Can child abuse be prevented?

For a long feature recently, I interviewed several female prison inmates. Many of them have one thing in common: As children, they faced prolonged, gruesome physical and sexual abuse. As I talked to sociologists and criminal-justice researchers, I’ve found that this is not a coincidence. A huge percentage — some estimate as many as half or one-third — of female inmates suffered abuse as children.

The United States has a much higher rate of child maltreatment deaths than other rich countries, according to UNICEF. Reducing rates of child abuse and neglect could be considered a public health imperative. Poverty and family upheaval are closely associated with child mistreatment. Recent studies have shown that it's poverty, not reporting bias, that explains the higher rates of abuse and neglect in African American families, for example.

Abused children suffer a unique form of PTSD, and as I wrote The Atlantic last year, parental abuse and neglect contribute to toxic stress, which impairs a child's ability to learn and succeed in school. Children who suffer trauma are more likely to repeat grades and be diagnosed with everything from asthma to PTSD. Research shows that experiencing child abuse approximately doubles a person’s probability of committing a crime.

But how do you get poor parents — many of whom face immense daily stressors and who themselves lacked positive parenting role models — to be kinder and more engaged?

For my project, I will examine how experiencing abuse and neglect at a young age impacts long-term health and behavior. Studies are beginning to show that early child abuse can spark epigenetic changes that are linked to later-life health issues. Among other things, experiencing child abuse has been linked to a greater risk of hearing voices, PTSD, heart disease, diabetes, substance abuse, suicide, and other problems in adulthood. And it’s not just mental health: Women who were abused as children spend more on all types of health care.

What’s more, there’s some evidence that some people are genetically predisposed to violence, and when this predisposition is combined with experiencing physical violence throughout childhood, it might increase the likelihood that they will become lifetime offenders. (Most female child molesters were themselves abused as children, for example.) And psychological abuse, it seems, can be just as harmful as physical trauma.

Also, about 100,000 kids are paddled in U.S. schools every year. Nineteen states still allow paddling in public schools, and 838 children are hit in school on an average day. (Private schools in every state but New Jersey and Iowa are exempt from the state bans.)

Though only about a quarter of parents say paddling should be allowed in schools, about half of parents spank their own kids, and there’s some evidence that their ranks increased with the onset of the Great Recession and the attendant financial stress. Though American parents of 2-year-olds claim to spank children about 18 times a year, one study based on audio recordings of parents found they actually did so about 18 times per week.

I’m not equating paddling with long-term child abuse, but ideally this project — reported under the auspices of the National Health Journalism Fellowship and the Fund for Journalism on Child Well-Being — will shed light on the effect physical punishment can have on children. The example of Sweden, where all forms of corporal punishment were outlawed in 1979, shows how paid parental leave and better child-care can decrease parental stress and lower the likelihood that parents will strike their children. Perhaps American employers and policymakers can consider similar downstream effects.

Finally, I will examine the differences among child-abuse prevention strategies and see what we can learn from the most successful ones.

“When a child throws something off a high chair, some parents think he’s bad, and some think he’s so brilliant, he’s just discovered gravity,” Robert Sege, a Boston pediatrician and expert in child abuse, told me recently. The question is, How do you convince more parents of the latter?

[Photo by Boston Public Library via Flickr.]