Physical Abuse

According to the U.S Department of Health and Human Services (2013) about 686,000 children were reported to be victims of abuse and/or neglect in 2012. For years, multiple lives have been taken by abuse. For those who have lived through and survived abuse are able to help counselors, and medical professionals develop outstanding research on what abuse may do to ones body and mind. Abuse survivors not only have to deal with abnormalities in their life but their health. In most cases, children's abuse goes unknown, but its wide range of effects on not only the child's development but their brain is tremendous.

By intervening during a child's early stages of abuse and implementing the correct approaches and programs may help save a child and halt the trauma caused to the brain. Abuse causes physiological problems, health problems, changes in hormones and neurotransmitters. Not only does the brain of an abused person change, as they get older, from increased limbic system to a decrease in the cortex activity, one's brain cannot function normally because of traumatic events that have happened. (Martin H. Teicher M.D., Ph.D., 2000) (Impact on the physiology of the brain)

According to (Al Odhayani, A. et al, 2013) these are the types of abuse: physical abuse, emotional abuse, neglect, and sexual abuse. There are different methods of physical abuse such as cutting a child's skin, hitting, and forcefully shaking a child and physical abuse can be inflicting injuries internally and externally to a child. Techier, 2015 states emotional abuse can be verbal and nonverbal. By intentionally not acting to a child's pain, cries, screams can cause emotional abuse as well as humiliating, yelling or hurtful words. The third type of abuse is neglect, neglect can range from malnutrition, not bathing or providing proper hygiene to the child, shelter and anything that can cause delays to the child in its future or even harm the child and death. Lastly sexual abuse is doing something sexually to the child or acts that are sexually suggestive. This may be exploiting the child, molestation or rape.

In most cases, one's initial thought about family and friends is that they are there to protect, care and unconditionally love us. Unfortunately, for children who face abuse, the biggest influence of the abuser is their closest family members and friends. According to the World Health Organization, 2016 there are community and social factors that may put a child at risk for abuse. These factors include gender and social inequality, lack of services for families, social and cultural norms that promote violence, easy access to alcohol and drugs, high levels of unemployment and poverty. As well as community and social factors, there are also parental risk factors that can lead to child maltreatment such as lack of education on child development, financial difficulties, having been maltreated themselves as a child, or difficulty bonding with the newborn (World Health Organization, 2016).

It is also important to note that abuse can be considered for mothers who are carrying an unborn child and use harmful substances such as drugs or alcohol. Using harmful substances during pregnancy can cause harm to the child psychologically and physically. By doing so, the child can develop Fetal Alcohol Syndrome, which can range from mild to severe symptoms such as small head size, low IQ, behavioral issues, abnormal facial features, vision or hearing problems (CDC, 2018).

Furthermore, according to the World Health Organization 2002, other characteristics that put children at risk of physical abuse and neglect is if they are premature, handicap, or twins. Although these are risk factors, they are not major compared to parental and social variables. Many studies have shown that parents who suffer from low self-esteem, lack of control, and mental health problems are high risk for abuse and neglect. These factors conclude that parents lack social support and the inability to react within stressful situations that may cause them to yell, hit, or isolate their child due to being unable to positively provide to them in the proper and correct way.

In addition to these negative risk factors, studies have also shown that parents may have unrealistic expectations of their children. Parents may assume their children should be developmentally advanced or have high expectations of their children which causes the parent to impulsively react negatively to the child which can cause the child to cry, time out, hitting, and in general neglecting their child due to a parents high expectation (World Health Organization, 2002).

Abuse is a very traumatizing and a difficult experience, whether it is sexual, physical or emotional. When faced with abuse, one is also faced with the side effects and distinct patterns that they are marked with. Briere & Scott (2006) had six key areas in which child abuse affects psychological function in adult life:

1. Negative pre-verbal assumptions and relational schemata- Young children who are abused view themselves as not good enough. When having a low self-esteem, the child will grow and feel a certain way about themselves. This is why when they are adults they are afraid to interact with others, create relationships, and lack social interactions.
2. Conditioned emotional responses to abuse-related stimuli- Abused adults may face situations that overwhelm them and cause them to trigger anger, shame, or grief.
3. Implicit/sensory memories of abuse- When children are young and experience certain situations they have trouble explaining them or reacting a certain way. Sometimes they have flashbacks that can cause shock to their whole body and they feel as if they are experiencing a bad situation once again.
4. Narrative/autobiographical memories of maltreatment- When older, adults ask themselves questions and try to figure out why they were abused.
5. Suppressed or deep cognitive structures involving abuse-related material- Children do not understand abuse when they are younger, they respond to abuse with a last ditch psychological defense: suppress their knowledge of abuse. Which then causes a split off thinking that causes issues with relating to others and their thoughts.
6. Inadequately developed affect regulation skills- As an abuse victim gets older, they distance themselves from social situations, friendships, and relationships. Many times they develop avoidant coping styles so that they can escape their past and not be in an awkward situation. This can lead to drugs, alcohol, or even self-harming so that they cannot feel the pain.
(Martin H. Teicher M.D., Ph.D., 2000) (Impact on the physiology of the brain)

Developmentally, abuse is altering even at a child's earliest stage, infancy. During infancy the brain is one of the most underdeveloped organs and can be affected in the most impactful ways due to abuse. According to (Al Odhayani, A. et al, 2013) if an infant is shaken aggressively, the brain structure becomes damaged in which results in an infant developing mental retardation, visual and hearing issues, learning disabilities and other cognitive dysfunctions. Research from Canadian data has found that infants who were forcefully shaken that 19% died, 59% had neurologic deficits and other health effects, and the 22% appeared fine at the time of hospitalization. This goes to show that abuse on a child's brain can be affected as early as birth and the long term effects can damage the life of an innocent child. By the toddler age, which is about 1 to 3 years old, children express their abuse with frustration and anger.

This means that children will usually lash out in a negative way towards family, friends, and other individuals. The third stage is the preschool age, the preschool age has similarities with the toddler age in which they react towards abuse with anger. As for boys, they usually express their anger by bullying, or verbal expressions, as for girls they usually keep their thoughts and feelings to themselves which then makes them socially withdrawn. The fourth stage is the primary school age, primary school age is when children have peer interaction. Children in the primary school age distance themselves, have poor performance in school, miss school, and lack friendships.

The last stage is adolescence, usually an adolescent child may engage in behavior that can be harmful to themselves and others. Behavior involves drinking, smoking, unprotected sex, or gang violence. (Al Odhayani, A. et al, 2013) As stated in Choudhuri, Santiago-Rivera, & Garrett 2012, at the primary school age children are still associated with their parents in terms of their identity and life choices. To counsel a child at this stage is when one needs to help the child verbally and help the child to learn healthy ways of navigating their environments. This may be difficult for individuals who are within an abusive home because there is no healthy structure to learn from.

There have been multiple studies done to a survivors brain, many of these individuals brains were scanned to measure the thickness in different regions of the cortex. When looking at the thickness of the cortex, the more thick the regions are suggests that the brain is developing in a healthy way. Along with scanning areas that are developing slower, one has a chance that their limbic system will increase which is when their sensitivity arises; this part of the brain is called the emotional brain. The limbic system controls many of the emotions and drives for survival that one needs. By the limbic system increasing, one reacts to situations differently and more emotionally. Along with the increase of sensitivity comes the cortex activity. The prefrontal cortex has been shown to be much smaller in individuals who have been maltreated (National Scientific Council on the Developing Child, 2012).

The prefrontal cortex is also critical in thinking, and emotion regulation (National Scientific Council on the Developing Child, 2012). The prefrontal cortex works with the amygdala and the hippocampus, in which the hippocampus is responsible for learning and long-term memory (McCrory, De Brito, & Viding, 2010; Wilson, Hansen, & Li, 2011). It is located in the frontal lobes of the brain, and that part of the brain requires events to be registered so that one learns from that specific experience. (Martin H. Teicher M.D., Ph.D., 2000) (Impact on the physiology of the brain) (Van Der Pit, Ruiter, 2016)

Furthermore, there is also an impact on the left and right hemisphere of the brain. There is an underdevelopment of the left-brain, a smaller corpus callosum, and neuroendocrine alterations. By having underdevelopment of the left brain one may have abnormal electroencephalograms (EEG's). EEG's test the electrical activity of the brain and if one has abnormalities with those EEG's, it can affect their language, which shows that the right hemisphere is more active than the usual healthy individual. Next is the corpus callosum, in abused children the corpus callosum is significantly smaller than a healthy individual.

This can lead to dramatic changes in one's personality and mood; abused children usually go from one hemisphere to the other because they do not know how to act towards people or situations. Along with mood changes, one's hippocampus, which is located in the temporal lobe and is also involved with memory and emotions, is affected tremendously. Cells in the hippocampus have a numerous amount of receptors that respond to stress hormone cortisol. A study in which was done at Yale Medical School by J. Douglas Bremner involved comparing seventeen adult survivors of childhood sexual or physical abuse and all of them had PTSD and then seventeen healthy subjects that were equally the same with the other people only not being abused.

Once the study was complete the left hippocampus of abused patients was 12% smaller than the healthy patients. The abused patients also had lower verbal memory scores, these studies suggested that child abuse could alter development of the left hippocampus and cause altering in verbal memory and other symptoms that will affect them in the future. (Martin H. TeicherM.D., Ph.D., 2000) (Impact on the physiology of the brain) (Van Der Pit, Ruiter, 2016)

Additionally, the neuroendocrine has alterations in the brain of someone who was abused. This means that when a child is being abused their brain adapts to their environment, so eventually it becomes a normal event to them. That being said, when one is stressed their hormones in the brain change and causes the child to cope with abuse in a different way, so in the future abuse may pass from generation to generation because one has adapted to that life (Teicher, 2002). Any effect to the neuroendocrine system can alter changes of psychological and physiological functions. (Martin H. Teicher M.D., Ph.D., 2000) (Impact on the physiology of the brain) (Van Der Pit, Ruiter, 2016)

Not to mention, alterations on the brain due to abuse are salient, many states have consequences for individuals who have caused death to a child. In particular the death penalty may be given to an individual who caused a child to die due to abuse. According to (Dunham, R. B. 2017) Indiana authorizes the death penalty to an individual who has killed a child if the child was less than 12 years of age. Although, there is this consequence within states, it does not decrease the amount of children who are being mistreated or abused everyday.
It is very draining for an individual to have to deal with the emotions, and effects of abuse. One consequence of abuse is that a child produces dysphoria (chronic low-level unhappiness) this can continue on into adulthood and could cause one to eventually get addicted to drugs and alcohol so that they alleviate the pain.

It is best to intervene and treat a child who is being maltreated at a young age so that it is a possible that one can alter the negative effects on the developing brain. This is crucial due to being able to implement intervention plans at the early stages so that a child can learn to cope, and to alleviate any negative symptoms or thoughts. Abused children are not only affected physically, mentally, and emotionally by abuse but also if they are in a abusive environment. (Martin H. Teicher M.D., Ph.D., 2000) (Impact on the physiology of the brain) (Van Der Pit, Ruiter, 2016)

According to the (World Health Organization, 2016) there are effective programmes and approaches that can integrate parenting education which can increase knowledge of child development, multi-component interventions which includes child care and social support to parents, and visits to parents to their homes to do check ups and educate them on anything that may be happening within the child's life. Other programs that can be both hospital and school based programs are programs that teach about shaken baby syndrome, which is taught to new parents within the hospital so that they understand that effects to an infant if shaken aggressively and unnecessarily. School based programs are to prevent child sexual abuse and to teach children body ownership, how to say no, how to disclose abuse to a trusted adult, and the differences between good and bad touch (World Health Organization, 2016). These prevention programs can potentially save many children from going through the traumatizing effects of abuse.

In addition to school, and hospital based programs, health care professionals also need to be educated to be able to detect abuse. It is critical that healthcare professionals are able to detect and appropriately report any type of abuse so that if a child is being abused, they can safely be taken care of. The World Report on Violence and Health stated that in New York state it is mandatory that health care professionals take a course that is 2 hours and helps them identity abuse, this is a requirement for these professionals to be able to be licensed at the end of their education. I believe this is important not only for the health care professional but for the child because it can save many lives by being able to identify if a child is in a harmful household or is being abused by one or multiple individuals.

Although this is important, it is also critical to do this in the most appropriate way, meaning, that the health care professional cannot cause more stress within the situation if they do believe a child is being abused because this may cause the parent, or family member, to put the child at risk if they do leave a hospital, or doctors office (World Health Organization, 2002).

In conclusion, child abuse can affect a child mentally, physically and emotionally. Research has shown that abuse can alter brain function which may cause children to have behavioral issues, lower verbal memory scores, get addicted to alcohol or drugs, and overall create physiological and psychological problems within the future.

As counselors, we need to adequately and appropriately handle victims of abuse so that we can provide the proper interventions that positively implement the strategies that plan for a successful healing process for a child who has been abused. As well as being able to provide intervention plans for any form of abuse to a child, it is also important to be able to detect and report suspected child abuse if in the presence of it. In which, I have to state that all states should be mandated to take a course on detecting child abuse within any environment whether it is a school, pediatricians office, or supermarket. By being able to carefully and appropriately detect abuse, one can save another child's life. The National Child Abuse Hotline is (1-800) 4-A-Child or (1-800) 422-4453.

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