233CHILDINDICATORSReported Child Abuseand NeglectEugene M. Lewithroughouthistory,childrenhavebeensubjecttosubstantialcruelty,Tincludingabandonmenttodieofexposure.Today,althoughsocietyseeks to protect children through child abuse laws, the task remains hugeandcomplex.Nottheleastreasonforthiscomplexityisthelackofuniversallyagreeduponstandardsastowhatconstituteschildmaltreatment.1EugeneM. Lewit,Ph.D.,isdirectorofresearchandgrantsforeconomicsattheCenterfortheFutureofChildren.Definingchildmaltreat-ment is largely a matter of so-cialnorms.Casualobserva-tioninpublicplaceswhereparentsandtheirchildrencanbefoundprovidesfrequentinstancesofchildrenbeinghitorseverelyscolded.Suchacts,evenhittingachildwithanobjectsuchasabelt,arenotgenerallyconsideredabuseaccordingtoeitherthelegalorinformalnormsofcurrentAmericansociety.Yet,suchac-tionsagainstchildrenarecon-sidered abuse in Sweden andseveralothercountriesandbyanumberofAmericansaswell.2eralChildAbusePreventionandTreatmentAct(PublicLaw93-247)establisheduni-formoperatingstandardswithrespecttotheidentificationandmanagementofchildmaltreatmentcases.However,individualstatescontinuetomaintaintheirowndefinitionsofmaltreatment,investigativeprocedures,services,andmon-itoringsystems.Consequently,becauseresponsibilityforad-dressingthevariousformsofchildmaltreatmentisdis-persed among many differentgovernmententities,thereisonly a limited amount of uni-formly collected and reportedinformationonthisseriousproblem.often call for a judgment as totheoutcome,purpose,orin-tentofanactionratherthanidentifythespecificcompo-nentsoftheactitself.Toim-posesomeuniformityonthereportingofchildabuseandneglect,theNationalCenteronChildAbuseandNeglecthas established a set of work-ingdefinitions.3 These defini-tions,presentedinTable1,stillleavemuchlatitudeforinterpretation,particularlybe-causeseveralcategoriesin-cludeactsthatcouldhavecausedinjurytoachild.Moreover, the specific actionsthatconstitutethevarioustypes of maltreatment are de-finedunderstatelawand,hence, may vary from one ju-risdiction to another.Despitesomeambivalenceaboutthedefinitionofchildmaltreatment, concern for thewelfareofchildrenintheUnitedStateshasalonghis-tory.Historically,protectingchildrenwasafunctionofpub-licandprivatechildwelfareagenciesatthelocallevel.In1974,thefederalgovernmentenactedlegislationthatgaveitamoredirectroleinchildprotectionpolicy.2TheFed-ThecurrentAmericandef-initionofchildmaltreatmentincludesphysicalinjury,sex-ualabuse,psychologicaloremotional harm, and general,medical,andeducationalne-glect.Althoughthesefunda-mentalcategoriesidentifyanumberofundesirableactsagainstchildren,thecatego-ries are fairly nonspecific andTheareaofchildabuseand neglect comprises a com-plexsetoftopics,includingthedifferenttypesofmal-treatment,theconsequencesoftheseactions,andpossibleresponsestopreventmaltreat-mentinthefirstplaceandtoaddresstheconsequencesofTheFutureofChildren SEXUAL ABUSE OF CHILDREN Vol.4No.2Summer/Fall1994234 THE FUTURE OF CHILDREN SUMMER/FALL 1994Table1DefinitionsofSelectedTermsUsedinNationalChildAbuseandNeglectStatisticsMaltreatment An action or failure to act by a parent, caretaker, or other person defined understatelawasaperpetratorofabuseorneglect,thatresultedindeath;physical,sexual,oremotional harm; or risk of harm to a child.NeglectorDeprivationofNecessities Atypeofmaltreatmentthatreferstothefailuretoprovideneeded, age-appropriate care.Physical Abuse A type of maltreatment that refers to physical acts that caused or could havecaused physical injury to a child.SexualAbuse A type of maltreatment that refers to the involvement of the child in sexual activitytoprovidesexualgratificationorfinancialbenefittotheperpetrator,includingcontactsforsexual purposes; prostitution; pornography; exposure; or other sexually exploitative activities.PsychologicalorEmotionalMaltreatment Atypeofmaltreatmentthatreferstoactsoromissionsthatcaused,orcouldhavecausedconduct,cognitive,affective,orothermentaldisorders,such as emotional neglect, psychological abuse, or mental injury.MedicalNeglectThefailuretoprovideforappropriatehealthcareofthechild,thoughfinanciallyableorofferedfinancialorothermeans,exceptwhenaparentorotherpersonresponsibleforthechildswelfareislegitimatelypracticingreligiousbeliefs,andbyreasonthereofdoes not provide specified medical treatment for a child.DeathasaResultofChildMaltreatment Achildsdeathasaresultofabuseorneglect,becauseeither(a)injuryresultingfromtheabuseorneglectwasthecauseofdeath,or(b)abuseorneglect was a contributing factor to the cause of death.Source:U.S.DepartmentofHealthandHumanServices,NationalCenteronChildAbuseandNeglect.Nationalchildabuseandneglectdatasystem:1990summarydatacomponent.WorkingPaperNo.1.Washington,DC:DHHS,April1992.maltreatmentwhenpreven-tionfails.Thisentirejournalissueisdevotedtosexualabuse,asinglesubsetofactivi-tiesthatrepresentapproxi-mately15%ofsubstantiatedcasesofabuseandneglectinthe United States.4 A compre-hensive review of all facets ofchild maltreatment is beyondthe scope of this short article;its intent is rather to examinethesources,limitations,andstrengthsofnationaldataonreportedcasesofchildabuseandneglect.Itishopedthatthisexaminationofdatathatareoftensensationallyre-ported will increase apprecia-tionforthecomplexityoftheproblemandinterestindevel-opingeffectiveinterventions.First,thearticleexaminessourcesofnationaldataonchildabuse,thenumberofcasesreported,andrecenttrendsinthedata.Thentheissuesofsubstantiationratesandthevariouscategoriesofabuseareaddressed,followedbybriefexaminationsofthecharacteristicsofthevictimsof abuse and of child fatalitiesrelatedtomaltreatment.Sources of DataTheoretically,informationonchildabuseandneglectcanbe gleaned from child protec-tiveservice(CPS)agencies,na-tionalsurveysofindividuals,andthecriminaljusticesys-tem. Of these various sources,themostfrequentlyciteddataonchildabuseandneglect,andtheprimaryfocusofthisarticle,arebasedonreportsallegingtheseactivitiesthatarereferredforinvestigationtoCPSagenciesineachstate.3,4Becausethesedataarebased on reports of suspectedcasesofchildmaltreatment,tions,andfalsereportsofabuse and neglect.A number of national sur-veysaddtothepictureofchildabuseandneglectinthiscountry.OnesuchsurveyisthefederallyfundedsecondNationalIncidenceStudyofChildAbuseandNeglect(NIS-2). This survey is cited brieflybyFinkelhorinthisjournalis-sue.5,6TheNIS-2wasaninten-siveefforttocollectdatainasmall(29)butrepresentativesampleofcountiesthroughouttheUnitedStates.Thesedatawere then extrapolated to thenationallevel.Astrengthofthesedataisthatmandatedreporters(healthcarepro-viders,educators,andsuch)wereinterviewedtoobtainanestimateofthenumberofprobablecasesofmaltreat-theycontainseveralsourcesof mentthattheyactuallyob-error,includinginstancesof served,notmerelythenum-realabuseandneglectthat berofcasestheyreportedtoarenotreported,reported childprotectionorlawen-casesthatdonotmeetdefini- forcementagencies.Weak-tionalcriteriainalljurisdic- nessesofthesedatainclude235 CHILD INDICATORS: Reported Child Abuse and Neglectthe inability to specify the ex-tentofduplicationamongre-portedcases;acomplex,multi-stagesamplingstrategythatmayhaveintroducedbiasintothe survey; and limited infor-mationontheprofessionalsparticipating in the study.7 Inaddition,thisdatacollectioneffortisrepeatedonlyeverysixtosevenyears(themostrecentfigures are for 1986), and con-sequentlythesedatacannotbeusedtoassesscurrenttrendsinabuseandneglect.Inaddition,adultshavebeensurveyedtodeterminetheirexperiencesofabuseaschildren.Thesesurveyscan-nottellusanythingaboutcurrentlevelsofmaltreat-ment, may be subject to recallerror,andoftenusebroadandinconsistentdefinitionsofabuse.Suchsurveysdosuggest,however,thatCPSdatamaysubstantiallyunder-statethelevelofabuseinthegeneralpopulation.(SeethearticlebyFinkelhorinthisjournalissue.)Surveyshavealsobeenperformedontheadultpopulationtodeter-minetherespondentsexpe-rience with child and spousalmaltreatmentatthetimeofthesurvey.2Ifthequestionswereansweredtruthfully,thesesurveyswouldbefreeof some of the biases found inCPSdata,butinalllikeli-hoodtheyaresubjecttoun-derreportingbiassincere-spondentsmaybereluctanttodiscloseabusivebehaviorevenifguaranteedconfiden-tiality.2Becauseofspacecon-straintsandthelimitationsofgeneralpopulationsurveys,thisarticledoesnotanalyzedatafromsuchsurveys.Datafromthecriminaljusticesys-tem are also not reviewed be-cause,althoughseverechildabusemaybeconsideredacrimeandresultinprose-cutions by the criminal justicesystem,thereisnotyetanyregular annual compilation ofnationalcriminaljusticedatathatprovidesusefulinfor-mationaboutallaspectsofchild abuse and neglect in alljurisdictions.(SeethearticlebyFinkelhorinthisjournalissue.)CPS-Based DataThetwoprimarysourcesofinformationonchildmal-treatmentintheUnitedStatestodayaretheAnnualFifty-StateSurveyoftheNationalCommittee for the PreventionofChildAbuse(NCPCA)4andtheNationalChildAbuseandNeglectDataSystem(NCANDS)oftheNationalCenteronChildAbuseandNeglect.3Althoughbothofthese sources produce annualdataonchildabusebasedonreportsfromstateCPSagen-cies,theyasksomewhatdif-ferentquestionsandfollowdifferentprocedures,andhencetheirreportsdifferinprecision,levelofdetail,andtimeliness.Since1982,theNCPCAhasconductedannualtele-phonesurveysofstatechildprotectiveserviceagenciestodeterminethenumberandcharacteristicsofreportsofsuspectedchildabuse,thenumberofabuse-relatedchildfatalities,andchangesinthestatusofchildwelfareserv-ices.4Statesarecontactedearlyinacalendaryearandqueriedabout their experiences in thepreviousyear.Amajorlimita-tionofusingthedatacollectedin this survey to provide a di-rectestimateofchildrenre-portedforsuspicionofvariouskindsofmaltreatmentisthewidevariationamongstatesindatacollectionandreportingprocedures. Another problemis that most states can only pro-videdataonthenumberofreportsreceived,notthenum-berofchildrensubjecttore-porting.Sincesomeofthesereportsapplytothesamefam-ily or child, often for the sameoffense,thisso-calleddupli-catedreportingtypicallyover-statestheactualnumberofchildrenreportedforsuspi-cionofmaltreatment.TheNCPCAfollowsanumberofestimationprocedurestoad-justthedataforinconsistentreportingamongstates,butcan do little to correct for du-plicatereporting.8Aspartoftheadjustmentprocess,datafromreportingstatesareprojectedontothenationalpopulationtoobtainnationalestimates.Differentstatesappearindifferentcategoriesofdataandindif-ferentyears,whichintroducessomeimprecisionintothees-timates. For example, Califor-nia,Washington,andWestVirginiacouldnotprovidedataonsubstantiatedcasesfortheyears1991to1993,andanumberoflargerstatesinclud-ingCaliforniaandNewYorkcouldnotprovidedataonchild abuse and neglect fatali-tiesin1993.Accordingly,theavailablereporteddataareprojected onto a national pop-ulationbasetoobtainnation-alestimatesofsubstantiatedcasesandoffatalitiesfrommaltreatment.Thismethodtreatsthestatesthatdonotreportasthoughtheyhavethesameratesofsubstantiationanddeathasthestatesthatdoreport.IncontrasttotheNCPCAdatacollectioneffort,theNationalCenteronChildAbuse and Neglect (NCCAN)hasbeenworkingsince1989underafederalmandatetoes-tablishtheNationalChildAbuseandNeglectDataSys-tem(NCANDS),anationwidedatacollectionandanalysisprogramonchildmaltreat-ment.3Atpresent,thisactivityisavoluntarydatabasedevel-opmentprograminwhicheachstateissentformsandinstructionsfordatacollec-tion. States are provided withtechnicalassistanceonreport-ingproceduresandwithfeed-backfromastandardreportofthedatatheysubmiteachyear.Theprocessallowsstatestocontributetotheconstructionofthenationaldatabaseandto alert the NCANDS team tolimitationsoftheirdata.Inturn,theNCANDSteamcanencourage and help the statesdevelopthecapacityforuni-formreportingofthedesireddata.Despitetheseeffortstoim-provedatacollection,theNCANDSisatpresentsubjecttomanyofthesameimportantdataproblemsastheNCPCA,includingthat(1)moststatescannotprovideunduplicatedcountsofchildrensubjecttoabuseifchildrenaresubjectto236morethanoneinvestigation,and (2) states vary in the waytheyhandleunsubstantiatedreports,andmanystatescom-pletely expunge these recordsso no information is availableaboutunsubstantiatedre-ports.3TheNCCANattemptstodealwiththeseandotherproblemsbyusingratiosbasedondatafromstatesthatareabletosupplycertaindatacomponentstomakeestimatesforstatesthatdonotsupplythosecomponents.Forcertaindetaileditems,onlydatafromthesubsetofstatesthatsupplythedetaileddataareanalyzed,andfrequentlythisdatain-cludesduplicatedcounts.Current Data onChild AbuseThemostcurrentnationaldata on the number of reportsofchildabuseandneglectcome from the NCPCAs 1993Fifty-StateSurvey.4Asillus-tratedinFigure1,accordingtothi ssurveyanesti mated2,984,000reportsofallegedchildmaltreatmentweremadetoCPSagenciesin1993.Therate of reports for child abuseorneglectin1993was45re-portsper1,000children.Thenumberofmaltreatmentre-portsandtherateofreportingincreasedbyapproximately50% between 1985 and 1993.NotshowninFigure1aredatafromtheNCANDS,thedatacollectionprojectoftheNationalCenteronChildAbuseandNeglect.NCANDSdat ahasl aggedbehi ndNCPCAdatabecausetheNCANDSefforthasfocusedonbuildinguniformdata-reportingcapacityinthe50states,theDistrictofColum-bia,Guam,andtheU.S.VirginIslands.Interestingly,theNCANDSandtheNCPCAreportalmostidenticalesti-matesofthenumberofre-portsofmaltreatmentduring1990-92.Sincebothorganiza-tionsrelyonreportsfromstateCPSagenciesfortheirnationalestimates,thesimilaritiesoftheirestimatessuggestthatthesourceofthedata,ratherthan the procedures followedinattemptingtoadjustforTHE FUTURE OF CHILDREN SUMMER/FALL 1994problematicdata,maybethekeyfactorintheprecisionofthesenationalestimates.Incontrast,asshowninFigure1,theestimateofre-portsofabusebasedonthe1986 NIS-2 is quite a bit lowerthan the NCPCA estimate for1986, despite the fact that theNIS-2wasdesignedtoidentifyunreportedaswellasreportedcasesofchildmaltreatment.ThemainreasontheNIS-2estimateislowerthanthatoftheNCPCAisthattheNIS-2wasintendedtoyieldanun-duplicatedcountofcasesofchildabuseandusedadefini-tionalstandardofmaltreat-mentwhichrequiredthatprofessionalsbereasonablyconfidentthatmaltreatmenthadoccurred.TheNCPCAsurveydataisbasedonsu-spicionofmaltreatmentanddoesnotcorrectforduplicatecounts.9 Given the divergencebetweentheNIS-2andNCPCAestimatesfor1986,itwillbeinterestingtoseethelevelofconcordancebetweentheNIS-3estimatestobepreparedfor1994andthoseproducedforthatyearbytheNCPCAandtheimprovedNCANDSsystem.Akeyquestionraisedbythe steep upward trend in re-portedcasesofsuspectedchildabuseoverthelastdecadeiswhether this trend representsanactualincreaseininstancesofmaltreatmentormerelychangesinreportingproce-dures.Therearenoquantita-tivedatawithwhichtoaddressthisimportantquestiondi-rectly;however,theNCPCAdoes query state officials as tothe most important factors ac-countingforchangesinre-ports of maltreatment in theirstate.4Inrecentyears,statesrespondingtothisqueryhavecitedincreasedpublicaware-ness,changesinreportingsystemsandprocedures,de-terioratingeconomiccondi-tions, and increasing levels ofsubstance abuse and violenceasfactorsintheriseinreports.AnecdotalreportsfromseveralstatescitedintheNCPCAreporthighlighttheinfluenceofchangesinreport-ingproceduresonreportedchild abuse and neglect statis-tics.4Forexample,inNorthCarolina, the implementationof direct on-line data entry bycountystaffin1992resultedinamoreaccuratecountofac-tualreportsanda23%in-creaseinreports.InWyoming,a20%declineinreportsfol-lowedachangeintherulesthat transferred jurisdiction ofallegationsofabusebynon-caregiverstothepolicefromthe CPS agency which reportsinthenationalsurvey.Substantiationand Type ofAbuseReportingallegationsofabuseisonlythefirststageinthechild protection process. Suchreportscallforaninvestiga-tionandadeterminationastowhetherthereissufficientevi-dence under state law to con-cludethatmaltreatmentoc-curredorthatachildisatriskfor maltreatment.3 Substantia-tionproceduresvaryamongstates,asdoratesofsubstan-tiation.Moreover,failuretosubstantiateareportofchildabuseand/orneglectdoesnotindicatethatthemaltreatmentdid not occur; instead, failuretosubstantiatemayreflecttheresourcesavailabletoCPSagenciesforinvestigatingre-ports,theprioritiesagenciesestablishforpursuingcompet-ingreports,ortheevidentiarycircumstancesofindividualcases.DatafromtheNCPCAssurveyssuggestthatfortheyears1991to1993approxi-mately35%ofreportedallega-tionsofmaltreatmentweresubsequentlysubstantiated.Thispercentageamountstoapproximatelyonemillionsubstantiatedreportsannu-ally.4OfNCANDSreports,39%weresubstantiatedorshowedindicationsofmal-treatmentin1992basedonaslightlydifferentsampleofstates.10 Both the NCPCA andtheNCANDSdatacontainsomeduplicatedcountsofsub-stantiatedcasesofmaltreat-ment.Althoughtheprecisenumber of duplicated cases isCHILD INDICATORS: Reported Child Abuse and NeglectFigure1237NationalEstimatesofReportsandSubstantiatedCasesofChildMaltreatment,1985 to 1993Therearenodefinitivenationaldataontheactualincidenceofchildabuseandneglect.Themostfrequentlyreportedstatistics are based on reports alleging these activities that are referred for investigation to child protective service(CPS)agenciesineachstate.Sincethesedataarebasedonreportsofmaltreatment,theymissinstancesofrealabuseand neglect that are not reported, may count more than once acts of maltreatment that are reported more than once,and may include false reports of maltreatment. Another important source of error in national data on reported childmaltreatmentisthattheproceduresfollowedbystateCPSagenciesinrespondingtoandmonitoringreportsofabuseandneglectvaryamongstatesandovertime.Asexplainedinmoredetailinthetextofthisarticle,thethreemajorsourcesofnationaldataonreportedmaltreatmentattempttodealwiththelimitationsofavailabledataindifferentways.Initsannualsurveyoffiftystates,theNationalCommitteeforPreventionofChildAbuse(NCPCA)attemptstostatisticallyadjustandprojectincompleteandnonuniformdatatoobtaintimelyandmethodologicallyconsistentestimates.TheNationalChildAbuseandNeglectDataSystem(NCANDS)oftheNationalCenteronChildAbuseandNeglectisagovernment-sponsoredefforttodevelopanationaluniformdatacollectionandanalysisprogram.EstimatesofthenumberofreportsofchildmaltreatmentfromtherecentlyinitiatedNCANDS(notshownhere)arealmostidenticaltoestimatesfromtheNCPCASurvey.Incontrasttotheseannualdatacollectionactivities,theNationalIncidenceStudyofChildAbuseandNeglect(NIS)onlycollectsdataonasampleofcountieseverysixtosevenyears,butisanintensiveeffortdesignedtoprovidean estimate of all cases of child maltreatment including those not reported to CPS or law enforcement agencies.n Data from the NCPCA annual surveys show a gradual but steady increase in the number of reported cases ofchildabuseandneglectsince1985(andevenearlier[notshown]).In1985,maltreatmentof1.9millionchildrenwas reported to CPS agencies. In 1993, the number reported was almost 3.0 millionan increase of more than50%ineightyears.n The1986NIS-2-basedestimate,whichissupposedtoaccountforunderreportedcasesofmaltreatment,issubstantiallybelowthe1986NCPCAestimateprobablybecausetheNIS-2wasintendedtoyieldanunduplicatedcountofchildabusecasesandusedadefinitionofmaltreatmentwhichrequiredthatprofessionalsbereasonablyconfident that maltreatment had occurred.n Approximately one million cases of maltreatment were substantiated annually in 1991 to 1993some 35% ofthereportedcasesofabuse.Dataseriesonbothinitialreportsandsubstantiatedcasescontainduplicatedreportsof maltreatment and so overstate the number of children actually reported to CPS agencies.Sources:McCurdy,K.,andDaro,D.Currenttrendsinchildabusereportingandfatalities:Theresultsofthe1993annualfifty-statesurvey.WorkingPaperNo.808.PreparedbytheNationalCenteronChildAbusePreventionResearch.Chicago:NationalCommitteeforPreventionofChildAbuse,April1994;U.S.DepartmentofHealthandHumanServices,NationalCenteronChildAbuseandNeglect.Executivesummary:Studyofnationalincidenceandprevalenceofchildabuseandneglect.Washington,DC:DHHS,1988.238 THE FUTURE OF CHILDREN SUMMER/FALL 1994notknown,datafromdetailedstudiesinseveralstatessuggestthatasmanyas10%ofsubstan-tiatedcasesmayrepresentdu-plicatedcountsofchildren.11Comparisonoftheesti-mateofchildmaltreatmentcases for 1986 from the NIS-2withthenumberofsubstan-tiated cases reported for 1991to1993,providessomeevi-denceforthepossibledegreeof underreporting of abuse inCPS-baseddata.TheNIS-2usedadefinitionofmaltreat-mentthatissimilartosubstan-tiation/indicationstandardsusedinsomestates;and,inaddition, the NIS-2 attemptedtoidentifycasesofmaltreat-mentknowntopotentialre-portersbutnotreportedbythem.TheNIS-2countofcasesfrom1986exceedsthenum-berofsubstantiatedcasesforrecentyearsbyapproximately60%,whichsuggeststhatim-provedreportingalonecouldleadtoasignificantincreaseinthenumberofcasessubstanti-atedbyCPSagencies.TypesofMaltreatmentData are also collected on thetypesofabuseorneglectthatchildrensuffer.Thisinforma-tionisnecessarytoprovideappropriatepreventionandtreatmentservicesandtomon-itortheimpactoftargetedpro-gramsandsocialforcesonchildmaltreatment.Da t a f r o mt he 1 9 9 3NCPCAsurveycategorizedbytype of abuse and neglect arereportedinFigure2.Thecategoriesarenotmutuallyexclusive. Neglect is the mostcommonformofreportedandsubstantiatedmaltreatment.Thedistributionofcertaintypesofmaltreatmentvariesbetweenreportedandsub-stantiated cases. For example,30%ofreportedcasesconcernphysicalabuse,butphysicalabuseaccountsforonly25%ofsubstantiatedcases.Sexualabuse,however,comprisesahigherproportionofsubstan-tiatedcases(15%)thanre-portedcases(11%).12As in all child abuse data,there is great variation in thewaysthatstatesclassifycases.3,4Some states group less severeformsofmaltreatmentintheothercategory.Arizonaclas-sified over 40% of its substan-tiatedcasesasotherin1993.4Pennsylvania CPS refers mostneglectcasestoanotheragencyanddoesnotreportthesecasesinthestatesstatis-tics.4InboththeDistrictofColumbia and New York, ne-glectaccountedforover80%ofsubstantiatedcasesin1993,whileinHawaiimorethan50%werecasesofphysicalabuse.4Victims ofMaltreatmentDataareavailablefromvariousstates in the NCANDS on theage, race or ethnic group, andgenderofvictims.11Generally,thereportednumberofvic-timsdeclinesgraduallywithincreasingage.Thehighestpercentageofvictims,7%ofthetotal,isintheunderone-year-of-agegroup.Theper-centage falls below 6% by age8andbelow4%atage16.11More than 50% of the victimsofmaltreatmentarereportedaswhite,26%asblack,and10% as Hispanic.3About53%ofreportedchild victims of abuse and ne-glectarefemaleand46%male.Thisgenderdifferenceis the result of the much high-erfrequencyofsexualabuseamongfemales.Exceptforsexualabuse,maltreatmentappearstooccurwithequalfrequency in both sexes.3Trends in ChildAbuse FatalitiesAlthoughdeathsofchildrenfromabuseorneglectarerela-tivelyinfrequent,theyrep-resentthemosttragicconse-quencesofmaltreatment.In1992,accordingtotheNCPCA,anestimated1,149childrendiedfromabuseorneglect.4Childmaltreatmentfatalitiesarerelatedtoage.Onthebasisofdatafrom23states,theNCPCAreportsthat86%ofchildrenwhodiedasaresultofmaltreatment were under agefivewhile46%ofvictimswereless than one year old.4Thereisstrongreasontobelievethattheseofficialsta-tisticsundercounttheactualnumberofmaltreatment-related fatalities in the UnitedStates. Accumulated evidencesuggeststhatsomefatalitiescurrentlylabeledasacciden-tal, child homicides, and Sud-denInfantDeathSyndrome(SIDS)mightbeattributedtomaltreatmentiftheyweresub-jectedtocomprehensiveinves-tigations.Arecentanalysissuggestedthattheremaybetwiceasmanydeathscausedbychildabuseandneglecteachyear as are reported by eithertheNCPCAortheNCANDS.13Figure3presentsdataonmaltreatment-relateddeathsfor the years 1985 (the earliestyearforwhichdataarere-por t edbyt heNCPCA)through1992.Overthiseight-yearperiod,reporteddeathsrangedfromanestimated878to1,195perannum,andthedeath rate ranged from 1.3 to1.9deathsper100,000chil-dren.14Althoughthedeathrate and number of deaths in-creasedbyapproximately50%duringthisperiod,thesamerate of increase as in the num-ber of reports of maltreatment(seeFigure1),almostalltheincreaseindeathsinthesedataoccurredbetween1985and1986.15Totalprojectedfatali-tiesandnationaldeathrateshavevariedmodestlysince1986,butonaveragetheyhavechangedlittleoverthistimespan.Thisconsistencyissur-prisingbecausereportedcasesofmaltreatmentincreasedsteadily over this time periodandbecausestateshavepaidincreased attention to cases ofpossibleabuse-relatedmortal-ity through more complete re-cordkeepingandincreaseduseofmultidisciplinarydeath-reviewcommittees,whichfo-custheirattentiononanalyz-ing the circumstances of childfatalities in a county or state.3Althoughthevastmajori-tyofcasesofmaltreatmentdonotresultindeath,therela-tiveconstancyoftherateofmaltreatment-relatedfatalitiesinrecentyearsraisesanim-portantquestionaboutwheth-ertheobservedincreaseintheCHILD INDICATORS: Reported Child Abuse and Neglect 239Figure2BreakdownofReportsandSubstantiatedCasesbyTypeofAbuseandNeglect,1993NCPCAAnnualSurveyPhysicalAbuse30%SexualAbuse11%4%n n It appears that reports of sexual abuse and emotional abuse are more likely to be substantiated than reports ofphysicalabuse.Source: McCurdy, K., and Daro, D. Current trendsinchildabusereportingandfatalities:Theresultsofthe1993annualfifty-statesurvey.WorkingPaperNo.808.PreparedbytheNationalCenteronChildAbusePreventionResearch.Chicago:NationalCommitteeforPreventionofChildAbuse,April1994.Reported Cases (Data from 27 States) SubstantiatedCases(Datafrom35States)EmotionalAbuse2% Other10%PhysicalAbuseNeglect47%25%SexualAbuse15%EmotionalAbuseOther10%Neglect47%Categoriesofchildmaltreatmentincludevarioustypesofabuseandneglect.Althoughthereissomeagreementamongreportingagenciesonthegeneralcategoriesofmaltreatment,theclassificationsvarysomewhatamongstates.Inaddition,somestatesdonotclassifyandothersdonotmaintainorreportinformationoncasesthatarenotsubstantiated. Thus, information on the types of maltreatment which are reported but unsubstantiated is limited.n n Neglectconstitutesalmosthalfofallcasesofreportedandsubstantiatedmaltreatment.reports of child abuse reflectsarealincreaseinabuseoronlyanincreaseinreporting.16This is an important issue notonlyforthoseconcernedaboutthewell-beingofchildren,butalsoforthoseevaluatingtheefficacyofchildprotectiveservices.Asteadydeathrateinthefaceofrisingreportsofmal-treatmentwouldsuggestin-creasingly effective child pro-tectiveservicesifitwerenotforuncertainty about the reasonsfortheincreaseinreportsofmaltreatmentthemselves.17ConclusionPreviouslyoftendisregardedbytheAmericanpublic,thetopicofchildabuseandne-glecthasrecentlygarneredheightenedattentioninthepublicmedia.Storiesoflargenumbers of children living inhorrifyingsqualorandofyoungchildrenreturnedtotheirnaturalfamiliesonlytobemurderedbyabusivepar-entsfillfrontpagesandna-tionaltelevision.18Yet,despitethesesensationalaccounts,itisdifficulttoreallyknowwhatishappeningnationallyregard-ingtheincidenceofchildmal-treatment.Somerecentdatareviewedin this article suggest that thelevelofabuseandneglectmaybestabilizingafteralongpe-riodofreportedincreases.Yet,theavailabledataonreportsofabusearebasedonallegationsreportedtoCPSagencies,notactualcasesofmaltreatment,and these data include dupli-catereports.Evendataonsub-stantiatedcasesofabusere-flectduplicatedreportsandvariablecriteriaforsubstantia-tion.Accordingly,changesinthesedatamayreflectchangesinthepropensitytoreportsus-pectedabuseandneglect,andchangesinthewayreportsaretabulatedandpresented,asmuchaschangesintheinci-dence of maltreatment.Thereisaneedforbetternationaldatasystemstohelpusunderstandtheproblemofchildmaltreatment. TheNCANDSprojectoftheNa-tional Center on Child AbuseandNeglect,withitsinteractiveapproachtocollecting,coordi-nating,standardizing,analyz-ing,anddisseminatinginfor-mation on child maltreatmentisanencouragingdevelop-ment, but much remains to bedone. On the surface, improv-ed data collection efforts mayappeartodolittleforchildren240 THE FUTURE OF CHILDREN SUMMER/FALL 1994Figure 3Fatalities Related to Child Abuse and Neglect, 1985to 1992YearDeaths of children caused by abuse or neglect are relatively infrequent. In 1992, an estimated 1,149 children, or 1.8per100,000,werereportedtohavediedasaresultofmaltreatment.Itisgenerallyfeltthatdeathsfrommaltreatmentare substantially underreported and that some cases of accidental death, child homicide, and Sudden Infant DeathSyndromemightberelabeledaschildmaltreatmentdeathsifcomprehensiveinvestigationsweremoreroutinelyconducted. Thenumberofannualchildabuseandneglectfatalitiesincreasedsubstantiallybetween1985and1987,buthasremainedrelativelyconstantsincethen. Because of the protracted investigations associated with some fatalities, final numbers are frequently delayedand may be subject to revision. Fatalities for 1993 are not included in this figure because much of the data areincompleteortentative.Infact,severalmajorstatesindicatedinthe1993surveythatcasesfrom1991and1992werestillunderreview.Source:McCurdy,K.,andDaro,D.Currenttrendsinchildabusereportingandfatalities:Theresultsofthe1993annualfifty-statesurvey.WorkingPaperNo.808.PreparedbytheNationalCenteronChildAbusePreventionResearch.Chicago:NationalCommitteeforPreventionofChildAbuse,April1994.whoaremaltreated.Thesechil-drenexperienceabuseandneglectfirsthand.Amoreaccuratecountingofthein-stancesofmaltreatmentdoesnothing to lessen the victimsordeal.Butaccuratestatisticsarevitalifsocietyistoeffec-tivelycombatmaltreatment.Accuratedataoncaseloadsarenecessarytotheplanning,staffing,andbudgetingofCPSagencies.Accuratedataonchangesinratesofmaltreat-ment are necessary for evalu-atingCPSprogramstodeter-minewhatworksandwhatdoesnt.Dataoncasesofabuse and neglect that are notreportedorthatlieoutsidethepurviewofCPSagenciesarenecessary to get a full pictureofthescopeofchildmal-treatment.Recentdataonchildmal-treatment, some of which thisarticlereviews,presentamixedpictureofsocietysre-sponsetotheproblem.Themostencouragingfindingisthattherateofchildfatali-tiesassociatedwithmaltreat-ment has remained fairly sta-ble over the past seven years.Fundingforchildprotectionservices has also increased inmanystates,althoughrecentdata suggest that, on average,only70%ofreportedcasesarepursuedbyCPSagencies.4Perhapsmostdisturbingisthereportthatmorethan40% of children whose deathsareattributedtomaltreat-menthadcontactwithCPSagenciespriortooratthepr oxi mal t i meof t hei rdeathsapercentagethathasnotchangedoverseveralyears.4,18,19CHILD INDICATORS: Reported Child Abuse and Neglect241Ultimately,anyefforttotifyingandaddressingmal-usenationaldatatomonitortreatment.Thisupwardbiasintheincidenceofchildmal-nationalincidencedatawilltreatment must accommodateimpedeassessmentofpoliciesthefactthat,despiteincreaseddesigned to address the prob-interestinthisproblem,a lemofchildabuseandne-largenumberofcasesofabuseglect, and it will be necessaryand neglect are still not beingtofocusoncarefullydefinedreported.Thecurrentincom-and measured indices of mal-pletenessinreportingindi-treatmentinordertoaccu-catesthatlevelsofreportedratelyjudgewhether,how,andsubstantiatedcasesof andwhyanyprogressisbe-abusearelikelytoriseasmoreingmadeincombatingthisresourcesaredevotedtoiden-scourge.ThehelpfulcommentsandsuggestionsofRichardBarth,DeborahDaro,DavidFinkelhor,Karen McCurdy, and Ying-YingYuanaregratefullyacknow-ledged,asarethecommentsofRichardBehrman, HowardBauchner, Deanna Gomby, CarolLarson, Li ndaQui nn, PatShiono,andDonnaTerman.DeborahHerrenhelpedwithmanuscriptpreparation.Theusual caveats apply.1. Technically, the term child maltreatment refers to a variety of activities harmful to chil-dren,includingphysical,emotional,andsexualabuse,andgeneral,educational,andmedicalneglect.Thepopulartermfortheseactivitiesis child abuse.Thisarticleusesthetermsinterchangeably.Thespecifictypesofchildabusephysical,sexual,emo-tionalareidentifiedassuch.2. Straus,M.A.,andGelles,R.J.Societalchangeandchangeinfamilyviolencefrom1975to 1985 as revealed by two national surveys. Journal of Marriage and the Family (August1986)48:465-79.3. U.S.DepartmentofHealthandHumanServices,NationalCenteronChildAbuseandNeglect. National child abuse and neglect data system: 1990 summary data component. Work-ingPaperNo.1.Washington,DC:DHHS,April1992;U.S.DepartmentofHealthandHumanServices,NationalCenteronChildAbuseandNeglect. Child maltreatment1992: Reports from the states to the National Center on Child Abuse and Neglect. Washington,DC:DHHS,1994.4. McCurdy, K., and Daro, D. Current trends in child abuse reporting and fatalities: The results ofthe 1993 annual fifty-state survey. Working Paper No. 808. Prepared by the National Cen-teronChildAbusePreventionResearch.Chicago:NationalCommitteeforPreventionof Child Abuse, April 1994.5. For a brief review of the federally funded second National Incidence Study of ChildAbuseandNeglect(NIS-2),seethearticlebyFinkelhorinthisjournalissue,p.35.6. U.S.DepartmentofHealthandHumanServices,NationalCenteronChildAbuseandNeglect. Executive summary: Study of national incidence and prevalence of child abuse andneglect. Washington, DC: DHHS, 1988.7. Daro,D.,Jones,E.,andMcCurdy,K.ReliabilityandvalidityoftheNationalIncidenceofChild Abuse and Neglect Study conducted by Westat Associates in 1988: Methodological review.Chicago:NationalCommitteeforPreventionofChildAbuse,1988.8. Inordertocorrectforinconsistentreportingamongstates,theNCPCAcalculatesonastate-by-state basis the percentage change in reports from one year to the next andthencomputesthemeanrateofchangeofallstatesthatreportdata.Themeanper-centagechangeinreportsbetweenabaselineyear,suchas1986,andthecurrentyearis then multiplied by a count of children reported as maltreated by the AmericanHumaneSocietyinthebaselineyeartoobtainanestimateofchildrenreportedtobesubjecttoabuseandneglectinthecurrentyear.Thismethodisbasedontheassump-tion that individual state reporting practices do not vary substantially from one year tothe next. When the NCPCA identifies a state where reporting practices have changedsubstantially,itappearstoignorethatstateinconstructingitsnationalestimatefortheyearinwhichthechangeinreportingoccurred.Indescribingitsadjustmentpro-cedures, the NCPCA has reported that its national estimates were adjusted to anunduplicatednationalestimateofchildrenreportedforabusein1986issuedbytheAmericanHumaneSociety.Itappears,however,thatthebaselinecountusedbytheNCPCA was of duplicated reports and hence that the NCPCA data reflect duplicatedreports.(PersonalcorrespondencewithKarenMcCurdy).TheNCPCAfollowssimilar,thoughnotexactlythesame,estimationproceduresindeterminingthenumberofchildrenconfirmedasvictimsofmaltreatmentandthenumberofchildmaltreatmentfatalitiesconfirmedbyCPSagencies.(Seenoteno.4,McCurdyandDaro.)9. Comparison of NIS-2 data and CPS-based NCPCA counts is complicated. The NIS-2usedtwodefinitionsofmaltreatment.OnecorrespondedtotheNIS-1definitiontoal-THE FUTURE OF CHILDREN SUMMER/FALL 1994 242low for comparisons over time. The other was more inclusive and counted childrenwho were endangered but not necessarily harmed yet. This article uses data based ontheseconddefinition.Theyyieldanestimateofmaltreatedchildrenwhichismorethan60%greaterthantheestimateresultingfromthemorerestrictivedefinition.Usingthemoreinclusivedefinition,theNIS-2foundthatonly46%ofcasesofmal-treatmenthadbeenreportedtoCPS.However,only44%ofchildrenreportedtoCPSwerecountableasmaltreatedundertheNIS-2reviseddefinition.Hence,thereisafairly substantial number of children who are counted in only one dataset. This largepoolofchildrenisonepotentialsourceofgrowthinabusestatisticsovertime.(Seenoteno.7,Daro,Jones,andMcCurdy.)10. Most states use only two categories, substantiated and unsubstantiated, to reflect disposi-tions of investigations of reported abuse and neglect. Some states use a third category,indicated,todenotecasesforwhich,althoughmaltreatmentcannotbesubstantiated,there is reason to suspect that the child was maltreated or at risk of maltreatment.(See noteno.3, Child maltreatment 1992: Reports from the states to the National Center onChild Abuse and Neglect.)11. See note no. 3, Child maltreatment 1992: Reports from the states to the National Center onChild Abuse and Neglect.12. A slightly different picture is presented by data on substantiated cases of maltreatmentfrom 49 states in the 1992 NCANDS. In the NCANDS, types of maltreatment are alsonot mutually exclusive because states may count victims in more than one category iftheysufferedmorethanonetypeofmaltreatment.Inthesedata,49%ofsubstantiatedtypes of maltreatment were classified as neglect, 23% as physical abuse, 14% sexualabuse,5%emotionalmaltreatment,3%medicalneglectand12%other/unknown.(See noteno.3, Child maltreatment 1992: Reports from the states to the National Center onChild Abuse and Neglect, p. 14.)13. McClain,P.W.,Sacks,J.J.,Froehlke,R.G.,andEwigman,B.G.Estimatesoffatalchildabuseandneglect,UnitedStates,1979through1988.Pediatrics(February1993)91:2:338-43.14. The NCPCA data on child maltreatment fatalities are subject to several sources of impre-cision.Notallstatesreportannually,andthereportednumberofmaltreatmentfatali-ties is subject to revision in subsequent years. For each year in its data series, theNCPCAprojectsdatafromthereportingstatesontothenationalpopulationofchil-dren. This method can introduce substantial error in any particular year if large statesdonotsubmitreports.ThisarticledoesnotreportNCPCAdatafor1993becausedatafromstatesrepresenting40%ofthechildpopulationunder18weremissing,andre-ports from many other large states were listed as still under review.15. McClain and colleagues found no evidence of any increase in their estimates of abuseandneglectfatalitiesbetween1979and1988.(Seenoteno.13,McClain,Sacks,Froehlke, and Ewigman.)16. Mostmaltreatmentfatalitiesareattributedtothephysicalabuseorneglectofyoungchildrenandinfants.Accordingly,oneexplanationfortherelativeconstancyofthefatalityratedespiteasubstantialincreaseinreportsofmaltreatmentmightbethatmostoftheincreaseintheincidenceorreportingofmaltreatmentinvolvedolderchil-drenorformsofmaltreatmentotherthanphysicalabuseandneglect.Comparisonsofthe distributions of victimized children by age and maltreatment type, however, donot reveal any substantial shifts in these distributions in recent years. (See note no. 3,Child maltreatment 1992: Reports from the states to the National Center onChild Abuse andNeglect.)17. The maltreatment-related death rate is only a simple and very limited criterion bywhich to evaluate the CPS system. However, it is a measure of the ability of CPS tointerveneeffectivelyinvery-high-riskcases.18. Ingrassia, M., and McCormick, J. Why leave children with bad parents? Newsweek. April25,1994,pp.52-58.19. Thismay,however,besomethingofareportingartifactbecausethedeathsofchildrenwho were known to CPS may be more likely to be classified as resulting from maltreat-ment than deaths of children who had no contact with CPS.