Almost 30 years ago, Curtis (1963) suggested that abused and neglected children would ''become tomorrow's murderers and perpetrators of other crimes of violence, if they survive" (p. 386). Subsequently, a number of small-scale clinical reports described prior abuse in the family backgrounds of adolescents who attempted or succeeded in killing their parents (Easson and Steinhilber, 1961; King, 1975; Sendi and Blomgren, 1975). Since then, larger and more systematic studies have explored the relationship between child abuse, neglect, and violent behavior in delinquents (Alfaro, 1981; Geller and Ford-Somma, 1984; Gutierres and Reich, 1981; Hartstone and Hansen, 1984; Kratcoski, 1982).
In one study, childhood abuse or neglect significantly increased a child's risk for an arrest during adolescence by more than 50 percent (26 versus 17 percent) (Widom, 1989b).5 Abused and neglected children began their official criminal activity approximately one year earlier than the control subjects (16.5 versus 17.3 years) and had approximately twice the number of arrests. Early childhood victimization was associated with increased risk of arrest as a juvenile (prior to age 18) compared with controls. When considering delinquency, degrees of aggression must be taken into account. Some clinical studies indicate that violent delinquents are more likely to have suffered severe abuse than nonviolent delinquents (Lewis and Shanok, 1977; Lewis et al., 1979, 1982).
Physical aggression and antisocial behavior are among the most consistently documented childhood outcomes of physical child abuse. Most studies document physical aggression and antisocial behavior using parent or staff ratings (Aber et al., 1990; Hoffman-Plotkin and Twentyman, 1984; Perry et al., 1983; Salzinger et al., 1984); other measures, such as child stories (Dean et al., 1986); or observational measures across a wide variety of situations, including summer camps and day care settings (Alessandri, 1991; Bousha and Twentyman, 1984; Howes and Eldredge, 1985; Howes and Espinosa, 1985; Kaufman and Cicchetti, 1989; Main and George, 1985; Trickett and Kuczynski, 1986; Walker et al., 1989). Some studies indicate that physically abused children show higher levels of aggression than other maltreated children (Hoffman-Plotkin and Twentyman, 1984; Kaufman and Cicchetti, 1989) although other studies indicate that neglected children may be more dysfunctional (Rohrbeck and Twentyman, 1986).
Not much is known about the psychosocial status of siblings of abused children. Several studies suggest that the child's experience of witnessing violence toward siblings or parents may be as harmful as the experience of victimization itself (Rosenbaum and O'Leary, 1981). Some studies have suggested that children who see violence in their homes may view such behavior as an appropriate means of resolving conflict and also see violence as an integral part of a close relationship (Groves et al., 1993; Jaffe et al., 1988; Straus, 1992). However, research on the effects of a child's witnessing family violence is contradictory and characterized by methodological flaws. In many studies of the effects of observing family violence, for example, the child subjects are often themselves the victims of physical child abuse.
Linkages between parental behaviors that have emotionally or psychologically destructive consequences on children have not been clearly established. While verbally or symbolically abusive acts designed to terrorize or intimidate a child (such as constant belittling or the destruction of a favorite object or pet) are associated with severe long-term consequences (Vissing et al., 1991), the processes by which children interpret aggressive or neglectful actions are poorly understood. The failure to provide age-appropriate care (such as parental availability and nurturance), cognitive stimulation, or achievement expectations also can have profound psychological impact, especially when such omissions occur during critical child and adolescent developmental periods.
For example, we have little evidence about similarities or differences in gender responses to experiences of early abuse and neglect. In studies of violence and sexuality, research on the nonsterotypic relationship (violence: female and sexuality:male) may yield important insights. Large-scale studies assessing the consequences of child abuse and neglect for boys and girls are necessary to compare outcomes for different types of maltreatment.
Research in the area of childhood victimization has generally not examined interrelationships among problem behaviors and symptoms of dysfunction in other spheres of living. Since childhood victims may be at risk for the development of multiple problem behaviors, an examination of the co-occurrence of problems should provide a fruitful direction for future research.12
In many different studies of various types of maltreatment, researchers have identified a small but significant group who have few or no problems. These "protected" children should be targeted for future study. What protective factors or interventions occur in the lives of the abused or neglected children that appear to lead to more positive outcomes? Studies are needed with sample sizes and diverse cultures large enough to examine multiple outcomes, while simultaneously adjusting for relevant demographic characteristics.
The assessment of consequences for abused and neglected children is complicated by the co-occurrence of other problems (or co-morbidity) in the children and their parents. Certain forms of childhood victimization constitute acute stressors, and child maltreatment often occurs against a background of chronic adversity. The presence or absence of certain characteristics or other adverse events may influence a child's response to childhood victimization, and in some cases the combined effects of two stressors (such as family environment and poor caretaking) may be greater than the sum of the two considered separately. The social context is particularly important, since the effects of abuse or neglect often cannot be separated from other problems confronting families experiencing a variety of problemspoverty, unemployment, stress, alcohol and drug problems, and violence in the community.
Generational studies of child abuse and neglect are needed to help identify the familial or cultural patterns passed on from generation to generation that society defines as abusive. In addition, future research needs to: (1) emphasize family dynamics that serve as protective factors versus those that
It would be especially informative to know how the consequences of abuse differ depending on the developmental stage and cultural environment of the individual. A few studies suggest the promise of an approach that can analyze specific age differences in the expression and nature of outcomes. For example, if victims are assessed as children, the full extent of the consequences may not be manifest. As children grow and develop, new symptoms associated with their abuse may emerge that can be examined in prospective longitudinal studies. Much can be learned from research on the processes by which other forms of parental unavailability and apparent rejection or neglect (resulting from actions such as divorce, death, or chronic injury) have psychological influences on the child.
Recommendation 6-2: The consequences of child abuse and neglect should be examined in a longitudinal developmental framework that examines the timing, duration, severity, and nature of effects over the life course in a variety of cultural environments.