The International JOURNALof INTERDISCIPLINARY SOCIAL SCIENCES

Volume 4, Number 12

Interdisciplinary Contributions to the Prevention of Child Maltreatment

Lucien Lombardo and Karen A. Polonko

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Typeset in Common Ground Markup Language using CGCreator multichannel typesetting system http://www.commongroundpublishing.com/software/ Interdisciplinary Contributions to the Prevention of Child Maltreatment Lucien Lombardo, Old Dominion University, Virginia, USA Karen A. Polonko, Old Dominion University, Virginia, USA

Abstract: Interdisciplinarity at its core involves epistemologically reconceptualizing a problem and challenging discipline/s within which the problem is embedded. This paper attempts to show how re- search on child maltreatment within disciplines can be integrated within the context of new paradigm that epistemologically challenges the prevailing traditional paradigm within individual disciplines and reconceptualizes the problem of child maltreatment, leading to new insights on child maltreatment and how to prevent it. To do so, we draw on a newly emerging model of children and child-adult rela- tionships, adultism (child-centered, child rights) conceptualizing research and policy within the context of the social inequality and the oppression of children, where children are denied human rights and are disproportionately victims of maltreatment and exploitation. This stands in contrast to the degree to which individual disciplines within the social sciences, physical sciences, medical fields, and applied sciences and professions are steeped epistemologically in adult-centered (colonial, parent rights) perspectives which conceptualizes children within the context of adult agendas of obedience and in- feriority, at best a paternalistic view of child-caring vs. child rights. In turn, this allows us to see how much of the prior research (or lack of) and policy of different disciplines has supported the maintenance of the oppression of children most generally and child maltreatment specifically. In contrast, the new model of children and child-adult relationships, adultism, allows us, in a truly interdisciplinary way, to epistemologically reconceptualize against children and challenge the assumptions about children embedded in individual disciplines. This leads to an unmasking of the oppression of children, violence against children and thereby holds the hope for policies to prevent it.

Keywords: Child Welfare, Child Maltreatment, Children’s Rights, Child Caring, , Child Welfare , Child Abuse Prevention, Adultism, Human Rights, Interdisciplinary, UN Convention on the Rights of Children

HE RECENT UNITED Nations World Report on Violence against Children details how adults continue to perpetrate multiple forms of violence against children on a wide scale throughout the world (Pinheiro 2006). This report, appearing almost 20 Tyears after the nearly universal ratification of the UN Convention on the Rights of the Child, reflects the persistence of a problem more widespread and pervasive than poverty, HIV-AIDS and malnutrition. The problem of child maltreatment crosses cultural, religious, racial and ethnic, gender, economic and geographic boundaries. Yet the problem of child maltreatment is one often denied or ignored. While various traditional disciplines have explored aspects of child maltreatment, the narrowness of individual disciplinary concerns has tended to divert attention from the larger context within which child maltreatment is embedded. In this sense, it can be argued that the disciplinary approaches contribute to perpetuating the problem. Thus, the area of child maltreatment can benefit from the problem-oriented “critical” interdisciplinary explanation

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that is “useful to oppressed groups” for which greater political equality is desired (Klein 1996: 15). Ideally, interdisciplinary efforts have the potential to yield critical advances in science and policy to the degree that they can establish common ground among the single ap- proaches/disciplines via epistemological challenges and reconceptualizations. As Klein (1990:196) observes

Interdisciplinarity is a means of solving problems and answering questions that cannot be satisfactorily addressed using single methods or approaches. Whether the context is a short-range instrumentality or a long-range reconceptualization of epistemology, the concept is a long range attempt to define and establish a common ground.

In practice, interdisciplinary research and policy efforts often have not yielded the benefits hoped for as a result of many obstacles (see Kessel et.al. 2008). Interdisciplinary efforts in- volve or house individuals from different disciplines, but typically each is trained in the unique interests, assumptions, theory and methods of their own discipline. This makes it unlikely that common ground will be established in a way that will yield new insights or advances. Also, few scholars have had the training required to epistemologically challenge and reconceptualize the area under scrutiny or more fundamentally, to challenge the assump- tions embedded in their disciplines. This continues to restrict the potential of interdisciplinary efforts as they tend to take place within the dominant paradigm of the time and unreflexively support the status quo in terms of traditional values and the existing structure of inequality between groups. Although rare, successful efforts at interdisciplinarity have led to profound epistemological revisioning not only of the problem, but also of the academic disciplines themselves (Klein 1990). This revisioning leads to critical advances in research and theory and policy. One such example especially relevant to our paper is the work by Harvard psychiatrist, Dr. Judith Herman. In Trauma and Recovery (1997), Herman reconceptualized the phenomenon of trauma by integrating studies of trauma across disciplines at both the micro (e.g., child abuse and wife battering within the family) and macro level (e.g., soldiers in war). By integrating insights from sociology, , biology and medicine into a “common ground,” Herman was able to delineate the deep-structure underlying the causes and consequences of different types of trauma and the reactions of perpetrators. In so doing, she illustrated how “repression, dissociation, and denial are phenomenon of social as well as individual consciousness” (Herman 1997: 9). In short, she was able to epistemologically reconceptualize the problem of trauma and recovery; challenge disciplinary research by delineating the victim-blaming and denial operating at the individual and societal levels; show how these processes are embedded in the traditional paradigm underlying research and policy on trauma across most disciplines; and provide critical new insights for practitioners and policy-makers into the healing of trauma. Given the magnitude of violence against children globally and the serious consequences that maltreatment has for these children throughout their lives, it is our hope that successful interdisciplinary efforts will yield similarly challenging insights and advances for understand- ing and preventing child maltreatment. As such, this paper attempts to show how research on child maltreatment across disciplines can be integrated in an interdisciplinary effort within the context of an emerging new paradigm, adultism (child rights), which epistemolo-

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gically challenges the prevailing paradigm of child maltreatment within individual disciplines and reconceptualizes the problem, leading to new insights on child maltreatment and how to prevent it.

Child Maltreatment: Traditional Disciplinary Approaches As observed by scholars in many disciplines including sociology (Thorne 1987), education (Adan 1991), psychiatry (Miller 1990a; 1990b) and developmental psychology (Coles1997), research on children in general is notably lacking. As was the case with other groups in the past such as women and minorities, it is assumed that children are not important to study and have no contributions to make to our knowledge. Likewise, it is assumed that children’s relationships to parents/adults and their position in society are benevolent. Even traditional interdisciplinary “child studies” departments focus on various aspects of adult agenda items in their courses and research. As outlined by Thorne (1987) and others, the little research that does study children has tended to focus very traditionally on adult agendas and interests. This research on children comes primarily from disciplines of psychology, child development and child welfare and focuses on the following themes:

• Socialization / Internalization: Social Psychology: focus on how parents (and society more generally) get children to accept their values and beliefs as the child’s own • Discipline/punishment/control of children: Psychology/Sociology: focus of childrearing is parental control of children rather than responsibility and respect; equates discipline with punishment; compares which type of punishment—e.g., spanking, guilt, love withdrawal, i.e., emotional-physical violence, is best for securing obedience, compliance and control per se • Child Development: Psychology/Education: focus on stages of biological, intellectual and moral development of infants and children; development is conceptualized as linear as children are seen as mentally and morally inferior to adults; interest in children primarily as adults in the making • Child Threats: Clinical Psychology/Criminology: focus on working class, poor and minority children; children who challenge adults • Child Victims: focus on victimization to push traditional adult agendas---children as “victims” of working mothers and daycare; children as victims of “urban homelessness” or “HIV-AIDS,” or other issues where adults are the primary beneficiaries of this attention

Moreover, when violence against children is studied, the researchers, practitioners and policy- makers who are steeped in traditional perspectives, tend to focus only on the rare cases of child maltreatment that are actually reported, investigated and substantiated by official agencies. The number of official cases grossly underestimates the true extent of child abuse and neglect as shown by self-report surveys (English, 1998; Scher et al, 2004). As Prinz et al (2009: 1) state: “The official rates of substantiated CM, and even the referral rates for al- leged maltreatment, likely represent only the tip of the iceberg in terms of problems and child adversity…. For example, Theodore et al. (2005) found in an epidemiological study conducted in the Carolinas that maternal reports of physical abuse from anonymous telephone surveying were ‘40 times greater than the official child physical abuse reports’.” Thus, focusing on official rates acknowledges only the most egregious cases of child mal-

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treatment and allows these traditional researchers and practitioners to argue that child mal- treatment in the family is rare and to perpetuate other common myths about child maltreatment including:

• Child maltreatment by parents is rare; • Child maltreatment can be explained by the individual psychopathology of the rare adult perpetrators; • Child maltreatment has nothing to do with the less severe forms of violence against children, which is seen as “discipline” that children need; • Children are resilient and won’t suffer long-term effects from maltreatment; • Parent rights to control children through a variety of physical and emotional disciplinary measures will decrease risk of later problems like substance abuse, etc.

In all of these ways, violence against children is ignored, minimized, and/or justified. In all of this, the child is lost. The field of Child Welfare, both academic departments and government agencies, is charged with protecting children. Theoretically, those in the field should act as advocates for children and protect them from maltreatment, from the perpetrators, who are typically the parents/parental caretakers. However, fundamental assumptions in the field of Child Welfare subvert this process (Polonko and Lombardo 2005). A traditional approach to Child Welfare includes the following assumptions:

• “Family Privacy”—i.e., parent rights take precedence over child protection; • Parents have the right to raise and treat children as they see fit without government inter- ference unless violations are severe; • Child abuse/maltreatment is permissible as long as it does not cross the line to egregious abuse or neglect where the child’s life is in danger; • Child abuse/maltreatment is “rationalized” as unfortunate but understandable given parent stresses from unemployment, poverty, teen motherhood, lack of social supports for the adults or presence of a difficult child, etc; • Vulnerability (physical/mental) of very young children justifies less state intervention to protect children from parents rather than more, as “parents have rights” which must be protected from State interference even if the parents are perpetrators

These assumptions about Child Welfare’s view of the ‘family’ in relation to violence against children are easy to compare to violence against women in the “family.” Historically women had no rights to legal protection from the physical or sexual violence perpetrated within the family—i.e., domestic abuse by their husbands. In order to protect traditional family relation- ships and men’s power within the family (patriarchy), “family privacy” i.e., husband’s rights to treat his wife as he saw fit without government interference, took precedence over the woman’s protection from physical and sexual violence and abuse. The field of law is another academic discipline and societal institution that impacts rela- tionships between children and adults. The law can work to protect children from violence and prevent child maltreatment or it can provide legitimacy for violence against them. Inter- national research shows that law and custom fail to protect children throughout most of the globe. Instead, they operate from traditional assumptions, primarily giving legitimacy to

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violations of children’s physical integrity by actually authorizing or not prohibiting and other forms of child violence and exploitation in a wide variety of contexts. For example, only 42% of the world’s children are protected legally from corporal punishment within schools; and only 2 percent of the world’s children are protected from physical pun- ishment within the family. (Global Initiative to End All Corporal Punishment of Children, 2006). The latter is especially critical to note since the majority of violence against young children is committed by parents. Unfortunately, lacking the kind of integration that challenges a field to move forward, the only common ground among these diverse fields appears to be sharing similar traditional assumptions about the place of the child as a topic of study, the nature of adult-child relation- ships, and child safety and well being in the home. Research and policies that result from these traditional assumptions ignore the experiences of children and would protect the “family” i.e., parents, from government intervention on behalf of the child; protect the rights of the maltreating parents over the rights of the child to be protected from abuse and neglect; focus on the reasons that minimize child maltreatment; use child maltreatment to push dominant adult agendas—e.g., call for more money for the war on drugs to protect our children from drugs while ignoring or denying the strong relationship between abuse by parents as a child and later substance abuse as an adolescent. In short, these traditional per- spectives can be seen as leading unwittingly to policies that reflect individual and societal- level minimizing and denial of child maltreatment in the home and society. As we discuss below, a new perspective on children and child maltreatment has emerged over the past two decades. However, it must be stressed that this emerging perspective is still met with much resistance from adherents to the traditional paradigm and the latter are still very much in control of research and policy. For example, researchers and practitioners in the emerging perspectives typically face difficulties in obtaining funding for research and in having research accepted for presentation and publication. In addition, they face challenges from ‘parents’ rights’ groups who believe they are undermining family values. (See Thompson and Wilcox 1995; Davidson 2006)

Child Maltreatment: Emerging Perspectives across Disciplines In contrast to traditional perspectives, a growing number of researchers across disciplines are challenging long-held disciplinary assumptions and are reconceptualizating the area of child maltreatment. These emerging perspectives acknowledge that child maltreatment is widespread and has serious consequences. Rather than minimizing or justifying this reality, the emerging perspectives focus on explaining and understanding it, bringing the hope of finding ways to prevent it. Of considerable importance is the fact that these emerging per- spectives on child maltreatment are consistent with and can be integrated within emerging conceptual models of human rights, law, social inequality, discrimination and oppression, both in terms of research and policy. Regarding human rights advances, similar to the United Nations conventions on the bill of rights for and the elimination of all forms of discrimination against women (CEDAW, 1979) and the elimination of all forms of racial discrimination (CERD 1965), the United Nations Convention on the Rights of the Child (CRC) (1989) grants human rights to and eliminates many forms of discrimination against children, as a group. The following themes,

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asserted in the CRC, are reflected in the emerging interdisciplinary perspective on child maltreatment:

• Children are human beings with inherent dignity and worth and are entitled to the equal and inalienable rights accorded all members of the human family. (Preamble); • The vulnerability of young children requires States (governments) to provide children more protection from harm, not less; • The State (government) has the responsibility to protect children from all forms of viol- ence, neglect, maltreatment and/or exploitation by parents and any other caretaker.

By extending to children the rights of human beings that are granted to all members of the human family, the CRC created a new paradigm. In turn, this paradigm provided the foundation for an interdisciplinary effort that would allow for a profound reconceptualization of the status of children in societies in general and child maltreatment in particular. In the area of law, for example, the ratification of the CRC has served as the impetus for many countries to begin the process of creating new legislation and revising existing statutes to grant children the right to protection from violence. Leading academics in the area of law such as Bitensky (1998) have presented a proposal for law reform prohibiting corporal punishment of children. By analyzing US laws and international human rights treaties and by exploring the psychological, sociological, philosophical and ethical factors warranting prohibition, Bitensky articulated with and elaborated on an interdisciplinary framework embedded in the CRC. Building on these efforts, Lombardo and Polonko (2005) explored the different approaches to adult –child relationships manifested in human rights law and the American legal approach to corporal punishment of children. They identified two models: the human rights / child-centered model, which reflects the emerging interdisciplinary paradigm, and the colonial / adult-centered model, which reflects the traditional disciplinary approaches to child maltreatment. (See Figure 1.) The academic discipline of sociology is, in many ways, uniquely suited to build on the new paradigm embedded in the CRC and contribute to the building of an interdisciplinary effort as its focus is on the structure of relationships between groups in society. As such, sociology has a has a long-standing tradition of “debunking” or challenging taken-for-granted assumptions in society and studying the unequal distribution of resources and power, including unequal protection from violence under the law, with respect to class, race and gender. Concepts critical for the emerging perspective on children and child maltreatment include: structured inequality, unequal access to valued resources, discrimination, prejudice, the ab- sence of children’s rights, recognizing children as an oppressed group, and the understanding of child maltreatment-violence against children (and its justifications) as manifestations of this oppression. Similar to other groups with less access to resources, children as a group suffer discrimination. Children do not have social, civil, economic, legal or political rights or power and are denied access to valued resources. Underlying the insights from the disciplines of human rights, law and sociology as they articulate with the paradigm embedded in the CRC is the concept of adultism (also referred to as child oppression, child rights model) (Cohen, 2002; Kingston et al, 2002; Kennedy, 1998). Similar to sexism, racism and classism, adultism refers to a system of structured in- equality or oppression that permeates relationships between children and adults. It denies children equal access to resources, including resources that would protect them from violence

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or allow them to seek change; maintains adults’ power over them; promotes prejudice—ideo- logy that children are inferior to adults and need to be controlled; and provides ideological and legal support for child maltreatment in the form of violations of children’s physical and psychological integrity. Reconceptualizing child maltreatment through the concept of adultism permits the exam- ination of research and policy across disciplines in a new way that helps to integrate perspect- ives and research findings. This ‘critical interdisciplinarity’ as Klein describes it lets us re- conceptualize child maltreatment in a number of ways. It allows us to:

• Understand children as an oppressed group within the context of social inequality , dis- crimination and prejudice (sociology); • Focus on the need to study the ways in which children suffer inequality and the con- sequences of that oppression for the children and society (sociology, psychology; psychi- atry); • View children as human beings entitled to human rights and in need of government safeguards from discrimination and harm within the context of a human rights perspectives (human rights; law); • Take children’s experiences of maltreatment (prevalence and forms) seriously and under- stand they are likely to be associated with profound negative consequences on multiple levels (neuro-physiology; psychology, sociology; epidemiology); • Recognize the importance of studying children as active agents who seek to cope with and make meaning from their experiences; • Search for causes and consequences that do not blame the victim; search for multiple pathways by which this violence or maltreatment is likely to impact the victim; • Call for a child-centered policy that advocates for children and seeks to protect children from harm.

The emerging approach to children and child maltreatment also alters traditional social science approaches to data on child maltreatment and children’s invisibility in research and pedagogy. Traditional approaches to child maltreatment view child violence within the context of parent discipline, predict low rates of child maltreatment globally and focus on official reports of child maltreatment. In contrast, the newly emerging perspective views gathering data on the prevalence and forms of child maltreatment as critical for both scientific and humanitarian reasons. In addition, when embedded in a human rights model, the powerlessness of children, particularly with respect to their parents, can be acknowledged, leading to predictions of high rates of child maltreatment globally. In turn, this leads us to the study child abuse and neglect with data from nationally representative samples and not just the egregious cases that comes to the attention of officials; to explore the possibility of connections between the most and least severe forms of violence against children as we do with adult groups; and to look at all of the manifestations of child maltreatment within larger contexts of child oppres- sion (from child labor, female genital mutilation, sexual abuse and the sex slave trade, to children in war).

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Emerging Perspectives: Prevalence of Child Maltreatment As Fernando (2001: 9) states: “The sheer frequency and kinds of ways in which children’s rights are violated across the globe every day is staggering.” With respect to prevalence globally, the traditional approach to child maltreatment or violence against children would be to minimize (“just represent as parent attempts to discipline and control”), justify (“not abuse but a “cultural norm” or “necessary evil” to help the “family”), deflect (focus on “clean water” and “nutritious lunches” rather than child physical abuse) or deny the many forms of violence against children. Once child maltreatment is viewed within the framework of adultism, the experiences of children around the world become more visible. The widespread prevalence and many dif- ferent forms of child maltreatment are predicted and can be explained. Such an explanatory model is needed as data show, for example, that:

• Globally, hundreds of millions of children are victims of violence (Pinheiro, 2006); • Child Homicide: At a minimum, 57,000 children are reported murdered worldwide in one year. The majority of young children who are killed are murdered by their parents/ family. (Krug et al, 2002; Pinheiro, 2006); • Child Physical Abuse: The majority of children in industrialized and developing countries are subjected by their parents to corporal punishment and a sizeable percent to severe physical abuse. Examples of estimates for severe physical abuse, as Pinheiro (2006:52) reviews, include research which found in the Kurdistan Province of the Islamic Republic of Iran that 38.5% of children aged 11-18 had experienced physical abuse at home that caused mild to severe physical injuries; in the Republic of Korea, “kicking, biting, choking, and beating of children by parents are alarmingly common”; in the US, 16% of children suffer severe physical abuse at the hands of their parents (Kolko 2002); • Child Emotional Abuse: Rates for emotional abuse of children by parents are similarly high. Globally, the majority of parents have yelled or screamed at their child in the past 6 months (Krug et al, 2002); while rates of the more severe forms of emotional abuse, at least in the US range from 10-15% (Dong et al 2004; Scher et al, 2004); • Child Sexual Abuse: Rates for child sexual abuse vary globally. Depending on the severity of the abuse, estimates vary substantially, but on average, child sexual abuse for girls ranges from 20-25% and for boys 5-10% (Krug et al, 2002; Pinhero 2006); • Child Maltreatment: In the US alone, while approximately three million children are reported to official agencies for severe maltreatment in any given year (English, 1998), data from nationally representative studies show that at least 35% of adults in the US have experienced one or more forms of child abuse-maltreatment (Scher et al 2004); • Female Genital Mutilation: Estimates suggest that in sub-Saharan Africa, Egypt and the Sudan alone, 3 million girls and young women are subjected to genital mutilation/cutting every year. This mutilation involves the parent and is carried out on increasingly young girls before the age 4 ( UN 2006:10; UNICEF, 2005a, 2009); • Child Trafficking: globally, 1.2 million children are trafficked every year (UNICEF, 2009); • Child Labor: 218 million children are engaged in exploitative child labor. Of these, 126 million are in hazardous work and close to 6 million children work under especially horrific circumstances. (ILO 2006).

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In sum, as would be predicted within the emerging framework which acknowledges the rel- ative powerlessness of children as a group, literally hundreds of millions of children in our world are suffering one or more forms of maltreatment and exploitation. In contrast to the focus on danger to children from strangers, the abuse and exploitation of children in both rich and poor countries is most typically perpetrated by parents/family who are given the most power to treat children as they wish and is most commonly perpetrated against the youngest children who have the least resources and are the most vulnerable As discussed in the next section, the widespread prevalence of child abuse is cause for grave concern not only because of the suffering of these children, but also because child maltreatment is asso- ciated with profoundly negative human and social consequences.

Emerging Perspectives: Consequences of Child Maltreatment Research, practice and policy steeped in traditional approaches to child maltreatment often either ignore, dismiss or redefine research on the consequences of child maltreatment since these consequences do not fit the prevailing paradigm of adult dominance over children. For example, although research on the consequences of child maltreatment is typically quite strong in terms of methods and analyses, results are often dismissed as not conclusive enough. Alternatively, it is argued that the consequences of maltreatment such as a teen’s aggression, substance abuse or risky sex occur because they were not ‘disciplined’ enough – meaning physically punished -- in spite of much data showing the opposite to be true. In the traditional approach, research on consequences is folded into concepts in the existing disciplinary models such as failed child development or inadequate socialization. The newly emerging perspective is able to view the consequences of child abuse within the larger context of social inequality and violation of human rights which make clear that the consequences of physical and sexual violence are substantial. This paves the way for interdisciplinary integration of new insights. Research findings from many disciplines includ- ing sociology (Gershoff, 2002; Straus, 1994), psychology (Briere, 1992; Erikson and Egeland, 2002), criminal justice (Widom, 2000; Widom and Ames, 1994), law (Bitensky, 1998), medicine and neurophysiology (Anda et al, 2006; Perry, 1997), have found that children experiencing child abuse and neglect, and even the less severe forms of maltreatment, are more likely to suffer negative consequences in one or more areas as children, teenagers and/or adults. These consequences include:

• Physical injuries; death • Psychological problems (e.g., depression, suicide, low self-esteem, ); • Cognitive/Developmental problems (e.g., cognitive developmental decrease, reasoning, problem solving and language problems, lower educational achievement); • Impaired Moral Reasoning (e.g., less developed conscience, lower empathy); • Increased aggression in children and adolescents (e.g., more physical aggression, higher rates of arrest as an adolescent and adult for violent and nonviolent crimes); • Substance abuse of legal (alcohol and cigarettes) and illegal drugs as a teen and adult; • Risky sexual behaviors (e.g., early age at first intercourse, higher rate of STD’s, multiple partners, and teenage pregnancy); • Violent relationships with spouse and abuse and neglect of their own children.

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(See Figure 2 for research on the effects of “just” spanking a child—the less severe form of physical violence). In addition to the many negative consequences listed above, the Adverse Childhood Ex- periences (ACE) research provides epidemiological evidence that negative childhood exper- iences act as precursors to risk factors for disease, disabilities and early mortality. As can be seen in Figure 3, the more adverse experiences that are experienced in childhood, the more likely these children, when older, will contract a number of diseases and suffer ill health, and the more likely they will engage in behaviors that put them at risk for disease, including drug usage and addiction, early intercourse, and teen pregnancy and paternity and domestic violence (Felitti, et. al 1998). Felitti reflects a reconceptualization of the consequences of child maltreatment when he asks whether child maltreatment should be revisioned as a public health problem rather than as a problem of individual children and individual adults. He challenges us to see what is identified as “personal or social problems” in traditional approaches as ‘mechanisms for coping’ with child maltreatment in the emerging model. As Felitti (2001: 3) observes:

For instance, a male child with an ACE Score of 6 has a 4,600% increase in the likeli- hood of later becoming an iv drug user. Since no one injects heroin to get endocarditis or AIDS, might heroin be used for the relief of profound anguish dating back to child- hood experiences; might it be the best coping device that an individual can find? If so, is this a public health problem or a personal solution? How often are public health problems personal solutions? Is drug abuse self-destructive or is it a desperate attempt at self-healing, albeit while accepting a significant future cost? This is an important point because primary prevention is far more difficult than anticipated.

In summary, it is clear that child maltreatment has negative consequences for children when young and are carried into adulthood affecting both individual life chances and the quality of social life and social problems in our communities. By linking these various consequences to the common source of child maltreatment, the emerging paradigm provides a model which allows for the integration of research findings from different disciplines.

Emerging Perspectives: Consequences of Child Maltreatment Explained Research from scholars in a number of separate disciplines (including medicine, epidemiology, neurophysiology, psychiatry, etc.) has provided solid evidence that explains why the con- sequences of child maltreatment are so widespread, diverse and long-lasting. The newly emerging perspective described above is able to integrate this research and that from other disciplines within the context of the human rights, oppression of children and the adult be- havior, institutions and social conditions that impact children. This provides critical links to anchor and merge the prior data on prevalence, causes and consequences. Implications of this research for other fields and disciplines are acknowledged and help us understand the persistence of child maltreatment across generations and its near universality across cultures.

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Effects of Child Maltreatment on the Child’s Brain and CNS Recent research in the discipline of the neurobiology of brain development in response to trauma, i.e., physical abuse, and neglect in childhood has helped shed light on the process by which child maltreatment leads to the adverse consequences described above. As sum- marized by Bruce Perry M.D., PhD (1997), physical abuse of children (trauma) leads to the overdevelopment of lower-level brain functions resulting in heightened fight or flight re- sponses which in turn increases the risks of aggression, reactivity, impulsivity, hyperactivity. In contrast, child neglect leads to an underdevelopment of higher-level brain (cortical-limbic) functions which increases the risks of lower cognitive development, greater reactivity, etc. (See Figures 4 and 5.) Where both trauma and neglect fill children’s worlds, the risks are particularly serious. This maldevelopment of the brain/CNS in response to child maltreatment is linked to behaviors that are typically seen as social problems and attract additional mal- treatment by adults in their lives rather than attempts to heal and protect the child. These effects of child physical abuse and neglect are identified in emerging research in sociological, psychological, criminal justice, law, neurobiology and epidemiology. As Perry (1997: 141) observes:

Depending upon the time in development, the nature and extent of the abuse and the presence of attenuating factors, the developing brain will be impacted differentially. These experiences may occur in utero or in the perinatal period, impacting the brainstem and resulting in symptoms of anxiety. Experiences in the perinatal and first few years of life can impact the midbrain resulting in impulsive and aggressive symptoms.

Perry notes that there are critical links between the consequences of violence and neglect on children’s coping behavior, adult responses to such behavior and belief systems that support violence (one of which is adultism). As Perry (1997: 139) states:

Even the majority of traumatized and neglected children do not become remorselessly violent. Belief systems, in the final analysis, are the major contributors to violence. Racism, sexism, misogyny, children as property, idealization of violent “heroes,” cul- tural tolerance of child maltreatment, tribalism, jingoism, nationalism -- all unleash, facilitate, encourage, and nurture violent individuals. Without these facilitating belief systems and modeling, neglected and abused children would carry their pain forward in less violent ways -- as silent, scarred, adult members of the vast army one comment- ator has termed the ‘Children of the Secret’ (Vachss, 1991).

The summary of the Adverse Childhood Experiences research provided by the ACE Pyramid (Figure 6) also illustrates this path from experiences of child maltreatment, to impaired brain development and related social, cognitive and emotional functioning, to the adoption of ‘risky’ behaviors, and onset of associated diseases and social problems.

Effects of Child Maltreatment on the Child’s Psychological Development Research in the disciplines of psychology and psychiatry is clear that child maltreatment can have powerful and long-lasting negative effects on the child’s psychological development. This is reflected in defenses developed; reality denied; self hate; impaired self referent; de-

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pression, anxiety, etc., as children struggle to give some meaning to and cope with their ex- periences of maltreatment. The following observations illustrate how reconceptualizing maltreatment from the child’s perspective leads to deeper understanding of its impact and the importance of taking children seriously:

• “Repeated trauma in adult life erodes the structure of the personality already formed, but repeated trauma in childhood forms and deforms the personality.” (Herman 1997: 96). • “Not all abused children have the ability to alter reality through dissociation. And even those who do have this ability cannot rely upon it all the time. When it is impossible to avoid the reality of the abuse, the child must construct some system of meaning that justifies it. Inevitably the child concludes that her innate badness is the cause.” (Herman 1997: 103). • “Perhaps an even more critical issue, however, is the likelihood that severe child mal- treatment may interfere with the child’s access (emphasis in original) to a sense of self --- whether or not she or he can refer to, and operate from, an internal awareness of per- sonal existence that is stable across contexts, experiences, and affects. Without such an internal base, the survivor is prone to identity confusion, boundary issues, and feelings of personal emptiness.” (Briere 1992: 43). • “In most cases, however, one’s own childhood suffering remains actively inaccessible and thus forms the hidden source of new and sometimes very subtle humiliation for the next generation. Various defense mechanisms will help to justify this: denial of one’s own suffering, rationalization (I owe it to my child to bring him up properly), displacement (it is not my father but my son who is hurting me), idealization (my father’s beatings were good for me), and more. And above all, there is the mechanism of turning passive suffering into active behavior.” (Miller 1981: 70)

Psychiatrist Alice Miller (1990b: 9) uses this term ‘poisonous pedagogy’ to describe the techniques used by parents to control, to punish, to teach and “to condition a child at an early age not to become aware of what is really being done to him or her.” This perspective gives us great insights into the formation of adultism in response to maltreatment. It also helps us understand how ‘adultism” is reproduced from maltreatment from generation to generation. Poisonous pedagogy normalizes adultism and the child maltreatment and oppression embed- ded in this concept. As Miller (1990b: 4) states:

The former practice of physically maiming children, exploiting, and abusing children seems to have been gradually replaced in modern times by a form of mental cruelty that is masked in the honorific term child-rearing (emphasis in original). Since training in many cultures begins in infancy during the initial symbiotic relationship between mother and child, this early conditioning makes it virtually impossible for the child to discover what is actually happening to him. The child’s dependence on his or her parents’ love also makes it impossible in later years to recognize these traumatizations, which often remain hidden behind the early idealization of the parent’s for the rest of the child’s life.

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Since this ‘poisonous pedagogy’ starts in infancy (a period when brain development occurs at its most rapid pace) the process of how children cope with trauma and neglect lays the groundwork for the range of personal and social problems (described earlier) that continue over the life course. It also lays the groundwork for the victim repressing, minimizing, denying their experiences of child maltreatment and/or blaming his or herself. Finally, ‘poisonous pedagogy’ supports the infliction of maltreatment on another generation of chil- dren.

The Cycle of Violence against Children within Families Understanding the consequences of child maltreatment as well as the reasons for these con- sequences helps us to understand why there is a ‘cycle of violence’ in families across gener- ations. As illustrated in Figure 7, being abused as a child significantly increases the chances that this child will grow up to become a parent who abuses his/her own children because of the direct effects on the child’s brain/CNS, the modeling and the toxic ideology that accom- panies abuse as well the direct effects on the child’s developing personality structure, defense mechanisms and sense of self. In addition to these direct effects, being abused as a child significantly increases the chances of growing up to abuse one’s own children indirectly through the negative consequences that result from abuse which in turn increase the risks of abusing your child. For example, child maltreatment leads to many negative consequences like mental health problems, substance abuse, violent relationships and in turn, parents who have mental health problems, abuse substances and have violent relationships are more likely to abuse their children. Being able to understand the direct and indirect effects of child maltreatment in perpetuating the cycle of violence in families is, in part, thanks to the merging of insights across many disciplines associated with the emerging perspectives.

Conclusion

Interdisciplinary and Child Maltreatment: A New Model The emerging model of child maltreatment, anchored in the foundation provided by the CRC and based in the conceptual model of adultism, seeks to provide a way to explain connections among the findings provided by diverse disciplines. This model leads us to see the diverse forms and widespread prevalence of child maltreatment as a manifestation of the inequality between adults and children. It also allows us to understand how the processes of coping with child maltreatment lead to personal and social problems. Finally, the model helps us understand the reproduction of child maltreatment across generations. We have attempted to demonstrate that the problem-oriented “critical” interdisciplinary explanation that is “useful to oppressed groups” for which greater political equality is desired (Klein, 1996: 15) is indeed applicable to understanding child maltreatment and the lack of human rights which supports it. This ‘critical’ interdisciplinary problem-oriented approach to understanding child maltreatment also poses epistemological challenges to the larger social science disciplines. These include:

• Challenges to traditional research and policy in areas as diverse as drug abuse, teenage pregnancy, juvenile delinquency to include child maltreatment as an explanatory variable

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along side the politically traditional causes such as “the need for more discipline and control of children”; • Challenges to traditional child welfare policy to consider earlier preventive and more acute child protective interventions instead of maintaining that it is best for children if the State does not intervene unless egregious violations have taken place; • Challenges to all researchers and policy makers in the area of child maltreatment to consider adultism in their framing of research questions and policy actions. This will give the structural inequality between children and adults political potency on behalf of children.

As Herman made clear, perpetrator defenses supporting violence against children operate at the micro and macro level. At the macro level of societal institutions, laws and policies, violence against children is minimized, justified or denied reflecting and maintaining the unequal distribution of resources between parents / adults and children. At the micro level of family (and individual child care workers and therapists), violence against children is minimized, justified and / or denied reflecting and perpetuating the coping mechanisms they used to survive the maltreatment they themselves suffered as children. If we are to eliminate child maltreatment, we must recognize, as Herman (1997:9) stated: “To hold traumatic reality in consciousness requires a social context that affirms and protects the victim…For the individual victim, this social context is created by relationships…. For the larger society, the social context is created by political movements that give voice to the disempowered.” As the above analysis shows, the emerging model for understanding the reality of child maltreatment gives voice to children and their experiences at the individual and social level. This leads us to understand that to prevent child maltreatment, at the macro level, move- ments that extend rights to children, changing laws and our social and cultural relationships to children are needed. At the micro level, we must break the cycle---starting with children, teaching them new ways, treating child victims quickly; educating parents before they have children; encouraging adults to serve as enlightened witnesses. It also means that as research- ers, practitioners, policy-makers and therapists, the journey to end violence against children begins within each one of us.

Addendum: Nixzmary Brown a Case Study A problem-oriented interdisciplinary studies approach to child maltreatment allows us to see the importance of ‘adultism’ in the lives of children. The case of Nixzmary Brown puts a human face on this academic analysis. Nixzmary’s case represents millions of children who are maltreated and exploited in a wide variety of contexts around the world. Nixzmary Brown died in Brooklyn, NY on January 12, 2006, at the age of 7 due to repeated torture, beating, abuse and malnutrition at the hands of her step-father and mother. Her of- fenses were taking a snack from the refrigerator and jamming a computer printer with some toys. Child Protective Services were called on Nixzmary’s behalf many times. As reported in the New York Times (Nov. 12, 2008) “The judge called the Bedford- Stuyvesant apartment where Nixzmary lived with her parents and her five siblings a ‘house of horrors.’ There, the 7-year-old was bound to chairs with rope or bungee cords, beaten and forced to defecate in a cat’s litter box. Child welfare workers failed to heed warnings that Nixzmary was being abused.” (NY Times Nov 12, 2008)

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In this case, there is reference to the ‘cycle of violence’. The NY Times (Jan 20, 2008) reports “The thrust of his defense is that Mr. Rodriguez gave Nixzmary the same kind of discipline that Mr. Rodriguez’s father had given him, including hitting him a lot and holding his head under cold water.” An interdisciplinary understanding emphasizing the effects and processes through which child maltreatment works increases our understanding of the gen- erational reproduction of abusive parenting practices. Finally, the death of Nixzmary Brown at the hands of her ‘caretakers’ also illustrates the importance and pervasiveness of the ideology of adultism that a critical interdisciplinary analysis makes visible. The parents in this case were found guilty of manslaughter. However, the ideology of adultism prevented our child welfare and legal institutions from protecting Nixzmary and thousands of other children before they are hurt or killed. “To draw a bright line in the law (between abuse and physical punishment), said Martin Guggenheim, a pro- fessor at New York University School of Law, would be to cross the threshold of what the United States Supreme Court once called ‘the private realm of family life which the state may not enter,’ and to intrude on parents’ constitutional right to raise children as they see fit.” NY Times, Jan 20, 2008).

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of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study”, American Journal of Preventive Medicine. 14/4 May: 245-258. Felitti, V. J. (2001) “Reverse Alchemy in Childhood: Turning Gold into Lead” Health Alert. 8/1: 1-4. Fernando, J.L (2001) “Children’s Rights: Beyond the Impasse” The Annals of the American Academy of Political and Social Science, 575: 8-24 Gershoff, E.T. (2002) “Corporal Punishment by Parents and Associated Child Behaviors and Experi- ences: A Meta-Analytic and Theoretical Review” Psychological Bulletin 128/4: 539-579. Global Initiative to End All Corporal Punishment of Children (2006) Global Summary of the Legal Status of Corporal Punishment of Children. (http://www.endcorporalpunishment.org/) Hagberg, J. (2005) The Link Between Corporal Punishment and Teen Pregnancy. Unpublished Masters Thesis. Old Dominion University. Herman, J. (1997) Trauma and Recovery. NY: Basic Books. International Labor Organization (2006) Facts on Child Labour – 2006. ILO: Geneva, Switzerland. Kennedy, D. (1998) “Reconstructing Childhood”, Thinking: The Journal of Philosophy for Children 14/1: 29-37. Kessel, F., Rosenfield, P. and Anderson, N. (Eds.) (2008) Interdisciplinary Research: Case Studies from Health and Social Science. Oxford, UK: Oxford University Press. Kingston, B., Regoli, B and Hewitt, J.D. (2002) “The Theory of Differential Oppression: A Develop- mental-Ecological Explanation of Adolescent Problem Behavior”, Critical Criminology 11: 237-260. Klein, J. T. (1990) Interdisciplinarity: History, Theory and Practice. Detroit, MI: Wayne State University Press. Klein, J. T. (1996) Crossing Boundaries: Knowledge, Disciplinarities and Interdisciplinarities. Char- lottesville, VA: University of Virginia Press. Kolko, D. J. (2002) “Child Physical Abuse.” Chapter 2 in The APSAC Handbook on Child Maltreatment. 2nd ed. Eds. J.E.B. Myers, L. Berliner, J. Briere, C. T. Hendrix, C.Jenny, and T. A. Reid. Thousand Oaks, CA: Sage Publications: 21-54. Krug, E.G., Dahlberg, L.L., Mercy, J. A., Zwi, A.B. and Lozano, R. (Eds) (2002) World Report on Violence and Health. Geneva: World Health Organization. Lombardo, L.X. and Polonko, K.A. (2005) “Comparative Analysis of the Corporal Punishment of Children: An Exploration of Human Rights and U.S. Law”, International Journal of Compar- ative and Applied Criminal Justice. 29/2: 173–200. McLoyd, V. (1998) “Socio-Economic Disadvantage and Child Development,” American Psychologist, 53 /2: 185-204. Miller, A. (1981) Prisoners of Childhood: The Drama of the Gifted Child and the Search for the True Self. NY: Basic Books. Miller, A. (1990a). Banished Knowledge: Facing Childhood Injuries. NY: Anchor Books. Miller, A. (1990b) For Your Own Good: Hidden Cruelty in child-rearing and the roots of violence. NY: Farrar, Straus and Giroux. Perry, B.D. (1997) “Incubated in Terror: Neurodevelopmental Factors in the ‘Cycle of Violence’” in Children in a Violent Society. J. Osofsky, Ed. NY: Guilford Press, 124-149. Pinheiro, P.S. (2006) World Report on Violence against Children, New York: United Nations, (ht- tp://www.violencestudy.org/a553). Polonko, K.A. and Lombardo, L.X. (2005) “The Pedagogy of Child Welfare: A Need for Reflection”, 10th International Society for Prevention of Child Abuse and Neglect (ISPCAN) European Regional Conference on Child Abuse and Neglect, Berlin, Germany, September. Prinz, R. J., Sanders, M.R., Shapiro, C.J., Whitaker, D.J. and Lutzker, J.R. (2009) “Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial” Prevention Science 10:1-12. DOI 10.1007/s11121-009-0123-3.

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Scher, C.D., Forde, D.R., McQuaid, J.R. and Stein, M. (2004) “Prevalence and Demographic Correlates of Childhood Maltreatment in an Adult Community Sample,” Child Abuse and Neglect, 8/2:167-180. Straus, M. (1994) Beating the Devil Out of Them: Corporal Punishment in American Families. NY: Lexington Books. Straus, M. and Paschall. M. (2009) “Corporal Punishment by Mothers and Development of Children’s Cognitive Ability: A Longitudinal Study of Two Nationally Representative Age Cohorts.” Journal of Aggression, Maltreatment, and Trauma. 18:459-483. Theodore, A.D., Chang, J.J., Runyan, D., Hunter, W. M., Bangdiwala, S.I., and Agans, R. (2005) “Epidemiologic Features of the Physical and Sexual Maltreatment of Children in the Caroli- nas”, Pediatrics11/3: 331-337. Thompson, R. A. and Wilcox, B.L. (1995) “Child Maltreatment Research: Federal Support and Policy Issues”, American Psychologist. 50/9: 789-793. Thorne, B. (1987).”Re-visioning Women and Social Change: Where are the Children?” Gender and Society 1/1:85-109. U.N. (2006). Report of the independent expert for the United Nations study on violence against children. UN General Assembly, August 2006. UNICEF (2005) Facts on Children. Available http://www.unicef.org/media/media_9482.html Accessed 1-2006. UNICEF (2005a) Changing a Harmful Social Convention: Female Genital Mutilation/Cutting. Innocenti Digest No. 12 Florence, UNICEF Innocenti Research Centre. UNICEF (2009) Facts on Children. Accessed at http://www.unicef.org/media/media_35903.html on November, 2009. Vachss, A.H. (1991) Sacrifice. NY: Knopf. WHO (2008) World Health Organization Fact Sheet No. 241: Female Genital Mutilation. Accessed at http://www.who.int/mediacentre/factsheets/fs241/en/ on September 1, 2009. Widom, C. (2000) “Child Abuse and Later Effects”, National Institute of Justice Journal. Washington, D.C. (http://www.ncjrs.gov/pdffiles1/jr000242.pdf). Widom, C. S. and Ames, M.A. (1994) “Criminal Consequences of Childhood Sexual Victimization.” Child Abuse and Neglect 18 (4):303-318.

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Figure 1: Human Rights (Child Centered) and Colonial (Adultism) Perspectives of Adult Child Relationships Human Rights/Child Centered Perspective (Supports Child Welfare and the Prevention of Child Maltreatment at All Levels) • Recognizes that children are an oppressed group • Age, gender, class do not determine a person’s human dignity • Those who attempt to take away another’s human dignity violate their own • Child-adult relationships are built on mutual respect and value • Children and adults share a common humanity and mutuality of status • Children’s voices matter • The meanings children attach to their experiences are of utmost importance • Long-term child development is a central concern of • Dignity in inherent in all life, including children • Children have a right not to have their human dignity degraded • Children have a right to physical integrity, to be protected from violence • Corporal punishment is violence • Harm to children extends beyond the physical to subjective experience of harm • The state has a responsibility to protect children from all forms of violence, neglect, maltreatment or exploitation from parents or any person who has care of children • The state has a responsibility to afford children equal protection under the law • Children’s vulnerable status requires more protections • Research and knowledge informs the law

Colonial / Adultism Perspective of Children (Supports Child Welfare and the Prevention of Child Maltreatment at All Levels) • Children are inferior to adults • Age, gender and class are markers of human dignity • Those who take away another’s human dignity are rewarded with power • Child-adult relationships are built on inequality and adult dominance • Dignity is not an inherent characteristic of children • Children don’t have a voice • The meanings children attach to their experience are of little importance • Short term control of children is the central concern of child discipline • Children’s human dignity may be degraded for their own good • Children have no right to physical integrity or protection from parents • Corporal punishment is not violence • Harm to children is almost exclusively defined in terms of observable injuries • The state has a responsibility to protect parents’ right to use force and violence to ‘discipline’ children and raise children as parents see fit. • The state may only intervene on behalf of a maltreated child if parent’s violations are egregious • Children’s vulnerable status justifies greater parent control of children • Law reflects power relationships between groups seen as unequal.

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Figure 2: Consequences of Parent’s Corporally Punishing their Children Serious consequences of child maltreatment are not just a result of severe child maltreatment. The less severe forms of child maltreatment, such as “just spanking,” also result in many negative consequences for the child and society, just to a lesser extent than the more extreme physical abuse (Gershoff, 2002:544; Straus 2009, 1991; Hagberg, 2005). Research on spanking children based on nationally representative studies, many longitudinal, as well as meta-analyses based on close to 100 studies over the past 62 years show that: the more frequently a child is spanked, the greater the likelihood that child is to have one or more of the following problems:

Physical Danger

● Increased risk of being a victim of the more severe physical abuse Mental Health and Emotional Problems as a Child, Adolescent and Adult

● Decreased mental health of child, adolescent and adult ● Higher rate of depression and suicide ideation. ● Lower self-esteem. Moral Development Problems

● Decreased moral internalization ● Less developed consciences ● Greater alienation and anomie ● Decreased quality of relationship between parent and child Cognitive and Developmental Problems

● Lower cognitive development, decreased IQ ● Lower reasoning, problem solving, and language skills. Aggression and Violence as Child and Adolescent

● Increased child aggression ● Increased likelihood child will assault a sibling and other child outside of the home Delinquency, Anti-Social Behavior and Risky Sexual Behavior as Adolescents

● Increased child and adolescent delinquent and antisocial behavior including truancy, underage drinking, stealing and/or selling drugs ● Increased rates of arrests for violent and nonviolent crimes ● Earlier age at first intercourse and increased risk of teenage pregancy Criminal and Antisocial Behavior as Adult

● Higher arrest rates for violent and nonviolent criminal behavior Violent Relationships as Adults

● Increased risk of abusing own child ● Increased risk of abusing own spouse

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Figure 3: Consequences of Child Maltreatment: Findings from Epidemiology – Effects of Adverse Childhood Experiences on Health and Health Risk Behaviors Compared to those who suffered none, persons who suffered 4 or more Adverse Childhood Experiences were at significantly greater risk of all of the following (odds ratios of risk factors adjusted for age, gender, race and education) as adults: Greater Risk of Health Problems as Adults a : Consider self an alcoholic 7.4X Ever used illicit drugs 4.7X Ever injected drugs 10.3X 50+ intercourse partners 3.2X Ever had sexually transmitted disease 2.5X Greater Risk of Disease a : Ischemic Heart Disease 2.2X Any Cancer 1.9X Chronic Bronchitis / Emphysema 3.9X Greater Risk of Violence, Drugs, Teenage Pregnancy b: Victim of Domestic Violence 4.0X Ever had drug problem 12.0X Ever addicted to drugs 9.0X Intercourse by 15 yrs 4.2X Teen Pregnancy 2.0X Teen Paternity 2.0X Sources: a Felitti, V. J., et al. (1998) b Anda, R . (2009)

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Figure 4: Consequences of Child Maltreatment: Effects of Child Physical Abuse and Neglect on Brain and CNS Development Brain Func- Higher More De- Lower More Primitive Level CMR: Cortical Modula- tion in Non- veloped Level Midbrain tion Ratio abused, Phys- Cortical (Arousal, Reactive) (Ability of Higher- ically Abused, (Cognitive Brainstem Mature Level of Brain Neglected Thought) (Regulates Heart Rate, to Modulate Lower Children Limbic Blood Pressure, Fight or Level Impulses, Re- (Attachment, Flight, etc) sponses, Reactions) Empathy) Non-Abused 20 10 2.0 and Non-Neg- Optimum Optimum Healthy CMR lected Children Trauma—Child 20 14 1.4 Physical Abuse No effect Overdeveloped Compromised CMR Primitive reactions, fight Normally developed up- or flight per part of brain unable Males aggressive, impuls- to modulate overde- ive, reactive and hyperactive veloped lower part of Females more likely to brain dissociate Child Neglect 16 10 1.6 Underdeveloped No effect Compromised CMR Un- Lower cognitive derdeveloped upper part development of brain unable to modu- Less developed at- late normally developed tachment, more re- lower part of brain active, impulsive Trauma—Viol- 16 14 1.1 ence and Neg- Underdeveloped Overdeveloped Most Compromised lect Lower cognitive Primitive reactions, fight or CMR: Serious Risk: development flight Underdeveloped upper Less developed at- Males aggressive, impulsive, part of brain unable to tachment, more re- reactive and hyperactive modulate overdeveloped active, impulsive Females more likely to disso- lower part of brain ciate Adapted from: Perry (1997). See http://www.childtrauma.org/CTAMATERIALS/incub- ated.asp

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Figure 5: Images of Healthy Brain and Abused Brain, Source: Anda (2009)

Figure 6: Support for Importance of Childhood Experiences of Maltreatment and Blending of Epidemiology and Neurodevelopment, Source: Centers for Disease Control and Prevention, THE ADVERSE CHILDHOOD EXPERIENCES STUDY: http://www.cdc.gov/nccdphp/ace/pyramid.htm

Adverse Childhood Experiences Pyramid: This diagram models the path way of the impact of Adverse Childhood Experiences to adult disease, disability and social problems and early death. Central to this process is the social, emotional and cognitive impairment (often the result of the effects of trauma and neglect on brain development in formative years) and the adoption of health-risk behaviors (forms of coping with the adverse childhood experiences) which then lead to disease, disability and social problems, and early death.

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About the Authors Dr. Lucien Lombardo Dr. Lucien Lombardo received his PhD in Criminal Justice from SUNY, Albany. He has taught “Understanding Violence: From Suicide to Genocide” and “Violence in the World of Children: From Corporal Punishment to War”. He has written extensively on prisons, vi- olence, children’s rights and interdisciplinary education. He is co-editor with Dr. Karen A. Polonko of “Children and Young People in a Changing World”, Special Edition of Global Bioethics, Vol. 18. Winter 2005. He has served as coordinator of Interdisciplinary Programs and has been actively involved in interdisciplinary curriculum development. He has been at Old Dominion University since 1977.

Karen A. Polonko Dr. Karen A. Polonko is Professor of Sociology and University Professor at Old Dominion University. She received her PhD in Sociology from Indiana University. She has taught courses on the sociology of children, marriage and families, child welfare and violence

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against children globally. She is coauthor of the book “The Sexual Bond” and has published widely in the areas of families and children. She is co-author of “Children and Young People in a Changing World”, Special Edition of Global Bioethics, Vol. 18. Winter 2005. Current interests include research on violence against children globally, assessment of implementation of the UN CRC, and the long-term consequences of corporal punishment on children.

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EDITORS Mary Kalantzis, University of Illinois, Urbana-Champaign, USA. Bill Cope, University of Illinois, Urbana-Champaign, USA.

EDITORIAL ADVISORY BOARD Patrick Baert , Cambridge University, Cambridge, UK. Norma Burgess , Syracuse University, Syracuse, USA. Peter Harvey , University of Adelaide, Adelaide, Australia. Vangelis Intzidis , University of the Aegean, Rhodes, Greece. Paul James , RMIT University, Melbourne, Australia. Mary Kalantzis , University of Illinois, Urbana-Champaign, USA. José Luis Ortega Martín , Universidad de Granada, Granada, Spain. Bertha Ochieng , University of Bradford, Bradford, UK. Francisco Fernandez Palomares , Universidad de Granada, Granada, Spain. Miguel A. Pereyra , Universidad de Granada, Granada, Spain. Constantine D. Skordoulis , University of Athens, Athens, Greece. Chad Turnbull , ESADE Business School, Barcelona, Spain.

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