Title: The worst combinations of child abuse and neglect
Author(s): P. Ney, T. Fung, and A.R. Wickett
Affiliation: University of British Colombia; University of Calgary, Alberta
Citation: Ney, P., Fung, T., & Wickett, A.R., “The worst combinations of child abuse and neglect,” Child Abuse and Neglect, v. 18, no. 9, 1994, pp. 705-714.
No research has examined the effects on children of combinations of various types of abuse and neglect. Most researchers have investigated either sexual abuse or physical abuse taken alone. Because different types of abuse often exist in combination, researchers need to study their combined effects. This study is one attempt to do so. Five types of abuse or neglect are identified—physical abuse, physical neglect, emotional neglect, verbal abuse, and sexual abuse.
The hypotheses of this study are as follows: (1) different forms of abuse/neglect are often combined, (2) the effects of some combinations are worse than those of others, and (3) the order of onset of the different kinds of abuse/neglect is significant.
In fact, this study showed that less than 5% of victims of abuse/neglect experience only one kind, that neglect preceding abuse has more negative effects than other orderings, and that a combination of physical neglect, physical abuse, and verbal abuse was related to the worst effects.
A sample of 167 children and adolescents between the ages of 7 and 18 were interviewed or given a questionnaire. Younger children were more likely to be interviewed, and older ones more likely to be surveyed. Of that number, 118 came from clinical sources, 23 from criminal sources, and 26 from a high school population.
For each kind of maltreatment, the child was asked to indicate its nature, severity, frequency, and duration, by whom (s)he was victimized, and the age of onset. These reports were then coded on a 9-point scale.
The children were also asked to rate their thoughts and feelings in a number of different categories, including their enjoyment of living, their outlook for their future, and their expectations for a happy marriage, having children, living to an old age, and developing into the person they could be. They were instructed to check the appropriate selection on a list or draw a mark across a 9 cm visual analog scale.
Sexual abuse was found to be more correlated to physical abuse than to any other form of maltreatment. Physical abuse and verbal abuse were most likely to be combined. For each kind of maltreatment except sexual abuse, severity of abuse and frequency of abuse were highly correlated:
Of the five kinds of maltreatment, physical and verbal abuse were most strongly correlated with the children’s enjoyment of living, belief that their future was poor, and expectation that they had a poor chance of a happy marriage, having children, living to an old age, or developing into the person they could be. Sexual abuse was the most weakly correlated with these variables.
There were twenty possible combinations of two or three types of abuse/neglect. When ranked in order from strongest to weakest correlation with negative effects, the first ten were as follows:
When combinations of four at a time were ranked from strongest to weakest correlation with negative effects, they appeared in the following order:
Emotional and sexual abuse were found to have the highest rate of correlation between early age of onset and extent (a composite of frequency and severity) of mistreatment.
When neglect preceded abuse, the effect of the mistreatment seemed to be greater than when the two forms of maltreatment began simultaneously or when abuse preceded neglect.
This study found a higher prevalence of combinations of different kinds of abuse/neglect than other studies had, but it agreed with others that such combinations are the rule rather than the exception. A previous study had found that psychological maltreatment occurred in almost all cases of physical maltreatment.
The authors write that “sexual abuse does not appear to have a prominent effect on the measures we have used” but that “it is important for clinicians to understand the effects of all types of abuse, particularly sexual abuse, in the context of the neglect which often precedes it.” Finally, they note that “emotional neglect is most closely correlated with later development of psychiatric illness” and that “this is an important concept that should be pursued.”