Authorities More Aware of Child Abuse Now

By John Gever, Senior Editor, MedPage Today Published: January 04, 2011 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

Action Points   Explain that a telephone survey study of children and adolescents found that exposure to violence was common, but authorities knew about at least one incident in nearly half of the cases. Note that this represented an increase in awareness of episodes compared with a similar study in the early 1990s. Medical personnel, police, and school officials appear to be learning about more incidents of violence against children and teens than they used to, but there is still substantial room for improvement in reporting, researchers said.    Among some 2,650 youths in a telephone survey who reported exposure to violence in the previous year, 45.7% said the authorities knew about at least one of the violent incidents, according to David Finkelhor, PhD, of the University of New Hampshire in Durham, and colleagues. A similar survey conducted in 1992 indicated that only about 25% of violent incidents were reported to schools or police. However, authorities' awareness in the current survey, reported in the January issue of Archives of Pediatric and Adolescent Medicine, varied widely by the specific type of incident. For some, such as murders, school threats, and vandalism, awareness rates approached or surpassed 90%. But just 16.9% of the 1,600 respondents who reported peer or sibling assaults said the authorities knew about them. Finkelhor and colleagues reported rates of 25% or below for eight other types of incidents, including psychological or emotional abuse, bullying, genital assaults, dating violence, and rape. Still, even the low numbers were higher than in the 1992 survey, when only 6% of sex-related incidents were said to have been disclosed to police or other authorities. "The higher rates of victimizations known to authorities found in the current study may mean that past efforts to promote disclosure have been working and should be sustained," the researchers wrote. "However, the study also shows that a considerable portion of childhood/adolescent exposure to victimization is still unknown to authorities." In an accompanying editorial, two Yale University researchers called the overall findings "welcome news," insofar as they reflect an increase over time in authorities' awareness of violence affecting young people. But Andrea Gottsegen Asnes, MD, MSW, and John M. Leventhal, MD, also noted that the study showed just how common such violence is, with nearly 60% of respondents reporting at least one incident. The study "speaks to the enormity of the problem of victimization experienced by children and adolescents in our society," they wrote, and called on the clinical and public health communities to step up efforts to help young people cope with it. Finkelhor and colleagues analyzed results from a random, nationwide telephone survey conducted in 2008 that reached 4,549 children and teens up to age 17. The survey included oversampling of telephone exchanges with high proportions of African-American, Hispanic, and low income households to ensure adequate coverage of these subgroups. Final results were weighted to reflect national demographic distributions. Respondents were asked about their experiences in the preceding year with more than 40 types of violence. Of these, 26 involved direct victimization; the remainder included witnessing violent acts or knowing about violence against close friends or relatives. Just over 58% of respondents gave a positive response in at least one category. Peer and sibling assaults were the most common at 1,600, followed by emotional bullying (875), witnessing a weaponless assault (720), being assaulted with no weapon (573), and physical bullying (558). The survey also asked what specific categories of authorities knew about the incident: medical, school, or police. Overall, school authorities were the most likely to be aware of an episode -- 43.2% versus 12.7% and 1.8% for police and medical personnel, respectively. Medical authorities were most often in the dark, responses indicated. The highest percentage was 19.1% for sexual abuse by a nonspecific adult. Medical personnel knew about only 10% of caretaker abuse cases, 7.7% of assaults with a weapon, 7.4% of incidents of sexual abuse by a known adult, and 3.5% of rapes. Respondents indicated that most types of serious crimes they had witnessed had been reported to police in about 40% to 85% of cases. For incidents in which the respondents were the victims, participants believed police awareness was often much lower -- ranging from 3.4% of robberies to 34.4% of gang assaults. Finkelhor and colleagues also identified several factors that were associated with increased or decreased awareness by authorities. For nonsexual assaults, factors pointing to decreased awareness included a family member perpetrator, incidents away from school, assaults occurring in suburbs versus cities or rural areas, injuries considered minor, and a male victim (all P<0.05). Fewer factors were significantly associated with authorities' knowledge of sexual victimization, partly because such incidents were relatively uncommon. Only about 360 participants reported sex-related incidents, of which three-quarters involved sexual harassment, flashing, or consensual underage sex. Police awareness was enhanced (P<0.05) when sexual victims were African American and when perpetrators were adults. School officials were more likely to learn of incidents when serious injuries were involved, when incidents took place at school, and when children under 10 were the victims. It also appeared that police and school authorities tended to be unaware of sex-related incidents in which family members or peers were the perpetrators. "An important task is for authorities to persuade children and families that they have resources to help in these situations and that they can provide protection against retaliation for individuals who disclose their victimizations," Finkelhor and colleagues wrote. The study's chief limitation was its reliance on respondents for data on the number and type of incidents and on authorities' awareness of them although the same methodologies were used for previous studies. The survey was funded by the Department of Justice. Study authors and editorialists declared they had no relevant conflicts of interest.

Primary source: Archives of Pediatric and Adolescent Medicine Source reference: Finkelhor D, et al "School, police, and medical authority involvement with children who have experienced victimization" Arch Pediatr Adolesc Med 2011; 165: 9-15. Additional source: Archives of Pediatric and Adolescent Medicine Source reference: Asnes A, et al "Connecting the dots in childhood and adolescent trauma" Arch Pediatr Adolesc Med 2011; 165: 87-89.