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I ' ‘ ‘I'Sf :- f‘ 3"“ A» A — 1 ~ ‘ t" P169 t-—-§Altam .,: n..un-t-.% 1 --. .' ‘3 6-“. This is to certify that the thesis entitled THE STATE OF PSYCHOLOGICAL TREATMENT SERVICES FOR THE PHYSICALLY ABUSED CHILD IN WAYNE COUNTY, MICHIGAN presented by Maria Lilia Ortega-Trude] has been accepted towards fulfillment of the requirements for M.ED. Teacher Education degree in [g j % /’YZ.[L//Z‘ ‘7é/ v Major professor Date 7'] '85 0-7539 MS U is an Affirmative Action/Equal Opportunity Institution bViSSI.) RETURNING MATERIALS: Place in book drop to LJBRARJES remove this checkout from w your record. FINES will be charged if book is returned after the date stamped below. C). cry—34' ;.\‘ :1: ;_J --- €25.30 (“-5 1‘ THE STATE OF PSYCHLOGICAL TREATMENT SERVICES FOR THE PHYSICALLY ABUSED CHILD IN WAYNE COUNTY, MICHIGAN BY Maria Lilia Ortega-Trudel A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF EDUCATION Department of Education 1985 ABSTRACT THE STATE OF PSYCHOLOGICAL TREATMENT SERVICES FOR THE PHYSICALLY ABUSED CHILD IN WAYNE COUNTY, MICHIGAN By Maria Lilia Ortega-Trudel The thesis provides an overview of available psychological treatment services for the physically abused or neglected child in Wayne County Michigan. This is presented in four sections: (1) historical and legal perspectives of child abuse and neglect; (2) literature review of the child's role in the battered child syndrome and the developmental, psychological and psychosocial effects of abuse on the child; (3) an overview of the Wayne County Department Of Social Services psychological treatment provided to the abused or neglected child; and, (4) results of a phone survey as to the availability of psychological treatment services to the physically abused or neglected child in the private and public sector. Results of the phone survey's 79 responding agencies show 14 offer direct psychotherapy, 18 offer individual play therapy, 14 provide psychological testing, and 11 provide educational assessments to a yearly average of 6% of all substantiated cases in Wayne County. FOR MY PARENTS, ELOISA AND ANTONIO ORTEGA, IN LOVING THANKS FOR THEIR GUIDANCE AND WISDOM TABLE OF CONTENTS INTRODUCTION ................................................. CHILD ABUSE AND THE LAW ...................................... A. Federal and State Legislation... ........ ...... ......... B. Child Abuse Legislation in the State of Michigan. ...... Table 1 ............................................ A LITERATURE SURVEY OF CHILD ABUSE ........................... A. Treatment of the Abused Child .......................... B. The Role of the Abused Child ........................... 1. The Premature Baby and Abuse..... ....... .... ..... 2. The Physically Handicapped, Mentally Ill and Mentally Retarded Child ......................... 3. The Natural Disposition and Temperament of an Abused Child............. .................. 4. The "Special Child" ....... . ...................... 5. An Abused Child: The Caretaker's Own Image or the Image of Another ......................... C. Developmental, Psychological, and Psychosocial Effects of Abuse on the Child ......................... 1. Problems in Effective Communication .............. 2. The Aggressive Nature of an Abused Child ......... ii Page 10 20 33 35 36 42 45 48 51 54 55 59 61 62 Chapter Page 3. Anxiety and the Child ............................ 64 4. The Abused Child's Non-Organic Failure to Thive.. 65 5 6 . Role Reversal and the Abused Child ............... 68 . Learning, Adjustment and Impaired Impulse Control of the Abused Child ..................... 78 7. The Abused Child's Employment of Primitive Defense Mechanisms .............................. 81 8. The Impaired Self-Concept of an Abused Child ..... 82 IV. THE PROCEDURE AND DETERMINATION OF A CHILD ABUSE CASE IN MICHIGAN ............................................ 84 A. The Reporting of Child Abuse ........................... 84 Table 2 ............................................ 85 Table 3 ............................................ 88 B. The Procedure and Determination of a Child Abuse Case ................................. 91 Table 4 ............................................ 100 V. A SURVEY OF AVAILABLE TREATMENT SERVICES IN WAYNE COUNTY, MICHIGAN ...................................... 101 Table 5 ............................................ 107 Discussion ........................................... . 118 VI. CONCLUSIONS AND RECOMMENDATIONS .............................. 121 LIST OF TABLES TABLE Page i Court Judgements In Child Abuse Cases ......................... 33 ii Referrals Substantiated And Unsubstantiated For Wayne County FYs 1979 - 1984 .............................................. 85 iii Mandated And Non-Mandated Wayne County Referrals For FYs 1979 - 1984 .................................................. 88 iv Wayne County Department Of Social Services Referrals To Other Community Agencies ..................................... 100 v Survey Of Available Treatment Services In Wayne County, MiChigan....OOOOOOOOOOOOOOO OOOOOOOOOOOOOOOOO O. ..... O ......... 107 iv CHAPTER I INTRODUCTION The physical abuse and neglect of children are not modern phenomenons, both have endured for centuries with a varying degree of intensity and acceptance. The existence of physical abuse and neglect of children has been recorded in fairy tales, mythology, the Bible, and throughout the history of humanity. Although the physical abuse of children has existed since the beginning of humanity, only recently has it rendered itself to discussion. Most fairy tales express two of children's most common and greatest fears, being abandoned and being eaten. In one favored style of fairy tale writing, the leading characters are children (usually on their own), whose adventures include the .possibility of being eaten by an evil character. For example, in Hans Christian Anderson's Hansel and Gretal, two young children are thrown out of their home by their father at their evil stepmother's insistence, since there was not enough food for all to eat. After the children are lost in the woods and tricked into a wicked witch's oven, they then escape and find their way home to their remorseful loving father. In the original version of Brother Grimm's Snow White, the wicked stepmother instructed the huntsman to bring Snow White's lungs and liver for her to eat. In Walt Disney's movie version, the stepmother asked for 1 2 Snow White's heart. In "The Juniper Tree", by the Brother Grimm's, a stepmother wanting her stepson's inheritance, killed the boy and cooked him in a stew. While Baba Yagas, a Russian fairy tale witch, ate children and placed their heads on stakes around her house as a warning to others. In Baba Yagas, as in many other fairy tales, the story happily ends whith a last-minute rescue by a parental figure. Although fairy tales usually have happy endings, with the young safe at home, mythology does not. In Roman mythology, Saturn, father of the Roman Gods devoured his children. Jupiter, the only child who escaped, gave Saturn a drink that forced him to spit the others out. In Greek mythology, King Saul tried to sacrifice his son Jonathon since he thought this would bring him victory in battle. In another Greek myth, an oracle who warned Laius that his infant Oedipus would grow up and threaten his life, ordered Laius to kill the child. Similar accounts are found in the Bible. Abraham was told by God to sacrifice his son Isaac. As Abraham drew a knife to his son's throat, God, convinced of Abraham's piety allowed Abraham to substitute a ram in Isaac's place. Nimrod, the King of Babylon, decreed the slaughter of 70,000 infant boys out of fear of a phr0phesized conqueror. Another Old Testament story recalls the slaughter of all Hebrew male infants, ordered by the Pharoah in fear of the prophesized king. Many scholars believe that Hell was the name of Gehenna (or Ge-Hinnom), the valley near Jerusalem where children were sacrificed. Later, the valley was turned into a garbage dump that burned continuously and became the image of the fires of Hell (Chase 1979). In the New Testament, King Herod in fear of the pr0phesized king ordered the killing of all children younger than two-years old. This event has been called the "Slaughter of the Innocents" and because Jesus 3 was saved, marks the beginning of Christianity. To remind children of this massacre, there was a period during the 1600's when most Christian countries would whip their children on Innocent's Day (Samuel X. Radull, 1968, p. 3). Infanticide was once viewed as the only Option for unmarried mothers. So common were the killing of illegitimate children in Germany and most of Europe, Goethe used it as a theme in “Faust", while Frederick the Great held an essay contest on how best to eliminate the practice. The most common form of punishment for infanticide during the eighteenth-century in Germany was sacking. The offender was placed in a sack, often with two live animals and thrown into a river. In 1740, Frederick the Great changed the punishment from sacking to decapitation. The Japanese have practiced infanticide for hundreds of years as a means of population control. Because it is mainly done by farmers, the farming term mabiki, or thinning out, has been used to describe infanticide in Japan. In two and a half centuries, between 1600 and the late 1850's it is estimated in northern Japan alone, between 60,000 and 70,000 cases of mabiki were recorded each year (Chase, 1979). Near the end of the nineteenth-century mabiki became illegal. This was not due to moral issues, but because Japan adopted a national policy to encourage population growth for industrial and military use. During the nineteenth-century, English writers, particularly Charles Dickens, wrote in great detail of the suffering of children in factories. As a result of their cheap rate of labor, children were a major part of the industrial work force. The beating of children by schoolmasters and other adults were so common and described so often in the novels of Charles Dickens, that the beating of a child soon became known as, "to give a child the dickens"(Chase, 1979). 4 The inhumane treatment, by the factory owners, led to many parents refusing to allow their children to work. Consequently, many factories would negotiate for the children found in the poorhouses. For example, a Lancashire manufacture agreed to take one "idiot" for every twenty "normal" children (Mantoux as quoted in Piven and Cloward, p. 28). Many of these children, as young as three years old worked sixteen hour days, often shackled to their work station. Children were starved, beaten, and many committed suicide or were killed. Often they were dumped into large barrels of cold water to keep them awake (Mantoux, 1962). The First Factory Act in 1802 made it illegal to use orphan children in factories. Yet, those children whose parents were alive were permitted to continue working. Children were also used as chimney sweepers. They worked day and night in hazardous conditions. Many suffered mental and physical damage and often died from cancer of the scrotum and pulmonary consumption. 80 common were these two diseases among children it became known as the "chimney sweeper's disease". The use of children as chimney sweepers was outlawed during the nineteenth-century. Throughout the industrial revolution the practice of parents killing their children continued. As noted in the 1890 edition of the Encyclopedia Britannica: The modern crime of infanticide shows no symptoms of diminishing in the leading nations of Europe. In all of them it is closely connected with illegitimacy in the class of farm and domestic servants. The crime is generally committed by the mother for the purpose of completing the concealment of her shame, in order to escape the burden of her child's support . . . The paramour sometimes aids in the crime, which is not confined to unmarried mothers. (Encyc10pedia Britannica, 9th ed. 1890 vol. 13 p. 3). Although the Encyclopedia Britannica was erroneous in labeling infanticide as a modern crime, it clearly authenticates that the practice was widespread During this period many infants who were farmed out for care (virtually all being illegitimate), had died in the "lying—in" or "baby-farming" houses of London. So large were the number of dead infants, that the House of Commons in 1871 ordered an investigation of these baby-farming houses. It was discovered that farming out was a disguise for infanticide (Chase, 1979). In the United States, the belief that society has a moral obligation and a right to intervene to ensure the rights of children's welfare, is a recent one in our history. The first recorded child cruelty case in the United States was not decided until 1874. A New York church worker, while visiting an elderly dying woman in a tenement house was told of a child named Mary Ellen Wilson who was beaten daily by her adoptive mother. The church worker was told that the child was chained to her bed, fed only bread and water, and was seriously ill as a result of this maltreatment. The church worker who sought assistance from the police, District Attorney's office, and other agencies was turned away because no law existed to help Mary Ellen (Chase, 1979). In desperation, the church worker turned to the American Society for the Prevention of Cruelty to Animals. Pointing out that Mary Ellen was a member of the animal kingdom, and thus, subject to the same laws that protected animals from serious abuse and neglect, the society took legal action. After an investigation the adoptive mother was taken to court. It was discovered that Mary Ellen had indeed suffered greatly at the hands of her stepmother as noted in an excerpt from an article appearing in the New York Times, April 10, 1874: The Connollys made no appearance in court, and on her examination the child made a statement as follows: My father and mother are both dead. I don't know how old I am. I have 6 no recollection of a time when I did not live with the Connollys. I call Mrs. Connolly mamma. I have never had but one pair of shoes, but I cannot recollect when that was. I have had no shoes or stockings on this Winter. I have never been allowed to go out of the room where the Connollys were, except in the night time, and then only in the yard. I have never had on a particle of flannel. My bed at night has been only a piece of carpet stretched on the floor underneath a window, and I sleep in my little under-garments, with a quilt over me. I am never allowed to play with any children, or to have any company whatever. Mamma (Mrs. Connolly) has been in the habit of whipping and beating me almost every day. She used to whip me with a twisted whip --a raw hide. The whip always left a black and blue mark on my body. I have now the black and blue marks on my head which were made by mamma, and also a cut on the left side of my forehead which was made by a pair of scissors. (Scissors produced in court). She struck me with the scissors and cut me; I have no recollection of ever being kissed by any one--have never been kissed by mamma. I have never been taken on my mamma's lap and caressed or petted. I never dared to speak to anybody, because if I did I would get whipped. I have never had, to my recollection, any more clothing that I have at present --a calico dress and skirt. I have seen stockings and other clothes in our room, but was not allowed to put them on. Whenever mamma went out I was locked up in the bedroom. I do not know for what I was whipped --mamma never said anything to me when she whipped me. I do not want to go back to live with mamma, because she beats me so. I have no recollection of ever being on the street in my life (Sloan, 1981). Mrs. Connolly, who was found guilty of assault and battery, was sentenced to one year in the Penitentiary at hard labor. After a search for a living relative proved fruitless, Mary Ellen was sent to “The Sheltering Arms" to live. Elbridge T. Gerry, legal adviser to the American Society for the Prevention of Cruelty to Animals at Mary Ellen's trial and a philanthropist, formed (as a result of this case) the Society for the Prevention of Cruelty to Children in 1874 (Sloan, 1981). In 1949, the General Assembly of the United Nations enacted the Universal Declaration of Human Rights. Among the articles were: Article 5. No one shall be subject to torture or to cruel, inhumane, or degrading treatment or punishment. *** Article 25. (1) Everyone has the right to a standard of living 7 adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age, or other lack of livelihood in circumstances beyond his control. (2) Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection (Bakan, 1973). It is apparent that the authors of these articles were concerned with the quality of life. If such needs are not met and such rights are not upheld, the future of man has no assurance. This thesis will address the helpless children who are physically and mentally abused by the people who have given them life. These children typically have no advocate, and are too weak to defend themselves against assault. Many cannot speak on their own behalf because they have yet to learn how to speak. The second section of this thesis will present a comparison of state child abuse laws and Michigan's child abuse legislation (P.A. 1975 No. 238). Also, the number of child abuse convictions per substantiated child abuse cases in Michigan will be reviewed. The third section will discuss the role of the child. It will outline the role of premature infants (Martin et. al., 1970; Klein & Stern, 1971; Dreyfus-Brisac, 1974); the physically handicapped and mentally ill child (Birrell & Birrell, 1968; Soeffing, 1975); the mentally retarded child (Sandgrund, Gaines, & Green, 1974; Nickamin, 1973; Brandwein, 1973); children's temperment (Milowe & Lourie, 1964; Thomas et. al., 1968; Ounsted, Oppenheimer, & Lindsay, 1974); a child reminding parents of someone they know (Green 1979; Green, 1978); or a responsibility not capable of handling (Elmer, 1967; Hunter et. al., 1978; Kempe, 1973; Garbarino, 1977). The third section will conclude with a literature review of the 8 developmental, psychological, and psychosocial effects of abuse on the child. Such effects include: problems in effective communication and overaggressiveness (Brandura, 1973; Reidy, 1977; Freud, 1920; Freud, 1926); non-organic failure to thrive (Barbero & McKay, 1975; Spitz, 1946; Gordon & Jameson, 1979; Sroufe, 1978; Matas et. al., 1978); role reversal with the parent (Helfer, 1973); depression and self-destructive behavior (Toolan, 1967; Toolan, 1975; Pheffer, 1977); as well as, learning and school adjustment difficulties (Green, 1978). The first half of the fourth section, will review the procedures and treatment services administered by the Wayne County branch of the Michigan Department of Social Services, for the physically abused child. This will include the number of referrals and the number of substantiated cases, as well as the number of cases referred to other agencies within the past five years. The second half of the section will present data obtained from a phone survey of Wayne County counseling agencies. The focus of the survey concerned the available services offered to abused children. The final section will present a discussion of the previous four sections. In addition, recommendations as to the availability of treatment and services for the abused child in Wayne County will be presented. CHAPTER II CHILD ABUSE AND THE LAW In 1961, under the direction of Dr. C. Henry Kempe, The American Academy of Pediatrics sponsored a symposium on child abuse. Their intent was to eXpose the magnitude of child abuse in the United States. Due to the large number of child abuse cases reported in 1961, the Childrens Bureau of the Department of Health Education and Welfare awarded grants for the study of child abuse. The following year the American Humane Society substantiated 662 cases in which each state and social class were represented. It also noted that of the 662 cases, 27% resulted in fatalities (Radbill 1968). In January 1962, the Childrens Bureau of the Department of Health Education and Welfare assembled a group of consultants (consisting of attorneys and pediatricians), to compose a "model law " for the purpose of protecting abused children. The pr0posed model law had the following basic features as noted by Dr. Larry 8. Silver (1967): (1) It recommends reporting by physicians or institutions of any case in which there is reasonable cause to suspect a battered child. (2) It suggests procedures for this reporting. (3) It provides immunity from liability for the physician. (4) It establishes that neither the physician-patient privilege, nor the husband-wife privilege may be grounds for excluding evidence. (5) It declares that anyone not reporting a suspected case of a 9 10 battered child would be guilty of a misdemeanor (p. 101). By 1967, all 50 states and the District of Columbia had enacted a child abuse law. The following is an overview of child abuse statutes in the United States. A. FEDERAL AND STATE LEGISLATION. Forty-three states have included a purpose clause within their statute. The goals of most child abuse reporting laws are: "first to encourage the reporting of an abused child as quickly as possible; second, to appoint an agency to receive and investigate reports of suspected child abuse in an effort to prevent further abuse; third, to provide, where appr0priate, services and treatment; and fourth, to preserve family unity and welfare whenever possible (Sloan, 1981). Ten states limit this clause to "the protection of children who have had injuries inflicted on them." Six states limit this clause to the protective services the child will receive, and "to protect the child's welfare and prevent further abuse." Colorado has the most extensive purpose clause which includes legal, social, psychological, familial, and economic policies (Schwartz 8 Hirsh, 1982). The defining of child abuse and neglect has been a difficult task for lawmakers. It must be broad enough to include every type of maltreatment, yet inclusive enough to protect the rights of parents to raise their children. The Childrens Bureau Model Act defines abuse as "serious physical injury or injuries inflicted by other than accidental 11 means" (Schwartz & Hirsh, 1982). This definition contains the element of deliberateness of abuse in order to be considered physical abuse. This has been criticized by The American Medical Association and the Council of State Governments for not including the child whose abuse is a result of parental neglect jeopardizing the child's safety. These two organizations have proposed that the definition should include "serious injuries as a result of abuse or neglect" (Schwartz & Hirsh, 1982). Each state defines child abuse and neglect differently. A survey of definitions displays a wide list of maltreatment which comprises abuse and neglect. Such elements include battering; dependency, deprivation; abandonment; exploitation, over-work; emotional maltreatment; failure to provide necessities, pr0per supervision, or care; excessive corporal punishment; and harm or threatened harm to a child's' welfare by acts of omission (Sloan, 1981). Abuse can not only be physical but also include sexual exploitations, and mental or emotional injuries. Although corporal punishment can be defined as non-accidental physical abuse, no state prohibits a parent from using "reasonable corporal punishment". Five states (Colorado, Ohio, Oklahoma, South Carolina, and Washington), expressly permit "reasonable'I corporal punishment in their statutes, noting that it does not constitute abuse (Sloan, 1981). Twenty-six states provide for the use of force by a person responsible for the care and supervision of a minor to maintain discipline (Sloan, 1981). Corporal punishment is also a widely held acceptable practice in schools. In a 1977 United States Supreme Court decision (Ingramham v. Wright), the court ruled that spanking pupils was not "cruel and unusual punishment". To date only three states, New Jersey, Massachusetts, and Maine, prohibit the use of corporal punishment (Schwartz & Hirsh, 1982). 12 The federal Child Abuse Prevention and Treatment Act defines a child "as a person under the age of 18 or the age specified by the child protection law of a state" (P.L. No. 93-247), as amended by Act of 1978 (P.L. No 95-266). Forty-nine states have set the age limit of reportable children at 18 years or younger, while Wyoming set the reportable age limit at 16 years or younger (Sloan, 1981). Several states have made provisions for exceptions to their limits. For example, Delaware has no age limit for the mentally retarded. In Ohio the age limit for the physically or mentally handicapped is extended to age 21. North Dakota's law does not apply to those individuals who are married or in military service. Each state has laws which identify mandated individuals for the reporting of child abuse. The earliest laws required only physicians to report child abuse, since it was assumed their contact with children and medical expertise enabled them to readily identify abusers. However, many laws have been amended to include a large number of individuals who have daily contact with abused children. Forty-two states now require reports from teachers or other school personnel. Forty-six jurisdictions require reports from social workers. Further surveys of state statutes indicate 43 require nurses, 37 require hospitals, 31 require residents or interns, 25 require coroners and medical examiners, 20 require surgeons, 25 require dentists, seven require clergymen, four require attorneys, and 18 require any person to report suspected child abuse cases. Two states, Maryland and Maine, give mandated reporters discretion not to report a suspected child abuse case under certain circumstances, i.e., efforts are presently or will be made to remedy abusive environment; reporting would inhibit caretaker from seeking counseling, or life or health is not immediately threatened 13 (Sloan, 1981; Schwartz & Hirsh, 1982). Under the federal Child Abuse Prevention and Treatment Act, to be eligible for federal grants, states must provide "immunity for persons reporting instances of child abuse and neglect from prosecution, under any state or local law, arising out of such reporting" (P.L. No. 93-247, Section 4(b)(2)(A)). By removing the threat of legal action, it is anticipated individuals will be encouraged to report suspected child abuse cases. All fifty states grant immunity to those individuals reporting suspected child abuse or neglect cases from civil and criminal charges. Ten states grant immunity from the photographing of the injuries. Nine states authorize immunity for those taking x-rays of suspected battered children. Thirty-seven states require individuals to act in good faith when reporting suspected cases before granting immunity. Eighteen states grant immunity where good faith is presumed to have initiated the report. Fourteen states extend immunity to any authorized person involved in the temporary removal of a child suspected of having been maltreated. Twenty-two states authorize selected individuals (i.e. physicians or other medical personnel) to take photographs or x-rays of injured children without parental permission. Thirteen states require those authorized to take photographs or x-rays to notify the designated child protection service of their actions or to forward the photographs or x-rays (Sloan, 1981; Schwartz & Hirsh, 1982). The degree of certainty required for a reporter to make a report has been an area of controversy. The courts have employed the objective standard of the reasonable man. Thus, those mandated must report the case if a reasonable man under exact circumstances would believe child abuse had occurred. This standard provides greater protection for the 14 child and ensures the speedy delivery of needed services (Schwartz & Hirsh, 1982). Forty-one states impose a criminal penalty for failure to report a known case of abuse. It is generally a misdemeanor for not reporting suspected abuse when mandated to do so. The typical penalty ranges anywhere from five to thirty days in jail and/or a $10 to $100 fine up to one year in jail and/or a $1000 fine. Four states abolish immunity to civil liability when a mandated reporter does not knowingly or willfully report a known case of abuse. In a California case (49 Cal. SBJ 118 (1971)), a father brought action against four doctors and the city police on behalf of his 3-year-old son who had sustained brain damage after repeated beating by the custodial mother's boyfriend. The child had been examined by all four doctors before the abuse was reported to the city police (who chose not to pursue the case). A $600,000 out of court settlement was agreed upon (Schwartz & Hirsh, 1982). It is a commonly held belief that the best method of reporting suspected child abuse is by telephone. This assures that the child's needs will quickly be addressed. The purpose of a written report is to provide written documentation of the referral. States vary as to the contents of required written reports and to what agency written and oral reports should be addressed to. Yet, all agree that reports should be made as soon as possible. There are three possible recipients of suspected child abuse cases: the police, the courts, or social service agencies. Many states designate the police to be the recipients of suspected child abuse reports. This may be because: (1) the police are available at all times; (2) pe0ple's natural reaction to physical abuse is usually to 15 notify the police; (3) many small communities do not have readably available access to social services agencies; (4) police officers are authorized to enter a home if they believe a child's life is threatened thus preventing further harm; and, (5) police are able to exercise authority other agencies cannot, which may be beneficial in certain cases (Schwartz & Hirsh, 1982). However, there exists many disadvantages to having the police monitor suspected child abuse cases. Consequently, some states hold other sources responsible. Such disadvantages include: (1) that the police do not have the training or resources for family therapy; (2) once questioned by the police, many families become apprehensive to Openly cooperate or seek treatment for fear of arrest; (3) successful prosecution of the abuser is rare, most are acquitted. Thus, the abuser may come to believe his actions towards his child are acceptable. In those rare circumstances where the abuser is convicted, sentencing is very light and the child remains in need of psychological services; (4) the police cannot provide services to diagnose the problem, meet the immediate needs of the child, draw a plan to protect the child from future abuse, and treat the family; and, (5) people are more reluctant to make reports if they know it may possibly lead to an arrest (Schwartz & Hirsh, 1982). The second possible recipient of suspected child abuse reports are the courts. Reasons cited for the use of the courts are: (1) decisions rendered in the court are backed with authority; and (2) the court can obtain treatment even though a criminal conviction was not made. However, there exists many disadvantages of having the courts receive suspected child abuse cases. Three major disadvantages are: (1) judicial intervention should not be the first step, rather it should be 16 the last step taken; (2) the courts are overburdened with cases and a limited amount of judicial resources exist; and (3) the courts should not be the investigator, petitioner, and judge of child abuse cases (Schwartz & Hirsh, 1982). The trend in most states is to have social service agencies receive suspected child abuse reports. The major reasons for this are that social service agencies are best qualified to identify what happens to children in abusive environments. Furthermore, they are equipped with professionals to evaluate the hazardous circumstances and decide when removal is best for the child and they can offer services in the treatment of the family unit even when removal of the child unnecessary. Although social service agencies appear to be a logical choice, there are inherent limitations. Thus far, social service agencies have done little in providing necessary treatments and follow-up services. They are often understaffed and underbudgeted with many not providing services outside regular business hours (Schwartz & Hirsch, 1982). Although there has been little agreement as to who should receive suspected child abuse reports, one thing is agreed upon. In an effort to ensure services will be carried out, fragmentation of services should be avoided. A single receiving agency should be used; one that meets the interdisciplinary needs of the abused children and their families. The temporary emergency removal of a child from their home is viewed as a traumatic but at times necessary precaution. The emergency removal of a child may be made after a determination that remaining in the home would be hazardous to the child's welfare and life. Such clauses are found in only six state statutes (Schwartz & Hirsh, 1982). No reported model act contains provisions outlining the temporary emergency removal of a battered child into protective custody. Most of these laws 17 authorize physicians, law enforcement officers, and social service workers to remove the child from the home when a threat of further abuse exists. The responsible authority is required to notify a family court of their actions as soon as possible. New York has noted that once an abused child is removed from the home, the remaining siblings are in danger of being abused. Therefore, New York family court often remove the remaining siblings from the home. Relying on the "imminent danger doctrine" in the case of In re J., 71 Misc.2d 47, 335 NY2d 815 (1972), the presiding judge declared: "experience teaches that if a parent abuses one child, he will then abuse them all" (Schwartz & Hirsch 1982, p. 310). Many jurisdictions have passed statutes protecting communications between patient (including children) and physician if the statements were necessary to enable the physician to render treatment. This encourages full disclosure by a patient to a physician for ensuring proper treatment. As a privilege that is given, it may also be taken away. Legislation to remove a privilege, in this case confidentiality between patient and physician, is unnescessary when it is in the best interest of the child's welfare to disclose information. Nevertheless, only thirty states have included a clause abrogating privileged communications between patients and physicians. Presently thirty-two states abolish the privilege of communication between husband and wife in child abuse cases. This is a necessary step since abuse usually occurs in the home with virtually no witnesses outside of the immediate family. In United States -v- Allery, 526 F.2d 1362 (8th Cir. 1975), a federal district court ruled against the defendant for attempted rape based upon his wife's testimony. On appeal the court stated, "the general policy behind the husband-wife privilege 18 of fostering "family peace" retains as much vitality today as it did when it was first created. But a serious crime against a child is an offense against the "family harmony'' and "to society as well." The attorney-client privilege is the oldest known privilege of its kind. While Cannon 37 of the Code of Professional Ethics states, "It is the duty of a lawyer to preserve his clients confidences", Nevada has abolished this privilege in cases of child abuse. Thereby creating a conflict between state law and professional ethics. Whether to pursue at the court level is a difficult situation for any child protection service worker. The welfare of the child takes precedence over all matters. The court's actions are usually limited to: (1) the removal of a child temporarily or permanently from the home; and, (2) to procure treatment when the child is in immediate danger or any previous attempts of treatment have been unsuccessful; or when the parents have made inadequate attempts to meet the child's needs. Furthermore, the courts intervention may be necessary when one of the followings occurs: (1) Families refuse to cooperate with the investigation and there is reason to suspect that a situation of abuse and neglect exists; (2) Families are unwilling to accept needed services although their child is in substantial danger; (3) The investigation indicates the need for removal of the child; and, (4) The family is eligible for services only if the child is a dependent of the court (Sloan pp. 77-78). ' There are two types of courts: criminal and civil, and either one may be involved in child abuse cases. Civil court is less rigid than criminal court, its major interest in a child abuse case is to protect the child from further abuse and to provide treatment to the child and their family. A criminal court's major role in child abuse cases is the criminal prosecution of the abusive or neglectful caretaker. Since it 19 deals solely on criminal prosecutions, its goal is the deterance or rehabilitation of the abuser through probation or incarceration. It does not attempt to provide treatment services for the child or ensure the child's safety. Hence, a criminal court is less often the avenue taken. Juvenile court, family court, children's court, or domestic relations court are the names given to the civil court that address the child's needs. A juvenile court has exclusive jurisdiction over many family and child related legal issues while the individual is still a minor (the usual maximum age limit is 16 or 18). Although juvenile court proceedings for child abuse vary throughout the nation, the Constitution guaranties the basic rights of due process. Nevertheless, because of its unique nature, child abuse cases may be handled differently than others. There is a greater degree of invasion of privacy than in most cases. Some states allow social service workers to photograph and x-ray a child without parental consent. Proper notice of proceedings are given to the parents. Thereby enabling them to hire an attorney and prepare to address the allegations being made against them. Except in emergency situations, a hearing is held for the removal of the child from it's home without parental consent. The right to counsel varies from state to state. Eighteen states appoint a guardian ad litem to represent the child. Eleven other statutes require that the guardian ad litem must be an attorney. Nine states require legal counsel to be appointed to represent the abused or neglected child in court proceedings. Only one state, South Carolina, provides both guardian ad litem and legal counsel for abused children (Sloan, 1981). The prosecution of child abusers is often plagued by the limited 20 availability of evidence. By its very nature, child abuse occurs at home with no impartial witnesses. Often the abuse is committed against a child too young to testify against the abusers. Usually those individuals, (such as physicians or school teachers), who upon realizing that the odds for conviction are low, will either refuse to testify or reluctantly do so. It is usually the case where the prosecution's only available witness is the child. Unfortunately the child's testimony adds little credence to the abuse --for the child fears repercussions of his testimony. It has been determined that evidence of a prior crime is admissable in court. In United States -v- Woods, 484 F.2d 127 (4th. Cir. 1973), the appellate court upheld the admission of prior crimes into evidence. Six of the infant's siblings had died under similar suspicious circumstances. Although the defendant had never been accused or convicted, there was suspicion of abuse leading to the deaths. Because of the secretive nature of child abuse, there were no witnesses to the infants death. Thus, prior case evidence was found to be admissable to insure a fair trial. B. CHILD ABUSE LEGISLATION IN THE STATE OF MICHIGAN. In Michigan, the first child abuse law was enacted in 1964, amended in 1966 and 1967, with total revisions in 1975 and amended again in 1978, 1980 and 1984. Today, Michigan's Child Protection Law, P. A. 1975, No. 238, is established (as noted in its' purpose clause) as: An Act to require the reporting of child abuse and neglect 21 by certain persons; to permit the reporting of child abuse and neglect by all persons; to provide for the protection of children who are abused or neglected; to authorize limited detainment in protective custody; to authorize medical examinations; to prescribe powers and duties of the state department of social services to prevent child abuse and neglect; to safeguard and enhance the welfare of children and preserve family life; to provide for the appointment of legal counsel; to provide for the abrogation of privileged communications; to provide civil and criminal immunity for certain persons; to provide rules of evidence in certain cases; to provide for confidentiality of records; to provide for the expungement of certain records, to prescribe penalties, and to repeal certain acts and parts of act. Section 2 of the act defines terms used within the context of the law as follows: (a) "Central registry" means the system or organized mode of keeping a record of all reports filed with the department pursuant to this act in which relevant and accurate evidence of child abuse or neglect is found to exist and which is maintained at the department. (b) "Child" means a person under 18 years of age. (c) "Child abuse" means harm or threatened harm to a child's health or welfare by a person responsible for the child's health or welfare which occurs through non-accidental physical or mental injury; sexual abuse; sexual exploitation; or maltreatment. (d) “Child neglect" means harm to a child's health or welfare by a person responsible for the child's health or welfare which occurs through negligent treatment, including the failure to provide adequate food, clothing, shelter, or medical care. (e) "Sexual abuse" means engaging in sexual contact or sexual penetration as defined in section 520(a) of the Michigan Penal Code, Act No. 328 of the Public Acts of 1931, being section 750.520(a) of the Michigan Compiled Laws, with a child by a person responsible for the child's health or welfare. (f) "Sexual exploitation" includes allowing, permitting, or encouraging a child to engage in prostitution by a person responsible for the child's welfare; or allowing, permitting, encouraging, or engaging in the photographing, filming, or depicting of a child engaged in a listed sexual act as defined in section 145(c) of Act No. 328 of the Public Acts of 1931, being section 750.145(c) of the Michigan Compiled Laws, by a person responsible for the child's health or welfare. (9) "Relevant evidence" means evidence having any tendency to make the existence of any fact that is at issue more probable 22 than it would be without the evidence. (h) "Department" means the state department of social services. (i) “Expunge” means to physically remove or eliminate and destroy a record or report. (j) "Local office file" means the system or organized mode of keeping a record of a written report, document, or photograph filed with and maintained by a county or a regionally based office of the department. (k) "Person responsible for the child's health or welfare" includes, but is not limited to, a parent, legal guardian, stepparent, or any other individual to whom a parent or legal guardian delegates the care of the child. It should be noted that Michigan does not make an exception of age for those who are mentally retarded, married, or in military service in 2(b). Furthermore, Michigan's definition for abuse includes the deliberativeness of abuse in 2 (c). In subsection 2(f) the department of social services is designated to receive reports of suspected child abuse cases. Michigan is one of forty-seven states to appoint this department to receive reports (Sloan, 1981). Subsection 3(1) identifies those individuals required to report suspected child abuse or neglect and procedures to be: A physician, coroner, dentist, medical examiner, nurse, a person licensed to provide emergency medical care, audiologist, psychologist, family therapist, certified social worker, social worker, social work technician, school administrator, school counselor or teacher, law enforcement officer, or duly regulated child care provider who has reasonable cause to suspect child abuse or neglect immediately, by telephone or otherwise, shall make an oral report, or cause an oral report to be made, of the suspected child abuse or neglect to the department. Within 72 hours after making the oral report, the reporting person shall file a written report as required in this act. If the reporting person is a member of the staff of a hospital, agency, or school, the reporting person shall notify the person in charge of the hospital, agency, or school of his or her finding and that report has been made and shall make a c0py of the written report available to the person in charge. One report from a hospital, agency, or school shall be considered adequate to meet the reporting requirement. A member of the staff of a hospital, agency, or school shall not be dismissed or otherwise penalized for making a report 23 required by this act. Michigan is one of forty-three states not requiring clergymen; one of forty-six not requiring attorneys; one of forty-eight not requiring pharmacists; one of thirty-three not requiring Optometrists; one of twenty-eight not requiring osteopaths; and one of forty-eight not requiring parole officers to report suspected child abuse cases (Sloan, 1981). In addition, it has been clarified by the Attorney General that "The identity Of a "reporting person" is confidential" (0p. Atty. Gen. 1978, No. 5297, p. 430). Subsection 3(2) discusses that written reports of suspected child abuse shall contain: The . . . name of the child and a description of the abuse or neglect. If possible, the report shall contain the names and addresses of the child's parents, the child's guardian, the persons with whom the child resides, and the child's age. The report shall contain other information available to the reporting person which might establish the cause of the abuse or neglect and the manner in which the abuse or neglect occurred. Complete report of the child's name, primary caretaker, and reasons to suspect child abuse or neglect provides indespensible information. Thereby assuring a complete and accurate assessment of the child's status by the investigating department caseworker. Michigan is one of twenty-four states requiring a written report of suspected child abuse following oral reports. Subsections 3(3) and 3(4) indicate how and where a report shall be filed, whereas, subsection 3(5) identifies those who may receive c0pies of written reports of suspected child abuse or neglect as follows: Upon receipt of a written report of suspected child abuse or neglect, the department may provide c0pies to the prosecuting attorney and the probate court of the counties where the child suspected of being abused or neglected, resides and is found. Subsection 3(6) identifies instances where the department of social 24 services shall transmit a copy of the written report of suspected child abuse or neglect to the prosecuting attorneys as follows: If the report indicates a violation of section 145(c) of the Michigan Compiled Laws Penal Code, Act No. 328 of the Public Acts of 1931, being section 750.145(c) of the Michigan Compiled Laws, and the department believes that the report has basis in fact, the department shall transmit a COpy of the written report to the prosecuting attorney of the counties in which the child resides and is found. Subsection 3(7) explicitly deals with the identification of sexual abuse as: ". . . the pregnancy of a child less than 12 years of age or the presence of a venereal disease in a child who is over 1 month of age but less than 12 years of age shall be reasonable cause to suspect child abuse and neglect. The Opinion of the Attorney General on this subsection states that: Diagnosis of a venereal disease or a vaginal infection based upon smear and culture indicating sexual abuse of a minor child under the age of 12 years would require a report of suspected child abuse or child neglect to be filed with the department of social services. (0p. Atty. Gen. 1980, No. 5815, p. 1075). Section 4 identifies others who may report suspected child abuse or neglect as follows: "In addition to those persons required to report child abuse or neglect under section 3, any person, including a child, who has reasonable cause to suspect child abuse or neglect may report the matter to the department or law enforcement agency. Section 5 concerns the confidentiality of the identity of those reporting a suspected child abuse or child neglect case as: The identity of a reporting person shall be confidential subject to disclosure only with the consent of the person or by judicial process. A person acting in good faith who makes a report or assists in any other requirement of this act shall be immune from civil or criminal liability which might otherwise be incurred thereby. A person making a report or assisting in any other requirement of this act shall be presumed to have acted in good faith. This immunity from civil or criminal liability extends only to acts done pursuant to this act and does not extend to a negligent act which causes personal injury or death or to the malpractice of a physician which results in 25 personal injury of death. The Attorney General has issued an opinion pertaining to this section which states: Other persons and agencies, other than the "reporting person," such as the department of social services, hospital employees, members of social agencies, health care workers and relatives and friends of the allegedly abused or neglected child, will, of necessity, contribute reports, documents and photographs in conjunction with and subsequent to the filing of the initial referral, however, their contribution to the records are afforded the more limited confidentiality applicable to department files . . . which permits disclosure of records to certain specified individuals or agencies. (0p. Atty. Gen. 1978, No. 5297, p. 430). The Attorney General has further stated that: The thrust . . . of the Child Protection Law is to provide protection for the "reporting person" consistent with the broader purpose of the act to encourage reporting of child abuse and neglect." "Both the central registry system and the materials filed in connections with cases listed in the registry, are subject to the confidentiality provisions of the Child Protection Law whether originated by the Department of Social Services or transmitted to it by other persons or agencies." “The confidentiality of the identity of a "reporting person" can be breached only with the consent of the "reporting person" or by judicial process." "Information which is confidential by statute is not subject to disclosure under the Freedom of Information Act. (0p. Atty. Gen. 1978, No, 5297, p. 430). Section 6 establishes the right to detain a child in the hospital and for examinations to be conducted, as well as for the reporting of all medical evaluations of the child as follows: (1) If a child suspected of being abused or neglected is admitted to a hospital or brought to a hospital for outpatient services and the attending physician determines that the release of the child would endanger the child's health or welfare, the attending physician shall notify the person in charge and the department. The person in charge may detain the child in temporary protective custody until the next regular business day of the probate court, at which time the probate court shall order the child detained in the hospital or in some other suitable place pending a preliminary hearing as required by section 14 of chapter 12(a) of Act No. 288 of the Public Acts of 1939, as amended, being section 712(a).14 of the Michigan Compiled Laws, or order the child released to the child's parents, guardian, or custodian. 26 (2) When a child suspected Of being an abused or neglected child is seen by a physician, the physician shall make the necessary examinations, which may include physical 'examinations, x-rays, photographs, laboratory studies, and other pertinent studies. The physician's written report to the department shall contain summaries of the evaluation, including medical test results. (3) If a report is made by a person other than a physician, or if the physician's report is not complete, the department may request a court order for a medical evaluation of the child. The department shall have a medical evaluation made without a court order if the child's health is seriously endangered and a court order cannot be obtained. The Attorney General has interpreted this section to state: Inasmuch as there is no violation of the physician-patient privilege when a hospital provides medical information on children to the department of social services staff conducting a protective services investigation under the Child Protection Act, a hospital is required to provide such medical information as is encompassed in (Section 3(2) and Section 6(2)) even absent a parental release. (0p. Atty. Gen. 1978, No. 5406, p. 724.) Michigan is one of only twenty-two states authorizing the taking of photographs and one of twenty-one states authorizing the taking of x-rays. Michigan is one of thirteen states requiring medical examination reports, photographs, and x-rays to be forwarded to the Children's Protective Services. Michigan is one of forty-one states for which medical examinations are not paid for at public expense (Sloan, 1981). Section 7 calls for the establishing of a central registry system to maintain documents and photographs; confidentiality of information in the central registry along with the amending or expunging or reports. Section 7 reads as follows: (1) The department shall maintain a central registry system to carry out the intent of this act. A written report, document, or photograph filed with the department pursuant to this act shall be a confidential record available only to one or more of the following: (a) A legally mandated public or private child protective agency investigating a report of known or suspected child abuse or neglect. 27 (b) A police or other law enforcement agency investigating a report of known or suspected child abuse or neglect. (c) A physician who is treating a child whom the physician reasonably suspects may be abused or neglected. (d) A person legally authorized to place a child in protective custody when the person is confronted with a child whom the person reasonably suspects may be abused or neglected and the confidential record is necessary to determine whether to place the child in protective custody. (e) A person, agency, or organization, including a multidisciplinary case consultation team, authorized to diagnose, care for, treat, or supervise a child or family who is the subject of a report or record under this act, or who is responsible for the child's health or welfare. (f) A person named in the report or record, if the identity of the reporting person is protected pursuant to section 5. (g) A court which determines the information is necessary to decide an issue before the court. (h) A grand jury which determines the information is necessary in the conduct of the grand jury's official business. (i) A person, agency, or organization engaged in a bona fide research or evaluation project, except information identifying a person named in the report or record shall not be made available unless the department has obtained that person's written consent. The person, agency, or organization shall not conduct a personal interview with a family without the family's prior consent and shall not disclose information which would identify the child or the child's family or other identifying information. (j) A person appointed as legal counsel pursuant to section 10. (2) A person or entity to whom a report, document, or photograph is made available shall make the report, document, or photograph available only to a person or entity described in subsection (1)(a) to (j). This subsection shall not be construed to require a court proceeding which otherwise would be Open to the public to be closed. 28 (3) A person who is the subject of a report or record made pursuant to this act may request the department to amend an inaccurate report or record from the central registry and local office file. A person who is the subject of a report or record made pursuant to this act may request the department to expunge from the central registry a report or record in which no relevant and accurate evidence of abuse or neglect is found to exist. A report or record filed in a local office shall not be subject to expunction except as the department shall authorize, when considered in the best interest of the child. If the department refuses the request for amendment or expunction, or fails to act within 30 days after receiving the request, the person shall be granted a hearing to determine by a preponderance of the evidence whether the report or record in whole or in part should be amended or expunged from the central registry on the grounds that the report or record is not relevant or accurate evidence of abuse or neglect. The hearing shall be before a hearing officer appointed by the department and shall be conducted pursuant to the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, as amended, being sections 24.201 to 24.315 of the Michigan Compiled Laws. If the investigation of a report conducted pursuant to this act fails to disclose evidence of abuse or neglect, the information identifying the subject of the report shall be expunged from the central registry. If evidence of abuse or neglect exists, the information identifying the subject or the report shall be expunged when the child alleged to be abused or neglected reaches the age of 18, or 10 years after the report is received by the department, whichever occurs later. The Attorney General's opinion on the amendment and expungement of records is as follows: Although Section 7(2) of the Child Protection Law refers to amendment and expungement of inaccurate or unsubstantiated reports and records in the central registry, it is clear that material contained in the central registry or duplicated elsewhere are subject to amendment and expungement. A finding by a court of competent jurisdiction that here was no child neglect or abuse raises a presumption and the report or record was not substantiated and must therefore, be amended or expunged. (0p. Atty. Gen. 1978, No. 5297, p. 430). As to the confidentiality of records kept in the central registry, the Attorney General has stated that: Both the central registry system and the material filed in connection with cases listed in the registry, are subject to the confidentiality provision of the Child Protection Law whether originated by the Department of Social Services or transmitted to it by other persons or agencies. (0p. Atty. Gen. 1978, No. 5297, p. 403). 29 In addition, the Attorney General interpreted disclosure of reports, documents and photographs as follows: Other persons and agencies, other than the “reporting person", such as the department of social services, hospital employees, members of social agencies, health care workers and relatives and friends of the allegedly abused or neglected child, will, of necessity, contribute reports, documents and photographs in conjunction with and subsequent to the filing of the initial referral, however, their contribution to the records are afforded the more limited confidentiality applicable to department files described in Section 7(1), which permits disclosure of records to certain specified individuals or agencies. (0p. Atty. Gen. 1978, No. 5297, p. 430). Michigan is one of ten states which expunges documents when the child reaches 18 years of age. It is one of thirteen which takes action when a report is unfounded. One of forty-five not to give notice to persons listed in the registrars. One of forty-six not to give notice to a listed persons rights to challenge contents of files. One of ten to allow a listed person in the registry to make amendments, sealing, or expunction of a file. And only one of twelve states to allow persons listed in the registry to have a hearing on a request to amend, seal or expunge a file. (Sloan, 1981). Section 8 outlines investigative procedures of reported suspected child abuse or neglect cases, the involvement of law enforcement officials and probate court along with abuse and neglect in institutional settings as follows: (1) Within 24 hours after receiving a report made pursuant to this act, the department shall commence an investigation of the child suspected of being abused or neglected. (2) In the course of its investigation, the department shall determine if the child is abused or neglected. The department shall cooperate with law enforcement officials, courts of competent jurisdiction, and apprOpriate state agencies providing human services in relation to preventing, identifying, and treating child abuse and neglect; shall provide, enlist, and coordinate the necessary services, directly or through the purchase of services from other 30 agencies and professions; and shall take necessary action to prevent further abuses, to safeguard and enhance the welfare of the child, and to preserve family life where possible. (3) In conducting its investigation, the department shall seek the assistance of law enforcement officials within 24 hours after becoming aware that 1 or more of the following conditions exists; (a) Abuse or neglect is the suspected cause of a child's death. (b) The child is the victim of suspected sexual abuse or sexual exploitation. (c) Abuse or neglect resulting in severe physical injury to the child requires medical treatment or hospitalization. For purposes of this subdivision, "severe physical injury" means brain damage, skull or bone fracture, subdural hemorrhage or hematome, dislocation, sprains, internal injuries, poisoning, burns, scalds, severe cuts, or any other physical injury that seriously impairs the health or welfare. (4) Law enforcement officials shall cooperate with the department in conducting investigations pursuant to subsection (3) and shall comply with sections 5 and 7. (5) Involvement of law enforcement officials pursuant to this section shall not relieve or prevent the department from proceeding with its investigation or treatment. (6) In each county, the prosecuting attorney and the department shall develop and establish procedures for involving law enforcement Officials as provided in this section. (7) If there is reasonable cause to suspect that a child in the care of or under the control of a public or private agency, institution, or facility is an abused or neglected child, the agency, institution, or facility, shall be investigated by an agency administratively independent of the agency, institution, or facility being investigated. If the investigation produces evidence of a violation of section 145(c) of the Michigan Penal Code, Act No. 328 of the Public Acts of 1931, being section 750. 145(c) of the Michigan Compiled Laws, the investigating agency shall transmit a copy of the results to the investigation to the prosecuting attorney of the county in which the agency, institution, or facility is located. The prosecuting attorney may proceed under section 135 to 145(c) of Act No. 328 of the Public Acts of 1931, as amended, being sections 750.135 to 750.145(c) of the Michigan Compiled Laws, when a violation of these sections has occurred. The Attorney General has declared that: 31 Under this section the Department of Social Services may delegate to law enforcement officials or the probate court those aspects of the investigation which will assist it in carrying out its duties, although the responsibilities under the act may not be delegated. (0p. Atty. Gen. 1979, No. 5443, p. 53). The Child Protection Law . . . grants to the Michigan Department of Social Services the authority and the responsibility to investigate the situations where children are abused by a teacher or other school administrators in either a public or private school and requires the department, during the course of such investigation, to take such action as is necessary to insure the welfare of such children; in such investigation, the department should make every effort possible to coordinate its actions with those of the parent or legal guardian. (0p. Atty. Gen. 1978, No. 5396, p. 708). The criminal prosecution of a child abuse or neglect case in Michigan appears to be uncommon. A survey of the Michigan Department of Corrections for 1975 through 1983 shows that a total of 672 people were charged with committing or attempting to commit a child abuse or neglect related crime (sexual abuse crimes are included, since a break-down of the type of substantiated abuse could not be attained for all nine years from the Michigan Department of Social Services). Of those 621 individuals, 188 were given prison sentences; 393 were placed on probation; 40 received jail sentences; and in 51 cases no ruling was reported. During the same nine year period (1975-1983) there were 161,210 substantiated referrals to the Michigan Department of Social Services (taken from the Health and Welfare Data Center Children's Protective Services Management Information - Age and Sex of Victim PS-316 for 1979 through 1983; and Substantiated Referrals To Protective Services For Neglect and Abuse for 1975 through 1978 provided by Lensworth Cottrell Jr. and Margaret Answinger of the Michigan Department of Social Services). Thus, the ratio of individuals receiving some form of conviction (resulting in either a prison, jail, probation) during 1975 to 1983, for committing or attempting to commit any of the eight related proscribed crimes listed in the Michigan Department of Corrections 32 Statistical Presentation, are 1 in every 259.59 substantiated child abuse or neglect referrals to the Department of Social Services. See, TABLE 1. The eight proscribed crimes are: 1) Cruelty to children (M.C.L.A. 750.136); 2) Torturing of children (M.C.L.A. 750.136(a)); 3) Accosting, enticing or soliciting children for immoral purposes (M.C.L.A. 750.145(a)); 4) Accosting, enticing or soliciting children for immoral purposes second offense (M.C.L.A. 750.145(b)); 5) Children, exposing with intent to injure or abandon (M.C.L.A. 750.135; (6) Enticing away a child under 14 years (M.C.L.A. 750.350); (7) Indecent liberties with a child (M.C.L.A. 750.336); and, (8) Enticing away a female under 16 (M.C.L.A. 750.13). YEAR 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 TOTAL TABLE 1 COURT JUDGMENTS IN CHILD ABUSE CASES 30% RECEIVED A PRISON SENTENCE. 63% RECEIVED A TERM OF PROBATION. 06% RECEIVED JAIL AND/OR FINE. NUMBER OF SUBSTANTIATED CASES PRISON PROBATION JAIL or FINE 15,594 47 (37%) 74 (59%) 5 (4%) 15,361 35 (25%) 101 (72%) 5 (4%) 16,163 17 (43%) 20 (50%) 3 (8%) 14,014 11 (27%) 24 (59%) 6 (15%) 17,826 7 (17%) 32 (78%) 2 (5%) 17,277 12 (32%) 23 (62%) 2 (5%) 18,000 6 (24%) 17 (68%) 2 (8%) 15,099 18 (31%) 32 (55%) 8 (14%) 15,902 16 (30%) 35 (66%) 2 (4%) 15,974 19 (32%) 35 (59%) 5 (8%) 161,210 188 393 40 34 TABLE 1 (cont'd.). YEAR TOTAL CONVICTIONS PER CASE 1974 126 1 per 123.76 cases 1975 141 1 per 108.94 cases 1976 40 1 per 404.08 cases 1977 41 1 per 350.35 cases 1978 41 1 per 434.78 cases 1979 37 1 per 466.95 cases 1980 25 1 per 720.00 cases 1981 58 1 per 260.33 cases 1982 53 1 per 300.04 cases 1983 59 1 per 270.75 cases TOTAL 621 1 per 259.59 cases NOTE: DUE TO THE ROUNDING OF PERCENTAGES THE TOTALS MAY NOT EQUAL 100%. TAKEN FROM THE MICHIGAN DEPARTMENT OF CORRECTIONS STATISTICAL PRESENTATION FOR FYS 1974-83 AND THE DEPARTMENT OF SOCIAL SERVICES REPORT PS-5333 FOR FYS 1974-83. CHAPTER III A LITERATURE SURVEY OF CHILD ABUSE The literature concerning this study has been divided into three areas. The first section is an overview of the treatment of children in both physical abuse and neglect cases. The second area reviews work exclusively on the role of the abused child, the specific areas are: (1) premature baby; (2) physically handicapped, mentally ill, and the mentally retarded child; (3) natural disposition and temperament of an abused child; (4) the "special child"; and, (5) children reflecting the caretaker's own image or the image of another in child abuse. In conclusion, the third section is concerned with studies addressing the developmental, psychological and psychosocial effects of abuse on the child, appropriately: (1) problems in effective communication; (2) the aggressive nature of an abused child; (3) anxiety and the abused child; (4) the non-organic failure to thrive in an abused child; (5) role reversal and the abused child; (6) the abused child and depression; (7) learning, adjustment and impaired impulse control of the abused child; (8) the abused child's employment of primitive defense mechansims; and, (9) the impaired self-concept of an abused child. 35 36 A. TREATMENT OF THE ABUSED CHILD Studies concerning the treatment of the physically abused child are scarce. Spinetta and Rigler (1972) asserted that most studies focus primarily on demographic and causal factors, rather than on the abused child as a separate subject. The few studies and observations which have been conducted, indicate that physical abuse causes serious psychological consequences for the child. This is an observation which presents serious implications. The victimized children have been described as aggressive and full of hatred (Fontana, 1973); to be uncontrollable, negativistic and subject to severe temper tantrums (Johnson & Morse, 1968); they will exhibit a lack of impulse control (Elmer, Sahler, & Friedman, 1970); and are most apt to withdraw and be inhibited (Rolston, 1971). As a result of physical abuse, cognitive and neurological deficits have been observed in this pOpulation (Martin, 1972; Martin, Beezley, Conway, & Kempe, 1974; McRae, Ferguson, & Lederman, 1973; Morse et. al., 1970; Sandgrund, Gaines, & Green, 1974; Lewis, Shanok, Pincus, & Glasser, 1979). Thus, the psychological, cognitive, and neurological damage to the young victims of child abuse itself, merits further study. It is no surprise that children who are abused tend to become very violent and hostile juveniles. By the time of their adolescence, they have witnessed and experienced a great amount of violence and despair. These children have gained an embedded hatred for the world. After having reviewed the available literature concerning children and adolescents who kill, Bender and Curran (1940) noted five categories of etiological factors which played a major role in the young and developing lives of these children: (1) intensification of a family 37 rivalry situation; (2) foster home situations in which the feelings of love were insufficient to curb aggressive tendencies; (3) organic inferiority; (4) educational difficulties; and, (5) the child's tendency to identify himself with aggressive parents and pattern their behavior. Bender and Curran further stated: "It has been our experience that children who were treated with violence which cannot always be anticipated react with blind violence which is an expression of their fearful insecurity." (p. 297) Other studies have noted that delinquent children who were referred to clinics, suffered from previously unrecognized, undiagnosed, and untreated psychiatric, neurological, and educational disorders. These disorders appear to have played an important role in the child's delinquent behavior (Lewis, 1976a; Lewis & Balla, 1976; Lewis & Shanok, 1976). In a study by Lewis, Shanok, Pincus, & Glaser (1979), ninety-seven boys residing in a Connecticut correctional school were Observed. One area of interest regarded whether the boys had ever been a victim of abuse or a witness to abuse. A child was deemed to have been abused by their parents or guardians, if he had been: hit with a closed fist; beaten with a stick, board, pipe or belt buckle; beaten with a belt or switch other than on the buttocks; or had been deliberately cut, burned or thrown. A child was considered to have witnessed abuse if he had Observed someone, namely a family member or a friend, receiving any of the above mentioned treatment. A child was not considered to have been abused if he had been hit with an Open hand, or beaten with the leather part of a belt or switch on the buttock only. The results indicated that those children who had committed more violent offenses, were significantly more apt to have a history as a 38 victim of abuse, whereas, those children who committed offenses with less violent overtones were less likely to be victims. According to the interviews, the type of abuse varied in intensity from being beaten with a fist, to being chained to a chair and burned. The two samples also differed in terms of exposure to violence. An incredible 78.6% of the more violent children were known to have witnessed extreme violence directed at others, mainly in their homes, compared to 20% of the less violent children. This difference existed even though the family unit of the more and less violent delinquents (e.g. broken homes, mother or father present in the home), were similar in both groups. The decisive factor was the quality of family interactions that distinguished the two groups. A correlation coefficient of r = 0.373, with p greater than .001 indicating that the degree of violence committed by a child, was strongly associated with having been abused. Many of the juveniles were found to have paranoid symptoms and a multiplicity of major and minor neurological abnormalities which may have been a result of the physical abuse in their lives. Consequently, the physically abused child may have a greater tendency to be a juvenile delinquent. The reasons for this are usually: (1) Physical abuse often causes damage to the central nervous system, which contributes to impulsivity, attention disorders, and learning disabilities. Thus, the ability to experience success in our society is diminished; (2) Physical abuse provides a model with which to identify; and, (3) Physical abuse may result in hostility and rage toward the abusing parent, as well as authority figures and other individuals. Accordingly, the child acts out his anger by attacking those around him. Theorists B. F. Skinner (1974) and Albert Bandura (1969a), have contended that an adult is primarily the product of his environment. His 39 family, friends, and society have taught him to be aggressive while still a baby. They believe that learning is the key to the deveIOpment of behavior. One learns through reinforcement and modeling. Observing someone behave in a particular manner may affect behavior. Therefore, Skinner and Bandura have concluded that: (1) observations may teach an individual how to perform something new, that one either previously could not do, or would not have thought of doing; (2) one may learn what occurs when one acts in a certain manner and as a result of this, chooses to change ones behavior; and, (3) a model may suggest how to behave in unusual and difficult situations. Classical experiments by Albert Bandura, Dorothea Ross and Sheila Ross (1963), and David Hicks (1967), provide a good example of modeling. After having viewed a film of a child attacking an inflatable doll with a rubber mallet, viewers were more likely to imitate the actor than if they had not watched this film. Since children learn (model) from their parents, it may be argued that an abused child will be more apt to abuse their own children rather than one who was not abused. Theoretically, a child who is abused should have a high degree of hostility towards the parents and the world in general. The expression "monkey see, monkey do" exemplifies this idea in simple terms (Curtis, 1963). As the child grows he continues to feel a loss of control over his life, he learns not to trust anyone, and fails to learn how to solve his problems or to meet his needs. The child feels worthless and is easily discouraged. At this point, having felt unloved and unwanted, the adult who was abused as a child may now have a child to combat his loneliness. The problems of abused children do not disappear with adulthood. In a finding which indicated that abused children usually became abusive parents (Spinetta & Rigler 1972), the authors noted that children who 40 were raised in an abusive environment, had their senses conditioned so as not to allow them to receive or transmit positive messages. While this creates difficulties in communicating with peers, it makes it impossible to establish a communication system with a newborn infant. The results of this is a parent/baby interaction that breaks down very early in the relationship. In 1979, Green reported the results of a study of child-abusing fathers at the Downstate Medical Center treatment program. The background of these child-abusing fathers played an important role in shaping their abusive predisposition. As children, they lived in a world in which violence was an integral part of daily living; the use of physical punishment was widely condoned. It was found that the abusing fathers shared several personality traits with the abusing mothers. They exhibited impaired impulse control, which is believed to be due to having received harsh punishment as a child and identifying with violent parental models. The child-abusing fathers tended to feel worthless and devalued, reflecting the rejection and criticism accorded to them by adults during their own childhood. They exhibited disturbances in identity formation. The father's identifications were unstable and were controlled by hostile introjections derived from the internalization of "bad" self and object representations of their early childhood. They employed projection and externalization as mechanisms to defend themselves against awareness of underlying feelings of worthlessness. These men often had limited vocational skills. When employed, they performed menial work or attained little satisfaction from their work. Their source of feeling of masculinity and positive self-esteem come from controlling their families through violent acts. The behavior of these child-abusing fathers were 41 those of paranoia, passive-aggressive, and inadequate personality disorders. Their impulsivity and use of projected mechanisms were further brought out by their excessive drinking (Green, 1978). The abuse usually occurred when the father was reluctantly left to care for the child, either due to the mother's temporary or permanent absence. Abuse was also more likely to occur during marital discord. The threatened loss of spousal love and support often brought painful memories of their own childhood object loss. The reminder of object loss usually engendered frustration and rage toward their own children. The loss of a job also placed much strain on the marriage, which resulted in the father becoming more dependent on his wife and family for emotional support. Therapy for the child-abused fathers was very difficult. Not ever having learned to trust, they were suspicious and distrustful of authorities including therapists. Their fragile self-esteem caused them to interpret advice as criticism, and they attempted to project their guilt onto others. Furthermore, they were Often late or missed appointments with their therapists (Green, 1978). Since studies have indicated that the abused rather than the non-abused child, will also abuse their own children, there is certainly an urgent need to treat the children in order to end the constant cycle. If untreated, the vicious cycle will not be broken. Treating the emotional scars of abuse while the abused are still young and impressionable, gives hope that they will not strike their children. It is important that these children successfully pass Erik Erikson's psychosocial developmental stages. They need to learn to trust rather than to distrust; autonomy and not shame; initiative and not guilt; industry and not inferiority; and identity and not identity diffusion. 42 Society suffers when abused children grow-up and turn to a life of crime. Duncan et. al., (1958) reported the results of a study of six male adult prisoners convicted of first degree murder. All six were from a good social standing family. Four of the men had case histories of having been physically abused by their parents as children. The remaining two, although not abused as children, were overtly psychotic. It is highly unlikely that there exists a one-to-one relationship between child abuse and later crimes of violence. Many other aspects Often come into play to help determine the child's chosen path. Yet all to often, these children have a disadvantage from the beginning --they lack a basic trust in others. This in essence, is a loss of human resources. If these individuals had not been abused, they might not have turned to a life of crime and instead reached their fullest potential of becoming contributing members of society. It is important when addressing the issue of child abuse to realize the psychological implications such extreme torture has on a young child's mind. One possible consequence of such treatment, which is of great public concern, is the probable tendency of these children to become "tomorrow's murderers and perpetrators of other crimes of violence if they survive" (Curtis, 1963). Many of these people may not have chosen the violent path, had they received psychological services in early life. Yet, all too often, the mental health field has chosen to counsel the offenders and not the victims Of child abuse. 8. THE ROLE OF THE ABUSED CHILD. Steele and Pollock (1974) stated that as a result of child abuse, there exists a severe psychopathology which disrupts the "mothering 43 function" in the deveIOpment of children who later become abusers. Increasingly, research on abused and neglected children suggest that this psychopathology may be due to the child playing a more than passive role in abuse. Gelle's (1973) social-psychological model of the causes of child abuse maintain that a certain amount of child—produced stress contributes to the abuse of the child. Helfer (1975) suggested a psychodynamic model of abuse that in order for abuse to occur, these three conditions must exist: (1) a very special kind of child, (2) a crisis or series of crisis, and (3) the potential in the parent for abuse. Although the potential to abuse may be composed of many characteristics the parent acquired as he moved through his own "world of abnormal rearing"; abuse is usually set off by a "special child", a crisis, or both. Helfer noticed that the child is either viewed by the parent as being special, or actually is a special (different) child. Green (1968) offered a four-factor explanation of the etiology of child abuse similar to Helfer's (1975), but added as a fourth factor "a cultural tolerance for severe corporal punishment." (p.175). It was argued that if the parents found severe corporal punishment to be abhorrent to their beliefs, abuse will not necessarily ensue. Sandgrund, Gaines, and Green (1974) believed that child abuse appears to result from the interaction of three components: (1) Immediate environmental stress; (2) Personality traits of the parent; and, (3) actual characteristics of the child that make him vulnerable to scapegoating. Milowe and Lourie (1964) believed that the child's role in abuse was significant when: (1) the child had a defect that contributed to a lack of responsiveness resulting in parental frustration; (2) physical damage resulting from parental neglect or mishandling; and, (3) characteristics in the child's personality or temperament that served to 44 invite others to hurt him. In a study of child—abusing fathers at the Downstate Medical Center's treatment program, Green (1979) concluded that children who demonstrated physical or behavioral deviation are vulnerable to abuse by impulsive fathers for several reasons. First, the child creates a constant burden on the resources of the family. Second, in addition to being burdensome, children with congenital abnormalities, chronic physical illness, mental retardation, and brain damage are facilely scapegoated by narcissistic, egomanical fathers who regard the child to be a new indicator of their own defective self-image. Third, colicky, irritable, and hypertonic infants respond poorly to nurturance and are very difficult to satisfy and comfort. Fourth, the father may perceive the unresponsiveness to nurturance as a threat to their parental competence. Fifth, the fathers may be resentful of the excessive demands their children place on their wives. And lastly (sixth), the father views the child as a rival for his spouse's attention due to the lack of previous satisfaction of his own dependent longings. This rivalry with the child for his spouse's love and attention is a reenactment of the father's unresolved sibling rivalry during his own childhood. The father's jealousy is usually evidenced during the child's first year of life when the child needs the greatest amount of nurturing and attention. There exists a closely related pattern of child abuse and the theme of sibling rivalry in stepfathers who abuse their stepchildren. Green goes on to further state, that: "The unresolved issues of maternal deprivation, sibling rivalry, and frequent evidence of an alcohol abuse support the hypothesis that the basic conflicts of the abusing fathers rests at a preoedipal level." (p. 276). Although this last statement confirms Steele and Pollock's (1968) observations, this does conflict 45 somewhat with Gladston (1971), who attributes child abuse to be primarily a result of parental oedipal guilt and oedipal conflict in the father's maltreatment of their children. Nevertheless, the fact that the child's role is more than a benign stimulus remains clear. Child abuse calls for either the actual or perceived "special" child and its' demands. Whether the child is at fault is not important to the parents. What is important to the parents is that the Child is "different". 1. THE PREMATURE BABY AND ABUSE. Premature babies have a substantial risk of being abused. Elmer and Gregg (1967) found that in a sample of twenty battered children in the Chicago area, 33% had been premature at birth. In a retrospective analysis of child abuse in the District of Columbia, Fomufod, Sinkford, and Lorey (1975) found ten out of thirty—six (27.8%) of abused children to be of low birth weight (for which information was available) . They noted that this was in comparison to the incidence rate of 13.2% of low weight for birth infants in the District of Columbia area. Martin et. al., (1970) noted that 14.5% of 292 suspected abused children in England had a low birth weight. This 14.5% is twice the national average for England. Klein and Stern (1971) studied eighty-eight battered children at the Winnipeg Children's Hospital and found that eleven (12.5%) were premature at birth. Klein and Stein (1971) also reviewed the records of fifty-one abused children in the Montreal area and found twelve (23.5%) to have been of low weight for 46 birth infants. This is of further significance when noted that the average rate of premature births in the Montreal area is between nine and ten percent annually. Klein and Stein SUggested that multiple factors such as pre-existing mental retardation, maternal deprivation, and isolation from the mother in the the early post-partum period may have increased the risk for these infants. They further suggest that certain social characteristics of the mothers, such as poverty or lack of prenatal care, may result in the delivery of low weight for birth infants. Martin et. al. (1974) studied a group of fifty-eight abused children in Colorado. In their sample, eleven (19%) had weighed less than 2500 grams (5.5 pounds) at birth. This 19% was in comparison to an incidence rate of 9.2% of all babies born in 1971 in Colorado. They concluded that normal mean 1.0.5, of even their smallest prematurely born child, do not support the hypothesis that mental retardation or brain damage stemming from prematurity elicits abuse. They believed that the prematurity itself contributed to the abuse in these cases. Bishop (1971) suggested that premature babies are particularly subject to abuse by their parents. He pointed out that most premature infants are hypersensitive to all stimuli. Thus, these infants may vehemently object to even the most gentleness of handling. Mussen, Conger and Kasgan (1974) expounded that the premature baby is more likely to be restless, distractible and burdensome to care for, rather than a full-term baby during their first year of life. They noted that this may be due to premature infants being more prone to anoxia and colic which adds to the irritability during the newborn period. Disturbances in sleep patterns are very common among premature infants, which as pointed out by Dreyfus-Brisac (1974), can further contribute to the difficulty in 47 nurturing the infant. Ounsted, Oppenheimer and Lindsay (1974) noted that "the colicky child syndrome" was a prominent feature during infancy of most of the abused children in their sample. Elmer and Gregg (1967) proposed that maternal attitudes toward premature infants is very important. They believe one reason why these infants were abused was that the mother may have perceived the child as being "abnormal", simply because it was premature. In Leidermen's (1974) study, he found that there existed a significant difference in both attitudes and behavior of mothers of premature infants, and mothers of full-term infants. Leidermen went on to state that "premature infants are more likely the victims of battering by their parents and more likely to have behavior problems as children" (p. 154). It has been alleged that the hospital practice of separating mothers from their premature infants for prolonged periods of times, is a detriment to the bonding between mother and child. Fanaroff, Kennell, and Klaus (1972) reviewed records of the frequency of visits of 146 mothers in comparison to their low for birth weight infants. Thirty-eight mothers visited their babies less than three times during a two week period. In a follow-up study of these babies, six to twenty-three months after hospital release, it was noted that in the eleven cases of abuse or failure to thrive, nine (81.8%) of the eleven mothers were in the infrequent visiting group. There is an uncertainty as to what degree prematurity plays in the context of abuse. It can be deduced that there does exist a corollation between child abuse and (a) premature infants, (b) the characteristics noted of premature infants, (c) the frequency in which a mother visits her premature infant while in the hospital, and (d) the mothers perception of the premature infant. What has been concluded is that 48 premature infants should be considered to be children at risk within the battered child syndrome. 2. THE PHYSICALLY HANDICAPPED, MENTALLY ILL AND MENTALLY RETARDED CHILD. There are studies that suggest a corellation exists between child abuse and the physically handicapped, as well as the mentally ill and mentally retarded. After surveying a sample of ninety-seven abused children of the Denver Department of Welfare, Johnson and Morse (1968) noted that, based on child welfare worker reports, 70% of the children had exhibited either mental or physical deviations prior to the reported abuse. Although data in this study cannot thoroughly substantiate that these behaviors were congenital (prior to abuse), the following were also noted: (1) twenty percent were considered unmanageable due to severe temper tantrums; (2) nineteen percent had retarded speech developments; and, (3) seventeen percent demonstrated either a learning disability or mental retardation. Ounsted, Oppenheimer and Lindsay (1974) cited the case of an abused child who was found to be blind. Upon hearing this, the parents broke out crying, the mother saying that "he cried and cried and he never looked at me" (p. 448). From a two-year nation wide study, Gil (1970) discovered that 29% of the abused children in his 12,000 children sample had demonstrated abnormal social interactions in the year preceding the abusive act. Gil also reported that 22% were suffering from either a deviation in physical or intellectual functioning. Approximately thirteen percent of school-aged children in his sample were in special classes or were in 49 grades below their age level. Of those children, half had experienced abuse prior to the study year. In an analysis of forty-two cases, Birrell and Birrell (1968) found congenital physical abnormalities (cleft lip, fibrocystic disease, talipes, etc.) in eleven (26%) of their sample. In a similar study, Lynch (1975), found a significantly greater frequency of serious illness in the first year of life among the abused children. After having reviewed material from the National Clearing House on Child Abuse and Neglect, at the American Humane Association in Denver, Soeffing (1975) reported on 14,083 abused and neglected children in 1974. Soeffing found that of this population sample, 1,680 had one or more "special" characteristics. Such "special“ characteristics were: 288 classified as mentally retarded; 195 who had been born prematurely; 250 which had a chronic illness (e.g., multiple sclerosis, diabetes); 234 physically handicapped; 130 were either twins or triplets; 180 with a congenital defect; 669 considered as being emotionally disturbed; and, 267 who had "other special characteristics." It was pointed out that many children did not have their physical handicaps diagnosed, thus these numbers fall short of an accurate representation. After studying seventy school-age schiZOphrenic children, Green (1968) found that twenty-three percent had a history of abuse. Green suggested that since schiZOphrenic children usually respond poorly to nurturance, they are generally found to be unrewarding to parent's needs, and are emotionally "deviant", accordingly there is an increased risk of physical abuse. Although many studies have indicated a relationship between the abused child and the high rate of mental retardation, the complexity of the phenomenon combined with the numerous interacting variables, makes 50 any relation as to cause and effect tenuous. Elmer (1965) reported that 55% of the children in her study had an 1.0. of less than 80. Morse, Sahler and Freidman (1970) found 43% of their sample of abused children were classified as mentally retarded. All but one child of this 43% had been classified as mentally retarded prior to the abuse. In a study conducted by Sandgrund, Gaines, and Green (1974), children from the same socioeconomic background were divided into three groups: (1) confirmed abuse; (2) confirmed neglect; and, (3) nonabused controls. The neglect group was used to safeguard against the variable of neglect upon the abused children. Thereby assuring that the results would be representative of abuse and not neglect. Results indicated that 25% of the abused sample were classified as mentally retarded, 20% of the neglected were deemed mentally retarded, and only 3% of the nonabused were categorized as mentally retarded. Children known to have suffered serious head trauma injuries were not included in this study, thereby assuring that the findings would not reflect damage to the brain or central nervous system. Nickamin (1973) suggests that the child with neurological dysfunction can be very difficult to tolerate. These babies appear to be unhappy throughout infancy and are very difficult to appease. Their crying consists of high-pitched, disagreeable screaming. A study by Marting et. al., (1974), found similar results. Forty-three percent of a sample of 37 abused children with no history of head trauma, manifested a slight to severe history of neurological dysfunctions. It was also noted that of a sample of twenty-one abused children, 29% with a history of skull fractures did not manifest any neurological dysfunction. Brandwein (1973) hypothesized that the increased frequency of mental retardation among abused children was due primarily to brain damage 51 received during the abuse. He further stated that such variables as: (a) socioeconomic factors, (b) stress, (c) prenatal care (or lack of it), (d) parental deprivation, (e) differences in learning, (f) reinforcement contingencies, (g) physical damage to the central nervous system from abuse, and (h) genetic variables as well as the inherent flaw of intelligence measurements in accounting for any of these variables, cannot be ignored. Yet, in view of present knowledge in this area, the variables having the greatest impact to the disproportionate retardation associated with abuse, will not be readily known for some time. However, one should not overlook the distinct possibility that the child born with mental deficiencies may be at a higher risk. A child's mental deficiencies may make them highly vulnerable to scapegoating. 3. THE NATURAL DISPOSITION AND TEMPERAMENT OF AN ABUSED CHILD. Individual dispositions and behavioral styles present from birth may also contribute to abuse. Thomas, Chess, and Birch (1968) conducted a longitudinal study on the different temperaments infants display. 0n the basis of gathered data, they demonstrated that from birth, children display nine different temperament styles. These nine temperament styles exist in clusters accounting for three "types" of children: (1) The "slow-to-warm-up" child demonstrates a pattern of activity consisting of quiet withdrawal and slow adaptation to new stimulis; (2) The "difficult" child exhibits irregularity in biological functions, nonadaptibility, predominantly negative (withdrawal) responses to new stimuli, high intensity, and frequent negative mood expressions; and, (3) 52 The "easy" child shows regularity in biological functions, positive approach responses to new stimuli, easy adaptability to change, and predominately positive mood characteristics of mild or moderate intensity. In Thomas et. al's. study, roughly 70% of the difficult children deveIOped behavior problems. Only ten percent of their sample were comprised of "difficult" children, yet they accounted for 23% of the children who later deveIOped behavior problems. Milowe and Lourie (1964) conducted a study in which most of the sample was comprised of hospitalized, "difficult" children. The researchers believed that these children exhibited negative temperamental behavior as a result of the physical abuse. Yet, it was soon discovered that the nurses found it very difficult to work with these infants for eight—hour shifts. The nurses regarded these children as difficult to manage, irritable,continual criers, and unappealing overall in nature. A review of these children's histories revealed that two of the children had been abused in two different homes because of their temperament. Like Thomas et. al's. (1968), Schoffer and Emerson (1964) studied the temperament of infants and noted two types of infants: "noncuddlers" and "cuddlers". The "noncuddlers" always actively resisted close physical contact. The "cuddlers" are those who readily accepted close physical contact. They determined that the behavior of "cuddlers" or "noncuddlers" in infants, was not necessarily a result of the mother-child relationship. Nor was the difference in temperament a clinically bad sign. The "noncuddling" preference of an infant presented a pathological mother-child relationship only if, the mother was too rigid to attempt an alternate method of relating to the child, or if she perceived this to be a form of rejection. The results of a pathological mother-"noncuddler" infant were noted by Ounsted, Oppenheimer and Lindsay 53 (1974) in a study of twenty-four battered children. Approximately two-thirds of the mothers complained that the child would not cuddle. Differences among infants have also been found to exist in the soothe-ability of a child, once they begin to cry. Korner (1971) pointed out the serious implications of a young, inexperienced mother having a difficult-to-soothe baby. Such an infant can directly affect the mother's feelings of competence. Consequently this may lead to frustration and a dislike for the child. Benjamin (1961) pointed out that babies with low sensory thresholds are most likely to deveIOp colic during the first few weeks of life. This may further aggravate a developing mother-child relationship, especially in a young, inexperienced mother. Woolf (1966) has noted seven infant states of sleep: (1) regular sleep; (2) irregular sleep; (3) periodic sleep; (4) drowsiness; (5) alert inactivity; (6) waking activity; and, (7) crying. Taking this one step further, Korner (1974) has suggested a concept of "state immaturity". Infants found to be in this state exhibit a limited range of states (e.g. two or three). Infants in the immature state have been found to be very difficult to care for, and many subsequently develop psychOpathological symptoms. Again, this can make the well-intentioned mother feel rejected, incompetent, ineffectual and depressed --maybe enough to abuse a child. Therefore, when raising a child, it is important to realize that there is no established "right" way. Parents need to focus on each child's particular needs and temperament. When this is not observed, the end results are parents who feel extreme guilt over the deviant behavior of their infant. 54 4. THE "SPECIAL CHILD". The "special child" is viewed differently from all other children and is usually selected as a scapegoat, either because he is truely different from his siblings, or for the inexplicable reason that he is simply viewed as different. The child may fail to respond in an expected manner. They may be mentally retarded, hyperactive, have a speech impediment or may simply have blue eyes when the parents wanted brown. Parents with a potential to abuse in a stressful milieu will pick this "special child" to abuse. The parent's perception of the child plays a major role in abuse. Johnson and Morse (1968) pointed out in a study of battered children and their siblings, that while 36% of the abused children were born out of wedlock, 40% of the non-abused siblings were illegitimate as well. There were also similarities among the siblings in terms of personality and intellectual performance. Morse, Sahler and Friedman (1970) observed twenty-five abused children. Fifteen were considered to be different by their parents. Nine of the children were retarded and three of these were considered to be sickly by their parents. Six were regarded by their parents to be bad, selfish, spoiled-rotten, or deficient in comparison to their siblings. A three-year follow-up study showed mothers of six abused children, who were progressing normally, to have a good parent-child relationship. However, mothers of seven abused children, who were disturbed at follow-up, were described to have a poor parent-child relationship. In a study reported by Bishop (1971), four cases of young children overdosed with sedatives by their mothers was cited. These mothers 55 perceived their child as "damaged". No support of this perception was provided from physical examinations of the children. Bishop concluded that when the parental perception of a "damaged" child is counter to objective evidence, the risk of abuse may be even greater for a child. Martin and Beezley (1974) similarly found that the children with mild or borderline abnormalities are at a greater risk, while the severely handicapped children are at a lower risk for abuse. They suggested that this ambiguity (mild abnormalities in some areas of deveIOpment and normal in others), presents the greatest amount of stress to the parent. Hence, it is not necessary for a child to be special, but the parent's perception of the child as different can be sufficient to instigate abuse. There is a need to further study parental perception of the special child who is at a greater risk for abuse. In planning prevention and treatment programs, those who deal with abused children need to keep the special child postulate in mind. 5. AN ABUSED CHILD: THE CARETAKER'S OWN IMAGE OR THE IMAGE OF ANOTHER. In many cases of abuse the child is scapegoated for reminding the caretaker of someone disliked. Other times the child may remind the caretaker of his own faults. In these cases the child is abused because of pathological identification with others. Green (1978) noted that the scapegoating of a child may be due to the child being perceived as the major source of the family's frustrations. The parents project negative attributes that they hold, onto the child. Hence, the father who may 56 have a "low" self-image of himself, derived from early negative childhood experiences, may transfer his own characteristics of a "low" self-image on to his child. Green (1979) points out that a child whose behavior or appearance reflects its parents objectionable traits, may be at a greater risk for abuse. Green further goes on to write "In order to maintain a positive facade, the father may deny and project his own negatively perceived personality attributes and impulses, onto a normally functioning child. On other occassions, actual deviancy on the part of the child will enhance its being identified with the father" (p. 277). The breeding grounds for abuse are usually comprised of any of five factors. First, is a need to have had a dreadful rearing experience. More often than not, those who abuse their children had poor parental models as children. Thus, they suffered greatly at the hands of their parents. The second factor involved is never having had a basic trust in others. Abusive parents tend to isolate themselves from others. They tend not to seek help when they apparently need counseling. They are still fearful of being rejected or criticized; in essence they share many of the characteristics found in paranoia. Thirdly, their low self-image contributes heavily towards a potential to abuse. The abusive parents view themselves as worthless, no-good individuals. This low self-image results from a feeling that they have never been able to please anyone. Here again if a child has a difficult temperament or is not easily soothed, this too can contribute to a low self-image. A fourth factor is a shallow relationship between husband and wife or boyfriend and girlfriend. In these instances, the two peOple are usually held together more out of need and fear than out of love and happiness. Despite the discord within the relationship, they remain together. The 57 relationship's frustration affects the handling of the child. The fifth factor for a potential to abuse, are unrealistic expectations of a child. Abusive parents often demand children to perform chores around the house, which they are not capable of doing. Frequently, two and three-year-olds are expected to care for their younger siblings, clean house, bath themselves or prepare meals. Most abusive parents believe that they should not give into the demands of their children or allow them to "get away with anything." The abusing parents believe that children need to be periodically shown who the "boss" is, and to respect authority. Children should not be "sassy" or "stubborn" according to abusive parents (Steele, 1980). In a crisis situation (crisis being such minor incidents as the car not starting or as major as losing a job, a marriage separation, or a death in the family), the parent needs to employ the use of self-confidence, ingenuity, and useful knowledge of how to seek help to cope with a crisis. Having had a poor childhood experience or possibly being very young themselves, many of these parents lack a sense of self-confidence. Experiencing only few successful events in their lives, many lack the ingenuity or useful knowledge required to COpe with a crisis. Wherefore, the smallest of problems may have a greater impact on an abusive parent, than on those who do have an ability to COpe. When a crisis cannot be adequately managed, the event becomes more distressing and may even deveIOp into a series of crisis. The crisis may make the parents vulnerability more apparent. Feeling desperate and helpless, these inexperienced and ill prepared parents turn to abusing their children as a means of releasing tension, as well as to project their weaknesses onto another, thereby, saving "face". The parents who lack support in raising their children, appear to 58 have abandoned their responsibilities and withdrawn their efforts to provide adequately for their children. The need for abusing parents to have ample support systems or "life lines" (Kempe, 1973), cannot be overemphasized. Without support, they are overburdened by the tremendous responsibility of raising a child. Heavy child care responsibility characterized by large family size (Gil, 1970; Light, 1973; Polansky et. al., 1968; Smith, 1975), children spaced closely together in age (Elmer, 1967; Hunter et. al., 1978; Martin, 1976), along with excessive mobility (Gil, 1970; Smith, Hanson, & Noble, 1974) have been previously reported as sources of stress which may possibly contribute to abuse. Abusive parents often employ poor parenting skills. They view the child as "bad", "evil", or as "a monster". They routinely employ harsh discipline which often is inappropriate for the child's age or transgressions. Often, they cannot provide emotionally for themselves or others. An abusive parent commonly believes that if they have a child, an emotional void in their lives will be filled. They are usually impulsive and seek immediate gratification, with little or no regard for the long-term consequences of their actions. In addition, the abusive parent usually lives in a chaotic, unsafe or unclean home (Kempe, 1973). Abusive parents are usually very immature, unsure of themselves and ill prepared to be parents. Many have never had help in deveIOping positive parenting skills. Consequently, the abusive and negative parenting skills of their parents are repeated. Many are very young and lack the maturity to handle their own affairs, let alone those of another human being. As a result, the child is a responsibility the parent is not ready or capable of handling (Kempe, 1973). Often a child may present a financial burden which the parents are ill prepared to manage. Social and economic stress appears to increase 59 the likelihood of abuse (Garbarino, 1977), with high unemployment, low socioeconomic status, minimal education, and one-parent family structures distinguishing many of the abusive families (Gelles, 1975; Oil, 1970; Kaduskin, 1974; Martin, 1976). Whereas these factors, in and of themselves, do not necessarily lead to child abuse and neglect, their combined effects may place additional stress on the family, thus, increasing the probability of abuse, especially when tolerable levels of stress are surpassed (Belsky, 1980). This does not suggest that child abuse is confined to one sector of society, but that these predisposing factors are likely to be more severe among the poor and deprived in the community. Hence, the abused child may present itself to be a financial burden on its' family. The child in this case is more susceptable to abuse. C. DEVELOPMENTAL, PSYCHOLOGICAL, AND PSYCHOSOCIAL EFFECTS OF ABUSE ON THE CHILD. While it may be possible to diagnose and possibly treat the physical results of child abuse, the emotional scars are not as easily detected and even harder to treat. In a few cases, some of the pathological characteristics might have preceded and even instigated the abuse. The majority of children, however, experienced the abuse and pathological child-rearing early in life, during critical stages of their psychological and cognitive deveIOpment. The blow of malicious acts by primary objects on these impressionable children is thought to be the major determinant of their subsequent abnormal behavior. As these 60 children become older and their psychopathology remains untreated, the likelihood of further abuse increases. The result is a spiraling cycle of abnormal behavior and maltreatment. Behavioral observations of abused children have indicated that these children may exhibit many deviant behaviors. Such observations have found an abused child to be: stubborn, unresponsive, negativistic, and depressed (Johnson and Morse, 1968), fearful, apathetic, unappealing, and having little need for human contact, as well as a desire to provoke attack from others (Galdston, 1965). In an enlightening study, Green (1968) noted a significant number of self-mutilating schiZOphrenic children who had a history of physical abuse. Green suggested that, along with a poor self-concept, the important elements of this self-destructive behavior were the child's overall impaired ego functions and poor impulse controls which had resulted from the abuse. Green, Gaines, & Sandgrund (1974) reported that abused children demonstrated deficits in global ego functions. Specifically, such ego functions as reality testing, defense Operations, and body image were significantly impaired when compared with those of nonabused children. Green et. al's. found that the abused children's intellectual functions were significantly depressed. They suggested that as a result of chronic, harsh, abusing child-rearing practices, the ego functions that are normally responsible for self-preservation in children are so impaired as to result in children who are self-destructive in nature. It was further found that such abuse resulted in deviant personality and behavior. Such traits and defenses of the psychological impairment included: a basic suspicion and mistrust of adults, low frustration tolerance and impulsitivity, a need for immediate gratification, a need 61 to exploit, manipulate, and control others; expression through motor activity rather than by veralization; and a use of symbols. The children were preoccupied with violent fantasies depicting scenes of physical attack, spankings, and retaliation. This preoccupation with sadism and masochism was brought out in play with dolls and puppets. The themes of their violent play consisted of the acting out of masked detailed portrayals of the original abuse. DeveIOpmental lags in areas Of speech and language were often evidenced. Enuresis appeared to be common among this group. The abused children frequently were observed to demonstrate precocious achievments in such areas as: (1) motor ability; (2) an ability to perform household duties such as cooking, cleaning, and infant care at an incredibly early age; and, (3) an overall "street-smartness". The boys in this sample often would wholeheartidly strive in tests of strength, skills, and endurance in an attempt to see themselves as powerful and secure. Yet, beneath the mask of independence and strength, there lived helplessness, depression and children starving for, but uncomfortable with and fearful of, human contact. These children as a result of receiving such maltreatment, manifested a sense of "badness" and "worthlessness". 1. PROBLEMS IN EFFECTIVE COMMUNICATION. Since certain skills which a child learns are considered innate in nature (having been deveIOped through time and physical growth), there are other skills that by love, nurturance and careful molding, deveIOp 62 throughout the formative childhood years. These nurtured skills allow the child to reach its fullest potential and become a functioning adult who will contribute to the next generation. One such skill is the art of effective communication An infant is born with a remarkable and highly sophisticated, communication system. Through the use of touch, taste, smell, seeing, hearing, and movement, a child learns of its world. At this point the child is very dependent on its caretaker to introduce a pleasant, peaceful world. The infant learns that when he cries he will be held, rocked, fed, and comforted; when he looks into his caretaker's eyes he will feel a special bond of love; when touched it is gentle, soft, and it feels good; and the smells of the house bring a warm comforting feeling. In an infant who's spirit is crushed, as that of a battered child's, its senses receive painful and negative stimuli. For these children, crying brings threats; looking into its caregiver's eyes the child sees anger; being touched hurts; and smells of the caretaker's house ignites fear into the child's soul. Everyday of this child's life is filled with negative messages of fear, pain, anger, and threats. Until finally, the child can edure no more and then "shuts off" his senses. He learns not to love and care; because it hurts too much when he does. Having given up relating to others at such an early age, it is typical that these children have poor communication skills (Helfer, 1980). 2. THE AGGRESSIVE NATURE OF AN ABUSED CHILD. It has long been expounded upon, that observations of aggressive behavior leads to aggression. This view is basic to the social learning theory (Bandura, 1973). There have been many reports that point to a 63 significant relationship between the level of a child's aggressiveness and the severity of physical punishment employed by their parents (Sears et. al's., 1957). Accordingly, mothers who used physical and verbal attacks to discipline their children, were found to have children who were physically and verbally aggressive in peer relations (Hoffman, 1960). Ulrich (1967) suggested that physical pain, discomfort or the absence of positive reinforcement may lead to aggression in children. Using a sample of 20 physically abused, 16 nonabused neglected, and 22 nonabused/non-neglected children, Reidy (1977) compared the results of aggresive fantasy as measured by the Thermatic Apperception Test (T.A.T.) and the Behavior Problem Checklist (the B.P.C. was teacher rated). An analysis of scores indicated that abused children expressed significantly more fantasy aggression than both the neglected and nonabused/non-neglected children. There existed no significant difference between the nonabused/non-neglected children and the neglected children. Reidy took this one step further and compared scores of abused children living in their natural home and those living in foster homes to learn if aggression was effected by place of residence. It was found that these two groups did not differ significantly in the amount of aggression as measured by the B.P.C. or during free play. However, t-tests indicated that abused children in their natural homes expressed significantly more fantasy aggression than those who were living in foster care homes. The results may have been due to a Type I error, since the results were extracted from another study. Because this was not part of the original study, and the) original study indicated that fantasy aggression was the only point of difference in these two groups, it may be concluded that no differences exist between aggression and those who are abused while living in their natural home and those who 64 live in a foster home. Other studies have shown that abused children exhibit hostile and aggressive attributes (Elmer, 1967; Fontant, 1973; Johnson & Morse, 1968; Morse et. al., 1970). It has also suggested that intervention needs to take place soon after abuse is discovered, rather than waiting until the resulting behavior problems surface. 3. ANXIETY AND THE ABUSED CHILD. Abused children appear to have difficulties in object relations (namely separation anxiety) and suffer from anxiety attacks. Kahn's (1963) concept of "cumulative trauma", may be applied to the long-term noxious stimulation which abused children incure during their formative years. These children are flooded by a quality and quantity of malicious acts which render the ego functions powerless. This Often results in severe panic states, which is a prime example of Freud's (1920 & 1926) concept of "traumatic neurosis" (p. 145), and the "breaking of the stimulus barrier" (p. 116). The abused children often experiences feelings of helplessness, annihilation, and humiliation. These feelings are often augmented by a loss of ego boundaries. Usually,the states of anxiety will originate, just prior to, in anticipation of, or during parental attacks. Abused children will demonstrate psychotic behavior at the time of anxiety attacks, which are due to the relentless ego regressions and momentary suspension of reality testing. Another form of anxiety was found in the reenactment of the attack (Green, 1978). These children appeared to be preoccupied with playing out 65 the traumatic assault. Violence was often the projected theme to their free play, drawings, fantasies, and overt behavior. It was also found in therapeutic relationships, that the child would act out the role of the "bad child", and discerned a form of punishment from the "parent" therapist. Such fixation to the trauma may be seen as a defense reaction which allows the child to re-create, master, and finally gain control of the harsh effects of anxiety. In doing so, the child may be able to control his anxiety by lashing out to those around him. The abused child often reacted with intense anxiety to the threatened or actual separation of the primary object. This anxiety can be attributed to the number of experiences of separation and abandonment by the primary caretaker during infancy and childhood. It has been suggested that the abused child is more apt to experience separation anxiety (Green, 1978; Green, 1979). For each beating the child receives, it is interpreted as a withdrawal of parental love and a wish to be rid of the child. Lack of object constancy may also be due, in part, to cognitive impairment and/or cerebral dysfunction. Thus,, such impairments may obstruct the construction and internalization of the mental representation of the absent Object. This was made most apparent during therapists vacations. The child would often ask to take an object with him which would serve to represent the therapist during the absence (Green, 1978). 4. THE ABUSED CHILD'S NON-ORGANIC FAILURE TO THRIVE. According to Barbero and McKay (1975), failure to thrive is a syndrome during infancy and early childhood noted by retarded growth 66 patterns, with origins found to be either organic or non-organic in nature. A failure to thrive diagnosis is usually made when the suspension of physical growth results in weight and height below the third percentiles on the Bostong Growth Standards (Pollitt and Eichler, 1976). Due to the diagnosis lack of specifying the cause of the disorder, these children are often hospitalized to determine etiology. There usually exists a deveIOpmental "slowness", occasional vomiting, diarrhea, and feeding difficulties. As the child grows, he usually experiences periods of weakness, tiredness, and irritability. Hospitalization is usually a result of progressive weight loss and extreme emaciation. These children are usually described as apprehensive, frightened, apathetic, and withdrawn. The majority of children (Bullard et. al., 1967) are found to have organic basis for the disease (e.g. congential heart disease, central nervous system defects, and malabsorption problems). Yet, even after large-scale hospital examinations, there remains a good number of patients whose arrested growth can not be attributed to an organic pathology. These children are often referred to as having non-organic failure to thrive and have been the subject of recent research. It has been noted that children who are Often abused suffer from non-organic failure to thrive (Gordon & Jameson, 1979). It has long been suggested that non-organic failure to thrive is a result of the effects of institutionalization and maternal deprivation on infants. Spitz (1946), the forerunner in this area, noted that infants living in an institution demonstrated characteristics of growth retardation. He believed that such traits were a result of their lack of sensory and social stimulation. Widdowson's (1951) findings pointed out that children receiving adequate meals in an unfavorable psychological 67 environment, namely institutions, exhibited retarded growth and social developmental patterns. Coleman and Provence, (1957) found growth failure and development delays in children who had received inadequate mothering to be similar to Spitz (1946) and Widdowson's (1951) findings. Other findings of maternal deprivation (Talbot et. al., 1947) and psychopthology (Evans et. al., 1974; Fischoff et. al., 1971) have been noted to be significantly related to a non-organic failure to thrive. Bullard et. al. (1967) applying an Ainsworth Stranger Situation (1962) experiment to numerous distorted mother-child interactions, noted that maternal behavior which may be depriving to the child at one stage of development, may be viewed very differently by the same child at another stage of deveIOpment. Leonard et. al (1966) examined the development of attachment to a caretaker in non-organic failure to thrive patients. The subjects, four to ten months of age, demonstrated "delay in establishment of specific strong attachment to parents" (p. 609). It was also noted that "in this age group when specific ties to parents are usually deveIOping, it was striking that no child showed any evidence of anxiety with a stranger or a displeasure at being left by parents" (p. 609). In a study conducted by Gordon and Jameson (1979), a replication of an Ainsworth Strange Situation, with twelve non—organic failure to thrive and twelve controls, yeilded significant results. Use of the Ainsworth Attachment scales revealed that six of the twelve non-organic failure to thrive were classified insecurely attatched, while only two of the twelve controls were classified insecurely attached. Interestingly, none of the non-organic failure to thrive infants were found to be securely attached. The two groups can be distinguished on the basis of their affective behavior. The non-organic failure to thrive toddlers displayed a tendency to use the milder affect of fretting rather than employing the 68 stronger one of crying during the mother's absence. Only two of the twelve cried, while nine of the twelve fretted. Alternatively, the control group engaged in both crying and fretting in equal frequency. While it should be noted that the sample size of the Gordon and Jameson (1979) experiment was small, it did reveal that half of the non-organic failure to thrive toddlers were experiencing difficulties in mother-child attatchment of sufficient severity as to be deemed insecurely attached. Follow-up studies have indicated a poor prognosis for this group, resulting in deficient deveIOpmental outcomes. Sroufe (1978) and Matas et. al.,(1978) have found that insecurely attached children, with non-organic failure to thrive, continue to experience difficulties of emotional development at ages two and three. While attachment has been an area of considerable attention (Bowely, 1967; Aimsworth, 1969, 1973), only recently have studies been limited to that of normally deveIOping children. Such inattention of the abnormal population has resulted in a narrow range of observations in the deveIOpment of attachment. Results of recent work (Gordon and Jameson, 1979; Sroufe, 1978; Matas et al, 1978) have contributed to a deeper understanding of attachment in the development of the abnormal population. Children who have been diagnosed non-organic failure to thrive, who are often abused children, are frequently found to be insecurely attatched. This, results in a poor prognostic outcome and develops into further emotional difficulties. 5. ROLE REVERSAL AND THE ABUSED CHILD. Normally, children gradually learn a need to be responsible for their own actions. The parent, during early childhood, frequently takes 69 responsibility for their child's actions. As the child grows, the parent accepts less and less responsibility for their child's actions and teaches the child to take more and more responsibility for their own behavior. Children reared, as Helfer (1973) claimed, in a "world of abnormal rearing“, learn that they need be responsible for their parent's actions. The child is taught "learned helplessness", guilt; and at a very early age, to perform household duties normally performed by adults. When these children reach adulthood, they find themselves ill prepared to accept responsibility for their own actions, as well as an apprOpriate control over their environment. Role reversal is a very common trait in the "world of abnormal rearing". This is characterized by the child taking on the parental role. For example, one may see a three-year-Old comforting his crying mother; this may be followed a few days later by the mother ignoring her crying child. This role reversal in time lends itself to feelings of frustration by the child. This frustration may result in a "learned helplessness" for the child. Learned helplessness is characterized by the child perceiving outcomes which are independent of the child's responses. In time, the child generalizes such failure to all situations and finally stOps trying to succeed, to solve problems, or achieve any set goals. This may also be accompanied by a guilt formed from parental statements such as: "I wouldn't have gotten mad if you hadn't. . . ", or "If it weren't for you. . . ". Therefore, the child learns that he is to blame for his parents inadequacies in handling a crisis. Another trait of role reversal is the premature expectations of the child to perform household tasks which are more in line with adult responsibilities. Often, parents demand their children to feed into their egocentric personality by demonstrating skills, cleverness, 70 strength, and exemplifying adulation and respect. However, the abuse instills none of these feelings into the child, rather a fear and avoidance which is usually met with additional attacks when the parent feels betrayed. Traumatic environmental states, including maternal deprivation, parental rejection, family disorganization, physical abuse, and stimulus deprivation, have been noted as precursors to bodily self-mutilation, head banging, and suicide. According to Freud: "In the child, depression generally takes the form of a pervasive personality characteristic, woven into many aspects of his life for many years." (p.273). Unfortunately, the major signs of depression are usually over-looked. They are unnoticed since most do not expect to find depression in children (Toolan, 1967); or it is believed they do not experience depression. We assume children's moods are fickle and their behavior is just a stage they are going through and will outgrow. Another reason is that depression may take on the form of either truancy, somatic preoccupations, restlessness, or antisocial acting out. Freud believed that suicide represents hostility and aggression which is turned inward either from the death instinct (thantos), or from the loss of a love object. Thus, if one were to look at the home life in terms of Freud's theory, one would find maternal loss and rejection when the mother is withdrawn or depressed. Thereby causing such adverse affects on the child that he turns his pain inwards. The conclusions of a study conducted by E.J. Anthony (1967), pointed out three reasons for the difference between the depression of a child and the depression of an adult, they were: (1) an inability to verbalize an affective state (the expression of feelings and emotions so as to be 71 understood); (2) incomplete development of the ego; and, (3) the absence of an accordant self-representation. Depression among children is seen as the main determinant of suicide by Cytryn and McKnew Jr. (1972). They noted three types of depressive reaction. These are masked depressive reaction of childhood, acute depressive reaction of childhood, and chronic depressive reaction of childhood, which are defined as: (1) Masked depressive reaction of childhood - The child uses the defense mechanism of acting out to cope with his depression; (2) Acute depressive reaction of childhood - One finds this following a traumatic event. The depressive signs and symptoms are short lived and recovery is quick and lasting. In this situation one has an immediate precipitating cause with which the trauma is associated; and, (3) Chronic depressive reaction of childhood - Here one finds no immediate precipitating cause. The child usually has a history of repeated separation from the mother figure. Starting in infancy with presence of a chronic depression in the mother; the presence of the depressed mood and behavior, including suicidal thoughts, begins very early in childhood. Anaclitic depression is depression in small children deprived of their mothers. This occurs in three stages, which are: (1) the child actively demostrates resistance and violent emotional reactions in an apparent attempt to bring the mother back; (2) there is an active rejection of adults; and (3) there is a withdrawal of interest in peOple and a decreased activity level. The psychodynamic theory believes that the child perceives his parents abandoning him for being bad. This is followed by a decrease in self-esteem and self-worth. Such feelings and behaviors such as frustration, anger, guilt, exaggerated needs for love, attention needs, support, desire to be punished or to punish or both, are predominant. 72 Consequently, the child's aggression towards his parents increase. This in turn is self-inflicted due to a need for self-expression. Types of suicide (Toolan 1975) outlined by this theory include: (1) A wish to gain SUpport and strength through joining the powerful lost loved object. (2) Retaliation for the abandonment or threat of abandonment by his parents. The child in this case feels that the parent can not leave him, instead he will leave the parent. (3) The use of blackmail and manipulation to punish the parents and to receive love and attention. The child believes, that once he is dead, the parents will be sorry for not having treated him better. (4) The child feels so guilty for his transgressions, he believes he should die to make things right again. (5) Suicide may be a symbolic murder of someone else. (6) There may be disintegration of the personality. A psychotic child may hear voices ordering him to commit suicide. (7) Suicide may be a cry for help. The child may feel overwhelmed with problems and, thus, by committing suicide call attention to the need for help (pp. 342-344). In a study conducted at Bellevire HOSpital in New York, Toolan (1968) deveIOped five categories of causes for suicide among children. These five categories are: (1) internalization of anger at another; (2) manipulative attempts to either gain love or punish others; (3) a cry for help and distress signal; (4) psychotic-like reaction to inner disintegration; and, (5) a wish to join a dead relative. Pfeffer of Cornell Medical Center (1981) deveIOped a Specific Factors Significantly Correlating with Suicidal Behavior List for children. These factors are: (1) depression; (2) hOpelessness; (3) worthlessness; (4) a wish to die; (5) severe depression in the mother; (6) depression and suicidal behavior; (7) a preoccupation with death; (8) a concept that death is temporary; and, (9) a concept that death is pleasant (pp. 154-159). It is probable that if a child is experiencing a 73 number of the above listed factors, the child may choose to end his life. Hendin (1969) reviewed the case histories of suicidal black adults and found their childhood was often marked by physical abuse. Sabbeth (1969) noted an overall impairment of ego functions and impulse control in abused children, facilitated by the replication of parental hostility and rejection. The child's compliance with parental wishes for his destruction and or disappearance was represented through self-destructive behavior. This acting out of parental hostility has been documented as an important factor in the etiology of adolescent suicidal behavior (Sabbeth, 1967). The self-destructive behavior of the abused child may be viewed as the end result of feelings of low self-esteem and self-hatred into action. Many times depression will be expressed through boredom, restlessness, excessive fatigue, or difficulty in concentration. Depression may be triggered off by a threat or actual loss of a parent or parent substitute. Suicidal children many times have a history of marginal emotional and social adjustment problems. They are helpless, passive, "cling-ons", dependent, and lonely. Often they have episodes of depression which will last up to several months. Children with masked depressive reactions show elements of psychopathology, compulsive behavior, hysteria, or obsessive behavior. Suicidal children have a behavior pattern of being irritable, impulsive, and having negative self-attitudes. Furthermore, suicidal children are more apt to be rigid thinkers; involved in conflict situations; with communication problems (Poznanski and Zrull, 1970). Suicide is often a punishment against the environment and an attempt to secure love. It can also emerge under the influence of guilt. Studies have shown that families with children who are continually 74 injured by accident, also have a high incidence of psychosomatic illnesses, family stress, and other psychological illnesses (Husband & Hinton, 1978; Pliones, 1977). Other commonalities have been found to exist in families of suicidal children. Such attributes include parents who are emotionally immature and exhibit great fluctuations in their emotions. This emotional instability creates a sense of insecurity in the child, making it difficult for the child to rid himself of infantile fixations (Richman, 1979). Another commonality is the parents constant denial of love, threats of withholding rewards, and threats of ostracism as a means of punishment. One of the greatest tragedies is for the child to feel unwelcomed or starved for affection. They usually come from big families where they are the oldest or the youngest child. They were often unwanted or unplanned for children. The families are usually characterized as disorganized and there exists parental disharmony, cruelty (threats or actual), abandonment, dependency on the child, and delinquency. Frequently, the suicidal child comes from broken homes and are separated in either a more traumatic fashion, or at an earlier age than non-suicide attempters (Finch & Pozaski, 1971; Andre, 1970; and Henry & Shart, 1954). It is important to note that the root of the problem lies in how the family handles feelings of frustration (Finch & Poznanski, 1971). If the family approaches sources of frustration irrationally and immaturely, the child will suffer. Green (1968) studied sixty abused, thirty neglected, and thirty normal children ages five to twelve-years-old in New York City. His findings indicated that self-destructive behavior existed in forty percent of the abused children. This was significantly higher than the normal and the neglected children. A study conducted of depression by Mattsson et. als., (1969) 75 indicated that forty percent of the suicidal children they studied were depressed one month before being seen for counseling. This is significantly higher than the thirteen percent found in the ninety-five non-suicidal children observed. Similar findings were found by Otto (1970) when he studied 581 suicidal children and discovered thirty-eight percent had been depressed three months before an attempt. A Canadian study (Nahielng & Lawler 1965) revealed that mental illnesses ranging from chronic alcoholism to severe neurosis are many times a part of the home-life of these children. They found no significant difference in intelligence scores, yet the suicidal children are usually behind in school. There exists a high incidence of sexual molestation, child beating, heavy drinking, and a delinquent sibling in the family. The child, in general, feels tired of living. The parents of suicidal children are a key factor in their child's decision to commit suicide. Frequently, at least one parent has a history of chronic depression. The child and parent may be depressed at the same time, usually with the parent exhibiting the depression first. The mother is often found to be angry, depressed, or withdrawn, while the fathers are typically passive, weak, absent, or rejecting, (Anna Freud, 1965). A suicidal child is often the "expendable child" (Sabbath, 1969). Parents say things like, "drop dead", or "you're a pain to have around" which makes the child feel unwanted. There exists a level of deprivation which in turn leads to aggression and depression, as well as sadomasochistic attitudes on the part of the child (Finch & Poznanski 1971). Those children diagnosed as having an abnormal disorder evidence some inclination towards suicide. Suicide also occurs in persons who 76 otherwise show no evidence of classifiable psychopathology. Most display few warnings to those around them. The suicidal child's fantasy material is usually violent and their figure drawings are usually inadequate and damaged. There is a major methodological limitation in diagnosing suicidal tendencies in children. The major problem is testing children before their attempt. Lester (1970) conducted a major study in this area. His results found the T.A.T., Bender-Gestalt, Semantic Differential and the Rosenzelig Picture-Frustration Tests are of little or no value in assisting to identify those of high suicidal risk. The Rorshack and the M.M.P.I. were helpful to a minor degree. In a study by Green (1978) sixty abused, thirty neglected and thirty normal children of ages five to twelve-years-old were studied. These children shared the same basic family constellation. Data pertaining to incidence of self-destructive behavior and self-mutilation was obtained through interviews with the child's mother. Such forms of self-mutilation and self-destructive behavior included self-biting, self-cutting, self-burning, hair pulling, head banging, suicide attempts, and suicidal gestures or threats. Results indicate a significantly higher incidence of self-destructive and self-mutilation among the abused sample. Of fifty-nine abused children for which information could be obtained, 24 (40.6%) exhibited self-destructive behavior, 5 of 29 (17.2%) of the neglected sample and 2 of 30 (6.7%) of the normal controls demonstrated self-destructive behavior. These differences were significant at the .05 level. Of the twenty-four self-destructive abused children in Green's study, five were suicide attempters (four girls and one boy), two made suicidal gestures (2 boys), and twelve were self—mutilators (five girls and seven boys). Six of the self-mutilators also demonstrated suicidal 77 ideations, and five boys expressed suicidal ideations only. In virtually all the cases this pathological behavior was precipitated by parental beating or were a response to actual or threatened separation from the primary object. The results of this study (Green, 1978) are particularly noteworthy, since it is unusual to find a high incidence of self-destructive behavior in a predominately latency and preadolescent population. Cases of self-destructive behavior of this magnitude are usually confined to older groups. Studies have indicated that the vast majority of those admitted to psychiatric facilities for self-destructive behavior are adolescents and adults (Mattson, A. & Hawkins, 1967; Sabot, L., Pack, R. & Raskin, J. 1969). Therefore, it may be deduced that certain events taking place during a normal latency period appear to have a self-preservative function. Contributing to increase control over impulses, maintenance of normal self-esteem and more effective ways of handling stress and conflict during a normal latency period are: rapid growth of ego and superego structure; intellectual and cognitive development; and, the establishment of stable identifications with loving parents. It appears that abused children have a marked deficiency in these areas. These children are habitually blamed for the inadequacies of their parents. Unable to understand the scapegoating process, the child believes he is at fault and deserving of the inflicted punishment. Throughout this process, the child's self-hatred and low self-esteem increases and finally concludes in self-destructive behavior. Carrying out parental hostility directly toward the child, has been depicted as an important factor in the etiology of adolescent suicidal behavior. This same study declared the suicidal child to be aggressive and destructive at home and in school. They were frequently described as 78 hyperactive with a minimal frustration tolerance. Motor activity was the preferred mode of expression, rather than verbalization. Due to inadequate superego models and poor internalization processes, these children lacked the usual superego restraints found in normal latency children. Such a faulty SUperego may contribute to a self-destructive behavior. As Green (1978) has revealed, self-destructive activity in an abused child does not appear to be fundamentally due to self-punishment out of conflict, guilt and superego pressure, but rather, from primitive, learned behavior patterns. This learned response has its origins in the earliest painful encounters with contemptuous primary objects; during the first months of life and before ego differentiation and verbalization has developed. 6. LEARNING, ADJUSTMENT AND IMPAIRED IMPULSE CONTROL OF THE ABUSED CHILD. In some cases it is possible that pathological characteristics, evidenced by the abused children, may have foreshadowed and even instigated the abuse. However, most children sustain the beginnings of abuse and pathological childrearing in their first or second year of life. Thus, subjected to harsh treatment during crucial cognitive and psychological developmental stages. The impact of malicious primary objects on helpless, impressionable children is considered to be the major determinant of their subsequent abnormal behavior. The conclusions of Greents (1978) study noted that most of the abused children had demonstrated major difficulties in school adjustment. 79 Deficient academic performance was evidenced to be due to their limited attention span, frequent hyperactivity and cognitive impairment. At times, these children manifested such specific learning disabilities as dyslexia, expressive and receptive language disorders, and perceptual-motor dysfunctions on the basis of a minimal brain dysfunction or maturational lag. Abused children often demonstrated aggressive behavior (Green, 1978; Sears et. al., 1957; Hoffman, 1960; Elmer, 1967; Fontanta, 1973; Johnson & Morse, 1978; Morse et. al., 1970) and poor impulse control which often contributed to difficulties with peers and teachers (Green, 1978; Helfer, 1973). These behavioral problems were brought to the parents attention, which in turn was followed by further physical abuse. Subsequently, a spiraling cycle consisting of: academic and behavioral difficulties at school; parental notification; physical abuse by the parent; and, an increased disruptiveness in the classroom, due to the displacement of a rage towards the parents which is directed to the teachers. Habitual school difficulties resulted in disciplinary actions and classes for the emotionally or intellectually impaired. Such placement additionally diminishes the child's self-esteem. Green (1978) found that the majority of children in his study had been abused during the first two years of life. The resultant psychopathology in most of these children had been present prior to latency, but was not recognized until school and day care centers confronted the parents. Such adverse experiences inevitably left a distinct impression on the cognitive apparatus, ego functions, object relationships, identifications and libidinal organization of the battered children. One of most important skills a child must gain, is an apprOpriate manner whith an ability to learn the most Oportune time to seek a 80 fulfillment of his needs. The deveIOpment of the ability to delay gratification of one's needs, is a gradual process. If a four-year-old is asked if he would like a cookie today, or a whole package of cookies on Sunday, he will probably take the one cookie today. Delaying the need until Sunday calls for considerably more deveIOpmental skills than most four-year-olds have obtained. The child must learn that a package of cookies is more than one cookie, and that the offeror will be present on Sunday to complete the proposition. In time, through modeling and training, the child masters these concepts and learns to delay the gratification of his needs. Abused children are not as fortunate as non-abused children. They contemplate no reason to delay their gratification until another day. The future never brings better times than the present. The future is usually filled with pain. So why wait until tomorrow and possibly lose what one could have had today. Their lives are filled with empty promises. Green (1978) noted that abused children in his study often demonstrate aggressive and assaultive behavior. Young battered children aged four-years-old to fourteen-years-old, were found to be restless, hyperactive, and with a minimal frustration tolerance. While the older children frequently exhibited a delinquent behavior. Additionally, the loss of impulse control was a common characteristic of these children; which is believed to be due to dysfunctions in the central nervous system resulting from physical abuse. The abused children did not have the usual superego restraints found in non-abused children; a consequence of an inadequate superego model and faulty internalization processes. 81 7. THE ABUSED CHILD'S EMPLOYMENT OF PRIMITIVE DEFENSE MECHANISMS. For three years, Green (1978) conducted a study involving twenty abused children partaking in an out-patient individual psychotherapy setting. Treatment was supplemented by therapeutic involvement of their parents, counseling, crisis intervention, and home visits by a nurse. The findings indicated that the children often suffered from acute physical and psychological assaults, occurring within an environment characteristic of poverty, family disorganization, and interruptions of maternal care leading to an early experience of object loss, and emotional deprivation. It was revealed that abused children employed a greater number of such primitive defense mechanisms as denial, projection, introjection, and splitting. Use of these defenses enabled them to cope with their hostile environment and internalized parental images. They were unable to integrate the loving aspects and the violent aspects of their parents. Thereby providing an explanation for the child's SUpport of their parents conjectured denials of abuse and rationalizations regrading inflicted injuries. Such tendencies served three purposes: (1) the fulfillment of a need to suppress knowledge of parental attacks brought on by a fear of additional punishment; (2) the child is able to protect himself from the awareness of an actual and internalized hostile parent image; and, (3) to protect the parent from his own "murderous rage". Often the child's image of the "bad" parent was subjected to denial and projected onto someone else. Thus, enabling the child to maintain the fantasy of having a "good" parent. The defense mechanisms of Splitting was most often employed by children in relation to the parent 82 who provided the greatest amount of nurturing. If the child did not use this defense and acknowledges the caretakers violent behavior, their relationship would have been jeOpardized. 8. THE IMPAIRED SELF-CONCEPT OF AN ABUSED CHILD. The abused child's world is one filled with unrealistic demands imposed by their parents. These children are not allowed to cry, required to eat well, smile, talk, and walk at an early age; and remind the parent of someone they like. Children should not explore their surroundings; pull pots out of the cupboards; make noise; or spill food on the floor. The child should look after their parents with a total disregard for their own needs. The parent's of abused children have no understanding of what childhood means, and therefore place incredible demands on their child. These children constantly striving to please their parents often suffer physical abuse when they fail. Green (1978) wrote of a seven-year-Old girl whose mother stated she could not tolerate her daughter's poor academic performance. The mother said her daughter was stupid and was certain she was retarded. Upon the therapist's observation of the child's black eye, scratches, and bruises, the mother admitted her husband had struck her daughter. The little girl, on the other hand, attributed her injuries to fights at school and falls --denying her parents transgressions. The daughter admitted to being stupid and stated: "If I only had done the laundry, my mother wouldn't have been beaten up by my father and we wouldn't have broken up". Tests indicated the girl's 1.0. to be 108 (p. 99). 83 The battered child is often sad, disheartened, and self-belittling. Chronic physical and emotional scarring, humiliation, and scapegoating results in a poor self-concept. This is aggravated and reinforced with each new episode of violence. The child inherits an impaired awareness of "self", consisting of painful sensations associated with the primary objects. This impaired self-awareness converts itself into a devalued self-concept, with the growth of cognition and language skills. Abused children eventually come to hold themselves with the contempt that their primary objects have accorded them. The child ultimately believes that the constant punishments, beatings and threats of abandonment are justly deserved, regardless of their actual (or lack of) transgressions. In time, the child begins to question his abilities, judgments, and more importantly --worth. This internalization of parental contempt represents the beginnings of the formation of a punitive superego. It was noted by Green (1978), that many severely deprived children appeared to prefer beatings to abandonment by the primary object. Early experiences of separation and deprivation appear to heighten the child's sensitivity to the threats of abandonment, which is interpreted as a cumulative trauma that may Crush the ego development. 84 CHAPTER IV THE PROCEDURE AND DETERMINATION OF A CHILD ABUSE CASE IN MICHIGAN Michigan Public Act 238 of 1975 (as amended in 1978, 1980, and 1984) mandated the Department of Social Services as the sole agency responsible for providing protective services to abused and neglected children (See, TABLE 2). This chapter will outline the role of the Department of Social Services (0.5.5.); the proceedures for reporting suspected child abuse; D.S.S. investigative proceedures of a suspected child abuse case; and the action taken when D.S.S. substantiates a case of abuse, primarily services provided to the child as outlined in the Michigan Department of Social Services - Services Manual. A. THE REPORTING OF SUSPECTED CHILD ABUSE. Presently, there is an after hours telephone number maintained by at least one staff member of the Department of Social Services. This procedure addresses the concern of an available D.S.S. worker at all hours. The appointed staff member is required to log incoming complaints, access the verocity of the complaint and the severity of the child's maltreatment. If necessary the worker will make an immediate 85 A>wrm N mmmmmm>rm mcmmq>zaH>Hmo >20 :zmcwma>qu>4mo mom z>mmm xmmmxmmc n>mmm mcmmq>quwqmc >mm n>mmro>c am» 2024: Hoq>r nwmmro>o am» 3024: soum-mo 8.28» w.m~a Asogv w.wao so.oum .omo-md m.muo w.om~ Asmgv w.mmm um.swm somz-mm m.uow w.mum Aswgv w.~om wo.mmm 28mm-mw o.mm~ w.mws Apogv w..mm w~.mmz Ammw-ma ©.N~m w.wmm Awmgv w.w~o so.msm zoam” A.V 41mmm 3>< mm 30mm 41>z ozm nIHro Hznz n>mmw ANV 4o4>r zozqzr< n>mmro>om >zo 41m zozqzr< >mm o>mmro>o >rmo wmvmmmmzam qzomm o>mmm n>mz~mc owu va >rr 4wCMm >25 zmmrmna >mm Hzorccmou >zc. Aav 4>xmz mmoz zmvomq zczwmm vmnwdd m