The Physical Abuse of Adolescents

JOURNAL OF SOCIAL ISSUES VOLUME 35, NUMBER 2, 1979 zyx zyxw The Physical Abuse of Adolescents Patricia Libbey University of Minnesota Rodger Bybee Carleton College zyxwv T h e literature on adolescent abuse suggests that it may differ from child abuse. Issues raised in the literature focus on severity, provoking behavior by the adolescents, and community norms for discipline as crucial issues. There are several models of the dynamics of adolescent abuse in the literature. These issues and theoretical models are examined by reviewing twenty-five cases of adolescent abuse from a public welfare office in a large midwestern city. Implications of the findings for reporting injuries and planning interventions are discussed. Interest in the maltreatment of children has focused on very young “battered children.” Now it is becoming increasingly apparent that the physical abuse of adolescents is also widespread. With the onset of reporting and record keeping requirements, we now know that almost half of the known cases of abuse involve youth between the ages of 12 and 18. However, the concern about adolescent abuse is new and very little research has been done. To date, only a few articles have been published. Our argument for the need to understand the nature of abuse toward adolescents is based on the assumption that there may be important differences between adolescent abuse and child abuse. Such differences may effect definitions of incidents, explanations of incidents, and plans for interventions by public and private agencies. Correspondence regarding this article may be addressed to Dr. Rodger Bybee, Education Department, Carleton College, Northfield, MN, 55057. This study was supported in part by a grant from T h e National Institute of Mental Health. 101 102 PATRICIA LIBBEY AND RODGER BYBEE zyxw Estimates of the incidence of adolescent abuse based on abuse report registries, national surveys and research studies vary considerably. T h e American Humane Association (1 978) reported that approximately 36% of abuse and neglect cases involved the age group 10-18. In his national survey Gil (1973) found that 16.9% of reports were for youth over 12 years of age. If the next lower age grouping, 9 to 12, is included, then the incidence rate is 28.3% of all reported abuse. In a recent survey reported by Gelles (Note l), 66% of youth of ages 10 to 14 were struck, and 34% of youth of ages 15 to 17 had been hit by their parents. In this issue Gelles and Straus report an interesting finding based on their national survey of family violence. They found the rate of abuse peaked at two ages, the youngest (3 and 4 year-olds) and the oldest (15 to 1 7 year olds). This pattern seems particularly important relative to the dynamics of violence toward youth. In a nationwide study of adolescent girls Knopoka (1975) unexpectedly discovered that many had violent encounters with adults. Twelve percent had been beaten and 9% reported being raped at some time in their life. Knopoka reports that many also attempted running away or suicide. While it is difficult to identify the exact incidence rate of adolescent abuse because of different age groupings, variations in definitions of abuse and differing sampling methods, it does seem clear that substantial numbers of adolescents are being abused. This paper is an inquiry into the physical abuse of adolescents. In order to clarify the problem, we first review the literature and theories of adolescent abuse. Then, we present the findings from a review of 25 case studies. Finally, we discuss our findings and suggest areas for further research. zyxw zyxwvu A REVIEW OF LITERATURE O N ADOLESCENT ABUSE Information and theories about adolescent abuse come from two sources. One source is research on or discussions of confirmed cases of adolescent abuse (Lourie, 1977a, and Note 2; Berdie, Baizerman, & Lourie, 1977; and Cabot, & Carouso, Note 3). There are also articles about adolescents initially identified as having other problems such as: juvenile delinquency (Steele, Note 4); running away (Opinion Research Corporation, 1978); attempted suicides (Jacobs, 1971; Connell, 1972); and, truancy (Libbey & Bybee, Note 5). In looking for possible explanations for this behavior, these authors found that significant numbers of these ADOLESCENT ABUSE zyxw zy 103 adolescents had experienced physical violence in their families. While the causal relationship between these problems and abuse is not clear and needs further study, the evidence for adolescent abuse is clear. From these articles several issues and theories emerge. They focus on the definition of adolescent abuse, on models accounting for such abuse, and on suggestions for interventions in abusive families. Definitions, explanatory models and interventions are often presented as conceptually isolated, when in fact they are all interrelated. This caveat should be noted as various aspects of adolescent abuse are discussed, and especially as public policies are developed around the problem of adolescent abuse. zy zyx Definitional Issues Most discussions of definitions focus on the terms “adolescent” and “abuse.” Issues most often center on the age that should mark the beginning and ending of adolescence, and on differentiating between physical, sexual and emotional abuse and neglect. Since this paper is an inquiry into only the physical abuse of adolescents and we have chosen to study persons between the ages of 12 and 18, we will not explore these two issues any further. A more important definitional issue surrounding adolescent abuse involves distinguishing between “abusive incidents” and “disciplinary incidents.” The task of differentiating between discipline and abuse is faced by participants (i.e., the adolescent and parent or caretaker) and observers (i.e., social worker, police, school personnel, hospital staff). The definition in turn affects their decisions to report, deny, or confirm an incident as abusive. However, the major difficulty with most definitions, as Parke (1977) points out, is that they focus on the parent as the sole agent inflicting injury on a passive victim, not mentioning the extent of the injury, the child’s role in elicitingabuse, or community norms governing child-rearing patterns. Yet all three of these factors-severity of the injury, behavior of the adolescent and community norms for discipline-are cited in the literature on adolescent abuse as important elements in abusive families. Each aspect plays a role in any attempt to define an incident as abuse or as discipline. Adolescent abuse is generally less severe than child abuse and some injuries may be overlooked for that reason (Lourie, 1977b). In addition to the fact that injuries may go unnoticed, however, a less severe injury may also be discounted in those communities where physical punishment such as hitting, slapping, zyx 104 zyxw zyxwvut PATRICIA LIBBEY A N D RODGER BYBEE or whipping with a belt are acceptable. In fact, in 20 states child abuse laws specify that only “serious injuries” be reported (Fraser, 1974). If adolescent abuse is less severe than child abuse, and if reporting is mandatory only for serious injuries, then adolescents, caretakers, caseworkers and law enforcement officers are all likely to think of less serious injury as acceptable physical punishment, and not report the incident. T h e problem of trying to distinguish between discipline and abuse is further compounded if, as Berdie et al. (1977) suggest, others perceive the adolescent as intentionally contributing to the situation, by acting out of control and hence “deserving” punishment. This raises questions such as: Is a bruise from being hit by a belt “discipline” rather than “abuse” if the incident was preceded by rule-breaking or law-breaking behavior? T h e severity of an injury and the presence of “provoking” behavior by the adolescent tie into the difficult task of differentiating between discipline and abuse vis-a-vis community norms. As Lourie (1977a) points out, “violence ranges from what most people would consider acceptable punishment to what all would consider abuse.” (p. 268) According to Parke (1977) this range is not marked by any clear legal definition. For Parke, abuse is a communitydefined phenomenon that must be viewed in the context of community norms governing the appropriate conduct of adults in their interactions with children. Assuming that identifiable community norms exist, how might these norms affect the decision to report? Later, we report findings from case material and discuss their implications for refining and clarifying the definition of adolescent abuse. zyxw Explanations of Adolescent Abuse Researchers studying child and adolescent abuse have offered several hypotheses to account for the dynamics resulting in an abusive incident. Three sets of these will be discussed below, as three alternative models of abuse. Lourie (Note 2) substantiated an earlier study (Lourie, 1977a) by reviewing 70 cases of “confirmed” adolescent abuse. He reports that most adolescent abuse begins in the family when the youth reaches adolescence. T h e hypothesis is that the special characteristics of adolescent development are contributing factors for cases of abuse that begin after childhood. He cites the two major tasks of adolescence, separation and control, as potentially leading to conflict in the family. He further suggests that, if these common developmental tasks occur at a time when parents are also zyxw zy 105 ADOLESCENT ABUSE experiencing the normal stresses of middle age, which may be exacerbated by socio-economic difficulties, the possibility of abuse is increased. This model describes a situation in which the developmental tasks of the adolescent and the mid-life tasks of parents increase tensions within the family. Adolescents are asserting themselves and parents have a lowered threshold of tolerance for adolescent behavior. When a particular incident occurs (e.g., breaking a rule), abuse can be the result. In general, abuse is a case of the parent “going too far” in disciplining and is either a single reported incident or it occurs infrequently. The family system is stressed but not dysfunctional. Kempe and Kempe (1978)present an alternative model which emphasizes severe behavioral difficulties of the adolescent (such as stealing, failure in school, aggressiveness and running away). These behaviors are often present in families where the parents or caretakers also have problems (such as immaturity, isolation and acting irrationally). Kempe and Kempe assume that the dynamics of adolescent abuse are similar to the dynamics of child abuse though the actual abuse may not have started until adolescence. Research on runaways and on delinquents who were subsequently found to have been abused agrees with this view. I n this model of abuse some of the characteristics associated with abuse of younger children are present, albeit in slightly different forms. T h e “difficult” or “special” child who was perhaps colicky or hyperactive now is labelled “aggressive” or “provoking.” The parents are characterized as lacking in warmth and are rigid and controlling disciplinarians. T h e emphasis in this model is on the psychopathology of both parent and adolescent. T h e third model is sociological. The sociological theme has been widely developed in child abuse literature (Gil, 1973;Gelles, 1973; Giovannoni & Billingsley, 1970). Although no research has been carried out specifically on the sociological and situational aspects of confirmed cases of adolescent abuse, both Lourie (Note 2) and Kempe and Kempe (1978)cite the presence of such factors as poverty, job loss, and social isolation as stresses which contribute to abuse, but they do not consider these factors primary. All of these models include the relation: parent child crises = abuse. But each emphasizes a somewhat different aspect of the equation and none of them asks whether increased parental, child or societal problems will lead to an increase in the frequency, intensity and severity of abuse. In our review of the data we will explore the interaction among parent, child and social stress, and the possibility of corresponding changes in the type, frequency or severity of abuse. zyxwv + + 106 zyxw zyxwvu zy PATRICIA LIBBEY AND RODGER BYBEE Intervent ions We could find no studies reporting the effectiveness of intervention programs for adolescent abuse. The case studies in our review did not include any assessment of intervention programs. Several issues are raised in the literature, though, that could be explored in our review of the case material. First is the issue of whether abused adolescents conceal their injuries, do not seek help and resist therapy or intervention (Patrick & Wander, 1974; Kempe & Kempe, 1978), or if their added maturity enables them to act on their own behalf. Parke (1977) suggests that we have not appreciated the full range of individual competence among children who are capable of understanding the sociolegal and moral basis of their rights. This would imply that adolescents would be likely to seek help and report being abused, yet they do not. Secondly, we wished to know whether abusive families were isolated from social support systems. zyxw A REVIEW 0~2.5CASESOF ADOLESCENT ABUSE In order to begin the search for answers to these questions, both practical and theoretical, we initiated a study of reported cases of adolescent abuse in cooperation with the staff of a county welfare office in a large midwestern city. The study was conducted over a ten month period. It included all reported cases of adolescent abuse during that period. While we reviewed cases of sexual abuse, they are not reported here. Our research started with a review of the literature on adolescent abuse. We also attended meetings with personnel associated with an active child abuse team (e.g., case workers, school personnel, probation officer and psychologists). We developed questions and had them reviewed by the child abuse team. After revisions, they formed the bases of our data collection. (See the column headings in Tables 1 and 2). One social worker was assigned to cover adolescent abuse cases under a grant from the National Institute of Mental Health. This person was a specialist in adolescent abuse case work. The case worker’s observations and collection of other information was done independently of our work. The case worker observed the families, reviewed records and discussed the problem with school personnel and other professionals closely related to the case (e.g., social workers, psychologists, physicians, attorneys, law enforcement officers, etc.). The case worker’s files and experience were used to complement the data sheets we had developed. ADOLESCENT ABUSE zyxw 107 Earlier studies in adolescent abuse have not reported case by case information or summaries of that information. Usually one or two cases are described as typical and then implications are discussed. In order to avoid this problem and to let the reader gain a better sense of adolescent abuse, we present the case information in Tables 1 and 2. During the study we reviewed 25 cases of physically abused adolescents. Demographics of the adolescents and families and information pertaining to the confirmed incidents are summarized in Table 1. T h e range of ages reported was 12 to 17 with the majority (14) reports in the 15, 16 and 17 year old group. This finding should be noted in reference to rate patterns reported by Gelles and Straus in this issue. Sixty-four percent were girls. Twenty-two were Caucasian, one was Oriental and two were Black. Men were the perpetrators twice as often as women. In 10 cases it was the father, 5 the stepfather, and 2 the father by adoption. Six mothers, 1 stepmother and 1 mother by adoption were reported. T h e family makeup included 13 with both natural parents, 7 divorced and remarried, 3 single parents, 2 adoptive parents. T h e most prevalent means of abuse was hitting (20 cases). In more then half of those cases the perpetrator used an object such as a stick or belt. T h e usual physical results were bruises, contusions, cuts and scratches. In 80% of the cases (20) abuse started with the onset of adolescence; the rest had experienced some abuse in childhood. Twenty-five percent of those beginning in adolescence (5) were single incidents; 50% (10) were sporadic and 25% (5) were chronic and ongoing. A range of socio-economic classes are represented although most were from lower middle or upper lower groups. Only three families were classified by the case worker as in a low economic group. T o help clarify issues concerning definitions and explanations of adolescent abuse, we developed Table 2 outlining the dynamics of abuse in the families. Columns 1, 2, and 3 identify the case reviewed and the age and sex of the adolescent. T h e cases were arranged in Column 4 in order of the frequency of abuse beginning with one-incident cases and ending with cases ongoing since childhood. T h e next three Columns 5, 6, and 7, center on the adolescent and include childhood history, general adolescent behavior, and behavior at the time of the incident. The next two Columns, 8 and 9, detail the adolescent’s and parent’s zyxw z z zyxwvut zyxwvu c 8 TABLE 1 PHYSICAL ABUSECASES Case Age Sex 2 14 F 3 17 F Ethnicity Mother (occasionally father) Caucasian Adopted father Adopted mother (enabled) Oriental 5 17 M Caucasian 6 16 F Caucasian 7 16 F Caucasian Perpetrator Siblings and Abuse 4 children victim-oldest no others abused only child Adopted father 5 children Adopted mother victim-oldest no others abused 5 children Father victim-next to youngest no others abused 3 children Father victim-oldest no others abused 4 children Stepfather victim-oldest no others abused 2 children Unknown victim-oldest (mother or babysitter) no others abused Socio Economic Status lower middle upper middle upper middle Confirmed Incident Injury or Effects Frequency of Abuse hit with stick spatula & banged head on wall hit with belt on arms, back, buttocks & thighs hit with radio microphone &bitten by mother hit with closed fist bruise marks and emotionally upset continuous after adolescence massive bruises 3 minor incidents in past year hit with shoe bruise bruises, scratches, bite marks, poor ongoing from infancy judgment, fantasizing symptoms of concussion 1st incident v > td CI 9 c W W ? > z zy s zyxwvutsrqp 8 17 F Caucasian & Spanish 9 14 M Caucasian middle lower middle U 3 other incidents-used objects middle (military) hit girl in head with rifle butt bruise & swelling on head 2 other incidents lower unconfirmed, but social worker is certain adolescent was abused severe black eye, broken arm, (not healing after one month) unknown $ P W .e W m m TABLE 1P-ntinued 11 13 M Caucasian Stepmother 14 16 F Caucasian Father 15 16 F Caucasian Father 17 12 F Caucasian 18 13 M Caucasian 20 14 M Caucasian Stepfather 21 16 M Caucasian Stepfather 22 16 23 14 2 children victim-oldest other abuse unknown 2 children victim-youngest no others abused 4 children victim-youngest no others abused 4 children victim-next to oldest no others abused 2 children victim-youngest no other abuse 3 children victim-youngest no othen abused 4 children victim-youngest no others abused 3 children victim-oldest no others abused 5 children victim-youngest no others abused lower middle zyxwvu zyxw unable to confirm a specific incident bruises, scratches & cuts, emotional disturbance chronic and ongoing middle hit adolescent in head with fist contusion owasionally over past 2 years upper lower hit adolescent in face with fist lacerated lip 1st incident since childhood zyxwvutsrqp Father Stepfather upper lower hit adolescent with belt small bruise, upper arm 1st incident in 3 years upper lower hit in face with hand black eye “hitting is a way of life” upper lower grabbed adolescent & pushed upstairs to room adolescent hit in face during fight 3 scratches & 1 scrape 1st incident swelling, bruise on left jaw 1st incident lower middle zyxwvutsrqponmlk zyx z F Black Mother F Caucasian Father middle lower adolescent hit with a stick bruise on upper arm lower middle hit on thigh & buttocks with belt bruises on thighs & buttocks regular hitting (but never before with a stick) 1st incident c. 0 z z zyxwvut zyxwvu c. CI TABLE 1-Continued PHYSICAL ABUSECASES zyxwvutsrqpo zyxwvu Ethnicitv Perpetrator Case Am Sex 24 17 M Caucasian Mother 15 F Caucasian Mother 29 14 F Caucasian Father 30 13 F Caucasian Father 31 17 M Caucasian Father 25 0 32 14 F Caucasian Stepfather 33 17 F Caucasian Father 34 13 M 35 17 F Black Mother Caucasian Mother Siblings and Abuse Socio Eeonomic Status Confirmed Incident Injury or Effects Frequency of Abuse 4 children victim-youngest no others abused 2 children victim-oldest no other abuse 2 children victim-oldest no other abuse 1 child middle adolescent hit on head with stick two bumps on head occasional middle mother and adolescent had a fight leg broken during discipline bruises & scratches frequent for a Ye= broken leg 1st incident bruises 4 natural 5 adopted victim-youngest no others abused Only child lower middle hit with belt on thighs hit with hand in head ongoing for 7 months 1st incident 3 children victim-oldest no others abused 4 children victim-oldest no others abused 2 children victim-oldest lower middle lower middle lower middle F3 W black eye bruises 2 > 3 c hit with belt on thighs beat around head with fists small bruises 3 times recently bruises on head several times since adolescence lower hit with belt bruises, cuts on thigh several times since divorce 1 year upper middle grabbed hand burn on hand from cigarette 1st incident lower middle TI n> 8 '2P z n W M zy zyxw zy zyxw ADOLESCENT ABUSE 111 perception of the incident. Columns 10 and 11 present the case worker’s observations of the parent’s childrearing practices and significant events in the family history. The last two Columns, 12 and 13, describe the family’s interaction with social agencies. Summaries and discussion of the data in Table 2 are organized around the issues raised in the review of the literature. These issues are: (1) how to make distinctions between abuse and discipline; (2) how to construct explanatory models of abusive incidents; and (3) how to intervene appropriately in abusive families. We assume that understanding these issues will in turn affect social policy decisions on the prevention, recognition and treatment of adolescent abuse. zyxw zyxw A buse or Discipline? Based on the review of the literature, we were interested in looking at the adolescent abuse cases with three questions in mind. How severe was the injury? What did the adolescent do previous to the incident? What perception did the participants have of discipline in general? Our data show that in most cases the physical injury was relatively minor. There were 11 body bruises, 7 head injuries, 3 scratches or burns, all minor, and 3 with massive bruises or broken bones. Earlier discussions with abused and non-abused adolescents (Libbey & Bybee, Note 5) revealed that most of 40 adolescents questioned in that study believed that hitting the head was abusive, but spanking or using a belt was not severe and could be termed discipline. So, we separated the injuries into two categories, body bruises and injuries to the head. In these cases 44% were minor body bruises; 38%were head injuries. Head injuries occurred in the families where discipline was generally physical. Theorists have suggested that adolescent behavior may be interpreted as “provoking” or “deserving” of punishment. We therefore assessed the adolescent’s behavior in the incident by noting both the adolescent’s activities immediately prior to the incident and his or her less recent behavior that might be important for understanding how the injury occurred. Twenty-two of 24 abusive incidents were immediately preceded by the adolescent disobeying or arguing with the parent. One other case was an injury that occurred when the adolescent became involved in a parent’s fight. Disagreements were typical adolescent-parent conflicts such as cleaning up a room, closing a door, staying out too late or leaving food about the house. However zyxwv zyxwvuts zy zy zyxwvutsrqponmlk 112 PATRICIA LIBBEY AND RODGER BYBEE TABLE DYNAMICS OF (2) (1) (3) (4) Frequencc Injury Perpetrator (5) Childhood Behavior (6) (7! Behavior at Time of Abuse (8) Adolescent’s Response and Explanation zyxwvu Adolescent Behavior Case Age Sex 35 I7 F 1st incident Cigarette burn o n hand Mother Normal childhood Good student. Recently breaking mother’s rules & not living u p to her expectations. Was not enthusiastic about going to brother’s banquet. Showed to school nurse. Girl & mother arguing, mother chased her, pulled her hair. 6 16 F 1st incident Bruise Father No problems Good student. Classical guitar, She and sister shopping for Christmas presents. Recent arguing with parents. Went to hospital, worried about concussion. 29 14 F 1st incideni Broken leg from fall when father was carrying her u p to room. Father Good student Active in church, good student. Refused to clean up room, Talking back. Neighbor’s daughter told parents who reported. Girl said break was an accident. 23 14 F 1st incident Bruises on thighs with belt Father Good student Good potential. Past year cutting class, trying pot & associating with undesirable group. Told counselor School called at youth serparents about vice bureau. missing school, losing a school related job. 20 14 M 1st incident Scratch marks Stepfather No problems Truant from school. OK when there. Truancy because of taking care of mother. 3 17 F 3 in last year Massive bruises Adopted father Vowed in 3rd grade to become doctor. 32 14 F 3 times in I 1 months Bruised with belt Stepfather Good Boy got in fight between mother and stepfather who had just learned he had been out of school. Lied to parents Excellent about boy grades. friend. Slept Defying parents with Caucalast 4 months; sian boy very complifriend. ant until then. Showed school nurse. Defying mother Lied about going out over rules with girl after grandfriend not almother died lowed to see. who was careHe hit her by taker 3 years lake in weeds. ago. Told school counselor. Showed school nurse 1 week later when bruises were still painful. Said her isolation from friends had been worse than beating. zyxw zy zyxwvutsr zyxwvutsrqpo zyxwvu 113 ADOLESCENT ABUSE n L AD~LESCENT ABUSE (9) Parent’s or Caretaker’s Explanation (10) Childrearing Approach Parent’s Past History Past Agency Involvement Privilege denial. Mother over-directing in children’s Mother involved in children’s activities, initiated 2 family counseling sessions over girl’s behavior, then quit. 2 private agencies in last 9 months. Mother did not like her deficiencies being discussed, quit. Girl requested no intervention. Case is being monitored. Father expressed concern over his response. None School social worker and older brothers monitoring. Same as girl, she fell Talking, grounding, Parents were high school sweethfrom his grasp privilege denial, earts. Had to get and twisted her warm family married, pregnant leg. with this child. Father ambitious, owns 2 service stations & works 7 days a week. None Monitoring since stories fit, parents cooperative. Father felt badly, trying to shock her since other children had not been this way. Using grounding privilege denial. Warm family except when Father is drinking. Father has been in alcohol treatment. Mother in Alanon. Older 3 were very good, her actions upset them. Youth service bureau to ward off more serious problems. Continue treatment at youth service bureau. Same stress on truancy. Also mother had been drinking. Stepfather uses grounding not force, hunts & fishes with boy. Both show concern for boy, Extended family until recently. Mother had surgery, started drinking. Boy had been staying home to take care of her. Welfare dept. social service worker. Boy did not want service. There appeared to be family supports available. Father said it was his duty to discipline for citizenship. Highly disciplined closed formal family Older, Chinese adopted girl as orphan. Disowned girl after she reported incidmt. County welfare for adoption when she was 3. Shelter home, then foster home, therapy for girl. Same story. Stepfather rigid, demanding. Mother easygoing & cares but feeling helpless. Unmarried mother with 2 jobs to support. Married recently to obese man I I years younger. He was in foster homes as youngster. Child guidance clinic 2 years, child not cooperating. Family counseling. Mother said burn was an accident. lives. Angry over earlier Ground, privilege argument about denial. chores and profanity, lost control when she swore at wife Disposition zyxwvuts zyxwvutsrqponmlk zyxwv 114 PATRICIA LIBBEY AND RODGER BYBEE TABLE 2 DYNAMICS OF (1) (2) (3) (5) (6) Childhwd Behavior Adolescent Behavior Case Age 33 17 Occasional bruises on head and neck Father Good 34 13 Occasional. Onset at adolescence. Bruises on thighs Mother 25 15 Frequent fighting for a year Bruises Mother 22 16 Regularly, 1st time with stick Bruises Mother 7 16 30 18 2 Sex (4) Frequence Injury Perpetrator (7! Behavior at Time of Abuse (8) Adolescent’s Response and Explanation Good, but defy- Arguing over girl’s sassy being mother over curfew. havior. Mother told father. H e yelled, she swore & pushed, he hit. Told principal because she was called to office after being truant Adequate student, involved in sports. Defying mother Did not come home on & teachers time. for a year since mother’s divorce & move away from father. Wants to be with father. Told police that mother’s boyfriend did it. 1st grandchild. Special attention. Acting prodisly. Unknown Expelled from 4 schools in past year. Not a standout, now truant. 3 other times Recently bruised Father 20% congenital hearing problem. Held back in grade school. Few friends. Se- Refused father’s Showed school nurse her order to close ductively agbruise. a door. gressive toward men, childish toward boys. 13 Ongoing 7 months Belt bruises Father Good Good in school, maiure. Girl lied to father ahout school detention. Told counselor at youth service bureau. I3 Hitting is way of life Black eye Stepfather 2 years Drug involvement, on probation for stealing, hall fights in school. Mother confronted boy over stealing. Father hit. Boy says he deserved it. Boy told school nurse. Onset with adolescence Bruises on arm and hand Mother Good Below potential in school, poor peer relations. Fight with younger sister. Father called police because mother hitting daughter. Very distraught. 14 zyxwv zyxwvuts below grade school level in school Girl broke grounding rules. Good reputaArgument with tion at school. stepfather over dishes. She showed school nurse Showed bruises to school nurse. zy zyxw zyxwvutsrq 115 ADOLESCENT ABUSE Continued zyxwvutsr zyxwv ADOLESCENT ABUSE (9) Parent’s or Caretaker’s Explanation (10) (11) (12) Childrearing Approach Parent’s Past History Past Agency Involvement Dad strict physical Same story. Dad disciplinarian. says he is strong physical discipliMother an uneffcuive screamer, narian. Believes in lenient & deit, this got out of manding. hand. Father on late shift. 5 family counseling Both parents sesessions over v e d y disciplined boy’s stealing. as children. 13 year old son shoplifting recently. (13) Disposition Youth service bureau Divorce court Child guidance clinic family counseling. Indulging when Mother has had exyounger, controllnssively high ing now. expectations about acting Catholic social service for a year. Shelter homes for 1-1/2 months. Now home with family counseling. No explanation Mother is very controlling. Mother on welfare, many moves, had stroke, has weight problem. Welfare School social worker monitoring. Worried about her seductiveness. Controlling, but inconsistent. Father’s hearing poor, lots of yelling. Worked in construction until injury, now a janitor. Mother took daugh- Family & individual counseling. ter to planned parenthood clinic. School counselor & school nurse helping. Same Father rigid physical discipline Parents divorced 8 yean ago, girl lived with mother until 7 months ago. None Mother said she did it. Concerned mother. Tried many disciplines, nothing worked. Mother is afraid of all the fighting. Mother divorced I year ago, said he was inadequate. Left state, made good stan here, boy & mother are highly motivated. Child returned to California and mother. zyxwvuts Same story as boy. Punching is a way of life. Child out Probation officer has been advising of control. stepfather to k a c k boy up side of head.” Family on welfare in Probation youth paat. Both parents service bureau alcoholic. Now counseling boy in have a family resapccial program taurant. in school. Same explanation Mother has history of mental illness & retardation. Father sober for 5 years. Sister mentally retarded. Mother has no warmth. Yelling & hitting is a way of life. Boy committed another crime on probation, in group home & drug treatment. 15 year involvement Child with relatives. with every social agency in county. Child protection for 10 years. Evaluations for all family members. Now worker with expertise in mental retardation on case. zyxwvut zy zyxwvutsrqponmlk zyxwvuts zyxwvutsr 116 PATRICIA LIBBEY AND RODGER BYBEE TABLE 2 DYNAMICS OF (1) (2) (3) (4) Frequence Injury Perpetrator (5) (6) Childhood Behavior Adolescent Behavior (7) Behavior at Time of Ahuse (8) Adolescent’s Response and Explanation Case Age Sex 31 17 M 1st incident Black eye, bruised cheek, fist, open hand Father Good Probation for minor theft. Poor student behind currently. O n psych ward, drug involvement. Left psychiatric ward, came home, refused to go back, arguing about boy’s problems boy tried to leave. Went to hospital for eye treatment with older sister. 14 16 F Occasional past few years Contusion on head Father Unknown Runaway, quit school, working below ability. Nestling with boyfriend. Went to hospital because of blurred vision. zyxwvutsrqp I7 F Twoother times Bruise on forehead Stepfather Unknown “Wstudent Trying to pro tect mother from father Stepfather drunk, threatening mother with a rifle. Ncighhor called police. 21 16 M 1st indication of injury Bruise o n jaw Father Small for age Small, hyperactive o n ritalin, schok behavior problem, truant, fights, manipulates. He was being disciplined for not staying home when sick, stepfather stepped in & hit him with object. Natural father brought to hospital to have jaw examined. Social worker reported. 24 17 M Boy claims mother & father hit in past Bumps on head Mother Hearing loss & deformed ear Tardy at school, Left sandwich in bureau below potendrawer. tial worker, loner. Some pot smoking. I7 I2 F 1st time in 3 years, under child protection previousIY Bruises by belt Father Unknown Competes with 7 year old sister for attention. Cries easily, school OK. 15 I6 F 1st time father hit since childhood Split lip Father Unknown Has attempted Stepmother suicide twice. reading her Poor self condiary, girl cept. Authoripushed stepty problems mother; fawith teachers. ther stepped in and hit her. 8 Boy went to youth counseling agency to report abuse, says mother is always hitting him & yelling f o r little things; also called police. Went swimming Ran away, police put her without permission, came in shelter. Shelter home late. mother reported. Girl called police. Said she was out of line but did not deserve injury. zyxw zyxwvu 117 ADOLESCENT ABUSE Continued ABUSE ADOLESCENT (9) Parent’s or Caretaker’s Explanation (10) (1 1) (12) Childrearing Appro+ch Parent’r Past History Past Agency Involvement Disposition Same explanation Very controlling father. Parents divorced when boy in preschool. Mother alcoholic, died when boy was 12. Father fought for custody. Heavy beer drinker. Juvenile court, 2 hospital drug treatments, 1 half way house, 2 adolescent psych programs. Remains on psych ward. Boyfriend is source of all trouble. Child out of control, No warmth, rnoning to phy6ical punishment. Father on mental disability, breakdown 3 years ago. Mother is dry alcoholic. Father snw his whole family shot in Burma. Probation officers. Child protection worker (?) Child Abuse team allowed girl to live where she wants. Counseled family. zyxwvutsrq zyxwvut zyxwvu zyxwvuts Doesn’t remember he was drunk. Rigid, no warmth in Stepfather a heavy family. drinker fights with wife, daughter trim to protect. Boy was hitting & pushing mother holding a wrench so father grabbed him & pushed him to ground. Did not hit. No discipline works, Parents divorced 12 Child guidance clin- First placed with No contact, but parents showed police pot in boy’s room. same story u c e p t girl left 3 daya later after a family meeting. Same story as girl. Added he was tired of constant fighting between wife &daughter. haw given up after being “y controlling. unknown (military) Alcohol treatment for father. Marital counseling, protection worker. yenrs ago. Stepfathcr had reccnt surgery on arm. ic. Youth service for counseling. natural father, now with 28 year old brother. Very rigid, tough & authoritarian. Parents previously took car away, said it was unsafe. Check on him regularly at school. Mother is tough. Boy & parents attending counseling sessions at youth service bureau. School & youth agency are monitoring. A lot of yelling, mother is ineffective. Father hit her before. Girl under child protection previously. Father is alcoholic. Child protection, al- 3 family counseling coholic treatment. sasions. Case being monitored. Special program for father after work related accident. 2nd marriage for father. Yelling &hitting, no warmth. Mother was in hos- Another county pital psych ward. welfare dept reGirl removed ferred to this from both county. No action parents’ homes, until present stepfather tried school involved. sexual molestation l-1/2 years ago. Families feud constantly. In shelter home working with psychiatrist. zyxwvut zy zy zyxwvutsrqponmlk 118 PATRICIA LIBBEY AND RODGER BYBEE TABLE 2 DYNAMICS OF (1) (2) (3) (4) (5) (6) Frequcnce Injury Perpetrator Childhood Behavior Adolescent Behavior (7! Behavior at Time of Abuse (8) Adolescent’s Response and Explanation Case Age Sex I1 13 M Chronic since 10 years old Bruises & scratches Stepmother Signs of emotional disturbance age 11. Poor school attendance & behavior Runs away, withdrawn & frightened. Unknown Adolescent reported incident after living in treatment center for 7 months. 9 14 M Chronic neglect & abuse Untreated broken arm Mother suspected Severe retardation, aggressive behavior. Uncontrolled behavior, running away. Unknown Adolescent unable to communicate verbally. 5 17 M Ongoing from infancy Bites & scratches Adopted mother & father Development lags from early abuse. Adopted age 1. Runaway. Bizarre behavior. Fantasizes extensively. “Goofing off” Told school psychologist in 50% (11) of these cases, parents report that the adolescent had also been “generally difficult” recently, that is, truant, stealing or running away. In the rest of the cases, either there was “serious” acting out behavior or there were no special behaviors noted. T h e majority of adolescents were categorized as having shown “difficult to handle” or serious behavior problems (chronic truancy, stealing, running away) either previous to or immediately preceding the abusive incident. There are also the issues of how community standards of discipline might affect definitions of abuse and in turn decisions to report an injury. We collected information on whether the parent thought the incident was discipline or abuse. We also asked the social worker for an assessment of family discipline. In 10 cases the parents or caretakers stated they were “disciplining the adolescent.” T h e social worker characterized 18 families as generally physically and verbally punitive. T h e other 7 were classified as believing that “in anger” they had “gone beyond” their normal means of discipline which had not included physical punishment in the past. T o summarize, the abuse was not generally severe; the adolescents had broken rules prior to the incident, and parents zyxw zyxwvuts zyxwvutsr 119 ADOLESCENT ABUSE Continued ADOLFXENT ABWSE (10) (1 1) (12) (13) Childrearing Amroach Parent’s Past Historv Past Agency Involvement DisDosition Mother denies abuse. Physical punishment used extensively. Both parents married previously, close to divorce again. Mother has a daughter she claims is result of a rape. Child guidance clin- Unable to substantiate, sent back to ic, psych ward, hospital, Catholic residential trurment. social service. county welfare. Mother denies abuse. Claims boy hurt himself. Yelling & hitting Welfare mother, single parent. Social worker in past for neglect; boy in several special programs for retarded, many caretakers in home. Live-in facility for retarded. Denied abuse, only harsh discipline. Rigid & authoritarian, no warmth. Child guidance Ecnter, residential treatment, Catholic social service, detention center. Foster a r c therapist. (9) Parent’s or Caretaker’s Exdanation zyxwvut Deeply religious, hard working. Four natural children after adoption. Authoritarian. zyxw zyxwvu commonlyjustified the incident as being disciplinary. The distinction between abuse and discipline is still not clear, and we suspect it will remain unclear as long as physical punishment is a socially accepted means of disciplinary action. Models Explaining Abuse The research literature on abuse is concerned with developing models to help understand how abusive incidents come to be. There are three major models or explanations in the literature on adolescent abuse. The first model holds that abuse may take place when normal adolescent development behaviors surrounding the issues of separation and control combine with the parents’ normal developmental changes of middle age (decline in health, in attractiveness, in job status or the like). This is a picture of a reasonably well-functioning family in a time of temporary stress brought on by the usual vicissitudes of life. In the second model, one or more members of the family is characterized by emotional disorders or severely troubled or troublesome behavior at home or in the community. In this model, psychopathology is the dominant cause. The third model has a sociological emphasis. Poverty, job changes or loss, accidental injury, and absence of 120 zyxw zyxwvuts PATRICIA LIBBEY AND RODGER BYBEE community resources, are typical factors believed to be major contributors to abusive behavior in families. T h e difference between models is a matter of emphasis. It might prove instructive to review the data from the viewpoint of each. Particular attention is given to Lourie’s model (1977a; 1977b; Note 2) emphasizing normal developmental stresses of adolescents and their families since he develops more detailed distinctions between adolescent and child abuse than do other theorists. Specifically,Lourie describes three patterns which differ in the onset and the severity of adolescent abuse. T h e patterns parallel distinct, although often overlapping, styles of family interaction. T h e first pattern involves sporadic and often accidental injury, occurring only in families that are child-oriented or overindulgent. T h e children are very good until adolescence when they start normal provocative testing behavior. The second pattern includes more severe and more frequent physical injury, occurring in families that were not abusive previously, but have always had rigid and physically punitive disciplinary practices. More psychopathology is found in these families than in the first set. T h e third pattern involves abuse continuing from childhood into adolescence. These parents are often disorganized and inadequate; the adolescents are often involved with the juvenile justice system, where abuse is overlooked or not detected because of other problems. T o parallel these patterns, cases are arranged in Table 2 on the basis of onset of abuse, severity of the injury, and type of injury. In summarizing the cases on the bases of the three theoretical models, we found that 13cases could be characterized as reasonably well-functioning families who had recently been under stress from either divorce, job change, surgery or provoking behaviors by the adolescent-all “normal” developmental changes of either the adolescent or adult. In the other 12 cases there was psychopathology or disturbed behavior by either the adolescent or parents, and often by both, as is evidenced by past agency involvement. A typical example was the chronically truant adolescent who used drugs and who had a parent with a history of mental illness or alcoholism. T h e cases generally followed a pattern of increasing frequency and severity of abuse as the presence of psychopathology and other social factors increased. In a small group of cases where abuse had been chronic and ongoing since childhood we found retarded, emotionally disturbed or hyperactive adolescents, much like the “special children” described in child abuse literature, ADOLESCENT ABUSE 121 combined with adults who also had multiple psychological and sociological problems. Social factors outside of family interactions and personality characteristics did seem to be present for five of the families, and in two cases these factors did appear to be primary influences on the home situation. In one case, the boy had been truant from school because his mother had been drinking as a result of an earlier operation. In the other, the family was on welfare and moved frequently but got along with each other without difficulty. However, in most cases, social factors appeared to be only minor contributing factors, while developmental stresses or psychopathological behaviors were more important influences. A more detailed review of the cases based on the frequency and severity of abuse suggested some support for Lourie’s patterns, some additions and some discrepancies. In the first 5 cases (See Case numbers 35, 6, 29, 23, 20) in which abuse occurred once and was minor, none of these children had trouble with their parents and school personnel when younger. Their parents showed warmth and concern and did not use physical punishment. Four incidents were characterized as “accidental,” or as loss of control as a result of anger in an overheated argument. However, only one mother was viewed as over-indulging by the case worker. T h e next group of occassional incidents, (See Cases 3, 32, 33, 34, 25, 22, 7, 30) were all minor bruises except one; we also found only one over-indulging mother. These adolescents were characterized as having been good children; as adolescents, their behavior was provoking. But, one or both of the parents were described by the case worker as rigid and controlling disciplinarians. Little or no psychopathology is evident in these families; but the stressful events, such as divorce, illness, job change, and remarriage, in combination with rigid childrearing methods, appear to be significant factors in these incidents. This previously undetected pattern, of sporadic abuse in stressed families in which parents exercise rigid control and physically punitive disciplinary practices, should be investigated further. T h e next group of 7 cases (See Cases 18, 2, 31, 14, 8, 21, 24) also involve sporadic incidents of abuse occurring only in adolescence. However, this group has two distinguishing characteristics: the injuries are all to the head, and one or more members of the family show severe behavior difficulties or emotional disturbance. Numerous social agencies have been involved with these families in the past, dealing with problems such as alcoholism, zy 122 zyxwvuts zyxwvu PATRICIA LIBBEY AND RODGER BYBEE mental illness and welfare for the parents; and drug abuse, truancy and inadequate school work for the adolescents. The group falls in Lourie’s second pattern, which emphasizes more severe injury and psychopathology. However, we find more criminal offences and previous agency involvement than he suggests. T h e remaining 5 cases (See Cases 17, 15, 11, 9, 5) involve abuse that has been ongoing since childhood. These cases are similar to the previous group of cases, except that the adolescents show more signs of emotional disturbance, and all but one did not report abuse immediately. Perceptive social workers and psychologists “discovered” the abuse, or the adolescent told them about being abused after a therapeutic relationship had been established. In summary, this review of cases does confirm that in over half (13) of these cases, the abuse began in adolescence and was related to the particular stresses of adolescent development and usual problems of middle age in adults. However, the frequency and intensity of abuse seems related to other family dynamics such as flexibility and warmth, rigidity and use of physical punishment as a means of control. T h e other 12 cases represented escalations from usual forms of physical punishment or continued abuse that had begun in childhood. This group included dysfunctional families and evidence for psychopathology of adolescent or adult. Social factors are found scattered through all groups. It does seem clear that the accumulation of factors is related to the type, frequency and intensity of abuse. Reexamining the equation “parent youth+ stress = abuse” we think it is important to underscore the dynamic relationship among the elements of the equation. In the past, researchers have stressed one element (e.g., a “special child”). Now we should understand that many factors may interact within a family system (i.e., the left side of the equation) and that interplay results in effects on the frequency, type and severity of abuse (i.e., the right side of the equation). + zyxwvu Interventions Table 2 shows that the social worker and the child protection team planned interventions that also closely parallel the three models. T h e more severe problems in the family, the more frequently residential treatment and/or family therapy was used. T o date no followup has been carried out on these cases. We were interested in learning whether the adolescents were active in making reporting and intervention decisions. Sixteen ADOLESCENT ABUSE 123 of the adolescents initiated the intervention process by defining the incident as abusive and seeking help from some adult. However, adolescents from reasonably well-functioning families desired minimal involvement of outsiders. We also found that in cases of chronic abuse, the adolescents had been in therapy for months before they spoke of abuse by their parents. In addition to the large numbers of adolescents who played an active role in making decisions about interventions, we also found that most families (20) had been involved with a variety of social agencies previously. Prior agency involvement was less or nonexistent for families with little or no history of abuse. We find these data particularly interesting in light of the idea that abusive incidents are more likely to occur when resources in the community are scarce, or when families feel in isolation from these resources. Clearly, in this study the families with problems had sought and/or received help previously. None of the adolescent abuse literature discusses the role of the school, but in this case review we found that the schools played a role both in identifying and in treating adolescent abuse. In 10 of the cases, adolescents told a school nurse, counselor or teacher of an injury. School personnel reported the injuries as required by law. The laws do not require school involvement in treatment (or prevention), but in our data, in 1 7 of the cases, the school was directly involved in the intervention. The school was indirectly involved in a total of 21 cases, because those adolescents were experiencing moderate to severe school problems. Half of the adolescents were of good or high intelligence but underachieving. Three had special educational needs. The rest were performing at expected levels. None were truant or acting out in the classroom. Ten had poor relationships with their peers. zy zyxwvu DISCUSSION A N D SUMMARY In this study of case file data on type and degree of adolescent abuse, most incidents did not result in severe injuries. But the tables do not show the degree of emotional confusion or disturbance reported by the adolescents. Some adolescents made a point of telling the social worker that the physical injury did not bother them as much as the emotional trauma. We had no information on the norms for physical punishment in this community. Since 18 of the cases were bruises caused by belts or open-handed slaps, traditional punishment in some communities, the question 124 zyxw zyxwvu PATRICIA LIBBEY AND RODGER BYBEE of norms and the adolescents’ acceptance or non-acceptance of those standards must be an area of further study. These data also indicate that mild to severe acting-out behavior by the adolescent is frequently an antecedent of abusive incidents. Knowing this can help treatment planning but also may affect the definition and decision about whether or not to report an injury. Adolescents or adults who believe that physical punishment is acceptable for misbehavior may be reluctant to report an injury following misbehavior. Further research should not only try to discern adolescents’ views of their own behavior, but should also include interviews with other witnesses to the incidents, so that we can begin to understand what distinctions can be made between out-of-control rage and acceptable discipline. T h e review of the data suggests that there are multiple factors, at individual, family and community levels, that contribute to conflicts resulting in violence. T h e comparative significance of each was not determined, nor was the social worker’s “assessment” of the adolescents’ or adults’ personality traits corroborated by other measurements. Reports were based on information provided by other social agencies who had been involved with the family or school personnel and records on the adolescent. Further research should plan specific means for measurement of psychopathological traits in family members and for extracting family dynamics. Finally, interventions in adolescent abuse cases have not been examined in relation to the changing moral and legal structure surrounding the issue of the rights and responsibilities of children and parents vis Ci vis one another. T h e literature and laws on abuse assume that children have the right to a childhood free of violence, but society assumes the right of the parent to use physical punishment. Adolescent abuse may differ from child abuse not only because it appears to be less severe, but also because the distinctions between abuse and discipline may be unclear to the adolescent, the parents and the community professionals who are required to report on or intervene in abuse cases. Since many adolescents in this group were showing moderate to severe misbehavior, and since most parents believed they were disciplining the youth, distinguishing between community norms for discipline and for abuse is an important task for further research. Multiple explanatory models should be used in further study. T h e data showed that a sizeable minority of reported adolescent abuse cases are from otherwise reasonably well-functioning fami- zyxwvu zyxwv ADOLESCENT ABUSE 125 lies, and that no single current model is rich enough to explain all cases of abuse. Adolescent abuse also appears to differ from child abuse because many adolescents may take an active and mature role in reporting and explaining abuse and in planning interventions. Finally, the school’s role in intervention has not been realized to its fullest potential. School personnel need in-service training in identification, intervention and treatment of adolescent abuse victims. This paper has explored the relatively unstudied area of adolescent abuse. It can be both likened to, and differentiated from, maltreatment of younger children, toward which most of the effort of both researchers and professions has been directed. More work still needs to be done regarding all the themes of this issue: definition, incidence, causes, consequences, prevention and treatment. Perhaps the substance of this paper can help guide some of that work. zyxw zyxwvuts zyxwv zyxwvu zyxwvu REFERENCE N O T E S 1. Gelles, R. Violence toward children in the United States. Paper delivered at the annual meeting of the American Association for the Advancement of Science, Denver, CO: February, 1977. 2. Lourie, I. S. Family dynamics and the abuse of adolescents: A case for a developmental phase specific model of child abuse. Paper delivered at the Second International Congress on Child Abuse and Neglect, London, England, September 1978. 3. Cabot, D. & Caruso, G. Adolescent abuse: A symptom of a family in crisis, Interrelationship between adolescent and middlescence. College Park, MD: Prince George’s County Hotline, Inc., 1977. 4. Steele, B. Psychological dimensions of child abuse. Paper delivered at the annual meeting of the American Association for the Advancement of Science, Denver, CO, February 1977. 5. Libbey, P., & Bybee, R. Study of frecond chance’students, a report to District 834. Stillwater, MN, June 1978. REFERENCES zyxwv American Human Association. National analysis of official child neglect and abuse reporting. Denver: American Humane Association, 1978. Berdie, J., Baizerman, M., & Lourie, I. Violence toward youth: Themes from a workshop. Children Today, 1977, 6, 7-10; & 35. Connell, H. M. Attempted suicide in school children. The Medical Journal of Australia, 1972, 1 , 686-690. Fraser, B. A summary of child abuse legislation, 1973. In R. Helfer & C. H. Kempe, The battered child. Chicago: The University of Chicago Press, 1974. Gelles, R. Child abuse as psychopathology: A sociological critique and reformulation. American Journal of Orthopsychiatry, 1973, 43, 61 1-621. 126 zyxw zyxwvuts zy zyxwv zyxwvu zyxwv PATRICIA LIBBEY AND RODGER BYBEE Gil, D. Violence against children. Cambridge: Harvard University Press, 1973. Giovannoni, J., & Billingsley, A. Child neglect among the poor: A study of parental adequacy in families of three ethnic groups. Child Welfare, 1970, 19, 31-40. Jacobs, J. Adolescent suicide. New York: Wiley Interscience, 197 1. Kempe, R., & Kempe, C. H. Child abuse. Cambridge: Harvard University Press, 1978. Knopoka, G. Young girls: A portrait of adolescents. Englewood Cliffs: Prentice Hall, 1975. Lourie, I. S. T h e phenomenon of the abused adolescent: A clinical study. Victimology, 1977, 2, 268-276. (a) Lourie, I. S.The abuse of adolescents. In A. Thomas, Children alone. Reston, Virginia: The Council for Exceptional Children, 1977. @) Opinion Research Corporation. National statistical study on runaway youth. Washington, D.C.: Office of Child Development, DHEW, 1978. Parke, R. D. Socialization into child abuse: A social interactional perspective. In J. Tapp & F. Levine, Law, justice and the individual in society. New York: Holt, Rinehart and Winston, 1977. Patrick, J., &Wander, R. Treatment of the adolescent crisis patient. Psychotherapy: Theory, Research and Practice, 1974, .?, 23-28. zyxwv