Child abuse presents real challenge Parents should look out for warning signs

CHILD ABUSE is not as openly discussed in society as it should be. Abuse, which is often just associated with violence, may not always be as simple and evident as bruises or broken bones. Ignoring the needs of a child, putting them in unsupervised, dangerous situations or making them feel worthless or stupid can have serious repercussions.
Dr Nicholas Scull, Clinical Director of the Psychological Services Department at the Fawzia Sultan Rehabilitation Institute, talks about the different types of child abuse and its consequences, misconceptions regarding abuse and appropriate disciplinary methods.
As most children in Kuwait spend a significant amount of time with caregivers, appalling accounts of abuse in these situations surface from time to time to present a real challenge to working parents. Dr Scull shares some warning signs that can help parents detect harmful environments.

Question: Let us start by talking about the different kinds of abuse. What are the most prevalent forms in Kuwait?
Answer: There are different kinds of child abuse; there’s emotional abuse, physical abuse, sexual abuse and child neglect.
Emotional abuse includes constant belittling, shaming and humiliating a child, calling names and making negative comparisons to others, telling a child he or she is ‘no good’, ‘worthless’ or ‘a mistake’, frequent yelling, threatening and bullying, ignoring and rejecting the child as punishment, giving him or her the silent treatment, limiting physical contact and affection. All of this can severely damage a child’s mental health and social development, leaving lifelong psychological scars.
Physical abuse involves physical harm or injury to the child. It can result from a deliberate attempt to hurt a child or from severe discipline.
Child sexual abuse is a complicated form of abuse which brings along a lot of guilt and shame. It doesn’t always involve body contact, exposing a child to sexual situations or materials is sexually abusive, whether or not touching is involved.
Child neglect is a pattern of failing to provide for a child’s basic needs, whether it be adequate food, clothing, hygiene, or supervision.
The most common form that we see in our clinic is emotional abuse and that is true also in a lot of Western countries as well where some research has been done on abuse prevalence. But we have also seen many cases of physical and sexual abuse. Child abuse seems relatively common in Kuwait although I’m not aware of any studies on the actual prevalence of it in Kuwait.

Q: What are the consequences of abuse for children?
A: They are quite severe, actually. Abuse can have long lasting effects throughout life, damaging a child’s sense of self, ability to have healthy relationships and ability to function at home, at work and at school.
It can cause children to become fearful of people; it can cause nightmares and a lot of anxiety. It can also cause them to shutdown and start to avoid people. It can cause depression and sadness. Research suggests that most of these consequences are long lasting especially if they don’t get treatment.
Abuse by a primary caregiver damages the most fundamental relationship of a child, which makes it very difficult for them to learn to trust people. This can lead to unhealthy relationships because of the inability to discern what a healthy relationship is as well as difficulty in maintaining relationships due to fear of being controlled or abused.
There is research that suggests that children who are disciplined with physical punishment, spanking, hitting, slapping, etc actually do poorer in school, they tend to have lower grades, self esteem, and they also tend to have more behavioral problems in school. They also tend to be more aggressive and more likely to hit people as they grow up.

Q: Why does abuse occur?
A: There are cultural differences in how we define abuse. What may be considered abuse in the West would not be considered abuse in Kuwait. Also, people tend to do what they know and many people who abuse children have been abused themselves. Sometimes abuse can also occur due to a lack of awareness of proper child discipline techniques.
Regarding child discipline, parents have to ask themselves if they are disciplining the child to teach them a lesson and encourage proper behavior or if they are disciplining them out of anger. Sometimes parents are just so angry that they cannot control themselves and they take it out on their children. Unfortunately, this can lead to harsh disciplinary techniques or abuse.

Q: So when disciplining children, what punishments are appropriate and what are not?
A: That’s a tricky question because it again weighs in on the cultural norms and what might be appropriate in one country may be inappropriate in another. Also, no single technique will work with every child. Generally, though, psychologists suggest that hitting and other forms of physical punishment is not an effective way of disciplining children. Children who are punished physically such as being hit, spanked, slapped, etc, tend to have lower grades, more behavioral problems, lower self-esteem, and even lower IQ’s.
Children tend to do what they are taught and what they observe. If a parent or caregiver is hitting a child, they are going to be all the more likely to hit because that is what they are being taught. So hitting is typically not an effective way of disciplining children.
First, parents should be very clear with their children about the rules. In general, rules should be clear, concise, and age appropriate (No hitting, no name-calling, etc). Parents can make a list of the house rules and post it to remind their children. Children like to have structure and consistency and rules, rewards, and consequences should be clearly understood by the child. Rules and disciplinary techniques should also be age appropriate.
One technique parents can use is called positive reinforcement. This is simply focusing positive attention and praise on the child’s good behaviour. “Good job putting all of your toys away.”
Younger children can also be “redirected” toward positive behaviour when they start to misbehave.
If a rule is broken, parents of younger children can try using a ‘time-out’. A time-out involves removing the child from the environment and sitting them somewhere quiet and away from toys and other people. Typically time-outs should not be longer than 5 minutes and one minute per year of the child’s age, is appropriate. Time-outs can help children calm down and recollect themselves. Time-outs are inappropriate with adolescents and teenagers.
Parents of school-aged children and adolescents can also establish what’s called a token economy system. So parents can begin by setting small goals for their children like finishing their homework every night for the entire week by 6 pm. Each day they meet this goal, they receive a point. These points can be exchanged for extra privileges and rewards such as extra 15 minutes on the PlayStation. Parents can keep track of the points using a calendar or a chart using stickers and placing it in a place where the child can easily see it. Start with easily attainable goals to help build confidence. Younger children typically need the reinforcement to be more immediate, while older children can have the reinforcement delayed until the end of the week, for example. Ultimately, it is easier to reinforce good behavior rather than discipline children for bad behaviour.
Another technique parents of school-aged children can consider is withdrawing privileges. For example, if a child hits their sibling, parents can remove the privilege of using the computer or playing outside with friends or cousins. The consequences should be immediate and consistent. That means that every time a particular rule is broken, a consequence should be applied. But we also want it to be proportional and fair to the rule being broken.
It is also important for both parents to be actively involved and consistent with disciplining their children. Sometimes one parent may be the disciplinarian while the other may be very permissive but this sends mixed signals. It is important for both parents to work together. No single technique works with all children so it is also important for parents to experiment with a few different techniques to see what’s effective for their child. Their child’s individual character and temperament will also determine what works and what doesn’t.

Q: A lot of working parents in Kuwait leave their children with caregivers. There are several instances of abuse being reported at the hands of these caregivers. How can parents detect abuse in such cases?
A: There are some really clear warning signs that parents can keep an eye out for. Firstly, you have to pay attention for the physical signs of abuse, where there are cuts or bruising on the child’s head, face, arms and legs; those are obviously warning signs.
There are also behavioural signs that parents must identify. They must take notice if their children are avoiding certain people. For example, if they suddenly do not want to go to daycare anymore or they are avoiding certain members in the family and refusing to go to a social gathering where a certain family member is going to be. That would be a way to keep an eye out for them. Agitation is also a good sign; sometimes children have a hard time sitting still and seem preoccupied. That can be a warning sign. Nightmares are also a warning sign; as does suddenly becoming afraid of being alone.
Sometimes when kids are being hurt, they complain about frequent physical symptoms. So, if the child is otherwise healthy and the doctor is saying that nothing is wrong with them but they continue to complain of stomach problems or headaches, the child may be trying to communicate that they are under some emotional stress and it may be necessary to rule out the possibility of abuse.
In the cases of sexual abuse sometimes children may find it hard to sit comfortably. If they start to become preoccupied by sex and topics of sex at an early age before they seem ready to, in terms of maturity and age, that could indicate inappropriate exposure to some sex topics.

Q: Why do caretakers abuse children?
A: In some cases, caretakers just haven’t had the proper training in child development and are unaware of appropriate ways of responding to children. They may not know proper disciplinary techniques and so sometimes just resort to maladapted ways of disciplining children. Sometimes when caretakers feel overwhelmed or exhausted, they may become more irritable and less patient, possibly resulting in harsher techniques. It’s important that parents are actively involved in the care of their children so that they can intervene if they feel like their caretaker isn’t disciplining their children appropriately.

Q: How should parents approach the issue with children when they suspect abuse?
A: It is vital to have a close and trusting relationship with your child. Parents must take time out to bond with their child and explain to them and make it very clear that they can come to them to talk about anything they want. Even if it is something they feel guilty about or if they feel like they have done wrong, they should also be able come to their parents and talk about it. Parents should create an open environment for their children to be able communication about all subjects, especially difficult or painful ones.
Another thing that parents can do if they suspect that their child has been hurt is to be direct about what they are concerned about. So parents must sit with their child privately, not in front of a large group, and explain why they are concerned. They can start the conversation with, “I noticed that you no longer want to spend time with so and so, we are very worried about you, we’ve noticed that you have some bruising on your arm, has anybody hurt you?” Parents can start with a question like, “has anybody hurt you” or “is anybody hurting you now”?
It is also important for parents to not interrogate their children. They must demonstrate that they are there to help them and that they will not get into trouble for speaking out. Especially, in the case of sexual abuse, where there can be such shame and guilt attached to it and it is really hard to open up about that especially in Kuwait.
Most of all, it’s important that parents communicate to their children that the abuse is not their fault. Abuse can cause extreme guilt and shame and it’s important that parents reassure them that they have done nothing wrong and that they will put a stop to the abuse. It is imperative that children are sure that their parents are their allies and that they are not going to get angry with them.

Q: In most cases, abuse results out of a conflict between the caregiver and the child. Can conflicts justify abuse?
A: Child abuse is never justifiable. We would never want a caregiver hitting the child, calling them names, or abusing them sexually. So, it is never okay for a caregiver to do that to the child. Even in cases of extreme acting-out, it still doesn’t justify the caregiver slapping them or hitting them. No conflict is large enough to justify a caregiver hitting a child.

Q: How can we detect neglect?
A: Some of the ways you can detect neglect is by observing a child; are they always dirty, are they clothed properly, do their clothes have holes in them, are they clean, do they smell bad? Is the child underfed or malnourished at all?
There is also emotional neglect that we see more commonly in Kuwait. That is where children feel alone and quite lonely because they haven’t developed strong attachments especially at home and that can be more difficult to notice. When children lack close connections with caregivers, it can often cause sadness, depression, social isolation, and difficulty making friends. Children may sit by themselves quite a bit or feel alone a lot of the time, unable to make friends. On the other hand they may be overly emotionally-needy and are anxious about being separated from people; they feel like they have to always be with somebody.

Q: Are all children vulnerable to abuse?
A: Yes, all children are vulnerable to abuse. Abuse occurs across nationalities, socio-economic status, race and ethnicity. Sometimes, it is happening in families you would not suspect. Sometimes abuse, especially emotional abuse, can be very subtle and you may not even know it unless you really looked at a child and spoke to him or her to understand why they are behaving in a certain way.

Q: How do we prevent abuse?
A: The best way to prevent abuse is through education. People should be informed about proper child discipline techniques, what abuse is, and how to recognize it. It is also important to educate children about how to keep themselves safe, including teaching them what is inappropriate touching and what they should do if someone touches or hurts them inappropriately. Another way to prevent abuse is for parents to be actively involved in their children’s lives, monitoring who they are spending time with and ensuring that their children feel comfortable telling them if someone does hurt them.
A lot of parents also have their kids abused by family members or caregivers, and they don’t know where to turn. There can be a lot of shame attached to the abuse, which can prevent families from reaching-out for help. However, it is very important that if parents suspect that there is abuse that they work with a licensed mental health professional because the consequences can be long lasting. It is important to have proper intervention and treatment and the sooner the better.

Q: Can you tell us a little bit about what your clinic is doing in this regard?
A: The Fawzia Sultan Rehabilitation Institute (FSRI) is a non-profit health clinic designed to provide the highest quality services at rates everyone can afford. We offer a range of health services including physiotherapy, speech/language therapy, occupational therapy, nutrition consultations, and counseling and psychological services. In our Psychological Services Department, we have 5 licensed mental health clinicians and psychologists who offer counseling services to children, adolescents, and adults. We also specialize in psychological assessments for children when they are having problems in school and adults for a range of concerns. All of our services are highly confidential and are available in English, Arabic, and Hindi.
All of our clinicians are experienced working with child abuse and we are actively involved in trying to de-stigmatize mental health issues in Kuwait, especially child abuse. We are currently writing a proposal and seeking donors to fund and establish a mental health division for children who have been abused. The division will offer state-of-the-art counseling and mental health services for children and families at no cost. The division will also have a prevention component, which will send our clinicians out into the community to train families, teachers, counselors, and medical professionals in identification of abuse and how to appropriately respond and refer to licensed mental health professionals. I know that people are becoming more aware of this issue in Kuwait and if people would like to donate money or become involved in this project, they can contact me at n.scull@fsrikuwait.org or 2572-0338. For more information about FSRI, please visit: www.fsrikuwait.org.

biography
Dr Nicholas Scull, PhD is the Clinical Director of the Psychological Services Department at Fawzia Sultan Rehabilitation Institute (FSRI) and he is also the President of the Middle East Psychological Association (MEPA). He holds a doctorate in counseling psychology from the University of Wisconsin-Madison and a Masters degree in social work from Bryn Mawr College. As a licensed psychologist and clinical social worker (US), he conducts individual, family, couples, and group counseling and works with both adults and children.