Child Abuse and Neglect: A Global Problem in Need of a Global Solution ISTSS joins Global Collaboration
Karestan C. Koenen, PhD
January 15, 2013
I was 24 years old and working in a preschool the first time I called child protective services. Robbie, not yet even 3 years old, was already considered the class troublemaker. When the other children sat in their chairs eating snacks, Robbie would push the back of their chairs, causing the children to fall onto the hard tile floor. He seemed to enjoy breaking toys too, especially the dolls, which he destroyed by ripping off their limbs. One morning, I discovered bruises and handprints all over Robbie’s back. When I brought this to the attention of the head teacher she said, “We don’t interfere with how parents discipline their children.”
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“I want to die,” sobbed Johan, the 7-year-old boy in my office. By now I was in my second year of clinical psychology graduate school and Johan had been brought in for a neuropsychological evaluation. In the middle of the test he broke down. “I tried to kill myself with a pillow,” he said and proceeded to show me how he had tried to smother himself. “But it didn’t work, it didn’t work.” Inexperienced, scared, and out of my depth I asked him why he wanted to die? “So my daddy doesn’t hurt me anymore,” he replied.
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One night as I slept outside my hut in Gaya, Niger where I served as a Peace Corps volunteer, I was startled by the sound of a knock at my gate. Kadija, the 10-year-old girl who brought me water every morning had been sent to me by her mother. “My mama said to come sleep with you,” she said in Hausa, “my dad.” Kadija’s mother had previously asked me if I would take her daughter to the city to live with her sister, but would not tell me why. When I saw the tears streaming down Kadija’s face I understood why. “Come in,” I said. “You can sleep next to me.”
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“I saw her! She’s dead, but she was in my room screaming that I am crazy and stupid and I must be,” Mercedes sobbed. I was a psychology intern working for Dr. Marylene Cloitre on a treatment study for adult women with PTSD related to childhood abuse. Mercedes was in treatment for the first time in her life and recounting a childhood of horrors ranging from severe physical abuse by her mother to repeated sexual abuse by a series of her mother’s boyfriends starting at the age of 5. Now 30, she was experiencing vivid flashbacks from her childhood that made functioning impossible.
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In October 2012, societies for traumatic stress studies – representing five continents – came together with the goal of forming a global collaboration to address an issue of major public health importance. In an historic moment, the group agreed to work collaboratively as a true international society by focusing on one global issue: child abuse and neglect, and its latent impact.
Child abuse and neglect is clearly a global public health problem that requires a global solution. Child abuse and neglect has adverse consequences not only for the victims but also for their offspring and society at large. According to estimates from the World Health Organization, more than 40 million children are victims of child abuse annually. Child abuse is shockingly prevalent even in politically and socially stable nations such as Switzerland, where a recent report estimates that 40 percent of girls and 11 percent of boys had been sexually abused. Sexual abuse prevalence rates as high as 21 percent for men and 56 percent for women were also found in the Netherlands. And in situations of social and political instability, child abuse escalates particularly rape and murder of young girls, as recently documented in Syria.
The latent impact of childhood abuse and neglect has been documented…the adverse life course consequences of abuse that range from poorer cognitive functioning to mental disorders to type-2 diabetes, cardiovascular disease and stroke. Women who were abused as children are less likely to praise their own children. Cross-generational studies show that offspring of women who were abused are more likely to experience trauma and PTSD themselves. More recently, it has been shown that offspring of abused women are also at higher risk of a wider range of adverse outcomes including autism.
The Collaboration chose child abuse and neglect based on the following criteria:
- Inconsistent dissemination and implementation of evidence based practices
- Inconsistent integration of helping agencies
- Lack of political prioritization
- Pressure to find new delivery methods
- Need for community resilience and empowerment
- Need for cultural sensitivity and customization
The goals of the collaboration are to collect and synthesize core guidelines for prevention and treatment that can be customized for specific cultural contexts. Capitalizing on the latest developments in technology, the Collaboration aims to disseminate these guidelines using an application that will allow for worldwide distribution and cultural customization. The Collaboration will work together to develop a proposal to secure funding to develop both the guidelines and the application. The Collaboration has set an ambitious timeline for their activities, aiming to define the scope of the guidelines and the application prototype by their next meeting in Bologna (June 4, 2013), hosted by the European Society for Traumatic Stress Studies.
I have been an ISTSS member for 15 years and have served on the Board of Directors for 5 years. I have never been more proud to be a member of ISTSS than when, on November 1, 2013, the Board of Directors committed ISTSS to:
- Continue to enable this collaboration
- Provide limited financial support for administrative services and conference calls
- Participate in the collaboration
- Seek opportunities to align with the objectives of the collaboration in any number of ways as they present themselves
Our support of this collaboration is fully in line with the six goals ISTSS set for 2013 (see our strategic plan). For example, the development and dissemination of guidelines related to child abuse and neglect falls under Goal #2: Dissemination and Collaboration and Goal #3: Societal Impact. Participating in the Collaboration is consistent with Goal #5: Global Relationships.
As ISTSS president, I encourage all members of our society to consider ways we can align ourselves with the objectives of the Collaboration and bring them to my attention. Many of you are doing work in the area of child abuse and neglect, and we would like to highlight this work at our Annual Meeting, in Traumatic StressPoints, on our website, and in our social media outreach. Follow our participation in the Collaboration on Twitter @ISTSSnews, on Facebook (search ISTSS) and through our LinkedIn groups.
The goals of the collaboration are lofty and worthy of support.
“The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low, and achieving our mark.”
I wish you all a happy and healthy 2013.
― Michelangelo Buonarroti