Encyclopedia of Infant and Early Childhood Development, vol 1 (Academic Press, 2008) pdf

EDITORS-IN-CHIEF

  Marshall M. Haith received his M.A. and Ph.D. degrees from U.C.L.A. and then carried out postdoctoral work at Yale University from 1964–1966. He served as Assistant Professor and Lecturer at Harvard University from 1966–1972 and then moved to the University of Denver as Professor of Psychology, where he has conducted research on infant and children’s perception and cognition, funded by NIH, NIMH, NSF, The MacArthur Foundation, The March of Dimes, and The Grant Foundation. He has been Head of the Developmental Area, Chair of Psychology, and Director of University Research at the University of Denver and is currently John Evans Professor Emeritus of Psychology and Clinical Professor of Psychiatry at the University of Colorado Health Sciences Center.

  Dr. Haith has served as consultant for Children’s Television Workshop (Sesame Street), Bilingual Children’s Television, Time-Life, and several other organizations. He has received several personal awards, including University Lecturer and the John Evans Professor Award from the University of Denver, a Guggenheim Fellowship for serving as Visiting Professor at the University of Paris and University of Geneva, a NSF fellowship at the Center for Advanced Study in the Behavioral Sciences (Stanford), the G. Stanley Hall Award from the American Psychological Association, a Research Scientist Award from NIH (17 years), and the Distinguished Scientific Contribution Award from the Society for Research in Child Development.

  Janette B. Benson earned graduate degrees at Clark University in Worcester, MA in 1980 and 1983. She came to the University of Denver in 1983 as an institutional postdoctoral fellow and then was awarded an individual NRSA postdoctoral fellowship. She has received research funding form federal (NICHD; NSF) and private (March of Dimes, MacArthur Foundation) grants, leading initially to a research Assistant Professor position and then an Assistant Professorship in Psychology at the University of Denver in 1987, where she remains today as Associate Professor of Psychology and as Director of the undergraduate Psychology program and Area Head of the Developmental Ph.D. program and Director of University Assessment. Dr. Benson has received various awards for her scholarship and teaching, including the 1993 United Methodist Church University Teacher Scholar of the Year and in 2000 the CASE Colorado Professor of the Year. Dr. Benson was selected by the American Psychological Association as the 1995–1996 Esther Katz Rosen endowed Child Policy Fellow and AAAS Congressional Science Fellow, spending a year in the United States Senate working on Child and Education Policy. In 1999, Dr. Benson was selected as a Carnegie Scholar and attended two summer institutes sponsored by the Carnegie Foundation program for the Advancement for the Scholarship of Teaching and Learning in Palo Alto, CA. In 2001, Dr. Benson was awarded a Susan and Donald Sturm Professorship for Excellence in Teaching. Dr. Benson has authored and co-authored numerous chapters and research articles on infant and early childhood development in addition to co-editing two books.

EDITORIAL BOARD

  Richard Aslin is the William R. Kenan Professor of Brain and Cognitive Sciences at the University of Rochester and is also the director of the Rochester Center for Brain Imaging. His research has been directed to basic aspects of sensory and perceptual development in the visual and speech domains, but more recently has focused on mechanisms of statistical learning in vision and language and the underlying brain mechanisms that support it. He has published over 100 journal articles and book chapters and his research has been supported by NIH, NSF, ONR, and the Packard and McDonnell Foundations. In addition to service on grant review panels at NIH and NSF, he is currently the editor of the journal Infancy. In 1981 he received the Boyd R. McCandless award from APA (Division 7), in 1982 the Early Career award from APA (developmental), in 1988 a fellowship from the John Simon Guggenheim foundation, and in 2006 was elected to the American Academy of Arts and Sciences.

  Warren O. Eaton is Professor of Psychology at the University of Manitoba in Winnipeg, Canada, where he has spent his entire academic career. He is a fellow of the Canadian Psychological Association, and has served as the editor of one of its journals, the Canadian Journal of Behavioural Science. His current research interests center on child-to-child variation in developmental timing and how such variation may contribute to later outcomes.

  Robert Newcomb Emde is Professor of Psychiatry, Emeritus, at the University of Colorado School of Medicine. His research over the years has focused on early socio-emotional development, infant mental health and preventive interventions in early childhood. He is currently Honorary President of the World Association of Infant Mental Health and serves on the Board of Directors of Zero To Three.

  Hill Goldsmith is Fluno Bascom Professor and Leona Tyler Professor of Psychology at the University of Wisconsin–Madison. He works closely with Wisconsin faculty in the Center for Affective Science, and he is the coordinator of the Social and Affective Processes Group at the Waisman Center on Mental Retardation and Human Development. Among other honors, Goldsmith has received an National Institute of Mental Health MERIT award, a Research Career Development Award from the National Institute of Child Health and Human Development, the James Shields Memorial Award for Twin Research from the Behavior Genetics Association, and various awards from his university. He is a Fellow of AAAS and a Charter Fellow of the Association for Psychological Science. Goldsmith has also served the National Institutes of Health in several capacities. His editorial duties have included a term as Associate Editor of one journal and membership on the editorial boards of the five most important journals in his field. His administrative duties have included service as department chair at the University of Wisconsin.

  Richard B. Johnston Jr. is Professor of Pediatrics and Associate Dean for Research Development at the University of Colorado School of Medicine and Associate Executive Vice President of Academic Affairs at the National Jewish

  Medical & Research Center. He is the former President of the American Pediatric Society and former Chairman of the International Pediatric Research Foundation. He is board certified in pediatrics and infectious disease. He has previously acted as the Chief of Immunology in the Department of Pediatrics at Yale University School of Medicine, been the Medical Director of the March of Dimes Birth Defects Foundation, Physician-in-Chief at the Children’s Hospital of Philadelphia and Chair of the Department of Pediatrics at the University Pennsylvania School of Medicine.

  He is editor of ‘‘Current Opinion in Pediatrics’’ and has formerly served on the editorial board for a host of journals in pediatrics and infectious disease. He has published over 80 scientific articles and reviews and has been cited over 200 times for his articles on tissue injury in inflammation, granulomatous disease, and his New England Journal of Medicine article on immunology, monocytes, and macrophages.

  Editorial board

  Jerome Kagan is a Daniel and Amy Starch Professor of Psychology at Harvard University. Dr. Kagan has won numerous awards, including the Hofheimer Prize of the American Psychiatric Association and the G. Stanley Hall Award of the American Psychological Association. He has served on numerous committees of the National Academy of Sciences, The National Institute of Mental Health, the President’s Science Advisory Committee and the Social Science Research Council. Dr. Kagan is on the editorial board of the journals Child Development and Developmental Psychology, and is active in numerous professional organizations. Dr. Kagan’s many writings include Understanding Children: Behavior,

  

Motives, and Thought, Growth of the Child, The Second Year: The Emergence of Self-Awareness, and a number of cross-cultural

  studies of child development. He has also coauthored a widely used introductory psychology text. Professor Kagan’s research, on the cognitive and emotional development of a child during the first decade of life, focuses on the origins of temperament. He has tracked the development of inhibited and uninhibited children from infancy to adolescence. Kagan’s research indicates that shyness and other temperamental differences in adults and children have both environmental and genetic influences.

  Rachel Keen (formerly Rachel Keen Clifton) is a professor at the University of Virginia. Her research expertise is in perceptual-motor and cognitive development in infants. She held a Research Scientist Award from the National Institute of Mental Health from 1981 to 2001, and currently has a MERIT award from the National Institute of Child Health and Human Development. She has served as Associate Editor of Child Development (1977–1979), Psychophysiology (1972–1975), and as Editor of SRCD Monographs (1993–1999). She was President of the International Society on Infant Studies from 1998–2000. She received the Distinguished Scientific Contribution Award from the Society for Research in Child Development in 2005 and was elected to the American Academy of Arts and Science in 2006. Ellen M. Markman is the Lewis M. Terman Professor of Psychology at Stanford University. Professor Markman was chair of the Department of Psychology from 1994–1997 and served as Cognizant Dean for the Social Sciences from 1998–2000. In 2003 she was elected to the American Academy of Arts and Sciences and in 2004 she was awarded the American Psychological Association’s Mentoring Award. Professor Markman’s research has covered a range of issues in cognitive development including work on comprehension monitoring, logical reasoning and early theory of mind development. Much of her work has addressed questions of the relationship between language and thought in children focusing on categorization, inductive reasoning, and word learning.

  Yuko Munakata is Professor of Psychology at the University of Colorado, Boulder. Her research investigates the origins of knowledge and mechanisms of change, through a combination of behavioral, computational, and neuroscientific methods. She has advanced these issues and the use of converging methods through her scholarly articles and chapters, as well as through her books, special journal issues, and conferences. She is a recipient of the Boyd McCandless Award from the American Psychological Association, and was an Associate Editor of Psychological Review, the field’s premier theoretical journal.

  Arnold J. Sameroff , is Professor of Psychology at the University of Michigan where he is also Director of the Development and Mental Health Research Program. His primary research interests are in understanding how family and community factors impact the development of children, especially those at risk for mental illness or educational failure. He has published 10 books and over 150 research articles including the Handbook of Developmental Psychopathology,

The Five to Seven Year Shift: The Age of Reason and Responsibility, and the forthcoming Transactional Processes in Development.

  Among his honors are the Distinguished Scientific Contributions Award from the Society for Research in Child Development and the G. Stanley Hall Award from the American Psychological Association. Currently he is President of the Society for Research in Child Development and serves on the executive Committee of the International Society for the Study of Behavioral Development.

FOREWORD

  This is an impressive collection of what we have learned about infant and child behavior by the researchers who have contributed to this knowledge. Research on infant development has dramatically changed our perceptions of the infant and young child. This wonderful resource brings together like a mosaic all that we have learned about the infant and child’s behavior. In the 1950s, it was believed that newborn babies couldn’t see or hear. Infants were seen as lumps of clay that were molded by their experience with parents, and as a result, parents took all the credit or blame for how their offspring turned out. Now we know differently.

  The infant contributes to the process of attaching to his/her parents, toward shaping their image of him, toward shaping the family as a system, and toward shaping the culture around him. Even before birth, the fetus is influenced by the intrauterine environment as well as genetics. His behavior at birth shapes the parent’s nurturing to him, from which nature and nurture interact in complex ways to shape the child.

  Geneticists are now challenged to couch their findings in ways that acknowledge the complexity of the interrelation between nature and nurture. The cognitivists, inheritors of Piaget, must now recognize that cognitive development is encased in emotional development, and fueled by passionately attached parents. As we move into the era of brain research, the map of infant and child behavior laid out in these volumes will challenge researchers to better understand the brain, as the basis for the complex behaviors documented here. No more a lump of clay, we now recognize the child as a major contributor to his own brain’s development.

  This wonderful reference will be a valuable resource for all of those interested in child development, be they students, researchers, clinicians, or passionate parents.

  T. Berry Brazelton, M.D. Professor of Pediatrics, Emeritus Harvard Medical School

  Creator, Neonatal Behavioral Assessment Scale (NBAS) Founder, Brazelton Touchpoints Center

PREFACE

  Encyclopedias are wonderful resources. Where else can you find, in one place, coverage of such a broad range of topics, each pursued in depth, for a particular field such as human development in the first three years of life? Textbooks have their place but only whet one’s appetite for particular topics for the serious reader. Journal articles are the lifeblood of science, but are aimed only to researchers in specialized fields and often only address one aspect of an issue. Encyclopedias fill the gap.

  In this encyclopedia readers will find overviews and summaries of current knowledge about early human development from almost every perspective imaginable. For much of human history, interest in early development was the province of pedagogy, medicine, and philosophy. Times have changed. Our culling of potential topics for inclusion in this work from textbooks, journals, specialty books, and other sources brought home the realization that early human development is now of central interest for a broad array of the social and biological sciences, medicine, and even the humanities. Although the ‘center of gravity’ of these volumes is psychology and its disciplines (sensation, perception, action, cognition, language, personality, social, clinical), the fields of embryology, immunology, genetics, psychiatry, anthropol- ogy, kinesiology, pediatrics, nutrition, education, neuroscience, toxicology and health science also have their say as well as the disciplines of parenting, art, music, philosophy, public policy, and more.

  Quality was a key focus for us and the publisher in our attempts to bring forth the authoritative work in the field. We started with an Editorial Advisory Board consisting of major contributors to the field of human development – editors of major journals, presidents of our professional societies, authors of highly visible books and journal articles. The Board nominated experts in topic areas, many of them pioneers and leaders in their fields, whom we were successful in recruiting partly as a consequence of Board members’ reputations for leadership and excellence. The result is articles of exceptional quality, written to be accessible to a broad readership, that are current, imaginative and highly readable.

  Interest in and opinion about early human development is woven through human history. One can find pronounce- ments about the import of breast feeding (usually made by men), for example, at least as far back as the Greek and Roman eras, repeated through the ages to the current day. Even earlier, the Bible provided advice about nutrition during pregnancy and rearing practices. But the science of human development can be traced back little more than 100 years, and one can not help but be impressed by the methodologies and technology that are documented in these volumes for learning about infants and toddlers – including methods for studying the role of genetics, the growth of the brain, what infants know about their world, and much more. Scientific advances lean heavily on methods and technology, and few areas have matched the growth of knowledge about human development over the last few decades. The reader will be introduced not only to current knowledge in this field but also to how that knowledge is acquired and the promise of these methods and technology for future discoveries.

  CONTENTS

  Several strands run through this work. Of course, the nature-nurture debate is one, but no one seriously stands at one or the other end of this controversy any more. Although advances in genetics and behavior genetics have been breathtaking, even the genetics work has documented the role of environment in development and, as Brazelton notes in his foreword, researchers acknowledge that experience can change the wiring of the brain as well as how actively the genes are expressed. There is increasing appreciation that the child develops in a transactional context, with the child’s effect on the parents and others playing no small role in his or her own development.

  There has been increasing interest in brain development, partly fostered by the decade of the Brain in the 1990s, as we have learned more about the role of early experience in shaping the brain and consequently, personality, emotion, and

  Preface

  intelligence. The ‘brainy baby’ movement has rightly aroused interest in infants’ surprising capabilities, but the full picture of how abilities develop is being fleshed out as researchers learn as much about what infants can not do, as they learn about what infants can do. Parents wait for verifiable information about how advances may promote effective parenting.

  An increasing appreciation that development begins in the womb rather than at birth has taken place both in the fields of psychology and medicine. Prenatal and newborn screening tools are now available that identify infants at genetic or developmental risk. In some cases remedial steps can be taken to foster optimal development; in others ethical issues may be involved when it is discovered that a fetus will face life challenges if brought to term. These advances raise issues that currently divide much of public opinion. Technological progress in the field of human development, as in other domains, sometimes makes options available that create as much dilemma as opportunity.

  As globalization increases and with more access to electronic communication, we become ever more aware of circumstances around the world that affect early human development and the fate of parents. We encouraged authors to include international information wherever possible. Discussion of international trends in such areas as infant mortality, disease, nutrition, obesity, and health care are no less than riveting and often heartbreaking. There is so much more to do.

  The central focus of the articles is on typical development. However, considerable attention is also paid to psychological and medical pathology in our attempt to provide readers with a complete picture of the state of knowledge about the field. We also asked authors to tell a complete story in their articles, assuming that readers will come to this work with a particular topic in mind, rather than reading the Encyclopedia whole or many articles at one time. As a result, there is some overlap between articles at the edges; one can think of partly overlapping circles of content, which was a design principle inasmuch as nature does not neatly carve topics in human development into discrete slices for our convenience. At the end of each article, readers will find suggestions for further readings that will permit them to take off in one neighboring direction or another, as well as web sites where they can garner additional information of interest.

  AUDIENCE

  Articles have been prepared for a broad readership, including advanced undergraduates, graduate students, professionals in allied fields, parents, and even researchers for their own disciplines. We plan to use several of these articles as readings for our own seminars.

  A project of this scale involves many actors. We are very appreciative for the advice and review efforts of members of the Editorial Advisory Board as well as the efforts of our authors to abide by the guidelines that we set out for them. Nikki Levy, the publisher at Elsevier for this work, has been a constant source of wise advice, consolation and balance. Her vision and encouragement made this project possible. Barbara Makinster, also from Elsevier, provided many valuable suggestions for us. Finally, the Production team in England played a central role in communicating with authors and helping to keep the records straight. It is difficult to communicate all the complexities of a project this vast; let us just say that we are thankful for the resource base that Elsevier provided. Finally, we thank our families and colleagues for their patience over the past few years, and we promise to ban the words ‘‘encyclopedia project’’ from our vocabulary, for at least a while.

  Marshall M. Haith

  and

  Janette B. Benson Department of Psychology, University of Denver

  Denver, Colorado, USA The following material is reproduced with kind permission of Oxford University Press Ltd Figure 1 of Self-Regulatory Processes The following material is reproduced with kind permission of AAAS Figure 1 of Maternal Age and Pregnancy Figures 1a, 1b and 1c of Perception and Action The following material is reproduced with kind permission of Nature Publishing Group Figure 2 of Self-Regulatory Processes The following material is reproduced with kind permission of Taylor & Francis Ltd Figure 4b of Visual Perception

  A Abuse, Neglect, and Maltreatment of Infants D Benoit and J Coolbear, University of Toronto, Toronto, ON, Canada; The Hospital for Sick Children, Toronto, ON, Canada A Crawford, _ã

University of Toronto, Toronto, ON, Canada; Mount Sinai Hospital, Toronto, ON, Canada

2008 D Benoit. Published by Elsevier Inc. jurisdictions, the reporting of cases of suspected

  Glossary child maltreatment is required by law.

  Adrenocorticotropin-releasing hormone (ACTH) – Substantiated case of maltreatment – A case Hormone released from the pituitary gland through the where child maltreatment is confirmed following an action of corticotropin-releasing hormone (CRH) as investigation. part of the hormonal cascade triggered by stress. ACTH then acts on the adrenal glands to stimulate the release of cortisol.

  Corticotropin-releasing hormone (CRH) system – In response to stress, a hormonal cascade is triggered Introduction by the release of CRH from the hypothalamus.

  Release is influenced by stress, by blood levels of The history of childhood is a nightmare from which we cortisol, and by the sleep/wake cycle. CRH activates have only recently begun to awake. The further back in the release of ACTH, which in turn stimulates the history one goes, the lower the level of child care and the release of cortisol from the adrenal glands. more likely children are to be killed, abandoned, beaten, Cortisol – Stress hormone that mediates the body’s terrorized and abused. alarm response to stressful situations. It is Lloyd De Mause, The History of Childhood produced by the adrenal glands as a result of

  Infant maltreatment has existed across all cultures, all

  stimulation by ACTH. Cortisol, secreted into the

  socioeconomic strata, and in all historical epochs. In fact,

  blood circulation, affects many tissues in the body,

  there is evidence of infanticide from antiquity. The including the brain. increasing recognition that children have the right to

  Hypothalamic–pituitary–adrenal (HPA) axis – The

  protection, and that they are not the property of their

  HPA axis is one of the two stress response caregivers, led to the modern child protection movement. systems of the body (the other is the

  In 1874, the advocacy of the Society for the Prevention

  sympathetic–adrenal–medullary system), which

  of Cruelty to Animals in the case of Mary Ellen, a young

  consists of the hypothalamus, the pituitary gland, and

  girl who was severely abused by her stepmother, led to

  the adrenal glands. The HPA axis activates and an unprecedented judicial intervention and protection. coordinates the stress response, through the action

  Shortly afterward, the New York Society for the Preven-

  of hormones, by receiving and interpreting

  tion of Cruelty to Children was established, which gave

  information from other areas of the brain (amygdala

  rise to the founding of similar societies. Since then the

  and hippocampus) and from the autonomic nervous

  complex social and familial dynamics of child maltreat- system. ment have been increasingly recognized. It was not until

  Reported case of maltreatment – A case where

  1962, however, following a medical symposium the pre-

  physical, sexual, and emotional abuse, neglect, or

  vious year, that several physicians, headed by Denver

  exposure to interpersonal violence is suspected and

  physician C. Henry Kempe, published the landmark the

  reported to a child protection agency. In many

  ‘battered child syndrome’ in the Journal of the American

  Medical Association. The battered child syndrome described

  a pattern of child abuse that included both physical and psychological aspects and established it as an area of aca- demic and clinical focus. In the early twenty-first century, the enormous social burden of child maltreatment remains timely, unresolved, and an important public health and policy issue. Every day, clinicians and investigators con- tinue to attend to individual infants and children who are maltreated and make their way through the complex- ities of healthcare and judicial systems. The impact of maltreatment on infants and children, particularly early and repeated abuse, is one of the most significant emo- tional and psychological traumas that a child can endure. Unlike other traumatic events in which the infant or child may be soothed by the ameliorating comforting of their caregiver, child maltreatment is most often committed by a caregiver or attachment figure. This double rupture, the lost sense of the safety and predictability of the world, and the loss of caregiver protection and security, make maltreatment a breach of profound magnitude for many infants.

  Incidence and Prevalence

  The incidence and prevalence rates of maltreatment in infancy (i.e., ages 0–3 years) are difficult to ascertain, in part because of the lack of universally accepted definitions of various types of maltreatment across countries. Further, there is consensus that much maltreatment goes unreported and that each year infants die as a result of their caregivers maltreating them. In the US, 3 million reports of child abuse or neglect are made each year and at least 1.5 million are substantiated. In Canada, recent data indicate that, in 2003, over 38 child abuse investigations per 1000 children were conducted and nearly half of the cases were sub- stantiated. Estimates from various European and Eastern European countries reveal that between 3 and 360/1000 of children are maltreated. The wide range of incidence and prevalence rates reflect the varying definitions of maltreat- ment used in various jurisdictions around the world and the inconsistent reporting, investigation, and recording practices. In every country where relevant data have been collected, neglect occurs up to three times as often as abuse and incidence rates of maltreatment are highest for infants from birth to age 3 years.

  Definitions

  There are no universally accepted definitions of infant or child maltreatment. Definitions also vary depend- ing on the professional discipline involved (e.g., child inconsistency hinders the collection of reliable vital statis- tics and interferes with scientific research on infant mal- treatment. The lack of universally accepted definitions of maltreatment may also contribute to delays in protecting maltreated infants and in providing them and their families with adequate assessment and intervention.

  

  lists various definitions of child maltreatment.

  Risk Factors for Maltreatment

  Infant maltreatment occurs in complex social and inter- personal circumstances. There is no single factor that predicts risk to an infant, and the absence of identifiable risk factors does not confer immunity from maltreatment. Rather, a profile of risk indicators must be considered within the individual, familial, economic, and social con- texts of each infant. Most of the data on risk indicators for child maltreatment come from the study of child physical and sexual abuse. Data regarding risk indicators for emo- tional abuse and neglect are limited. Risk indicators may be broadly separated into child and household or caregiver characteristics. Further, there is support for the position that environmental factors beyond the child’s immediate family or household – such as factors within the local community – may also play a role in creating high-risk caregiving situations. This perspective on the human ecology of child maltreatment posits that social impover- ishment, such as low socioeconomic neighborhoods, poor community social support networks, observable criminal behavior within the community, poor housing condi- tions, and poor access to social services and programs, are environmental correlates of child maltreatment, and that rates of child maltreatment may be responsive to social change. Most information about risk factors related to child maltreatment comes from research on children older than age 3 years and this is reflected in the informa- tion provided in the following.

  Child Factors

  1. Age. American epidemiologic data indicate that inci- dence rates for child maltreatment are highest in infants, up to age 3 years.

  2. Gender. In the 0–3 age group, based on Canadian data, rates of substantiated maltreatment for males and females are similar overall (51% vs. 49%, respectively). More females are physically abused (57%) sexually abused (53%), and emotionally maltreated (56%) in this age group, while more males are neglected (58%).

  3. Child psychological and developmental functioning. Problems in the areas of psychological and developmental func- tioning and disability in children who are maltreated are likely under-reported, as not all children receive

  Abuse, Neglect, and Maltreatment of Infants

  Abuse, Neglect, and Maltreatment of Infants Table 1 Definition of child maltreatment

  1. Emotional maltreatment

  a. Emotional abuse (child has suffered or is at substantial risk of suffering from mental, emotional, or developmental problems caused by overly hostile, punitive treatment, or habitual or extreme verbal abuse such as threatening, belittling, etc.) b. Nonorganic failure to thrive

  

c. Emotional neglect (child has suffered or is at substantial risk of suffering from mental, emotional, or developmental problems

caused by inadequate nurturance/affection) d. Exposure to nonintimate violence (between adults other than caregivers) – e.g., child’s father and an acquaintance

  2. Exposure to domestic violence

  a. Child directly witnesses the violence

  b. Child indirectly witnesses the violence (e.g., sees the physical injuries on caregiver the next day or overhears the violence)

  3. Neglect

  

a. Failure to supervise – physical harm (including situations where child was harmed or endangered as a result of caregiver’s

actions, e.g., drunk driving with a child, or engaging in dangerous criminal activity with child) b. Failure to supervise – sexual abuse (caregiver knew or should have known of risk and failed to protect)

  c. Physical neglect (e.g., inadequate nutrition, clothing, unhygienic or dangerous living conditions)

  

d. Medical neglect (caregiver does not provide, refuses, or is unavailable/unable to consent to treatment, including dental services)

  e. Failure to provide psychological/psychiatric treatment (also includes failing to provide treatment for school-related problems such as learning or behavior problems, infant development problems) f. Permitting criminal behavior (caregiver permits or fails/unable to supervise enough)

  g. Abandonment (caregiver died or unable to exercise custodial rights and no provisions made for care of child)

  

h. Educational neglect (knowingly allows chronic truancy ( 5 days/month), fails to enroll child, repeatedly keeps child at home)

  4. Physical abuse

  a. Shake, push, grab, or throw (including pulling, dragging, shaking)

  b. Hit with hand (e.g., slapping and spanking)

  c. Punch, kick, or bite (also hitting with other parts of the body – e.g., elbow, head)

  d. Hit with object (e.g., stick, belt; throwing an object at a child)

  e. Other physical abuse (e.g., choking, stabbing, strangling, shooting, poisoning, abusive use of restraints)

  5. Sexual abuse

  a. Penetration (penile, digital, or object penetration of vagina or anus)

  b. Attempted penetration

  c. Oral sex

  d. Fondling

  

e. Sex talk (proposition, encouragement, or suggestion of a sexual nature; face to face, telephone, written, internet, exposing

child to pornographic material) f. Voyeurism (perpetrator observes child for own sexual gratification)

  g. Exhibitionism (perpetrator exhibited self for own sexual gratification)

  h. Exploitation (e.g., pornography, prostitution)

Adapted from Trocme´ N, Fallon B, MacLaurin B, et al. (2005) Canadian incidence study of reported child abuse and neglect – 2003: Major

findings. Minister of Public Works and Government Services Canada.

(accessed on May 2007).

  that relied on reports by child protection workers, 6.5% of all victims of child maltreatment had a found that child functioning, in the areas of physical, disability, defined as mental retardation, emotional dis- cognitive, behavioral, and/or emotional health, is esti- turbance, visual impairment, learning disability, physi- mated to be impaired in 50% of cases where child cal disability, behavioral problem, or medical problem. maltreatment has been substantiated. In about one- third of cases at least one problem related to physical health and emotional and/or cognitive functioning is

  Household and Caregiver Factors documented, with the most common concerns being depression or anxiety, followed by learning disability.

  1. Family structure. Estimates suggest that 43% of mal- Ten per cent of maltreated children have a developmen- treated children live in single-parent families. Nearly tal delay. In 40% of cases where child maltreatment is one-third of cases involve children living with both investigated, behavioral concerns are identified. It is biological parents. Approximately 16% of maltreated important to remember that these child-functioning children live in blended families with a step-parent as characteristics are not necessarily causal in the mal- caregiver. In cases of sexual abuse, the absence of a treatment, and may be sequelae of the maltreatment. biological parent in the household or the presence of

  An American study reported that, in 34 states surveyed,

  single-parent status is a risk indicator for physical abuse and neglect.

  2. Age of primary caregiver. Overall, both male (80%) and female (64%) caregivers who maltreat children tend to be over 30 years of age. The proportion of females under 30 years of age is somewhat increased for neglect and emotional maltreatment.

  3. Gender of perpetrator. The majority of nonmentally ill caregivers who cause child maltreatment fatalities are male; however, the younger the maltreated child is, the more likely the perpetrator is to be the child’s mother. Men and women both appear to be equally culpable of nonaccidental injury. Men are over- whelmingly more often the perpetrators in the sexual abuse of both girls and boys (95% and 80% of the time, respectively). Children are twice as likely to be neglected by women than by men, reflecting the fact that women are more often primary caregivers of young children than men.

  4. Number of siblings in the household. In 65% of cases the maltreated child has at least one other sibling who is living in the household and is also investigated for allegations of child maltreatment.

  5. Socioeconomic status. The primary income in families where there is child maltreatment is from full-time employment in the majority of cases (57%); 24% of the time, income is from benefits and/or social assis- tance; and 12% of the time from part-time or sea- sonal work. In cases of neglect, a higher proportion of families obtain their income from benefits or part- time employment.

  6. Housing. The majority of children who are maltreated live in rental accommodations (56%), while 32% live in purchased homes, and 1% live in hostels or shelters.

  7. Mental illness. American data demonstrate that of caregivers convicted of criminal offenses pertaining to child maltreatment, more than 50% had received psychiatric treatment, and almost one-third have been admitted to hospital for psychiatric treatment. Forty two percent of these mothers were suffering from either major depression or schizophrenia. Another study estimated that 27% of female care- givers and 18% of male caregivers were identified as having a mental health impairment.

  8. Substance abuse. Approximately 18% of female care- givers and 30% of male caregivers abuse alcohol in cases of substantiated child maltreatment. Retro- spective data show that rates of physical and sexual abuse are doubled in cases where caregivers are also reported to have a history of alcohol abuse, with rates markedly increased when both caregivers are sub- stance abusers.

  9. Caregiver history of maltreatment as a child. There is whether a childhood history of maltreatment in the caregiver increases the risk for abusive or neglectful behavior as a caregiver. In retrospective studies documenting a link between a history of childhood abuse or neglect and abuse or neglect of one’s children, the link is weak. For example, one study indicated that 25% of abusive female care- givers and 18% of abusive male caregivers were maltreated as children; these rates were higher in cases of child neglect and emotional maltreatment.

  In general, 20% of caregivers who were abused as children go on to abuse their own children, whereas 75% of perpetrators of child sexual abuse report having been sexually abused as children.

  10. Prior history of criminality. Men who injure their chil- dren more commonly have a history of prior criminal- ity and antisocial personality traits. One study estimated that 16% were involved in criminal activity. Women in these partnerships often have a psychiatric history, and may be incapable of providing protection to the child.

  11. Domestic violence. Approximately 50% of female care- givers who maltreat their children have themselves been victims of domestic violence, including physical, sexual, or verbal assault, in the 6 months prior to the child maltreatment.

  Impact of Maltreatment

  During infancy, abuse, neglect, or exposure to interpersonal violence are stressful experiences that can be devastating and may result in pervasive psychological, behavioral, cognitive, and biological deficits. An infant or young child may witness interpersonal violence by being present; or hearing the violence from another room; or seeing bruises, black eyes, broken bones on the caregiver; or by having an incapacitated or unavailable caregiver. Infants and toddlers are more negatively affected when they witness their pri- mary caregiver being threatened or harmed (e.g., being exposed to interpersonal violence) than when they are injured themselves. During infancy, most maltreatment is perpetrated by a caregiver or attachment figure rather than a stranger, and this may have a particularly deleterious impact on the infant. The infant who is maltreated, or is not protected from harm by a caregiver or attachment figure, comes to view the world as unsafe and dangerous; adults as untrustworthy; and the self as unworthy of love, affection, and protection. Such an infant is likely to develop an attach- ment relationship with his or her primary caregiver that is insecure-disorganized. In turn, insecure-disorganized infant–caregiver attachment is linked to the most negative socioemotional outcomes and the most severe forms of

  Abuse, Neglect, and Maltreatment of Infants dissociation, difficulty regulating and expressing negative emotions, low self-esteem, and poor school achievement). There is growing evidence to suggest that emotional abuse and neglect, including exposure to interpersonal violence, can create even more harmful consequences for the child’s functioning and outcome than physical and sexual abuse. Chronic childhood trauma interferes with the capacity to integrate and process sensory, cogni- tive, and emotional information and sets the stage for unfocused and maladaptive responses to subsequent stress. Long-term maltreatment has more pervasive effects than single-incident traumas.

  Impact on Brain and Development There is considerable evidence to indicate that maltreat- ment experiences in the early years have a profound effect on the developing brain, affecting both acute and long-term development of neuroendocrine, cognitive, and behavioral systems. Alterations in the central neurobiological systems that occur in response to adverse early-life stress lead to increased and abnormal responsiveness to stress, increase the risk of psychopathology in both childhood and adult- hood, and can lead to lifelong psychiatric sequelae such as mood disorders and anxiety disorders (e.g., generalized anxiety disorder, post-traumatic stress disorder (PTSD), and panic disorder). The association between childhood trauma and the development of mood and anxiety disorders may be mediated by changes in the same neurotransmitter and endocrine systems that modulate the stress response and are implicated in adult mood and anxiety disorders

  

  The impact of early adversity may differentially affect individuals; some people with a history of severe maltreatment are well adjusted, while others manifest more profound developmental and psychiatric consequences.

  This likely has to do with complex gene–environment inter- actions which are only beginning to be delineated. One theory underlying the relation between genetic predisposi- tion to major psychiatric disorders and the impact of early traumatic experiences during critical phases of develop- ment is that persistent changes occur in specific neuro- biological systems in response to early stress, which later mediate adaptation to subsequent stressful life events and mood and anxiety symptoms. Specifically, stress has a major impact on the hypothalamic–pituitary–adrenal (HPA) axis, which is one of the two stress response systems of the body and consists of the hypothalamus, the pituitary gland, and the adrenal glands ). The HPA axis activates and coordinates the stress response by receiving and interpret- ing information from other areas of the brain (amygdala and hippocampus) and from the autonomic nervous system. In response to acute situations of stress, a hormonal cas- cade is triggered with the release of corticotropin-releasing hormone (CRH) from the hypothalamus, which stimulates the release of adrenocorticotropin-releasing hormone (ACTH) from the pituitary gland. ACTH then triggers the production of cortisol within the adrenal cortex which is secreted into the blood circulation. Cortisol then provides negative feedback at the level of the hypothalamus, the pituitary, and the hippocampus, thereby shutting off the stress response. This sequence of hormonal responses and negative feedback allows humans to deal with experi- ences of stress in ways that allow them to recover from stressful events.

  There is empirical evidence to suggest that following early-life stress, the set point of HPA-axis activity in response to stress is permanently altered so that subsequent adaptation to stressful situations throughout the lifespan may be affected. In other words, infants who are maltreated and traumatized might later react with overwhelming stress to innocuous or mildly stressful events. There is also evidence to suggest that early-life stress is related to persistent sensitization of pituitary–adrenal and auto- nomic stress responses, most likely caused by CRH hyper- secretion, and may increase risk for psychopathology during adulthood. For example, research shows the impli- cation of the CRH system in adult mood and anxiety disorders. This is because the HPA axis is involved not only in the stress response but also in the development of mood and anxiety disorders. Dysregulation of the CRH and the other downstream hormones (ACTH and cortisol;

  

  ) may explain the symptoms of increased vigi- lance and enhanced startle response observed in patients with anxiety disorders, such as PTSD, and may in part explain the high incidence of comorbid anxiety and mood disorders. It is important to note that most clinical studies

  Stress Brain Negative feedback

  Pituitary gland Adrenal gland Hippocampus Hypothalamus

  CRH ACTH Cortisol Figure 1 The hypothalamic–pituitary–adrenal (HPA) axis.

  Abuse, Neglect, and Maltreatment of Infants Abuse, Neglect, and Maltreatment of Infants