How prevalent is child abuse and neglect?

Iriss.fm, episode 20
Published on 17 Oct 2012

Risks of child maltreatment and sexual abuse. Reflecting on research findings and controversies, Lorraine Radford addressed a meeting of Scottish Child Care and Protection Network on 27 April 2012. She posed a number of questions, including: Are children's lives getting worse? Is there any evidence that our child protection efforts over the last 30 or 40 years have been making a difference? She also considers why child protection registrations have been declining in the area of sexual abuse and what this means in relation to the experiences of children between the ages of 11 to 17.

Date of recording
Audio transcript

What follows is a direct transcription of the audio recording, made by Iriss specifically to assist people with hearing difficulties. Because of the differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

Are children's lives getting worse? Is there any evidence that our child protection efforts over the last 30 or 40 years have been making a difference? Lorraine Radford, an independent researcher and former head of research at the National Society for the Prevention of Cruelty to Children, reflected on these and other questions about child protection and abuse at a meeting of the Scottish Child Care and Protection Network on 27 April 2012.

When we talked about preparing this presentation I thought it would be interesting to try and address some questions that I thought you might have about the prevalence and impact of child abuse and neglect, and so these are some of the questions that we thought might be of interest to you. Firstly, obviously how prevalent is child abuse and neglect today, where it's often said that child abuse is hidden and we know that there's a gap between cases that are brought to the attention of the authorities, the police and Child Protection Services, and there's a lot more happening in the population. And one of the problems has been, certainly in the United Kingdom, that we haven't had very good population representative and rigorous research into the topic in the UK. A lot of our information on child protection issues has come from the USA where they seem to fund things more generously than we do in the UK and it's difficult to be able to sort of take data from the USA and so to transpose that onto the United Kingdom because of the completely different welfare systems that we have in the UK and in USA. So I want to look at that and I want to look at some questions about, well how do you ask, and you know, if you ask about something like that which is obviously a very sensitive issue, will people actually tell you about it truthfully and particularly if you are asking children, can we even ask children such things?

The second thing that I wanted to look at was in relation to risks, because we are focusing, in this event, on the risks of child maltreatment for young people between the ages of 11 to 17 who tend to be a neglected group in child protection terms. So looking at the specific risk issues for that age group. The types of child maltreatment, there's been a lot of debate about neglect and why is it that neglect seems to be so prevalent, some of the international research literature is suggesting that some types of child maltreatment seem to be declining in prevalence but not neglect, so what, how do we interpret that, what does that mean for our practice?

I wanted to also look at the gender implications. A lot of my work has been in the area of the overlapping aspects of maltreatments and abuse of adults, looking at issues like the impact of domestic violence and how that affects children and young people, and what that means in terms of how we understand and work with child protection issues in relation to gender. And there has been some debate and I experienced it myself within the NSPCC as to whether or not is gender relevant even to child maltreatment issues? So I wanted to have a quick look at that and look at our data in that area.

And finally I wanted to address the question about, well what's happening with child maltreatment ... are children's lives getting worse, is there any evidence that our child protection efforts over the past 30 or 40 years have been making a difference for children's lives, and there is also a debate about, well what's happening with sexual abuse, why is it that ... you know, child protection registrations seem to be declining in the area of sexual abuse and what does that mean in relation to the experiences of children between these ages of 11 to 17?

So those are some of the questions that I thought we might cover, okay so looking at the first session, I am going to tell you a little bit about the methodology and what we did in the NSPCC study and how do we know, from research, that what we have got from research is an accurate picture of children and young peoples experiences? It's an area which is really fraught with conflict, if you look at some of the literature going back to the, oh gosh, well the mid 1970s, there was some horrendous conflict over the research and how you conduct research on family violence and domestic violence issues, and researchers in America, if you talk to them, will say ... well, our research was so controversial we had death threats in the space of doing our study, so it is an area where there are really huge emotions and also a great ... a lot of ideological and political differences about what you can do, the right way to ask, you know what you will be missing if you don't ask about the right things, and one of the most crucial things here is obviously how you conceptualise and think about maltreatment and abuse issues and how that affects peoples lives, it's not straightforward of course, because what you can ask people in the context of a survey doesn't accurately represent the context of their lives and their lived experiences, it's very difficult to dig underneath and to get those contextual issues in the space of a survey. So in doing this research there are conceptual issues, how you theorise, how you understand it, how you define these issues and I am going to be touching on some of that in some of the slides that I present you. There are methodological issues, how you ask, do you ask adults or do you ask the children themselves, a lot of the earlier research focused just on what adults said retrospectively about their experiences, and the NSPCC, when they did their first study in 1998, asked adults, because they felt that they couldn't ask children, it was ethically too risky and also in those days it was thought, well you know, we can't ask children these things, it's too upsetting. But actually there are mixed views on that still: there are some people that take the children's rights approach and argue that, well it's been adults that have defined traditionally and historically what abuse to children matters, and we haven't asked children about what abuse matters to them, and if you talk to children - which is what we did when we set up this research - if you talk to children who are survivors of abuse, they feel quite strongly that they have the right to tell adults what they think and what they experienced in the course of their everyday lives and what matters to them. And so there are split views even now about whether or not you can do it.

Also if you're conducting research like this, we know that a lot of abuse issues go together, some neglect doesn't often happen in isolation from emotional abuse, for example, if you are living with domestic violence, there's often an overlap between domestic violence and experiencing either neglect or abuse from the perpetrator of domestic violence as well. So some of these things go together, but the research literature, if you look at the research literature, has tended to concentrate historically on solo issues, so it's stuff on child sexual abuse or it's stuff on physical violence to children, or it's stuff on neglect, and there's very little that brings together all of those things. The NSPCC study in 1998-99 was quite unique because they did look at a whole range of issues, they wanted to look at children's experiences at home, at school and in the community, so they included things like bullying, which is often outside of the arena of child protection issues, but if you talked to children and young people who are being bullied, actually it's very significant for them that they are being bullied at home as well as in the community. So if you are thinking about impact, do you need to bundle all those things in together and look at those things to be able to identify what the impact of child maltreatment might be on children's lives? Is it safe to ask children? Do we ask children at school or do we ask them at home? What do we do about our responsibilities to protect children as well as our responsibilities to respect their rights to participate and to give us their views and how do we balance those difficult tensions when we are conducting this type of research? How do we ask children and young people in ways that are age appropriate, particularly if you are wanting to do a population survey? And there are also the politics of research, I think particularly in recent years, since the murder of Peter Connolly, that there has been a huge level of emotionality about child protection issues and in many respects it's not helped the way in which we victimise childhood, and position children in that sort of box as a certain type of victim. So if you look at the media representations of victims - child victims - they are invariable very young, babies, and they are portrayed as innocent children who, you know, completely horrendous monstrous adults have abused or neglected, and we know that the reality of child protection isn't always like that at all and it doesn't help, particularly children in the age group that we are looking at today, 11 to 17s, to be positioning them in that way because of the impact of abuse on that age group and how it affects them.

So the politics of research is difficult too and you can't be sure that if you conduct research and you craft it well that your findings are going to be reflected truthfully when they are disseminated, particularly through the media and other channels.

There are also practical things to look at, like the time, the resources available to do the research and where the research is being conducted. When we set up our study we were told we had an hour to conduct all the information we wanted, so we set up a group of international experts to advise us on how to design it, after we had done our consultations with social workers in the NSPCC, and also young survivors, and international experts: everybody had brilliant ideas about what you could ask about and in variably you find that the experts will say, ‘oh no, you must ask more about internet abuse because it's the latest issue for children', and so you end up with a list of a thousand questions and then realise actually, well can you actually ask an 11 year old a thousand questions on all these issues. Is that ethical, is that fair and is that not abusive in many respects? And also can you do that and get in and out of their house, talk to their parents first and do that in the space of an hour? No of course you can't, so there are practical things that you need to think about.

So a whole series of questions. I think one of the most important questions that we grappled with when we set up this research was the issue of the definitional aspects and what you include, because if you look at the history of our definitions of child maltreatment, historically we have broadened our definitions, so we have had adults defining what matters, so initially we had definitions that focused on life threatening physical violence and life threatening neglect, and through the history of the development of children protection we have broadened out our conceptualisation of child maltreatment and we have included within our understanding, sexual violence, living with domestic violence and emotional abuse in that period of time until relatively recently. So there are some things that we still don't recognise as being victimisations that we will count in child maltreatment studies. So some things that would happen to adults would be regarded as criminal acts of violence. They are not criminal acts of violence because adults have the power to define what matters, so physical punishment is an example, it's not counted often as a form of child maltreatment because we legally sanction it in the United Kingdom. There are other types of victimisation of children which, up until relatively recently, have been ignored as child protection issues, an obvious example is intimate partner abuse amongst teenagers. There are other things that happen, like for instance bullying that we don't often count and don't take into consideration when we are thinking about impact, and you can't separate the impact that easily if you are doing this type of study. But if you look at why children call organisations like Childline, bullying is one of the top reasons for calling Childline, so we have to take it into account. So if we are designing a survey like this and we are defining child maltreatment, what do we do, do we take an adult definition of what counts or do we ask children to tell us about all of the things that happen and then look at what they tell us and interpret it from that way? So do we take that definition that looks like victimisation and what matters to children and what might harm them, and again there's some controversy over that. We chose that latter approach, that we wanted to hear what children said about all the different things that might happen.

I didn't do this by myself, lots of resources within the NSPCC whilst the work was being done. The international expert group and obviously the other people who are in my research team and some of the people who worked very hard on the study all the way through the 3 year process, Suzanne Coral and Christine Bradley particularly, and also Stefan Colisher from the University of Cardiff who helped us with the time analysis and Helen Fisher from King's University in London. So it's now published on the NSPCC website so you can download this and read it for yourself if you'd like to have a look.

So the initial plan for the NSPCC was that they wanted to have an update on what they had done in the earlier study led by Pat Corson when the data was collected in 1998 to 99, and they wanted to look at whether or not things had changed in the past 10 years at the time, that's when we first thought about doing it. The other thing is that obviously things have changed a lot in that period of time, so I was asked to consider whether or not we would want to take into account, so those changes in methodology and how we work with children, and also the changes in the child maltreatment prevalence research literature. And so what we decided to do is that we wanted to look at, not just a lifetime prevalence, but also things that had happened in the past year, because then you get comparability with other victimisation surveys in the United Kingdom, so things like the British Crime Survey for Children which they also started doing in 2009. And we wanted to take a similar approach to the earlier study by looking at the things that happened to children at home, in school and the community, so we had comparability with the UN study of children's experiences of violence where they looked at what happened to children in the different settings in which they live their lives.

So for our study we used a measure of maltreatment and victimisation which was called the Juvenile Victimisation Questionnaire, which was a measure which looks at a whole series of different things from sexual violence, through to peer violence, to sibling violence, as well as maltreatment and neglect issues, and we also included some questions from the earlier NSPCC study, the reason we pitched the JVQ is that we did some research and we found that there were 2 instruments that had been used widely across the world at the time for asking children about their experiences of maltreatment and victimisation and the 2 instruments that had been the most, had the most endorsement from international experts were the JVQ which had been tested quite rigorously and tested against validated child protection cases and trialled in a number of different studies in a number of different contexts, and also something called the Ispscan I-Cast tool. Now when we looked at the I-Cast, at the time when we started our study, it hadn't been trialled, so there wasn't evidence that it would actually accurately produce the findings that you want on child maltreatment although it had been designed by experts. When they trialled that actually the people that used it said that actually the JVQ seems to produce better evidence, so it looks like we used the right measures. And we wanted to use age appropriate impact measures, so we had a series of different measures, of trauma impact on children, so we didn't want to just ask how much it happened, but we wanted to say well, you know, what's the evidence that it was harmful in terms of children's emotional wellbeing? So we used age appropriate measures, so different measures depending on how old the child was and for the older children we used the age appropriate measures of the trauma symptom checklist and the trauma system checklist for children. And we also used a self report measure on delinquency and to measure the impact.

So what we did is, it was a UK wide household survey, we used traditional crime survey techniques, so it was a random sample identifying households through the postcode address file, and we conducted the fieldwork between March 2009 and November 2009, altogether we interviewed 6196 participants. We used what's called Computer Assisted Self Interviewing, which means that for sensitive questions, they use it in crime surveys and victimisation research, basically it means that the person conducting the interview has a laptop computer, so they are not asked the questions face to face, they have the questions on a screen and they press their answers and then when they have finished providing their answers the laptop closes down, so the interviewer doesn't know what they have said. So we used this method to ask children and young people. We tested it first before we did it with children and young people and it was touch screen so they could press buttons actually and a lot of the young people thought it was quite fun. So altogether we interviewed ... we took a decision to interview parents and guardians of children under the age of 11 as proxy interviewers for their children's experiences, now you might say well why would you want to talk to parents, they are not going to tell the truth, when in actual fact they tell you a heck of a lot, a lot more than you expect about things that they have done themselves, things that their partners and other people have done to their children. And the other thing to bear in mind is that of course it's not just parents who maltreat children and young people, so although of course there are things that parents done know about for their younger children, and you are likely to get an undercount when you talk to parents, parents still do tell you a lot more than you would get if you tried to rely on just recorded cases, so it is worth doing.

We talked to 2275 children between the ages of 11 to 17, we decided 11 was our cut off because of the nature of the questions in the JVQ, they had been tested and cognitively tested with children and young people. We tested them with a group of survivors ourselves from NSPCC Services and the questions we had assumed to be most appropriate for that age range. We had lots of debates about, what about children with learning difficulties, what would we do, and that was partly why we used the Audio Cassie approach, so that for children they could decide to turn it off, so you could have the headphones on and hear the questions as well as see them on the screen: nobody else could hear the questions apart from the young person, and we felt that would help children that might have reading or learning difficulties, but interviewers were instructed to check whether or not the child was able to understand the questions adequately. And to have comparability with the earlier NSPCC study we interviewed 1761 young adults between the ages of 18 to 24, because the earlier study had asked adults only. So our response rate was 60.4% which is comparable with other studies in the United Kingdom, whether it's on maltreatment or ... soap powder, so it's relatively good, in fact it was better than the British Crime Survey for children, they had a lower response rate for their children's interviews. And we looked at the demographics of our sample and they were broadly similar to the UK population for under 25s in terms of gender, ethnicity, income, but the data that I present you will be weighted to adjust for any differences between ... slight differences between our sample and the UK population.

Okay ethical issues, I could talk for days on the ethical issues because they are a complete and utter nightmare. How we set it up is was that we looked at the experience of other researchers who had done it, we talked to our own social workers in the NSPCC, we talked to children in services, particularly survivors and also parents, we tested out how to do it with them. In terms of picking up the pieces, we had our ethical plan. We talked to young survivors about ... you know, if we had asked you this and we asked them to do the interview, and that was incredibly helpful in terms of how we cope with picking up the pieces afterwards. So every single person had a debrief sheet which said, you know ... it said thank you and gave information on who they could contact if they wanted to. We wanted to give children and young people the control over what happened next and so that was one of the biggest ethical debates that we had about how much control we would allow children and young people, so I had quite a fight with social workers who wanted to give more control to the professionals than to the young people. I felt it was unethical to say to children, I want to ask you about abuse but if you tell me I am going to tell someone else, and I think we had to be up front. So we decided that we had a show card which said ‘these are the types of questions you are going to be asked if you complete this survey', and so they had an idea we were going to ask them about things like rape and sexual abuse before they filled in the questions and they had lots of control on how they could skip and escape, because they were told ‘you don't have to answer, you can stop now, nobody is going to know, and its not going to affect ...' Everybody had a token payment, so the parent was given two £5 vouchers and one £5 voucher was meant to be for the child, I don't know whether they all got it, but some ... so the young people were told that they would get a £5 voucher if the parents did it, but they were told if they skipped that wouldn't affect that. In terms of ... through the interview there were various stages that said ‘it looks like you are having a tough time, would you like to talk to somebody in confidence and what's a safe and private way to contact you to do that?' And so we gave them the control to tell us, and so some of the cases, when we got the files through, we said that we had to review them within 24 hours, so they came straight to us, we looked at them in 24 hours to look at the pattern of answers, discuss them with social workers and our helpline about what would be the best things to do before we then tried to make any real contact. Most of the real contact was made through Childline or through our NSPCC helpline if they asked for it, but actually it's much less than you expected, so after 6196, it was 191, which was less than you'd think, really.

So overview of some of the findings ... okay, this is just an overview of everything that happened, everything they told us about from peers to siblings, so let me explain about this chart, there's the different age groups, so I am going to tell you about all age groups but focus on the 11 to 17's in what I say, so we have got the ... light blue is under 11's, the green is 11 to 17's and the grey colour is 18 to 24, and what we just said about increased reporting rates for the 18 to 24, so they were asked to talk about what happened before the age of 18, so this is retrospective. So you get higher rates of reporting in that retrospective group than you get from the 11 to 17's. Now partly that is because of the way in which people reposition experiences it seems, from our follow up interviews, but partly it's also because not everybody from 11 to 17 has got to age 18 and the experiences accumulate through the life course. The other thing you will notice is of course out of these, peers and siblings do a lot and for most of them there's an increase with age apart from siblings because the peak for experiencing some sort of violence or abuse from a sibling and not all of that would be regarded as abusive by the children, the peak is about ages 8 to 9 for sibling victimisation.

So what does this mean? Okay so you have got ‘maltreatment by parent or guardian' in the first column, ‘maltreatment by another adult' in the second columns, the next column is ‘exposure to domestic violence between parents', the next column is ‘intimate partner victimisation', so it's abuse from your partner. We only asked children over the ages of 11 about that. And then we have got ‘sexual abuse' which is contact and non contact, and then ‘abuse from peers and siblings' in the final ones. So basic findings were for our 11 to 17's, we had 1 in 5 who said that they had experienced in their childhood at least 1 act of maltreatment from a parent or guardian, and maltreatment included physical violence, sexual abuse, it included neglect and it excluded smacking because we counted that separately because of the legal issues about what counts, and also we counted separately ‘exposure to domestic violence', because domestic violence is very variable in its impact and we wanted to count that separately as well.

So that's what was covered, so it was the usual things, emotional abuse, physical abuse, neglect and sexual abuse by parent or guardian. It was 1 in 8, 13% of 11 to 17's had been neglected. 1 in 12 had been maltreated by an adult who didn't live with them or who wasn't a parent. 1 in 6 of the 11 to 17's had been exposed to domestic violence in childhood. 1 in 6 of the 11 to 17's had experienced sexual abuse, contact and non contact. And 1 in 12 of young people between the ages of 11 to 17 had experienced abuse from their own partners. These are lower rates than we had from our NSPCC study which was done in schools and the reason for that is that Christine Barter who did that research, talked to older children, and if you look at our rates, somebody at 11 might never had had a partner.

So the figures for sexual for the past year should be 0.6% for the under 11's, so that's actually right, isn't it? But for the 11 to 17's it's 9.4%, so it's almost 10% of children and young people between the ages of 11 to 17 have experienced some form of sexual abuse in the past year. For peers the numbers are also wrong, it should be 39.8% ... I have got the right figures here on this slide but the wrong figures in your pack, so the right figures are on the slide but the figures in your pack are wrong. So we are wrong for peers and we are wrong for siblings, so you could change your numbers if you wanted to. Okay so what does this show you? In terms of what's known about and what's now known about, we have got ‘maltreatment by parent or guardian' at 6% of the UK population in 2009. At the time we had 3% of the UK child population being recognised as being children in need and 0.3% of children subject to child protection plans or on child protection registers, depending on which part of the UK we are talking about. So it gives you some idea of the scale of the gap between known and unknown.

Looking at ‘lifetime and past year', okay so what we have talked about so far, so those columns for maltreatment are, did that ever happen, so it could have been once, it could have been thousands of times. So the NSPCC wanted us to look at severe maltreatment by a parent or guardian, or severe maltreatment by other people which is what we have got here actually, which is why you have got the red line being a bit higher than parent or guardian, so what we have got here is, the blue line is ‘any maltreatment by parent or guardian', the red line is ‘severe maltreatment by parent or guardian or other people', and then the green line is ‘sexual abuse' for each age group.

Severe maltreatment we defined as maltreatment which would be frequent, which has greater potential for injury, which caused an injury, maltreatment that would be regarded as being more serious if you looked at it in relation to the criminal law, maltreatment that included other things, so if it was neglect as well as physical violence, and also what the young person themselves said about whether they thought it was abuse or a crime or an act of violence. So if you look for ‘severe maltreatments' and compare that with any maltreatment, you see that actually quite a lot of the severe maltreatment, the maltreatment was covered by the severe, so again that gives you an indication that the measures that we uses were relatively accurate in terms of picking up on the severity of what was happening with the children and young people.

So it was 18.6% of 11 to 17's had experienced severe maltreatment in childhood. That's a lot ... it's almost 1 in 5 children, and 3.7% of 11 to 17's had experienced severe maltreatment in childhood but also have been maltreated in the past year.

Okay so looking at the types, this just gives you a few figures really, almost 10% had experienced neglect by a parent or guardian, applying these more severe criteria for neglect, so stuff that was persistent, happened over a period of time, and we know that neglect isn't a one off act but it's more like a process that undermines wellbeing.

So there's some of the things that we left out, 6.9% included physical violence, but if you take into account physical punishment, which we counted separately, 45.9% of 11 to 17's had experienced physical punishment from a parent in the past year. ‘Sexual abuse by a parent or guardian' was reported very infrequently by this age group, it was less than 1%, 0.1% and when we interviewed the young adults who had reported sexual abuse by a parent or guardian, again the numbers were very small, they were a bit higher than for this age group, but the types of sexual abuse that they were telling us about were very, very severe sexual abuse that included things like rape from age 2 upwards and also, you know, extensive use of abusive images of children and trading in abusive images. 17.5% of 11 to 17's had been exposed to domestic violence.

Okay what is this showing you? This is showing you that what you ask will give you different results actually. We did some work for the World Health Organisation looking at, well what are the patterns across the world, or even across Europe, in terms of children's experience of abuse, and I did some comparative work looking at Europe and looking at rates of sexual abuse of children across Europe, and what we found out from that was really quite surprising, very high rates of sexual violence against children and young people in places like Sweden and Denmark, and part of the reason we think that is is well firstly because of the awareness of children and young people, so what children and young people know about, they might be more willing to talk about, so it might be related to the openness about sexuality in Sweden and Denmark, but it's also related to how you ask and the number of questions. So the more questions you ask, the more people will eventually say, ‘yes that did happen'. So again there are methodological issues there in terms of how you ask. What this is showing you is the data on neglect and how the rates of neglect will vary, so it's got messages for your assessment too and how you ask about neglect in relation to assessment issues, so you will see that the red line is our ‘measure of neglect' that we used in the study which was based on the measure used in the definition in Working Together at the time, so it included things like physical neglect, medical neglect, educational neglect, lack of safety and supervision and emotional neglect. So if you apply that broad measure then you get much higher rates, if you apply ... the measure that we used was ‘severe neglect', so things that are likely to cause children significant harm, then you get a lower rate of neglect, and then if you apply the measure which was the JVQ measure, which is 1 question, which is just on physical neglect, well did you not have enough to eat, somewhere safe to live or have medical treatment when you were sick, then you get a much lower rate ... less, on the whole it's 1.6% of physical neglect for children between the ages of 11 to 17. So a lot of variation in the studies in terms of the types of things that you are going to find out.

Okay this is ... on the gap between known and unknown - how big is the gap, well it depends on who did it really. So what we found was that if somebody had been physically hurt by a care giver between the ages of 11 to 17, in about 1 in 5 cases, they hadn't told anybody, so they hadn't even told a friend about it, so it was only the surveyor, researchers that they had told. If they had experienced contact sexual abuse by an adult, it was about 1 in 3 cases where they hadn't told anybody. But if it was contact sexual abuse by somebody else under the age of 18, it was 4 out of 5 cases, nobody else knew. So there are big issues here in terms of reaching out to those children.

Okay what's this showing ... gosh, this is a complicated chart. This is just making the point about how experiences vary developmentally, because we are looking at 11 to 17's, you won't be able to see this unless you have got real eagle eyes at the back, I know, what it's showing you is these are past year rates of reporting for different experiences and different types of victimisation, and we have aggregated them into 3 year gaps to flatten out the graph a bit, so it's 0 to 2, 3 to 5, 6 to 8, 9 to 11, 12 to 14 and 15 to 17, and reading from top to bottom, we have got the top line which is everything that ever happened to you, right ... and you will see that the patterns are increasing through childhood and a decline in the later teens overall. This sort of, well I suppose it's purple, isn't it, this line ... this is peers, so experiencing abuse or victimisation by peers, and you can see how this is related to life stages for children and the periods of transitions, how their experiences will change, and a bit of a decline in the later teens. This blue line here, this is siblings, so what I said to you earlier about sibling abuse, 6 to 8 ... I think we need to think about these experiences differently though because again when we went back and re-interviewed some of our older young people, young adults, about their experiences and we talked to some who had experienced sibling victimisation, there is a group of sibling victimisation which happens where it's an older sibling, very often, and it happens to a young person in their teens where quite often there are other things happening in the family and the victimisation is really quite severe and unsafe stuff.

This line here which is the next highest line is ‘sexual victimisation', so that's contact and non contact and you can see for most types of victimisation things tend to go up in the teens. Parent or guardian maltreatment is this line, this was surprising for the NSPCC, actually some people didn't like that finding because the messages in child protection have been ‘we should be concentrating on younger children because of their vulnerabilities' but if we get this message that you have got increased parent maltreatment for young people in their teens, what does that mean in terms of our child protection messages? There are many reasons why a teenager might experience more victimisation, sometimes it can be because of conflict, you know, an older teenager and parents, that might heighten the abuse that they are experiencing anyway, what we found from our re-interviews with young adults was that actually what also happened, particularly in the later teens, was that some children and young people started to fight back and that increased the risk to those children and young people, although not in all cases, there were some young people who were actually very successful in fighting back. There was one young girl that we interviewed who had fought off her sexually abusive father who had been raping her since she was 2, and she got to the age of 14 and had all sorts of other things happening in her life and decided to just punch him in the face when he came into her room one night, and she said that that stopped the sexual abuse, she was never raped after that, but the physical violence just got worse at that stage. So there are all sorts of things that are happening with that.

The yellow line is ‘victimisation from adults not living in the home' and then the bottom line is ‘contact sexual abuse'. So basically what we need to bear in mind is that the risk to children will vary developmentally and of course the biggest risk to children are people that you know and who live in the home, and for babies and children of course a great vulnerability within the home, but for older children then the types of perpetrators that they are exposed to are a wider group of potential perpetrators, so a wider group of peers, a wider group of adults, including strangers, and strangers were the greater risk to this older age group.

Again this is showing you a similar thing for ‘past year, lifetime and severe maltreatment', a similar pattern, again for that age group 12 to 14, we have got that increased risk and then a slight decline, you see 15 to 17 take themselves out of the situation and then you have got other vulnerabilities, haven't you, so children running away?

Okay ‘gender and victimisation', I don't know why we have cut the top of the graph off here actually ... so what's this showing you, this is showing you what boys and girls experienced lifetime, for different types of victimisation, and this is ‘maltreatment by parent or guardian', so not a lot really, this is ages 11 to 17, so not a lot of difference in whether or not it's a boy or a girl that's maltreated and also for other adults, a slight difference here between boys rates in blue and girls in green. ‘Exposure to domestic violence' a slight difference here, well the big differences here are a bit predictable really aren't they ... sexual victimisation for girls, higher rates reported, this is contact and non contact, and also peers, so higher rates of peer victimisation for boys than for girls. Siblings, interestingly girls reporting a bit more.

This graph shows you who does what to who in gender terms, this is from a male parent to a male child, a male parent to a female child, a female parent to a male child and a female parent to female child, then you have got both, so you have got both to male, so it's Mum and Dad, and then both to female, what's this showing you? For our 11 to 17's, not a huge difference in terms of who does what to whom in some respects, but what we found was a bit surprising here was the female to female; the mothers more likely to be perpetrating maltreatment on girls than to boys in that age group, and again there are reasons for that, boys are more likely to fight back at a different age potentially. So the gender issues are interesting in terms of just looking at any act of maltreatment, so this is, did it happen once? When you look at the severity and you take the severity factor in gender issues, we were a bit surprised there, so if you look at domestic violence and you look at sexual abuse and severe maltreatment, you get a gender pattern. So for our severe maltreatment what we found was that in cases of ‘severe physical violence by a parent', for our 11 to 17's, in 72.9% it was a male who was the perpetrator in those cases, so you get more gendering for the severe type than for the everyday mundane. Now what does that tell you, I don't know because maltreatment is often a process, not a one off act and it may be that our severe measure of maltreatment measures the more extreme types of violence where somebody actually gets hospitalised. For domestic violence actually we found overwhelmingly that children were saying it was a male who was the perpetrator.

So what I want to focus on is looking at some of the findings on sexual abuse, impact and also that argument about whether or not it's going up or going down. Something that we need to take away with us in relation to the sexual abuse was the role of other young people under the age of 18 in sexual abuse. So the most likely perpetrators of sexual abuse were other young people under the age of 18, they were responsible for nearly 66% of the cases of sexual abuse. Parents and guardians, it was less than 5%, but as I have said that tended to be very serious sexual abuse that young people were telling us about, and 3.6% were siblings.

Again this illustrates what we have been saying already about the lifetime rates and the particular risks of different types, so these are different types of sexual victimisation, so the yellow line is showing you everything, the green line is showing you ‘contact sexual abuse', the red line ‘non contact' and there were gender differences there in relation to the types of non contact sexual victimisation that children were reporting, quite a lot of non contact sexual victimisation for that slightly younger group, but differences between boys and girls. And boys also reporting also a lot of non contact sexual victimisation but a lot from peers and some of that also involved girls under the ages of 18 in that sexual victimisation.

And then we have got the ‘cyber', and this is interesting this graph because we have got this pattern of sexual abuse using mobile phones or the internet and particularly, you will see in a minute, for teenage girls. ‘Lifetime contact', this is showing you the differences between boys and girls, so the pink line is the girls rates and how those increased dramatically and you get adult patterns of sexual abuse emerging in the later teens, and then it does actually then decline a bit because young girls and young women are the groups most at risk. And then you have got the rates for boys, for ‘contact', which might be a bit more than you were expecting too and then the green line is for both genders. This is ‘non contact' and you can see the differences between the genders is less marked here, but for the girls, again, you have got that big peak, 15 to 17 for ‘non contact sexual abuse' and you will see from the next slide that part of the explanation for that is the particular vulnerability of girls to cyber sexual victimisation.

Okay so just to say something about impact, and this is relevant for child maltreatment and also for sexual abuse and what we were saying earlier about the overlap between different types of victimisation, so we know that victimisation experiences accumulate as does the harm from that and if you were exposed to one form of maltreatment you are more likely to be experiencing other things. So the child that presents with bullying at school is more likely to also have other things happening in their lives than the child who doesn't present with those experiences. So looking at ... what we did is we did some statistical analysis to look at the relative risks of experiencing other things if you had been victimised in one way, and so if you had experienced physical violence from a parent or guardian, an 11 to 17 year old was 4 times more likely than a child who hadn't been maltreated by a parent or guardian to also experience contact sexual abuse, or to be exposed to domestic violence in the family. If they had been maltreated by a parent or guardian, they had double the risk of also being experiencing partner abuse, or abuse from an adult not living in the home. If they are maltreated by a parent or guardian they also had a greater risk of being abused as well by a sibling or by a peer.

We looked at the impact, as I said we looked at the trauma symptom and also the delinquency measures and what we did in our modelling is that we looked at anything, we looked at any type of maltreatment, so we looked at maltreatment by itself and trauma symptoms, and then what we did that was unique for the UK, is that we put in all things that you had experienced. So whether you experienced bullying sexual as well, and what impact that had, so looking at maltreatment, taking into account other types of victimisation that they experienced, taking into account other vulnerabilities that we know will affect children, like their age, like whether or not they have a disability or a parental disability or parental mental health issues, their social grade, so taking into account all the other vulnerabilities in the models. And we found that children who experienced any type of victimisation, so even sibling or peer victimisation has a detrimental impact on their emotional wellbeing, they are more likely to have high levels of trauma symptoms than children who don't. But the more types of things you experience and the more severe the maltreatment, obviously the higher the level of trauma symptoms. So children who experience severe maltreatment, including sexual abuse or physical violence were more likely, much more likely to have a high level of adverse trauma symptoms and also adverse behavioural symptoms. So again just to illustrate that, so ‘severely maltreated children' were 7 times more likely to have current suicidal ideation than children who weren't severely maltreated. They were also 5 times more likely to say that they had wanted to harm themselves in the past month than children who hadn't been severely maltreated.

The next slide illustrates the same thing I think ... right so there's a small group of children who experience a lot of things and this just illustrates what I have just said, this is the ‘trauma symptoms', so the higher the level of the trauma symptoms on the trauma symptom checklist, and this is the number of different types of victimisation, and what we are counting here is this group of children who come in that category called ‘poly victimised'. So they are not abused just by mum and Dad but by a partner and by other people in their community and peers and siblings as well, s the further you go along the chart, these are the number of different types of victimisation. So the children with the greatest amount of different victimisation experiences, so it's not just that you have been neglected lots and lots of times, you have been neglected and had these other things happen. These are the children who have the worse outcomes in trauma symptomology. Exactly the same pattern for delinquency: so the children that experience the most different types of abuse are the ones that have the highest level of delinquency and this was especially the case for girls because we found that for girls there is a huge association between high levels of victimisation and problem behaviour. As you know delinquency is also strongly associated with gender issues, boys are more likely to engage in delinquency for girls, regardless of whether they have been victimised and most children and young people grow out of crime at a certain age.

Okay just looking very quickly at the question about ‘what's happening, is it going up or is it going down?' and ‘is the world more dangerous for children than it was 10 to 11 years ago when the NSPCC did their first study?'

There are 3 arguments here and some of these will be familiar with you, there's the argument that's put forward by American researchers, Jones and Finkelhor, who argue that looking at data from a number of different sources, there are indications that child maltreatment has actually declined in recent years and there is some good news from this they argue, in that our child protection efforts are having some impact, and they argue that the decline is greatest for sexual abuse. They also look at self report data to suggest that this is the case. So they compared findings from a national study of children's experiences of victimisation from 2003 with 2008 and they argued that there are significant declines in lots of experiences of violence and abuse for children in that period of time. On the self report studies, the areas where you haven't got change for maltreatment, there's a decline in physical violence for parental maltreatment and a decline in emotional abuse by parents in that time, but what you haven't got a decline in is in neglect by a parent.

The other argument is an argument that has recently been put forward by Ruth Gilbert, Peter Sidebottom and colleagues in an article in the Lancet which came out online and they looked at comparative data from 6 nations, so they looked at hospital admissions of children, they looked at child protection data, and they looked at child maltreatment related deaths across those countries. So they are looking at official documents, not self report across those 6 European nations. And they argue that the evidence is very mixed but there is no evidence, either for or against the argument that there is a decline in children's experiences of abuse and there's no evidence of a decline in sexual abuse because it just isn't there. What they suggest is that there might be a number of explanations, one explanation might be that there hasn't actually been any change, another explanation that they put forward is that maybe there's a change in 2 directions, so there's a change in recognition, responding and identification as we have become more aware, so our efforts are better in that we are detecting more and responding to more and responding to them earlier, potentially, but there's also a change in the other direction in that children are exposed to different types of abuse than previously, like cyber victimisation, and also perhaps more children are coming forward. So there are changes in 2 directions which means that you have got a flattening out which suggests there's no difference. Which is the third explanation, increase of better awareness and intervention potentially.

Okay so comparing NSPCC findings from 2009 with 1998 to 99, what we found for the 18 to 24ss, we doubled up a set of questions that were exactly the same as the questions they asked in 1998 to 99 with the 18 to 24's in the current study, so they got 2 sets of questions about abuse. And what we found was that there were significant, statistically significant reductions in the reports by the young adults for their experiences of physical violence from a parent, so this is the decline from 98 to 2009, 13% to 9.8%, for regular verbal aggression and also for coerced sexual acts, and that was from anybody, not just from parents. But what we found was no significant change in young people's reports for neglect. Does that tell us whether it's going up or it's going down? Some explanations we need to be aware of. One is the changing context of children's experiences and what I mentioned earlier was the cyber victimisation and what's happening with cyber and online abuse ... this is the graph for girls, very high rates, for 15 to 17 year olds 13.3% had experienced cyber abuse and it was 2.9% for the males of that age group. So significant issues vary in terms of the different types of victimisation which they didn't ask about in 1998 to 99, so the different things happening.

The other thing that you might want to be aware of is the argument that's put forward by researchers like Nico Trocme, who says that sexual abuse might not be declining at all, but what's happened is that we have thrown up the thresholds, that the thresholds, evidence reporting and training have changed so much that we have taken our eyes off the ball in relation to sexual abuse and that we are not training people to ask the right questions, we are not picking up on it. Another explanation is that they might be a diversion into the Criminal Justice System for some of these cases with increasing criminalisation of online use of abusive images and that might be taking more difficult threshold cases out of the Childhood Protection arena into the Criminal Justice arena. But there are huge potentials I think in relation to thinking through some of those issues and what they mean in terms of our practice for protecting children from sexual abuse.

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