"When I went to school and was with my friends, I realized that other kids' dads didn't beat them. Other kids' dads didn't hate them. That was a time of reckoning in my life. I grew up in an environment where abuse was a daily event. A day without a beating was a good day. A day without verbal abuse never occurred."

- Deborah, age 18

Nearly 40% of the children abused or neglected are five years of age or younger, with the greatest risk being in the first year of life. Of these children, 45% were subjected to neglect, 22% to physical abuse, and 13% to sexual abuse. Other forms of abuse include medical neglect (2%), emotional maltreatment (4%). and "other" (13%). The maltreatment was inflicted by parents in 76% of the cases, with other family members responsible in another 12%. Every day, on average, there are three deaths resulting from abuse or neglect.

A similar picture can be painted for the children in our state. In 1993, 2,297 children were confirmed victims of child abuse and neglect, a decrease of 0.5% from 1992, but an increase of 124% since 19802. That computes to a rate of 7.7 victims per 1,000 children.

As with the national data, the youngest children are at greatest risk, with over 20% of the victims being under three years of age. The type of maltreatment experienced by Hawai`i's children exhibits a pattern different from the national one. The analysis of 1992 data prepared for Hawai`i Kids Count by the Department of Human Services indicated that 51% were victims of physical abuse, while 23% were subject to neglect, 13% to both abuse and neglect, and 12% to sexual abuse. Parents were the perpetrators in 83% of the cases, with 7% the responsibility of other family members.

The Effects of Maltreatment On Child Development
Developing normally is a difficult task for the abused and neglected child. Abuse and neglect affect some children profoundly and others to a lesser degree. Some reasons for the differences are the child's own personality, neurological damage from abuse, the influence of significant people in the child's life, and other biological and malevolent environmental factors.

Each developmental period provides new conflicts for the maltreating family. Birth and early bonding may be complicated by the emotional immaturity of the mother, the relationship or lack of relationship between the mother and significant others, and other environmental factors. Inadequate bonding leaves the child at risk for abuse. In her review of the literature, Cynthia Tower identified the most prevalent effects at each developmental stage.

The abused or neglected child between birth and one year often demonstrates poor motor control, a lack of social responsiveness, slow language development, and a general mistrust of the environment. From one to four years of age, the child may develop a passivity combined with hyper-vigilance about his or her surroundings. This child is slow to reach out or to explore and has little interest in developing autonomy. By four to eight years, the child's developmental delays appear more significant. He or she has difficulty relating to peers and is often unable to make the transition to structured learning in the classroom. Abused children often have difficulty internalizing standards -- some because they have observed no consistent standards at home and others because the rigidity in their home life does not encourage them to be self-directed.

The maltreated child between ages eight and twelve often feels isolated and alienated from peers. School problems and behavior problems are probably part of the child's life. Preadolescence is a classic age for sexual abuse to commence. Adolescence marks the quest for control, separation, and identity -- important psychological work usually hampered by maltreatment. The abused youth is likely to demonstrate poor self-esteem and a poor body image, which often leads to self-injurious behavior. They frequently separate abruptly from the family of origin through running away, becoming pregnant, or some other method of separation.

What is Child Abuse and Neglect?
The maltreatment of children is deeply enmeshed in historical values and perspectives. The concept of child maltreatment has been defined and redefined throughout history. Society is slowly evolving from viewing children as property, subject to the whims of the family and society, to the recognition that children have rights of their own. Each period in history -- as well as each culture -- has a concept of how children should be treated.

Clearly, the concept of child abuse and neglect has evolved rapidly from the 1962 identification of the "battered-child syndrome" by Dr. Henry C. Kempe. The first US abuse survey was taken by D. C. Gil in 1967-686. He concluded that 7,000 children were abused annually. Fifteen years later the National Center for Child Abuse and Neglect (established in 1974) reported nearly a million cases annually. No society has approved of battering children and incest has been a fairly universal taboo. These two concepts have been wedded in the last three decades into a powerful single notion. There has been increased awareness of the issue by both the public and professionals, as witnessed by the growth in the number of books published annually: in 1965 there were none; by 1975 there were 9; by 1985 there were more than 1807; this year's list will surely be more than double that.

Physical Abuse
Physical abuse is a concept that is difficult to define. Its definition depends largely on the mores and values of the times. Today most specialists agree that abuse involves the non-accidental injury of a child at the hands of the caregiver. However, even this general definition is subject to cultural interpretation that has created problems and misunderstandings. Jill E. Korbin has examined cross-cultural perspectives of child abuse and neglect. "No culture sanctions idiosyncratic harm to children outside the realm of social norms. While definitions legitimately vary, each group maintains concepts and definitions of behaviors that are beyond the standards of acceptable conduct," Korbin states.

Neglect
Neglect of children is a result of parental failure to meet basic human needs -- adequate food, shelter, safety, and affection. This category also includes medical neglect, the conscious or unconscious actions of parents in not securing medical attention, especially in life-threatening situations. Many states recognize educational neglect, when parents do not insure the school attendance of children.

Emotional Maltreatment
Emotional maltreatment remains the most difficult type of abuse or neglect to define or isolate. Some child development experts argue that almost all parents are guilty of emotional maltreatment of children at some time or other. It clearly underlies physical and sexual abuse and neglect, but it may also exist alone. Emotional maltreatment has its roots in a variety of societal and personal deficiencies of the abuser. Children who are emotionally abused or neglected tend to demonstrate anger, behavior problems, depression, and withdrawal.

Sexual Abuse
Abuse may be viewed as part of total family dysfunction or a failure of the family to protect its children. There is agreement that sexual abuse -- whether through molestation in or outside the family, pornography, or prostitution -- takes place for the gratification of the adult. In the past few years, experts have seen an increasing number of sexual abuse cases, despite society's hesitancy to recognize its existence.

Sexual abuse almost always progresses over time, usually in five specific phases: engagement (perpetrator gains access and conveys to the child that the behavior is acceptable), sexual interaction (the longer the abuse has gone on, the more advanced and complex it becomes), secrecy (perpetrator uses his power to dominate, bribe, emotionally blackmail or threaten so that the abuse can continue), disclosure (purposefully or accidentally, may or may not happen in childhood), and suppression (those close to the child encourage and often compel the child to recant or forget the abuse).

From various studies of adults reporting their own past experiences, it has been found that between 9 and 52 percent of the females and between 3 and 9 percent of the males had some sexual abuse exposure as children. Only .5% of America's children were reported (.2% confirmed) as victims of sexual abuse in 1993. David Walters, in an overview of physical and sexual abuse, suggested that there are at least six reasons for this underreporting: Sexual abuse is difficult to identify and prove and easy to deny.

Adults are often reluctant to believe children and hesitate to attribute such behavior to other adults. Efforts to treat focus on punishing the offender. In family situations, the other family members are less likely to report because prosecution upsets the family balance both economically and physically. Those investigating cases may feel discomfort in talking about sexual issues and not screen cases properly or do not recognize signals that sexual abuse is occurring.

Treatment methods are not coordinated or sufficiently effective to elicit a desire for treatment on the part of families or victims. Investigators, too, feel treatment is not effective enough to warrant the trauma children are exposed to when the case is reported. Society's taboo on sexual deviations places a stigma on both victim and perpetrator and, therefore, not to report is not to suffer disgrace. Girls have been more likely to report their victimization, although it is beginning to be known that more boys are abused than is reported. The degree of trauma a child experiences is based on a variety of factors, such as the identity of the perpetrator, the extent and duration of the abuse, and the point of and reactions to disclosure.

Factors Impacting the Trends
What is the true incidence of child abuse and neglect? This question has been debated for many years. Are there really 125% to 130% more people abusing their kids now than were in 1980? That is the increase in the number of confirmed instances of abuse and/or neglect. However, retrospective studies of adults who report abuse from their childhood and other anecdotal data indicate that much abuse does not come to the attention of those who keep the official records. Reports of abuse are much higher for ethnic minorities, but this may not mean that there is more abuse in those families. It may be that those families have fewer ways to hide or may have child-rearing practices that differ from those of the 'reporter'.

Some have cited changes in the laws regarding who is required to report suspected abuse as a factor in the increased reporting. Hawai`i's mandatory reporting law was first enacted in 1967. It specified that doctors, dentists, registered nurses, school teachers, social workers and coroners must report to the department of social services any instances where they had reason to believe that injury had been caused by abuse or neglect. Medical examiners were added to the list in 1977 and police officers or law enforcement officers added in 1979. In 1982 the laws governing child abuse and neglect were rewritten, with the list of those specifically required to report suspected abuse and neglect augmented by the addition of psychologists; pharmacists; employees of agencies providing social, medical, hospital, or mental health services, including financial assistance; employees of the courts, correctional institutions, parole or probation offices; and employees of licensed day care center, foster care home, group child care center, or similar institution. At the same time, the definition of 'child abuse and neglect' was specified: "...physical injury, psychological abuse and neglect, sexual abuse, negligent treatment, or maltreatment... by a parent, legal guardian, or person responsible for that child's care..." In 1987 the definition was clarified by stating that abuse or neglect meant an act or an omission by someone living with or responsible for the child's care and listing injuries and actions which constitute abuse or neglect.

There has been no substantive change in mandatory reporting in the last 13 years while the number of reports and number of confirmed reports continued to rise. Educators make the largest number of reports from known sources in Hawai`i (15%), with medical personnel (14%), social services employees (13%), and the legal/justice system (10%) close behind. Nearly 30% come from anonymous reporters.

The definition of child abuse and neglect in Hawai`i has been unchanged in eight years and the known incidence has increased. It seems clear that it is not change in the law that is driving the increased number of cases reported and confirmed. Some of the increase is undoubtedly due to changing public attitudes toward corporal punishment and to the growing recognition of the rights of children.

The Outlook In Hawai`i
Between 1969 and 1979, there were 6,956 confirmed reports of abuse and neglect. From 1980 through 1990, the corresponding number was 18,559. Between 1980 and 1992, there were 43 reports in which children were permanently disabled and 38 where children died. While the number of children who were confirmed victims decreased by 0.5% in 1993 as compared to 1992, the number with no injury, requiring no treatment decreased by 20%. The number with injuries defined as serious, permanently disabling, or fatal increased by 38%.

Using three-year averages to find the essence of trends, since the numbers are not large and subject to wide annual fluctuations, it can be seen that the youngest children are suffering increasing proportions of abuse and neglect. In the 1980-1982, children in the first two years of life were victims in 14% of the cases; in the 1990-1993 period (age-specific data are not available for 1991 due to conversion of computer program), they constituted over 20% of the victims.

In 1980, military dependent children were 16% of the confirmed victims of child abuse and neglect; by 1992, that proportion had declined to 9%. Military children constituted 12% of the child population of the state in both 1980 and 1990. Both Hawai`i County and Maui County have experienced significant increases. Of the confirmed reports in the state, Hawai`i accounted for 8% in 1980, 17% in 1992. Maui was site of 6% of the confirmed reports in 1980, 13% in 1992. This occurred while their child populations were only increasing from 10% to12% (Hawai`i) and 8% to 10% (Maui) of the state child population. Clearly, the efforts of some programs are causing the rate to pause from the dramatic increases in child abuse and neglect during the late 1980's. However, the incidence reduction in some parts of the state are co-existing with rate increases in other communities.

What Can Be Done?
As Congresswoman Pat Schroeder commented during a 1993 public hearing on child abuse: "You can't wring your hands and roll up your sleeves at the same time." Action will have a greater impact than lamentation. In the next issue paper, other relevant concerns will be investigated: An act of domestic violence occurs more frequently than any other crime in the United States. Studies of battered women have found that 50% to 75% of their children are also victims.

Parental abuse of alcohol and use of other drugs has been identified as a major factor contributing to child maltreatment and death in the US. A third paper will offer recommendations for action.