PSYCHOLOGICAL IMPACT OF CHILD ABUSE IN UNREPORTED CASES

​INTRODUCTION 
Child Rights gained momentum in the 20th century. Children were considered “young adults” until then and there was a lack of special laws to protect their vulnerability. Parents and caregivers often exploited children’s gullibility. Child abuse occurs when parents or caregivers abuse the child physically, emotionally, sexually and neglects to give the child proper care. The abuse can have negative impacts and can shun the emotional and physical growth of the children. Today, child abuse is a global issue. The World Health Organization (WHO) defines child abuse and child maltreatment as “all forms of physical and/or emotional ill-treatment, sexual abuse, neglect or negligent treatment or commercial or other exploitation, resulting in actual or potential harm to the child's health, survival, development or dignity in the context of a relationship of responsibility, trust or power”. Nearly 3 in 4 children suffer physical violence at the hands of their parents or caregivers.
According to WHO, child abuse can be physical, emotional, sexual and neglect. It is important to identify the symptoms of such abuse to provide utmost care to the victims. Child abuse can be a single episode or several episodes taking place over time. 
Child Abuse is a criminal offence. Every State has its procedure and laws that deal with child abuse. India has one of the largest child population in the world. Regardless of the laws and policies implemented to curb child abuse, the condition is yet to become better in the country. The number of child sexual abuse cases increases every year in the country. “As many as 109 children were sexually abused every day in India in 2018, according to the data by the National Crime Record Bureau, which showed a 22 per cent jump in such cases from the previous year.”

TYPES AND SYMPTOMS OF CHILD ABUSE 
According to WHO, child abuse can be physical, emotional, sexual and neglect. It is important to identify the symptoms of such abuse to provide utmost care to the victims. Child abuse can be a single episode or several episodes taking place over time. 

• Physical Abuse is in the form of hitting, throwing, choking, burning etc. These acts are done on purpose to injure the child. Physical abuse is often visible compared to other forms of abuse since it leaves marks on the child, though it may not be the case always. While the common symptoms of any kind of abuse are withdrawal from friends, mood swings, anxiety, depression and self-harm; physical abuse can be identified when the child’s explanations do not match the injuries.
  
• Emotional Abuse is often in the form of name-calling, bullying, teasing, rejection, negative criticisms, and can lead to depression, delayed emotional growth, loss of self-esteem and loss of interest in previously enjoyed activities. 
  
• Sexual Abuse occurs when the child is sexually exploited by an adult, teenager or even by a stronger child. Sexual abuse can be physical, emotional or verbal. Kissing the child forcibly, touching his/her genitals, sexually talking to the child, rape, oral sex etc. are forms of sexual abuse. Sexually abused children can have more knowledge about sexual activities that might be inappropriate to his/her age and increased chances of pregnancy. 
  
• Neglect to provide adequate shelter, care, food etc. for the growth and well-being of the child can lead to diminished physical growth in children in terms of height and weight. Common symptoms of neglect are poor or no supplies to meet physical needs, poor hygiene, lack of medical attention and poor attendance in school.  
  

PSYCHOLOGICAL IMPACT
Aside from the immediate physical injuries, children can experience through maltreatment, a child’s reactions to abuse or neglect can have lifelong and even intergenerational impacts. Childhood maltreatment can be linked to later physical, psychological, and behavioural consequences as well as costs to society as a whole. These consequences may be independent of each other, but they also may be interrelated. For example, abuse or neglect may stunt the physical development of the child’s brain and lead to psychological problems, such as low self-esteem, which could later lead to high-risk behaviours, such as substance use. The outcomes for each child may vary widely and are affected by a combination of factors, including the child’s age and developmental status when the maltreatment occurred; the type, frequency, duration, and severity of the maltreatment; and the relationship between the child and the perpetrator.
Child abuse and neglect can cause a variety of psychological problems. Maltreatment can cause victims to feel isolation, fear, and distrust, which can translate into lifelong psychological consequences that can manifest as educational difficulties, low self-esteem, depression, and trouble forming and maintaining relationships. Researchers have identified links between child abuse and neglect and the following psychological outcomes. 

• Diminished executive functioning and cognitive skills- Disrupted brain development as a result of maltreatment can cause impairments to the brain’s executive functions: working memory, self-control, and cognitive flexibility (i.e., the ability to look at things and situations from different perspectives). Children who were maltreated also are at risk for other cognitive problems, including difficulties learning and paying attention. 
  
• Poor mental and emotional health- Experiencing childhood maltreatment is a risk factor for depression, anxiety, and other psychiatric disorders throughout adulthood. Studies have found that adults with a history of ACEs had a higher prevalence of suicide attempts than those who did not. Further, adults with major depression who experienced abuse as children had poorer response outcomes to antidepressant treatment, especially if the maltreatment occurred when they were aged 7 or younger.
  
• Attachment and social difficulties- Infants in foster care who have experienced maltreatment followed by disruptions in early caregiving can develop attachment disorders. Attachment disorders can negatively affect a child’s ability to form positive peer, social, and romantic relationships later in life. Additionally, children who experience abuse or neglect are more likely to develop antisocial traits as they grow up, which can lead to criminal behaviour in adulthood. 
  
• Post-traumatic Stress- Children who experienced abuse or neglect can develop posttraumatic stress disorder (PTSD), which is characterized by symptoms such as persistent re-experiencing of the traumatic events related to the abuse; avoiding people, places, and events that are associated with their maltreatment; feeling fear, horror, anger, guilt, or shame; startling easily; and exhibiting hypervigilance, irritability, or other changes in mood. PTSD in children can lead to depression, suicidal behaviour, substance use, and oppositional or defiant behaviours well into adulthood, which can affect their ability to succeed in school, and create and nurture important relationships. 
  
• Toxic Stress- Strong, frequent, or prolonged activation of a person’s stress response system, often referred to as toxic stress, can have long-lasting damaging effects on an individual’s health, behaviour, and ability to learn. Toxic stress can be caused by experiencing ACEs, including child maltreatment. It can change an individual’s brain architecture, which can cause the person’s stress response system to be triggered more frequently and for longer periods and place him or her at an increased risk for a variety of physical and mental health problems, including cardiovascular disease, depression, and anxiety. Trauma-informed approaches, however, can help improve outcomes for individuals affected by toxic stress, and there is evidence that social and emotional support (e.g., consistent parenting practices, community supports) can alleviate its effects. 
  

RISK FACTORS FOR CHILD ABUSE

• Domestic violence: Even if the abused parent does their best to protect their children, domestic violence is still extremely damaging. Getting out is the best way to help your children.
  
• Alcohol and drug abuse: Parents who are drunk or high may be unable to care for their children, make good parenting decisions, or control often-dangerous impulses. Substance abuse can also lead to physical abuse.
  
• Untreated mental illness: Parents who are suffering from depression, an anxiety disorder, bipolar disorder, or another mental illness may have trouble taking care of themselves, much less their children. A mentally ill or traumatized parent may be distant and withdrawn from their children, or quick to anger without understanding why. Treatment for the caregiver means better care for the children.
  
• Lack of parenting skills: Some caregivers never learned the skills necessary for good parenting. Teen parents, for example, might have unrealistic expectations about how much care babies and small children need. Or parents who were themselves victims of child abuse may only know how to raise their children the way they were raised. Parenting classes, therapy, and caregiver support groups are great resources for learning better parenting skills.
  
• Stress and lack of support: Parenting can be a very time-intensive, stressful job, especially if you’re raising children without support from family and friends, or you’re dealing with relationship problems or financial difficulties. Caring for a child with a disability, special needs, or difficult behaviours is also a challenge. It’s important to get the support you need, so you are emotionally and physically able to support your child.
  

RELATIONSHIP BETWEEN POVERTY AND CHILD ABUSE
Poverty is especially harmful to children during the early years of life, a finding demonstrated by countless studies over the years. It has been linked to disruptions in learning and academic performance. Several studies have shown that children living in poverty begin to show lower cognitive and academic readiness, as early as age two, and to perform worse on several cognitive measures – a finding that continues as children progress through school. Poor children are more likely to repeat a grade, to be expelled or suspended from school, and to drop out of school. Children from poor households are also more likely to suffer from chronic health conditions, including asthma, diabetes, hearing, vision and speech delays. The effects of living in poverty persist well into adulthood. Childhood poverty has been linked to overall poor health and higher rates of mortality in adulthood. Childhood poverty and chronic stress can even lead to problems regulating emotions as an adult.
Linked to a host of negative outcomes, poverty is often considered the single best predictor of child maltreatment, especially child neglect and child abuse. Data compiled by the Third National Incidence Study of Child Abuse and Neglect indicate that children from families with annual incomes below $15,000 were over 22 times more likely to experience maltreatment than children from families whose income exceeded $30,000. These children were almost 56 times more likely to be educationally neglected and over 22 times more likely to be seriously injured. While poverty is linked with maltreatment, the relationship is not all that simple.
Not all parents who live in poverty abuse their children, and many who do are not poor. The link between child abuse and poverty can be explained in several ways. For instance, it is possible that experiencing poverty generates family stress, which in turn, leads to a greater likelihood of abuse or neglect. Or perhaps, parents living in poverty do not have access to the resources necessary and are unable to provide appropriate care for children. Or, other factors (e.g., substance abuse) may make parents vulnerable and more likely to be both poor and abusive or neglectful. Children experience neglect more often than any other forms of maltreatment. Lack of housing and transportation, in addition to access to substance abuse treatment, are common themes in child neglect cases. Poverty and child neglect are linked. We need to continue to invest in efforts that address poverty-related safety risks for children and keep children and families together.
NEED FOR EARLY IDENTIFICATION AND APPROPRIATE ACTION 
Child abuse must be reported to the official authorities mandatorily. Identification of child abuse is a difficult task. Teachers and other elders must talk to the child if they notice any peculiarity in their behaviour. It is important to have such conversations with children because more often than not, children are unaware that they are being abused. It is necessary to teach children the appropriate terms of body parts as it can protect them and they will be able to share what exactly happened with them. Toys can be used as an aid to help the child speak up. Physical exams, lab tests, X- rays etc., can help in diagnosing and taking appropriate action. 
Once, it is identified that the child has been abused, he/she should be provided with a safe environment away from the abuser. The child must be provided with medical attention and follow-up care to ensure the child’s well-being. Alternatively, consulting a therapist is highly recommended. Therapy can help the child to learn to trust again and boost one’s confidence. Trauma-focused cognitive behavioural therapy can help the child deal with the traumatic experiences and child-parent psychotherapy can improve the child-parent relationship. 
Child abuse of boys, often go unnoticed and their behaviour changes are mistaken for age-related changes. It becomes even more difficult to identify abuse in boys because of stereotypes about men and masculinity. In 2007, the Ministry of Women and Child Welfare, supported by United Nations Children’s Fund, conducted a study to understand the magnitude of child abuse in India, they found that 53.22% children faced one or more forms of sexual abuse and among them; the number of boys abused was 52.94%.  What most are unaware of is that boys and girls become victims nearly at the same rate (48.5% and 51.2% respectively). Another research co-led by Duke Global Health Institute (DGHI) professor Kathryn Whetten shows that orphaned boys are as vulnerable to abuse as girls. 1 in 5 women and 1 in 13 men report having been sexually abused as a child aged 0-17 years. Children who experience child abuse are more likely to be arrested as juveniles and perpetrate violence therefore it is necessary to break this cycle of violence. 
By reducing the incidence of child abuse and neglect through primary prevention approaches and providing comprehensive, trauma-informed care when it does occur, communities can limit its long-term consequences. In trauma-informed care, service professionals acknowledge a child’s history of trauma and how that trauma can have an impact on the symptoms or consequences being experienced by the child. 
CONCLUSION 
Child abuse and neglect can have devastating and long-lasting effects on a child and can result in detrimental societal impacts, including high costs for services and increased involvement in the juvenile and criminal justice systems. However, communities can act to stem the effects of maltreatment and even prevent it. Evidence-based services and supports can promote protective factors that mitigate the effects of maltreatment as well as provide families and communities with the tools to stop maltreatment before it occurs. Child welfare agencies can work with families and communities to spearhead initiatives that build upon strengths and address needs.