Researcher Christopher Wildeman has spent his whole career describing and quantifying the more unpleasant parts of people’s lives and his latest study on the surprising prevalence of childhood maltreatment is no exception. Still, there is a bit of a silver lining, he told me.
“This is the sort of issue that both the right and left shouldn’t have a hard time supporting,” said Wildeman, an assistant professor of sociology at Yale University. “It’s the sort of thing that once we become more aware of it, designing interventions that could diminish maltreatment rates is something anyone can get behind.”
According to Wildeman and his study colleagues, one in eight U.S. children will experience confirmed maltreatment by the time they turn 18 years old. The term “child maltreatment” includes neglect as well as physical, sexual or emotional abuse. The finding, which is greater than other maltreatment estimates, was published earlier this week in JAMA Pediatrics. To calculate the one-in-eight finding, researchers examined eight years of official data on confirmed maltreatment cases from the National Child Abuse and Neglect Data System.
Specifically, researchers wanted to get at the cumulative effect of confirmed maltreatment cases, so they took the same approach that the Census uses to calculate life expectancy at birth. That method essentially asks this question: Starting at birth, if a person is exposed to the latest age-specific mortality rates, how old can we expect that person to be when she or he dies? Similarly, Wildeman and colleagues asked what would happen if a hypothetical child is exposed to age-specific, confirmed initial maltreatment rates from 2004 through 2011. Based on that data, what proportion of children could ever expect to experience maltreatment? The answer is one in eight — a prevalence that’s nearly 14 times higher than the confirmed annual child maltreatment caseload.
Wildeman noted that about three-quarters of the data used in the study concerned cases of neglect. He also emphasized that for child protective officials to confirm a case of neglect, the neglect is highly chronic or very severe, such as a 7-year-old left alone to care for younger siblings or a child showing up at school malnourished.
“(This finding) alerts the American public to the fact that child maltreatment is a pressing social problem on the same scale as a whole host of other childhood experiences that we pay so much attention to,” Wildeman told me. “In my mind, it seems like an obvious underestimate…but let’s just say that even if this is the absolute floor — that one in eight children experience maltreatment — it’s just tragic how few resources we give to preventing maltreatment. It’s kind of amazing that we basically ignore this topic.”
Typically, there are two types of child maltreatment estimates. The first are annual estimates of confirmed cases from Child Protective Services. According that data, only 0.9 percent of children experienced confirmed maltreatment in 2011. The second examines maltreatment based on self-reported data, which in some cases has found that more than 40 percent of children can expect to experience maltreatment. Wildeman and colleagues — Natalia Emanuel, John Leventhal, Emily Putnam-Hornstein, Jane Waldfogel and Hedwig Lee — put themselves in the middle of those two methods to calculate the cumulative risk of maltreatment using confirmed case data.
“Even though few children experience maltreatment in any given year that doesn’t mean that few children will ever experience it,” Wildeman said. “Our broader motivation for doing this study is that things that happen to small proportions of kids are easier to ignore. They’re horrible and tragic and they pull at the heartstrings, but they don’t seem to matter much at a broader level. (With our findings), it becomes harder to say that.”
In addition to the one-in-eight finding, the study uncovered some startling disparities as well. For black children, the cumulative prevalence of maltreatment is one in five and for American Indian children, it’s one in seven. Overall, nearly 21 percent of black children are estimated to experience maltreatment, followed by 14.5 percent of American Indian children, 13 percent of Hispanic children, 10.7 percent of white children and 3.8 percent of Asian/Pacific Islander children. Girls are more likely to experience maltreatment than boys. Wildeman said he was shocked by the high prevalence among black children — “that’s the finding that kept driving us to go back to check and recheck our data and analysis.”
“The fundamental causes of disparities we see are about life circumstances that make parents feel overwhelmed,” he said. “This is fundamentally a structural issue; it’s not about individual parenting.”
Wildeman told me that if one in eight children are experiencing maltreatment so severely and consistently that it’s being confirmed by child protection officials, it suggests that many more parents than we'd like to believe are feeling completely overwhelmed and don’t have the resources to properly cope. He said he hopes advocates use the study’s findings to call for supportive policies and programs, whether it be reimbursement for nurse home-visiting programs, paid sick leave policies or something as seemingly simple as a safe neighborhood playground.
From a public health perspective, childhood maltreatment is linked to profound health effects throughout the lifespan. As Wildeman and his colleagues noted in their study, such maltreatment is associated with higher rates of mortality, obesity, HIV infection, mental health problems, suicide and a higher likelihood of engaging in criminal behavior. The cost of childhood maltreatment in the U.S. is estimated at $124 billion each year, with per-person costs akin to diseases such as diabetes or stroke.
Indeed, because such maltreatment is linked to so many health problems later in life, preventing adverse childhood experiences is often described as the ultimate primary prevention tactic. For example, public health officials with the Centers for Disease Control and Prevention have called on communities to rally around the primary prevention of child abuse and neglect in their “Essentials for Childhood Framework,” which argues that creating community environments that support safe, stable and nurturing relationships between children and caregivers could be key in preventing childhood maltreatment and raising healthy adults.
“We need to support proactive public policies to try to make parenting less overwhelming for people,” Wildeman said. “Diminishing childhood maltreatment rates is something we need to take very seriously.”
To request a full copy of the study, visit JAMA Pediatrics.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
I've heard too many stories recently of people being arrested for "neglect" because they let a kid walk or bicycle to school, play outside alone, or sit in a car in a safe neighborhood for five minutes to believe that all putative neglect as defined in America is chronic and severe enough to have lifelong health consequences.