233 - A Qualitative Analysis of Victims of Child Maltreatment Diagnosed with Torture: A Single Center Study

Publication Number: 2224.233

Luke I. Hartman, Nationwide Children's Hospital, Columbus, OH, United States; Hannah E. Stephen, Nationwide Children's Hospital, Etna, OH, United States; Alison Humphreys, Nationwide Children's Hospital, Columbus, OH, United States; Kristin Garton. Crichton, Nationwide Children's Hospital, Columbus, OH, United States

Background: Knox et al. defined child torture in 2014 as “at least two physical assaults, occurring over at least two incidents or a single extended incident, and at least two elements of psychological abuse such as isolation, intimidation, emotional/psychological maltreatment, terrorizing, spurning, or deprivation inflicted by the child’s caretakers resulting in prolonged emotional distress, pain and suffering, bodily injury/disfigurement, permanent bodily dysfunction, and/or death.” This definition has led to improvements in the understanding and recognition of child torture. Since 2014, there has been a scarcity in research on this topic. Additional scholarly work is needed to further characterize torture cases and the specific disclosures made by victims.

Objective: This study sought to better characterize victims and perpetrators of child torture, as well as patterns of torture amongst families. We implemented forensic interviews of victims to explore the types of maltreatment disclosed and consider adding sexual abuse victimization to the criteria of the diagnosis of child torture.

Design/Methods: This is a retrospective study of patients < 18 years of age seen between January 1, 2024, and December 31, 2024, by the child protection team at a large Midwestern children’s hospital and found to have concern for child torture. The researchers identified cases by reviewing documentation completed by medical providers and forensic interviewers. This data then underwent qualitative analysis to address the above objectives.

Results: 34 cases of child torture were identified, 7 of which were sibling sets. The total number of victims was 46, with 29 (63%) being female. The most frequently reported perpetrators of child torture were the victim’s father, mother, or stepfather. The most common disclosures were neglect (70%), terrorizing (76%), being hit with an object (76%), cuts, welts, or bruises (80%), and other forms of physical abuse (89%). In 18 cases (39%), the patient was sexually abused by the same perpetrator of the alleged torture. One additional case would have been classified as child torture if sexual abuse was a component of the diagnostic criteria.

Conclusion(s): This study expands understanding of the demographics of child torture and the breadth of maltreatment types disclosed by children. This is a novel use of forensic interviewing to obtain more complete histories in high-risk children, which could serve to improve their safety. Finally, the frequent co-occurrence with sexual abuse suggests the need to expand torture criteria.