CHAPTER-1(INTRODUCTION)

1.1. INTRODUCTION/BACKGROUND

Child abuse or child maltreatment is physical, sexual, and/or psychological maltreatment

or neglect of a child or children, especially by a parent or a caregiver. Child abuse may
include any act or failure to act by a parent or a caregiver that results in actual or potential
harm to a child, and can occur in a child's home, or in the organizations, schools or
communities the child interacts with. Definitions of child maltreatment can vary across
the sectors of society which deal with the issue, such as child protection agencies, legal
and medical communities, public health officials, researchers, practitioners, and child
advocates. Since members of these various fields tend to use their own definitions,
communication across disciplines can be limited, hampering efforts to identify, assess,
track, treat, and prevent child maltreatment( Bonnie , Steven 2010).

In general, abuse refers to (usually deliberate) acts of commission while neglect refers to
acts of omission . Child maltreatment includes both acts of commission and acts of
omission on the part of parents or caregivers that cause actual or threatened harm to a
child. Some health professionals and authors consider neglect as part of the definition of
abuse, while others do not; this is because the harm may have been unintentional, or
because the caregivers did not understand the severity of the problem, which may have
been the result of cultural beliefs about how to raise a child. Delayed effects of child
abuse and neglect, especially emotional neglect, and the diversity of acts that qualify as
child abuse, are also factors ( Friedman , Billick: June 2015).

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While studying in this subject we get to know a different types of abuse suffered by an child
each and every years and such types are as followed;

1) Physical abuse

Physical abuse often does not occur in isolation, but as part of a constellation of behaviors
including authoritarian control, anxiety-provoking behavior, and a lack of parental warmth. The
WHO defines physical abuse as: Intentional use of physical force against the child that results
in – or has a high likelihood of resulting in – harm for the child's health, survival, development
or dignity. This includes hitting, beating, kicking, shaking, biting, strangling, scalding, burning,
poisoning and suffocating. Much physical violence against children in the home is inflicted with
the object of punishing (World Health Organization and International Society for Prevention of
Child Abuse and Neglect 2006).

As of 2006, for instance, Paulo Sergio Pinheiro wrote in the UN Secretary-General's Study on
Violence Against Children: Corporal punishment involves hitting ('smacking', 'slapping',
'spanking') children, with the hand or with an implement – whip, stick, belt, shoe, wooden spoon,
etc. But it can also involve, for example, kicking, shaking or throwing children, scratching,
pinching, biting, pulling hair or boxing ears, forcing children to stay in uncomfortable positions,
burning, scalding or forced ingestion (for example, washing children's mouths out with soap or
forcing them to swallow hot spices( Pinheiro 2006).

2) Sexual abuse

Sexual abuse refers to the participation of a child in a sexual act aimed toward the physical
gratification or the financial profit of the person committing the act (Theoklitou, Kabitsis,
Kabitsi 2012).

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Effects of child sexual abuse on the victim include guilt and self-blame, flashbacks, nightmares
insomnia, fear of things associated with the abuse (including objects, smells, places, doctor's
visits, etc.), self-esteem difficulties, sexual dysfunction, chronic pain, addiction, self-injury,
suicidal ideation, somatic complaints, depression, post-traumatic stress disorder, anxiety, other
mental illnesses including borderline personality order and dissociative identity disorder (Coons
August 1994)., propensity to re-victimization in adulthood, bulimia nervosa, and physical injury
to the child, among other problems. Children who are the victims are also at an increased risk of
sexually transmitted infections due to their immature immune systems and a high potential for
mucosal tears during forced sexual contact. (Thornton.; Veenema 2015).

3) Psychological abuse

There are multiple definitions of child psychological abuse:

 In 2013, the American Psychiatric Association (APA) added Child Psychological Abuse
to the DSM-5, describing it as "non-accidental verbal or symbolic acts by a child's parent
or caregiver that result, or have reasonable potential to result, in significant psychological
harm to the child."( Donald,1 February 2014).

 In 1995, APSAC defined it as: spurning, terrorizing, isolating, exploiting, corrupting,

denying emotional responsiveness, or neglect" or "A repeated pattern of caregiver
behavior or extreme incident that convey to children that they are worthless, flawed,
unloved, unwanted, endangered, or only of value in meeting another's needs (John E.B
2011).

In 2014, the APA (American Psychiatric Association) stated that:

 "Childhood psychological abuse as harmful as sexual or physical abuse."

 "Nearly 3 million U.S. children experience some form of [psychological] maltreatment
annually."

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  Psychological maltreatment is "the most challenging and prevalent form of child abuse
and neglect."

In 2015, additional research confirmed these 2014 statements of the APA ( Loudenback,25
October 2015).

Victims of emotional abuse may react by distancing themselves from the abuser, internalizing
the abusive words, or fighting back by insulting the abuser. Emotional abuse can result in
abnormal or disrupted attachment development, a tendency for victims to blame themselves
(self-blame) for the abuse, learned helplessness, and overly passive behavior.

4) Neglect

Child neglect is the failure of a parent or other person with responsibility for the child, to provide
needed food, clothing, shelter, medical care, or supervision to the degree that the child's health,
safety or well-being may be threatened with harm. Neglect is also a lack of attention from the
people surrounding a child, and the non-provision of the relevant and adequate necessities for the
child's survival, which would be a lack of attention, love, and nurturing ( Theoklitou , Kabitsis ,
Kabitsi ,2012).

Some observable signs of child neglect include: the child is frequently absent from school, begs
or steals food or money, lacks needed medical and dental care, is consistently dirty, or lacks
appropriate clothing for the weather.

Neglectful acts can be divided into six sub-categories (Australian Institute of Family Studies,
September 2015):

 Supervisory neglect: characterized by the absence of a parent or guardian which can lead
to physical harm, sexual abuse, or criminal behavior;

 Physical neglect: characterized by the failure to provide the basic physical necessities,
such as a safe and clean home;

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  Medical neglect: characterized by the lack of providing medical care;
 Emotional neglect: characterized by a lack of nurturance, encouragement, and support;
 Educational neglect: characterized by the caregivers lack to provide an education and
additional resources to actively participate in the school system; and

1.2 STATEMENT OF THE PROBLEM

Children are the pillar of the future but many of them get abused and victims which leads
country as more undeveloped. Child abuse is highly debate problem which solutions are still
needed to find out.

Some of the reasons behind the child abuse is:

 isolation and lack of support - when there is no one, such as extended family, friends, a
partner or community support to help with the demands of parenting
 stress - financial pressures, job worries, medical problems or taking care of a family
member with a disability can increase stress and overwhelm parents
 unrealistic expectations - lack of understanding of a child or young person's
developmental stages and behavior.
 lack of parenting skills - not knowing how to help children and young people learn, grow
and behave in a positive way
 drug and alcohol problems - addiction or substance abuse may limit a parent's ability to
meet their children's needs
 low self esteem and self confidence - sometimes insecure parents doubt their ability to
meet their child's needs and do not seek help and support
 Past childhood experiences - parents may have experienced abuse as a child in their own
families, which could have caused them to develop an insecure attachment style.

Community attitudes are also a contributing factor to child

abuse. There is still some acceptance in the community for the use of physical force for the
purposes of discipline and punishment of children and young people.
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Attitudes vary across different communities and those that can inadvertently support abuse
include:

a. acceptance of the use of violence and force

b. acceptance of physical punishment of children and young people
c. acceptance of parents 'ownership' of children and young people and their right to treat
children and young people as they see fit
d. racism
e. inequality between men and women
f. lack of community understanding about the consequences of harm experienced in
childhood(Department of child safety, youth and women, Feb 2 2020)

Similarly, some of the consequences of child abuse are :

a) Medical and Physiological Consequences

Abuse and neglect may result in serious health
problems that can adversely affect children's development and result in irremediable lasting
consequences. Early studies of physically abused children documented significant neuro-motor
handicaps, including central nervous system damage, physical defects, growth and mental
retardation, and serious speech problems (Elmer; and Gregg, 1967).

b) Cognitive and Intellectual Consequences

Some consequences of abused child is problematic school performance (e.g., low grades, poor
standardized test scores, and frequent retention in grade) is a fairly consistent finding in studies
of physically abused and neglected children (Eckenrode, J., M. Laird, and J. Doris
1991) , with neglected children appearing the most adversely affected. The findings for sexually
abused children are inconsistent.
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c) Psychosocial Consequences

Sexually abused children, particularly those abused by a family member, may show high levels

of dissociation, a process that produces a disturbance in the normally integrative functions of

memory and identity . Many abused children are able to self-hypnotize themselves, space out,

and dissociate themselves from abusive experiences (Kluft, 1985).

In some clinical studies, severely abused children appear to be impervious to pain, less
empathetic than their non-abused peers, and less able than other children to put their own
suffering into words (Barahal ,R.M 1981).

1.3 MAGNITUDE OF PROBLEM

Child maltreatment is a global public health problem. There is limited information about this
problem in low-income countries. We aimed to document the prevalence and factors associated
with physical punishment of children less than 14 years of age in Nepal. Study design:
Population-based cross-sectional study. Methods: We conducted an in-depth analysis using data
from the Nepal Multiple Indicator Cluster Survey, a nationally representative multi-stage-
stratified cluster sampling survey. Data were collected from 13,000 households in 520 sample
enumeration areas.

We assessed prevalence of physical punishment and different child violence related acts on 5081
children aged 3-14 years for whom complete information on all acts and attitude towards
violence was available. Logistic regression was used to investigate the association between
physical punishment of child and factors such as household and maternal demographics. Results:
Our results suggested violence is common across Nepal, with data showing one in every second
child is physically punished. One in every third (33%) of children were spanked, hit or slapped
on the bottom, 25% were hit or slapped on the face and approximately 3% were beaten up hard.

Odds of facing physical punishment were higher among children aged 3-5 years (odds ratio [OR]
2.9, 95% confidence interval [CI]: 2.0-4.3), aged 6-8 years (OR 2.8, 95% CI: 2.2-3.7), engaged
in child labour activities (OR 1.4, 95% CI: 1.1-1.7), with mother that accepted wife beating by
husband is justified (OR 1.2, 95% CI: 1.1-1.4), whose father is currently abroad (OR 1.5, 95%
CI: 1.2-1.9) and whose father is away from home but in the same country (OR 1.60, 95% CI:
1.1-2.3).

The risk was also higher among children living in households that believe physical punishment
of children is necessary (OR 3.5, 95% CI: 2.9-4.3) and from lower caste/indigenous
(dalit/janajati) ethnicity (OR 1.3, 95% CI: 1.1-1.7). Those less likely to experience physical
punishment included female children (OR 0.7, 95% CI: 0.6-0.9) and children with an older
mother (34-49 years; OR 0.5, 95% CI: 0.3-0.9). Conclusions: Our results suggest that physical
punishment of children is common across Nepal with varying severity. Prevention efforts should
focus on designing and promoting interventions that support parents to adapt alternative forms of
parenting practices.(Child maltreatment in Nepal; October 2017).

Nearly 700,000 children are abused in the U.S each year. An estimated 678,000 children (unique
incidents) were victims of abuse and neglect in 2018, the most recent year for which there is
national data. That’s about 1% of kids in a given year. However, this data may be incomplete,
and the actual number of children abused is likely underreported.
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Fig; Child Advocacy Center statistics regarding child abuse

CAC’s( CHILD ADVOCACY CENTER) help abused children each year to recover them such
like:

 CACs serve more than 370,000 kids each year, helping them to recover.  In 2019,
Children’s Advocacy Centers around the country served some 371,060 child victims of
abuse, providing victim advocacy and support to these children and their families.

 CACs heal more than 200,000 kids each year. Our members offer 210,113 kids science-
backed counseling and therapy services to help them recover from trauma and avoid the
lifelong impacts of trauma.

 Kids with problem sexual behaviors get help at CACs. Treatments offered for children
and youth with problematic sexual behaviors are successful; after treatment, 98% never
go on to hurt another child.
  CACs educate more than 2 million people each year, helping prevent abuse. We provided
2,294,935 people with abuse prevention education in 2019, up 288% in the past decade.
(National Children’s Alliance 2019;Carpentier, Silovsky & Chaffin 2006).

 1.4 HISTORY

The whole of recorded history contains references to acts that can be described as child abuse or
child maltreatment, but professional inquiry into the topic is generally considered to have begun
in the 1960s (McCoy.; Keen 2013). Two centuries ago,cruelty to children, perpetrated by
employers and teachers, was widespread, and corporal punishment customary in many countries.
But, in the first half of the 19th century, pathologists studying filicide (the parental killing of
children) reported cases of death from paternal rage The July 1962 publication of the paper "The
Battered Child-Syndrome" authored principally to pediatric psychiatrist C. Henry Kempe and
published in The Journal of the American Medical Association represents the moment that child
maltreatment entered mainstream awareness. Before the article's publication, injuries to children
—even repeated bone fractures—were not commonly recognized as the results of intentional
trauma. Instead, physicians often looked for undiagnosed bone diseases or accepted parents'
accounts of accidental mishaps such as falls or assaults by neighborhood .

The study of child abuse and neglect emerged as an academic discipline in the early 1970s in the
United States. Elisabeth Young-Bruehl maintains that despite the growing numbers of child
advocates and interest in protecting children which took place, the grouping of children into "the
abused" and the "non-abused" created an artificial distinction that narrowed the concept of
children's rights to simply protection from maltreatment, and blocked investigation of the ways
in which children are discriminated against in society generally. Another effect of the way child
abuse and neglect have been studied, according to Young-Bruehl, was to close off consideration
of how children themselves perceive maltreatment and the importance they place on adults'
attitudes toward them. Young-Bruehl writes that when the belief in children's inherent inferiority
to adults is present in society, all children suffer whether or not their treatment is labeled as
"abuse"(Young-Bruehl ,2012).

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1.5 LITERATURE REVIEW

Children are our future, yet we still resist knowing historically what we have done to create the
future. We deny knowing about child-hood, because then we might have to face how we have
treated our future. (H. Lawton, 1988)

This review of the literature is related to children who have experienced the effects of trauma due
to maltreatment. The literature review is broken down into five parts. First, different types of
maltreatment children experience will be described. Second, the prevalence of maltreatment will
be presented. Third, the physical, psychosocial, and behavioral effects of maltreatment will be
discussed. Fourth, implications of maltreatment for schools are explained, including the
cognitive, social, emotional, and behavioral implications. Fifth, common treatments for
maltreatment and its resulting trauma are described. These five areas were selected for the
literature review to provide a comprehensive overview of child maltreatment and the challenges
presented as a result of its resulting trauma.

TYPES OF MALTREATMENT

1. Sexual abuse( Sneddon 2003)

2. Emotional abuse (Haugaard, 2000).

3. Physical abuse (Sneddon, 2003).

PREVALENCE OF CHILD ABUSE

In prevalence of child abuse the Child Maltreatment Report is completed by the National Child
Abuse and Neglect Data System (NCANDS), based on annual data collected from Child
Protective Services (CPS). These measurements assessed victimization, parenting behavior,
parent conflict, parental dysfunction, family adversity, residential stability, family risk index,
trauma symptoms, and demographics. Based on their findings, the largest majority of
maltreatment perpetrators were parent. The prevalence of child maltreatment can be affected by
parenting style. Hostile and inconsistent parenting is the strongest predictor of child

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symptomatology related to maltreatment (Turner et al., 2012). Turner and colleagues conducted
their study using 2,017 children, ranging in age from two to nine years old. Nine measurements
were used and correlations were computed to draw conclusions about the association of
parenting style and prevalence of maltreatment.

EFFECTS OF ABUSE

Maltreatment and its resulting trauma have serious effects on children’s health and development,
leaving both long and short-term emotional and behavioral difficulties. Children who have been
diagnosed with PTSD(posttraumatic stress disorder) may develop psychiatric or medical
conditions as a result of maltreatment (Cohen, Berliner, & Mannarino, 2010)

A. Physical effects of maltreatment.

In a review of the research, (Cohen, Perel, DeBellis, Friedman, and Putnam (2002) described the
physical problems associated with PTSD as a result of maltreatment. It can cause a child’s stress
adaptation systems to be overwhelmed, resulting in overstimulation of the amygdala which may
explain recurrent traumatic memories and excessive fear and emotional memory processing,
increased dopamine levels contributing to overgeneralized fear, hyper vigilance, and paranoia.

B. Psychosocial effects of maltreatment.

In addition to physical health problems, children who have experienced maltreatment may
display a variety of psychosocial problems. (Marquis, Leschied, Chiodo, and O’Neill (2008)
found that these children have impaired interpersonal relationships with peers and adults and
intense feelings of rejection.

C. Behavioral effects of maltreatment.

Marquis et al. (2008) found that maltreatment may lead to higher rates of conduct problems,
physical and verbal aggression towards peers and adults, and noncompliance.

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IMPLICATION OF ABUSE

Those children who get abused have a problems in school , family and society as a result they
become slow learner , difficulty to make friends, loneliness, lower achievement.( Frederick and
Goddard (2010) . Cognitive effects are evident in a child’s ability to function academically in the
school setting( Putnam (2009). However ,a child who get maltreated are not able to express their
emotional bond with others and causes of self- esteem.

The main purpose of all these review is to give a particular questions answer i-e (1) Is there
sufficient data examining child maltreatment? (2) What areas of child maltreatment have studies
addressed? (3) What areas of child maltreatment require additional research? (4) Does the
research on child maltreatment provide guidance on implementing strategies in schools that may
provide positive outcomes for child maltreatment victims?

METHODS

The purpose of this thesis is to conduct a critical and descriptive review of the research, based on
treatment studies, specifically related to children who have experienced trauma due to
maltreatment—whether because of physical, sexual, emotional, or psychological abuse and
neglect, their effects on children, and the potential impact in school and how educational
personnel can support the needs of these students.

This chapter presents the methods used to obtain articles for this research study. First, an
explanation is provided of how studies were identified and selected for inclusion in this study,
including eligibility criteria, sources of information, search terms, and study selection. Second,
an explanation of the coding procedures used to organize specific elements of each study is
described. These coding categories included the type of maltreatment, participant characteristics,
the research setting, the study design, treatment approaches and length, outcome measures, and
whether the intervention has been used, and implemented, in schools by educators. These areas
were selected in order to develop a comprehensive understanding of the treatment based studies
with children who had experienced maltreatment, in order to obtain or expand upon strategies, to
provide applications for use in the school setting.
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STUDY IDENTIFICATION AND SELECTION
A systematic search was performed to collect data based research studies related to child
maltreatment and the treatments aimed to mediate the effects of this maltreatment.
1. Eligibility criteria
Here, for specific research different published articles has included i-e Post Traumatic
Stress Disorder (PTSD) was added to the Diagnostic and Statistical Manual of Mental
Health Disorders, third edition (DSM-III). As well as different participants have included
who have suffered the same abuse in childhood. However , a deep study of method helps
to identify the strategies for those children who studied at school.
2. Search terms
During multiple searches, a variety of search terms were used in conjunction with the
previously stated parameters to obtain studies. Searches were conducted using the
following Boolean phrases: abuse and neglect, child abuse, childhood, childhood trauma,
effects of child maltreatment, impact of childhood trauma, implications of childhood
maltreatment, maltreatment, neglect, trauma, and treatment.
3. Study selection
Initial searches produced 1,886 articles. Article screening was conducted by reading
titles and abstracts to see if the article met the study criteria. Reading the titles and
abstracts of the studies excluded a majority of the studies initially found. The remaining,
approximately 200 articles, were completely read and studies were selected that met the
inclusion criteria. These studies included (a) children, ranging in age from pre-school to
high school or two to eighteen years old, (b) the children experienced the maltreatment
 during childhood, (c) a treatment approach was used in the study to address the effects of
the maltreatment, and (d) a publication date 1980 or later. Based on the inclusion criteria,
1,873 articles were excluded because they did not meet all of the inclusion criteria.

CODING PROCEDURES
All of the articles obtained from the search were coded using four categories:
(a) Type of maltreatment: The category include a different types of abuse i-e sexual,
mental, emotional.
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(b) Settings : The settings includes households, classroom, society, hospital

(c) Study design : These design features included research study, randomized
controlled trial, and randomized effectiveness trial. According to the (What
Works Clearinghouse (2003), group design studies should incorporate three
indicators in order to meet the “gold standard” criteria for an evidence-based
practice. These indicators include using a randomized control trial study design,
including at least 300 participants (at least 150 in each the control and treatment
groups), and the intervention was implemented in at least two settings. In terms
of single case design, (Horner et al. (2005) outlined seven indicators for single
subject studies. Each indicator had at least one descriptor, with as many as five,
to describe specific study elements and criteria that would support meeting the
indicator criteria
(d) Treatment approaches: Treatment approaches were coded using the following
categories: (i) cognitive approaches, (ii) family approaches, (iii)
psychotherapeutic approaches, and (iv) social treatment approaches.
STRATEGIES.
One strategy for identifying new adaptive thoughts is illustrating a person with a thought bubble
and brainstorming new thought options to replace previous maladaptive thoughts. Students must
be taught how to replace maladaptive thoughts in order for the positive ones to be internalized.
While the adult support is being faded away, self-monitoring can be used to continue to support
the child in thinking the new positive thoughts. One challenge to this approach is that a child’s
cognitive distortions can interfere with these processes, making it difficult for a student to see his
or her actions realistically. Therefore, the adult may have to scaffold supports or help the child
address the maladaptive thoughts prior to using self-instruction or self-regulation strategies
(Mayer et al., 2005 )

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LIMITATIONS
There are several limitation, first is none of the studies has met all quality indicators outlined for
group and single case research as well as some of studies have met its criteria but not all of them.
The one single case design study did not meet any of the quality indicators for experimental
control, potentially impacting the application of the results of that particular intervention since
additional variables or factors were not necessarily considered or controlled. The prevalence of
child maltreatment and attention given to it far exceeds its body of treatment research.

1.6 CAUSE AND EFFECTS

A) Causes of child abuse

Child abuse is a complex phenomenon with multiple causes( Fontana October 1984) The World
Health Organization (WHO) and the International Society for Prevention of Child Abuse and
Neglect (ISPCAN) identify multiple factors at the level of the individual, their relationships,
their local community, and their society at large, that combine to influence the occurrence of
child maltreatment.

1. Especially , society cultural norms like harsh physical punishment of children, economic
inequality, and the lack of social safety nets.
2. Children with moderate or severe disabilities are more likely to be victims of abuse than
non-disabled children (Jone , Bellis , Wood, et al. 8 September 2012)
 3. Unemployment and financial difficulties are associated with increased rates of child
abuse.

4. Parental mental health has also been seen as a factor towards child maltreatment.
According to a recent Children’s Health Watch study, mother's positive symptoms of
depression display a greater rate of food insecurity, poor health care for their children,
and greater number of hospitalizations.( Casey; Goolsby; Berkowitz; Frank; Cook; Cutts;
Black.; Zaldivar; Levenson (February 2004).

B) Effects of child abuse

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Child abuse can result in immediate adverse physical effects but it is also strongly associated
with developmental problems and with many chronic physical and psychological effects,
including subsequent ill-health, including higher rates of chronic conditions, high-risk health
behaviors and shortened lifespan( Middlebrooks.; Audage. (2008).

Maltreated children may grow up to be maltreating adults. A 1991 source reported that studies
indicate that 90 percent of maltreating adults were maltreated as children. Almost 7 million
American infants receive child care services, such as day care, and much of that care is poor
(Cohn Jonathan (2011)

I. Emotional

Child abuse can cause a range of emotional effects. Children who are constantly ignored,
shamed, terrorized or humiliated suffer at least as much, if not more, than if they are physically
assaulted. According to the Joyful Heart Foundation, brain development of the child is greatly
influenced and responds to the experiences with families, caregivers, and the community. Abused
children can grow up experiencing insecurities, low self-esteem, and lack of development. Many
abused children experience ongoing difficulties with trust, social withdrawal, trouble in school,
and forming relationships( American Humane Association 2015)

II. Physical
The immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or
severe (broken bones, hemorrhage, or even death). In some cases the physical effects are
temporary; however, the pain and suffering they cause a child should not be discounted. Rib
fractures may be seen with physical abuse, and if present may increase suspicion of abuse, but
are found in a small minority of children with maltreatment-related injuries (Kemp, Dunstan ,
Harrison, Morris, Mann , Rolf , Datta , Thomas, Sibert , Maguire(2008).

The long-term impact of child abuse and neglect on physical health and development can be:

 Shaken baby syndrome

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 Impaired brain

 Poor physical health

 Exposure to violence during childhood is associated with shortened telomeres and with
reduced telomerase activity

III. Psychological

Children who have a history of neglect or physical abuse are at risk of developing psychiatric
problems, or a disorganized attachment style. In addition, children who experience child abuse or
neglect are 59% more likely to be arrested as juveniles, 28% more likely to be arrested as adults,
and 30% more likely to commit violent crime A study by Dante Cicchetti found that 80% of
abused and maltreated infants exhibited symptoms of disorganized attachment.

1.7LAWS AND POLICIES

Certain policies in Nepal against child abuse is mentioned below:

A. Right to live:
(1) Every child shall have the right to live with dignity.

(2) The Government of Nepal, Province Government and Local Level shall take necessary
measures required for preventive and security service including prevention of possible accidents,
minimization of risks that may occur on the children, in order to protect the rights of the child to
live and development.

B .Right against discrimination:

(1)No discrimination shall be made against any child on grounds of religion, race, caste, tribe,
sex, origin, language, culture, ideological thought, physical or mental condition, physical
disability, marital status, family status, employment, health condition, economic

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or social condition of him or her or his or her family or guardian, geographical area or
similar other ground.

(2) No one shall discriminate between son and daughter, son and son or daughter and daughter or
children from ex-husband or wife or present husband or wife in maintenance, education or health
care of children.

C. Right to education:

(1) Children below six years of age shall have the right to learn in a proper way according to
their age and level of development and to pre-child development.

(2) Every child shall have the right to acquire free and compulsory education upto the basic level
and free education upto the secondary level pursuant to the prevailing law in a child friendly
environment.

(3) Dalit children shall have the right to acquire free education with scholarship pursuant to the
prevailing law.( Nepal Law Commission, The Act Relating to Children 2075(2018).
 D. Provincial and Local Level Child Rights Committee:

(1) There shall be a Provincial Child Rights Committee in each Province, to be chaired by the
Minister of the Province overseeing the matters relating to children.

(2) There shall be a Local Child Rights Committee in each Local Level, to be chaired by a
Member of the Rural Municipality or Municipality designated by the Vice-Chairperson or
Deputy-Mayor of such Rural Municipal Executive or Municipal Executive respectively.

E. Local Level to enforce the rights of the child:

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(1) If a person violates the rights of a child referred to in Chapter 2 or does not fulfil his or her
liabilities towards the child referred to in Chapter 3, the concerned child or the stakeholder may
file an application with the judicial committee of the Local Level where the child is residing, for
the enforcement of such rights or liabilities.

(2) If, in making inquiry pursuant to sub-section (2), it appears that the person concerned has
violated the rights of the child or has not fulfilled her or his liabilities towards the child, the
judicial committee shall, within thirty days of the receipt of the application, order the person,
organization or agency concerned at the Local Level to enforce the rights of the child or fulfil the
liabilities towards the child.

F. Punishment:

(1) If any person, organization or body violates any of the child rights set forth in Chapter-2 or
does not fulfil any of the liabilities towards the child set forth in Chapter-3, such a person or the
chief of such organization or body shall be liable to a fine of up to fifty thousand rupees.

(2) If the guardian or any family member does not fulfil his or her liabilities or if the mother,
father or guardian alters the name and surname of the child with the intention of acquiring undue
benefits or misappropriates the child’s property, such a mother, father or family member or
guardian shall be liable to a fine of up to one hundred thousand rupees.

G. Compensation:

(1) The juvenile court shall cause the recovery of such a reasonable compensation in lump sum
or instalments from the offender to the victim child that is not less than the amount of fine
imposed on the offender committing the offence against the child under this Act and the
prevailing law, having regard to, inter alia, the loss caused to the education, and physical and
mental health, development and family of the child victim. ( Nepal Law Commission, The Act
Relating to Children 2075(2018).

1.7EFFORTS MADE BY NGOs/ INGOs AND GOVERNMENT

20

Some efforts made by an government and NGOs/INGOs against child abuse are:

1. Protection of Children from Sexual Offence (POCSO) Act

The 2012 Protection of Children from Sexual Offence (POCSO) Act enables fast-tracking and
efficient prosecution in rape law (Section 376), which previously allowed child molesters a legal
loophole.

POSCO lays down a seven years prison term that can extend to life imprisonment. The Act
necessitates cases to be resolved in 60 days. From harassment to gang-rape, all sexual crimes
against children fall under POCSO, which takes the child's verdict as the final word. POCSO
makes it illegal to witness and not report child abuse, either by phone or in person, and police
officers must bring cases to the attention of Child Welfare Committee within 24 hours.

2. Corporate Social Responsibility

The Companies Act (2013) has established the essence of corporate social responsibility in India.
According to the Act, companies with a net worth of rupees 500 crores or more, or a turnover of
rupees 1,000 crores or more, or earning a net profit of rupees 5 crores or more must invest on
corporate social responsibility.

Across 120 countries, child rights NGO Save the Children works with corporates on of child-
development issues and gives companies clear and measurable impact on their investments.  The
NGO has streamlined processes to plan, monitor and report large-scale programmes to provide
aid and relief to children (Save the children, 2 November 2016).

3. Increasing services to families such as home visiting, early childhood education, and
parent education.

Child neglect often occurs when parents are overwhelmed with an array of stressors, including
the difficulties of coping with poverty and its many associated burdens, single parenthood,
limited parenting skills, depression, substance abuse, interpersonal violence, as well as the daily

21

stressors most parents face (DePanfilis 2006). Services such as home visiting, early childhood
education, and parent education provide emotional support, knowledge, and guidance on how to
provide a nurturing environment for children. In addition, ensuring that all children have a
quality education will help ensure this important need is met. Other services can assist potential
parents in considering their readiness for a family, the number of children they wish to have, and
appropriate spacing between births. These services can also help parents effectively care for the
children they already have. In sum, services that strengthen families and support parents should
in turn enhance children’s development, health and safety, and help prevent child neglect.

4. Providing mental health services to parents and neglected children and youth.

Many neglected children have parents who are emotionally unstable or depressed. Mental health
services can assist such parents to become emotionally healthier and better able to adequately
care for their children. In addition, children often face adverse and potentially long-
term psychological consequences due to neglect. Mental health services, especially at an early
point, can help mitigate these consequences and can help ensure that neglect is not transmitted to
the next generation.

5. Ensuring access for all children to affordable, quality health care, including prenatal,
dental, and mental health services.

Access to health care is critical to child and family well-being and helps protect against neglect.
Without health insurance, families are less likely to seek timely and preventive health care.
When they do, the cost of that care contributes to a family’s economic insecurity. Both of these
are risk factors for neglect. In addition, children’s health care providers are a valuable source of
support and advice for parents as they raise their children. They inform parents about community
resources such as home visiting programs and parent support groups that can help prevent child
abuse before it happens and provide information about child development and strategies for
dealing with a variety of parenting challenges. Hence, these are the efforts made by an
government and NGOs in different countries including Nepal.

22

1.8CASE STUDY

Case – I
Six year-old girl, the second of four children in her family, was brought to the University Medical
School Hospital by her stepmother with loss of consciousness and a story of falling from a sofa.
Physical examination revealed absence of pupillary light reflex with fixed, dilated pupils, and
absence of breathing and pulse. She was intubated but did not respond to cardiopulmonary
resuscitation. She was pronounced dead after thirty minutes of resuscitation. Postmortem
examination of the child was performed one day after death, which revealed numerous different
colored old and new bruising between 0.5-1 cm on her neck, chest, back, and lower extremities, a
red-purple old bruise of 1 cm over her right eyebrow, another red-purple old bruise of 0.5 cm on
the right side of her forehead, and an old wound with dried scabbing of 6 cm at the back of her left
shoulder. In internal examination, there was a widespread red new ecchymosis on the internal
surface of her occipital scalp and over the vertex, and a linear occipital fracture. There were also
 occipital subdural hemorrhage, subarachnoidal hemorrhage at the left temporal lobe, and brain
edema. The cross sections of her lungs were edematous, and there was a laceration at the right
renal capsule. The cause of death was brain damage due to blunt head trauma. The eyes were not
removed for retinal examination. Forensic report was filed with the police department.At the end of
the forensic investigation, her stepmother confessed that she slammed the child against a wall
because of bedwetting. After the stepmother hit the children head against the wall, she also kicked
her until the child became unconscious. To resuscitate her,stepmother took her to the bathroom,
shook her by the shoulders and wetted her head by the use of a hose. The girl slipped from her
hand and hit her head against the wall again, which started wheezy breathing but she did not gain
consciousness. The stepmother was convicted with involuntary manslaughter in Criminal Court.
On appeal, seven months later, she was acquitted. There was no report filed with Child Protective
Services. None of the other siblings was assessed for possible abuse. No expert witness was invited
to trial.

Source: Middle East Journal of Family Medicine

23
 Case – II

Two and a half year-old male, youngest child of a family with four children was brought to the
emergency room of a University Medical School Hospital because of bleeding from the right ear
and projectile vomiting after falling from a top bunk bed. Physical examination revealed no
abnormalities except for bleeding from the right ear. He was observed for 24 hours after his vital
signs were stabilised and was discharged to his parents with a diagnosis of head injury. Six days
later, he returned to the same hospital complaining of right facial asymmetry while talking.
Physical examination revealed superior posterior tympanic hematoma in the right ear.
Computerised tomography (CT) of the head verified the tympanic hematoma and revealed right
temporal linear fracture. Treatment for right peripheral facial paralysis was prescribed and he was
again discharged to his parents. Four months later, he returned to the hospital for a third visit
because of falling from a balcony, a distance of 3-4 meters. Physical examination revealed, left
peri-orbital edema and red fresh bruising, superficial abrasions over the right temple and cheek, and
deformity and pain on palpation of the left forearm, all of which indicated acute trauma. X-ray of
the left forearm revealed acute spiral fracture of the ulna and the radius. His abrasions were
dressed, and his forearm was cast in the emergency room. Since the attending physician suspected
inflicted trauma, hospitalisation was suggested. The father refused hospitalisation and discharged
his son against medical advice, which prompted a forensic report to the police department. The
father was tried for abusing his son and sentenced to one year, six months of jail time. There was
no report filed with the Child Protective Services. There was no recommendation to assess the other
children in the family, either. No expert witness was invited to trial.

Source: Middle East Journal of Family Medicine

24
 Case - III

Four year-old male child of a family with three children was brought to the University Medical
School Hospital by his father complaining of vomiting after he woke up following a fall six hours
prior to coming to the hospital. His mother and father provided a different fall history. His father
reported the child fell down while walking but his mother reported he fell from a sofa. The
assessment at the emergency room revealed a child in coma with Glascow coma scale of four,
irregular breathing, left midriatic pupil (4 mm), left deviation of the eyes, and hemiparesis on the
right side. The cranial CT revealed 3.5 cm size left-temporo-parietal epidural hematoma. He was
taken to the operating room. Epidural hematoma was drained via left temporal craniectomy. Skeletal
survey and retinal examination were not done. Inconsistent history of trauma prompted a forensic
report to law enforcement. On discharge to his parents, he had residual right upper extremity paresis
and limited medical vision on his left eye.

His father was tried criminally for physically abusing his son. Criminal investigation revealed that
he got annoyed with being interrupted by the child playing near him while he was praying. He
pushed the child toward the wall. The child lost his consciousness subsequent to impact from the
wall. After the father was tried for involuntary child endangerment, he was acquitted. No expert
witness was invited to trial. There was no report filed with Child Protective Services, nor was there
an abuse assessment of the other children of the family.

Source: Middle East Journal of Family Medicine

25
REFRENCE

1. Bonnie S.F; Steven P.L, eds. (2010). Encyclopedia of Victimology and Crime Prevention.

Sage Publications. pp. 86-92

2. Friedman E; Billick S.B (June 2015). "Unintentional child neglect: literature review and

observational study". Psychiatric Quarterly

3. World Health Organization and International Society for Prevention of Child Abuse and

Neglect (2006). "1. The nature and consequences of child maltreatment" (PDF). Preventing

child maltreatment: a guide to taking action and generating evidence. Geneva, Switzerland.

4. Pinheiro, P. S (2006). "Violence against children in the home and family" (PDF). World

Report on Violence Against Children. Geneva, Switzerland: United Nations Secretary-

General's Study on Violence Against Children.

5. Theoklitou D, Kabitsis N, Kabitsi A (2012). "Physical and emotional abuse of primary

school children by teachers". Child Abuse Negl. pp 64–70.

6. Coons, P.M. (August 1994). "Confirmation of Childhood Abuse in Child and Adolescent

Cases of Multiple Personality Disorder and Dissociative Disorder Not Otherwise Specified".

The Journal of Nervous and Mental Disease. 182 (8): 461–4.

7. Thornton, C. P.; Veenema, T. G (2015). "Children seeking refuge: A review of the

escalating humanitarian crisis of child sexual abuse and HIV/AIDS in Latin America".

Journal of the Association of Nurses in AIDS Care. 26 (4): 432–442.

8. Donald Black (1 February 2014). DSM-5 Guidebook: The Essential Companion to the

Diagnostic and Statistical Manual of Mental Disorders,

9. John E. B. Myers (2011). The APSAC Handbook on Child Maltreatment. SAGE Publications

Inc. pp. 126–130

10. Loudenback, J (25 October 2015). "Is Emotional Abuse as Harmful as Physical and Sexual

Abuse?". Chronicle of Social Change. Archived from the original on 22 December 2015.

Retrieved 11 December 2015.

11. .Australian Institute of Family Studies. September 2015. Archived from the original on 15

September 2015.

12. .Elmer, E; and G. Gregg (1967) Developmental characteristics of abused children. Pediatrics

40(4)(October)PP:596-602.

13. . Eckenrode, J; Laird ,M and Doris, J (1991) Maltreatment and Social Adjustment of School

Children. National Center on Child Abuse and Neglect. Grant 90CA1305. U.S. Department

of Health and Human Services, Washington, DC.

14. Kluft, R.P., ed.(1985 )Childhood Antecedents of Multiple Personality. Washington, DC:

American Psychiatric Press.

15. . Barahal, R.M.,(1981) The social and cognitive development of abused children. Journal of

Consulting and Clinical Psychology 53:335-343.

16. Child Maltreatment in Nepal , Occtober 2017; in public health 151: 106-113.
17. .Carpentier, M, Silovsky, J, & Chaffin, M. (2006). Randomized trial of treatment for children

with sexual behavior problems: Ten year follow-up. Journal of Consulting and Clinical

Psychology, 74, 482-488.

18. McCoy, M.L.; Keen, S.M. (2013). "Introduction". Child Abuse and Neglect (2 ed.). New

York: Psychology Press. pp. 3–22.

19. Young-Bruehl, Elisabeth (2012). Childism: Confronting Prejudice Against Children. New

Haven, Connecticut: Yale University Press.

20. H. Lawton, 1988, The Psychohistorian's Handbook, p. 124

21. Child Abuse & Neglect( September 2020). Amanda L. Elmore | Elizabeth Crouch

22. Haugaard, J. (2000). The challenge of defining child sexual abuse. American Psychologist,

55, 1036-1039

23. Sneddon, H. (2003). The effects of maltreatment on children’s health and well-being. Child

Care in Practice, 9, 236-250

24. Turner, H.A., Finkelhor, D., Ormrod, R., Hamby, S., Leeb, R.T., Mercy, J.A., & Holt, M.
(2012). Family context, victimization, and child trauma symptoms: Variations in safe, stable,
and nurturing relationships during early and middle childhood. American Journal of
Orthopsychiatry, 82, 209-219.

25. Cohen, J.A., Berliner, L., & Mannarino, A. (2010). Trauma focused CBT for children with
co-occurring trauma and behavior problems. Child Abuse & Neglect, 34, 215-224.

26. Marquis, R.A., Leschied, A.W., Chiodo, D., & O’Neill, A. (2008). The relationship of child
neglect and physical maltreatment to placement outcomes and behavioral adjustment in
children in foster care: A Canadian perspective. Child Welfare, 87, 5-25
27. Frederick, J., & Goddard, C. (2010). ‘School was just a nightmare’: Childhood abuse and
neglect and school experiences. Child and Family Social Work, 15, 22-30.

28. Putnam, S.E. (2009). The monsters in my head: Posttraumatic stress disorder and the child
survivor of sexual abuse. Journal of Counseling & Development, 87, 80-89.

29. Horner, R.H., Carr, E.G., Halle, J., McGee, G., Odom, S., & Wolery, M. (2005). The use of
single-subject research to identify evidence-based practice in special education. Council for
Exceptional Children, 71, 165-179

30. Mayer, M., Lochman, J., & Van Acker, R. (2005). Introduction to the special issue:
Cognitive-behavioral interventions with students with EBD. Behavior Disorders, 30, 197-
212.

31. Fontana VJ (October 1984). "The maltreatment syndrome of children". Pediatric Annals. 13
(10): 736–44.

32. Jones, L, Bellis, MA, Wood, S et al. (8 September 2012). "Prevalence and risk of violence
against children with disabilities: a systematic review and meta-analysis of observational
studies". The Lancet. 380 (9845): 899–907

33. Casey, Patrick; Goolsby, Susan; Berkowitz, Carol; Frank, Deborah; Cook, John; Cutts,
Diana; Black, Maureen M.; Zaldivar, Nieves; Levenson, Suzette (February 2004). "Maternal
depression, changing public assistance, food security, and child health status". Pediatrics. 113
(2): 298–304.

34. Middlebrooks, J.S.; Audage, N.C. (2008). The Effects of Childhood Stress on Health Across
the Lifespan (PDF). Atlanta, Georgia (USA): Centers for Disease Control and Prevention,
National Center for Injury Prevention and Control. Archived from the original (PDF) on 5
February 2016.
35. Cohn Jonathan (2011). ""The Two Year Window." (Cover story)". New Republic. 242 (18):
10–13. Archived from the original on 10 September 2015.

36. American Humane Association. Archived from the original on 22 April 2015.

37. Kemp AM, Dunstan F, Harrison S, Morris S, Mann M, Rolfe K, Datta S, Thomas DP, Sibert
JR, Maguire S (2008). "Patterns of skeletal fractures in child abuse: systematic review".
BMJ. 337 (oct02 1): a1518.

38. Nepal Law Commission, The Act Relating to Children 2075(2018).

39. Save the Children;2 November 2016

40. DePanfilis, Diane (2006). Child Neglect: A Guide for Prevention, Assessment and
Intervention. Washington, DC: U.S. Department of Health and Human Services,
Administration of Children and Families).

ABBREVIATION

APA: American Psychiatric Association

CPS: Child Protective Services

PTSD: Post Traumatic Stress Disorder

CBS: Columbia Broadcasting System

POCSO: Protection of Children from Sexual Offence

CACs: Child Advocacy Center

CI: Confidence Interval

WHO: World Health Organization

CT: Computerized Tomography

ISPCAN: International Society for Prevention of Child Abuse and Neglect

NCANDS: National Child Abuse and Neglect Data System

APSAC: American Professional Society on Abuse of Children