Introduction:

From the moment a child is born and all throughout the crucial period in life we deem as childhood, they are acquiring the abilities to flourish as a human being. From a psychosocial standpoint, the child forms their first attachment relationships with caregivers and this serves as the foundation for a healthy sense of self and the capacity to form trusting relationships with others throughout life (Bowlby, 1969; Cicchetti, 2016). The child is also learning, through interaction with others, how to regulate their own emotions and is developing a framework for relating to the greater world. Physiologically, brain development is occurring at a rapid pace. Billions of neuronal connections are created and then altered as the child adapts to their immediate environment (Brain Architecture, Harvard University Center on the Developing Child; Stiles, 2008; Stirling & Amaya-Jackson, 2008). For example, the limbic system, which is responsible for the regulation of emotions including that involving stress and anxiety, is evolving and adapting to the various environmental stimuli a child encounters in the immediate environment.  From a holistic point of view, every aspect of a child’s development (psychological, socio-relational, physiological/neurobiological) is inextricably interconnected and interdependent with the environmental context the child is in.

Recognizing the interconnectedness of child development involves realizing that when one domain of development is affected, the others are also simultaneously altered for better or worse. Child abuse, in any of its forms, is a devastating environmental consequence that can debilitate every aspect of healthy development from childhood into adulthood. A recent Canadian study with a representative sample across the country found that approximately one-third of children have experienced some form of maltreatment (Afifi, et al, 2014). In the United States, approximately one in four children have suffered from abuse (U.S. Department of Health and Human Services, 2014). Below, the impact of child abuse on different areas of development throughout the lifespan is examined. It is necessary to keep in mind that these adverse effects do not occur in isolation, but rather apply across all areas required for a child to grow and flourish in adulthood.

Psychological/Behavioural Consequences:

From infancy onwards, a child develops and gradually consolidates a sense of self, which becomes a point of reference for both relating to the self and the world at large. In this complex, multi-faceted process, developing the capabilities to process and regulate emotion is a necessary component for adaptive functioning (Blair & Diamond, 2008; Cicchetti, 2016; Kim-Spoon, Chicchetti, & Rogosch, 2013). In fact, researchers have postulated that the ability to regulate negative emotion is critical to healthy socio-emotional development. In other words, when a child learns how to monitor their negative emotions and respond accordingly, they develop a healthier self-concept along with more effective relationships with others.  The systems that regulate emotion also work hand in hand with cognitive systems, the processes responsible for thinking, understanding, and acquiring knowledge (Calkins & Perry, 2016 as cited in Cicchetti, 2016). When the emotion systems become dysregulated, this disrupts the communication that takes place with the cognitive systems, and results in poor adjustment and maladaptive behaviour.

The adaptive regulation of emotions begins in the earliest attachment relationships a child has with his/her caregivers (Bowlby, 1969). Children who are securely attached learn to process and regulate their own emotions through the loving responsiveness of their caregivers. When children are maltreated through abuse or neglect, their ability to process and regulate emotions are disrupted, and this can have severe consequences both on the further development of the self and on their ability to relate to others. Recent studies demonstrate that children who have been abused display more negative emotion (e.g., fear, anger, sadness) and are more reactive to negative emotion perceived in others (Cicchetti, 2016; Cicchetti & Ng, 2014). In terms of brain development, neural pathways that process negative emotion become overdeveloped, leading to an increased propensity to perceive environmental stimuli as being negative or threatening (Ayoub et al., 2006 as cited in Cicchetti, 2016). Hyper-responsivity and overreactivity to negative emotion is associated with emotion dysregulation and this in turn can have severe consequences for children both internally (within the self) and externally (in relation to the world) (Kim-Spoon, et al., 2013). For example, a child who has suffered abuse in a threatening home environment will become hypersensitive and reactive to negative emotional cues they perceive to be threats (Pollak, 2008). This may actually be adaptive in a dangerous home environment where the child may need to engage in self-defense, but becomes maladaptive when these responses are transferred into other social contexts such as at school when relating to peers. Overall, when child maltreatment occurs, a child’s developing emotional systems are severely disrupted, hampering their ability to regulate emotions, which in turn leads to further maladaptation throughout childhood and beyond.

With emotional dysregulation serving as a significant mediating link, child abuse is associated with a number of devastating psychological and socio-emotional consequences. (Cicchetti, 2016; Fergusson, Boden, & Horwoord, 2008; Jumper, 1995; Kim-Spoon, et al., 2013; Miller, et al., 2016; Stirling & Amaya-Jackson, 2008). Internal consequences, that is, those primarily affecting the individual’s internal state of well-being, can include heightened risk of depression, anxiety disorders, somatic disorders (physiological complaints with psychological origins), and suicidal ideation. In one recent study, Miller and colleagues (2016) found that emotional maltreatment in childhood was a direct predictor of suicidal ideation in both children and adolescents. Other forms of child abuse (physical, sexual, neglect) have also been shown to have similarly severe consequences that perpetuate into adulthood. A Canadian study with a representative sample across ten provinces found robust associations between three forms of child abuse (physical, sexual, exposure to domestic violence) and adverse mental health outcomes (Afifi, et al., 2014). External consequences, that is, those that manifest behaviourally, include aggression, delinquent acts, conduct disorder, personality disorders, and substance abuse, etc. Again, these may appear in childhood, but generally persist throughout adulthood, severely limiting an individual from effectively participating in society. Finally, a number of studies have revealed that child abuse is also associated with increased number of teen pregnancies, juvenile arrests, low academic achievement, and adult criminal behaviour (Kelley, Thornberry, & Smith, 1997; Langsford, et al., 2007; Widom & Maxfield, 2001). Overall, the evidence gathered from a vast array of studies demonstrate how child abuse, a contributing factor of emotional dysregulation, negatively impacts life outcomes across a variety of domains.

Socio-relational Consequences:

As soon as a child is born, they form an attachment relationship to their caregiver(s). This relationship and the type of attachment formed set the foundation for both the development of the child’s self-concept (also known as, internal working model) and their ability to relate to others in a healthy, adaptive way (Bowlby, 1969; Cicchetti, 2016). In other words, the type of attachment a child has with their caregiver has significant influence on their emotional, cognitive, social, and even physiological development. How a child learns to attach to others early in life has direct implications for the attachment relationships they form throughout life. When these early attachment relationships are disrupted through child abuse, the consequences on one’s relation to the self (e.g., self-concept, self-esteem, self-worth) and one’s relation to others (e.g., peer and intimate relationships) are destructive and far-reaching.

When children are maltreated by their caregivers, they are increasingly at risk of developing disorganized and insecure attachments (Cichetti, 2016; Cyr et al., 2010). That is, children are caught in a double bind whereby they must rely on their caregivers for support and sustenance while these particular individuals are also the source of their suffering (Hesse & Main, 2006). The consequences of being attached to caregivers in a disorganized manner are far-reaching and can manifest in difficulty relating to others later in life. For example, it has been found that school-aged children who have been abused have more difficulty relating to their peers (Cicchetti & Toth, 2015 as cited in Cicchetti, 2016). More specifically, these children are found to either withdraw from relating to their peers or to behave aggressively towards them. Some children may exhibit both types of these behaviours. Teisl and Cicchetti (2008) have also found that maltreated children have disruptions in their ability to socially process information. That is, they are more prone to making errors when interpreting social cues, respond more aggressively, or perceive the intent of others as being hostile. Finally, emotional dysregulation, a consequence of abuse covered in the previous section, has been found to mediate the link between maltreatment and the risk of being victimized by peers.

The effects of child abuse on one’s ability to relate to others do not end in childhood. Many studies have converged on the finding that child abuse is associated with relational dysfunctioning throughout life (Colman & Spatz Widom, 2004; Davis, et al., 2001; Espeleta, et al., 2016; Harford, et al., 2014; Salva, et al., 2013; Sperry & Widom, 2013). Adults who were maltreated as children tend to have more difficulty in interpersonal relationships, including those of a romantic nature and they receive lower overall social support. Specifically, child abuse, as indicated by research findings, is a predictor of more disruptions in romantic adult attachments, greater fear and avoidance of intimacy, and lower willingness to form/maintain relationships. A study examining family closeness in middle-aged and older adults showed that child abuse, especially emotional maltreatment within the family, significantly disrupted family closeness even into old age. Finally, interpersonal aggression has also been found to be associated with all forms of child abuse.

Physiological/Neurobiological Consequences:

Due to the interdependence of human development, a child’s physiological systems develop in conjunction with the psychological and socio-emotional ones. Exposure to various environmental stimuli in childhood (e.g., interactions with caregivers) directly shapes the neural circuitry and other physiological systems governing one’s ability to relate to oneself and to the world. In terms of neurobiology, the brain is extremely plastic and adapts itself to the immediate environment to ensure optimal adjustment and functioning (Stirling & Amaya-Jackson, 2008). When a child is immersed in a threatening environment, the brain and bodily systems adapt by developing a highly sensitive fight or flight system to deal with the threatening stimuli, resulting in an altered stress response (Gunnar & Donzella, 2002 and De Bellis, et al., 1994 as cited in Stirling & Amaya-Jackson, 2008). Cicchetti and Toth (2015) have found that child abuse disrupts different brain regions and neural circuitry (as cited in Cicchetti, 2016). These disruptions and alterations in neural physiology have significant consequences for all aspects of development including the emotion regulating systems, cognitive processing , language capabilities, and mental health (U.S. Department of Health and Human Services, 2001).

Researchers through a number of studies have also revealed that child abuse is strongly associated with a range of negative health outcomes in both childhood and adulthood (De Bellis & Zisk, 2014; Heim, et al., 2010; Norman, et al., 2012; U.S. Department of Health and Human Services, 2001). Different forms of child abuse are associated with increased risk of sexually-transmitted diseases, obesity, and substance abuse. Furthermore, child maltreatment, through causing biological and developmental disruptions, may also act as a contributing factor to the majority of adult diseases such as heart disease, cancer, high blood pressure, liver and lung disease, etc.

Summary:

Human development is a holistic process. From a child’s first breath onwards, they are absorbing all aspects of the environment and using these experiences to inform their development across multiple domains. Ensuring that a child feels safe and secure is critical to their potential to flourish as a human being. This requires a nurturing environment for growth and consistent loving responsiveness from caregivers and other members in the child’s immediate environment. Child abuse disrupts the process of healthy development and severely impairs a child’s ability to relate to oneself, others, and the world at large. The consequences across psychological, social, and physiological domains are devastating and persist into adulthood. The devastating outcomes of child abuse underscore the necessity of protecting children through providing them with resources for safety practices to prevent and intervene in the event of maltreatment. Ensuring that our children are safe, nurtured, and provided with the opportunity to develop to their full potential is a mandate that is crucial for the present day and the future.