The Australian Child Maltreatment Study: National prevalence and associated health outcomes of child abuse and neglect

To the Editor: Mathews and colleagues1 recently reported on the prevalence of child maltreatment in Australia and its association with adverse outcomes, drawing on a population survey of 8503 people aged 16 years and over — the Australian Child Maltreatment Study (ACMS).

Understanding the extent of child maltreatment and those most at risk is of considerable importance to policy and practice, noting the widely documented negative impacts on health, education, employment, and other social and economic outcomes. A strong dose–response relationship has also been reported; the more disturbing the child maltreatment, the worse the reported outcomes, and conversely the lower the child protection concern, the lower the risk of harms.2,3

The ACMS headline finding that 62% of individuals interviewed had experienced child maltreatment brings to the forefront the debate around defining child maltreatment thresholds.4 When should undesirable parenting practices be considered child maltreatment? Some tensions and distress within families will be hard to avoid altogether — but at what point is a distressing family environment equal to child maltreatment, carrying the implication that a policy and service response is needed. Where should we set the threshold?

The questions adopted by the ACMS were carefully selected based on the Juvenile Victimisation Questionnaire. However, the interpretation of the survey responses as child maltreatment perhaps warrants further discussion. Is the threshold for defining child maltreatment in the ACMS consistent with community expectations and with research findings concerning risk of harms, noting the observed relationship between severity of maltreatment and level of harm? Consider for example the question “Did any of your parents often ignore you, or not show you love and affection?” used in the ACMS to define child maltreatment “if occurring over a period of weeks or more”. Might this (and other questions) capture individuals unlikely to be widely defined as victims of child maltreatment or the parents as perpetrators of abuse or neglect?

The alarming findings of the ACMS are bringing needed attention to issues of child safety. However, the findings also highlight the need for a discussion around how we define child maltreatment if we are to identify those most in need of our support, to prevent and ameliorate harms.