Child abuse is defined as causing or permitting any harmful or offensive contact on a child's body; and any communication or transaction of any kind which humiliates, shames, or frightens the child. Some child development experts go a bit further and define child abuse as any act or omission, which fails to nurture or in the upbringing of the children. The Child Abuse Prevention and Treatment Act defines child abuse and neglect as: <<at a minimum, any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm.>> Child abuse can be classified as physical, emotional, neglect or sexual. Physical Abuse: This type of abuse can be defined as the inflicting of physical injury upon a child. This may include burning, hitting, punching, shaking, kicking, beating, or otherwise harming a child. The parent or caretaker may not have intended to hurt the child, the injury is not an accident. It may, however, been the result of over-discipline or physical punishment that is inappropriate to the child's age. Emotional Abuse (also known as verbal abuse, mental abuse, and psychological maltreatment): This type of abuse includes acts or the failures to act by parents or caretakers that have caused or could cause serious behavioral, cognitive, emotional, or mental disorders. Neglect: This type is defined as the failure to provide for the child's basic needs. Neglect can be physical, educational, or emotional. Physical neglect can include not providing adequate food or clothing, appropriate medical care, supervision, or proper weather protection (heat or coats). It may include abandonment. Educational neglect includes failure to provide appropriate schooling or special educational needs, allowing excessive truancies. Sexual Abuse: It refers to the inappropriate sexual behavior with a child. It includes fondling a child's genitals, making the child fondle the adult's genitals, intercourse, incest, rape, sodomy, exhibitionism and sexual exploitation. To be considered child abuse these acts have to be committed by a person responsible for the care of a child (for example a baby-sitter, a parent, or a daycare provider) or related to the child. The prevalence of child abuse has been reported as 4.5% to 21.6% in epidemiological studies and 14.6% to 48% in clinical studies. An epidemiological study in Mexico found at 16% to 20% prevalence, being the physical and emotional abuse the more frequently reported. This study also showed that the mother is the perpetrator in a high percentage of cases and mentioned some characteristics of the patients and their families which were associated with the different types of abuse. There are many factors that may contribute to the occurrence of child abuse and neglect, such as an inadequate family environment, the history of illness or any disability in the children or the presence of psychopathology in the parents. Parents may be more likely to maltreat their children if they abuse drugs or alcohol. They also may not be able to cope with the stress associated with their children care. Child abuse has been associated with psychopathology. The impairments in significant areas of child development caused by maltreatment may account for the elevated symptoms of depression, anxiety, conduct disorders and substance abuse among children and adolescents with histories of physical and sexual abuse. In particular, children and adolescents with externalizing disorders such as Attention Deficit Hyperactivity Disorder (ADHD), oppositional defiant disorder or conduct disorder may be in a higher risk for maltreatment. The objectives of this study were to examine the frequency of maltreatment reported by adolescents with psychiatric disorders and explore their demographic characteristics and family functioning. Methods The sample included male and female adolescents (13 to 17 years old) attending the inpatient and outpatient services at the Child Psychiatric Hospital in Mexico City. After giving their informed consent, the patients and their parents were assessed with the Semistructured Interview for Adolescents, a diagnostic interview which follows DSM-IV criteria for 17 major diagnoses. After that, adolescents were asked to fulfill a survey for child abuse, a previously designed questionnaire to explore the presence of physical, emotional, sexual abuse, and neglect. This questionnaire also assesses some characteristics of the parents and the family (income, educational level, family structure and conflict resolution, among others). The obtained data were analyzed with descriptive statistics. Results One hundred patients (50% male, mean age 14.79±1.60 years old, with a mean of 7.8±1.68 years of school) were evaluated. Most of them (56%) were living with both parents, the parents educational level more frequently reported was middle school (32% of the mothers and 30% of the fathers). Intimate partner violence was reported by 22% of the sample. According to the psychiatric diagnostic interview, the most frequent diagnoses in the sample were major depressive disorder(61%), ADHD (39%), conduct disorder (31%), substance abuse (31%) and anxiety disorders (17%). The rates of the different types of abuse reported by this sample of adolescents were as follows: Emotional abuse (77% perpetrated by the mother and 61% by the father), physical abuse (41% perpetrated by the mother and 34% by the father), severe physical abuse (29% perpetrated by the mother and 26% by the father), neglect (8%) and sexual abuse (24%). A 19% of the sample reported to be physically abused by the mother before the age of 5, while 11% reported to be physically abused by the father by the age of 5. Patients with ADHD and those with conduct disorder reported the highest frequencies of abuse. The adolescents with substance abuse disorders reported high frequency of emotional abuse. When patients were asked to give their opinion about the frequency with which they were physically punished, the investigators found that a high percentage of adolescents agreed to receive physical punishment (22% considered to be punished <<with reason>> and 12% considered normal to be hit). Only 8% to 11% considered that their parents hit them excessively. The sample was divided according to their diagnoses in patients with externalizing disorders, internalizing disorders and substance abuse/dependence and the frequency of the different types of abuse was calculated. The physical abuse by the mother was more frequent in patients with externalizing disorders and substance abuse; the physical abuse by the father was more frequent in patients with externalizing disorders. These patients also reported the highest frequency of severe physical abuse and emotional abuse by the mother. The frequency of sexual abuse was reported by 22% or each diagnostic group. When the patients were asked to explain why were they physically punished, the main reasons exposed were disobedience and disrespect; however, more than 20% explained that their parents were intoxicated with alcohol or drugs while punishing them. Conclusions The frequency of abuse reported by this sample of adolescents with psychiatric disorders was higher than the reported in an epidemiologic sample, particularly in the rates of sexual abuse. The present sample also exhibited unfavorable social, demographic and familial characteristics. Emotional abuse was the most frequently reported in this sample. The mother was the more frequently perpetrator for physical and emotional abuse.
El concepto de maltrato o abuso en la infancia incluye acciones y omisiones infligidas al menor, generalmente por personas del medio familiar, que interfieren con su desarrollo integral y lesionan sus derechos como persona. El maltrato se clasifica como físico, físico grave, emocional, negligencia y abuso sexual. La prevalencia del maltrato se ha reportado en estudios epidemiológicos (4.5% a 21%) y en estudios de población clínica (6% a 48%) realizados en varios países. En México la encuesta de maltrato infantil y factores asociados reportó una prevalencia del maltrato de 16% a 20%, siendo el maltrato físico, el maltrato físico grave y el maltrato emocional los más frecuentes. El maltrato infantil es un problema multicausal. Dentro de los factores familiares asociados al maltrato se han mencionado la desintegración familiar, la violencia entre los padres y el menor nivel educativo de éstos. La psicopatología se ha reportado en 9% de los niños y adolescentes maltratados, mencionándose al maltrato como predictor de ésta. Se ha encontrado mayor frecuencia de trastornos afectivos, ansiosos, conductuales y de abuso de sustancias en sujetos víctimas de maltrato crónico. Los objetivos del presente trabajo fueron determinar la frecuencia y tipos de maltrato reportados por pacientes adolescentes con psicopatología y determinar la frecuencia de los factores demográficos y de funcionamiento familiar que se han asociado al maltrato en estos pacientes. Método El diseño del estudio fue transversal y descriptivo. La muestra incluyó adolescentes de 13 a 17 años de ambos sexos, usuarios de los servicios de consulta externa, urgencias y hospitalización del Hospital Psiquiátrico Infantil <<Dr. Juan N. Navarro>>. Los pacientes fueron evaluados con la Entrevista Semiestructurada para Adolescentes para obtener el diagnóstico y contestaron la Encuesta de Maltrato Infantil, que incluye apartados para determinar la presencia de maltrato, las creencias del sujeto acerca del mismo, antecedentes de patología en el adolescente, características de la estructura y nivel socioeconómico familiar y su estilo para solucionar conflictos. Se utilizó estadística descriptiva para el análisis de datos. Resultados La muestra se conformó de un total de 100 pacientes (50% hombres, edad promedio 14.79±1.60 años), 56% pertenecía a una familia integrada. Para ambos padres el nivel de escolaridad más frecuentemente reportado fue de secundaria, 22% reportó violencia entre sus padres. Los diagnósticos más frecuentemente encontrados fueron episodio depresivo mayor (61%), trastorno por déficit de atención e hiperactividad (TDAH)(39%), trastorno disocial (31%), abuso de sustancias (31%) y trastornos de ansiedad (17%). Las frecuencias reportadas de los diferentes tipos de maltrato fueron: maltrato emocional 77%, maltrato físico 41%, negligencia 8% y abuso sexual 24%. La madre perpetró el abuso físico y emocional con mayor frecuencia. Los pacientes con TDAH y trastorno disocial reportaron las frecuencias más altas de todos los tipos de abuso, los adolescentes con diagnóstico de abuso de sustancias también reportaron alta frecuencia de abuso emocional. El abuso sexual fue reportado con frecuencia similar por los pacientes con trastornos afectivos, de conducta y por uso de sustancias. Al preguntar a los pacientes las razones por las que sus padres los golpeaban, la desobediencia y la falta de respeto fueron las razones más frecuentemente reportadas; el maltrato también se atribuyó a que los padres estuvieran nerviosos o hubieran consumido sustancias psicoactivas, siendo estas razones más frecuentemente expuestas por los adolescentes con diagnóstico de abuso de sustancias. Conclusiones La muestra estudiada de adolescentes reportó frecuencias elevadas de maltrato y abuso sexual. También presentó indicadores demográficos desfavorables (familias desintegradas, violencia ente los padres y baja escolaridad de los mismos), que deben tomarse en cuenta como factores de riesgo para el maltrato, aunados a la psicopatología.
