Child Maltreatment: Consequences

Child maltreatment affects children’s health now and later, and costs our country as much as other high profile public health problems. Neglect, physical abuse, custodial interference and sexual abuse are types of child maltreatment that can lead to poor physical and mental health well into adulthood. The physical, psychological, behavioral and economic consequences of child maltreatment are explained below.

Prevalence: About 14% of Children Suffer Abuse

• An estimated 681,000 children were confirmed by Child Protective Services as being victims of maltreatment in 2011 (USDHHS, 2012).
• A cross-sectional, US national telephone survey of the child maltreatment experiences of 4,503 children and youth aged 1 month to 17 years in 2011 found that 13.8% experienced child maltreatment in the last year (included neglect, physical abuse, emotional abuse, custodial interference, or sexual abuse by a known adult) (USDHHS, 2012).

Cost: Abuse Cost U.S. $124 Billion in 2008

Child maltreatment affects children now and later, and the costs to our country are significant:

• Improper brain development
• Impaired cognitive (learning ability) and socio-emotional (social and emotional skills)
• Lower language development
• Blindness, cerebral palsy from head trauma
• Higher risk for heart, lung and liver diseases, obesity, cancer, high blood pressure and cholesterol
• Anxiety
• Smoking, alcoholism and drug abuse

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Physical

• In 2011, approximately 1,570 children died from abuse and neglect across the country—a rate of 2.10 deaths per 100,000 children (USDHHS, 2012).
• Maltreatment during infancy or early childhood can cause important regions of the brain to form and function improperly with long-term consequences on cognitive, language, and socioemotional development, and mental health (DHHS, 2001). For example, the stress of chronic abuse may cause a "hyperarousal" response in certain areas of the brain, which may result in hyperactivity and sleep disturbances (Dallam, 2001; Perry, 2001).
• Children may experience severe or fatal head trauma as a result of abuse. Nonfatal consequences of abusive head trauma include varying degrees of visual impairment (e.g., blindness), motor impairment (e.g., cerebral palsy) and cognitive impairments (National Center on Shaken Baby Syndrome, 2009).
• Children who experience maltreatment are also at increased risk for adverse health effects and certain chronic diseases as adults, including heart disease, cancer, chronic lung disease, liver disease, obesity, high blood pressure, high cholesterol, and high levels of C-reactive protein (Felitti et al., 1998; Danese et al., 2009).

Psychological

• In one long-term study, as many as 80 percent of young adults who had been abused met the diagnostic criteria for at least one psychiatric disorder at age 21. These young adults exhibited many problems, including depression, anxiety, eating disorders, and suicide attempts (Silverman et al., 1996).
• In addition to physical and developmental problems, the stress of chronic abuse may result in anxiety and may make victims more vulnerable to problems such as post-traumatic stress disorder, conduct disorder, and learning, attention, and memory difficulties (Dallam, 2001; Perry, 2001)

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Behavioral

• Children who experience maltreatment are at increased risk for smoking, alcoholism, and drug abuse as adults, as well as engaging in high-risk sexual behaviors (Felitti et al., 1998; Runyan et al., 2002).
• Those with a history of child abuse and neglect are 1.5 times more likely to use illicit drugs, especially marijuana, in middle adulthood (Widom et al., 2006).
• Studies have found abused and neglected children to be at least 25 percent more likely to experience problems such as delinquency, teen pregnancy, and low academic achievement (Kelley et al. 1997). Similarly, a longitudinal study found that physically abused children were at greater risk of being arrested as juveniles. This same study also found that abused youth were less likely to have graduated from high school and more likely to have been a teen parent (Langsford et al., 2007). A National Institute of Justice study indicated that being abused or neglected as a child increased the likelihood of arrest as a juvenile by 59 percent. Abuse and neglect also increased the likelihood of adult criminal behavior by 28 percent and violent crime by 30 percent (Widom & Maxfield, 2001).
• Early child maltreatment can have a negative effect on the ability of both men and women to establish and maintain healthy intimate relationships in adulthood (Colman et al., 2004).

Economic Consequences

• The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States in 2008 is approximately $124 billion in 2010 dollars. This economic burden rivals the cost of other high profile public health problems, such as stroke and Type 2 diabetes (Fang et al., 2012).
• The estimated average lifetime cost per victim of nonfatal child maltreatment is $210,012 (in 2010 dollars) including:
  • childhood health care costs
  • adult medical costs
  • productivity losses
  • child welfare costs
  • criminal justice costs
  • special education costs
  • The estimated average lifetime cost per death is $1,272,900, including medical costs and productivity losses (Fang et al., 2012).
  • Research suggests the benefits of effective prevention likely outweigh the costs of child maltreatment.

Most of the studies examining the consequences of child maltreatment have used a retrospective approach. This requires conducting studies to determine if any association exists between a history of childhood abuse and/or neglect and current health conditions in adults. Fewer research projects have employed a more rigorous longitudinal approach. This type of research strategy identifies children who are at risk or who have already been maltreated and follows them for a long period of time, sometimes decades, to see what conditions develop.

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Additional Resources

• Long-Term Consequences of Child Abuse and Neglect [PDF 189 KB]
• Adverse Childhood Experiences Study

References

Colman, R., Widom, C. (2004). Childhood abuse and neglect and adult intimate relationships: A prospective study. Child Abuse and Neglect,28(11):1133–1151.

Dallam, S. J. The long-term medical consequences of childhood maltreatment. In: Franey K, Geffner R, Falconer Reditors. The cost of child maltreatment: Who pays? We all do. San Diego (CA): Family Violence & Sexual Assault Institute; 2001.

Danese, A., Moffitt, T. E., Harrington, H., Milne, B. J., Polanczyk, G., Pariante, C. M., et al. (2009). Adverse childhood experiences and adult risk factors for age-related disease. Archives of Pediatrics and Adolescent Medicine,163(12):1135–1143.

Department of Health and Human Services (DHHS), Administration on Children, Youth, and Families. Child Maltreatment 2007 [online] 2009 [cited 2009 Apr 7].
Available from URL: http://www.acf.hhs.gov/programs/cb/pubs/cm07/index.htm

Department of Health and Human Services (DHHS), Administration on Children, Youth, and Families. Understanding the effects of maltreatment on early brain development. Washington (DC): Government Printing Office; 2001.
Available from URL: http://www.childwelfare.gov/pubs/focus/earlybrain/earlybrain.pdf [PDF 454 KB]

Fang, X., Brown, D. S., Florence, C. S., & Mercy, J. A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse & Neglect, 36(2), 156–165.

Felitti, V., Anda, R., Nordenberg, D., Williamson, D., Spitz, A., Edwards, V., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J of Preventive Medicine, 14(4):245–258.

Finkelhor, D., Ormrod, R., Turner, H., & Hamby, S. (2005). The victimization of children and youth: A comprehensive national survey. Child Maltreatment, 10(1):5–25.

Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2013). Violence, Crime, and Abuse Exposure in a National Sample of Children and Youth: An Update. JAMA Pediatrics, 167(7), 614-621. Doi:10.1001/jamapediatrics.2013.42.

Kelley, B. T., Thornberry, T. P., & Smith, C. A. In the wake of childhood maltreatment. Washington (DC): National Institute of Justice; 1997.

Langsford, J. E., Miller-Johnson, S., Berlin, L. J., Dodge, K. A., Bates, J. E., & Pettit, G. S. (2007). Early physical abuse and later violent delinquency: a prospective longitudinal study. Child Maltreatment 12(3):233–245.

National Center on Shaken Baby Syndrome. [online] 2009 [cited 2009 Apr 07].
Available from URL: http://www.dontshake.com

Perry, B. D. The neurodevelopmental impact of violence in childhood. In: Schetky D, Benedek E, editors. Textbook of child and adolescent forensic psychiatry. Washington (DC): American Psychiatric Press; 2001. p. 221–238.

Runyan, D., Wattam, C., Ikeda, R., Hassan, F., & Ramiro, L. Child abuse and neglect by parents and other caregivers. In: Krug E, Dahlberg LL, Mercy JA, Zwi AB, Lozano R, editors. World report on violence and health. Geneva,Switzerland: World Health Organization; 2002. p. 59–86.
Available from URL: http://www.who.int/violence_injury _prevention/violence/global_campaign/en/chap3.pdf [PDF 176 KB]

Silverman, A. B., Reinherz, H. Z., & Giaconia, R. M. (1996). The long-term sequelae of child and adolescent abuse: a longitudinal community study. Child Abuse and Neglect 20(8):709–723.

U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2012). Child Maltreatment 2011 Available from http://www.acf.hhs.gov/programs/cb/research-data-technology/statistics-research/child-maltreatment.

Widom, C., Marmorstein, N., & White, H. (2006). Childhood victimization and illicit drug use in middle adulthood. Psychology of Addictive Behaviors 20(4):394–403.

Widom, C. S, & Maxfield, M. G. An update on the "cycle of violence." Washington (DC): National Institute of Justice; 2001.
Available from URL: http://www.ncjrs.gov/pdffiles1/nij/184894.pdf [PDF 128 KB]