Maltreatment 211Epidemiology
Obviously, ascertainment methods and definitions will strongly influence
reported rates. In England, about 3% of children under the age of 13 are
brought each year to the attention of professional agencies for suspected
abuse. A tenth of this figure, 3 per 1,000, are on the official Child
Protection (Safeguarding) Register for the whole age range 0–18 years.
This prevalence figure is more than doubled for the first year of life, but
then settles down to around 3 per 1,000 for children aged 1–16, after
which there is a considerable drop. Looked at another way, it is important
to note that there is still serious abuse frequently coming to light in the
10–15-year adolescent age group. Fatal abuse occurs in about 1 in 10,000
of the population, with violence-induced intellectual disability being about
as common in the first year.
In England and Wales, the most commonly registered predominant
category of maltreatment is physical abuse, followed by sexual abuse, then
neglect; emotional abuse is seldom registered. However, more common
than all of these categories, accounting for about half of all registrations,
is the non-specific ‘grave concern’, used where there is thought to be
a serious risk of abuse, for example, because siblings are known to be
abused, or because there is a convicted sex offender living at home.
The above figures refer to abuse reported to authority. A large epidemi-
ological survey was carried out in the UK in 2,000 with nearly 3,000
respondents. Some 7% of children were rated as experiencing serious
physical abuse in their families, 6% serious absence of physical care, 6%
serious emotional maltreatment, and 5% serious absence of supervision.
In the USA, the Government has carried out National Incidence Surveys
at regular intervals, and these indicate that the prevalence of abuse in
children under 18 is 2.5–4%. The lower figure includes only demonstrated
harm to the child, the higher includes danger of being harmed in the view
of community professionals and child protection services. These figures
are very similar to UK rates of ascertainment. However, unlike the UK, in
the USA, emotional abuse is the commonest predominant form registered
(1.2%), soon followed by physical abuse (1%, of which three-quarters
are considered severe), neglect (0.9%), and sexual abuse (0.7%). There
are over 2,000 deaths a year resulting from recognised abuse and neglect,
in addition to over 6,000 homicides per year of children aged under 8,
generally by family members.
These figures give the predominant type of maltreatment at the time
of registration. However, more detailed studies show that there is a large
degree of overlap, with multiple forms of abuse being the rule rather than
the exception. Thus physical abuse severe enough to reach an official
register seldom occurs in the absence of emotional abuse, and there is
not infrequently a degree of neglect; intrafamilial sexual abuse tends to
occur in an atmosphere of inadequate personal boundaries and emotional
distortions; and so on.