Child abuse and neglect
Summary of the lectures + possible exam questions & answers
2024-2025
Ilse van Meurs
HC1 Introduction and consequences
Prevalence and types of maltreatment
Prevalence - 127.000 children every year (maltreatment = abuse & neglect combined)
maltreatment - 4-16% physical abuse
- 10% neglect/emotional abuse
- 5-10% sexual abuse
Tip of the iceberg: most studies look at case reports or self-rapport, which means many children
and families where maltreatment is happening, are undetected
● case reports: are only the worst cases, many families aren’t in the picture
● self-rapport/parent-rapport: isn’t really reliable → shame & social desirability bias
● retrospective: not always reliable; it’s hard to remember what happened exactly
Gray areas: the definition of maltreatment can differ, for example when comparing different
cultures → think about obesity or strict diets for young children
Statements 1. non-accidental burning a child = physical abuse → true
about CAN 2. not taking a child to the doctor when he/she needs to = emotional abuse → false
(green = true) 3. drunk driving by the parent (with the child in the car) = physical neglect → true
4. locking a child in a room = emotional neglect → false
Consequences of child abuse and neglect
ACE-Study - Medical study focused on obesity, weight and ACEs (Adverse Childhood Experiences)
Felitti et al: - Note: this is an old study
Somatic health - Method: 13,494 Kaiser Health Plan members who completed standardized medical
in adulthood evaluations at the Health Appraisal Clinic (1996 & 1996)
- a week after the visit they sent questionnaires, 70,5% filled it in
- ACEs: physical abuse, psychological abuse, sexual abuse, substance abuse in household,
mental illness in household, mother treated violently, criminal behavior in household
Result: child abuse and neglect is related to many aspects
of physical and mental health
● cumulative effect: if you’ve experienced more
ACEs, you experience more negative outcomes
(psychological and physical)
○ more ACEs = higher risk for health problems
● ACEs are related to risk in
1. physical and mental health
2. social development → romantic relationships
and friends
3. educational outcomes
4. child’s brain structure development
5. neuroendocrine system → stress-system
Positive National Survey of Children’s Health, sample: 22,628 children aged 6-17. They used parent report:
Childhood - mental health disorders, added ACEs (divorce, discrimination, sibling violence)
Experiences - Positive Childhood Experiences (PCEs) they looked at:
(PCEs) - 1. supportive relationships: family communication/resilience, mentorship
(Hinojosa, 2. safe, stable environment: neighborhood safety and support
2024) 3. opportunities for constructive social engagement: sports, other activities
, Results
● cumulative effect: more ACEs = more negative mental health outcomes
○ graph: they specify how many ACEs they have (x-axis) → division
between 0-4
● moderation effect: the PCEs have a moderation effect: the relationship
between ACEs and mental health outcomes differed for how many PCEs
you experienced
→ more PCEs = less negative outcomes, even if you experienced ACEs
Limitations
● parent report (trustworthy?)
● causality: everything is measured at the same time point; it’s not a longitudinal study
● more PCEs should be added
CAN subtypes Random selection of households, N = 2510, mean age = 48.4 and 53.3% = female. They used the
& Health CTQ (Childhood Trauma Questionnaire)
(Clemens et al, Results
2018) Graph: presents odds ratios (OR) for various health conditions in adulthood, based on different
types of child maltreatment. Higher OR = stronger
association between a type of maltreatment and
the health condition
● experiencing any form of child
maltreatment significantly increases the
likelihood of major chronic health issues in
adulthood
○ physical neglect and physical
abuse are the strongest predictors
of health problems in adulthood
○ sexual abuse is only significantly
associated with obesity, diabetes,
cancer, COPD and strokes
● the intensity of maltreatment increases health problems
● the number of maltreatment subtypes increases health problems
Limitations
● the mean age = 48; a retrospective design → it’s hard to look back correctly on childhood
● only one questionnaire
● mechanisms: why are the results happening? → biological, socioeconomic, behavioral?
MUSP: Mater- Longitudinal study of 40 years, N = 5200 at 14 years, N = 3778 at 21 years
University of - self-report and cognitive testing
Queensland - measures: substantiated maltreatment and 46 different outcomes, in clusters:
Study of 1) cognition and education, 2) psychological and mental health, 3) addiction and
Pregnancy substance abuse, 4) sexual health, 5) physical health
(Strathearn et Results
al, 2020) when children experienced child abuse/neglect:
1. lower cognitive scores
2. negative educational / employment outcomes
3. mental health problems
4. substance use & addiction
5. sexual health problems
6. physical health problems
→ emotional abuse and neglect had the most prominent associations with these outcomes
Limitations
● only 7.1% (n = 511) experienced CAN
● self-report
, Final discussion
Important What could be a problem with retrospective studies about the consequences of CAN?
questions to - Retrospective studies rely on participants recalling past events, which can introduce
ask yourself several limitations like memory bias (difficult to accurately recall details of childhood
experiences), social desirability bias (modify answers due to shame/fear) and selection
+ overview bias (tip of the iceberg; retrospective studies often focus on case reports; not
whole course representative for the entire population)
What is the meta-analytic evidence for the long-term consequences of child maltreatment?
- meta-analytic studies confirm child abuse
and neglect have significant long-term
effects on health and well-being, including:
● physical health (Felitti et al;
ACE-study)
● mental health
● social & educational outcomes
○ difficulties forming
relationships (Hinojosa)
○ poorer academic and
employment achievements
(Strathearn et al)
● substance abuse (Strathearn et al)
● cumulative effects (Hinojosa)
○ more ACEs = higher risk of
mental and physical health problems
○ PCEs can moderate these effects
HC2 Mechanisms
Biological
mechanisms
Childhood psychological adversity → biological change → adult outcomes
● everything depends on development, for example sensitive periods
Methodological considerations
Critical Critical reflection on research done on child abuse and neglect
reflection on ● Measures: prospective versus retrospective
, CAN research ○ prospective research = during childhood, when it’s happening
(Danese et al., → for example child services can report it
2020) ○ retrospective research = asking adults about their childhood
→ there is little overlap between people who received both prospective
and retrospective research: individuals on who was reported they were
abused, didn’t report that themselves in retrospective studies
● cause can be memory loss or social desirability
Assumption of equivalence = the assumption that prospective and
retrospective measures of childhood trauma can be used interchangeably
→ this is not true!
Measures: objective versus subjective measures
-childhood maltreatment and internalizing and externalizing disorders
● if there is an objective measure the internalizing and externalizing disorders are not
significant → different measures have different information and meanings
Measures: cross-sectional versus longitudinal
hypothetical scenarios for association between childhood victimization and cognitive functioning
- cross-sectional data: differences → maltreated versus non-maltreated
● maltreated individuals have lower cognitive abilities
- longitudinal data: changes → pre-trauma versus post-trauma
● if you don’t look at change over time, it’s hard to interpret data
- assumption of change = the assumption that cross-sectional differences between adults
with or without childhood trauma are the result of longitudinal changes
With versus without adjustment for pre-existing differences
- adjustment means controlled for cognitive abilities before maltreatment
Graph: association between childhood
trauma and cognitive functioning in the
E-Risk and Dunedin studies (twin-studies)
● results (graph): E-risk study:
compared to non-maltreated
children, maltreated children had
lower IQ at ages 12 and 18, and
poorer executive function +
processing speed at age 18 (dark
bars; not adjusted) → however,
these differences were largely
accounted for by cognitive abilities
at age 5 and residual effects of SES (light bars; adjusted)
○ within sibling pairs, they did not find associations between maltreatment and
Summary of the lectures + possible exam questions & answers
2024-2025
Ilse van Meurs
HC1 Introduction and consequences
Prevalence and types of maltreatment
Prevalence - 127.000 children every year (maltreatment = abuse & neglect combined)
maltreatment - 4-16% physical abuse
- 10% neglect/emotional abuse
- 5-10% sexual abuse
Tip of the iceberg: most studies look at case reports or self-rapport, which means many children
and families where maltreatment is happening, are undetected
● case reports: are only the worst cases, many families aren’t in the picture
● self-rapport/parent-rapport: isn’t really reliable → shame & social desirability bias
● retrospective: not always reliable; it’s hard to remember what happened exactly
Gray areas: the definition of maltreatment can differ, for example when comparing different
cultures → think about obesity or strict diets for young children
Statements 1. non-accidental burning a child = physical abuse → true
about CAN 2. not taking a child to the doctor when he/she needs to = emotional abuse → false
(green = true) 3. drunk driving by the parent (with the child in the car) = physical neglect → true
4. locking a child in a room = emotional neglect → false
Consequences of child abuse and neglect
ACE-Study - Medical study focused on obesity, weight and ACEs (Adverse Childhood Experiences)
Felitti et al: - Note: this is an old study
Somatic health - Method: 13,494 Kaiser Health Plan members who completed standardized medical
in adulthood evaluations at the Health Appraisal Clinic (1996 & 1996)
- a week after the visit they sent questionnaires, 70,5% filled it in
- ACEs: physical abuse, psychological abuse, sexual abuse, substance abuse in household,
mental illness in household, mother treated violently, criminal behavior in household
Result: child abuse and neglect is related to many aspects
of physical and mental health
● cumulative effect: if you’ve experienced more
ACEs, you experience more negative outcomes
(psychological and physical)
○ more ACEs = higher risk for health problems
● ACEs are related to risk in
1. physical and mental health
2. social development → romantic relationships
and friends
3. educational outcomes
4. child’s brain structure development
5. neuroendocrine system → stress-system
Positive National Survey of Children’s Health, sample: 22,628 children aged 6-17. They used parent report:
Childhood - mental health disorders, added ACEs (divorce, discrimination, sibling violence)
Experiences - Positive Childhood Experiences (PCEs) they looked at:
(PCEs) - 1. supportive relationships: family communication/resilience, mentorship
(Hinojosa, 2. safe, stable environment: neighborhood safety and support
2024) 3. opportunities for constructive social engagement: sports, other activities
, Results
● cumulative effect: more ACEs = more negative mental health outcomes
○ graph: they specify how many ACEs they have (x-axis) → division
between 0-4
● moderation effect: the PCEs have a moderation effect: the relationship
between ACEs and mental health outcomes differed for how many PCEs
you experienced
→ more PCEs = less negative outcomes, even if you experienced ACEs
Limitations
● parent report (trustworthy?)
● causality: everything is measured at the same time point; it’s not a longitudinal study
● more PCEs should be added
CAN subtypes Random selection of households, N = 2510, mean age = 48.4 and 53.3% = female. They used the
& Health CTQ (Childhood Trauma Questionnaire)
(Clemens et al, Results
2018) Graph: presents odds ratios (OR) for various health conditions in adulthood, based on different
types of child maltreatment. Higher OR = stronger
association between a type of maltreatment and
the health condition
● experiencing any form of child
maltreatment significantly increases the
likelihood of major chronic health issues in
adulthood
○ physical neglect and physical
abuse are the strongest predictors
of health problems in adulthood
○ sexual abuse is only significantly
associated with obesity, diabetes,
cancer, COPD and strokes
● the intensity of maltreatment increases health problems
● the number of maltreatment subtypes increases health problems
Limitations
● the mean age = 48; a retrospective design → it’s hard to look back correctly on childhood
● only one questionnaire
● mechanisms: why are the results happening? → biological, socioeconomic, behavioral?
MUSP: Mater- Longitudinal study of 40 years, N = 5200 at 14 years, N = 3778 at 21 years
University of - self-report and cognitive testing
Queensland - measures: substantiated maltreatment and 46 different outcomes, in clusters:
Study of 1) cognition and education, 2) psychological and mental health, 3) addiction and
Pregnancy substance abuse, 4) sexual health, 5) physical health
(Strathearn et Results
al, 2020) when children experienced child abuse/neglect:
1. lower cognitive scores
2. negative educational / employment outcomes
3. mental health problems
4. substance use & addiction
5. sexual health problems
6. physical health problems
→ emotional abuse and neglect had the most prominent associations with these outcomes
Limitations
● only 7.1% (n = 511) experienced CAN
● self-report
, Final discussion
Important What could be a problem with retrospective studies about the consequences of CAN?
questions to - Retrospective studies rely on participants recalling past events, which can introduce
ask yourself several limitations like memory bias (difficult to accurately recall details of childhood
experiences), social desirability bias (modify answers due to shame/fear) and selection
+ overview bias (tip of the iceberg; retrospective studies often focus on case reports; not
whole course representative for the entire population)
What is the meta-analytic evidence for the long-term consequences of child maltreatment?
- meta-analytic studies confirm child abuse
and neglect have significant long-term
effects on health and well-being, including:
● physical health (Felitti et al;
ACE-study)
● mental health
● social & educational outcomes
○ difficulties forming
relationships (Hinojosa)
○ poorer academic and
employment achievements
(Strathearn et al)
● substance abuse (Strathearn et al)
● cumulative effects (Hinojosa)
○ more ACEs = higher risk of
mental and physical health problems
○ PCEs can moderate these effects
HC2 Mechanisms
Biological
mechanisms
Childhood psychological adversity → biological change → adult outcomes
● everything depends on development, for example sensitive periods
Methodological considerations
Critical Critical reflection on research done on child abuse and neglect
reflection on ● Measures: prospective versus retrospective
, CAN research ○ prospective research = during childhood, when it’s happening
(Danese et al., → for example child services can report it
2020) ○ retrospective research = asking adults about their childhood
→ there is little overlap between people who received both prospective
and retrospective research: individuals on who was reported they were
abused, didn’t report that themselves in retrospective studies
● cause can be memory loss or social desirability
Assumption of equivalence = the assumption that prospective and
retrospective measures of childhood trauma can be used interchangeably
→ this is not true!
Measures: objective versus subjective measures
-childhood maltreatment and internalizing and externalizing disorders
● if there is an objective measure the internalizing and externalizing disorders are not
significant → different measures have different information and meanings
Measures: cross-sectional versus longitudinal
hypothetical scenarios for association between childhood victimization and cognitive functioning
- cross-sectional data: differences → maltreated versus non-maltreated
● maltreated individuals have lower cognitive abilities
- longitudinal data: changes → pre-trauma versus post-trauma
● if you don’t look at change over time, it’s hard to interpret data
- assumption of change = the assumption that cross-sectional differences between adults
with or without childhood trauma are the result of longitudinal changes
With versus without adjustment for pre-existing differences
- adjustment means controlled for cognitive abilities before maltreatment
Graph: association between childhood
trauma and cognitive functioning in the
E-Risk and Dunedin studies (twin-studies)
● results (graph): E-risk study:
compared to non-maltreated
children, maltreated children had
lower IQ at ages 12 and 18, and
poorer executive function +
processing speed at age 18 (dark
bars; not adjusted) → however,
these differences were largely
accounted for by cognitive abilities
at age 5 and residual effects of SES (light bars; adjusted)
○ within sibling pairs, they did not find associations between maltreatment and
