Child Abuse and its Relationship to Conduct Disorder

An investigation into whether children and adolescents with a history of abuse are likely to meet the diagnostic criteria for Conduct Disorder.

 

Authors: Sadekie Lyttle, BCc., MSc. Clinical Psychology
Stacey Brodie, Phd. Counselling Psychology

ABSTRACT

Children and adolescents who have experienced child abuse generally are at a “high risk” for the social problems due to the conduct problems that they exhibit.  The pervasive symptoms identified in these children and adolescents include explosive temper tantrums, physical aggression, fighting, threats or attempts to hurts others (including homicidal thoughts), use of weapons, cruelty towards animals, fire setting, intentional destruction of property and vandalism, behavioural symptoms identified in the diagnostic criteria for Conduct Disorder.  Furthermore, a history of childhood abuse has been associated with higher rates of psychopathology in adulthood when compared to non-abused adults.  A sample of 70 substantiated cases of child abuse between the ages of 10 and 19 was identified to investigate whether the behavioural symptoms they displayed are severe enough to warrant a diagnosis of Conduct Disorder and identify the nature and differences in presentation across age, gender and type of abuse.  Participants were assessed using the Conduct Disorder Scale.  A demographic questionnaire was also administered.  The results indicated that 50% of the sample met the criteria for Conduct Disorder.   Those who met the criteria were sexually and physically abused, with high rates of aggressive conduct, hostility, deceitfulness/theft and rule violating behaviours.  Those neglected/abandoned had low rates of conduct problems when compared to other types of abuse and majority did not meet the criteria for Conduct Disorder.  Conduct problems were found to intensify between the ages of 13 and 15 years, with females exhibiting higher rates of aggressive conduct than males.  The results of this study suggest the need for assessment and therapy for children and adolescents who have experienced abuse as their conduct problems may be the characteristic response to an abusive experience.

Literature Review

Of most concern to the present study is the association between childhood abuse and delinquent/at risk behaviours of children and adolescents. Converging evidence suggests that abuse in childhood is associated with delinquent behaviour. Furthermore, the relationship between child abuse and delinquency was stronger for the more serious types of delinquency than for the minor forms of delinquency. It is suggested that approximately 15 to 30 percent of maltreated children go on to become delinquent.  On average, abused and neglected children were found to begin offending earlier and had a greater number of offences (Wisdom, 1989).
A significant number of studies conclude that having a history of child abuse has been associated with poor mental health, predisposes the individual to various mental illnesses and conduct problems.
The long-term outcomes of abuse on the developing child have been well documented.  Edwards, Holden, Felitti & Anda (2003), in their study of the relationship between multiple forms of child abuse (physical abuse, sexual abuse, and witnessing of maternal battering) and adult mental health found that lower mental health scores were associated with higher numbers of abuse categories. Additionally, emotionally abusive family environment and the interaction of an emotionally abusive family environment resulted in the decrease in mental health scores.
In an assessment of the rates of lifetime psychopathology in a general population sample who reported a childhood history of either physical or sexual abuse and those who did not for five psychiatric disorder categories, the results indicated that persons with a history of childhood physical abuse had significantly higher lifetime rates of anxiety disorders, mood disorders, alcohol abuse/dependence, and antisocial behaviour and were more likely to have one or more disorders than were those without a history of physical abuse (MacMillian, Fleming, Streiner, Lin, Boyle, Jamieson, Duku, Walsh, Wong & Beardslee, 2001). 
Women with a history of childhood sexual abuse had higher rates on all disorders.  In men, disorders were more prevalent if there was a history of sexual abuse and the current lifestyle outcome in most cases was alcohol abuse and dependence.  Overall, the research indicates that a history of childhood abuse, physical and sexual in particular, increases the likelihood of developing psychopathology in the long term especially in women (MacMillian, Fleming, Streiner et al, 2001). Spak, Spak and Allebeck (1998), in their study found that   increased scores on the conduct disorder scales were likely where there is a history of physical and sexual abuse in the childhood of participants.
The association between a history of childhood abuse and higher incidences of psychopathology, specifically where anxiety disorders such as Posttraumatic Stress Disorder, Panic Disorder, Social Phobia and Obsessive Compulsive Disorder and Mood Disorders such a Major Depression (Gladstone, Parker, Wilhelm, Mitchell & Austin, 1999; MacMillian et al, 2001; Penza, Heim & Nemeroff, 2003; Stein, Walker, Anderson, Hazen, Ross, Eldridge & Forde, 1996) are diagnosed. 
There were also associations found between having a history of child abuse and the likelihood of being diagnosed with alcohol and drug abuse/dependence (Ireland, Smith & Thornberry, 2002), Conversion disorder (Roelofs, Keijsers & Hoogduin, 2002), Dissociative Identity Disorder (Lewis, Yeager, Swica, Pincus & Lewis , 1997; Chu, 2000), Schizophrenia (Read & Argyle, 1999), Personality Disorders, specifically Borderline (Gladstone, Parker, Wilhelm et. al, 1999) and Antisocial Personality Disorder (MacMillian, Fleming, Streiner et al, 2001) and later conduct problems featured by higher levels of trait impulsivity, aggression, violence and delinquency (Ireland et al, 2002; Grilo, Sanislow, Fehon, Martino, & McGlashan, 1999; Brodsky, Oquendo, Ellis, Haas & Malone, 2001).
Salter, Richardson & Kairys (1985) assert that abused children display behavioural problems because they understand the world as being unpredictable and painful and that the adults who care for them are angry, impatient, depressed, and distant. This perception of the world tends to transformed these children into hostile, violent and unpredictable persons.  The abuse experience can result in a pattern of expecting the infliction of pain or injury from others, of behaving in ways to incite pain and injury, of distrusting closeness, feelings helplessness and powerlessness, and the development of wariness or suspicion of others. Older children often demonstrate some type of affective problem.  They numb themselves to abuse, become limited in their ability to perceive their own feelings, and have difficulty interpreting and responding to the emotional expressions of others. Due to the abuse, children and adults may develop a pattern of denying or limiting certain emotional responses and expressing only those with which they are most familiar, aggression and hostility so as to get what they want.
Both verbally and physically aggressive behaviour and passive compliance and avoidant behaviour have been reported by studies investigating physically abused children. Green (1978) suggests that aggressiveness is an effort by abused children to avoid feelings of helplessness and anxiety. For Helfer (1987) being raised in an environment where physical abuse is a common response to problems, feelings, and conflicts can impair several important developmental behaviours such as problem solving, accepting delayed gratification, and impulse control and without the opportunity to learn these behaviours, a child responds in ways that are modelled within the family which means that in response to conflict, abused children will resort to some type of verbal or physical hostility or passive compliance to resolve the problem or to meet their unmet needs.  
Emotional and physical abuse has been linked to lying, stealing, low self-esteem, emotional maladjustment, dependency, underachievement, depression, aggression, learning disorders, homicide, and suicide (Thomas, 2002; Osher and Tierney, 2001), as well as to psychological distress later in life (Hart, & Brassard, 1987). The consequences of sexual abuse vary with age and have long-term physical, mental, emotional and behavioural effects on the child.  Generally speaking, childhood sexual abuse is more than a sexual act – it affects all aspects of the victim’s life.  A child who seemed unharmed by childhood abuse can develop crippling symptoms years later and have difficulty in their interpersonal relationships (Hunter, 1990).  One study investigating differences in the amount of pathology for different age groups found that the highest incidence of psychopathology was among in sexually abused children aged 7-13 years who showed substantially elevated levels of hostility on scales of aggression and antisocial behaviour (Tufts New England Medical Center, 1984). This conclusion is consistent with Swanston, Parkinson, O'Toole, Plunkett, Shrimpton and Oates (2003) and Haskett & Kistner (1991), who concluded that having a history of child sexual abuse predicted self-reported criminal behaviour and aggressiveness. 
Gender differences have been identified regarding the expression of anger, one of the most common behavioural symptoms, in conflicts.  The popularly held view is that males show higher levels of aggression, passive aggression and impulsively express their anger.  They also more often had a revenge motive to their anger.  Females, on the other hand, were found to be angry longer, more resentful and less likely to express their anger (DiGiuseppe & Tafrate, 2003).  The differences have been explained to be the result of females using more situational cues in emotional perceptions (Pennebaker & Roberts, 1992); attending to differing dimensions and forms of anger expression (Smith, Ulch, Cameron, Cumberland, Musgrave & Tremblay, 1989); and them being more likely to confront interpersonal problems and express feelings openly (Biaggio, 1989).  Males however, tend to withdraw during conflicting interactions (Christensen & Shenk, 1991; Kurdek, 1995) and use denial (Canary et al., 1988). 
Consistently overall, studies indicate that abused children even during infancy often display more aggressive and problematic behaviours than non abused or non neglected children (Wisdom, 1989, 1996; Reidy, 1977; Burgess and Conger, 1978; Kinard, 1980; Barahal, Waterman & Martin, 1981; Bousha and Twentyman, 1984).  These studies also suggest the need to consider neglect as distinct from abuse, because in some cases neglected children appeared more dysfunctional than those abused (Rohrbeck and Twentyman, 1986).  Findings by Green, Russo and Navratil et al (1999) indicate a higher prevalence Conduct disorder (CD) in abused cases than in non-abused cases and is found to be probable precursor to future abusive behaviour (Elze, Stiffman & Dore, 1999). Abuse or neglect in childhood has been found to increase the likelihood of arrest for females by 77 percent (Wisdom, 1992). In the 1989 study, results indicated that males had a higher rate of delinquency, adult criminality and violent behaviours over females, with the severity of conduct problems varying with age such that as age increases, the more severe the conduct problems (Wisdom, 1989).
Relationships have been found between the specific diagnostic criteria for Conduct Disorder, that of serious violation of rules, deceitfulness or theft , aggression to people or animals  and destruction of property and different types of abuse.  Abrahams & Mungall (1992) and Molnar, Shade, Kral,Booth & Watters (1998) found that, the majority of children who run away are ages 14 and 16.  Seven percent (7%) of runaways are aged 11 years or less and they tend to be more boys (55%). The majority of adolescents who runaway were found to be physically abused in the home prior to running away and by a family member (Stiffman,1989; Hendessi,1992; Farber, Kinast, McCoard & Falkener,1984; National Research Council, 1993; Rees (1993). Farber and Joseph (1985) argue that one in six adolescents who are physically abused react by 'acting out', for example, running away, theft, substance abuse and refusing to attend school. Gutierres & Reich (1981) found that physically abused juvenile delinquents are about three times more likely than other delinquents to engage in escape behaviours, rather than aggressive crimes. According to McCord (1983), approximately 20% of abused children were convicted for serious juvenile crime such as assault as well as theft, auto theft, breaking and entering, or burglary.
Field (2004) asserts that a child, who is subjected to regular abuse, needs an outlet for their aggression and so they will act out their violent impulses on another child (bullying), or sibling, or family pet. Violence towards animals (e.g. torturing the cat or killing the dog) is a common early warning sign of forthcoming violence in adulthood.  It is necessary to note that most abused children do not become delinquent or criminal as adults, abuse makes it likelier that they will (Dodge, Bates, & Pettit, 1990; Todd & Gesten, 1999).
While recognizing that the nature of conduct disorder point to multi-factorial etiology, in which the social and family environments interact with the biological makeup of the individual as well as constitutional factors such as temperament, cognitive skills and acquired behavioural patterns, such as coping strategies and defence mechanisms influenced by family-related variables, with mediating factors such as social support systems and role models (Brown, 1999b). 
The researcher believes that since there is a statistical relationship between conduct disorder and antisocial personality - the personality type identified in criminals - whereby those who have been diagnosed with antisocial personality have a history of conduct disorder and have experienced some form of childhood abuse. It therefore becomes pertinent to investigate the relationship between child abuse and conduct disorder, especially in an environment where children and adolescents between the ages of 10 and 19 are increasingly found to be perpetrators of violent acts, or engaged in “other –destructive” behaviours and there is the concurrent increase in the rates of abuse in all categories.

Background to Problem

Child abuse and neglect affect children and adolescents across the genders.  Surveys give a better sense of the magnitude of the abuse problem in Jamaica, Caribbean wide and in the United States. Between 1993 and 1995, the number of reported abuse and neglect cases in Jamaica was 3500, an increase from 400 in 1984.  This increase may be attributed to more reporting, however, it is necessary to note that physical punishment is a fundamental practice in the majority of Jamaican homes which means that incidents of abuse may be labeled simply as “a good beating” (Brown 1999a).  The most recent federal estimate in the United States of the number of abused and neglected children doubled between 1986 and 1993 from 1.4 million to 2.8 million.  Of the 2.8 million endangered by abuse and neglect, 1.5 million were actually harmed; the remainder were judged to be at risk (Papalia, 1999).  The situation in Jamaica is far more alarming, as the physical abuse of children and adolescents is generally under-reported and under treated (UNICEF and PIOJ, 2000). 
According to the Ministry of Health (2000), only nine young people ages 10 to 24 were seen in a public hospital for “abuse syndromes” in 1998, and only 513 cases of child abuse were reported to the police in 1999.  Ward (2000) found that 10 percent of youth (11 percent of females and 9 percent of males) report having been sexually abused.  Caribbean –wide data Halcon, Beuhring and Blum, (2000) show that 16 percent of in-school Caribbean youth ages 10 to 18 have been abused physically and 10 percent sexually.  A survey by Hope Enterprises (2000) revealed that 24 percent of youth ages 10 –15 years, reported physical abuse by a family member in the past and 6 percent report ever being sexually abused by a family member.
Milburn’s study (cited by Williams 2001) reported that of 2220 cases of child abuse between 1991 and 1995 in Jamaica, it was found that victims are predominantly female and that sexual abuse is the most frequent form of violence.  Over 70 percent of perpetrators are males between the ages of 20 and 49, with a significant number of the perpetrators—25 percent—being under 19 years old.  Of the 1055 persons who sought care for sexual assault in 1999 in accident and emergency departments of public hospitals, just over half (561) were in the 10  to 19 age group, and about 1 out of 7 cases (141) were reported in children between the ages of 5 and 9 years.  Almost all of these cases were females (Ministry of Health, 2000).
Among children confirmed as victims by Child Protection Service agencies in the United States in 1997, more than half were 7 years and younger, and one –quarter were younger than 4 years old.  Approximately 22 percent of victims were children ages 8 to 11; another 25 percent were youth ages 12 to 18.  A greater number of neglect and medical neglect victims were children age 8 or older.  Approximately 53 percent of victims of child abuse were female, and 47 percent were male (Child Abuse and Neglect Fact Sheet, 2004).  Child abuse has become the leading cause of death among young children, at least 2000 are believed to die every year and 140, 000 are seriously injured (Papalia, 1999).
Concurrent with increasing incidences of child abuse in various forms is the growing concern regarding the increasing number of children and adolescents who display conduct problems and sometimes exhibit violent behaviour.  The incidence of juvenile delinquency as measured by the number of children and adolescents brought before the court for indictable offenses increased by approximately 6% from 1,600 in 1985 to 1,700 in 1986. 
Since 1986 however, juvenile delinquency in terms of numbers brought before the courts decreased steadily from 1,700 in 1986 to just over 1,000 in 1988 (a 41% decline).  This represented 2.8% of the under 28 population in 1988 (These figures of delinquency do not include children in need of care and protection, which are non-indictable offences).  The most common offence for which adolescents were brought to the Jamaican courts was “assault and wounding”, where there was an increase of 16 cases (4.1%) to 405 in 1989.  Larceny, the second major cause of adolescents coming before the courts, increased by 36 (1%) to 296 cases in 1989.  The number of murders by juveniles rose from 1 case each in 1987 and 1988 to 6 cases in 1989 (Brown, 1999b).

THEORETICAL EXPLANATIONS

Sigmund Freud presents a theoretical framework that can be applied to explain how children and adolescents react to stressors and the factors that affect their reactions.  These reactions are said to be the function of the individual’s personality and how it has developed.
According to Freud, the personality develops through the individual responding to four major sources of tension: (1) physiological growth processes, (2) frustrations, (3) conflicts and (4) threats.  As these tensions increase the individual has to adjust and readjust until he/she find a method suitable for reducing the tensions.  One such method is for the individual to apply the defence mechanism such as displacement. 
Displacement occurs when the original object choice of the tension (such as a parent) is rendered inaccessible by external or internal barriers (anticathexes) and the individual has to find a new object that is able to give relief for the tension (Hall, 1970).  Displacement may occur simply out of frustration, if a desire cannot be gratified because of an external obstacle, than a more accessible object is exchanged to gain the same gratification (Alexander, 1963).
According to Crittenden & Ainsworth, (1989), exposure to parental violence damages the developmental process whereby children acquire the ability to balance their inner aggression; therefore, the aggressive axis in their personality becomes dominant. Identification with the aggressor enables the physically abused child to be active, threatening rather than passive, and threatened.  Acting based on their experience at home, abused children are likely to approach the environment as a threat; to protect themselves they will anticipate injury by initiating the attack.
Abuse in any form is a stressful experience for a child, as the child develops and the abuse intensifies the child is forced to deal with the tensions associated with the abuse fuelled by anger and frustration.  Recognizing that he/she is not able to reduce his tension by abusing the abuser, the individual is therefore faced with having to find another way to reduce the tension.  To achieve this the individual applies the defense mechanism, displacement, in which the frustration is dealt with by finding a less threatening object to hit, rape or bully or projection and introjection whereby they identify with their abuser and then project their anger towards others or internalize their anger and engage in covert acts of aggression and deceitfulness.  In either case, the result is "other abuse" due to abuse on self by others, hence creating the cycle of violence.
The cycle of violence hypothesis or the notion of an intergenerational transmission of violence holds that abused children become abusers, and victims of violence become violent offenders.  The theory suggests that the type of abuse will affect the severity and chronicity of the behavioural symptoms such that, victims of physical abuse, followed by victims of neglect, are likely to have higher levels of violent behaviour.  This has been attributed to the victims of these types of abuse having a greater need to get back at their abuser, experience control or deal with their frustration (Wisdom, 1989).
An obvious relationship exists as it relates to conduct problems and parenting style, specifically poor parent-child relations. Harsh, lax, or inconsistent discipline has been associated with later conduct problems and in some instances abuse ( Maccoby & Martin, 1983, Baumrind, 1991)  Children need reasonable, consistent discipline to establish boundaries of acceptable and unacceptable behaviour.  Children who are treated harshly may view rough treatment as acceptable, those who are given no guidance may engage in whatever behaviour gets them what they want, and children who receive mixed signals are completely at a loss regarding appropriate behaviour (Belsky & Vondra, 1987; Silverman, Reinherz & Ginconia, 1996).  Adolescents exposed to violence at home may experience some of the same emotions and difficulties as younger school-age children for example; fear, guilt, anxiety, depression, and trouble concentrating in school and ultimately, their exposure to violence may lead them to become violent themselves.  Fagan & Wilkinson (1998) have shown that adolescents exposed to violence are more likely to engage in violent acts, often as pre-emptive strikes in the face of a perceived threat (Singer, Anglin, Song & Lunghofer, 1995).
According to Erickson an individual passes through eight developmental/ psychosocial stages.  Each stage is characterised by different psychological "crisis”, which must be resolved before the individual can move on to the next stage.  If the person copes with a particular crisis in a maladaptive manner, the outcome will be more struggles with that issue later in life.  In order for an individual to pass through the developmental milestones successfully, there needs to be a stable and consistent familial environment, which is often not available to the abused and neglected child. For the abused/neglected child, the absence of this stable and consistent familial environment results in him/her being developmentally arrested.  The nature and severity of conduct behaviours displayed by children and adolescents tend to be influenced by the developmental stage at which the abuse occurs.
Children who are maltreated between age eight and twelve, are likely to have developed into the nurturer of the parents.  Their lives are often ridden with school and behavioural problems and they feel isolated and alienated from their peers.  It is during this age period that sexual abuse usually occurs or intensifies (Tower, 1996).  These school-aged children who experience sexual abuse usually display symptoms of fear, mental illness, hyperactivity and regressive behaviour (Papalia, 1999).  Other symptoms include stealing, running away, starting fires, excessive bathing, being withdrawn and passive, girls pulling up skirts,  sexual inference in school artwork, teaching others how to masturbate,  becoming aggressive toward peers,  succumbing to periods of deep depression, falling grades,  alcohol or drug abuse (National Exchange Club Foundation, 2000).
 During adolescence, there is the quest for control, identity and separation, which is often impeded by abuse and neglect. Abuse during this period often results in the teen developing low self-esteem and poor body image, which often leads them to engage in a variety of self-injurious behaviour such as suicide attempts and display a myriad of behavioural/conduct problems, including substance abuse and illegal activities (Tower, 1996). Other symptoms include, early marriage, running away, pregnancy, substance abuse and getting in trouble with the legal system (National Exchange Club Foundation, 2000).
Not all individuals who are exposed to abuse and neglect demonstrate similar outcomes.   Martin (1976) suggests that five factors affect the effect of abuse and neglect in children: (1) The equipment (personality differences inherent in an individual child) of the child; (2) Neurological damage to the child; (3) Important others in the child’s life; (4) Biological considerations in addition to neurological damage from trauma; and (5) Malevolent environmental factors (Martin, 1976). 
In light of the literature, abused and neglected children and adolescents are generally at “high risk” for social problems due to their conduct problems as well as display higher incidences of developing pathologies in adulthood.  The researcher intends to identify a large sample of substantiated cases of child abuse and neglect through the auspices of the Children’s Home and Places of Safety and investigate the following hypotheses:
1.  Children and Adolescents with a history of abuse are likely to meet the diagnostic criteria for Conduct Disorder, where meeting the criteria is defined as obtaining a Conduct Disorder Quotient of 70 and over.
2.  The type of abuse will affect whether the diagnostic criteria is met for Conduct Disorder.
3.  There are significant differences between the type of abuse and the presentation of conduct disorder symptoms (aggressive conduct vs. hostility vs. deceitfulness/theft vs. rule violations)
4.  Adolescents between ages 16 and older are more likely to present with destructive-overt behaviours than other behaviours.
5.  The gender influences the presentation of the conduct problems such that males will obtain a higher aggressive score than females.

METHODOLOGY

Participants
A representative sample of 70 validated cases of child abuse, 24 males and 46 females was obtained from five (5) Children’s Homes.  Two of the homes were for boys and three were for girls.  The age of the sample ranged from 10 to 19 years and all those in the sample were considered "wards of the state".

Measures

Two primary measures were completed, firstly, the Demographic Questionnaire which collected data regarding the characteristics of the sample, age, gender and type of abuse.  Secondly, Conduct Disorder Scale (CDS), designed to help professionals diagnose Conduct Disorder and is used in the assessment of individuals between ages 5 and 22 who may present with behavioural symptoms that may be features of Conduct Disorder. The CDS is designed so that anyone who had direct, sustained contact with the referred individual could complete it.

Procedures

Quota sampling was the method used to ascertain and collect data about the sample. Informed consent was obtained from the Directors at the various homes.  The Directors supplied the researcher with children and adolescents who met the research criteria (those between 10 and 19 who have been abused, physically, sexually or have been neglected/abandoned).  Cases of physical abuse were considered those children and adolescents on whom an individual “knowingly and wilfully inflicted unnecessarily sever corporal punishment” or “unnecessary physical suffering” on a child.  Cases of physical abuse include such injuries as welts, bruises, burns, abrasions, bone or skull fractures and other evidence of physical injury.  Cases of sexual abuse are considered cases in which there is “assault and battering with intent to gratify sexual desires”, “fondling or touching in an obscene manner,” sodomy, and incest.  Cases of neglect are considered those in which the child was found to have no proper parental care or guardianship or to destitute, abandoned, or living in a physically dangerous environment.
Upon completion of questionnaires, responses were coded and entered into the Statistical Package for the Social Sciences (SPSS) for analysis.

Results

Data analysis revealed that half of the sample met the criteria for Conduct Disorder.  The majority of those who met the criteria were physically abused (65%), followed by those sexually abused (62%).  Only 27 percent of those neglected or abandoned could be considered likely to be diagnosed with Conduct Disorder behaviours.  Significant differences were found regarding type of abuse and presentation of conduct disorder symptoms.  Physically abused children and adolescents featured highly on all the subscales of Conduct Disorder Scale.  Those physically abused displayed more aggressive behaviours than the other abuse types and less than 20 percent of the abandoned or neglected children and adolescents displayed aggressive behaviours.  High rates of hostility and rule violations were identified among those physically abused.  Though those sexually abused rated low on the hostility subscale, 62% were rated high on the rule violations subscale.
In testing the hypothesis of adolescents between ages 16 and older were more likely to present with destructive-overt behaviours than other behaviours, the analysis indicated that only 40% of 16-19 year old presented with destructive overt behaviours.  The severity of conduct problems intensifies between 13 and 15 years.  Gender differences were evident as it relates to aggressive behaviours as females were found to be more aggressive than the males.

DISCUSSION

Childhood abuse has demonstrable long-term consequences for Conduct Disorder and other conduct problems and the results reported here provide significant indications in this regard.  In a direct test of whether children and adolescents who have been abused are likely to meet the diagnostic criteria for Conduct Disorder, the findings indicate that there is a 50% chance that a child will display conduct problems if they are abused, a conclusion supported by Ireland et al (2002), Grilo et. al. (1999) and Brodsky et. al.(2001).  This result is understandable as being abused does not automatically mean that the child will become delinquent or criminal but rather that the abuse makes it more likely (Dodge et. al, 1990; Todd & Gesten, 1999; Green et. al.,1999; Elze, 1999) and this likelihood is dependent on a number of factors such as personality differences inherent in the child, the presence of important others in the child’s life, other biological considerations and malevolent environmental factors (Martin, 1976; Papalia, 1999).
According to the “cycle of violence” hypothesis, individuals who experience physical abuse should show higher levels of aggressive behaviour than those who experienced other forms of abuse (Wisdom, 1989).  In a direct test of this hypothesis, the presentation of Conduct Disorder symptoms was examined as a function of the type of abuse experienced.  The findings were consistent with “the cycle violence” hypothesis; those physically abused, displayed higher levels of aggressive conduct than the other abuse types.   Green (1978) asserts that the aggressiveness displayed by physically abused children and adolescents is an effort by them to deal with feelings of helplessness and anxiety.  Freud would refer to this reaction as the child or adolescent applying the defence mechanisms of introjection, projection or displacement; where by the physically abused child or adolescent identifies with the aggressor, enabling him to become active and threatening, rather than passive and threatened. Approaching the environment as a threat, the physically abused child, to protect himself will either anticipate injury by initiating the attack or project or displaces his anger on those less threatening around him (Crittenden & Ainsworth, 1989; Hall, 1970).  One may find that the anger displayed by physically abused children and adolescent, may also be simply out of frustration, where a desire is not met satisfactorily (Alexander, 1963).  In addition, Helfer (1987) points out that by just being raised in an environment where physical abuse and aggression is a common response to problems, feelings, and conflicts can have the consequence of a child modelling this behaviour. The implication of this is that in response to conflict, abused children will resort to some type of verbal or physical hostility to resolve the problem or to meet their unmet needs.  This explains why 65% of those that experienced physical abuse in the sample were found to have Conduct Disorder.
The “cycle of violence” hypothesis also predicts that children who have experienced neglect (including abandonment) are likely to have higher levels of violent/aggressive behaviours than those who are sexually abused, because like those that are physically abused, neglected children and adolescents, have a greater need “to get back at” their abuser, to experience control or to deal with their frustration (Wisdom, 1989).  The findings however did not support Wisdom’s (1989) claim; as the Chi-square analysis (p=0.00235<0.05) revealed that those who were sexually abused had higher levels of aggressive behaviour (54%) compared to those who were neglected/abandoned (19%). This high level of aggressive behaviour demonstrated by the sexually abused in the sample, may be a reflection of the combined anger that they are said to experience towards the abuser, as well as at those who failed to believe or protect them (Porter, Block & Sgroi, 1983). Swanston et al. (2003) and Haskett et. al. (1991) have identified aggressiveness as a behaviour that is typical among those sexually abused. 
The difference in the reaction of the sexually abused group and those that were neglected/abandoned may lie in the nature of the abuse experience itself.  Whereas the sexually abuse child or adolescent may have physical and mental representations of the abuse, such as scars and memories, those that were neglected/abandoned may not.  Furthermore, if the neglect/abandonment occurred when they were younger, it is likely that at an older age, they will be indifferent to their biological parents or guardians; as they have become accustom to their current existence.  However, if it is that the abuse occurred at an older age, it is likely that they will perceive their current placement as better than what they were experiencing.  This is not to say that neglected/abandoned children and adolescents do not still wish or yearn for a relationship with their biological parents or that they may not be angry at the perpetrator of the abuse, but rather, that they may have less of a need to get need “to get back at” their abuser.
Not only did those physically and sexually abused display more aggressive behaviours than those neglected/abandoned, they demonstrated high levels of hostility and violation of rules.  This may reflect what the DSM IV (1994) refers to as an “overall pattern of repetitive behaviour where the rights of others or the social norms are violated and in which the basic rights of others or major age-appropriate societal norms or rules are violated” which implies that physically and sexually abused children and adolescents are more likely to be diagnosed with Conduct Disorder.
According to Erikson, during adolescence, there is the quest for control, identity and separation. Abuse during this stage of development threatens the adolescent's attempt at self-assertion and independence  (Santrock, 1995).  Failure to achieve these milestones often results in the adolescent presenting with a variety of self-injurious behaviour such as suicide attempts as well as a myriad of overt behavioural/conduct problems, including substance abuse and illegal activities (Tower, 1996).  A direct test of the behavioural presentation of 16-19 year olds to examined whether they display destructive – overt behaviours more than other behaviours.   The findings indicated that 16 -19 year olds did not present with destructive – overt behaviours more than other behaviours.  This may be due to the adolescents becoming more conscious of the consequences of their actions and thus are resorting to more covert behaviours that their guardians not able to identify.  It might also be that they engage in these destructive-overt behaviours in other settings such as school.
Most of the literature that examines gender differences in children and adolescents who have Conduct Disorder, indicate that the long term consequences of child abuse and neglect for females are manifested in subtle ways where as males are said to be more likely to exhibit aggressive overt behaviours such as threatening, vandalism, and confrontational behaviours.  Researchers claim, that abused and neglected/abandoned females are more prone to suffer depression and other psychiatric illnesses rather than direct their aggression "outwardly”.   The findings however, were not observed, as females were found to be more aggressive (81%) than males.  This finding may be because of possible differences between the type of abuse and neglect/abandonment that males and females experience, which in turn may differentially affect their respective presentation.  For example, whereas males are more likely to express their after repeated abuse, females tend to repress their feelings. (DiGiuseppe & Tafrate, 2003).    The difference in the findings may be a function of the females using differing dimensions and forms of anger expression (Smith, Ulch & Cameron, et al., 1989), expressing their feelings openly (Biaggio, 1989) or resorting to confrontation in when interpersonal problems arise, whereas the males tend to withdraw during conflictual interactions (Christensen & Shenk, 1991; Kurdek, 1995).

Conclusion and Recommendations

In conclusion this study has implications for the assessment and treatment of children and adolescents who have experienced abuse.  Though the physically abused in the sample appear to be the ones who are at the highest risk for conduct problems that would warrant a diagnosis of Conduct Disorder.  Those sexually abused and more so those who have been neglected/abandoned should be regarded as being beyond behaviour problems as their symptoms may be significantly different from the other abuse types and may have more adverse consequences (Rohrbeck and Twentyman, 1986).
It is therefore recommended:

  1. Children and adolescents who enter Children’s Homes are assessed for Conduct Disorder after approximately six months, especially if they are between 13 and 15 years.
  2. Where those abused have been found to be likely to have Conduct Disorder, counselling/therapy will require and approach that addresses both working with the child as it relates to his/her current behaviours while bearing in mind that some of the behaviours may be a consequence of the abuse experience.
  3. These children will benefit from a combination of Behavioural Therapy, the address the Conduct Disorder, especially as it relates to controlling their anger and developing new coping skills; and Individual Psychotherapy to help him/her deal with the abuse experience itself.  The researcher believes that the efficacy of the Behavioural Therapy is contingent on the child dealing with the abuse.
  4. The findings suggest that neglected/abandoned children and adolescents do not meet the criteria for Conduct Disorder, however, those working within the context should remain observant of other behaviours that they display.

Three limitations identified in the method used in this study require caution.  First, cases of child abuse and neglect were identified from official cases.  Biases associated with agency records such as underreporting exist.  Although the current findings cannot be generalized to unreported cases of child abuse or cases that are not recorded, it is reasonable to assume that the cases evaluated here, were, on average, more severe than the unreported cases. Second, the study could have been improved with the introduction of a control group matched as closely as possible by age and gender. Third, the strength of the findings could have been improved with a larger sample size.  These limitations can form the basis for the improvement of the methodology for further research.


Click on these links to visit our Journals:
Priory Bookshop | Search for papers and articles  | Psychiatry On-Line 
Dentistry On-Line
 |  Vet On-Line | Chest Medicine On-Line 
GP On-Line | Pharmacy On-Line | Anaesthesia On-Line | Medicine On-Line
Family Medical Practice On-Line


Home • Journals • Search • Rules for Authors • Submit a Paper • Sponsor us  

 

priory.com
Home
Journals
Search
Rules for Authors
Submit a Paper
Sponsor Us

Google Search


Advanced Search

 


 
 

Default text | Increase text size