A panel presentation on child abuse, organized by the Department of Social and Behavioral Sciences & the American Business Council Kuwait (ABCK), was held at the American University of Kuwait, following the recent change to Kuwait’s law regarding children in March. The panel, including Dr.Tahira Khokhar, Family Doctor, Fawzia Sultan Rehabilitation Institute, Dr. James Rose, Chair at the Department of Social and Behavioral Sciences at AUK, Dr. Sulaiman Al-Khadhari, Assistant Professor of Psychiatry Faculty of Medicine at Kuwait University, and Dr.Nicholas Scull, Assistant Dean, American University of Kuwait, discussed the various types of child abuse, their effects, possible signs, and treatment in Kuwait.
For her part Dr. Khokhar stressed the importance of the role of the society in the prevention of child abuse. “Everyone working with children, and their families are carers in society, and have a responsibility to try and stop or prevent the maltreatment of chilDr. en, including people working in healthcare settings; schools, playgroups, educational institutes, the police, social workers, and many others. It’s the moral duty of the civilians to report child abuse.” Dr. Khokhar discussed the different categories of child abuse.
The easiest form of child abuse to detect is physical abuse, in which bruises and marks are left on the child’s body. She then highlighted the various methods used by pediatricians to recognize physical child abuse, including awareness of unusual bruising patterns on children places such as the back or the face, taking into account the age of the child and the developmental capability to assess whether an accident or injury had occurred. Dr. Khokhar then continued onto discussing neglect as another form of child abuse. “Neglect is very common and one of the major causes of child abuse. Neglect is the consistent failure to meet the child’s physical and/ or psychological needs, resulting in impairment of the child’s health or development.
This can include a parent or carer failing to provide adequate food or shelter, protect the child from physical or emotional harm, ensure adequate supervision, access to medical treatment, or delaying seeking medical treatment. It can also include unresponsiveness to a child’s basic emotional needs such as withholding affection as it does emotional abuse,” she said.
Neglect can include a parent or carer failing to provide adequate food or shelter, protect the child from physical or emotional harm, ensure adequate supervision, access to medical treatment, or delaying seeking medical treatment. It can also include unresponsiveness to a child’s basic emotional needs such as withholding affection as it does emotional abuse. She continued by indicating the response to experiencing neglect, “children get into certain behaviours out of frustration. They may be destructive, troublesome or completely passive, withdrawn and introvert. In adolescence you might see running away from home” and may possibly become involved in illegal narcotics and substances. The third form, emotional abuse, is more difficult to recognize.
This could entail a child being constantly reprimanded, threatened or yelled at, the child develops a firm belief of being worthless. “What will happen to the children? They’re not going to be normal mentally. They’re going to have low self esteem, poor self image, lack of confidence, affecting school results, emotional and physical development, social interactions, and this can continue into their adulthood; they may find it difficult to form a stable relationship, and have a healthy life,” stated Dr. Khokhar.
Dr. Khokhar then shed light on the affects of domestic violence on children, stating, “children in the home where domestic violence occurs suffer and their mental and physical development suffers. These children usually end up being starved of attention, affection, and approval.” Dr. Rose then discussed the ways in which abuse can physically alter the brain’s structure, resulting in abnormal though processes.
“Child abuse is associated with a number of psychiatric conditions including low stress tolerance, anxiety, depression, contact disorders, PTSD, substance abuse and so on,” said Dr. Rose. A longitudinal study that followed victims of child abuse over a 45-year period discovered that as adults, the victims will remain at elevated risk of anxiety disorders, substance abuse, and schizophrenia.
Until the 1980’s most psychologists believed child abuse resulted in poor mental health outcomes largely due to interruptions in the attachment relationship between the caregiver and the child and due to abnormal psychosocial development, and abnormal learning, however, recently brain imaging research has revealed that child abuse may indeed result in long lasting abnormalities in brain structure and function. “One thing to consider is that infancy and childhood are periods of rapid brain development including reorganization of connections between neurons which comprise the brain. Early traumatic experiences may disrupt these neural developmental processes, and in particular, extreme and chronic stress, results in the production of stress hormones, which may cause abnormalities in brain structure.
This in term affects the cognitive abilities, the emotional reactivity and behavior of the child,” said Dr. Rose. Studies have found that chilDr. en that have abuse-related post traumatic stress disorder have smaller brain volume and large ventricles, regions in the brain that are fluid filled. The greater the degree of abuse, the smaller the volume of the brain. “It’s been known for some time that abused children are hyper attentive to displays of anger. For example, physically abused children devote greater attention to angry faces, they actually look at them longer, and they show greater physiological responses to anger compared to non-abused children and greater physiological arousal, that is a stress response, to angry voices as well. In other words they seem to be hyper attentive to social cues of anger,” highlighted Dr. Rose.
Dr. Al-Khandhari relayed the lack of awareness in Kuwaiti society to the degree of abuse occurring: “We don’t know exactly what’s happening in our culture but we know its an under reported issue and that people have started to pay some attention to it and realize that its an issue.” He highlighted the differences in resilience between children to overcome traumatic experiences with the aid of professionals who can provide tools to continue healthily through life. For his part, Dr. Scull stressed the lack of reporting mechanisms for child abuse in Kuwait.
“Kuwait is still developing its laws to protect chilDr. en. In 1990 Kuwait along with 104 other countries in the world, signed a UN convention on the rights of the child, which has been subsequently ratified. Unfortunately, after 25 years there are still no laws in Kuwait that protect children. Kuwait still doesn’t have any sort of formal reporting structure or body to help support children who are being abused,” stated Dr. Scull.
It is difficult to determine in Kuwait the frequency of child abuse, with Dr. Scull able to cite only two studies on the matter. “The first was a retrospective study, and what they did was they investigated 60,000 medical records from two hospitals in Kuwait over about 7 years. They found 16 cases of abuse, so there is clearly something wrong with the way things are recorded or doctors aren’t reporting things correctly.
A more recent study from 5 years ago was conducted at Kuwait University (KU). What they did was distribute surveys to 2500 KU students and asked about possible abuse that may have occurred before the age of 18 and 53 percent reported having been abused physically, 9percent of those cases actually resulted in needing medical attention. 16percent recorded emotional abuse and 25 percent reported sexual abuse. It is unclear if there is any overlap in the different types of abuse but it demonstrates there is a severe problem,” continued Dr. Scull.
He concluded by underscoring the resources available in Kuwait: “ The leading organization is Kuwait Child Rights Society, an organization by a team of doctors. There are therapists in Kuwait. Kuwait has a well developed system of private and public clinicians, although there aren’t any licensing laws in Kuwait so you have to ask for credentials. Working with children who have been abused is a specialty area. There is a hotline, you can call 115, which connects you to the department of ministry and they call it a hotline.” The next step in child protection is the formal creation of social services with an investigation team to aid in preventing further child abuse.