Report: Rates of sexual abuse of children have declined, but reasons not fully understood

Rates of physical and sexual abuse of children have declined over the last 20 years, but for reasons not fully understood, says a new report from the Institute of Medicine. Yet, reports of psychological and emotional child abuse have risen in the same period, and data vary significantly as to whether child neglect is increasing, decreasing, or remaining constant. However, determining the incidence of child abuse and neglect presents a number of challenges, because cases could be underreported and definitions vary among entities that collect such information. To prevent and treat the problem more effectively, the causes and consequences of child abuse and neglect need to be understood with greater specificity, the report says. It calls for a national strategic plan to advance research on child abuse and neglect as well as a national surveillance system to improve the accuracy of cases identified. The report updates the 1993 National Research Council report Understanding Child Abuse and Neglect.

"Child abuse and neglect are a serious public health problem that has broader and longer-lasting effects than bruises, broken bones, or psychological trauma," said Anne Petersen, chair of the committee that wrote the report and research professor at the Center for Human Growth and Development at the University of Michigan, Ann Arbor. "The impacts cascade throughout victims' lifetimes, not only affecting them but also their families and society."

Child abuse and neglect are a pervasive, persistent, and pernicious problem in the United States, the committee said. More than 3 million referrals for child abuse and neglect are received by child protective services each year that involve around 6 million children, although most of these reports were not possible to corroborate with the usual rigorous process required by most states. In 2011, state child protective services agencies encountered 676,569 children, or about nine out of every 1,000 children in the U.S., who were victims of physical abuse, sexual abuse, psychological abuse, and medical and other types of neglect. However, these figures underestimate the extent of the problem because of discrepancies between actual rates and the number of cases reported to authorities. For example, the most recent National Incidence Study of Child Abuse and Neglect from 2005 to 2006 estimated that the rate of child abuse and neglect was 17.2 of every 1,000 children, totaling more than 1.25 million children, and many more were determined to be at risk. Ascertaining an accurate number has other challenges, including different definitions of abuse and neglect among entities that collect information, various legal definitions across states, and diverse standards in determining incidence and prevalence rates by researchers. These uncertainties hamper understanding of the problem's causes and consequences and effective prevention and treatment interventions.

Despite these challenges, enough data are available to estimate the scope, prevalence, and characteristics of child abuse and neglect across the United States. Based on the National Child Abuse and Neglect Data System (NCANDS), the official reporting system for cases referred to state child protection authorities, about three-quarters of reported cases in 2011 were classified as neglect, about 15 percent as physical abuse, and about 10 percent as sexual abuse. Child victims of abuse and neglect are divided almost evenly between males and females. About 80 percent of perpetrators are parents, 87 percent of whom are biological parents. More than half of perpetrators are female.

Society is also affected by the consequences of the problem, the committee said. Each year, cases of child abuse or neglect impose a cumulative cost to society of $80.3 billion, of which $33.3 billion is direct costs -- such as hospitalization, childhood mental health care costs, child welfare system costs, and law enforcement costs -- and $46.9 billion is indirect costs -- including special education, early intervention, adult homelessness, adult mental and physical health care, juvenile and adult criminal justice costs, and lost work productivity. An analysis by the U.S. Centers for Disease Control and Prevention found that the average lifetime cost of a case of child abuse and neglect is $210,012 in 2010 dollars. Most of this total -- $144,360 -- is due to loss of productivity by the person who suffered the abuse or neglect.

While research carried out since 1993 has generated much knowledge that can inform programs and policies, some gaps remain, the committee said. A better understanding is needed about why there are declines in physical and sexual abuse but not neglect; why children have different sensitivity to abuse of similar severity; why some child victims respond to treatment and others do not; how different types of abuse impact a child's developmental trajectory; and how culture and social stratification affect the causes, consequences, prevention, and treatment of child abuse and neglect.

The committee formulated several recommendations focused on the development of a coordinated research enterprise that could inform policy and practice initiatives that ultimately will improve the well-being of children and their caregivers. The report calls for the implementation of a research agenda designed to advance knowledge and understanding of the causes and consequences of child abuse and neglect, as well as the identification and implementation of effective services for their treatment and prevention. It also recommended the creation of a national surveillance system that links data across multiple systems and sources, the development of structures necessary to train cohorts of high-quality researchers, and the formation of a mechanism for conducting policy-relevant research.