Research on the worst types of child abuse
There haven’t been a whole lot of studies comparing different types of child abuse. One reason for this is that it’s more challenging to conduct such research, and most scientists tend to specialize in one particular niche. The second reason is that most research is funded by either the government or advocacy organizations, neither of which are interested in funding studies that would disprove the industry’s long-standing assumptions. That said, the studies which have been done universally confirm the same pattern our organization has found, showing that subtle family variables and often ignored forms of maltreatment typically cause more damage to children than the issues we dramatize and dwell on as a society.

Ney et al. (1994) looked at the worst combinations of child abuse and neglect, comparing child sexual abuse (CSA), physical abuse, physical neglect, verbal abuse, emotional neglect, and various combinations of these. They found that the types of abuse that most strongly correlated with future adjustment problems was physical abuse, physical neglect, and verbal abuse. Among the top 10 worst combinations, verbal abuse appeared 7 times, physical neglect 6 times, physical abuse and emotional neglect 5 time, each, whereas CSA appeared only once. Put another way, verbal abuse was 7-times more correlated with poor outcomes than sexual abuse.

Eckenrode et al. (1993) studied 6 groups of children: those not abused, those sexually abused, physical abuse, neglect, sexual abuse in combination with neglect, and physical abuse in combination with neglect. Contrary to what many in the public would assume, it was found that sexually abused children and adolescents performed as well in school as non-abused controls in all areas measured, including standardized test scores, school performance, and behavior. Both neglect and physical abuse, on the other hand, were associated with poorer performance and more behavioral problems.

Rind, Tromovitch & Bauserman (1998) conducted a meta-analysis of around 100 other published studies to measure the potential harm caused by childhood sexual abuse in relation to other family variables. They found that CSA accounted for less than 2% of the variance in symptoms, and that family environment outperforms sexual abuse in explaining negative outcomes by a factor of 9. In other words, negative family environments appear to be at least 9- times more harmful to a child’s welfare than experiencing sexual abuse.

Moor (1992) accidentally arrived at a similar finding. Though she set out to study sexual abuse by itself, she included a scale for narcissistic parenting. She was surprised to discover that parenting variables dramatically outperformed sexual abuse in terms of predicting negative outcomes. “Although the focus of the present study was on NP (Narcissistic Parenting) as it relates to child abuse, it is important to note that this construct was found to be highly predictive of adult adjustment across the entire sample. …This finding is particularly informative considering that the NP scale did not inquire about the kind of obviously deficient parenting that is typically associated with pathogenesis, such as emotionally abusive parenting. Instead, it tapped subtle, seemingly innocuous, yet perhaps highly destructive aspects of parenting.” (p. 83) Not only was narcissistic parenting associated with poor self-esteem above and beyond both out-of-family sexual abuse as well as in-family incest, the opposite was not true: incest was linked to no future adjustment problems above and beyond narcissistic parenting. In fact, once parenting variables were accounted for, all associations between CSA and future adjustment scores “were rendered non-significant.” (p. 66)

Rutter and Quinton (1977) conducted a meta-analysis of factors leading to psychiatric disorders in children, and found 6 situations linked to mental health disorders: severe marital discord, low socioeconomic status, overcrowding or large family size, paternal criminality (maternal criminality was not studied), maternal psychiatric disorder, and admission into foster care. Kessler & Magee (1993) conducted a meta-analysis of the types of early experiences most likely to lead to a major depressive disorder by age 20. They found that paternal drinking, parental mental illness, violence in the family, parental marital problems, the death of a mother or father, and the absence of a close loving bond with an adult in childhood were linked to the onset of depressive disorder.

Phillips et al. (2005) conducted a meta-analysis of the adversity most likely to lead to anxiety and depression. They found 5 things that were correlated with future problems: economic hardship, early childhood health problems, maternal stressful life events, parental deviance, and mother-partner relationship problems. Maternal depression and prenatal stress were especially likely to lead to depressive disorders, while turbulence in parental relationships, stressful events, poverty, family instability and criminality in a other’s partner were most likely to lead to anxiety disorders.

The same pattern emerges when you look at individual symptoms or negative outcomes. Consider eating disorders, which popular culture commonly presumes to be a consequence of sexual abuse. Kent, Waller & Dagon (1999) conducted a regression analysis of child abuse experiences as they relate to future eating disorders, and found that only emotional abuse was significantly related to the onset of eating disorders. Kinzl, Traweger, Gauther & Biebl (1994) studied factors contributing to eating disorders, and found no link between sexual abuse & eating disorders, but did find higher rates for children experiencing family dysfunction. Rorty et al. (1994) studied factors contributing to bulimia by studying rates of various types of maltreatment in those with eating disorders compared to healthy controls. They found that only emotional and physical abuse showed any link to the onset of eating disorders.

Vicarious exposure to violence & aggression versus direct victimization
Another thing many people don’t realize is that mere exposure to violence or severe conflict is as damaging to children as abusing them directly. (Scheeringa & Zeanah, 1995; Hygge & Ohman, 1978) These intense situations can produce just as much fear and stress as when children are the recipients of abuse. (For a cinematic example that actually mirrors real life, consider the scene in The Town where the two adults start fighting, and the little girl abruptly goes from playing contentedly to screaming and crying in hysterics as though someone had just slapped her across the face or were trying to harm her.) Kids exposed to violence or angry conflict show similar stress reactions to those who are personally victimized (Perry, 1997), and suffer rates of PTSD that are just as high or even higher. (Jenkins & Bell, 1994; Sheeringa & Zeanah, 1995)

Mechanisms of Injury: Why Certain Forms of Child Abuse Are Worse Than Others
To better understand why popular perceptions about child abuse can be so misguided, and to gain a more accurate understanding of what harms children, you need to abandon the categories and stereotypes you’re used to viewing child abuse through and instead pay more attention to mechanisms of injury: Implicitly harmful elements within the child’s experience. Just as bones don’t break without a sufficient amount of force, harm to children doesn’t magically fall from the sky like pixie dust merely because adults choose to label a particular situation as wrong or abusive. Damage stems from some very down to earth principles, but this seldom corresponds to society’s stereotypical way of looking at things.

Mechanisms of injury are discussed in further detail on our page, ‘What Harms Children,1 but here’s a quick breakdown: Attachment injuries are most severe, since a child’s bond with their caregivers is the foundation upon which all other measures of wellbeing are built upon. Beyond that we have stress, pain, violence and/or aggression, conflict, instability, loss of autonomy or control, inadequate environments (physical or emotional neglect), and negative emotions like fear, shame, humiliation or despair. Social pain is also a significant factor, and one that comes in two forms: that inherent to the situation itself (such as the sting a child feels when ridiculed or berated), and that which comes from the outside in and is manufactured by others, such as the pain a child feels when others suggest her father is a bad man for what he did, or the stigma associated with poverty.

The pervasiveness of a mechanism of injury also impacts how harmful it is, which is why negative parenting and family environments often prove to be more influential than more sporadic instances of abuse. Living with a depressed parent may not seem lo have earth-shattering implications on its face; there’s no singular moment you can point to as being especially harmful or traumatic. But because children absorb their environment, living with parental depression incubates a child in this negative emotional climate day after day, year after year, and thus is usually more destructive than those situations society typically regards as being more traumatic.

Just as bones don’t break without a sufficient amount of force, children aren’t harmed unless they’re exposed to a specific mechanism of injury. Every potentially harmful situation will contain at least one of these mechanisms of injury in sufficient doses (i.e., especially intense or especially long-lasting and pervasive).

To better understand why popular notions about child abuse are so misguided, and to give you a more accurate and nuanced picture of child welfare, let’s explore some different situations according to the mechanisms of injury they contain, starting with the issue society dramatizes the most: sexual abuse.

If sexual abuse were typically a violent and aggressive act that induced pain and provoked fear in the child, there would be valid mechanisms of injury to presume the potential for trauma. The problem is that few cases contain such elements. Violence is rare, occurring in only around 1-2% of cases. Most situations contain no aggression and occur with someone the child has an affectionate relationship with. The stress of these incidents (if any) is usually mild; victims usually rate it around a 1 to 4 on a 10-point scale. Because children are born sexual creatures and have fully functional genitals capable of producing both pleasure and orgasm, these incidents can be every bit as pleasurable as they are uncomfortable. Such experiences also do not usually significantly impact the core aspects of a child’s daily life.

Thus mechanisms of injury in such are cases are notably absent. In fact the biggest potential for harm comes from the social stigma and conflict others outside the situation introduce. This is exactly what the science shows: Kids are typically harmed more by society’s response and the sexual shame we promote than by the experiences themselves. Of course, even non-violent situations can cause social injury or damage a child’s attachment to a caregiver ifan adult continues to push such things even after the child has expressed their dislike for such interaction. But even when this is the case, we produce a greater injury when we come in and abruptly sever that attachment, accomplishing in a single act what years and years of abuse could only whittle away at.

What I just discussed is only the typical scenario, and there certainly are cases where the circumstances are decidedly worse, altering the dynamics of these mechanisms of injury. Ifa child is repeatedly raped in a violent and painful way by someone who treats them with disdain and shows little regard for their feelings, the potential mechanisms of injury are far more numerous and far more significant—involving pain, fear, violence, loss of control, conflict, severe amounts of stress, etc.—making for a completely different story.

Now let’s compare the typical, non-violent case of sexual abuse to the mechanisms of injury present in one of the most harmful predicaments that society entirely ignores: Divorce. We may regard divorce as a normal and acceptable occurrence, but it can have earth-shattering implications wherein children are concerned.

First of all, most divorces are preceded by significant family conflict. This seldom subsides after a divorce; in fact, it often escalates. Not only is this conflict frequently quite severe, but it involves all the pieces that sit at the center of a child’s world.

Attachment injuries are ail-but certain, since divorce takes the two most important people in a child’s life and rips them apart. Not only does this instantly result in a 50% reduction in the availability of caretakers in the best of situations, since no matter which house a child is at they are deprived of one of their parents, but it’s all too common for the non custodial parent to effectively drop out of a child’s life afterwards, creating a significant scar.

Divorce introduces substantial instability into the child’s world. Put aside the fact that they’ve just learned that family isn’t stable and might break apart or abandon you seemingly out of nowhere, but there’s significant physical instability: change of homes, change of schools, all new schedules and routines, a disruption in family rituals, and so forth. Studies show it can take several years for kids to adjust to these changes, and just when they do, a remarriage often throws their world into chaos once again.

A child’s socioeconomic standing usually drops after divorce. Each parent becomes busier and less available as a parent. The stability of parenting and discipline both decline as parents try to co-parent across households.

Divorce isn’t just hard on the kids, it’s hard on parents, too. Thus it’s quite common for at least one ofa child’s parents to become depressed and more stressed, which leaves them less available as a parent, introducing yet another significant mechanism of injury. Other parents may react in an opposite manner, but one which produces the same effect: They start dating again or become preoccupied with rebuilding their life, neglecting their kids in the process.

Custody swaps are burdensome and stressful. At one point in time an arrangement known as “bird nesting” was introduced in an effort to create a more child-friendly divorce: the kids would stay put in their home while the adults moved back and forth between houses according to the custody schedule. Those adults who tried it quickly found the situation too unbearable, so they shifted this burden back to the children.

All told, if you tabulate all the possible mechanisms of injury, look at how likely each one is to occur, and assess these factors in terms of the overall disruption it causes to a child’s life, divorce contains more substantial mechanisms of injury than most types of child abuse, and it blows the typical non-aggressive molestation clear out of the water. When you strip away the social prejudices and look at a situation according to the fundamental elements each experience contains, a very different picture emerges.

Disastrous outcomes for parental divorce are certainly not written in stone. Parents who limit these potential mechanisms of injury can mitigate the damage. Kids are also resilient and can overcome the scars that a divorce produces. It’s just meant to illustrate how blind society is to the broader picture when it comes to child welfare. We suffer from a severe form of tunnel vision; one that has us responding overly harshly to some situations while entirely overlooking the potential consequences of others.

Picking Your Poison: Children’s Choices & What They Reveal About the Worst Forms of Child Abuse
We can discern quite a bit by looking at the behavior of children who’ve experienced multiple forms of abuse and the choices and/or tradeoffs they make in an attempt to improve their situation in life. This is perhaps the best indicator of what children actually find to be most bothersome. Here, too, we typically see a pattern that defies conventional expectations.

One adolescent girl, who experienced legitimate sexual abuse at the hands of a stepfather who abused her in every way imaginable, would choose intercourse with him as a punishment when given the choice of that or “the belt,” and on other occasions would “pay” with sex to earn something she wanted, like the ability to attend a school trip or go with her friends to the mall. (Darbouze v. Kibler, Nov. 17, 2021, Dist. Ct. for the 9th Cir.) While we can all agree that this girl should never have been placed in such a predicament to begin with, it hardly bodes well for the popular assumption that sexual abuse is the worst form of abuse.

Another girl lived with her father between the ages of 4 and 8. She describes him as “really mean.” She says he would hurt her, spank her hard with belts and hands, and yell at her. She and her brother also experienced sexual abuse, including an alleged incident of painful intercourse. Yet when given the choice between going along and a spanking, the former was less averse than the latter: “[He] would spank us really, really hard, and we didn’t want that to happen so we listened to him.” (Fowler V. Knipp, April 1, 2014, Dist. Ct. 9th Cir.) Throughout the court pages both she and her brother seem more focused on the physical abuse and general meanness they endured at their hands of their father than on the sexual abuse the trial was actually about.

In another case a girl began being molested by her stepfather at around the age of six. By 9 things had progressed to the point they were having intercourse. It continued through seventh grade, when the girl was 12. Yet she would often agree “to have sex with [her stepfather] in exchange for certain privileges, including being excused from punishment.” Her stepfather would release her from being grounded and allow her to play outside. She’d also have sex with him “to avoid getting a whipping.” (Heron v. Clay, 2009) Another 14-year-old would exchange sex for favors with her mother’s live-in boyfriend. (Martin v. Quarterman, 2008)

In line with what we discussed earlier about vicarious trauma, one boy would intentionally redirect his stepfather’s rage toward him in order to protect his mother: “I’d rather get a beating than watch my mother get beat up,” he says. (Perry & Szalavitz, 2017, p. 213)

One woman, “Ann,” grew up with an alcoholic father and grandfather. She experienced physical and emotional violence from both her mother and father, was raped multiple times as a teenager, hit by a car, and lost a close friend… a friend who was murdered by her own father. Yet of all these horrible experiences, Ann says that the thing that hurts the most is how little her parents seemed to care about her.”

“That’s the hardest thing for me,” she says, as tears fill her eyes. “To have parents that don’t see you as a person.” (Kwon, 2022, p. 50)

In one family, two young girls dealing with mental illness in the family would leave their home to spend weekends with Jim, an adult brother, even though he molested them and also beat his wife. (Kolker, 2020) A young adolescent girl from a dysfunctional home who had experienced both consensual and forced sex with her adult boyfriend rebuked prosecutors when they tried to blame her struggles on this illegal relationship as opposed to her unhappy home life: “I have been trying to kill myself since I was thirteen, before I even knew Paul. Until this day I still do, so it’s not because of Paul either.” (Rectenwald v. Bacca, April 29, 2021) These are all anecdotal stories, of course, but they are not unique. In fact, it seems to be a rather universal theme. Contrary to what is portrayed in movies and television, things like sexual abuse, which society incorrectly assumes to be the worst of the worst, is less bothersome to children than even things like discipline or spankings.

In another case that’s a prime example of how misguided assumptions lead to misguided responses, a 15-year-old girl, Aleah, has a habit of flirting with older men online. She cold-calls a 41-year-old man she doesn’t know, who initially blows her off, but she is persistent. Her persistence eventually pays off: they began talking online and a relationship develops that eventually turns sexual, at Aleah’s request. She sneaks out of her home each night to meet him. One night her parents discover her missing and call the police. They leave a message on her cell phone, but she calls back saying she doesn’t want to return home. The man she’s with tries to take her back to her parents, “but Aleah refused to get out of the car.” He repeats the process several times to no avail, as each time, the girl refuses to leave his car. Instead she insists she take her with him to Mexico. Eventually authorities catch up with the pair and he is arrested and sentenced to 71 months in prison for “enticing” a minor, when in reality, it was the other way around. But facts have always been irrelevant to the U.S. Injustice System.

Try to put aside for a moment whatever initial thoughts and ideas you’ve been conditioned with all your life, and look at the situation scientifically the way an objective observer might: This story is a prime example of how labels and stereotypes lead us astray. Whatever misery this teenager might have had in her home life, whether that be family problems or issues at school, she obviously very much preferred a sexual relationship with a 41-year-old man to living in her home. Yet rather than acknowledging that our notions of child abuse are arbitrary and misguided, authorities instead prosecute the man she flees to as a refuge from that unhappy home life, in direct opposition to every conceivable notion of “child welfare.” This child, through her choices, is shouting loud and clear that the things we prosecute and dwell on aren’t nearly as unpleasant and bothersome as the things we don’t. (United States v. Castellor. 213 Fed. Appx. 732, Jan. 24, 2007, 10th Cir. Ct. ofAppeals.) She’s fleeing from an unhappy situation society entirely ignores and doesn’t think of as abuse to seek refuge in a situation adults naively presume to be the worst of the worst, showing how completely misguided our nations about child maltreatment can be.

The same pattern holds true even when it comes to the ultra-hyped issues. Take the issue of child sex trafficking. One young girl, who was trafficked into sex slavery in her early teens and made to have sex with as many as 20 men each day, says that it wasn’t this but being whipped with a belt that was “the most painful,” worse than the sex. (Bhattacharjee, 2020, p. 106) Yet we have millions upon millions of dollars flowing into the fight against child sex trafficking, while largely turning our head at other forms of trafficking that leave children in much worse conditions. If it were physical abuse or the more injurious trauma of children being sold from their home (for any reason), would society have the same response? It appears not, based on what we see today.

Another teenage girl much prefers her life as a “sex trafficking victim” and would rather be “selling her body to men for money” than go back to her life in foster care, since she ran away from CPS to do this. When CPS eventually found the 16-year-old girl, who was officially listed as a “child trafficking victim” by a major U.S. organization (most likely the National Center for Missing & Exploited Children, though the court papers do not specifically say), she “continuously said that she wanted to go back to a man who was ‘someone that makes money off of her by having her sleep with other boys/men,” rather than returning to the supposedly “safe haven” of foster care. (M.D. v. Abbott, 192 F. Supp. 3D 684, Dec. 17, 2015) So foster care, at least in many cases, is far worse from the child’s standpoint than sexual “trafficking” is.

Harmful Environments That Aren’t Traditionally Thought ofAs Child Abuse

“There are countless people… who are kind, gentle, and highly sensitive and yet inflict cruelty on their children every day, calling it childrearing. …Cruelty can take a thousand forms, and it goes undetected even today, because the damage it does to the child and the ensuing consequences are still so little known.”
-AliceMiller (1983, pp. 1-05-106)

The picture is further complicated by the fact that many things which can be especially harmful to children aren’t necessarily illegal and aren’t traditionally defined as child abuse. For example, divorce can be one of the most traumatizing things for children to endure, and it’s also packed with more mechanisms of injury than most other forms of abuse: You have the family conflict, the abrupt separation, the instability, the parental conflict, the added stress of shuttling between two homes, the parental abandonment that so often occurs, and so forth. Aside from placement into foster care by Child ‘Protective’ Services, divorce contains more possible (and more severe) mechanisms of injury than just about any other negative environment.

You’ll frequently see severe reactions from children caused by their parents’ divorce. An 8-year-old girl starts banging her head every night for 30-60 minutes before falling asleep—a behavior that emerged in response to her parents’ separation and divorce. After putting the girl in therapy to deal with her behavioral problems, “Jessica’s mother was surprised to discover how much Jessica had to say about her father’s leaving.” (Ferber, 2006, p. 323)

“Everything just went to hell,” says Patricia Cornwell, describing how her life changed when her father walked out on the family when she was five. Their mother descended into psychosis, and the kids wound up in a foster home (The Week, Dec. 10, 2021, p. 10)

One girl descended into mental illness that lead to multiple stays in psychiatric hospitals and several suicide attempts after her parents divorced when she was 12. (Antrim, 2021) Such outcomes are virtually unheard ofwhen it comes to physical or sexual abuse, yet they are surprisingly common after a divorce or parental abandonment (as well as other attachment traumas such as foster care).

Some kids vomit from the stress of custody exchanges. (Sehgal, 2023) They often exhibit a number of behavioral problems. (Hetherington, 1992) They have trouble sleeping, experience nightmares, and struggle in school. (See our book: Children & Divorce)

Anne Roiphe talks about how her stepdaughter, now a married woman and mother, describes her parents’ breakup at age 7 “as the most terrible moment in her life. As she says this I have only to listen to the tightness in her voice, watch the slight tremble in her hand to know that the divorce seemed to her like an earthquake. The divorce caused a before and after and everything after it is tarnished, diminished by what went before. I wish this were not so. I wish that we could marry a new mate, repair, go on to undo the worst of our mistakes without leaving ugly deep scars across our children’s psyches, but we can’t.” (Roiphe, 2002, p. 189)

While three quarters of kids will eventually recover after their parents’ divorce, a full 25% will have serious, long-term social, emotional or psychological problems well into adulthood. (Hetherington & Kelly, 2002) This may not sound all that dramatic, but it’s 2 !/2 times that of children from in-tact families, and 3-8 times the rate of long-term problems seen in adults who were molested as children. (Landis, 1956; Gagnon, 1965; Rind, Tromovitch & Bauserman, 1998; Kendall-Tacket, Williams & Finkelhor, 1993)

Bullying is another often overlooked form of abuse, sometimes dismissed as a rite of passage in childhood. That it may be, but its consequences are every bit as severe as traditional forms of child abuse, and often much more so. Bullied kids are 7-times more likely to have low or below-average self-esteem as adults—43% compared to 6%. (Kidscape, 1999, p. 8) Psychotic symptoms increase twofold. (Costello, 20123) Bullied kids are 5-times more likely to be depressed. (Fox et al., 2003) Rates of suicide and suicidal thoughts also increase dramatically—anywhere from 4 to 9 times, depending on the study. Fox et al. (2003) found bullied boys are 4-times more likely to be suicidal, bullied girls 8-times as likely. A 1999 Kidscape survey found 46% of youth who are bullied contemplated suicide, compared with only 7% of those who weren’t bullied—an increase of nearly 700%. (Kidscape, 1999) A Yale University study found bullying victims are up to 9-times more likely to consider suicide. (Kluger, 2012)

Or take an issue like childhood obesity, something that is unlike any conventional form of maltreatment but is utterly disastrous for children. Some authorities have recommended that CPS begin taking obese kids away from their parents and putting them in foster care because of the severe consequences associated with childhood obesity. (This is a measure we DO NOT support, but which is already occurring in some extreme cases.) Yet there’s a reason such drastic measures are being proposed: weight problems in children typically have severe consequences that follow them around the rest of their life.

Overweight children are at greater risk for psychological problems and suicide. (Schneider & Brill, 2005; Brownell et al., 2005) They are bullied more often, live lonelier lives, and experience more discrimination. (Hellmich, 5-3-2010; USAToday, 9-22-2010) They have lower self-esteem, poor body image (Schneider & Brill, 2005; Miller & Downing,

1999), and higher rates of sexual dysfunction later in life. (Gorman, 2012) They have decreased mobility, get tired more often, and are less able to run, jump, climb, play, or do all the other things normal kids their age might do. When you add up all these effects, one study found overweight kids have a quality of life that’s comparable to that of kids who have cancer. ( _______)

Because physical activity boosts brain health and functioning, whereas sedentary lifestyles and carrying excess weight diminish it, inactive and obese children score lower on 1Q tests and exhibit lower levels of neural cognitive functioning. (Davis et al., 2007; Ayan, 2010; Hillman et al, 2005) Because of this, a child’s body mass has a direct correlation to their academic success. (Dwyer et al., 2001; Castelli et al., 2007)

Then there are the severe medical consequences. Young children in elementary school (7-, 8- and 9-year-olds) are developing diseases once seen only in middle age: high blood pressure, high cholesterol, fatty livers and type 2 diabetes. (Szabo, 4-13-2011) Overweight children suffer joint breakdown and chronic inflammation throughout their body. (Cruz et al., 2005) They experience much higher rates ofchronic pain (Stovitz et al., 2008), as well as allergies, asthma, and other chronic conditions. Obesity causes nerve damage throughout the body and can cause fluid accumulation inside the skull that leads to brain damage and chronic headaches.  Obese kids are twice as likely to break bones and experience higher rates of accidental injury. (Painter. 6-21-2010; Bazelmans et al., 2004) All told, weight problems are responsible for as much as 80% of the medical problems people experience. (Emanuel, 2017)

Being obese will drain years offa child’s life—those with a BMI over 45 by age 20 have already lost 13 years from their life expectancy—a reduction of22%, or more than a fifth of their life. (Hammond & Levine, 2010) Current habits are so bad that a child born in 2020 has around a 50/50 chance of developing diabetes in their lifetime, a dangerous condition that drains even more years off their life and lowers their quality of life even further. (Brophy- Marcus, 6-23-2011) Obesity also leads to increased rates of cancer. (Lloyd, 3-29-2012) Overweight individuals will spend nearly a million dollars more on medical care over the span of their lifetime. (Kadlec, 9-22-2008) Obesity is even killing dozens to hundreds ofkids every year from medical complications that wouldn’t exist if they were a healthy weight. (The exact number is hard to come by because these deaths are categorized as “asthma” or “heart failure” or “diabetes” rather than obesity.)

If you were to line up the consequences of obesity and inactivity and compare them to conventional forms of maltreatment, the harm from the former would generally dwarf the harm from the latter.

Father absence increases adolescent pregnancy rates by 7-8 times over. (Ellis et al., 2003) Adopted youth attempt suicide at a rate 4-times higher than the general population, and are also disproportionately represented in psychiatric hospitals and addiction treatment programs. (MacFarquhar, 2023)

Unsurprisingly, losing a parent also takes a severe toll. Forty-percent of bereaved children exhibit behavioral disturbances in the clinical range, compared to 10% for intact families. (Kranzler et al., 1990) Seventy-seven percent of children who experienced early parental loss went on to suffer at least 1 major psychiatric disorder in adulthood. (Breieretal., 1988)

There’s no perfectly precise way to compare such diverse forms of adversity. But if you look through the research as a whole, it becomes quite apparent that many types of situations—poverty, single-parenting, divorce, bullying, parental depression, dysfunctional families, overprotective parenting, childhood obesity, negative discipline, among many others—cause just as much destruction as conventional forms of child maltreatment like physical or sexual abuse, and often much more.

The only circumstances that stand out as being substantially more destructive than the others are the ones that society consistently disregards: CPS intervention and placement into foster care consistently produces the worst outcomes of all. Psychological abuse and emotional neglect are also right up there. Nearly all psychologically abused children will develop at least 1 menial illness, and three quarters will exhibit comorbid disorders, meaning they suffer from two or more co-occurring diagnosable mental health problems. (Egeland, 2009)

When Helping Hurts
The most tragic consequence of our stereotypical approach towards child abuse is that it’s easy to completely lose sight of what actually matters. There’s no better example of this than the way authorities attempt to “help” abused and neglected children.

Here’s another crucial thing to know when assessing the impact of different types of maltreatment: Being removed from the home by CPS workers trumps them all, consistently producing worse outcomes than any other type of child abuse. In other words, what CPS workers do to children is worse than any of the abuses they might remove a child for.

To those used to viewing child abuse in the stereotypical hierarchical fashion, this might sound incredulous. We menially group child abuse into the “bad” category and place those who “rescue” children at the opposite end of the spectrum into the “good” category. But life is never so simple, and like an amateur surgeon blindly cutting into a patient, it’s quite easy to do harm. If the way we respond to child abuse or neglect creates more stress, emotional injury and turmoil than the abusive environment does, we’re harming children, not helping them.

If you want to know what it’s like once Child “Protective” Services gets involved, put yourselves into the shoes of a child, and then imagine the trauma of being kidnapped, the pain of having your parents die (and possibly your siblings too), the lingering dread that comes with parental abandonment, all the stress of a conflict-ridden divorce, the turmoil of your family ripping apart, the insecurity of losing your home and being uprooted from all you’ve ever known, the stress of switching schools and being plucked down with strangers, accompanied by all of the acute fear that might be induced by a brutal rape or violent attack. Now roll all of these traumas up into one devastating package, and you’ll have some idea of the trauma that children go through when CPS workers steal children from their family. That’s what the government does to “protect” children from abuse.

Needless to say, the trauma that comes with CPS removal is quite severe, and far more damaging to children than all but the most extreme cases of abuse. It contains every mechanism of injury you could name—attachment trauma, fear, severe stress, conflict, emotional pain, instability, environmental turmoil, and so on—and it contains them in extreme doses. Children scream, cry, and are sometimes pepper sprayed by police to pry them away from their parents. Children have been known to go mute afterwards, suffer sudden psychotic breaks, become homicidal or suicidal, or show other symptoms of extreme trauma afterwards. Such reactions are virtually unheard of even in cases of severe child abuse of the conventional variety. The type of extreme reactions you see in foster kids are usually only seen in the most severe traumas (for example, think of a child trapped in earthquake ruble with a shattered pelvis for 3 days, or a child who watches her mother being stabbed to death before having her own throat slit and spending a day laying in blood next to her mother’s dead body before being found). Those types of traumas.

The behavioral problems of foster children are notorious, even though you don’t see the same level of behavioral problems among abused kids who aren’t removed from their home. In fact, rates of depression, psychiatric disorders, psychosis, suicidal or homicidal thoughts, and pretty much every other problem you can name are higher among foster kids than they are in any other vulnerable population, including abused children. Ironically, abuse and neglect are rampant throughout the foster care system, and kids are also murdered at higher rates in state custody than they are in their natural homes. (See our book: Child Maltreatment—A Cross Comparison)

Kools & Kennedy (2003) studied rates of psychopathology using a comparative analysis, and found rates of psychopathology in foster children of 46-80%, compared to 10% in a general population sample of disadvantaged kids. (Disadvantaged kids from households with a low socioeconomic status are often used as a proxy measure in studies, because low SES consistently produces poor outcomes that are roughly comparable to other types of child abuse or childhood adversity.) Leslie et al. (2003) also found that foster children have a rate of behavioral problems up to 4-times that of children from other disadvantaged backgrounds, and rates of developmental disorders of up to 6- times that of low SES kids.

Clausen et al. (1998) looked at mental health problems among foster children and found that 75-80% scored in the problematic range for either social or behavioral problems (or both). Haflon et al. (1995) looked at the general welfare of foster kids and found that 84% had developmental or emotional problems. These high rates of psychological and behavioral disorders are at least triple what you’d typically find in a sample of abused or neglected children.

Those defending the government’s adversarial policy of removal like to claim that the severe problems seen in foster kids are really due to the abuse they suffered before the entered the system. This claim holds no water whatsoever. Not only does it ignore the fact that children in foster care exhibit damage far above and beyond what populations of abused and neglected kids who remain in their homes exhibit, but it ignores decades of research on attachment trauma and the very obvious and severe mechanisms of injury that come from uprooting a child from everything they’ve ever known in such a combative and traumatic fashion. When studies have attempted to tease out this cause-effect relationship, they’ve found that abused children who are “rescued” by the system really are worse off than abused kids who remain in their natural homes. (Doyle, 2007a; 2007b)

Child Protective Service’s fatal flaw is that they attempt to “help” in combative ways, and by attacking the most crucial measure of a child’s wellbeing: attachment. Such an adversarial “guns blazing” approach does far more harm than actual abuse typically does. So scientifically speaking, the worst child abusers in America all work for the U.S. government.

Rethinking the Popular Assumptions About Child Abuse
As the preceding evidence makes clear, popular assumptions about the worst types of child abuse are completely detached from reality. In fact, you could accurately say that the ideas governing popular culture and our legal response to these situations is pretty much the precise opposite of what science tends to show to be most harmful to children.

So what are we to make of this evidence? There are two main reasons I just spent so much time taking a hand grenade to everything you thought you knew about the subject of child abuse. The first is that misinformation and flawed assumptions have disastrous consequences for children and society. Every day we are responding to abuse with measures that are far more harmful than the abusive situations we are trying to remedy. We’re basing our efforts to help on all the wrong principles. We’re wasting time, money and resources on proxy battles while the factors that truly matter in terms of child welfare are seldom even considered as an after-thought.

The second thing I hope to have accomplished is to humble those inclined to throw stones and encourage a bit more compassion in how we respond to adverse situations of all types. I want you to imagine for a moment a world where a new law was passed mandating that every parent who had children when they got divorced was instantly arrested and thrown in prison for the remainder of their life. Any children who were still under the age of 18 would be subsequently snatched from their home and placed in foster care. After all, if “justice” requires punishing people according to the harm they do to children, then this has more scientific validity than our laws governing molestation or other forms of child abuse.

But is there anyone anyone of us who would think this to be a good idea and a positive development for children or society? Or would responding to people’s failures and imperfections in such a harsh and punitive manner only make an unfortunate situation exponentially worse, creating a whole bunch of collateral damage that doubled, tripled, quadrupled or more the amount of suffering in the world? And for that matter, shouldn’t those who are perpetrating these destructive responses deserve significant prison time as well?

As unfathomable as it might be to imagine society responding to something like divorce or childhood obesity with such punitive measures, the truth is that it’s every bit as silly, senseless, and destructive when we respond to more conventional forms of abuse in such a destructive manner. We wouldn’t help children of divorce by locking up their parents or feeding them stigmatizing ideas about their family while blowing up their home life even further, and we don’t help children who’ve been physically abused, sexually abused or neglected when we respond with such destructive measures, either. Such tactics go against every conceivable principle of child welfare.

Please share this information with your friends, and while you’re at it, send a link to your elected public officials. Education is the only weapon against ignorance. I hope that one day we can stop playing these nonsensical blame games and start focusing on things that will truly help those children who need it.

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