  66. 66.
    Swenson CC, Brown EJ: Cognitive-behavioral group treatment for physically abused children. Cogn Behav Pract 1999, 6:212–220.CrossRefGoogle Scholar
  67. 67.
    Deblinger E, Lippmann J, Steer R: Sexually abused children suffering posttraumatic stress symptoms: initial treatment outcome findings. Child Maltreatment 1996, 1:310–321.CrossRefGoogle Scholar
  68. 68.
    Webster-Stratton C, Hammond M: Treating children with early-onset conduct problems: a comparison of child and parent training interventions. J Consult Clin Psychol 1997, 65:93–109.PubMedCrossRefGoogle Scholar
  69. 69.
    Borrego J, Urquiza AJ, Rasmussen RA, Zebell N: Parent-child interaction therapy with a family at high risk for physical abuse. Child Maltreatment 1999, 4:331–342.CrossRefGoogle Scholar
  70. 70.
    Brunk MA, Henggeler SW, Whelan JP: Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. J Consult Clin Psychol 1987, 55:171–178.PubMedCrossRefGoogle Scholar
  71. 71.
    Urquiza AJ, McNeil CB: Parent-child interaction therapy: an intensive dyadic intervention for physically abusive families. Child Maltreatment 1996, 1:134–144.CrossRefGoogle Scholar
  72. 72.
    Wolfe DA, Edwards B, Manion I, Koverola C: Early intervention for parents at risk for child abuse and neglect: a preliminary report. J Consult Clin Psychol 1988, 56:40–47.PubMedCrossRefGoogle Scholar
  73. 73.
    Kolko DJ: Clinical monitoring of treatment course in child physical abuse: psychometric characteristics and treatment comparisons. Child Abuse Negl 1996, 20:23–43.PubMedCrossRefGoogle Scholar
  74. 74.
    Kolko DJ, Swenson CC: Assessing and Treating Physically Abused Children and Their Families. Thousand Oaks: Sage Publications; 2002. Kolko and Swenson are experts in the areas of evaluating and treating physically absuive families. This book is a comprehensive description of areas of assessment, methods of conducting these assessments, treatment efficacy, and therapeutic interventions for children, parents, and families.Google Scholar
  75. 75.
    Lipovsky JA, Swenson CC, Ralston ME, Saunders BE: The abuse clarification process in the treatment of intrafamilial child abuse. Child Abuse Negl 1998, 22:729–741.PubMedCrossRefGoogle Scholar
  76. 76.
    Swenson CC, Kolko DJ: Long-term management of the developmental consequences of child physical abuse. In The Treatment of Child Abuse. Edited by Reece R. Baltimore: Johns Hopkins University Press; 2000:135–154.Google Scholar
  77. 77.
    Swenson CC, Randall J, Henggeler SW, Ward D: The outcomes and costs of an interagency partnership to serve maltreated children in state custody. Children’s Services: Social Policy, Research, and Practice 2002, In press.Google Scholar
  78. 78.
    Kazdin AE, Wassell G: Predictors of barriers to treatment and therapeutic change in outpatient therapy for antisocial children and their families. Ment Health Serv Res 2000, 2:27–40.PubMedCrossRefGoogle Scholar
  79. 79.
    Hansen DJ, Warner-Rogers JE, Hecht DB: Implementing and evaluating an individualized behavioral intervention program for maltreating families. In Handbook of Child Abuse Research and Treatment. Edited by Lutzker J. New York: Plenum Press; 1998:133–158.Google Scholar
  80. 80.
    Chaffin M, Silovsky JF, Funderburk BW: Physical abuse treatment outcome study [unpublished manuscript]. Parent-child interaction training is a well established, scientifically based intervention for children with behavior problems. Chaffin et al. have conducted a randomized, controlled trial that applied this therapy to physically abusive families with great success. In doing so, they have combined efficacy and effectiveness with the goal of minimizing a serious social problem.Google Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Elissa J. Brown
    • 1
  1. 1.New York University School of Medicine Child Study CenterNew YorkUSA

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