The Merck Manual defines physical abuse involves the physical battery of a child. Emotional abuse involves the emotional or mental battery of a child, which often damages the child's emotional growth and self-esteem. Sexual abuse or molestation includes exposure, genital manipulation, sodomy, fellatio, and coitus. Vaginal penetration by an unrelated person constitutes rape. Often, the adult is a close family friend. If the adult is biologically related, the offense is termed incest. When young children are involved, the offense most often is nonviolent and repetitive and may be concealed within the family. Neglect includes failure to meet a child's basic physical and medical needs, emotional deprivation, and desertion.

Abuse: Generally, abuse is caused by the breakdown of impulse control in the parent or guardian. Four contributing factors are recognized:

Parental personality features: The childhood experience of the parent may have lacked affection and warmth, often included abuse, and was not conducive to the development of adequate self-esteem or emotional maturity. Lacking an early loving environment, abusive parents may look toward their children as a source of the affection and support they never received. As a result, they may have unrealistic expectations of what their child can supply for them; they are frustrated easily and lose control, unable to give what they never experienced. Drug or alcohol use may provoke impulsive and uncontrolled behaviors toward the child. Less commonly, a parent may be frankly psychotic.

A "difficult" child: Irritable, demanding, or hyperactive children may provoke parents' tempers, as may a handicapped child, who often is more dependent for care. Premature or sick infants separated from parents early in infancy and biologically unrelated children (eg, stepchildren) may not form strong emotional ties with their parents or guardians. Even in the absence of these conditions, parents may have unrealistic expectations of what a child's performance should be and may punish him severely with little justification.

Inadequate support: Parents may feel isolated, unprotected, and vulnerable without the physical and psychologic support of relatives, friends, neighbors, or peers, particularly in times of stress.

A crisis: Situational stress may precipitate abuse, particularly when support is unavailable.

Neglect: Often, neglect is seen among families with physical, psychologic, or substance abuse problems. Acute or chronic depression, especially maternal, is often present; chronic medical problems of a parent may also contribute. Drug or alcohol abuse by one or both parents frequently results in chronic impoverishment and a distortion of priorities in family life. Desertion by the father, himself inadequate, unable or unwilling to assert a controlling influence in the family, may precipitate neglect. Children of cocaine-using mothers are particularly at risk for desertion.

Manifestations of Abuse

History: Features suggestive of abuse are (1) parental reluctance to give a history of injury; (2) a history that may be inconsistent with the apparent stage of resolution of the injury and may vary depending on the information source; (3) a history of injury that is incompatible with the child's developmental capability; (4) an inappropriate response by the parents to the severity of the injury; and (5) delay in reporting the injury.

Physical: Common signs are skin lesions, such as ecchymoses, hematomas, burns, welts, and abrasions in various stages of development (eg, cigarette burns, arcuate bruises from extension cord whipping, symmetric scald burns of upper or lower extremities); serious traumatic injury to the mouth, eye, abdominal organs, and CNS, which may produce permanent damage; and fractures. Fractures may be single or multiple, and a skeletal survey may show bony injuries in various stages of resolution. Metaphyseal fractures and subperiosteal elevations in long bones occur in infants. Major diagnostic considerations in the examination are (1) multiple injuries at different stages of resolution or development; (2) cutaneous lesions specific for particular sources of injury; and (3) repeated injury, which is suggestive of abuse or inadequate supervision.

Physical signs of sexual abuse may include difficulty in walking or sitting, genital trauma, vaginal discharge or pruritus, recurrent UTIs, or a sexually transmitted infection. However, there may be no physical indications of injury. Sexually transmitted disease of any sort in any child < 12 or 13 yr must be viewed as the result of sexual molestation until ruled out.

Emotional: Emotional manifestations of abuse are less easily defined than are physical signs. In infants, failure to thrive is a common early observation. Delayed development of social and language skills often results from inadequate parental stimulation and interaction. Small children may be distrustful, superficial in interpersonal relationships, passive, and overly concerned with pleasing adults. The emotional impact on children usually becomes obvious at school age, when difficulties develop in forming relationships with teachers and peers. Often, emotional effects can be documented only after the child has been placed in another environment, at which time aberrant behaviors abate.

When a child has been sexually abused, his behavior (eg, irritability, fearfulness, insomnia) may be the only clue for diagnosis. Careful interviewing of the child by a trained professional may be the only means of adding necessary details. Older children may be threatened with physical injury by the offender if they tell and, thus, may conceal repeated assaults.

Manifestations of Neglect

Malnutrition, fatigue, and lack of hygiene or appropriate clothing are common due to inadequate provision of food, clothing, or shelter, despite available supportive community resources. Desertion or death by starvation is seen in extreme cases. As many as 1/2 of infantile failure-to-thrive cases may be due to neglect.

In early infancy, retardation of emotional growth may occur with blunting of affect and lack of interest in the environment. This commonly accompanies failure to thrive and is often misdiagnosed as mental retardation or physical illness. Signs of emotional deprivation in older children include poor attendance and performance at school and bad relationships with peers and adults.

Failure to seek preventive medical or dental attention, such as immunizations and routine health supervision, and delay in seeking care for illness may be clues to inadequate family functioning.

Checklist for Emotionally-Safe Classrooms -by Jane Bluestein, Ph.D.

Excerpted from Dr. Bluestein's latest book, Creating Emotionally Safe Schools (Deerfield Beach, FL: Health Communications, Inc., 2001) due out in August of 2001.

Survey:

Is your School an Emotionally Safe Place?

This survey lists a number of practices which characterize a school with an emotionally safe climate. It has been included to help you evaluate your school's goals, policies and intentions, as well as the degree to which each exists in actual practice. The list is deliberately idealistic and comprehensive. Studies suggest that each item is an important component of an emotionally safe school environment, and that emotional safety is built on a combination of all of the characteristics listed in this survey. As schools strive to achieve the specific behaviors each item suggests, they will no doubt see improvements in the culture of the school, as well as in the performance, commitment, behavior and interactions that occur within its walls. Likewise, as schools increase the agreement with each of the items in this survey, they can expect a reduction of stress commonly associated with failure, rebelliousness, disruptiveness and passive student behavior.

You may wish to use this survey to evaluate the degree to which your school is committed to each item in terms of its philosophy or vision, as well as the degree to which the behaviors described in each item regularly occur in actual practice. You can rate each item for an individual classroom, or according to your perception of the school environment as a whole.

Use the following scale to rate each item:

1- Strongly Agree

2- Somewhat Agree

3- Somewhat disagree

4- Strongly disagree

Need for Meaningful Outcomes (Positive Consequences), Structure, Boundaries (Limits) and Follow-Through

___ We make a deliberate effort to anticipate what students and teachers (and parents) will need in various situations in order to prevent problems from occurring.

___ We have and communicate boundaries and policies that clearly describe desirable and acceptable student behaviors.

___ We have and communicate boundaries and policies that clearly describe desirable and acceptable staff behaviors.

___ The school environment is reward oriented (as opposed to being punishment oriented): Rules and boundaries emphasize the positive consequences of cooperation and compliance.

___ Our goal is to motivate through access to positive outcomes, rather than through avoidance or fear of negative outcomes.

___ We attempt to motivate students with the promise of a positive outcome, rather than using statements that offer conditional approval or safety (avoidance of disapproval, punishment) for cooperation (threats).

___ We attempt to follow through consistently, withholding (or withdrawing) positive outcomes until students follow through on what is required on their end.

___ We are committed to avoiding warnings, threats, meaningless or delayed (negative) consequences.

___ We make students and their parents aware, as soon as possible, of changes in behavior or performance that could affect grades, promotion or graduation.

___ We communicate with parents on a regular basis about what their kids are doing well.

Need for Respect, Belonging and Dignity

___ We attempt to avoid equating students' worth with their behavior or achievement.

___ We attempt to avoid humiliation, shaming, sarcasm, ridicule or other forms of attack with regard to students' personality, achievement or behavior.

___ We attempt to avoid depending on negative adult reactions (anger, punishment, disappointment) in order to motivate students (or control their behavior).

___ We recognize that students have a need to experience meaningful positive outcomes, just as adults do.

___ We treat our students with the same respect we want them to show us and one another.

___ We recognize that our students have a need for dignity, purpose, success, impact (seeing outcomes of choices and behaviors), acceptance, belonging, attention, structure, power and fun, among other things.

___ We encourage students to have and voice their own thoughts and opinions.

___ We encourage students to speak up for their own instructional needs (for example, more help, additional information or resources, clarification, other learning needs).

___ We encourage inquiry and debate, and attempt to avoid negatively reacting to students who challenge or disagree with adults (although we do ask students to present their positions respectfully).

___ We attempt to adhere to the same standards of behavior (including language and tone of voice) that we expect or require from our students.

___ We regard-and use-a students' mistakes simply as opportunities for new learning.

___ We avoid responding with impatience, anger or disappointment to a student who is having difficulty understanding or mastering a new concept or performing a new skill.

___ We respect students' affective needs and are committed to listening and supporting their feelings in positive ways.

___ We work to eliminate prejudices toward students based on their racial or cultural background, physical appearance; academic, artistic or athletic competence; sexual orientation; family history; prior achievement or performance.

___ We avoid gossiping about students or their families.

___ We strive to stay aware of put-downs expressed by students or staff, especially those that involve the use of slurs or derogatory names or remarks.

___ We respond immediately to put-downs, slurs and derogatory names or remarks (rather than ignoring or excusing them).

Need for Autonomy (Power and Control)

___ We accept the importance of students learning decision-making and self-management skills.

___ We encourage kids to set goals and evaluate options in order to take responsibility for solving their own problems, rather than "rescuing" them or telling them what they should do.

___ We allow students to self-manage with regard to materials and resources.

___ We encourage students to self-manage their personal needs within clearly stated boundaries (ex: drinking water or using the rest rooms as needed)

___ We allow and encourage students to have input in and make decisions about their learning (topics, presentation, media, sequence, assignments, need for additional practice, readiness for the next skill or topic, etc.)

___ We allow and encourage students to have input in and make decisions about how, where and with whom they work.

___ We hold students accountable for their behavioral choices without blaming, shaming, attacking or punishing (ex: withholding positive outcome, privileges, credit for work due)

___ Students are encouraged to initiate and take risks regarding their own learning.

___ We allow and encourage students to create, design, request or renegotiate projects and assignments to make them personally meaningful and relevant.

Need for Recognition, Attention and Emotional Safety

___ We attempt to recognize positive behavior with statements that emphasize a positive outcome or meaningful benefit to the students, rather than using statements that emphasize the students' worth ("goodness"), our happiness or pleasure, or the students' ability to please us.

___ We attempt to reinforce positive behavior by allowing positive outcomes to occur, continue or become available, contingent, for example, on work completion or non-disruptive behavior.

___ We attempt to meet students' needs for attention in positive, constructive and proactive ways in order to diminish the tendency for them to act out to get these needs met.

___ We strive to stay aware of changes in patterns in students' behavior and to maintain a sense of how students are doing (that is, not just focusing on their academic performance).

___ We attempt to create emotional safety by noticing and supporting students in crisis.

___ We provide appropriate outlets for students in crisis.

___ Our students know that if they need to talk, we are willing to listen (or set a time when we can listen, or refer them to someone who can listen).

___ We respect students' needs for confidentiality to the degree that doing so will not put that student or anyone else in danger.

___ We strive to maintain awareness of how students treat one another.

___ We immediately respond to incidents we witness that involve any form of bullying, harrassment or threat to a student's safety.

Need for Options as a Learner (Individuality)

___ We attempt to determine what interests and motivates our students and use this information in our planning and instruction.

___ We attempt to identify various aspects of our students' individual learning needs (such as learning styles, modality preferences, dominance profiles, temperament or personality profiles), and use this information in our planning and instruction.

___ We attempt to identify various types of intelligences (linguistic, musical, logical-mathematical, spatial, bodily-kinesthetic, naturalistic, interpersonal and intrapersonal) and use this information to capitalize and build on students' strengths.

___ We provide resources and activities to accommodate a variety of intelligences in each class.

___ We attempt to accommodate a variety of modality strengths (visual, auditory, tactile and kinesthetic preferences) in our directions and activities.

___ We attempt to accommodate a variety of learning style and preferences in our instruction and assignments.

___ We recognize and attempt to accommodate the needs of tactile and kinesthetic learners (as well as high visual, verbal and auditory learners).

___ We acknowledge and appreciate the fact that some students may pay attention without sitting up straight and making continual eye contact.

___ We make sure kids have ample opportunities to move during the day.

___ We teach children ways to self-regulate (maintain appropriate alertness for the particular class or activity) without disrupting others.

___ We attempt to accommodate a variety of learning preferences by offering choices, particularly during independent work time (ex: seating or location in room, affiliation, music or sound, intake, etc.)

___ We offer a variety of assessment tools to allow students to demonstrate mastery in ways besides paper-and-pencil tests.

Need for Success (Academic, Social, Intrapersonal)

___ We assess student ability before beginning instruction or assigning tasks.

___ We attempt to accept students exactly the way they come to us, build on what they know, and encourage growth from wherever they start.

___ We attempt to provide opportunities for success for each child in the school, even if he or she is far behind curricular expectations.

___ We attempt to match instruction and assignments to individual student needs according to their current skill or mastery levels or prior experience.

___ We have adopted the belief that the primary purpose of evaluating a student's work is to determine what type of instruction or resources that particular student needs next.

___ We invite and consider student input and self-assessment when assigning placement, follow-up work or grades.

___ If a student fails to master a concept or skill, we see our role as that of improving understanding, rather than simply evaluating their performance before moving on to the next concept.

___ We encourage students to use our feedback to improve their work and resubmit (for a higher grade, for example, or until they get it right).

___ We attempt to build interpersonal skills such as communication skills, respect, tolerance, compassion, resistance to teasing and peer pressure, and other positive social behaviors.

___ We attempt to build intrapersonal (character) skills such as persistence, responsibility, honesty, integrity, as well as confidence, the ability to stick up for oneself, problem-solving skills and resistance to failure, defeatism or victim thinking.

Areas of greatest strengths:

Areas most in need of improvements: