Eveline M. Euser

A Global Perspective on Child Sexual Abuse: Meta-Analysis of Prevalence Around the World

Our comprehensive meta-analysis combined prevalence figures of childhood sexual abuse (CSA) reported in 217 publications published between 1980 and 2008, including 331 independent samples with a total of 9,911,748 participants. The overall estimated CSA prevalence was 127/1000 in self-report studies and 4/1000 in informant studies. Self-reported CSA was more common among female (180/1000) than among male participants (76/1000). Lowest rates for both girls (113/1000) and boys (41/1000) were found in Asia, and highest rates were found for girls in Australia (215/1000) and for boys in Africa (193/1000). The results of our meta-analysis confirm that CSA is a global problem of considerable extent, but also show that methodological issues drastically influence the self-reported prevalence of CSA.

Attachment security and disorganization in maltreating and high-risk families: A series of meta-analyses

The current meta-analytic study examined the differential impact of maltreatment and various socioeconomic risks on attachment security and disorganization. Fifty-five studies with 4,792 children were traced, yielding 59 samples with nonmaltreated high-risk children (n = 4,336) and 10 samples with maltreated children (n = 456). We tested whether proportions of secure versus insecure (avoidant, resistant, and disorganized) and organized versus disorganized attachments varied as a function of risks. Results showed that children living under high-risk conditions (including maltreatment studies) showed fewer secure (d = 0.67) and more disorganized (d = 0.77) attachments than children living in low-risk families. Large effects sizes were found for the set of maltreatment studies: maltreated children were less secure (d = 2.10) and more disorganized (d = 2.19) than other high-risk children (d = 0.48 and d = 0.48, respectively). However, children exposed to five socioeconomic risks (k = 8 studies, d = 1.20) were not significantly less likely to be disorganized than maltreated children. Overall, these meta-analyses show the destructive impact of maltreatment for attachment security as well as disorganization, but the accumulation of socioeconomic risks appears to have a similar impact on attachment disorganization.

Prevalence of Child Maltreatment in the Netherlands

The first nationwide prevalence study of child maltreatment in the Netherlands (NPM-2005) was designed as a replication of the National Incidence Studies (NISs) conducted in the United States. Child maltreatment cases were reported by 1,121 professionals from various occupational branches, trained in a detailed registration system of six types of abuse and neglect. In addition, cases registered by the Dutch Child Protection Services (CPS) were analyzed. For 2005, the overall prevalence rate was estimated to be 107,200 (95% CI 102,054-112,882) maltreated children aged 0-18 years, or 30 cases per 1,000 children. Neglect was the most prevalent type (56% of all cases) and sexual abuse had the lowest rate (4%). Of the maltreated children, 47% experienced more than one type of maltreatment. Major risk factors were very low parental education and unemployment. It is worrisome that CPS agencies only see the tip of the iceberg as only 12.6% of all maltreatment cases were reported to the CPS. Training of professionals in observing and reporting child maltreatment is badly needed. The absence of a legal obligation to report in the Netherlands needs reconsideration.

Elevated Child Maltreatment Rates in Immigrant Families and the Role of Socioeconomic Differences

Are immigrant families at elevated risk for child maltreatment, and if so, what role do socioeconomic and family composition factors play? In a national prevalence study on child maltreatment in the Netherlands, child maltreatment cases were reported by 1,121 professionals from various occupational branches. Maltreating families were compared to a national representative family sample on immigrant status and parental educational level and family composition factors. The authors differentiated between traditional immigrant families who immigrated as labor migrants from Turkey, Morocco, Suriname, and the Antillean Islands, and nontraditional immigrant families who more recently immigrated from countries with severe economic hardships or political turmoil (refugees). Traditional immigrant and nontraditional immigrant families were both significantly overrepresented among maltreating families, but this overrepresentation disappeared for the traditional immigrants after correction for educational level of the parents. Nontraditional immigrant families, however, remained at increased risk for child maltreatment even after correction for educational level. It is proposed that interventions to prevent child maltreatment in immigrant families should focus on decreasing socioeconomic risks associated with low levels of education.

Elevated Risk of Child Maltreatment in Families With Stepparents but Not With Adoptive Parents

Does child maltreatment occur more often in adoptive and stepfamilies than in biological families? Data were collected from all 17 Dutch child protective services (CPS) agencies on 13,538 cases of certified child maltreatment in 2005. Family composition of the maltreated children was compared to a large national representative sample of the Netherlands Kinship Panel Study (NKPS). Larger families, one-parent families, and families with a stepparent showed elevated risks for child maltreatment. Adoptive families, however, showed significantly less child maltreatment than expected. The findings are discussed in the context of parental investment theory that seems to be applicable to stepparents but not to adoptive parents.

Gehechtheid en kindermishandeling

Gehechtheid en kindermishandeling worden in dit hoofdstuk beschreven en gekoppeld vanuit wetenschappelijk en klinisch perspectief. Jaarlijks zijn naar schatting zo’n 119.000 kinderen slachtoffer van mishandeling, zo blijkt uit de meest recente Leidse Nationale Prevalentiestudie Mishandeling van kinderen en jeugdigen (NPM-2010). Risicofactoren voor kindermishandeling zijn aan te wijzen op verschillende niveaus, zoals de maatschappij, de nabije omgeving van het gezin en de ouder zelf. Kinderen in gezinnen met laag opgeleide ouders, werkloze ouders of alleenstaande ouders hebben een groter risico op mishandeling dan andere kinderen. Het zelf hebben meegemaakt van mishandeling door de ouders verhoogt het risico op mishandeling van eigen kinderen. De ontwikkeling van een verstoorde gehechtheidsrelatie als gevolg van mishandeling speelt daarin een belangrijke rol. Ook kunnen gehechtheidsproblemen een verklaring vormen voor emotionele en gedragsproblemen die mishandelde kinderen vaak hebben. Dit hoofdstuk gaat in op de achtergronden, diagnostiek, preventie en behandeling van gehechtheidsproblemen en kindermishandeling, waarbij nadrukkelijk aandacht wordt besteed aan (het ontbreken van) ‘evidence-based’ screeningsinstrumenten en behandelmethoden bij kindermishandeling en ernstige gehechtheidsproblemen.

19 Kindermishandeling en gehechtheid

In Nederland voert de overheid de laatste jaren intensief campagne tegen kindermishandeling. Het publiek wordt via affiches en andere media gewezen op het belang van het signaleren en melden van potentiele slachtoffers van kindermishandeling in de omgeving, bijvoorbeeld met de slogan: ‘In iedere klas zit wel een kind dat mishandeld wordt’. Tot voor kort ontbraken Nederlandse prevalentiegegevens, want naar het maatschappelijk zo belangrijke verschijnsel kindermishandeling is de afgelopen dertig jaar eigenlijk nog bitter weinig wetenschappelijk onderzoek verricht. Wel is er in de klinische praktijk veel ervaring opgedaan met diagnostiek, hulpverlening en preventie van kindermishandeling, hoewel de validiteit en effectiviteit van deze praktijk niet altijd wetenschappelijk is aangetoond. In de klinische praktijk is wel duidelijk geworden dat kindermishandeling doorgaans een symptoom van ernstig verstoorde gehechtheidsrelaties in het gezin is.