A look at child abuse cases over the last 20 years shows a reduction in rates of physical and sexual abuse. But while that may be good news, researchers from the Institute of Medicine (IOM) point out that reports of child neglect, which constitutes 75 percent of all child abuse cases, continue to rise. In a new report, the IOM posits that variance in state governments' ways with dealing with child neglect accounts for the lack of change.

The report found that of the six million child abuse cases reported each year to Child Protective Services (CPS), about eight percent are of physical abuse and nine percent are of sexual abuse. The remainder, more than 75 percent of the total, are cases of child neglect. About 20 percent of cases investigated by the CPS end with the child being removed from their home. Many more cases go on unreported.

Child Neglect: A Social and Public Health Problem

A 1993 National Academy of Sciences report, which was the last large scale report to examine the impact of different kinds of child abuse on a child's physical and emotional well-being, concluded that child abuse was a “devastating social problem.” Now, 20 years of further research has shown that child abuse also has long-term consequences and the impact on the public at large, Anne Petersen, chairwoman of the committee behind the report, told USA Today.

“Child neglect encompasses a huge number of different problems,” David Finkelhor, director of the Crimes Against Children Research Center at the University of New Hampshire, who wasn’t involved in the study, told CBS News. Finkelhor told CBS. An infographic accompanying the report shows the many ways that neglect might manifest, including failure to provide food, clothing, safe shelter, affection, supervision, medical care, and education. A child deprived of these basic needs could face very serious consequences, and even death. The majority of reported cases were children younger than 5 years old. In 2011, 1,545 children younger than four died because of the abuse or neglect they suffered.

Intervention and Ending Child Neglect

The researchers highlighted the importance of state governments to coordinate their strategy for tackling perpetrators of neglect. Each state vary in their definition of what constitutes neglect, and many officials fail to adequately respond. “Some states had dramatic, 100 percent increases in cases of neglect, and others had 100 percent decreases. That speaks to the complexity of the problem,” Lucy Berliner, a professor at the University of Washington’s School of Social Work and a member of the committee, told the Washington Post.

Parents who had problems with depression, substance abuse, or who were neglected or abused as children themselves were more likely to abuse their children, the report found. Researchers did not find an association between rates of abuse and the 2008 recession, despite another study concluding otherwise.

Abused children are at risk for long-term effects, such as depression, post traumatic stress disorder, and heightened anxiety. Children who have faced abuse may differ in the development of the prefrontal cortex of the brain, which is responsible for social behavior and decision making, and in the development of the stress response system.

“The effects seen on abused children’s brains and behavioral development are not static,” Mary Dozier, committee member and chairman of Child Development at the University of Delaware, told the Post. “If we can intervene and change a child’s environment, we actually see plasticity in the brain. So, we see negative changes when a child is abused, but we also see positive brain changes when they are more supported. Interventions can be very effective.”