WASHINGTON -- In the first major study of child abuse and neglect in 20 years, researchers with the National Academy of Sciences reported Thursday that the damaging consequences of abuse can not only reshape a child's brain, but can last a lifetime.
Untreated, the effects of child abuse and neglect, the researchers found, can profoundly influence a child's physical and mental health, their ability to control emotions and impulses, their achievement in school, and the relationships they form as children and as adults.
The researchers recommend an "immediate, coordinated" national strategy to better understand, treat and prevent child abuse and neglect, noting that each year, abuse and neglect costs an estimated $80 billion in both the direct costs of hospitalization, law enforcement and child welfare, and the indirect costs of special education, juvenile and adult criminal justice costs, adult homelessness and lost work productivity.
"Child abuse and neglect is a serious public health problem which requires immediate, urgent attention," said Anne Petersen, a professor at the Center for Human Growth and Development at the University of Michigan who chaired the research committee for the Institute of Medicine and the National Research Council of the National Academies. "The consequences can last into adulthood with significant costs to the individual, to families and to society."
The report, produced at the request of the U.S. Department of Health and Human Services, found that while rates of physical and sexual child abuse have declined in the past 20 years, rates of emotional and psychological abuse, the kind that can produce the most serious long-lasting effects, have increased. Rates of neglect have held fairly steady. Researchers say they don't know why.
"That's why we make that a research priority in our recommendations, said Lucy Berliner, a professor at the University of Washington's School of Social Work and a committee member. "We need to understand better the reasons behind these trends."
Berliner said the committee is proposing a coordinated strategy because they found so much variation among states, both in how abuse and neglect are defined and how local officials are trained to respond to it. "Some states had dramatic, 100 percent increases in cases of neglect," she said. "And others had 100 percent decreases. That speaks to the complexity of the problem."
Every year, child protective services receives 3 million referrals for child abuse and neglect involving about 6 million children, the report found, although the researchers say that, with unreported instances, the actual number is likely much higher. And, contrary to popular belief, the report notes, about 80 percent of the children in investigated abuse and neglect cases are not removed from the home.
Child victims are equally likely to be male or female, the report found. The majority are younger than 5. About 80 percent of the perpetrators are parents, the vast majority biological parents. More than half of the perpetrators are female.
Angela Diaz, director of the Mount Sinai Adolescent Health Center in New York and another committee member, said the report found three risk factors that increased the likelihood of child abuse: parental depression, parental substance abuse and whether the parents had been abused or neglected as children.
The researchers did not find an association between rates of abuse and times of economic hardship like the recent Great Recession.
"Researchers found relationships that were hard to make sense of: increases in child abuse in relationship to mortgage foreclosure but not to unemployment rates," Berliner said. "It's not all that straightforward. After welfare reform in the 1990s, there was a concern that as people lost their benefits, that would cause a spike in child abuse referrals. Instead, that was a period of the greatest reduction in child abuse referrals."
But while so much remains a mystery about the causes of abuse, and why some children respond to treatment and recover and others do not, the researchers said what has become clear , with the advances in brain science in the past 20 years is just how devastating and long-lasting the effects of abuse can be on the structure and the function of the brain.
Research has found that abuse and neglect can influence the amygdala, a part of the brain that regulates emotions, particularly fear and anxiety. Abuse has also been shown to change how the prefrontal cortex functions, the part of the brain responsible for thinking, planning, reasoning and decision-making, which can lead to behavioral and academic problems.
But there is hope, researchers said.
"The effects seen on abused children's brain and behavioral development are not static," said committee member Mary Dozier, chair of Child Development at the University of Delaware. "If we can intervene and change a child's environment, we actually see plasticity in the brain. So, we see negative changes when a child is abused, but we also see positive brain changes with the abuse ends and they are more supported. Interventions can be very effective."