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October 20, 1993, Vol 270, No. 15 >
ARTICLE | October 20, 1993

Adolescents as Victims of Family Violence FREE

Yank D. Coble, Jr, MD; E. Harvey Estes, Jr, MD; C. Alvin Head, MD; Mitchell S. Karlan, MD; William R. Kennedy, MD; Patricia Joy Numann, MD; Katherine A. Scheider; William C. Scott, MD; W. Douglas Skelton, MD; Richard M. Steinhilber, MD; Jack P. Strong, MD; Henry N. Wagner, Jr, MD; Jerod M. Loeb, PhD; Robert C. Rinaldi, PhD; Brenda Stewart; Katherine Voegtle
[+] Author Affiliations

The recommendations of this Report I (A-92) were adopted by the House of Delegates of the American Medical Association at the Annual Meeting, June 1992.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the scientific literature as of March 1992.

Reprint requests to the Council on Scientific Affairs, American Medical Association, 515 N State St, Chicago IL 60610 (Jerod M. Loeb, PhD).


JAMA. 1993;270(15):1850-1856. doi:10.1001/jama.1993.03510150084035
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Published online
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References

Adolescents experience maltreatment at rates equal to or exceeding those of younger children. Recent increases in reported cases of maltreatment have occurred disproportionately among older children and adolescents. However, adolescents are less likely to be reported to child protective services and are more likely to be perceived as responsible for their maltreatment. Adolescent girls are reported as victims more often than boys, especially in sexual abuse. However, boys may be less likely to be identified or reported and often are abused by nonfamily members. Parents of adolescent victims have higher average income and educational levels and are less likely to have a parental history of abuse than parents of younger children. A wide range of serious adolescent risk behaviors is associated with maltreatment. These include increased risk of premature sexual activity, unintended pregnancy, emotional disorders, suicide attempts, eating disorders, alcohol and other drug abuse, and delinquent behavior. Incarcerated youth, homeless or runaway youth, and youth who victimize siblings or assault parents have been shown to have high rates of prior maltreatment. Signs of maltreatment are often ambiguous for adolescents. Screening questions have been effective in prompting self-disclosure of abuse. Adolescents also experience problems in the child welfare system that offers fewer and less appropriate services for this age group. Recommendations are made regarding screening of adolescents for maltreatment, the development of better services for adolescents, research on parenting to prevent maltreatment, and training of school staff to identify and refer victims of maltreatment.

(JAMA. 1993;270:1850-1856)

REFERENCES

1 +
American Medical Association. AMA Diagnostic and Treatment Guidelines Concerning Child Abuse and Neglect . Chicago, Ill: American Medical Association; 1986;.
2 +
American Medical Association. AMA Mediocolegal Guidelines Concerning Child Abuse and Neglect . Chicago, Ill: American Medical Association; 1987;.
3 +
American Academy of Pediatrics, Committee on Child Abuse and Neglect.  Guidelines for the evaluation of sexual abuse of children. Pediatrics . 1991;; 87:254-259.
4 +
American Academy of Child and Adolescent Psychiatry. Guidelines for Clinical Evaluation of Child and Adolescent Sexual Abuse . Washington, DC: American Academy of Child and Adolescent Psychiatry; 1990;.
5 +
American Academy of Pediatrics, Committee on Child Abuse and Neglect.  Rape and the adolescent. Pediatrics . 1988;;81:595-597.
6 +
US Congress, Office of Technology Assessment. Adolescent Health, II: Background and the Effectiveness of Selected Prevention and Treatment Services . Washington, DC: Office of Technology Assessment; 1991;.
7 +
Garbarino J, Schellenbach C, Sebes J. Troubled Youth, Troubled Families: Understanding Families At-Risk for Adolescent Maltreatment . New York, NY: Aldine Publishing Co; 1986;.
8 +
Hibbard PA Ingersoll GM, Orr DP.  Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting. Pediatrics . 1990;; 86:896-901.
9 +
Kurtz PD, Kurtz GL, Jarvis SV.  Problems of maltreated runaway youth. Adolescence . 1991;;26: 543-555.
10 +
Oreskovich J, ten Bensel R.  Maltreatment of adolescents.  In: Hendee W, ed. The Health of Adolescents: Understanding and Facilitating Biological, Behavioral, and Social Development . San Francisco, Calif: Jossey-Bass Publishers; 1991;:347-376.
11 +
Zierler S, Feingold L, Laufer D, Velentgas P, Kantrowitz-Gordon I, Mayer X.  Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am J Public Health . 1991;;81:572-575.
12 +
Farber E, Joseph J.  The maltreated adolescent: patterns of physical abuse. Child Abuse Negl . 1985;; 9:201-206.
13 +
Widom CS.  Does violence begat violence? a critical examination of the literature. Psychol Bull . 1989;;106:3-28.
14 +
National Center on Child Abuse and Neglect. National Child Abuse and Neglect Data System— Working Paper 1: 1990 Summary Data Component . Washington, DC: US Dept of Health and Human Services; 1992;. Publication ACF 92-30361.
15 +
US Dept of Health and Human Services. Study Findings: Study of National Incidence and Prevalence of Child Abuse and Neglect: 1988 . Washington, DC: US Dept of Health and Human Services; 1988;.
16 +
Fisher B, Berdie J, Cook J, Day N. Adolescent Abuse and Neglect: Intervention Strategies . Washington, DC: US Dept of Health and Human Services; 1980;. Publication 80-30266.
17 +
US Dept of Health and Human Services. Recognition and Reporting of Child Maltreatment: Findings from the National Study of the Incidence and Prevalence of Child Abuse and Neglect . Washington, DC: US Dept of Health and Human Services; 1980;.
18 +
American Association for Protecting Children. Highlights of Official Child Neglect and Abuse Reporting 1986 . Denver, Colo: American Humane Association; 1987;.
19 +
Straus MA, Gelles RJ.  Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys. J Marriage Fam . 1986;;48:465-479.
20 +
Daro D, McCurdy K. Current Trends in Child Abuse Reporting and Fatalities: The Results of the 1991 Annual Fifty State Survey . Chicago, Ill: National Committee for Prevention of Child Abuse; 1992;.
21 +
Blum R, Runyan C.  Adolescent abuse: the dimensions of the problem. J Adolesc Health . 1980;; 1:121-126.
22 +
Powers JL, Eckenrode J.  The maltreatment of adolescents. Child Abuse Negl . 1988;;12:189-199.
23 +
Wauchope BA, Straus MA.  Physical punishment and physical abuse of American children: incidence rates by age, gender, and occupational class.  In: Straus MA, Gelles RJ, eds. Physical Violence in American Families . New Brunswick, NJ: Transaction Publishers; 1990;.
24 +
Gelles RJ, Cornell CP.  Hidden victims: siblings, adolescents, parents, and the elderly.  In: Intimate Violence in Families . Newbury Park, Calif: Sage Publications; 1990;.
25 +
Cohen M, Adler N, Beck A, Irwin CE Jr.  Parental reactions to the onset of adolescence. J Adolesc Health . 1986;;7:101-106.
26 +
Libbey P, Bybee R.  The physical abuse of adolescents. J Soc Issues . 1979;;35:268-276.
27 +
Berger AM, Knutson JF, Mehm JG, Perkins HA.  The self-report of punitive childhood experiences of young adults and adolescents. Child Abuse Negl . 1988;;12:251-262.
28 +
Miller A. Thou Shall Not Be Aware: Society's Betrayal of the Child . New York, NY: Farrar, Straus, and Giroux Inc; 1984;.
29 +
Kratcoski PC.  Youth violence directed toward significant others. J Adolesc . 1985;;8:145-157.
30 +
Paulson MJ, Coombs RH, Landsverk J.  Youth who physically assualt their parents. J Fam Violence . 1990;;5:121-133.
31 +
Garbarino J, Gilliam C. Understanding Abusive Families . Lexington, Mass: Lexington Books; 1980;.
32 +
Gil D. Violence Against Children . Cambridge, Mass: Harvard University Press; 1970;.
33 +
Straus M, Gelles R, Steinmetz S. Behind Closed Doors . New York, NY: Doubleday & Co Inc; 1980;.
34 +
Olsen L, Holmes W. Youth at Risk: Adolescents and Maltreatment . Boston, Mass: Center for Applied Social Research; 1983;.
35 +
Finkelhor D, Hotaling G, Lewis IA, Smith C.  Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl . 1990;;14:19-28.
36 +
Vander May BJ.  The sexual victimization of male children: a review of previous research. Child Abuse Negl . 1988;;12:61-72.
37 +
Berdie J, Berdie M, Wexler S, Fisher B. An Empirical Study of Families Involved in Adolescent Maltreatment: Final Report . Washington, DC: National Center on Child Abuse and Neglect, US Dept of Health and Human Services; 1983;. Grant 90-CA-837/Ol.
38 +
Lourie IS.  Family dynamics and the abuse of adolescents: a case for a developmental phase specific model of child abuse. Child Abuse Negl . 1979;;3:967-974.
39 +
Briere J, Conte J. Cited by: Kendall-Tackett HA, Williams LM, Finkelhor D.  Impact of sexual abuse of children: a review and synthesis of recent empirical studies. Psychol Bull . 1993;;113:164-180.
40 +
Kendall-Tackett HA.  Characteristics of abuse that influence when adults molested as children seek treatment. J Interpers Violence . 1991;;6:486-493.
41 +
Kendall-Tackett HA, Williams LM, Finkelhor D.  Impact of sexual abuse of children: a review and synthesis of recent empirical studies. Psychol Bull . 1993;;113:164-180.
42 +
Gelles RJ, Harrop JW.  The risk of abusive violence among children with nongenetic caretakers. Fam Relations . 1991;;40:79-83.
43 +
Pelcovitz D, Kaplan S, Samit C, Krieger R, Cornelius P.  Adolescent abuse: family structure and implications for treatment. J Child Psychiatry . 1984;;23:85-190.
44 +
Browne A, Finkelhor D.  Impact of child sexual abuse: a review of the research. Psychol Bull . 1986;; 99:66-77.
45 +
Polit DG, White CM, Morton TD.  Child sexual abuse and premartial intercourse among high-risk adolescents. J Adolesc Health . 1990;;11:231-234.
46 +
Berenson AB, San Miguel VV, Wilkinson GS.  Violence and its relationship to substance use in adolescent pregnancy. J Adolesc Health . 1992;;13: 470-474.
47 +
Gardner JJ, Cabral DA.  Sexually abused adolescents: a distinct group among sexually abused children presenting to a children's hospital. J Paediatr Child Health . 1990;;26:22-24.
48 +
Lewis DO.  From abuse to violence: psychophysiological consequences of maltreatment. J Am Acad Child Adolesc Psychiatry . 1992;;31:383-391.
49 +
Wiehe V. Sibling Abuse: Hidden Physical, Emotional, and Sexual Trauma . Lexington, Mass: Lexington Books; 1990;.
50 +
Corder B.  Adolescent parricide: a comparison with other adolescent murderers. Am J Psychiatry . 1976;;133:957-961.
51 +
Council on Scientific Affairs, American Medical Association.  Health care needs of homeless and runaway youths. JAMA . 1989;;262:1358-1361.
52 +
McCormack A, Janus MD, Burges AW.  Runaway youths and sexual victimization: gender differences in an adolescent runaway population. Child Abuse Negl . 1986;;10:387-395.
53 +
Seng MJ.  Child sexual abuse and adolescent prostitution: a comparative analysis. Adolescence . 1989;;24:665-675.
54 +
Elster AB, Kuznets N. Guidelines for Adolescent Preventive Services . Baltimore, Md: Williams & Wilkins; 1993;.
55 +
Sorensen T, Snow B.  How children tell: the process of disclosure in child sexual abuse. Child Welfare . 1991;;70:3-15.
56 +
Johnson RL, Sheir DK.  Sexual victimization of boys: experience at an adolescent medicine clinic. J Adolesc Health . 1985;;6:372-376.
57 +
Stein A, Lewis DO.  Discovering physical abuse: insights from a follow-up study of delinquents. Child Abuse Negl . 1992;;16:523-531.
58 +
Fisher B, Berdie J.  Adolescent abuse and neglect: issues of incidence, intervention, and service delivery. Child Abuse Negl . 1978;;2:178-192.
59 +
Trainor C. A Description of Officially Reported Adolescent Maltreatment and Its Implications for Policy and Practice . Denver, Colo: American Humane Association; 1984;.
60 +
Berger DP, Rolon Y, Sachs J, Wilson B.  Child abuse and neglect: an instrument to assist with case referral decision-making. Health Soc Work . 1989;; 14:60-73.
61 +
William T. Grant Foundation, Commission on Work, Family, and Citizenship. The Forgotten Half: Pathways to Success for America's Youth and Young Families . Washington, DC: William T. Grant Foundation; 1988;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
American Medical Association. AMA Diagnostic and Treatment Guidelines Concerning Child Abuse and Neglect . Chicago, Ill: American Medical Association; 1986;.
2 +
American Medical Association. AMA Mediocolegal Guidelines Concerning Child Abuse and Neglect . Chicago, Ill: American Medical Association; 1987;.
3 +
American Academy of Pediatrics, Committee on Child Abuse and Neglect.  Guidelines for the evaluation of sexual abuse of children. Pediatrics . 1991;; 87:254-259.
4 +
American Academy of Child and Adolescent Psychiatry. Guidelines for Clinical Evaluation of Child and Adolescent Sexual Abuse . Washington, DC: American Academy of Child and Adolescent Psychiatry; 1990;.
5 +
American Academy of Pediatrics, Committee on Child Abuse and Neglect.  Rape and the adolescent. Pediatrics . 1988;;81:595-597.
6 +
US Congress, Office of Technology Assessment. Adolescent Health, II: Background and the Effectiveness of Selected Prevention and Treatment Services . Washington, DC: Office of Technology Assessment; 1991;.
7 +
Garbarino J, Schellenbach C, Sebes J. Troubled Youth, Troubled Families: Understanding Families At-Risk for Adolescent Maltreatment . New York, NY: Aldine Publishing Co; 1986;.
8 +
Hibbard PA Ingersoll GM, Orr DP.  Behavioral risk, emotional risk, and child abuse among adolescents in a nonclinical setting. Pediatrics . 1990;; 86:896-901.
9 +
Kurtz PD, Kurtz GL, Jarvis SV.  Problems of maltreated runaway youth. Adolescence . 1991;;26: 543-555.
10 +
Oreskovich J, ten Bensel R.  Maltreatment of adolescents.  In: Hendee W, ed. The Health of Adolescents: Understanding and Facilitating Biological, Behavioral, and Social Development . San Francisco, Calif: Jossey-Bass Publishers; 1991;:347-376.
11 +
Zierler S, Feingold L, Laufer D, Velentgas P, Kantrowitz-Gordon I, Mayer X.  Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am J Public Health . 1991;;81:572-575.
12 +
Farber E, Joseph J.  The maltreated adolescent: patterns of physical abuse. Child Abuse Negl . 1985;; 9:201-206.
13 +
Widom CS.  Does violence begat violence? a critical examination of the literature. Psychol Bull . 1989;;106:3-28.
14 +
National Center on Child Abuse and Neglect. National Child Abuse and Neglect Data System— Working Paper 1: 1990 Summary Data Component . Washington, DC: US Dept of Health and Human Services; 1992;. Publication ACF 92-30361.
15 +
US Dept of Health and Human Services. Study Findings: Study of National Incidence and Prevalence of Child Abuse and Neglect: 1988 . Washington, DC: US Dept of Health and Human Services; 1988;.
16 +
Fisher B, Berdie J, Cook J, Day N. Adolescent Abuse and Neglect: Intervention Strategies . Washington, DC: US Dept of Health and Human Services; 1980;. Publication 80-30266.
17 +
US Dept of Health and Human Services. Recognition and Reporting of Child Maltreatment: Findings from the National Study of the Incidence and Prevalence of Child Abuse and Neglect . Washington, DC: US Dept of Health and Human Services; 1980;.
18 +
American Association for Protecting Children. Highlights of Official Child Neglect and Abuse Reporting 1986 . Denver, Colo: American Humane Association; 1987;.
19 +
Straus MA, Gelles RJ.  Societal change and change in family violence from 1975 to 1985 as revealed by two national surveys. J Marriage Fam . 1986;;48:465-479.
20 +
Daro D, McCurdy K. Current Trends in Child Abuse Reporting and Fatalities: The Results of the 1991 Annual Fifty State Survey . Chicago, Ill: National Committee for Prevention of Child Abuse; 1992;.
21 +
Blum R, Runyan C.  Adolescent abuse: the dimensions of the problem. J Adolesc Health . 1980;; 1:121-126.
22 +
Powers JL, Eckenrode J.  The maltreatment of adolescents. Child Abuse Negl . 1988;;12:189-199.
23 +
Wauchope BA, Straus MA.  Physical punishment and physical abuse of American children: incidence rates by age, gender, and occupational class.  In: Straus MA, Gelles RJ, eds. Physical Violence in American Families . New Brunswick, NJ: Transaction Publishers; 1990;.
24 +
Gelles RJ, Cornell CP.  Hidden victims: siblings, adolescents, parents, and the elderly.  In: Intimate Violence in Families . Newbury Park, Calif: Sage Publications; 1990;.
25 +
Cohen M, Adler N, Beck A, Irwin CE Jr.  Parental reactions to the onset of adolescence. J Adolesc Health . 1986;;7:101-106.
26 +
Libbey P, Bybee R.  The physical abuse of adolescents. J Soc Issues . 1979;;35:268-276.
27 +
Berger AM, Knutson JF, Mehm JG, Perkins HA.  The self-report of punitive childhood experiences of young adults and adolescents. Child Abuse Negl . 1988;;12:251-262.
28 +
Miller A. Thou Shall Not Be Aware: Society's Betrayal of the Child . New York, NY: Farrar, Straus, and Giroux Inc; 1984;.
29 +
Kratcoski PC.  Youth violence directed toward significant others. J Adolesc . 1985;;8:145-157.
30 +
Paulson MJ, Coombs RH, Landsverk J.  Youth who physically assualt their parents. J Fam Violence . 1990;;5:121-133.
31 +
Garbarino J, Gilliam C. Understanding Abusive Families . Lexington, Mass: Lexington Books; 1980;.
32 +
Gil D. Violence Against Children . Cambridge, Mass: Harvard University Press; 1970;.
33 +
Straus M, Gelles R, Steinmetz S. Behind Closed Doors . New York, NY: Doubleday & Co Inc; 1980;.
34 +
Olsen L, Holmes W. Youth at Risk: Adolescents and Maltreatment . Boston, Mass: Center for Applied Social Research; 1983;.
35 +
Finkelhor D, Hotaling G, Lewis IA, Smith C.  Sexual abuse in a national survey of adult men and women: prevalence, characteristics, and risk factors. Child Abuse Negl . 1990;;14:19-28.
36 +
Vander May BJ.  The sexual victimization of male children: a review of previous research. Child Abuse Negl . 1988;;12:61-72.
37 +
Berdie J, Berdie M, Wexler S, Fisher B. An Empirical Study of Families Involved in Adolescent Maltreatment: Final Report . Washington, DC: National Center on Child Abuse and Neglect, US Dept of Health and Human Services; 1983;. Grant 90-CA-837/Ol.
38 +
Lourie IS.  Family dynamics and the abuse of adolescents: a case for a developmental phase specific model of child abuse. Child Abuse Negl . 1979;;3:967-974.
39 +
Briere J, Conte J. Cited by: Kendall-Tackett HA, Williams LM, Finkelhor D.  Impact of sexual abuse of children: a review and synthesis of recent empirical studies. Psychol Bull . 1993;;113:164-180.
40 +
Kendall-Tackett HA.  Characteristics of abuse that influence when adults molested as children seek treatment. J Interpers Violence . 1991;;6:486-493.
41 +
Kendall-Tackett HA, Williams LM, Finkelhor D.  Impact of sexual abuse of children: a review and synthesis of recent empirical studies. Psychol Bull . 1993;;113:164-180.
42 +
Gelles RJ, Harrop JW.  The risk of abusive violence among children with nongenetic caretakers. Fam Relations . 1991;;40:79-83.
43 +
Pelcovitz D, Kaplan S, Samit C, Krieger R, Cornelius P.  Adolescent abuse: family structure and implications for treatment. J Child Psychiatry . 1984;;23:85-190.
44 +
Browne A, Finkelhor D.  Impact of child sexual abuse: a review of the research. Psychol Bull . 1986;; 99:66-77.
45 +
Polit DG, White CM, Morton TD.  Child sexual abuse and premartial intercourse among high-risk adolescents. J Adolesc Health . 1990;;11:231-234.
46 +
Berenson AB, San Miguel VV, Wilkinson GS.  Violence and its relationship to substance use in adolescent pregnancy. J Adolesc Health . 1992;;13: 470-474.
47 +
Gardner JJ, Cabral DA.  Sexually abused adolescents: a distinct group among sexually abused children presenting to a children's hospital. J Paediatr Child Health . 1990;;26:22-24.
48 +
Lewis DO.  From abuse to violence: psychophysiological consequences of maltreatment. J Am Acad Child Adolesc Psychiatry . 1992;;31:383-391.
49 +
Wiehe V. Sibling Abuse: Hidden Physical, Emotional, and Sexual Trauma . Lexington, Mass: Lexington Books; 1990;.
50 +
Corder B.  Adolescent parricide: a comparison with other adolescent murderers. Am J Psychiatry . 1976;;133:957-961.
51 +
Council on Scientific Affairs, American Medical Association.  Health care needs of homeless and runaway youths. JAMA . 1989;;262:1358-1361.
52 +
McCormack A, Janus MD, Burges AW.  Runaway youths and sexual victimization: gender differences in an adolescent runaway population. Child Abuse Negl . 1986;;10:387-395.
53 +
Seng MJ.  Child sexual abuse and adolescent prostitution: a comparative analysis. Adolescence . 1989;;24:665-675.
54 +
Elster AB, Kuznets N. Guidelines for Adolescent Preventive Services . Baltimore, Md: Williams & Wilkins; 1993;.
55 +
Sorensen T, Snow B.  How children tell: the process of disclosure in child sexual abuse. Child Welfare . 1991;;70:3-15.
56 +
Johnson RL, Sheir DK.  Sexual victimization of boys: experience at an adolescent medicine clinic. J Adolesc Health . 1985;;6:372-376.
57 +
Stein A, Lewis DO.  Discovering physical abuse: insights from a follow-up study of delinquents. Child Abuse Negl . 1992;;16:523-531.
58 +
Fisher B, Berdie J.  Adolescent abuse and neglect: issues of incidence, intervention, and service delivery. Child Abuse Negl . 1978;;2:178-192.
59 +
Trainor C. A Description of Officially Reported Adolescent Maltreatment and Its Implications for Policy and Practice . Denver, Colo: American Humane Association; 1984;.
60 +
Berger DP, Rolon Y, Sachs J, Wilson B.  Child abuse and neglect: an instrument to assist with case referral decision-making. Health Soc Work . 1989;; 14:60-73.
61 +
William T. Grant Foundation, Commission on Work, Family, and Citizenship. The Forgotten Half: Pathways to Success for America's Youth and Young Families . Washington, DC: William T. Grant Foundation; 1988;.

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