Child Abuse: Threat or Menace?
By Douglas J. Besharov and Jacob W. Dembosky
This article originally appeared in Slate, October 3, 1996.
With a new government-funded study in hand, Secretary of Health
and Human Services Donna Shalala diagnosed a rising epidemic of child abuse last
month. She reported that "child abuse and neglect nearly doubled in the United
States between 1986 and 1993"--and that was only the beginning of the ugly news.
The number of "serious" cases had quadrupled, and the percentage of cases being
investigated by the authorities had actually declined by 36 percent, trends that
she called "shameful and startling."
Is Shalala right? Is an unheeded child-abuse epidemic raging in
America? Or, as I think is more likely, is the methodology behind the study and
the interpretation of its numbers flawed? And if Shalala overstated the
child-abuse peril, is she undermining public interest in the problem by making
it appear too big and difficult to fix at a reasonable cost?
A Look at the Numbers
The secretary drew her statistics from the National Incidence
Study of Child Abuse and Neglect, which was conducted by Westat Inc., a
consulting firm that conducted similar studies in 1980 and 1986. In the new
study, about 5,600 professionals, a representative sample, were asked by Westat
whether the children they had served appeared to have suffered specified harms
or to be living under specified conditions. Westat then determined if the
reported "harms" and "conditions" met the study's definitions of "abuse" and
"neglect," and generated estimates of incidence.
The odd thing about Shalala's claim that the number of children
abused and neglected doubled from 1.4 million in 1986 to 2.8 million in 1993 is
that no other signs point to such a dramatic increase in child abuse and
neglect. Fatalities arising from child abuse have held roughly steady, ranging
from 1,014 in 1986 to 1,216 in 1993, according to the National Committee to
Prevent Child Abuse.
Of the 1.4 million additional cases reported, almost 80 percent
fall into three suspect categories. (Anywhere from 13 percent to 34 percent of
the 2.8 million children suffered more than one type of abuse or neglect.
Unfortunately, the study did not "unduplicate" these reports. Nevertheless, the
proportions I describe below provide a general picture of what is happening.)
Endangered children account for 55 percent of the increase. These
are cases where the child was not actually harmed by parental abuse or neglect,
but was "in danger of being harmed according to the views of community
professionals or child-protective service agencies" [emphasis added]. (See
Emotional abuse and neglect account for another 15 percent of the
increase. The great majority of emotional-abuse cases, according to the 1986
Westat study, involved "verbal assaults," and more than half of the
emotional-neglect cases involved "the refusal or delay of psychological care."
Educational neglect--the chronic failure to send a child to
school--added another 8 percent to the total of new cases.
All these cases warrant attention, but the explosion of numbers
may be caused by the growing reportorial sensitivity of professionals, that is,
"definitional creep." Professionals who become more sensitive to possible abuse,
or more adept at noticing it, would make more reports to Westat--even if the
actual incidence had not risen. In endangerment cases, at least, the study seems
to accept this explanation.
According to Shalala, the number of "serious" cases increased
between 1986 and 1993 from "about 143,000 to nearly 570,000." Her comments left
the impression that the cases involved life-threatening assaults, but the study
defines "serious" cases as any in which the child suffered "long-term impairment
of physical, mental, or emotional capacities, or required professional treatment
aimed at preventing such long-term impairment." Emotional maltreatment accounted
for fully half of the increase in serious cases. (See Figure 2.)
In cases labeled as serious physical abuse, the reported injury
could be mental or emotional.
Even in these "serious" cases, the study seems affected by
definitional creep. For example, in three categories (sexual abuse, physical
neglect, and emotional neglect), the number of cases described as "moderate"
declined even as the number of "serious" ones increased--strongly suggesting
that cases once viewed as only moderately threatening have now been "upgraded"
to the most dire category.
Shalala's assertion that investigations of child abuse and neglect
cases have dropped by 36 percent deserves closer scrutiny. In producing the
number of uninvestigated cases, the study compared the number of cases
identified by professionals with those known to local agencies. Of the cases not
investigated, 33 percent involved educational neglect. (See Figure 3.)
The main flaw here is that most educational-neglect cases are
handled by the schools; reports are made to protective agencies only when all
Another 30 percent of uninvestigated cases involved emotional
abuse and neglect. But child-protective agencies usually avoid these cases
because they tend to involve subjective judgments, and there is little that a
quasi-law-enforcement agency can do about them.
Definitional creep is clearly at play here, too. Professionals who
are increasingly willing to identify situations as harmful aren't necessarily
ready to equate them with the sort of abuse and neglect they are legally obliged
to report. And even if they did report these instances, child-protective
agencies would still be expected to screen them out.
Does Shalala Believe Her Own Hype?
Probably not. Radical action would be required if Shalala's
figures were even roughly correct. But instead of proposing radical action when
she released the report, she outlined modest steps that had long been planned
Having worked in the field for 30 years, I can testify firsthand
that the problem of child abuse and neglect is real. But however well meant,
exaggerating the severity of abuse endangers children. In the late '80s, for
example, the nation was told that 375,000 drug-exposed babies were born each
year; Washington policy-makers were immobilized by estimates that tens of
billions of dollars were needed to protect these children. In fact, the true
number was closer to 35,000, and a decade later, the government has yet to mount
a meaningful program for the children of addicts.
Overstatement may also obscure genuinely worrisome findings. Some
of the increases in sexual abuse, physical abuse, and physical neglect uncovered
by Westat may well reflect a true deterioration of conditions in disorganized,
poverty-stricken households. But Shalala paid scant attention to this
And to claim recklessly that too few cases are investigated is to
play with fire. Child-protective agencies are already overwhelmed investigating
about 2 million reports a year, two-thirds of which are dismissed as unfounded
or inappropriate. For many in the field, the most pressing need is to discourage
inappropriate reporting--not to blithely call for more.
Figures for specific types of maltreatment exclude endangerment
cases. Percentages total more than 100 because some children counted under more
than one type of abuse.
Percentages total more than 100 because some children counted
under more than one type of abuse.
These exclude cases of endangerment.
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