The Prevalence of Different Kinds of Child Abuse and the Characteristics That Differentiate Abused From Nonabused Male Adolescents

Abstract

Child abuse has proved to be one of the most important social challenges. The present study attempts (a) to determine the prevalence of child abuse in an urban area in Iran and (b) to differentiate abused from non-abused adolescent boys using parental and child characteristics. A survey was conducted to determine the prevalence of different types of child abuse. The prevalence sample comprised 2,100 students selected through a multistage random sampling procedure. Data were collected using the Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory, II (BDI-II), State Trait Anxiety Inventory (STAI), modified Hazan & Shaver Attachment Style Questionnaire (ASQ) and Symptom Check List 90 (SCL-90-R). Descriptive statistics and discriminant function analysis were used to analyze the data. The results showed that 14.85% of the subjects were exposed to child abuse, with emotional abuse being most prevalent (52.09%). Also, it appeared that variables such as parental depression and anxiety and children’s attachment styles, anxiety, and aggression can help discriminate abused boys from their non-abused counterparts.

Keywords

child abuse depression anxiety attachment styles mental health

It is generally assumed that the family, with its intimate and affectionate relationships and emotions, nurtures and supports the physical and emotional growth and actualization of children and teenagers. However, violence within the family is also so common in some parts of the world that the family has also been referred to as the most violent social institution after the police and the army (Straus & Gelles, 1990). Children’s experience of maltreatment and abuse within the family not only threatens their well-being in childhood (Kaplan, Pelcovitz, & Labruna, 1999) but it has also been linked to health problems in adulthood (Thompson, Arias, Basile, & Desai, 2002). Some (e.g., Foster, Forsyth, & Herbert, 1994) have asserted that family violence is the most important social challenge. Although child abuse is by nature for the most part hidden, studies have managed to reveal, though partly, that child abuse is prevalent in the world (Creighton, 2004; Hildyard & Wolfe, 2002).

The World Health Organization (2006) has provided definitions of child abuse and its major types. Child abuse or maltreatment constitutes all forms of physical and emotional ill-treatment, sexual abuse, neglect, and exploitation that result in actual or potential harm to the child’s health, development, or dignity. The major types of child abuse are Physical Abuse, Emotional Abuse, Sexual Abuse, and Neglect. Physical abuse of a child is a single or repeated inflicting of physical injury on a child. This may include hitting, punching, shaking, kicking, beating, burning, or otherwise harming a child. Such injury is considered abuse regardless of whether the caregiver intended to hurt the child. Emotional abuse includes the failure to provide a developmentally appropriate, supportive environment, including the availability of a primary attachment figure, so that the child can develop a stable and full range of emotional and social competencies commensurate with her or his personal potentials and in the context of the society in which the child dwells. Acts include restriction of movement, patterns of belittling, denigrating, scapegoating, threatening, scaring, discriminating, ridiculing, or other nonphysical forms of hostile or rejecting treatment. Child sexual abuse is the involvement of a child in sexual activity that he or she does not fully comprehend, is unable to give informed consent to, or for which the child is not developmentally prepared and cannot give consent, or that violate the laws or social taboos of society. Neglect is the failure to provide for the development of the child in all spheres: health, education, emotional development, nutrition, shelter, and safe living conditions, in the context of resources reasonably available to the family or caretakers and causes or has a high probability of causing harm to the child’s health or physical, mental, spiritual, moral, or social development. This includes the failure to properly supervise and protect children from harm as much as is feasible.

Most parents do not intend to hurt their children, and abuse usually occurs when parents lose their self-control. Mash and Wolf (1999) believe that most of the time the injuries inflicted by parents on children are not deliberate; rather, they occur as an unexpected consequence of a disciplinary action or punishment. In fact, an important factor triggering child abuse in many families is the belief that corporal punishment is an appropriate disciplinary method in child rearing (Straus & Donnelly, 2006).

Several researchers have proposed multifaceted explanatory frameworks to account for the complexity of child physical abuse and neglect. Some of the most prominent etiological theories of child physical abuse and neglect are Belsky’s (1993) ecological model, Cicchetti and Rizley’s (1981) transactional model, Milner’s (1993) social information processing model, and Wolfe’s (1999) transitional model. Although these models vary in many respects, an assumption common across each frame work is that child maltreatment reflects a multisystemic and dynamic interplay of various factors (e.g., distal and proximal, transient and long standing) at multiple levels (e.g., interpersonal, developmental, familial, and sociocultural. (Kolko, 2002). Considering a number of factors, including the characteristics of the individual child and his or her family, and those of the caregiver or perpetrator, these models explore the relationship between individual and contextual factors and consider violence as the product of multiple levels of influence on behavior.

Research has linked certain characteristics of the caregiver, as well as features of the family environment, to child abuse and neglect. Psychological and behavioral characteristics of the caregiver or aspects of the family environment may compromise parenting and lead to child maltreatment (World Health Organization [WHO], 2002). Recently, there has been an attempt to characterize potential abusers (e.g., Guterman, Lee, Lee, Waldfogel, & Rathouz, 2009; Herrenkohl, Tajima, Herrenkohl, & Moylan, 2008; Rodriguez, 2010). Parents more likely to abuse their children physically tend to have low self-esteem, poor control of their impulses, mental health problems, and to display antisocial behavior (Guterman, Lee, Taylor, & Rathouz, 2009; Hien, Cohen, Caldiera, Flom, & Wasserman, 2010; Klevens, Bayon, & Sierra, 2000; Lindell & Svedin, 2001; Sidebotham & Golding, 2001). As an example, some studies show that parents with history of depression and anxiety are more liable to abuse their children (Coohey, 2006; Griest, Forehand, Wells, & McMahon, 1980; Hammen, Rudolph, Weisz, Rao, & Burge, 1999; Pittman & Buckley, 2006). Brody and Forehand (1986) reported similar results from their study and concluded that child abuse is associated with mental problems in parents. Fergusson, Lynskey, and Horwoodd (1993) examined physically abusive mothers and found them to be more depressed than nonabusive mothers and to evaluate their children’s behaviors negatively. Abusive parents may also have unrealistic expectations about child development showing greater irritation and annoyance in response to their children’s moods and behavior, and being less supportive, affectionate, playful, and responsive, and more controlling and hostile to their children (Bardi & Borgognini-Tari, 2001; Klevens et al., 2000). Furthermore, childhood history of abuse in parents (Ertem, Leventhal, & Dobbs, 2000), domestic violence (Hunter, Jain, Sadowski, & Sanhueza, 2000; Madu et al., 2000), poverty (Bagley & Mallick, 2000; Hadi, 2000), and household overcrowding (Dubowitz & Black, 2001; Isaranurug, Nitirat, Chauytong, & Wongarsa, 2001; Kim et al., 2000) have also been linked to child abuse.

On the other hand, certain characteristics in children may make them vulnerable to abuse by their parents. Younger children are at greater risk for fatal and nonfatal physical abuse. Fatal cases of physical abuse are found largely among young infants (Adinkrah, 2000; Kotch, Chalmers, Fanslow, Marshall, & Langley, 1993) the majority of victims being less than 2 years of age (Menick, 2000). Sexual abuse rates, on the other hand, tend to rise with the onset of puberty, though the average ages for such abuse vary from country to country (Madu & Peltzer, 2000; Modelli, Galvão, & Pratesi, 2011; Olsson et al., 2000). Vulnerability to abuse also depends on the sex of the child. In most countries, girls are at higher risk than boys for infanticide, nutritional neglect, and forced prostitution (WHO, 2002). Findings from several international studies show rates of sexual abuse to be 1.5 to 3 times higher among girls than boys (Finkelhor, 1994; Laaksonen et al., 2011; Maikovich-Fong & Jafee, 2010; Pereda, Guilera, Forns, & Gomez-Benito, 2009). On the other hand, as regards harsh physical punishment, male children appear to be at greater risk in many countries (Hadi, 2000; Hunter et al., 2000; Shumba, 2001). Mental health problems in childhood and adolescence appear to represent important risk factors for increased victimization. In one study, Turner, Fnkelhor, and Ormrod (2010) found that children with high levels of co-occurring internalizing and externalizing symptoms were particularly likely to experience increased exposure to several forms of victimization, including peer victimization, maltreatment, and sexual victimization, controlling for earlier victimization and adversity.

The experience of maltreatment has frequently been linked to a range of attachment-related difficulties, including insecure bonding with caregivers, problems with emotional regulation, and negativistic views of self and others. More specifically, physically abused youth have been found to display avoidant attachment styles, while neglect has often been linked to the development of anxious or ambivalent patterns of attachment (Finzi, Ram, Har-Even, Shnit, & Weizman, 2001). For maltreated children who lack attachment security internal representations of self and others appear to be negativistic and include perceptions of maternal figures as untrustworthy (Toth, Cicchetti, Macfie, & Emde, 1997). Neglected children, in particular, may have difficulty viewing themselves in positive terms (Toth et al., 1997). Of relevance to personality adjustment is the possibility that negative representational models may endure and be generalized to encounters with other individuals, thereby impacting lifelong interpersonal adjustment (Lynch & Cicchetti, 1992; Toth & Cicchetti, 1996). The absence of a secure base of attachment results in maltreated children lagging behind peers in their cognitive and social development (Sroufe, Carlson, Levy, & Egeland, 1999), which may set the stage for later psychopathology and personality difficulties.

Another attachment-related concern is that of emotional regulation, or the ability to effectively manage and control the expression of intense emotional experiences, particularly those that are negative. In the case of child maltreatment, the development of emotional regulation may often be disrupted. Parental socialization of emotional regulation in children has been shown to mediate between maltreatment experiences and children’s management of their emotional expressions (Shipman & Zeman, 2001).

Although many children who are abused grow up to be productive members of society, child maltreatment contributes to a broad range of adverse physical and mental health outcomes that are costly, both to the child and to society, over the course of a victim’s life. These include violent victimization and the perpetration of violence, depression, smoking, obesity, high-risk sexual behaviors, unintended pregnancy, and alcohol and drug use (WHO, 2006). Maltreatment can significantly alter the child’s initial course of development and result in very diverse outcomes such as eating, mood or conduct disorders, illustrating the concept of multifinality. Child neglect has been hypothesized to be a risk factor for both obesity and underweight in early childhood. In one study, neglect chronicity did predict lower BMIs but only at ages 8 and 9 years suggesting that neglect may be related to children’s weight only in specific contexts (Bennett, Sullivan, Thompson, & Lewis, 2010). Neglected children may also be at increased risk for depressive symptoms mediated by shame-proneness (Bennett, Sullivan, & Lewis, 2010). Children who are abused display more maladaptive behaviors and various kinds of psychopathology (Higgins & McCabe, 2000; Margolin, 2000; Egeland & Sroufe, 1981).

One study revealed that neglected children are more aggressive, anxious, and withdrawn compared to nonneglected children (Hildyard & Wolfe, 2002). In Harter and Taylor’s (2000) study, individuals who had already experienced different kinds of child abuse were found to show paranoid and psychotic symptoms. Physically and sexually abused children also showed symptoms of obsession, anxiety, and somatization. Moreover, Brown (2000) studied 776 people and found that the adults and teenagers who were abused as children were three times more likely to be depressed than others who had not experienced such abuse. Paolucci (2000), too, reported that depression, anxiety, and other internalizing problems were as prevalent as externalizing problems such as conduct disorders and aggression in individuals who were abused in childhood. Abused and neglected children experience large and enduring economic consequences in the form of lower levels of education, employment, earnings, and fewer assets as adults (Currie & Widom, 2010). Child abuse and neglect also create financial costs: direct costs associated with treatment and care of victims as well as a range of indirect costs related to lost productivity, disability, decreased quality of life, and premature death (WHO, 2006).

To reduce the incidence and deleterious outcomes of child abuse for children in both the short and longer term, early identification and intervention with children who are experiencing maltreatment are necessary (Devaney & Spratt, 2009). Improving parenting practices and providing family support by informing parents about the optimal ways of interacting with children and the likely outcome of abuse and inattention are important.

The main purpose in conducting this study was to examine whether similar risk factors for child abuse as those reported in the literature for other cultures will also be found in the Iranian culture. The intent of the present study was to determine the prevalence of child abuse in a large sample of school-going boys and to differentiate between abused and nonabused boys on the basis of parental depression and anxiety and the children’s attachment styles. We hypothesize that abusive parents will report more depression and anxiety than nonabusive parents, abused boys will report more insecure attachment and psychopathology than nonabused boys, and that parental and child correlates of maltreatment will help discriminate abused boys from their nonabused counterparts.

Method

Participants

The initial study sample pool comprised 2,100 male students aged 12 to 14 years who were selected through random multistage sampling method. All students were selected from schools. Taking into account the number of boy schools in each educational district as well as the proportion of school children from each district, the number of boys to be selected from each school was computed and then selected using a cluster sampling procedure. As schools from upper, middle, and lower socioeconomic areas were selected proportionately; the sample consisted of boys from all socioeconomic strata. The mean age of the sample was 13.24 years (SD = 1.06).

After determination of the prevalence of child abuse, a purposive sample of 1,263 students reporting either no abuse or high abuse were selected for comparison on the study variables, which entailed administering certain questionnaires to their parents . Out of these, 893 students had both their parents turn in the questionnaires. Therefore, the final analysis was done on data obtained from 893 students and their parents. The mean age of this sample of students was 13.47 years. The mean age of the fathers and mothers were 47.61 years and 39.22 years, respectively; 21.94% of the fathers and 17.91% of the mothers had some university education; 48.04% of the fathers and 44.45% of the mothers had completed high school; and the remaining 30.02% of the fathers and 37.64% of the mothers had not completed high school.

Procedure

In this first stage of the study, all 2,100 boys were administered the Childhood Trauma Questionnaire. To determine the prevalence of child abuse, the frequency and percentage of different kinds of abuse were computed. Next, those with high abuse scores, that is, those reporting severe to extreme abuse (n = 312) and those reporting no abuse (n = 951) were selected and the attachment scale and symptom checklist were administered to these 1,263 children and the depression and anxiety scales were sent home to their parents. A written consent was obtained from the parents and children. Out of the 312 “abused” children 209 (67%), and out of the 951 “nonabused” children 684 (72%) returned the parental scales filled by both parents. As single-parent homes are rather rare in Iran, only data pertaining to the majority of the children, who live with both parents, were analyzed. In addition, data pertaining to students who had only one parent return the parent measures were excluded from the analyses.

Measures

Measures Completed by Children

Childhood Trauma Questionnaire (CTQ)

The Childhood Trauma Questionnaire is a standardized, retrospective 28-item self-report inventory that measures the severity of different types of childhood trauma, producing five clinical subscales each comprised of five items: Emotional Abuse, Physical Abuse, Sexual Abuse, Emotional Neglect, Physical Neglect (Bernstein & Fink, 1998). The measure also includes a three-item Minimization/Denial scale indicating the potential underreporting of maltreatment. Participants respond to each item in the context of “when you were growing up” and answer according to a 5-point Likert-type scale ranging from 1 (never) to 5 (very often), producing scores of 5 to 25 for each trauma subscale. The three items comprising the Minimization/Denial scale are dichotomized (never = 0, all other responses = 1) and summed; a total of one (1) or greater “suggests the possible underreporting of maltreatment (false negatives).” The CTQ has proven to be very stable over time with a test-retest reliability of 0.88 and internal consistency ranging from 0.80 to 0.97. Since sexual abuse is a taboo topic in Iran, most reports on it are anecdotal and open discussion of it with children is not acceptable. Therefore, due to cultural constraints, the items pertaining to sexual abuse were not administered. Only items pertaining to Emotional Abuse, Physical Abuse, Emotional Neglect, and Physical Neglect were used. Based on the responses of the children the severity of each type of abuse was determined as none if scores on that particular subscale was ≤ 5, slight if scores ranged from 6 to 10, moderate if scores ranged from 11 to 15, severe if scores ranged from 16 to 20 and extreme if scores ranged from 21 to 25.

The Modified Attachment Questionnaire (The Adult Attachment Questtionnaire [AAQ])

A modified version of the Adult Attachment Questionnaire was used to classify the children into the three attachment styles identified by Ainsworth (Hazan & Shaver, 1990). In this version the phrase “best friend” was substituted in place of “partner,” which features in the adult measure. The questionnaire consisted of three sets of statements, each set of statements describing an attachment style: secure, avoidant, and anxious-ambivalent. Essential characteristics of the paragraphs are

Secure: Trust, friendship, other positive aspects or relationships

Avoidant: Acute fear of intimacy

Anxious-Ambivalent: Peoccupation with intimacy and friendship and a desire for overinvolvement

The descriptions (without the titles) were presented to the subjects and they were asked to use a 7-point Likert-type scale (1 = strongly disagree to 7 = strongly disagree) to rate how well each set of statements described their feelings. Satisfactory psychometric properties have been reported for this instrument. In the present study test-retest reliability of .87 was obtained.

Revised Scale of Symptoms Checklist 90 (SCL 90-R)

The SCL-90-R is used as a screening measure of general psychiatric symptomatology (Buckelew, Burk, Brownelee-Duffeck, Frank, & DeGood, 1988). It includes dimensions measuring somatization, obsessive-compulsive, depression, anxiety, phobic anxiety, hostility, interpersonal sensitivity, paranoid ideation, and psychoticism. Individuals are asked to rate the severity of their experiences with each symptom over the past week on a 5-point scale ranging from 0 (not at all) to 4 (extremely). Holi (2003) found the reliability of this test to be satisfactory and reported its test-retest correlations ranging from 0.78 to 0.90 after 1 week and from 0.64 to 0.80 after 10 weeks. The internal consistency (Cronbach α ) of the test has been found to be 0.79 in this study and 2-week test-retest correlations (n = 50) was found to be 0.88 in this study.

Measures Completed by Parents

Beck Depression Inventory, II (BDI-II)

The Beck Depression Inventory Second Edition (BDI-II) is a 21-item self-report instrument intended to assess the existence and severity of symptoms of depression. Items indicate increases or decreases in sleep and appetite, agitation, concentration difficulty and loss of energy. When presented with the BDI-II, the individual is asked to consider each statement as it relates to the way they have felt for the past 2 weeks, to more accurately correspond to the DSM-IV criteria. Each of the 21 items corresponding to a symptom of depression is summed to give a single score for the BDI-II. There is a 4-point scale for each item ranging from 0 to 3. On two items (16 and 18) there are seven options to indicate either an increase or decrease of appetite and sleep. Cut score guidelines for the BDI-II are given with the recommendation that thresholds be adjusted based on the characteristics of the sample, and the purpose for use of the BDI-II. Total score of 0 to 13 is considered minimal range, 14 to 19 is mild, 20 to 28 is moderate, and 29 to 63 is severe. The scale has shown to possess clinical sensitivity and good reliability (Coefficient α = .92).

State Trait Anxiety Inventory (STAI)

The STAI is a self-report instrument that differentiates between the temporary condition of state anxiety and the longstanding quality of trait anxiety (Spielberger, Gorssuch, Lushene, Vagg, & Jacobs, 1983). The instrument consists of two scales containing 20 items each with a range of four possible responses (1 = not at all, 4 = very much so). One scale addresses state anxiety and the other scale addresses trait anxiety. The range of scores is 20 to 80, with higher scores indicating greater anxiety. Test-retest reliability coefficients for the Trait-anxiety scale ranged from .65 to .86, whereas the range for the State-anxiety scale was from .16 to .62.

Results

As appears in Table 1, 45.28 % (951) of the children reported none to slight abuse and 14.85% (312) of the children reported severe to extreme abuse.

Table 1.

The Frequency and Percentage of Different Kinds of Child Abuse

	Minimal		Slight		Moderate		Severe		Extreme		Total Number
Child Abuse Type	F	%	F	%	F	%	F	%	F	%	F	%
Emotional abuse	188	8.95	453	21.57	365	17.38	877	41.76	217	10.33	2100	100
Physical abuse	1299	61.85	471	22.43	265	12.62	55	2.62	10	0.48	2100	100
Emotional neglect	738	35.14	659	31.38	512	24.38	156	7.43	35	1.66	2100	100
Physical neglect	1582	75.33	293	13.95	153	7.25	69	3.28	3	0.14	2100	100
Total child-abuse	951	45.28	469	22.33	368	17.52	269	12.80	43	2.05	2100	100

Table 2 below summarizes the results of BDI-II, STAI, ASQ (modified), and SCL-90-R tests administered to 893 students (209 abused and 684 nonabused). As observed in Table 2, the average scores of the abused students are higher than those of nonabused students on all variables (except for secure attachment style). The associations between the predictor variables and the types of abuse are displayed in Table 3. As can be seen, emotional abuse and neglect appear to be associated with most of the parental and child variables studied.

Table 2.

The Mean and the Standard Deviation of the Two Groups in Predictor Variables

	Abused Group (n = 209)		Nonabused Group(n = 684)
Predictor Variables	Mean	SD	Mean	SD	t
BDI-II
Father’s depression	20.89	5.80	12.36	4.94	20.94**
Mother’s depression	17.23	5.47	13.51	4.92	9.31**
STAI
Father’s state anxiety	53.87	15.95	42.26	16.84	8.83**
Mother’s state anxiety	56.52	16.73	40.26	15.02	13.33**
Father’s trait anxiety	51.48	12.14	39.85	15.94	9.72**
Mother’s trait anxiety	55.75	15.58	41.47	14.24	12.40**
ASQ (modified)
Secure attachment	3.78	1.41	5.13	1.47	11.73**
Anxious-ambivalent attachment	4.12	2.03	3.40	2.42	3.90**
Avoidant attachment	5.01	1.72	3.18	3.01	8.37**
SCL-90-R
Somatization	.61	.90	.60	.98	0.13
Obsessive-compulsive disorder	.71	1.11	.58	.68	1.10
Interpersonal sensitivity	.56	1.84	.52	1.09	0.39
Depression	.65	1.75	.60	1.23	0.46
Anxiety	.89	1.21	.65	1.05	2.79**
Aggression	.79	1.04	.62	1.06	2.04*
Phobia	.76	.98	.58	1.26	1.89
Paranoid ideation	.56	1.82	.52	1.13	0.38
Psychotism	.55	.85	.53	1.06	0.25

Table 3.

The Correlations Between the Predictor Variables and Types of Abuse

	Emotional Abuse	Physical Abuse	Emotional Neglect	Physical Neglect
BDI-II
Father’s depression	.11**	.06	.09*	.04
Mother’s depression	.13**	.07*	.12**	.06
STAI
Father’s state anxiety	.17**	.15**	.18**	.02
Mother’s state anxiety	.12**	.09*	.17**	.02
Father’s trait anxiety	.18**	.05	.06	.04
Mother’s trait anxiety	.15**	.07	.05	.06
ASQ (modified)
Secure attachment	.02	.01	.03	.03
Anxious-ambivalent attachment	.12**	.07*	.19**	.02
Avoidant attachment	.14**	.12**	.18**	.01
SCL-90-R
Somatization	.05	.06	.06	.04
Obsessive-compulsive disorder	.01	.04	.08	.02
Interpersonal sensitivity	.04	.04	.02	.04
Depression	.05	.07	.05	.03
Anxiety	.19**	.21**	.17**	.05
Aggression	.17**	.18**	.12**	.19**
Phobia	.06	.04	.01	.03
Paranoid ideation	.01	.02	.02	.03
Psychotism	.02	.01	.02	.02

p < .05. **p < .01.

Discriminant analysis was performed to determine the variables that best discriminate the abused group from the nonabused group. As shown in Table 4, both the simultaneous (all 18 variables analyzed) and stepwise (only 10 variables) approaches demonstrated that the resulting discriminant functions have appropriate power (i.e., low Wilks’s Lambda and high χ²) to discriminate between the two groups of abused and nonabused boys. Note that 8 variables were eliminated in Stepwise Discriminant Analysis as their contribution to the prediction of group membership was insignificant.

Table 4.

The Summary of Common Discriminant Function Findings Through Simultaneous (18 Predictor Variables) and Stepwise Methods (10 Predictor Variables)

Information About Discriminant Function	Enter Method	Stepwise Method
Number of functions	1	1
Wilks Lambda	0.327	0.332
Chi square	426.586	418.112
df	18	10
Sig. discriminant function	0.001	0.001
Group membership prediction	73.8%	71.5%

As revealed in Table 3, the group membership predictive power of 18 variables calculated through the simultaneous method is 73.8%, while that of 10 variables through the Stepwise method is 71.5%.

The 9 discriminating variables appear in Table 5. As the table indicates, maternal and paternal depression and anxiety, avoidant and anxious attachment styles, anxiety, and aggression symptoms in children were found to play a significant role in predicting group membership.

Table 5.

The Summary of Stepwise Analysis Findings (10 Predictor Variables)

						Exact F
Step	Entered	Wilks’s Lambda	df: 1	df: 2	df: 3	Statistic	Sig.
1	Mother’s depression	0.625	1	1	398	294.321	0.001
2	Father’s state anxiety	0.532	2	1	398	168.110	0.001
3	Mother’s state anxiety	0.469	3	1	398	143.323	0.001
4	Child’s anxiety	0.421	4	1	398	127.818	0.001
5	Child’s avoidant attachment	0.399	5	1	398	121.356	0.001
6	Child’s aggression	0.364	6	1	398	108.114	0.001
8	Child’s anxious-ambivalent attachment	0.312	8	1	398	95.832	0.001
9	Father’s depression	0.311	9	1	398	94.554	0.001

Discussion

This study set out to identify the most prevalent kinds of child abuse and their potential correlates that can help discriminate abused children from nonabused ones. According to the findings, emotional abuse appears to be most prevalent (52.09%) followed by emotional neglect (9.09%), physical neglect (3.42%), and physical abuse (3.1%). On the whole, 14.85% of the participants were subject to severe to extreme abuse. The finding that emotional abuse is more prevalent than physical abuse is not consistent with USDHHS¹ reports (2003), while it conforms to the findings reported in Creigton (2004). A likely reason for this discrepancy is that the USDHHS reports data for official reports of abuse, while the current study presents data based on self-reports. In a recent study, Euser, van IJzendoorn, Prinzie, & Bakermans-Kranenburg (2010), reported neglect as the most prevalent type of child abuse (56% of all cases) and sexual abuse as the least (4%), and these authors pointed to very low parental education and unemployment as the major risk factors. These findings contrast with those of the present study. Apart from sample and methodological differences, sociocultural factors may have contributed to this difference. As noted by Zhai and Gao (2009) regarding Asian American families, family harmony and reputation, and indulgence to children is emphasized in Iranian culture too. Therefore, the finding of low rates of neglect is reasonable. Another possibility is that admitting to the use of emotional forms of disciplinary measures may be less embarrassing and may have prohibited the disclosure of other forms of maltreatment such as physical abuse or neglect. A third possible explanation for the high rates of emotional abuse reported by the present study might be indicative of the very general and inclusive operational definition of emotional abuse used in this study, which assessed nearly ubiquitous emotionally aggressive parenting acts such as yelling and calling the child stupid or lazy as instances of emotional abuse, thereby classifying the majority of children as having experienced emotional abuse. Whether the low rate of physical abuse revealed in this study reflect changing public attitudes regarding physical punishment is not known.

The factors with potential to predict these types of abuse can be classified into three groups of parental depression and anxiety, children’s attachment styles, and finally children’s mental health indices. More specifically, within the first group depression and state anxiety in both parents, within the second group children’s avoidant and anxious-ambivalent attachment styles, and finally within the third group children’s anxiety and aggression appeared to play a significant role.

The greater the depression and anxiety of parents, the more likely is child abuse. The results are in keeping with previous studies (Baierd, 1988; Ferguson et al., 1993; Coohey; 2006; Shay & Knutson, 2008), which endorsed the association between parental psychological health and child abuse. Anger is the likely mediator in the link between parental depression and distress and child abuse. Parents who suffer from psychological problems are often less tolerant and less flexible when faced with problems and challenges in parenting. They often lack the skills for coping with anger, stress, and child management as well as the ability to control their negative reactions and thoughts (Miller & Perrin, 1997). Depressed mothers are often passive and incapable of positive interactions with their children. These mothers often have poor self-esteem and perceive themselves as incapable of solving their own life problems. If coupled with marital discord and conflicts, parental distress can lower the threshold of their tolerance, impairing their role functioning as parents/mothers and making them resort to child abuse at the slightest provocation. The finding that parental state anxiety contributes to child abuse implies that anger and irritability may be involved.

Moreover, depression and anxiety can lead to some deficits in social and professional relationships, and thereby a reduced feeling of satisfaction. Many abusive parents are socially secluded (Kotch, Muller, & Blakely, 1999). Parental loneliness and isolation leads to a lack of social support. Families with social support receive assistance in performing their parenting functions and are, therefore, less likely to engage in abusive behaviors. Social isolation and limited interactions with neighbors, friends, and acquaintances is gaining ground in contemporary societies and is the case with the Iranian society too. The fact that trait anxiety in the parents failed to discriminate between abused and nonabused boys follows from the fact that these parental variables only correlated with emotional abuse. The lack of association between these variables and the other forms of abuse may have contributed to these variables not having sufficient potential to predict total abuse and, therefore, to discriminate between the abused and nonabused boys.

Child variables were found to be the third group of correlates, and in the present study, the attachment styles and certain indices of the mental health of children have emerged as significant predictors of child abuse. This finding is interesting as most previous studies have primarily focused on the demographic attributes of parents and society and not on children’s psychological attributes as predictors of child abuse.

Child variables found to be associated with child maltreatment included anxiety, aggression, and avoidant and anxious-avoidant attachment styles. This finding is in line with those of Hildyard and Wolfe (2002), Ireland, Smith, and Thornberry (2002), Margolin (2000) and Showers, Zeigler-Hill, and Limke (2006). In a recent study, maltreated preschoolers had lower rates of secure attachment and higher rates of disorganized attachment than did nonmaltreated preschoolers (Stronach et al., 2011). Anxious, depressed, maladjusted, and avoidant children are likely to aggravate feelings of anger and hopelessness in parents which, in turn, could trigger instances of child abuse. Such children are also likely to display disruptive behaviors at school and to be underachievers incapable of adjusting to peers, the school environment, and the needs of education and learning. All these may predispose them to be abused by parents. Alternatively, abused children may have had access to weak role models of socioemotional interactions and thus secure attachment may have failed to develop, disrupting the development of emotion regulation, mediating between maltreatment experiences, and children’s management of their emotional experiences (Shipman & Zehman, 2001).

Taken together, the findings of this study show that insecure attachment styles, anxiety, and aggressive tendencies in children on one hand, and parental depression and state anxiety on the other, account for the differences between boys who are abused and those who are not. Consistent with Wolfe’s (1999) assumption, maltreating behaviors probably develop in a graduated, stepwise manner, with relatively benign parent–child interactions becoming increasingly maladaptive. As parents try to socialize the child, the child’s temperament and life’s stresses challenge the parents’ skills at parenting, making insecure bonding as well as cognitive distortions a possibility. It is likely that when insecurely attached boys with negative internal representations of the self and others and impaired emotion regulation interact with parents having cognitive distortions and biases (Milner, 1993) coupled with reduced tolerance for stress and disinhibition of aggression (Wolfe, 1999), the expression of intense negative emotions follow, which manifests as emotional abuse in the case of parents and as anxiety and behavior problems in the children. As a result, a vicious cycle is created. Mental health problems in childhood and adolescence appear to represent important risk factors for increased victimization including maltreatment (Turner et al., 2010) and child abuse further exacerbates the child’s problems. The other indices of child mental health did not correlate significantly with any type of abuse experienced by the children, leading on to their not emerging as significant discriminating variables. It is likely that the prevalence of those mental health indices in the nonclinical sample studied was too low and, therefore, not significant enough to contribute to discriminating the abused boys from their nonabused counterparts.

The strength of this study is that it is probably the first large study on child abuse in Iran to be published internationally. However, the study is limited in that only data pertaining to middle school boys were obtained. Therefore, the findings cannot be generalized to all children. Furthermore, the age of the child, as well as educational and employment status of parents may have had an impact on child abuse. These variables were not controlled for. It is suggested that future research use more nuanced definitions of abuse based on actual parent–child interactions.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was financially supported by the University of Mohaghegh Ardabili, Ardabil, Iran.

Notes

Bios

Niloofar Mikaeili is an assistant professor and practicing clinician. Her research interests include child psychopathology.

Usha Barahmand is an associate professor in Clinical Psychology as well as a practicing psychologist. Her research interests include child and adult psychopathology.

Reza Abdi is an assistant professor in English. His research focus is on discourse analysis.

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