虐待儿童是一个全球问题。世界卫生组织(WHO)估计,每年在世界各地虐待或忽视了4000万儿童。因此,在所有社会和文化中都发现了虐待儿童,几乎总是被保密和否认所包围。由于识别不足和报告不足,虐待的儿童的确切人数尚不清楚。孩子们通常太年轻,无法理解或传达正在发生的事情。此外,由于虐待通常是由父母或看护者犯下的,即使孩子们知道自己受到虐待,他们也经常会感到忠诚,依赖性和情感联系,从而使他们无法报告虐待。仅在美国,估计有879,000名儿童在2000年遭受虐待和忽视。2001年,每天约有2,475名儿童遭到虐待,并向儿童保护服务部门报告了50,000多个可能的虐待和忽视儿童的报告。
历史和文化视角
对儿童权利,童工和体罚的态度(诸如打屁股,殴打和鞭打之类的儿童的身体纪律)的文化差异在于对儿童虐待的情况有很大的文化差异。富裕的工业化,基于技术的国家具有不同的观点。按照这样的国家的标准,在发展中国家的儿童的生活条件,质量和/或缺乏水,食物和庇护所与儿童虐待相称。在某些发展中国家,文化仪式涉及儿童生殖器的肢解(通常是女性),而男孩则被送往战争。什么是虐待儿童和虐待的概念化会遭受广泛的文化差异。
在美国,从最初的角度看,对孩子的人道待遇和充分护理的信念是,孩子被视为父母或照料者认为合适的财产。例如,马萨诸塞州的《 1654年顽固的儿童法》允许父母因不遵守规定而将顽固的孩子丧生。在整个殖民地,几乎将儿童奴役为学徒,或者以其他方式从事艰苦的劳动,几乎没有足够的钱来支付自己的食物。1870年,人口普查局报告说,每八个孩子中就有一个。到1900年,这个数字已降至六分之一。被遗弃,失控或虐待的孩子也被送入劳动者“向西”。虐待儿童和虐待儿童于1874年与玛丽·埃伦·威尔逊(Mary Ellen Wilson)的案例获得了关注,玛丽·埃伦·威尔逊(Mary Ellen Wilson)是8至10岁的孩子,被继母严重虐待。有关的公民转向预防动物残酷的协会,因为当时没有正式的组织来帮助受虐待的儿童。这一事件导致了儿童保护小组的诞生,并代表了公众对儿童待遇的看法的日益转变。玛丽·埃伦(Mary Ellen)案的结果是,预防儿童残酷的协会于1875年在纽约成立,开创了美国各地儿童的其他倡导和保护组织的发展。
什么是虐待儿童?
Federal legislation provides the basis for the definition of child abuse in the United States, although each state has its own statutes as well. In 2003, the Federal Child Abuse Prevention and Treatment Act (CAPTA) was amended by the Keeping Children and Families Safe Act to define child abuse as “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.” A “child” is typically defined as any person under the age of 18 years, although for some state definitions of sexual abuse, the definition of the age of a child is specified otherwise.
虐待儿童包括委托行为或对儿童行事。精神卫生专业人员通常会质疑护理人员的任何行动,从而导致痕迹,肿胀,瘀伤,烧伤或破坏孩子的皮肤;显然,诸如骨折或内部伤害之类的更严重伤害被认为是虐待的。属于委托行为是性虐待和剥削。
虐待儿童还包括遗漏或忽视的行为,涉及父母或其他护理人员在保护或照顾儿童的情况下失败或缺乏行动。这种遗漏行为包括但不限于未能为孩子的基本生理需求(例如食物,水,衣服和庇护所)提供充分的提供;未能通过危害或未能满足儿童的医疗需求提供足够的监督。被认为是虐待行为的例外。美国州法规通常免除由于宗教信仰而没有为子女提供医疗干预的父母。文化价值/实践和贫困也会在父母和照顾者之间在文化中设定的护理标准上存在很大差异。
虐待和忽视儿童的类型
Child maltreatment is a general term used to encompass all types of child abuse and neglect, including physical abuse, neglect, emotional abuse, sexual abuse, and exploitation. Neglect is the most common type of maltreatment, making up about 62.8% of known victims in 2000, followed by 19.3% being physical abuse cases, 10.1% sexual abuse, and 7.7% emotional abuse and neglect.
Physical Abuse
身体虐待涉及对孩子造成人身伤害,包括但不限于击打,拳打,踢,燃烧,殴打或摇动。这种行动被认为是身体虐待的,无论是父母或照顾者打算造成伤害。身体虐待可能是故意的,也可能是过度体罚的结果。
摇晃的婴儿综合症,在医学上也被称为鞭打摇摆的婴儿综合症,涉及通过用手臂,腿,肩膀或胸部摇动婴儿来造成的婴儿。由于颤抖,婴儿的头部被迫向前和向后,导致大脑与内部头骨相撞。可能导致严重的脑损伤和死亡。即使是婴儿的轻度摇动也会导致受伤或死亡。在美国,估计的摇动婴儿综合征病例每年为600至1,400,尽管由于诊断不足或事件的报告不足,该数量可能太低。婴儿无法说话解释发生了什么,父母/照顾者不容易承认这种行为。
蒙克豪森(Munchausen)的综合征代理,也称为委托人,是一种心理疾病,其中几乎总是母亲,谎言他们的孩子患有身体症状或实际上是故意诱发身体症状的,例如中毒或窒息。父母这样做是为了扮演有关父母的角色,并受到医学界的关注。这样的父母是出于自己的心理/情感原因故意制造或诱发孩子的病,而不是为了财务或物质收益(例如残疾收入)。估计每年诊断出400至500例病例,尽管肯定没有被发现。
儿童忽略
忽视儿童可以是身体上,教育或情感上的。它涉及遗漏的行为。除了诸如未能满足孩子的基本需求(例如食物和庇护所)之类的身体忽视外,教育忽视还涉及允许孩子不上学或故意忽视孩子的特殊教育需求。情绪忽视可能是忽视最困难的形式。它涉及未能为孩子(例如言语或身体的感情)提供基本的养育水平。情绪忽视也可能涉及在孩子面前对父母的暴力或宽容孩子使用酒精和毒品的情况。
情绪虐待
情绪虐待从遗漏行为转移到还包括委托行为,这些行为会导致儿童和/或严重的行为或精神障碍。情绪虐待可能涉及使用极端的惩罚,超出了一个合理的成年人认为适当的措施,例如将孩子锁在黑暗的壁橱中或更少的佛罗里德行为,例如重复的scorning和口头上降解孩子,习惯性地陪伴(指责孩子都会造成任何和所有人,以造成任何和所有人家庭中的问题或压力源)或拒绝孩子。这种忽视形式是最难检测到的,因为伤害不是物理的。
性虐待和剥削
性虐待和剥削涉及对孩子的任何不当性行为,例如触摸孩子的生殖器,性交或肛门性交,乱伦,强奸,口交,或强迫孩子表演。它还包括迫使孩子观看其他人的性行为,使孩子暴露于性材料或行为,或暴露或以其他方式向孩子展示生殖器。对儿童进行经济利益的性剥削涉及儿童卖淫和儿童色情制品的产生。无论是身体强奸还是以其他方式触及自己的意愿,或者更常见的是,当孩子被贿赂,说服,欺骗,强迫或诱惑时,这项活动被认为是性虐待的。
When the sexual abuse is occurring inside the family by an immediate family member such as the child’s parent, it is referred to as incest. Unlike physical abuse and neglect, sexual abuse is much more premeditated and planned by the perpetrator. When a child is victimized by either a person in or outside of the family, there are steps that these perpetrators take in order to gain and maintain access to a child. This process is frequently referred to as grooming a child for abuse. Perpetrators of sexual abuse will often try to create a special trust or bond with the child. They strive to convince the child that they are a special or unique friend, and may do so by confiding in the victim or telling the victim of their loneliness and that the child can help. The perpetrator will also give the child gifts or special privileges. Next the pedophile attempts to alienate the child. Alienation is easier to accomplish when the sexual abuse occurs within a family. The child is alienated from the mother and siblings because of special privileges or status afforded by the perpetrator. As the abuser dominates the life of the victim, access to friends, support, and sources of help are minimized, creating dependency on the perpetrator. Next, secrecy is emphasized. The child is either directly instructed not to tell anyone about the abuse, or the perpetrator is more subtle and convincing about the need for secrecy. The process of committing the actual sexual abuse typically involves progressive boundary violations. For example, first the perpetrator will simply be where they do not belong such as in the child’s bed or in the bathroom with the child. Such boundary violations progress to inappropriate touching of the child and so on. The sexual abuse expands from inappropriate looks, conversation, and touching to more and more intense abuse. Specifically, a child abuse accommodation syndrome (CAAS) has been identified among girls who have been repeatedly sexually abused by a male perpetrator over time. This syndrome involves stages of secrecy; helplessness; entrapment and accommodation; delayed, conflicted, and unconvincing disclosure; and retraction. The common experience of the victims recognized by the CAAS include the ideas that sexual abuse is almost always shrouded in secrecy and feelings of helplessness in the victim; fear and ambivalent feelings (especially toward a perpetrator who is a family member) cause victims to disclose abuse in delayed and unconvincing ways and often to recant their disclosure later; and it is common for sexually abused children to show little emotion about the abuse and to delay for long periods of time before disclosing the abuse.
受害者
男女儿童同样有可能遭受忽视和身体虐待。女孩的性虐待的可能性几乎是男孩的五倍。男孩更有可能被男性非家庭成员(例如老师或教练)进行性虐待,而女孩更有可能被男性家庭成员进行性虐待。因此,男孩和男孩具有不同的脆弱模式,应考虑到预防目的。
没有一群儿童免受虐待儿童的影响,所有年龄段的孩子都经历了虐待。从出生到3岁的幼儿受害率最高;它们包括最多的忽视案件(这是最常见的滥用形式。)理论上,虐待率下降了,年龄较大的孩子能够更好地了解正在发生的事情并将虐待透露给他人。随着年龄的增长,滥用率下降的一个例外是性虐待。女性性虐待受害者的中位年龄为11岁,男性为8岁。在所有虐待或忽视的受害者中,有一半是白人,24.7%是非裔美国人,大约14.2%是西班牙裔。美洲印第安人/阿拉斯加的当地人占受害者的1.6%,亚洲/太平洋岛民占受害者的1.4%。
虐待的迹象
孩子可能会显示出虐待的迹象,包括成年人周围的紧张情绪;避免或害怕回家;自卑;在他们的艺术,演奏或与他人互动中的积极或性主题;在发展上对性的不当知识或兴趣;频繁的身体伤害;和卫生差和修饰。有许多心身投诉(例如头痛,胃痛)和睡眠困难,尤其是噩梦,也很普遍,但绝不是虐待的独特之处。
对于身体虐待,怀疑是特定物体形状的伤害(例如皮带扣或手印),这是父母与孩子对伤害发生的情况之间的差异。特别是性虐待,生殖器或直肠疼痛,发红,瘙痒,肿胀和性传播疾病都是可能的性虐待的强烈指标。经过牢固的便盆训练后的回归行为和事故发生,经常表明某些压力源的发作强烈影响儿童。
死亡
The most tragic result of child maltreatment is the death of a child. Annually in the United States, an estimated 1,300 child deaths result from abuse and/or neglect. Fatalities are composed primarily of very young children, with more than 84% being less than 6 years old. The most common age of death is infancy (birth to younger than 1 year), which makes up more than 40% of the fatalities. Fifty-six percent of the deaths are male children, with the remaining 44% female. Neglect and/or the combination of both neglect and physical abuse cause almost all of the fatalities. For 82.8% of the total fatalities occurring annually, the abuse/neglect is perpetrated by one or both parents. Only a small percentage occurs when the child is in an out-of-home placement such as a foster home, group home, or residential treatment setting, although it is not rare for children to be abused and maltreated in such settings.
肇事者
身体虐待和忽视
虐待与贫困和经济劣势有关。与较低的社会经济状况相关的条件,例如有限的儿童保育选择,拥挤和不合格的住房以及有限的适当医疗保健提供了虐待的背景。父母占所有虐待或忽视案件的78%以上,这不足为奇,因为他们是儿童的主要看护人。身体虐待或忽视的父母通常来自他们也被虐待和忽视的房屋。这是滥用的多代循环的一部分。因此,这些父母缺乏成功的积极育儿榜样。平均而言,大多数虐待的父母在20多岁时都年轻,接近或低于贫困水平,缺乏高中教育,并且本身就是儿童虐待的受害者。这些父母缺乏经济资源和社会支持,并且应对技巧不足。他们是孤立的,也许与家人和朋友远离或疏远。但是,重要的是要记住,没有任何概况适合所有施虐者,并且在性别,所有种族/族裔和所有社会阶层之间渗透到跨性别者。 Abusive and neglectful parents generally interact less with their children. They often appear uninvolved or uninterested in the care and well-being of their children. They may also appear overly critical of their children and very rigid about discipline. A major risk factor for violence in any home is active substance abuse by a parent. Forty percent of known cases of child abuse and neglect involve substance abuse.
与孩子相关或无关的压力可以触发身体虐待。与孩子有关的压力源包括过度哭泣,例如与幼儿或绞痛的婴儿,喂养或便盆训练挑战,对孩子的不切实际的期望以及对孩子的不服从的高度夸张的看法。与孩子无关的压力包括经济,住房或个人问题,工作或亲人的丧失,父母或照料者的身体或精神疾病以及法律困难。除了家庭中的积极滥用药物外,虐待儿童的另一个主要危险因素是家庭暴力。住在男性护理人员在家中受到身体虐待的家庭中,他们也有严重的人身虐待受害者的风险。
性虐待
性虐待的肇事者也称为儿童骚扰者或恋童癖者。男性超过90%的时间遭受了性虐待。绝大多数案件是由孩子认识的人犯下的,其中多达80%的案件涉及家庭成员,例如父亲,继父或叔叔。此外,与那些被非家庭肇事者虐待的孩子相比,被家庭成员性虐待的孩子可能会经历重复且严重的虐待水平。由于虐待的重复性和严重性以及对虐待虐待的成年家庭成员的情感背叛,这些案件也往往会对孩子造成更严重的心理损害和后果。
性虐待的肇事者通常具有青春期出现的异常性唤醒模式。他们中的许多人对受害者有特定的性别和/或年龄偏好。除了绝大多数性虐待者是男性之外,没有其他特征,例如人格特征,职业或年龄,可以用来预测谁是虐待者。
Consequences Of Abuse
短期后果
虐待和忽视儿童不会以相同的方式影响所有儿童。虐待对儿童的影响取决于虐待发生的性质,严重性和时间,以及在虐待开始之前孩子的气质,个性和功能水平。受害者获得的情感支持和援助水平也很重要。证明孩子是否只有一种积极的,一致的和养育与他或她一生中的人的关系可以显着调解或保护孩子免受虐待的潜在影响。
Abuse can seriously interfere with a child’s normal development, resulting in emotional and behavioral symptoms in the child. Chronic, repeated abuse, especially by a parent, may interfere with a child’s ability to formulate an attachment or bond with a parent. Later, these children have difficulty establishing healthy, reciprocal emotional connections with others.
被虐待或被忽视的孩子也往往很难应付自己的情绪。他们可能会抑制情绪表达,并可能从事异常,适应不良和自欺欺人的行为,例如切割自己或滥用物质。受虐待的儿童有严重发展多种心理疾病的风险。被虐待的女孩倾向于发展更多的耻辱,自我羞辱和内在疾病,例如焦虑和情绪障碍。男孩倾向于表现出更多与表现出色行为有关的问题,例如身体和言语侵略和反抗以及行为障碍的发展。这些女孩和男孩对自己和世界缺乏自尊和积极的信念。他们经常觉得自己不值得爱,并为虐待而责备自己。
一般而言,虐待儿童证明了同伴关系中的两种模式之一。第一种模式是敌对行为之一。受虐待的儿童,特别是在身体虐待的情况下,倾向于将歧义甚至友好的行为解释为敌对或威胁。他们对他人的身体和口头上更具侵略性,并且具有有限的社交网络,具有侵略性和引人注目的行为。与忽视有关的第二种模式涉及撤回和避免同龄人。这样的孩子被撤回,被动,因此与表现出侵略性模式的孩子一样在社会上孤立。
虐待会干扰一个孩子,完成对他们的期望,包括损害学业成绩。受虐待儿童的成绩很差是很常见的。成绩的急剧下降可能是儿童生活中一些重大压力源的强烈指标。
Long-Term Consequences
Not all abused or neglected children develop psychopathology that can follow them throughout adulthood. Yet, all are at increased risk for doing so. The negative outcomes stemming from abuse can be avoided if children receive social support from nonoffending family members in addition to other intervention. However, without such support and the opportunity to develop healthy coping and interpersonal skills as well as a renewed ability to trust others who are worthy, these children are at tremendous risk for developing mood disorders (such as clinical depression and even suicidal behavior), posttraumatic stress disorders and other anxiety disorders, dissociative disorders, sexual adjustment problems in adulthood, and criminal and antisocial behavior.
治疗
父母和看护人最需要治疗,因为他们正在虐待儿童的情况实际上是最不可能寻求的。虐待儿童可能会感到羞耻和内gui,并害怕失去孩子。非家庭成员害怕犯罪影响的施虐者。最常见的是,只有在发现虐待后,治疗才是由于法律授权而进行的。
自1960年代以来,在美国,对儿童虐待的保护,社会工作方法一直是普遍的标准。目前,所有50个州和哥伦比亚特区都有强制性的报告法,要求专业人员和其他与儿童一起工作或互动的个人向儿童保护服务(CPS)机构报告可疑的虐待。虚假和恶意报告发生了,这是非常有问题的。
许多CPS机构都有儿童保护团队(CPTS)。这些是多学科的团队,当揭露合理的虐待儿童时,立即被要求采取行动。CPT包括接受过可能受害者和心理健康临床医生进行医学检查的儿科医生,他们接受了如何进行法医访谈以解决滥用可能性的培训。团队协调父母评估,肇事者和受害者的治疗计划以及所有必要服务的转诊。
与家庭内部施虐者的强制性报告立法和儿童保护服务有关的普遍哲学重点是家庭保存(在可能的情况下维持儿童,而不是在可能的情况下移走),这被认为符合大多数受虐儿童的最大利益(除了在极端,恐怖或防治病例中)以及与寄养儿童在寄养,团体房屋或其他住宅环境中的室外安置相比,还具有成本效益。需要对这些计划的结果进行更多评估和研究,以确定它们在虐待者康复方面的有效性以及对受虐待儿童的治疗效率。
In the United States, family preservation programs are modeled after the Washington State Homebuilders Program. These programs provide individualized treatment plans for each family. Treating abusive or neglectful parents frequently involves counseling multiproblem, complicated families. Counseling interventions are intensive and frequently referred to as “wraparound” services. Treatment for the abusers commonly involves individual and group counseling, including strong parent education and counseling in relaxation training, stress and anger management skills, cognitive restructuring to assist the parent in interpreting and responding to the child’s behavior more appropriately, problem-solving skills, and training in basic child-rearing skills. Parents are provided with exposure to positive parenting models and skills and may practice them through role playing and coaching from a clinician. Abusive parents may also need intensive substance abuse/dependency intervention, assistance with job training, and other social and financial assistance. Neglectful parents also frequently require training in how to manage everyday demands of living such as money management and housekeeping. Neglectful parents need to break a cycle of avoidance of interaction with their children and of daily responsibilities, replacing this with positive parent-child interactions and active care for their children and daily life responsibilities.
治疗for the victims of abuse is also important. For children who have been physically abused, play therapy, individual therapy, group therapy with other children, and on-site therapeutic interventions at the child’s school, day care, and home focus on rebuilding the child’s battered self-esteem and self-concept. Related goals include restoring the child’s sense of self-efficacy (sense of power or ability to have some control over themselves and their environment) and improving the child’s social behavior, cognitive development, and academic achievement.
For sexually abused children, treatment is aimed at helping the child realize that what they experienced was abuse, that it was wrong, and that it was not their fault. These children need to slowly, in a paced manner and safe environment, share and release their memories and feelings about the trauma in order to prevent or extinguish posttraumatic-stress-related symptoms and alleviate guilt, shame, and self-blame. As is the case with physical abuse, rebuilding the child’s self-esteem is an important therapeutic goal, as is helping the child to regain a sense of safety. Educating the child about sexual abuse and ways to prevent it from occurring (“I know I can tell my mommy if anyone tries to touch my private parts, or makes me feel uncomfortable”) is important.
关于性滥用者的治疗,不幸的是,治疗计划的结果很差,累犯率很高。因此,刑事法院制度倾向于专注于丧失能力(消除受害者的机会)和报应。尽管目前的治疗成功有限,但对治疗选择的研究正在扩大,恋童癖者的监狱治疗计划的可用性也在扩大。
预防
In the area of prevention of child abuse, prevention can occur at the cultural level. Cultural violence, as evidenced by strong violence in the media, has been linked as a promoter of violence within families. On a cultural level as well, the link between poverty and child abuse has been established. Thus, efforts to reduce cultural violence and poverty are theorized to have a direct impact on the welfare of children.
打破暴力的多代循环是防止未来虐待儿童的直接方法。由于许多虐待者被虐待,因此这些人在父母之前或在父母之前需要进行特定的干预,以防止周期永存。由于药物滥用也与虐待儿童有关,因此预防药物滥用和与父母的干预是防止虐待儿童的另一种方法。
预防和教育服务直接针对未来的父母也有很大的影响。产前医疗保护新母亲的健康状况,并使她处于更好的状态来照顾婴儿。产前计划,以家庭为中心的分娩和教练班,婴儿护理班和育儿班尽一切可能教育和准备父母满足照顾婴儿的需求,其目标也促进了婴儿与家庭之间的情感联系。Careful attention by the medical profession and the members of a new mother’s support system is recommended, so that postpartum psychological symptoms and disorders can be treated, preventing neglect and maltreatment of the infant, and alleviating the mother’s intense suffering caused by these often unrecognized and untreated disorders.
支持小组,育儿教育和社区计划也可以帮助缓解父母的压力。食品银行,庇护所,旧货店和紧急援助计划可以为父母提供一些帮助。一些社区甚至提供喘息的托儿服务,在虐待行为的边缘的父母可以暂时离开孩子。学校为儿童提供安全教育(有关陌生人危险等主题的计划),并教孩子在被虐待时该怎么办。全国虐待儿童热线致电1-800-422-4453可供所有社区成员使用。
概括
尽管预防和干预服务增加,公众意识和对虐待儿童的关注,但这个问题远未消失。只有通过对父母的持续教育和社会各个层面的变化,才能防止和消除虐待儿童的问题。
参考:
- ChildHelp(n.d.)。治疗and prevention of child abuse.从...获得http://www.childhelpusa.org/hotline.htm
- Connelly,E。R.(2000)。虐待和忽视儿童:检查心理后果。费城:切尔西
- Dorne,K。(2002)。美国虐待儿童介绍:历史,公共政策和研究(第三版)。纽约:刑事司法出版社。
- Finkelhor,(1994)。有关儿童性虐待范围和性质的当前信息。Future of Children, 4,31–53。
- Finkelhor,&Dzuiba-Leatherman,J。(1994)。儿童受害。美国心理学家,49岁,173–183。
- 葡萄,J。(编辑)。(2001)。虐待儿童:当代问题。San Diego, CA: Greenhaven.
- 国家关于虐待儿童和忽视信息的交换所,http://nccanch.acf.hhs.gov
- Ney,T。(编辑)。(1995)。True and false allegations of child sexual abuse: Assessment and case management。纽约:布伦纳/马泽尔。
- Schwartz-Kenney, M., McCauley, M., & Epstein, M. A. (Eds.). (2001).虐待儿童:全球观点。康涅狄格州韦斯特波特:格林伍德。
- Sgroi,M。(编辑)。(1982)。Handbook of clinical intervention in child sexual abuse.马萨诸塞州列克星敦:列克星敦书籍。
- Sgroi,S。M.(1988)。脆弱的人群:对性虐待儿童和成人幸存者的评估和治疗,第一卷。纽约:免费
- Summit,C。(1983)。儿童性虐待住宿综合症。虐待儿童& Neglect, 7,177–193。
- S.卫生与公共服务部,儿童和家庭管理。(n.d。)。儿童局的情况说明书和报告/出版物。从...获得http://www.acf.hhs.gov/programs/cg/publications