By Catherine Winters
MyHealthNewsDaily

Women who were abused during childhood may face a higher risk of having a child with an autism spectrum disorder, according to new findings. 

Women in the study who experienced the highest levels of physical and emotional abuse were 60 percent more likely to have a child with autism than women who weren't abused, the study found.

The most severe combination of physical, emotional and sexual abuse meant a woman in the study was 3.5 times more likely to have an autistic child than a woman who hadn't been abused, said lead study author Andrea L. Roberts, research associate in the department of social and behavioral sciences at the Harvard School of Public Health.

The researchers examined questionnaire data from more than 52,000 women enrolled in the Nurses' Health Study II, a large study of women's health that began in 1989.

Of the women in the study, 451 had a child with autism.

To assess whether the women had been abused during childhood, the researchers asked if the surveyed women had ever been hit hard enough to be bruised, or been struck by a belt or other object, and if they had been subjected to cruel punishments, insulting comments or screaming. Researchers also asked the women if they had ever experienced unwanted sexual touching or forced sexual contact by an adult or older child.

The researchers also investigated whether pregnancy-related risk factors, which have been associated with autism, further raised the risk for the condition. These risk factors include gestational diabetes, preeclampsia and premature birth. Other risks, such as smoking, use of medicines called selective serotonin uptake inhibitors and abuse by an intimate partner during pregnancy, were also examined.

Results showed that while the abused women more frequently suffered pregnancy-related risk factors, these factors explained only a small part of the link found between child abuse and autism risk.

The study shows an association, not a cause-and-effect link, researchers aid, and it's not clear how childhood abuse may contribute to autism.

But there are plausable ways to explain the association. One idea is that abused women may have a heightened response to stress, leading to inflammation or high levels of stress hormones, which affect the fetus' brain. Another possible explanation holds that parents who abuse children may be mentally ill, which may raise the risk for other mental disabilities, including autism, in relatives, Roberts said.

While provocative, the study results have limitations. First, the data was self-reported. What's more, knowing her child had autism may have influenced a woman's responses to the questionnaires.

One expert worried the findings may fuel parents' fears that they caused their child's condition.

"What is concerning is the potential effect this could have on mothers," said Tanya Paparella, director of the Early Childhood Partial Hospitalization Program at the University of California, Los Angeles, which treats young children who have autism. "We know that autism is strongly genetic in its origin, but we know very little about where the genetic risk factors lie and where the environmental risk factors lie, and very little about the combination of genetic and environmental risks."

Still, the study adds a new piece to the autism puzzle. "We are struggling a little with trying to find out what causes autism," Roberts said. "Our study points to a possible new direction in the research."

The fact that pregnancy-related risk factors for autism were higher in women who were abused "suggests that the effect of abuse can reach across generations," Roberts added. "As a society, we need to focus more on how children are cared for and give more support to families who might be at risk for abusing their children."

The study is published online today (March 20) in the journal JAMA Psychiatry.

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A new look at child abuse reports suggests there may have been a small but worrying rise in injuries to babies over the past decade or so. While most research suggests child abuse is down overall, the report published on Monday in the journal Pediatrics shows infants are far from safe.

The study contradicts government data collected over the same time, and it shows that health officials need to take a better look at whether child abuse is getting better, worse or staying the same, experts said.

“I think it’s premature to make any conclusions about whether it is going up or down,” says Dr. James Anderst, chief of the section on child abuse and neglect at Children's Mercy Hospitals and Clinics in Kansas City, Mo., who was not involved in the study. “Medical providers may be getting better at identifying abuse over time.”

Either way, it’s still happening and that’s a concern, says Dr. John Leventhal of Yale University, who led the study. “Maybe parents are doing better and hurting their children less in general, but there is a small group where there continue to be substantial injuries that end in hospitalization,” Leventhal said.

Leventhal and colleague Julie Gaither looked at statistics on children admitted to hospitals for serious injuries. Writing in the journal Pediatrics, they said they found a nearly 11 percent increase over 12 years in serious injuries to babies a year old and younger.

This is at the same time that two major national surveys of child abuse found decreases of between 55 percent and 23 percent in child abuse injuries overall, for all ages, between 1997 and 2009. It's important to point out that each study goes to different sources for data -- this week's study looks at hospital admissions, while the government studies examined reports of abuse filed to Child Protective Services and other agencies by doctors and other sources.

Child abuse is a serious problem in the United States. The Centers for Disease Control and Prevention says more than 740,000 children and youth are treated in hospital emergency departments for injuries resulting from violence every year.

“Child abuse, neglect or violence can actually affect the development of a child’s brain – impacting the child now and for years to come. Our Adverse Childhood Experiences (ACE) studyshows a connection between child maltreatment and some of the nation’s worst health problems, including depression and heart disease,” CDC child abuse expert Linda Degutis says in a blog on the agency’s website. 

CDC declined comment on Monday’s study in Pediatrics.

“I would say that the experts in this area are still trying to make sense of the various trends in physical abuse and explain why there are divergences,” said David Finkelhor of the University of New Hampshire, who led one of the studies showing a decrease in child abuse injuries between 1997 and 2009. “This new report is helpful but does not resolve any of the outstanding questions.”

Leventhal said it’s important to get better data, but says it’s difficult. “It is probably harder to substantiate a physical abuse case now than it was 15-20 years ago,” he says -- mostly because agencies have tightened the rules for classifying cases as child abuse. “My colleagues in child protective services say it is much harder.” Many, he says, classify abuse cases as neglect instead. But it would be important to get data to back this up.

Anderst and Leventhal both said education is an important way to help prevent child abuse. “Over 50 percent of the kids on my study were infants. Thirty to 40 percent of those infants had abusive head trauma, often known as shaken baby syndrome,” Leventhal said. That suggests parents are caretakers who are frustrated and don’t know how to cope with a wailing baby, he said.

“I think, regardless of the cause, the message is too many children, particularly very young children are  getting hurt,” he said. “And pediatricians and others who look after children need to craft clear messages so that children are not hurt by abuse.

Yale’s hospital has an approach called “Take Five.” “If you feel like you are going to lose it, put the baby in a safe place, namely a crib, step back and take five,” Leventhal says. Some states are also giving new parents information about not shaking their babies – even seemingly gentle shakes can cause traumatic brain injury. “There are now systematic efforts funded in part by the CDC to see whether education about crying infants, about stepping away, about not shaking a baby, change the likelihood that children end up in the hospital with those injuries,” Leventhal added.

Sometimes people were themselves beaten as children, and pass this behavior along, Anderst said. “Some people are just ill-prepared to be parents and don’t know how to handle children. Some people come from violent backgrounds and that is how they handle their problems.”

So how to change this behavior? “It’s the same way we get people to quit smoking. It is the same way we get people to wear seat belts. It is a combination of laws and enforcement of those laws and also supporting people so they can be better parents,” Anderst said.

He said government officials should think about those consequences when they cut programs to save money in state budgets.

Sometimes it's not the parents who are doing the harm but someone outside the family.

Dr. Suzanne Starling, a pediatrician at Eastern Virginia Medical School, has made intensive studies of who’s hurting kids, and found a consistent pattern: men are far more likely to hit, shake or batter young children. One study she published in the Southern Medical Journal found fathers committed 45 percent of attacks, and boyfriends of the mothers another 25 percent.

“Parents need to believe that the people close to them might have the potential to lose it with a frustrating circumstance such as a crying baby,” Leventhal advised. “They need to say each of the people who looks after their child, ‘my baby cries sometimes and it gets frustrating. If you feel that way, call me. I will come home from work. But don’t hurt my baby’.”

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Small children may be suffering the effects of the home foreclosure crisis in a serious way, researchers reported on Monday. They found a troubling increase in the number of young children with physical abuse showing up in hospital emergency rooms.

The researchers found just under a 1 percent increase in the number of general physical abuse cases reported at 38 pediatric hospitals every year between 2000 and 2009 and a more than 3 percent rise in the number of traumatic brain injuries seen in babies.

These increased rates seemed to directly correlate with the rate of mortgage foreclosures in a community, Dr. Joanne Wood of the Children’s Hospital of Philadelphia and colleagues reported in the journal Pediatrics. There might be something uniquely stressful about losing a home that can lead to child abuse, they suggested.

“It’s well known that economic stress has been linked to an increase in child physical abuse, so we wanted to get to the bottom of the contrasting reports by formally studying hospital data on a larger scale,” Wood said in a statement.

They found that each 1 percent increase in mortgage delinquencies correlated with a 3 percent increase in the number of children 6 and under hospitalized every year for suspected physical abuse and a 5 percent increase in admissions due to traumatic brain injury from abuse.

“As the foreclosure crisis is projected to continue in the near future, these results highlight the need to better understand the stress that housing insecurity places on families and communities so that we can better support them during difficult times,” Wood said.

They said their findings need more study to confirm them, especially because they contradict other data showing child abuse rates are down overall nationwide. It might be important to pinpoint communities that are particularly affected and help those parents cope, said Dr. David Rubin, a pediatrician at Children’s Hospital of Philadelphia who worked on the study.

“It is a reminder to me that when I see families in my practice who have lost their insurance or who have changed homes, to probe a little further about the challenges they are facing. As communities, we all need to reach out a little more to identify which families may be in crisis and help guide them to appropriate resources for support," Rubin said.

There was no link between suspected child abuse cases and unemployment rates, the researchers found.

“At the local and state levels, child welfare agencies should consider additional methods of tracking child abuse data, including hospital data. These efforts will enable public agencies to better monitor child abuse and neglect and to respond effectively to the needs of children and families,” the researchers advised.

“Pediatricians and other health care providers should be aware about housing insecurity that may be affecting families in their care. Providers can help connect patients and families to appropriate social services, such as cash assistance, food stamps, medical assistance benefits, and foreclosure counseling.”

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Jennifer Lynn Mothershead, 29, of Buckley, Wash., remains jailed on charges of first-degree child abuse after doctors said she nearly blinded her toddler daughter by replacing the child's medical eyedrops with household bleach.

Seattle doctors who may have been slow to report abuse in a toddler whose mother allegedly put bleach in the child’s eyes -- nearly blinding her -- are under state investigation.

Officials at the Washington state Medical Quality Assurance Commission have filed a complaint and launched an inquiry into the care of the girl, now 2, at Seattle Children’s Hospital, a spokesman confirmed.

The girl, identified only as K.L.M., was treated for nearly two months for severe eye injuries in spring 2011, but only reported as a possible abuse victim after suffering a head injury that sent her to a trauma center.

Her mother, Jennifer Lynn Mothershead, 29, of Buckley, Wash., has been charged with first-degree child abuse linked to allegations that she substituted bleach in the child's medical eye drops and administered them repeatedly. 

Internal commission staffers launched the probe this month after media coverage of the incident, said Donn Moyer, a state health department spokesman.

“We’re unable to comment beyond acknowledging that we’re investigating,” he said.

Officials at Seattle Children’s also declined to comment on the investigation.

Last month, msnbc.com reported that Dr. Avery H. Weiss, an ophthalmologist with the Roger Johnson Clinical Vision Laboratory at the hospital, said he suspected child abuse early in the weeks of treatment for unexplained eye damage and infections in March and April 2011.

“That’s why I put her in the hospital,” Weiss told msnbc.com in an April interview. He explained that the girl would improve under supervised care and then worsen when she returned to her mother.

But, he added, he wanted to make sure he was correct before alleging intentional harm.

“Before I say child abuse, I want incontrovertible evidence,” said Weiss, who specializes in treating children who have eye damage caused by shaken baby syndrome and other abuse.

By law, medical practitioners in Washington state are required to report child abuse or neglect “at the first opportunity,” or no later than 48 hours after there is “reasonable cause” to believe a child has been harmed. Failure to report child abuse is classified as a gross misdemeanor punishable by jail time or a fine, state statutes show.

But it wasn’t until May 12, 2011, that Weiss said he became certain. That day, the 14-month-old was flown to a nearby trauma center, Harborview Medical Center, with a subdural hematoma, or brain hemorrhage.

“That prompted the report,” he said.

On April 26, after a nearly year-long probe, Pierce county detectives arrested Mothershead. Court documents allege that she replaced the child’s eye drops with household bleach, then repeatedly “swaddled” the girl and forced the caustic substance into her eyes.

Investigators learned about the abuse only after confiscating the prescription eye drops. When the bottle was opened, a “noxious smell” filled the room, according to reports. Witnesses reported mild nausea.

“Of course we felt guilty,” Weiss told msnbc.com in the previous interview. “We knew from very early on that she had this. But we were reluctant to implicate the mother until we were 100 percent sure.”

Weiss recounted the case in an article in an April issue of a medical journal, where he acknowledged that medical staffers may have missed signs that the girl was being abused.

“After failing to respond to standard therapy, she was eventually identified as a victim of abuse,” Weiss and his co-authors wrote. “We discuss key findings that could have provoked earlier recognition.”

He said he wrote the report as a warning to other ophthalmologists that a chronic or unusual eye infection actually may be a sign of child abuse.

It’s not clear how long the investigation by the medical commission may take, said Moyer, the state health department spokesman.

Jennifer Mothershead remains lodged in the Pierce County jail, records showed. A second child born to her last August was placed in protective custody.

The toddler's father, Cody Mothershead, has custody of the child. The girl is expected to have permanent damage, including severe visual impairment, though not actual blindness.

"This child isn't going to be normal for the rest of her life," Weiss told msnbc.com. 

Cody Mothershead is also a mandatory reporter because he’s a math teacher at White River High School in Buckley. But reports indicate that he saw the child infrequently, for only a few hours every week to 10 days, and that Jennifer Mothershead prevented him from giving the girl her eye drops.

Weiss said he believed that Cody Mothershead didn’t realize the girl was being abused. 

Administrators in the White River School District apparently agree. On Thursday, district superintendent Tom Lockyer confirmed that Cody Mothershead remains in the classroom. 

Msnbc.com writer Sevil Omer contributed to this report.

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The child abuse that takes place in one year in the United States will cost the nation $124 billion over the victims' lifetimes, according to a new report from the Centers for Disease Control and Prevention.

The findings reveal the financial burden of child abuse is just as high or higher than that of costly health conditions, including Type 2 diabetes.

"No child should ever be the victim of abuse or neglect — nor do they have to be. The human and financial costs can be prevented through prevention of child maltreatment," said Linda C. Degutis, director of CDC′s National Center for Injury Prevention and Control.

In 2008, there were 1,740 confirmed cases of fatal child abuse, and 579,000 nonfatal cases of child maltreatment, which include physical abuse, sexual abuse, psychological abuse and neglect, according to the report.

The cost of health care, child welfare and other services for each victim who survived their abuse will be $210,012 over the average victim's lifetime, which is higher than the lifetime cost of stroke ($159,846 per person) and Type 2 diabetes (between $181,000 and $253,000 per person). The costs of each death due to abuse are even higher, according to the report.

Child maltreatment has been shown to have many negative effects on survivors, including poorer health, social and emotional difficulties, and decreased economic productivity. These negative effects over a survivor’s lifetime generate many costs that deleteriously affect the nation's health care, education, criminal justice and welfare systems. 

The estimated average lifetime cost per victim of nonfatal child maltreatment includes:

• $32,648 in childhood health care costs
• $10,530 in adult medical costs
• $144,360 in productivity losses
• $7,728 in child welfare costs
• $6,747 in criminal justice costs
• $7,999 in special education costs

The estimated average lifetime cost per death includes:

• $14,100 in medical costs
• $1,258,800 in productivity losses

The emotional and behavioral problems associated with child maltreatment include aggression, conduct disorder, antisocial behavior, substance abuse, intimate partner violence, teenage pregnancy, anxiety, depression and suicide, according to the report.

Better solutions to prevent childhood maltreatment must be found, the CDC said. A parent's or caregiver's behavior is influenced by a range of inter-related factors, such as how they were raised, their parenting skills, the level of stress in their life, and the living conditions in their community.

"Federal, state and local public health agencies as well as policymakers must advance the awareness of the lifetime economic impact of child maltreatment and take immediate action with the same momentum and intensity dedicated to other high-profile public health problems in order to save lives, protect the public's health, and save money,” Degutis said.

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