Unreported Early Abuse Can Have Widespread Health Effects in Adulthood

Unreported physical abuse in the first five years of life has long-term detrimental effects, according to a recent study published in Pediatrics.

Researchers from Duke University in Durham, North Carolina followed children from kindergarten level through adulthood. Parents were interviewed about responses to their kindergarten-aged child’s problem behaviors, and interviewers used this information to rate the probability that the child was physically abused in the first five years of life.

Adult outcomes were measured based on 23 indicators of education and economic stability, mental health, physical health, and substance use, Criminal convictions also were taken into account. 

“Understanding long-term effects of adverse experiences during childhood is important for identifying potential intervention targets and areas that children, parents, and communities would benefit from additional resources for preventive efforts,” says lead author Jennifer E. Lansford, PhD. 

Study Findings

The researchers found that adults who had been abused were more likely to have received special education services, repeated a grade, received government assistance, scored in the clinical range on externalizing or internalizing disorders, and have been convicted of a crime in the past year, compared with those who were not physically abused (while controlling for potential confounders). 

Those who had been abused were also more likely to report lower levels of physical health. However, there were no differences seen in relation to substance use.

"The majority of child abuse goes unreported to authorities, yet these findings suggest that even unreported physical abuse in community samples can have long-term, high-impact detrimental effects into adulthood," the authors wrote.

“Children who are physically abused in the first five years of life are more than twice as likely as children who are not abused for a wide range of detrimental outcomes in education, economics, mental health, physical health, and criminality into adulthood,” Lansford says. 

Lansford adds that although they expected to find long-term detrimental effects of early child abuse, the magnitude of the effects was notable, especially because of the study design. 

“These were community samples with abuse that had not necessarily been brought to the attention of the authorities, and the samples were followed prospectively from childhood into adulthood rather than samples asked to recall childhood experiences, which they might have misremembered,” Lansford explains. 

A Child's First Five Years 

“The first five years of life are a critical time for not only physical development, but social and emotional development as well,” says licensed clinical psychologist and parenting evaluator Melanie English, PhD, MSW.  

As well as learning to crawl, walk, and talk, children are also learning and comprehending emotions, routines, rules, and relationships. “They look at caregivers for love and attention and to meet their basic needs,” English says. “Healthy development means they are building trust in the people around them and therefore in their environment and this is an active and important process, even considered critical.”

It’s hard to later undo these early forming views of the world, which can be pervasive and persuasive over time. “As adults, our relationships and world are much bigger than when we were children, and include our relationships with our own children, significant others, co-workers, friends, and community,” English explains. “Early childhood can create a foundation for our world view and impinge many or all of our relationships and how we perceive ourselves in the world.” 

Different Types of Abuse

It’s important to recognize that not all abuse is physical, but can have consequences that are just as severe. “They can be emotional and psychological and could be yelling, breaking items, abusing pets, excessive discipline, or restricting food, comfort, toys, or love,” English says. 

“Those belittling labels and predictive statements (like ‘you’ll never amount to anything’ or ‘you’re worthless’) can be perceived as truth and have long lasting implications on self-esteem and self-regulation (think anxiety),” English explains. “For example, if a child hears over and over again that they are a loser, they will likely believe they are one.”

Sometimes, victims of abuse will explain that while a bruise will physically heal, an emotionally abusive and derogatory name or comment can linger much longer.  

How Can We Change Things?

Above anything else, Lansford emphasizes preventing physical abuse in the first place. “For example, pediatricians and educators can speak with parents about the importance of using only non-violent forms of discipline and provide guidance on alternatives to corporal punishment,” she suggests. 

She also highlights the need for other forms of support for parents to help prevent child abuse. And for children who have been abused, early intervention is important to try to prevent entrenchment of behavioral, emotional, and academic problems that can emerge early in response to abuse and persist into adulthood. 

In some cases, there’s a legacy of physical abuse. “We are products of our childhood and there are indeed learned cycles of abuse, even inadvertently, that parents employ for parenting perhaps without realizing or questioning it or because acknowledging and recovering from abuse in their past can be painful,” English explains.

But it’s important to acknowledge that there are also parents who work hard to break those cycles of violence–through counseling, resolve, and learning new parenting techniques. “They may have confronted their past or their own parents and decided they want to stop the abuse from continuing and break away from its hold or influence,” English says.