Scope of the problem
The Penn State case serves to remind the public that child abuse
is all too common in the United States. Although estimates vary
greatly depending on the source, the Fourth National Incidence
Study of Child Abuse and Neglect, released in 2010, found that
in 2005–06, one child in 25 in the United States, or 2. 9 million
children, experienced some kind of abuse or neglect. Most
of those children — 77 percent — were neglected. Of the 29
percent of those children who were abused, 57 percent were
physically abused, 36 percent were emotionally abused and 22
percent were sexually abused.
Estimates of the percentage of abused children who will
suffer long-term consequences vary widely. One review of
research on child maltreatment — including physical and sexual
abuse as well as neglect — published in the 2004 “Posttraumatic
Stress Disorder In Children and Adolescents: Handbook,” found
that PTSD rates ranged from 20 percent to 63 percent. In her
studies, psychologist Sheree Toth, PhD, director of the Mt. Hope
Family Center in Rochester, N. Y., and associate professor at
the University of Rochester, finds that as many as 90 percent of
maltreated infants have insecure or disorganized attachment.
“The bright side is that there are evidence-based treatments
that can dramatically improve the prognosis for these kids,”
says Toth. “We’ve shown that with intervention we can greatly
decrease rates of insecure and disorganized attachment.”
Interventions that work
A study published in 2006 in Development and Psychopathology
by Toth and her colleagues showed that before intervention, 90
percent of a group of 137 maltreated infants had disorganized
attachment and only one infant had secure attachment.
Of the 50 infants who subsequently received one of two
evidence-based therapies — infant-parent psychotherapy or a
psychoeducational parenting intervention — 58 percent had
secure attachment a year later. In comparison, only one child
among the 54 who received the standard treatment available in
the community had secure attachment a year later.
Other researchers have shown positive results using
evidence-based treatments to decrease the incidence of PTSD,
depression, aggression and other behavioral problems seen
in abused children. Mannarino, for example, has spent more
than 25 years developing and testing an intervention called
Trauma-Focused Cognitive Behavioral Therapy ( TF-CBT) to
treat children age 3 and older who have post-traumatic stress
symptoms from abuse. In 12 to 16 sessions, children and their
non-offending parents or caregivers learn about the specific
effects trauma can have on emotions and behavior, and develop
skills to manage their emotional distress, including relaxation
techniques and how to use words to express their feelings.
In addition, the therapists help the children construct
a narrative about their experience. “We talk about the idea
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