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Childhood Maltreatment and abuse | its impact on Adolescent Mental Health

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Maltreatment is the act of subjecting an individual to all forms of abuse, including neglect, physical torture, negligent treatment, exploitation, sexual abuse, harassment, and emotional abuse, among others. Maltreatment has potential or actual harm to someone’s health, dignity, development, and survival (Weiss et al., 2011).  Child maltreatment is a complex issue infringing on our modern society, and it has a far-reaching consequence on both physical and mental health for children below the age of 18. Child maltreatment practices are classified as follows: sexual abuse, physical abuse, emotional abuse, and neglect (Reyome, 2010). Physical abuse is violence that can cause physical injuries to the child. Sexual abuse is committed indecently to a child in either a forceful way or willingly (Pollak, 2015). Neglect is a condition that arises when the child is deprived of getting sufficient basic needs such as food, shelter, and clothing (Bartlett & Easterbrooks, 2012). Emotional abuse involves exposing the child to all forms of psychological traumatization, such as the use of abusive words and evincing rejection of the child, among others.

Child maltreatment has complex and profound effects on the child’s mental health, development, and survival. The complications that emerge from child maltreatment have long-term and lifelong consequences, which are linked with physical, behavioural, and psychological consequences (Garner et al., 2014). For instance, a child undergoing neglect or abuse may have a stunted physical development of the brain that leads to psychological complications. Further psychological and behavioral consequences include lowered self-esteem that can lead to substance abuse, diminished cognitive skills and executive functioning, posttraumatic stress, social difficulties, intent to commit suicide, and poor emotional among others (Goodman, Quas & Ogle, 2010; Van Wert, Mishna & Malti, 2016). Children undergoing maltreatment are vulnerable to future or long-term health issues such as diabetes, vision problems, arthritis, cancer, brain damage, bowel diseases, and migraine headaches, among others.

Understanding child maltreatment and its influence on the child’s mental health is important since it provides insight into stopping the act of maltreating Children. In addition, it acknowledges the public on the need to end child maltreatment. Therefore, the aim of this study emphasizes a developmental approach to understanding the Influence of maltreatment/abuse in childhood on adolescents’ mental health.

The risk factors of childhood maltreatment/abuse

Individuals with a history of abuse in childhood are at increased risk of maltreating their children.  According to the study done by Dixon, Browne, & Hamilton-Giachritsis (2005), found that parents who had experience of maltreatment in their childhood had partial mediation of child maltreatment under two risk factors that include family and parent factors. Parental factors are as follows: depression, anxiety, emotional problems, mental illness, reduced self-esteem, and substance abuse (Briere, 1992). Factors under the category of the family include low income, poverty, isolation, inadequate social support, early parental age, early maternal deprivation, and residing with stepparents.  The common factors that tend to intercede child maltreatment are becoming a parent below the age of 21, having depression or mental illness, and residing with an aggressive or violent adult (Dixon, Browne, & Hamilton-Giachritsis, 2005)

Parents who have undergone child maltreatment are prone to face future complications based on the intensity of the historical maltreatment they went through. Some of these complications include birth or pregnancy complications and physical disabilities. Individuals with a history of child abuse have high chances or a tendency to engage with aggressive partners. The parental history constituting child maltreatment has a higher likelihood of parents becoming violent to their children (Reckdenwald, Mancini & Beauregard, 2013). Consequently, these aspects create an intergeneration cycle of child abuse or child maltreatment that may not cease if there are no control interventions over further occurrences of similar events. Therefore, there is a need for enforcing child rights and policies that protect children from maltreatment.

Bowlby (1969) provides a concept of proximity attachment exhibited by the mother to child during early infancy and subsequently changing attachment dimensions across various ages of development. Positive behaviour patterns of the mother will complement the accomplishment of this kind of attachment since it is a way of survival for the toddler. Infant behaviours seek attention for attachment through looming objects and making loud noises when left alone until attainment of contact (Zeanah, Berlin, & Boris, 2011). The behaviours of seeking attachment cease immediately upon contact. They change to vocalizing, smiling, and clinging purposely to maintain the proximity of attachment to the mother.  A secured bond of attachment from the primary caregiver to the child is fundamental to the development of the (Hocking, Simons & Surette, 2016). The rationale underpinning this perspective is that attachment dictates the perceptions of the child about others and self-image throughout life.

The quality and nature of infant care differ among parents. However, parental responsiveness and attunement can yield a secure attachment. Children with a secure attachment can seek comfort from their caregivers in distressed situations. In this regard, children perceive to be sufficiently safe when they have low stress and can often explore their surroundings. On the contrary, parental harsh rejection and unavailability are related to avoidant and insecure attachment (Moss et al., 2011). The children perceive themselves as unable to seek care from their caregivers and unlovable. This perception is contagious, whereby the children may view others as disinterested and punitive. Avoidant and anxious children fear to seek comfort from their parents when distressed since they want to avoid punishment and rejection from their parents. Parental inconsistencies bring about ambivalent-anxious attachment that makes children believe that they cannot care for and sustain the interests of others (Wilkins, 2012). Ambivalent-anxious children are always vigilant of the responsiveness and whereabouts of their parents and portray intensified overtures to incite parental responsiveness.

There is immense and indisputable evidence that early parental attachment has a far-reaching impact on child development, especially at the middle-age level. Attachment influences childhood development from neurocognitive development to social-behavioural development competencies. The attachment quality is influenced by the interactions between the parent and the child (Pears et al., 2010). Various studies have shown that high quality of childhood attachment substantially influences later stages of development.

Adolescents have rapid social, cognitive, and neurological changes that create a social-cognitive dilemma that includes integrating diverse and new experiences with oneself and the world. In addition, adolescence provides a dilemma that tends to maintain the attachment to parents and explore social aspects away from parents. However, a successful adolescence transition requires parental attachment (Weiss et al., 2011). A healthy adolescence transition is enhanced through emotional connectedness and secure attachment from parents. Research asserts that the attachment security portrayed in childhood similarly affects adolescents’ development. A secure attachment foundation promotes social, emotional, and cognitive competence (Lowell, Renk, & Adgate, 2014). Adolescents with secure attachments have minimal interest in engaging in drug use, excessive drinking, and maladaptive activities. Female adolescents are less likely to get teenage pregnancy as compared to those with insecure attachment.

Insecurely attached adolescents are disposed to mental health issues such as inattention, anxiety, depression, conduct disorder, aggression, delinquency, and thought problems. In addition, insecurely attached female adolescents have high rates of eating disorders that contribute to their overweight (Mersky, Topitzes & Reynolds, 2012). Children undergoing maltreatment from their parents are at risk of getting detached from their biological parents and may proceed to seek attachment from other people. Consequently, they remain vulnerable to long-term mistreatment from strangers whom they endure working under them to gain basic needs. Adolescents with a better quality of attachment have social and adaptive skills that help them cope with different environments. In addition, they can enjoy positive relationships with minimal conflicts with family members, peers, and other adolescents (Pietromonaco, Uchino & Schetter, 2013). Adolescents undergoing maltreatment with less secure parent-adolescent attachment are associated with delinquent behavior, drug use, suicidality, and aggressive behaviors (Van Wert, Mishna, & Malti, 2016).

Mikulincer and Shaver (2007)provided an extension on Bowlby’s work concerning attachment and proposed two dimensions that can assist in finding the position of an individual in relation to attachment. The two dimensions include avoidance and anxiety attachment, which, in this case, apply to the adolescents’ security of attachment. Adolescents with a low score of avoidance and anxiety use brilliant affect-regulation and constructive strategies. On the other hand, adolescents with high scores on the two dimensions undergo insecurity problems and tend to seek secondary attachments either through hyper-activating methods or through deactivating attachment systems, mainly for coping with threats.

As noted in the literature above, adolescents seek relationships outside their families. An adolescent with a history of maltreatment is likely to fall into the dimension of avoidant attachment. They avoid closeness and the urge to seek proximity and avoid attachment needs in relationships (Paradis & Boucher, 2010). Adolescents with a high score of attachment anxiety depend on hyper-activating approaches in an attempt to attain their proximity, love, and support. However, they have little confidence in their proximity achievement. 

The attachment theory asserts that unreliable, inconsistent, and insensitive interactions with attachment figures can lead to an unstable mental foundation and insecurity. In addition, the competency for resilience in difficult or stressful situations will be affected, and the person will be disposed to a psychological breakdown. The insecurity of attachment among adolescents increases their vulnerability to mental disorders related to symptomatology factors that include developmental, environmental, and genetic factors. From the recent studies, attachment insecurities are the root cause of depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, and suicidal tendencies among adolescents and adults (Caldwell, Shaver & Minzenberg, 2011).

Attachment insecurity counts for many personality disorders adults and adolescents portray (Mikulincer & Shaver, 2007). A personality disorder is a mental illness whereby an individual does not show any concern for what is right or wrong and cares less for the feelings and rights of others. This goes in line with an avoidant attachment that might have developed because of maltreatment from parents. Anxious attachment in the context of personality brings about histrionic, borderline, and dependent disorders. On the other hand, avoidant attachment effects on personality include avoidant and schizoid disorders. According to Crawford et al. (2007), attachment anxiety leads to emotional dysregulation, which constitutes a bigger percentage of personality disorders that include cognitive distortions, anxiety, self-harm, narcissism, submissiveness, suspiciousness, and emotional lability. Avoidant attachment further leads to “personality inhibited ness’’ whereby a person has restricted emotional expressions, social avoidance, and intimacy problems (Crawford et al., 2007)

Attachment insecurities are sufficiently proven by various studies as the root cause of mental disorders among adolescents. The rationale underpinning this perspective is the fact that it begins from childhood. One of the main contributing factors to attachment insecurities is child maltreatment. Children undergoing mistreatment are likely to develop avoidant attachment in the late stages of development. Avoidant attachment is associated with stressful events such as sex abuse, torture, physical beatings from parents, neglect, and discomfort, among others. Life history plays a key role in determining the levels of psychological distress and avoidant attachments that lead to depression (O’Hara et al., 2015). The history of psychological, sexual, and physical abuse can transit to present insecure attachment between parents and their children. Other factors that strengthen insecurities of attachment include poverty, stressful environments, toxic relationships during adolescence, and mental health issues (Drake & Jonson, 2014). Child maltreatment has a huge impact on the psychology of a child. Research findings indicate that psychological problems can lead to attachment insecurities.

In conclusion, attachment insecurities increase vulnerability to psychopathology. Therefore, maintenance of a better quality of attachment would improve mental health and resilience among adolescents. The attachment theory proclaims that interactions with supportive and available figures can enhance positive emotions, i.e., love, satisfaction, relief, and gratitude. Secure adolescents are highly unperturbed in stressful situations, and they can recover quickly from distressing episodes. In this regard, they can generally manage their emotions, which would help better mental health. 

Bandura (1971) proposed a model based on social learning, including acquiring cognitive and social behaviours through observation. This is to ascertain that children view the elderly as their role models. Therefore, they tend to mimic the actions and behaviours portrayed by those they view as their models. In most cases, parents play a big part in being role models to their children. On occasions when children are within an environment constituted by a series of violence, they gain exposure to a set of rationalizations and norms that support violence (Goldberg, Muir & Kerr, 2013). In this context, they are denied a chance to learn nurturing and appropriate forms that depict child-adult interactions. Therefore, children perceive violence as a normal and acceptable way of perhaps solving problematic situations and expressing emotions. Punishments and rewards are the main catalysts that strengthen learning through observations when dispensed by the model. In relation to the aspect of child maltreatment, experiencing and observing, i.e., a mother hitting a child for badmouthing and then the child stops the behaviour through reinforced punishment. It is an approval for the child that violence works.

Many studies have established the interconnection of childhood victimization that has high chances of adulthood violence, and it’s due to this reason the intergeneration cycle of child abuse does not seem to end (Pietromonaco et al., 2013). It is indisputable that parents who observed and underwent childhood maltreatment would do the same to their children during the parenting period. On the contrary, children who only observe and may never have had the experience of child maltreatment have potentialities to embrace violence during interpersonal interactions at adult age or even in parenting (Zavala, 2013; Prinz, 2016). Through witnessing violence and other negative actions, children can learn violent and maladaptive approaches to reacting to anger and stress. Various studies have established that adults or parents who abuse their children are characterized to have come from a home that has marital violence and discord (Jennings et al., 2013).

Sexual abuse intergenerational patterns have a high degree of dependency on the childhood experience of molestation. A study conducted by Beck in 1989 proclaimed that 58% of the respondents (Child molesters) reported having undergone the experience of molestation in their childhood. This case was compared with other incidences of rape and sexual abuse, where the results showed similar findings as demonstrated by Beck’s findings. The history of sexual victimization also holds for the reasons for adult sexual offenders (Millett et al., 2013).

High hostility exposure to children in the home environment has downstream effects that are linked with maltreatment and adverse outcomes. For instance, consistent anger exposure signals a hostile and threatening environment that can influence the diurnal cortisol pulses among children that act as moderation between aggressive and abusive behaviour (Bernard,  Zwerling & Dozier, 2015). The intensity and consistency of anger observed by a child affect the child’s emotional classification and representations, which afterwards influence how the child judges other people (Plate et al., 2018). For the child to have social competence, he/she must be able to interpret emotions correctly, a failure that will damage the child’s social development. When the anger expressed by the child’s model is extreme, the child may adopt the expressed standard of anger to peers or other people (Plate et al., 2019). This indicates that the child had learned from observation, as the social learning theory stated. This kind of expression may have interpersonal relationship problems. Consequently, interactions with other peers may raise other problematic disorders such as depression, loneliness, and stress, among others. Therefore, parents and guardians should try as much as possible to control the expression of their anger to limit observational opportunities from children. This is a skill that is normally used in handling maltreated children for recovery purposes (Plate et al., 2019).

Adolescents normally belong to a crucial stage of development and have fluctuating emotional habits. The desire to have great autonomy as their colleagues and models puts them under pressure. In most cases, adolescents would want recognition of various aspects, including their physical appearances. Female adolescents are always alert to their physical outlook, which is why they would try as much to mimic celebrity models. In addition, the aspect of thin-ideal internalization has gained dominance among teenagers, which further leads to complications of eating disorders. Female adolescents who do not meet the expected standards of thinness have low self-esteem. Bodyweight Stigmatization has also been a contributing factor that may cause mental health disorders among adolescents.

Researchers have found that most of adulthood and adolescence mental health had its origin in childhood. Some of the disturbances affiliated with mental health have made many adolescents develop relationship difficulties, school failure, drug abuse, suicide, and the risk of engaging in dangerous maladaptive behaviours (Luke & Banerjee, 2012). This is because some of the activities that led to their presented impairment are continuously affecting their emotions whenever they encounter the prosecutors. According to social learning theory, children might pick behaviours from models that do not suit their actual lives, which may lead to self-denial and regret. For instance, excessive substance abuse, euphoria, violence, and anger, among others. In particular, the use of substance abuse has a huge impact on mental health. Some of the mental illnesses associated with substance abuse include anxiety and depression. There have been several cases recorded for teenagers seeking substance abuse to relieve them from stress and rejection from society because of their behavior. In addition, most of the recorded suicidal cases are associated with substance abuse such as consumption of hard drugs including cocaine, heroin, Bhang, and marijuana, among others.

In conclusion, the environment in which children are raised influences the child’s social and cognitive behaviours. According to Bandura’s theory of social learning, children tend to adopt some of the behaviours of people that offer closer attachment to the child and to whom they perceive to be their role models. Exposure to negative characters and behaviors in children has lifelong consequences on their personal behavior and mental health. Therefore, elderly individuals, parents, and guardians should try to suppress some of the toxic behaviours in front of their children.

Comparing and contrasting the attachment theory and social learning theory

The attachment theory emphasizes human relations that confers on emotional attachment. The principle upholds the main concept of this theory in the early developmental stages of a toddler’s attachment to the caregiver. The kind of attachment is dependent on parent-child interactions (Pickreign et al., 2011; Thomas & Zimmer, 2012). There are two types of attachment; they include a secure and insecure attachment. Secure attachment is essential for a child’s upbringing since it enhances a child’s social, physical, and mental health. On the contrary, insecure attachment leads to mental disorders of anxiety and avoidance because of poor interactions with the parents. Insecurities normally emerge in instances when the child undergoes maltreatment from parents or guardians.

The social learning theory also emphasizes the early stage of child development. It asserts that a child learns through observation, which defines the child’s cognitive and social behaviours. The individuals near the child greatly impact the child’s social behavior since the child tends to mimic the behaviors portrayed at their disposal. The mimicked behaviour can have either a negative or positive impact on the child’s social life.  For example, if the child sees their role models expressing their anger through violence and the action is justified, they tend to perceive violence as a normal way of solving anger issues.

Both the attachment theory and social learning theory have shown indicators or factors that can lead to child maltreatment in the intergenerational cycle (Juffer et al., 2017). Parents with a history of child maltreatment, such as attachment insecurities, have a high chance of maintaining attachment insecurities to their children. The reason behind this kind of response is related to the consequences they underwent that led to mental illness and personality changes (Hong et al., 2012). The same kind of scenario is reaffirmed in the social learning theory. For instance, when children are exposed to victimization or have an experience of being victimized, there is the likelihood that in their adult stage, they may embrace the same scenario, which then makes the intergenerational cycle of victimization complete. 

Both theories agree that child maltreatment has a lifelong consequence on a child’s mental health. Some mental health disorders include anxiety, depression, euphoria, cognitive distortions, submissiveness, and narcissism, among others.  In addition, personal characteristics are dependent on how the child is treated in all stages of development.

The differences between the attachment theory and social learning theory

The social learning theory indicates that learning is influenced by individuals who form part of the child’s environment, including peer group, caregiver culture, society, etc. On the other hand, the attachment theory only confines the caregiver as the person to whom the child relates throughout the early phase of development and gets to learn from the caregiver. The distinct point in this context relies on the number of individuals involved in the developmental process.

The attachment dependency or behavior changes simultaneously as the child’s mental and cognitive development (Goldberg et al., 2013). It is for this reason that most adolescents tend to be slightly detached from their parents when trying to find new relationships of attachment outside the family sphere. However, the attachment quality is elucidated depending on the parent or caregiver’s interaction (Cicchetti & Doyle, 2016). Ainsworth (1967) classified various behavioral patterns a child can adopt for the caregiver during interactions, including avoidant, secure, disorganized, and ambivalent behavior. On the other hand, social learning can last forever simply because every individual learns from other behaviours that suit them. Other people get motivated to adopt such behaviours through the results of such behaviours. For example, some undesired behaviours are associated with negative consequences; therefore, individuals may not be willing to embrace them in their own lives.

There is unintentional learning that prevails in the theory of attachment that is dominated by the caregiver at the infancy stage, such as eating and working. In the social learning theory, the child learns through two dimensions: unintentionally and intentionally. Unintentional learning occurs at the early stages of child development, which includes walking and eating. In the late stages of development, the child’s consciousness enables him/her to select behaviour based on certain motives. The parents can control some of the negative behaviours shown by children at the age of 8, and the child can avoid them. In this regard, some aspects of the two theories tend to be complemented by either of them. For instance, the interaction aspect must co-exist between the parent and child or the caregiver and the child. Some of the behaviours in both theories are learned through interactions.

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