218 Chapter 27
Thus, pre-existing or constitutional impairments may have predisposed
the child to being abused. For example, an irritable temperament might
be a cause rather than a consequence of abuse. Alternatively, the same
genetic or psychosocial factors that predispose the child or adolescent to
be abused may independently have predisposed the child to the additional
impairments. For instance, the genetic and psychosocial factors that result
in low parental IQ and thereby increase the risk of abuse also increase the
likelihood of low IQ in the child, whether or not abuse has taken place.
Physical effects
These effects on growth can be marked in severe cases, with NOFT and
psychosocial short stature described above.
Emotional regulation
More negative emotions are displayed, and emotional arousal to stressful
circumstances happens more quickly and takes longer to calm down.
Children may be hyperaroused and hypervigilant. More fear and hostility
is shown in response to adult arguments. Four general patterns may be
seen:
1 Emotional blunting and lack of social responsiveness.
2 Depressed affect with sad facial expressions, withdrawal and aimless
play.
3 Emotional lability, with sudden shifts from engagement and pleasure to
withdrawal and anger.
4 An angry emotional state with disorganised play and frequent outbursts
in response to slight frustrations.
Recently, physiological studies have shown abnormal diurnal patterns
of cortisol secretion in physically abused children that become more
normal after a year of foster care. Likewise, other physiological indices
of exacerbated reactions to stress are abnormal, such as adrenaline and
noradrenaline responses to anxiety-provoking stimuli. Adults who were
abused as children have raised levels of C-Reactive Protein, a general
inflammation marker associated with higher subsequent risk of cardiovas-
cular and other diseases.
Formation of attachments
Maltreated toddlers and infants show a preponderance of insecure at-
tachment patterns in response to separation and reunion with their
parents. Particularly common is the disorganised response, characterised
by fear, disorientation, switches between approach and avoidance, odd
expressions, freezing and other bizarre behaviours (see Chapter 32). The
insecure attachment pattern tends to persist through childhood and into
adulthood.