Abuse and Neglect

Childhood and Adulthood – Maltreatment, Neglect, and Abuse

Comparison

Introduction

Before reviewing the following tables, it helps to recall for a moment our own experiences with news coverage, our readings of the popular culture of medicine and public health, and any medical research we engaged in related to abuse–adult or child. This retrospection is used to define our impressions on child and adult abuse. Some of these impressions are accurate, others more subjectively defined. The population pyramid statistics of abuse and neglect provide us with support of many of our impressions out there, but also open the doors to new research questions.

The following are excellent examples of the kinds of research questions that population pyramid analyses of the abuse and neglect ICDs might resolve:

What descriptive feature about the maltreated or abused patient is used to form the dividing line between “child” and “adult”?
What is the difference between the terms mistreatment, maltreatment, neglect and abuse?
Is “adult” versus “child” an age-defined factor? a behavioral type? some of both in some cases?
What are the major forms of child abuse out there?
What are the differences between a physical abuse and a psychological abuse?
What are the most commom examples for each of these?
Which forms of neglect or abuse are most shared between genders, across childhood and adulthood patient groups?
What are the professional terms (as noted by the ICD descriptions) used to define these particular behaviors or interpersonal practices that are defined as neglect or abuse?
How are adult and child abuse practices most different from each other?
How are they most similar?
Which gender is abused the most relative to the other?
Which age group?
Which maltreatments and abuses impact both the very old and very young, but have different mechanisms and psychosocial or family-related reasons for onset in these two groups?
What is the most commonly noted form of child abuse noted in the news media? form of adult abuse?
What type of abuse follows an individual into his/her dying days, without really impacting personal survival rates that much due to other underlying disease histories?
What are some examples of culturally defined abuses for children and adults that may not occur across all ethnic groups in the United States?
When is one most likely to have abuse or neglect included in their medical records documentation if that individual was a male? female?
What is the peak age for abuse for boys versus girls? women versus men? both combined?

All Child Abuse

The 6 Childhood Abuse Type ICDs

There is a 1 to 2 year difference in male versus female abuse and neglect behaviors. The single most important form of abuse to note is that of Shaken Baby Syndrome (ICD9 = 995.55). This event is most likely to occur in children under 2 years of age, and may be accompanied by other indicators suggesting such abuse might prevail, such as elbow dislocation, signs of malnutrition or increase hospitalization, or incompletion of childhood immunization requirements as measured by HEDIS for childrend reaching the age of 2 during the study period. The other page in this site covering ICDs for the very young children also include indicators of poor health in this population, with lead exposure and resulting learning disabilities exemplifying the other kinds of health problems that can be prevented by focusing on these risks of young age neglect and abuse behavior as important public health research topics.

The types of research questions related to the above figures include:

Which ICD demonstrates the youngest age risk?
Which ICD demonstrates the second youngest age for risk?
Can you think of any examples of these youngest age risks?
Gender peak age differences are greatest for which type of abuse/neglect?
Gender symmetry is greatest for which ICD?
Which ICD most resembles the overall Childhood Abuse population pyramid?
Sexual Abuse, Battered Child Syndrome and Other forms of Abuse demonstrate the same kind of gender inequality with regard to peak age, and range of age when abuse happens. Younger boys tend to reach a peak age for abuse, after which the abuse rates taper. Younger girls demonstrate the possibility that there are two peak ages for abuse, and a continuous behavior of abuse or neglect between these two ages. How would you describe this relationship and what lines of socioeconomic reasoning and gender inequality related reasons could be assigned to this very stable human behavioral difference with young children?

All Adult Abuse

The 6 Adult Abuse Type ICDs

Adult abuse is more varied and diverse in its behaviors, actions, and resulting ICDs documented clinically with regard to age and gender. The reasons for these differences are very complex, and involve socioeconomic differences on behalf of the victim, gender inequality human behavior differences targeted towards the victim, gender-specific behavioral differences displayed on behalf of the perpetrator, and age-specific differences displayed on behalf of the perpetrator. This makes for a very intersting series of research questions realted to these findings. They include:

Which single Abuse/Neglect ICD best explains the majority of Abuse/Neglect cases?
What is the single most highest risk age-gender group for neglect and abuse?
Which two neglect/abuse activities are most responsible for this peak?
Which form of abuse is least gender specific? (exclude 995.85-other)
Which two neglect/abuse ICDs are most linked to the retirement years?
Which neglect/abuse behavior is most prevalent during the most productive mid-age years of life?
Why might there be four peak age ranges in the adult emotional/psychological abuse ICD? What might be some examples of these forms of abuse?
Why might there be two peak age ranges of abuse for the nutritional abuse/neglect ICD? What might these two age groups share as common behaviors or forms of abuse? How are they distinctly different from each other behaviorally, psychologically and in terms of socioeconomic and family/significant other/care provider relationships?

Childhood-Adulthood Physical Abuse Comparisons

Reviewing the above two physical childhood abuse ICDs with the adult physical abuse ICD, how do gender differences contrast and compare?
Compare the peak ages for these three ICDs, and compare these age-gender behaviors between the two major (child vs. adult) groups.
How do childhood and adult abusive behaviors differ in terms of reasons for onset, psychology, methods of abuse?
Of the three examples above, which displays the most gender symmetry? the least?
How do they compare regarding age differences and possible physical strength of abuser versus abused?
What other methods of detecting these differences in abuse behavior exist in the form of ICDs reviews (i.e. fracture, injury, emergency or urgent care needs, etc.)

Childhood-Adulthood Psychological/Emotional Abuse Comparisons

This abuse related behavior/activity demonstrates the greatest assymetry between genders. Childhood ICDs typically have one peak age, although female related childhood ICDs do demonstrate a possible two-peaked behavior regarding the twin peaks for abuse of young girls versus single peak for young boys. This may or may not be due to a recording-based error.

Research questions:

Which of the two demonstrates the least difference between gender statistics?
What behavioral, developmental, and biological reasons help to define this minute difference? (Internal Locus of Control)
What external locus of control or environmental and social features may be responsible for whatever minor differences do exist in child psychological abuse?
What lines of psychological reasoning can be used to explain why the abuser most at fault?
What is the peak age difference for child psychological abuse between genders?
Socioculturally and psychologically (in terms of parent/abuser psychology), why might this 1-2 year difference exist?
For adult emotional/psychological abuse, how and why do emotions play a more important role in this abusive behavior and the responses by its victims?
Why is there such a difference in 1-year incidence-prevalence rates between abused males versus abused females?
Three, possibly four, age-peaks exist for adult female emotional/psychological abuse. Define these age peaks.
What related research questions does this population health feature suggest may exist?
How does it compare to the much smaller age peaks of prevalence noted for males?
If these peaks were primary linked to interspouse/significant other relationships, are there age-specific causes for stress in the abuser’s/abusee’s life that might be related to these four distinct peaks?
If they were related to adult male/female-older age/retired parent relationships, how might these peaks be explained? (which are least explainable using this explanation for interrelationships?)
If they were related to adult male/female-child>18 year old relationships, how might these peaks be explained? (which are least explainable based on this relationship?)
Based on responses to these last 3 questions, which relationships appear to be most linked to adult emotional/psychological abuse syndromes?

Childhood-Adulthood Nutritional Neglect Comparisons

Research questions:

What are examples of Nutritional Neglect?
How might nutritional neglect change relative to the age group being impacted (i.e. older victims neglect versus younger groups)
Which of the above two graphs best demonstrates gender symmetry?
Where does the most symmetric impact occur in the Adult group?
How might you explain the gender assymetry for the mid-age adult group behaviors?
There are two childhood years peaks in the adult ICD. This is due to how the medical history was documented and may be due to mistaken ICD identification, or due to the common behavior of documenting children-related observations as adult-related events. These two peaks might suggest something about childhood peaks missed normally with just relying upon childhood related nutrition neglect behaviors. This could be due to coding of childhood related nutrition neglect behaviors as those having an impact on adulthood activities and health, being predicted as such by the clinician. What are some examples of these nutritional changes or maltreatments and are there any other ICDs that may related to these behaviors? (hint, ICDs for malnutrition, vitamin deficiencies, etc.)

Childhood-Adulthood Sexual Abuse Comparisons

Research questions:

What single feature is shared by these two graphs?
How is childhood female sexual abuse different from male child sexual abuse in terms or peak ages and age high prevalence age ranges?
The Adult sex abuse graph is nearly identical with two other ICDs–anorexia nervosa and bulemia. What important insights does this provide us with about human behavior and Adult Sexual Abuse activities?
Adult male sexual abuse involves mostly just two age groups. What are these two groups?
What psychosocial behaviors are most linked to these maltreatments?

Other Childhood-Adulthood Maltreatment, Abuse, and Neglect Behaviors Compared

Research Questions

For Childhood years, ICD 995.59, what forms of abuse/neglect might the above represent?
How about the same for adulthood?

Brian Altonen, MPH, MS