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Journal of Child & Adolescent Trauma

, Volume 7, Issue 1, pp 37–49 | Cite as

Child Torture as a Form of Child Abuse

  • Barbara L. Knox
  • Suzanne P. Starling
  • Kenneth W. Feldman
  • Nancy D. Kellogg
  • Lori D. Frasier
  • Suzanna L. Tiapula
Original Article

Abstract

This paper describes clinical findings and case characteristics of children who are victims of severe and multiple forms of abuse; and proposes clinical criteria that indicate child abuse by torture. Medical records, investigation records, and transcripts of testimony regarding a non-consecutive case series of 28 children with evidence of physical abuse, neglect, and psychological maltreatment, such as terrorizing and isolation, were reviewed for types of injuries, duration of maltreatment, medical and physical neglect, social and family history, and history of prior Child Protective Services (CPS) involvement. The median age was 7.5 years (9 months to 14.3 years). Thirty-six percent died. Duration of abuse ranged from 3.5 months to 8 years (median 3 years). Ninety-three percent of children were beaten and exhibited cutaneous injury; 21 % had fractures. There were 25 victims of isolation (89 %), as well as 61 % who were physically restrained and 89 % who were restricted from food or water. All of the children were victims of psychological maltreatment; 75 % were terrorized through threats of harm or death to themselves or loved ones and 54 % were degraded and/or rejected by caregivers. Nearly all children were medically neglected. Half had a history of prior referrals to CPS. The children in this case series were physically abused, isolated, deprived of basic necessities, terrorized, and neglected. We define child torture as a longitudinal experience characterized by at least two physical assaults or one extended assault, two or more forms of psychological maltreatment, and neglect resulting in prolonged suffering, permanent disfigurement or dysfunction, or death.

Keywords

Non-accidental trauma Physical abuse Psychological maltreatment Neglect Starvation 

References

  1. Allasio, D., & Fischer, H. (1998). Torture versus child abuse: what’s the difference? Clinical Pediatrics, 37(4), 269–271. doi: 10.1177/000992289803700410.CrossRefPubMedGoogle Scholar
  2. Allodi, F., & Cowgill, G. (1982). Ethical and psychiatric aspects of torture: a Canadian study. Canadian Journal of Psychiatry, 27(2), 98–102.Google Scholar
  3. Amnesty International. (1975). Report on torture. New York: Farrar, Straus and Giroux.Google Scholar
  4. Anda, R. F., Feletti, V. J., Bremner, J. D., Walker, J. D., Whitfield, C., Perry, B. D., . . . Giles, W. H. (2006). The enduring effects of abuse and related adverse experiences in childhood—a convergence of evidence from neurobiology and epidemiology. European Archives of Psychiatry and Clinical Neuroscience, 256, 174–186. doi: 10.1007/s00406-005-0624-4.
  5. Burgers, J. H., & Danelius, H. (1988). The United Nations Convention Against Torture: A handbook on the convention against torture and other cruel, inhuman or degrading treatment or punishment. Dordrecht: Martinus Nijhoff.Google Scholar
  6. Campbell, T. A. (2007). Psychological assessment, diagnosis, and treatment of torture survivors: a review. Clinical Psychology Review, 27, 628–641. doi: 10.1016/j.cpr.2007.02.003.CrossRefPubMedGoogle Scholar
  7. Cantwell, H. B. (1980). Child neglect. In R. E. Helfer & H. C. Henry Kempe (Eds.), The battered child (3rd ed., pp. 183–197). Chicago: University of Chicago Press.Google Scholar
  8. Christian, C. W., Block, R., & Committee on Child Abuse and Neglect, American Academy of Pediatrics. (2009). Abusive head trauma in infants and children. Pediatrics, 123(5), 1409–1411. doi: 10.1542/peds.2009-0408.CrossRefPubMedGoogle Scholar
  9. Cohn, J., Holzer, K. M. H., & Kock, L. (1981). Torture of children: an investigation of Chilean immigrant children in Denmark. Child Abuse & Neglect, 5(2), 201–203. doi: 10.1016/0145-2134(81)90042.CrossRefGoogle Scholar
  10. den Otter, J. J., Smit, Y., dela Cruz, L. B., Ozkalipci, O., & Oral, R. (2013). Documentation of torture and cruel, inhuman or degrading treatment of children: a review of existing guidelines and tools. Forensic Science International, 224(1–3), 27–32. doi: 10.1016/j.forsciint.2012.11.003.CrossRefGoogle Scholar
  11. Finkelhor, D., Turner, H., Ormrod, R., & Hamby, S. L. (2009). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124(5), 1411–1423. doi: 10.1001/jamapediatrics.2013.42.CrossRefPubMedGoogle Scholar
  12. Finkelhor, D., Shattuck, A., Turner, H. A., Ormrod, R., & Hamby, S. L. (2011). Polyvictimization in developmental context. Journal of Child & Adolescent Trauma, 4(4), 291–300. doi: 10.1080/19361521.2011.610432.CrossRefGoogle Scholar
  13. Goldfeld, A. E., Mollica, R. F., Pesavento, B. H., & Faraone, S. V. (1988). The physical and psychological sequelae of torture. Symptomatology and diagnosis. JAMA, 259(18), 2725–2729. doi: 10.1001/jama.1988.03720180051032.CrossRefPubMedGoogle Scholar
  14. Green, C. (2007). Politically-motivated torture and child survivors. Pediatric Nursing, 33(3), 267–270.PubMedGoogle Scholar
  15. Hart, S. N., Brassard, M. R., Davidson, H. A., Rivelis, E., Diaz, V., & Binggeli, N. J. (2011). Psychological maltreatment. In J. E. B. Myers (Ed.), The APSAC handbook on child maltreatment (pp. 79–102). Thousand Oaks: Sage.Google Scholar
  16. Herman, J. L. (1992). Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. Journal of Traumatic Stress, 5(3), 377–391. doi: 10.1007/BF00977235.CrossRefGoogle Scholar
  17. Hibbard, R., Barlow, J., Macmillan, H., Child, A., & Committee on Child Abuse and Neglect American Academy of Pediatrics. (2012). Psychological maltreatment. Pediatrics, 130(2), 372–378. doi: 10.1542/peds.2012-1552.CrossRefPubMedGoogle Scholar
  18. Hollingsworth, J., Glass, J., & Heisler, K. W. (2007). Empathy deficits in siblings of severely scapegoated children: a conceptual model. Journal of Emotional Abuse, 7(4), 69–88.CrossRefGoogle Scholar
  19. Kellogg, N. D., & Lukefahr, J. L. (2005). Criminally prosecuted cases of child starvation. Pediatrics, 116(6), 1309–1316. doi: 10.1542/peds.2004-2616.CrossRefPubMedGoogle Scholar
  20. Kempe, C. H. (1978). Sexual abuse, another hidden pediatric problem: the 1977C. Anderson Aldrich lecture. Pediatrics, 62(3), 382–389. Retrieved from http://pediatrics.aappublications.org/content/62/3/382.
  21. Kempe, C. H., Silverman, F. N., Steele, B. F., Droegemueller, W., & Silver, H. K. (1962). The battered-child syndrome. JAMA, 181, 17–24. doi: 10.1001/jama.1962.03050270019004.CrossRefPubMedGoogle Scholar
  22. King, J., Diefendorf, D., Apthorp, J., Negrete, V. F., & Carlson, M. (1988). Analysis of 429 fractures in 189 battered children. Journal of Pediatric Orthopedics, 8(5), 585–589.PubMedGoogle Scholar
  23. Knox, B. L., & Starling, S. (November 27, 2012). Child torture: Case reviews and analysis of institutional responses. Paper presented at the National District Attorneys Association National Center for the Prosecution of Child Abuse Investigation and Prosecution of Child Fatalities and Physical Abuse Conference, Honolulu, Hawaii.Google Scholar
  24. Roesler, T., & Jenny, C. (2009). Medical child abuse: Beyond Munchausen syndrome by proxy. Elk Grove Village: American Academy of Pediatrics. doi: 10.1016/B978-1-4160-6393-3.00061-0.Google Scholar
  25. Rosenberg, D. A. (1987). Web of deceit: a literature review of Munchausen syndrome by proxy. Child Abuse & Neglect, 11(4), 547–563. doi: 10.1016/0145-2134(87)90081-0.CrossRefGoogle Scholar
  26. Schmitt, B. D. (1987). Seven deadly sins of childhood: advising parents about difficult developmental phases. Child Abuse & Neglect, 11(3), 421–432. doi: 10.1011/0145-2134(87)90015-9.CrossRefGoogle Scholar
  27. Steele, B. (1987). Psychodynamic factors in child abuse. In R. Helfer, C. H. Kempe, & R. S. Krugman (Eds.), The battered child (4th ed., pp. 81–114). Chicago: University of Chicago Press.Google Scholar
  28. Stirling, J., Jr., & American Academy of Pediatrics Committee on Child Abuse & Neglect. (2007). Beyond Munchausen syndrome by proxy: identification and treatment of child abuse in a medical setting. Pediatrics, 119(5), 1026–1030. doi: 10.1542/peds.2007-0563.CrossRefPubMedGoogle Scholar
  29. Stover, E., & Nightingale, E. (1985). Introduction: The breaking of bodies and minds. In E. Stover & E. Nightingale (Eds.), Breaking of bodies and minds: Torture, psychiatric abuse, and the health professions (pp. 1–26). New York: Freeman.Google Scholar
  30. Tiapula, S., & Applebaum, A. (2011). Criminal justice and child protection responses to cases of severe child abuse: existing statutory frameworks for torture. National Center for the Prosecuton of Child Abuse Update, 23(1), 1–8.Google Scholar
  31. Tournel, G., Desurmont, M., Becart, A., Hedouin, V., & Gosset, D. (2006). Child barbarity and torture: a case report. The American Journal of Forensic Medicine and Pathology, 27(3), 263–265. doi: 10.1097/01.paf.0000233532.18076.14.CrossRefPubMedGoogle Scholar
  32. Welsh, J. (2000). Children and torture. Lancet, 356(9247), 2093. doi: 10.1016/S0140-6736(00)03414-0.CrossRefPubMedGoogle Scholar
  33. World Medical Association (1975, revised 2006). Declaration of Tokyo-guidelines for physicians concerning torture and other cruel, inhuman or degrading treatment or punishment in relation to detention and imprisonment. Retrieved from World Medical Association website: http://www.wma.net/en/30publications/10policies/c18/index.html.

Copyright information

© Springer International Publishing 2014

Authors and Affiliations

  • Barbara L. Knox
    • 1
  • Suzanne P. Starling
    • 2
  • Kenneth W. Feldman
    • 3
  • Nancy D. Kellogg
    • 4
  • Lori D. Frasier
    • 5
  • Suzanna L. Tiapula
    • 6
  1. 1.Department of PediatricsUniversity of Wisconsin School of Medicine and Public Health, American Family Children’s HospitalMadisonUSA
  2. 2.Eastern Virginia Medical SchoolChildren’s Hospital of The King’s DaughtersNorfolkUSA
  3. 3.University of Washington, and Seattle Children’s HospitalSeattleUSA
  4. 4.University of Texas Health Science Center at San AntonioSan AntonioUSA
  5. 5.Primary Children’s Medical CenterUniversity of UtahSalt Lake CityUSA
  6. 6.National Center for Prosecution of Child AbuseAlexandriaUSA

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