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It's everyone's job to make sure "I'm alright" Literature Review

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It's everyone's job to make sure "I'm alright" Literature Review

Causes of child abuse and neglect

This chapter looks at the various theories which have been put forward to explain the incidence of child abuse and neglect and considers the characteristics of abusers and victims of child abuse. Corby (2000) has been used extensively throughout the chapter because it is a useful source in terms of providing an overview of the various theories.

(i) Psychological theories

Psychological theories focus on the instinctive and psychological qualities of those who abuse. It is abnormalities within the individual abuser that are responsible for abuse, for example, abusive parents may themselves have been abused in childhood (Corby 2000).

Attachment theory

Attachment theory derives from the work of Bowlby (1951) who carried out studies into the nature and effects of maternal deprivation on young children. He theorised that any significant separation of a child from the mother in the first five years of life could lead to a variety of psychological and social difficulties in later life since proper bonding and attachment to the mother was crucial if a child was to benefit from physical protection and psychological security. Until the mid 1980s attachment theory was not directly applied to the problem of child abuse but poor attachment experiences are now seen to be a cause and a consequence of child abuse (Crittenden and Ainsworth 1989). The theory has been criticised because the focus is almost exclusively on the mother-child relationship and insufficient account is taken of the total dynamics of the family. Neither does the theory adequately explain sexual abuse (Corby 1993; 2000).

Psychodynamic theory

Psychodynamic theory claims that abuse and neglect are associated with maternal deprivation. The primary carer, who has often suffered abuse herself, displays a lack of empathy, sensitive awareness and response to her child (Steele and Pollock, 1974; Steele 1987). There is significant overlap between psychodynamic theory and attachment theory. Although the primary caretaker is not always the mother, the main focus is again on the mother-child relationship, and the mother's psychological make up is key. Psychological treatment focusing on improving the parent's ability to relate to other people is seen to be the solution to the problem. The theory has been criticised because of its neglect of social and environmental factors and its inadequacy in explaining sexual abuse (Corby, 1993; 2000; Finkelhor, 1986).

Learning theory

Learning theory stipulates that behaviour is shaped or learned by the interaction of an individual with his or her environment. Child abuse is, therefore, the result of having learned or experienced dysfunctional child care practices, or not having learned functional child care practices. For example, violent behaviour is learnt from observing aggressive role models, so that adults who have themselves experienced punitive treatment may rely on such methods to discipline their own children. Whilst the theory draws attention to the importance of childhood learning for adult development it has a number of flaws: it fails to take account of the gendered nature of most abuse, particularly sexual abuse and cannot explain why although both boys and girls are equally likely to have been abused, men are disproportionately represented among the abuser population; it can detract from the responsibility of the adult abuser; it does not explain why some people become perpetrators who have not themselves suffered abuse (Corby 1993; 2000; Brougham 1997; Browne, 1995; Deacon and Gocke 1999).

Cognitive approaches

Cognitive approaches merge to a large extent with modern learning theory approaches. The essential feature of cognitive theory is that the way people perceive, order, construct and think about the world is an important key to their behaviour. Lack of parenting skills, to cope with particular stages of their child's development, leads to patterns of child maltreatment. Cognitive theorists point to the value of finding out how parents who have abused children perceive that child's behaviour and intervention must be focused on helping them to perceive their children differently and using techniques to improve self control and self esteem (Corby 1993; 2000; Buchanan 1996).

(ii) Social psychological theories

Social psychological approaches fall between focus on the individual and focus on broader social factors, they focus on the dynamics of the interaction between abuser, child and immediate environment (Corby 2000).

Individual interactionist perspectives

Individual interactionist perspectives stress that behaviour is determined by interactions between people. Interactionists place greater attention on the dynamics of current relationships than on parental background or characteristics and take the child's contribution to situations of abuse much more into account and also that of the spouse or partner. They suggest that a climate of abuse can result from parents lacking skills to cope with difficult behaviour and from certain children continually exposing that inadequacy. A weakness of the theory as of many others is that individuals are seen in isolation from wider social influences and stresses (Corby 1993; 2000; Gardner 1993; Doyle 1996; Goddard 1996; Deacon and Gocke 1999).

Family dysfunction theory

Family dysfunction theory maintains that family dynamics contribute to abuse and that abuse occurs because 'normal' family boundaries, hierarchies and relationships have broken down. Family dysfunction theorists maintain that children are sometimes subject to violence by a parent as a means of 'getting at' the other parent or that a child may be a 'scapegoat', the bad one in the family and the reason for all the family's ills. With regard to physical child abuse family dysfunction theory has not had widespread influence as an explanatory theory but family therapy techniques as a mode of intervention have attracted more attention. Family therapy thinking has had more impact in explaining child sexual abuse. It suggests that child sexual abuse serves the function of keeping together families that would otherwise collapse, a classic scenario is the abuse of a teenage girl by her father who is considered to be seeking emotional and sexual gratification because communication and sexual relations with his wife have broken down (Kempe and Kempe 1978). A problem with family dysfunction theory as with many of the other theories is that it cannot account for abuse outside the family. It has also been criticised by feminist theorists for its lack of attention to power relations within the family (Hall and Lloyd 1992).

Social ecological approaches

Social ecological approaches hypothesise that where environmental conditions are unfavourable to families the incidence of abuse is likely to be higher. Stress as a result of living in environments that are not conducive to psychological health and development is seen to be a major contributory factor to child maltreatment which points to solutions other than focus on the individual, most notably community-based initiatives, to break down isolation and create a sense of belonging and shared problems (Garbarino and Gilliam, 1980). An ecological framework helps contribute to an understanding of why it is that families who are apparently similar in many key aspects can differ in their responses to stress and in their general ability to provide adequate parenting. There are difficulties with proving the validity of this theory, however, not least because of the fact that poorer communities are more likely to come under the close surveillance of public authorities and higher official rates of abuse could be a reflection of this (Corby 1993; 2000; Gardner 1993; Doyle 1996; Goddard 1996; Macdonald 2001; Deacon and Gocke 1999).

(iii) Sociological perspectives

Sociological perspectives emphasise social and political conditions as the most important reason for the existence of child abuse. It is forces in society which are responsible for child abuse, not individual factors. Sociological perspectives do not provide clear indicators for practice in that they look broadly at the conditions that create the climate for child abuse rather than at how this works out in individual cases. They have, therefore, not had a major influence on child protection thinking in Britain except in relation to sexual abuse and gender issues (Corby 2000).

The social cultural perspective

The social cultural perspective suggests there are certain factors within society which may contribute to the occurrence of abuse, for example, a society that endorses the attitude 'spare the rod and spoil the child' sets the scene for a variety of unwanted forms of violence of which physical child abuse is one. From this perspective child abuse is seen as similar to socially approved forms of violence rather than as a separate pathological phenomenon and the implications are that there is a need for change at a broad societal level to the way in which children are treated, in particular there is a need to encourage non-violent means of ensuring pro-social behaviour. The same sort of analysis can be applied to sexual abuse, i.e. because sexual exploitation of women is tolerated in advertising, prostitution, etc., and because children are sexualised in the media, a climate is set whereby sexual abuse results (Gil 1970). The major weakness of the perspective is that it does not explain why some people, living within a culture, abuse while most do not (Corby 1993; 2000).

The social structural perspective

The social structural perspective holds that child abuse is class related. It is the state not the abuser that is responsible for abuse because it sanctions inequality, and low standards of health, housing, education and leisure for the children of the poor (Parton 1985). The approach does justice to the fact that physical child abuse has a close association with deprivation but does not address child sexual abuse or emotional abuse which is generally considered not to be linked to class and poverty. Neither does it adequately explain why most poor people do not abuse their children (Corby 1993; 2000).

The feminist perspective

The feminist perspective has had a huge impact on practice. This perspective sees abuse as an extreme example of institutionalised male power over women and children, i.e. men sexually abuse children as a means of exerting power and control. Feminist commentators have provided a challenge to assumptions which equate abuse with maternal deficiencies, confuse the term 'parent' with mother and lead professionals to ignore male caregivers. With regard to physical abuse, women have been as implicated as men, but feminists argue that given the fact that women are mainly responsible for the care of children, they actually inflict less physical abuse in proportion to the amount of time children spend in their presence. Children spend far less time with their fathers and so they in fact pose a greater risk. Similarly mothers have been implicated in cases of neglect and emotional abuse to a greater extent than fathers because they are expected to be responsible for the care of their children. The role of men in neglect and emotional abuse has been ignored. The fact that a father may spend very little time with his children is not usually defined as neglect (Hall and Lloyd, 1992; Itzin, 2000; Farmer and Owen 2000; Corby 1993; 2000; Doyle 1996; Goddard 1996; Macdonald 2001; Deacon and Gocke 1999; MacLeod and Saraga, 1988; Daniel 1999; O'Hagan 1997; Tanner and Turney 2000).

The children's rights perspective

The children's rights perspective suggests that if children had the same rights in society as adults, rather than being the property of their parents, then they would be less likely to be the object of physical abuse and neglect. For example, we do not consider it proper to smack adults for misbehaving so neither should we smack children (Corby 1993; 2000; Doyle 1996; Goddard 1996). The United Nations Convention on the Rights of the Child recognises that the family has primary responsibility for the care and protection of children but states that there is also a need for legal protection (Buchanan 1996).

(iv) Integrated theories of child abuse

Virtually all researchers point to the dangers of adopting single cause explanations of child abuse. The term 'child abuse' covers a range of behaviours and problems so a search for a single or even a cluster of causes is likely to be in vain. Social work has been criticised for focusing too readily on problems and 'pathology' within individuals and families and not sufficiently taking into consideration the wider context within which individuals and families exist (Parton 1997; Goddard 1996; Corby 1993; Gardner 1993).

Finkelhor (1986) criticised single-factor theories for their inadequacies in explaining the diversity and complexity of child sexual abuse. He proposed an alternative integrated model which attempted to explain how it was that some adults became sexually interested in children and described the process whereby such offences were committed. The model suggests that four preconditions need to be met before abuse occurs:

  • the potential offender needs to have some motivation to abuse the child sexually, e.g. there must be a degree of sexual arousal to a child;
  • the potential offender has to overcome internal inhibitions against acting on that motivation, inhibitions which are built around notions of conscience, morality and fear of the law;
  • the potential offender has to overcome external impediments such as protective adults so that unimpeded access to a child can be achieved, for example, through baby sitting or organising children's activities; and
  • the potential offender has to undermine or overcome the child's possible resistance through sophisticated seduction techniques.

Finkelhor's model has been criticised, however, because it seems to say more about how sexual abuse occurs than why it actually happens (Goddard 1996; Macdonald 2001; Macdonald and Winkley 1999; Deacon and Gocke 1999).

Social interactional models emphasise the importance of viewing child maltreatment in the context of the family, community and wider society rather than emphasising only individual characteristics and stresses. There has been a move away from explaining child abuse as a symptom of an individual disorder or psychological disturbance towards seeing it as an extreme disturbance of childrearing which itself is part of a wider context of other serious problems such as poverty and anti-social behaviour. Interactive models generally build on a probabilistic risk-assessment process assuming that child abuse occurs when multiple risk factors outweigh protective, compensatory factors some of which may be enduring and others transient. Risk does not arise from a single causal factor but a combination of multiple interacting elements located at the individual, family, community and societal levels. The complexity of such an approach cannot be reduced to a checklist of factors which can be used in any clear or categorical sense to identify and predict abuse. The chances of these situational stressors resulting in child abuse and other forms of family violence are mediated by and depend on the interactive relationships within the family and other compensatory factors such as social support. Multi-focus theories of child abuse and neglect suggest that intervention should be focused at every level - at the individual, family, community and society level (Parton 1997; Browne 1995; Macdonald 2001).

Macdonald (2001) states that:

  • a range of factors can play a causal role in child physical abuse;
  • some factors are 'proximal' i.e. operate in the 'here and now' or are of recent origin, whilst others are 'distal' and/or have a more cumulative effect, e.g. early childhood separation;
  • some factors may exert a protective influence and act as 'buffers' against the deleterious effects or adverse events, e.g. a supportive adult partnership or social network; and
  • the dynamic interplay of all factors means that the significance of one set of variables depends, to some extent, on the presence or absence of others.

The people who sent letters to the National Commission of Inquiry into the prevention of child abuse (1996) identified a range of causes of child abuse. The single largest cause identified by respondents involved social/cultural factors, particularly the taboo, stigma and ignorance surrounding child abuse. Other factors mentioned were negative changes in society such as poverty, people not caring, and social pressures and society's attitudes to children. Other respondents felt that abuse was caused by family factors with inadequate parenting, problems in marriage or other relationships and cycles of abuse suggested as causes. A smaller number of respondents felt that sick or evil adults were responsible for causing child abuse.

(v) The characteristics of abusers

It has been suggested that perpetrators of child abuse may have certain characteristics which predispose them to abuse:

History of abuse

One of the most consistent findings in the literature and research is that many parents who abuse their children were themselves maltreated as children. Gibbons et al (Department of Health 1995) found, for example, that one in seven parents under suspicion were known to have been abused as children. In Meadows (1990) study of likely cases of Munchausen's syndrome by proxy, at least 70% of the mothers had had unhappy childhoods and could be considered to have suffered emotional abuse and at least a quarter had suffered physical or sexual abuse as children.

Buchanan (1996) reviewed a range of studies and found that rates of inter-generational child abuse varied from 1% to 100% but most commentators now accept that between 30% and 40% of parents who abuse will go on to abuse their children. This is considerably higher than the 2% to 3% seen in the general population. Some studies have found that high proportions of young sexual abusers have been sexually abused themselves but the percentages of young sexual abusers reporting abuse in childhood varies from 30%-80% (Kelly et al 2000). Watkins and Bentovim (1992) state that current evidence supports the conclusion that the sexual abuse of boys in childhood is an important contributory but not a necessary factor in the development of a perpetrator since the development of a perpetrator may not include an experience of prior personal sexual abuse. There is less evidence for girls but it appears that abuse may be a necessary perpetrator developmental factor.

Boulton and Hindle (2000) found that past events were linked to present emotional abuse. The theme of re-enactment was key in the cases they studied with the parent either threatening the child in a similar way to how they had been treated or attributing in the child characteristics belonging to their own parents.

As an explanation for abuse, generational links are contentious because:

  • most physical abuse studies focus almost entirely on the transmission of violence and abuse through mothers, there is very little research into the characteristics of male adults who physically abuse although men are responsible for at least half of all physical abuse cases;
  • although women experience higher levels of sexual abuse than men, sexual abuse by women is rare; and
  • the majority of abused children do not grow up to be abusing adults and knowledge of the circumstances in which abused parents do not abuse their own children is of as much importance to child protection workers as knowledge of the circumstances in which they do. Various protective factors in childhood such as the availability of other non-abusing carers and early secure attachment have been suggested as key (Gardner 1993; Corby 2000; Brougham 1997).

Social class/economic disadvantage

Some studies have demonstrated that there is a strong correlation between economic disadvantage and harm to children (Department of Health 1995; Baldwin and Caruthers 1998; Corby 2000; Gardner 1993). For example, Gibbons et al (1995) found that 57% of families involved in the child protection system lacked a wage earner and over half (54%) were dependent on Income Support. While there may be more cases of physical abuse or neglect amongst lower social classes, however, the same does not appear to be true of sexual and emotional abuse. Studies have been consistent in failing to find differences in rates of sexual abuse according to social class (Parton 1997). It has also been suggested that all forms of child abuse are a cross class phenomenon and that the higher proportions of lower social class families being suspected of physical abuse and neglect may only reflect the fact that such families are more susceptible to state surveillance. The link between economic disadvantage and child abuse is also contentious because not every parent who is disadvantaged abuses their children (Corby 2000).

Gender

Official child protection figures demonstrate that natural mothers play a negligible part in sexual abuse, are much more frequently implicated as abusers in neglect and emotional abuse cases and are slightly more frequently implicated as abusers than fathers in cases of physical abuse. The figures need further analysis, however: there is some support for the view that fathers, especially stepfathers, are more likely to abuse children seriously, for example, many child death inquiries are known to have been the result of father or male carer abuse (Corby 2000); figures for the perpetration of neglect and physical abuse may highlight the fact that mothers spend more time with their children than fathers and are not more likely to physically abuse or neglect them (this issue has already been discussed in the section on feminist perspectives on neglect) (Turney 2000; Tanner and Turney 2000).

Evidence about the gender of child sexual abuse perpetrators is more clearcut. Research has shown that the vast majority of sexual abusers of children are men (Eldridge 2000; Wyre 2000). Recorded crime rates suggest that sex offending by women is rare: between 50 and 100 women each year are convicted of sexual offences against children in England and Wales, in comparison with more than 5,000 men. Prevalence studies have produced a wide range of figures. Studies of female offenders suggest that:

  • they are more likely to have a history of abuse themselves than male offenders;
  • they are more likely to abuse boys than girls;
  • they are sometimes coerced by men to offend and may co-offend with other women or men; and
  • mental illness, or at least, psychological distress is commonly found in women abusers.

It is likely that levels of sexual abuse by females have been under reported because abuse by women, particularly mothers, has been a difficult issue for the community to contemplate. It is also possible that female-male abuse has sometimes been seen as a normative sexualisation experience or as of no consequence since males have retrospectively rated it as having no effect. Research has as yet failed to come up with a satisfactory explanation of why women are less likely to be the perpetrators of sexual abuse than men (Adshead et al 1994; Corby 2000; Watkins and Bentovim 1992).

Age

Physical abuse and neglect of children has been traditionally associated with young and immature parents but Corby (2000) concludes that the evidence is not strong enough to have much predictive value, even when it is considered in association with other factors indicative of risk. The age of the abuser is not generally considered to be an important issue in sexual abuse, although the abuse of younger children by adolescents has been the focus of much attention by researchers recently. It has been suggested that between a quarter and a third of all alleged sexual abuse involves young (mainly adolescent) perpetrators, and some studies have found that as many as half of all convicted child sexual abusers started to commit sexual offences in adolescence or earlier. Research has also shown that the risk of sexually abused boys abusing other children may be associated with factors in early childhood other than sexual abuse (Skuse et al 2000).

Family structure

Most official reports and surveys concur in their finding that children in lone parent families are more at risk of all forms of abuse and neglect than their counterparts in two parent families including sexual abuse which is perhaps surprising since children living in lone parent families might be expected to be safer from abuse by males (Department of Health 1995; Corby 2000). Finkelhor (1986) suggested that children in lone female headed households might be at greater risk of sexual abuse because they could be exposed to a greater number of male adult figures than those in two parent households. Hamilton and Browne (1999) found that children living in lone parent households were at greater risk of experiencing extra-familial abuse. It may be that there is less oversight or the lone parent is more reliant on extra-familial help and is, therefore, at risk of being targeted by potential abusers.

The statistics tell us nothing, however, about the reasons why levels of all forms of abuse are higher in lone parent families. Economic disadvantage is likely to be an important factor and issues surrounding the control and supervision of children and social isolation may also play a part. Moreover, more recent research has suggested that children in lone parent families are no more at risk of abuse than children in two parent families. Gibbons et al (1995) found, for example, that just over a third (36%) of the children in their sample dealt with under child protection procedures lived in a lone parent family and Egan-Sage and Carpenter (1999) found that less than a third of referred and registered children lived with a lone mother.

In Hamilton and Brown's (1999) study of referrals to police child protection units, children with step-parents were more at risk of experiencing an incident of maltreatment than children living with both biological parents. The child's stepfather or cohabitant of the mother was the perpetrator of the abuse in 11% of child protection referrals but if the rate of maltreatment by a stepfather was calculated as a percentage of stepfathers living in the child's home (18%), the rate of maltreatment by the stepfather, as a percentage of all cases, rose dramatically to 53%. While reconstituted families are over represented in abuse statistics there has been very little research into why this is the case or into the process of abuse in such families. There has been research into the issue of whether blood-tie parents are more likely to abuse their children sexually than non-blood-tie relatives, however, and findings seem to suggest that children are more at risk of being sexually abused by a step-parent or parent substitute than by a natural parent (Corby 2000).

Health

Research has documented high rates of psychiatric disorder in parents of maltreated children, for example, mental illness within the family featured prominently in 13% of child protection cases in the Gibbons et al (1995) study. Research has also demonstrated a significant association between fatal child abuse and mental health problems in caretakers. A study of Part 8 Reviews of child deaths and serious abuse in 1996 found that mental illness (maternal and paternal) was evident in 32 of the 100 cases. There has been no research linking mental illness with sexual abuse. Findings related to mental illness need to be treated with caution since mentally ill parents are over represented among poor, unemployed, socially and economically disadvantaged families and disadvantaged families are those most exposed to the surveillance of the child protection, mental health and other welfare agencies (National Children's Bureau Highlight (undated)).

There has only been a small amount of research into parents with learning difficulties who abuse their children but findings suggest there is evidence of a correlation between learning disability and officially reported child abuse. It is possible, however, that the difference is a result of people with learning difficulties having their child care practices exposed to greater scrutiny than those of other parents (Corby 2000; Cleaver et al 1998; Department of Health 1995; Lewis and Creighton 1999; Reder and Duncan 1999).

Alcohol and drug misuse

Alcohol has been linked with child abuse, particularly with child neglect, and there is growing concern about the association between drug misuse and child abuse. Studies in the US point to as many as half of all families being known to the public welfare system being affected by alcohol or drug misuse. Data available in Britain are patchy although information from Glasgow City's child protection register indicates that in 52% of cases on the register, alcohol and/or problem drug use was the underlying factor leading to registration (Scottish Executive 2001). There has been little empirical research into the connection between sexual abuse and alcohol abuse. More detailed information on the subject is clearly needed with much greater attention being placed on how and in what circumstances children are placed at risk by parental misuse of drugs and alcohol, in order to avoid assuming an automatic linkage between substance misuse and abuse of children (Corby 2000; Reder and Duncan 1999).

Social support

A connection between social isolation and child abuse has been suggested by research, particularly in relation to neglect. There is an assumption that social isolation is a causal factor, but it may be that families isolate themselves to prevent the discovery of abuse or that they become isolated because they are neglecting their children. There is a need for more detailed research into the way in which these variables interact (Corby 2000; Reder et al 1993). Appropriate forms of formal and informal social support may also act as a protective factor against child abuse and neglect (Thompson 1995).

(vi) Characteristics of abused children

While all children are potentially vulnerable to abuse by those adults who care for them because they are dependent on them for physical and emotional protection and care, research has highlighted certain trends:

  • under 1 year olds are more likely to be registered for physical abuse and neglect than those in older age groups, reflecting the concerns created by their particular vulnerability. The pattern is reversed for sexual abuse, with 10 to 15 year olds the age group most likely to be registered under this category;
  • girls and boys are equally likely to be registered for child abuse. Boys are more likely to come to official attention as a result of physical abuse, neglect and emotional abuse than girls and girls are considerably more likely to be represented in official child sexual abuse registrations than boys; and
  • although contentious, there is some evidence to suggest that particular children are singled out for abuse, for example, children who are not wanted, who are considered to be the wrong sex by their parents or who are perceived to be more difficult (Corby 2000; Gardner 1993; Goddard 1996).

All the evidence points to the fact that disabled children are more vulnerable to abuse than their non-disabled counterparts. Research has shown that children and young people with disabilities are at risk of abuse because:

  • they are often more dependent on adults and may be less able to resist abuse, they may be cared for by a number of adults or in a variety of settings where there may also be the potential for abuse by peers;
  • they may depend on adults for intimate care and may have little control in their lives;
  • they may be unable to recognise abusive behaviour because of lack of education and information and because they have reduced exposure to 'normal' child/adult interactions;
  • they may have little opportunity for involvement with adults or other children outside their home or care settings, and consequently may have reduced opportunities to disclose abuse;
  • they may have communication difficulties and be unable to convey their experiences to others or adults may be unable to communicate with them;
  • they may have low self esteem and may not be confident about the outcome of telling someone about the abuse;
  • their parents may experience considerable stress in coming to terms with the disability and in coping with the ongoing care of the child;
  • there is still considerable societal and professional reluctance to accept that disabled children are being abused; and
  • the separation of services to children and families and to people (including children) with a disability may mean there is inadequate knowledge and experience of child protection issues within services for disabled children and inadequate knowledge of disability within child protection services (Westcott and Cross 1996; Doyle 1996; Hobbs and Hobbs 1999; McGowan and Peyton 1995; Marchant and Page 1992; ABCD Consortium 1993).

Evidence has also pointed to a correlation between birth problems and later abuse and neglect. It is suggested that where there are problems at birth, such as prematurity, which result in early separation of the mother and child, there is a potential for poor mother-child relationships, rejection and abuse. Doubts have been raised, however, about the importance attached to immediate post-birth bonding and it has been suggested that other factors could account for the correlation between neonatal difficulties and child abuse:

  • looking after prematurely born and/or low birth-weight children who generally require more attention and care is likely to put carers under extreme stress;
  • it is probable that the majority of the mothers in studies who were experiencing peri-natal difficulties were from poor backgrounds and inadequate material resources for looking after young babies is probably a major factor in contributing to the quality of care that is provided. Much of the research which has been undertaken has been medical-based and has tended to underplay such social concerns; and
  • the focus of studies has been on the mother, more attention needs to be paid to the involvement (or lack of involvement) of fathers in early child care particularly since some studies have suggested that the lack of early bonding between fathers and children could be a contributory factor in the causation of child sexual abuse (Corby 2000).