injuries to a child's behaviour or habits, such as being fussy or clumsy. despite the abuse, the child may show attachment to the parent. sexual abuse main articles: child sexual abuse and child-on-child sexual abuse child sexual abuse (csa) is a form of child abuse in which an adult or older adolescent abuses a child for sexual stimulation. sexual abuse refers to the participation of a child in a sexual act aimed toward the physical gratification or the financial profit of the person committing the act. forms of csa include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure of the genitals to a child, displaying pornography to a child, actual sexual contact with a child, physical contact with the child's genitals, viewing of the child's genitalia without physical contact, or using a child to produce child pornography. selling the sexual services of children may be viewed and treated as child abuse rather than simple incarceration. effects of child sexual abuse on the victim(s) include guilt and self-blame, flashbacks, nightmares, insomnia, fear of things associated with the abuse (including objects, smells, places, doctor's visits, etc.), self-esteem difficulties, sexual dysfunction, chronic pain, addiction, self-injury, suicidal ideation, somatic complaints, depression, ptsd, anxiety, other mental illnesses including borderline personality disorder and dissociative identity disorder, propensity to re-victimization in adulthood, bulimia nervosa, and physical injury to the child, among other problems. children who are the victims are also at an increased risk of sexually transmitted infections due to their immature immune systems and a high potential for mucosal tears during forced sexual contact. sexual victimization at a young age has been correlated with several risk factors for contracting hiv including decreased knowledge of sexual topics, increased prevalence of hiv, engagement in risky sexual practices, condom avoidance, lower knowledge of safe sex practices, frequent changing of sexual partners, and more years of sexual activity. as of 2016, in the united states, about 15% to 25% of women and 5% to 15% of men were sexually abused when they were children. most sexual abuse offenders are acquainted with their victims; approximately 30% are relatives of the child, most often brothers, sisters, fathers, mothers, uncles or cousins; around 60% are other acquaintances such as friends of the family, babysitters, or neighbours; strangers are the offenders in approximately 10% of child sexual abuse cases. in over one-third of cases, the perpetrator is also a minor. in 1999 the bbc reported on the rahi foundation's survey of sexual abuse in india, in which 76% of respondents said they had been abused as children, 40% of those stating the perpetrator was a family member. united states federal prosecutors registered multiple charges against a south korean man for reportedly running the world's "largest dark web child porn marketplace." reportedly, the english translated website "welcome to video", which has now been taken consisted of more than 200,000 videos or 8tb of data showing sexual acts involving infants, children and toddlers and processed about 7,300 bitcoin, i.e. $730,000 worth of transactions. psychological abuse there are multiple definitions of child psychological abuse: in 1995, the american professional society on the abuse of children (apsac) defined it as: spurning, terrorizing, isolating, exploiting, corrupting, denying emotional responsiveness, or neglect" or "a repeated pattern of caregiver behavior or extreme incident(s) that convey to children that they are worthless, flawed, unloved, unwanted, endangered, or only of value in meeting another's needs" in 2013, the american psychiatric association (apa) added child psychological abuse to the dsm-5, describing it as "nonaccidental verbal or symbolic acts by a child's parent or caregiver that result, or have reasonable potential to result, in significant psychological harm to the child." in the united states, states' laws vary, but most have laws against "mental injury" some have defined it as the production of psychological and social defects in the growth of a child as a result of behavior such as loud yelling, coarse and rude attitude, inattention, harsh criticism, and denigration of the child's personality. other examples include name-calling, ridicule, degradation, destruction of personal belongings, torture or killing of a pet, excessive criticism, inappropriate or excessive demands, withholding communication, and routine labeling or humiliation. in 2014, the apa found that child psychological abuse is the most prevalent form of childhood abuse in the united states, affecting nearly 3 million children annually. research has suggested that the consequences of child psychological abuse may be equally as harmful as those of sexual or physical abuse. victims of emotional abuse may react by distancing themselves from the abuser, internalizing the abusive words, or fighting back by insulting the abuser. emotional abuse can result in abnormal or disrupted attachment development, a tendency for victims to blame themselves (self-blame) for the abuse, learned helplessness, and overly passive behavior. neglect child neglect is the failure of a parent or other person with responsibility for the child, to provide needed food, clothing, shelter, medical care, or supervision to the degree that the child's health, safety or well-being may be threatened with harm. neglect is also a lack of attention from the people surrounding a child, and the non-provision of the relevant and adequate necessities for the child's survival, which would be a lack of attention, love, and nurturing. some observable signs of child neglect include: the child is frequently absent from school, begs or steals food or money, lacks needed medical and dental care, is consistently dirty, or lacks appropriate clothing for the weather. the 2010 child maltreatment report (ncands), a yearly united states federal government report based on data supplied by state child protective services (cps) agencies in the u.s., found that neglect/neglectful behavior was the "most common form of child maltreatment ". neglectful acts can be divided into six sub-categories: supervisory neglect: characterized by the absence of a parent or guardian which can lead to physical harm, sexual abuse, or criminal behavior; physical neglect: characterized by the failure to provide the basic physical necessities, such as a safe and clean home; medical neglect: characterized by the lack of providing medical care; emotional neglect: characterized by a lack of nurturance, encouragement, and support; educational neglect: characterized by the caregivers lack to provide an education and additional resources to actively participate in the school system; and abandonment: when the parent or guardian leaves a child alone for a long period of time without a babysitter or caretaker. neglected children may experience delays in physical and psychosocial development, possibly resulting in psychopathology and impaired neuropsychological functions including executive function, attention, processing speed, language, memory and social skills. researchers investigating maltreated children have repeatedly found that neglected children in the foster and adoptive populations manifest different emotional and behavioral reactions to regain lost or secure relationships and are frequently reported to have disorganized attachments and a need to control their environment. such children are not likely to view caregivers as being a source of safety, and instead typically show an increase in aggressive and hyperactive behaviors which may disrupt healthy or secure attachment with their adopted parents. these children seem to have learned to adapt to an abusive and inconsistent caregiver by becoming cautiously self-reliant, and are often described as glib, manipulative and disingenuous in their interactions with others as they move through childhood. children who are victims of neglect can have a more difficult time forming and maintaining relationships, such as romantic or friendship, later in life due to the lack of attachment they had in their earlier stages of life. effects child abuse can result in immediate adverse physical effects but it is also strongly associated with developmental problems and with many chronic physical and psychological effects, including subsequent ill-health, including higher rates of chronic conditions, high-risk health behaviors and shortened lifespan. child abuse has also been linked to suicide, according to a may 2019 study, published in the cambridge university press. maltreated children may be at risk to become maltreating adults. a 1991 source reported that studies indicate that 90 percent of maltreating adults were maltreated as children. emotional physical and emotional abuse have comparable effects on a child's emotional state and have been linked to childhood depression, low self-compassion, and negative automatic thoughts. some research suggests that high stress levels from child abuse may cause structural and functional changes within the brain, and therefore cause emotional and social disruptions. abused children can grow up experiencing insecurities, low self-esteem, and lack of development. many abused children experience ongoing difficulties with trust, social withdrawal, trouble in school, and forming relationships. babies and other young children can be affected differently by abuse than their older counterparts. babies and pre-school children who are being emotionally abused or neglected may be overly affectionate towards strangers or people they have not known for very long. they can lack confidence or become anxious, appear to not have a close relationship with their parent, exhibit aggressive behavior or act nasty towards other children and animals. older children may use foul language or act in a markedly different way to other children at the same age, struggle to control strong emotions, seem isolated from their parents, lack social skills or have few, if any, friends. children can also experience reactive attachment disorder (rad). rad is defined as markedly disturbed and developmentally inappropriate social relatedness, that usually begins before the age of 5 years. rad can present as a persistent failure to start or respond in a developmentally appropriate fashion to most social situations. the long-term impact of emotional abuse has not been studied widely, but recent studies have begun to document its long-term consequences. emotional abuse has been linked to increased depression, anxiety, and difficulties in interpersonal relationships (spertus, wong, halligan, & seremetis, 2003). victims of child abuse and neglect are more likely to commit crimes as juveniles and adults. domestic violence also takes its toll on children; although the child is not the one being abused, the child witnessing the domestic violence is greatly influential as well. research studies conducted such as the "longitudinal study on the effects of child abuse and children's exposure to domestic violence", show that 36.8% of children engage in felony assault compared to the 47.5% of abused/assaulted children. research has shown that children exposed to domestic violence increases the chances of experienced behavioral and emotional problems (depression, irritability, anxiety, academic problems, and problems in language development). overall, emotional effects caused by child abuse and even witnessing abuse can result in long-term and short-term effects that ultimately affect a child's upbringing and development. physical rib fractures in an infant secondary to child abuse the immediate physical effects of abuse or neglect can be relatively minor (bruises or cuts) or severe (broken bones, hemorrhage, death). certain injuries, such as rib fractures or femoral fractures in infants that are not yet walking, may increase suspicion of child physical abuse, although such injuries are only seen in a fraction of children suffering physical abuse. cigarette burns or scald injuries may also prompt evaluation for child physical abuse. the long-term impact of child abuse and neglect on physical health and development can be: shaken baby syndrome. shaking a baby is a common form of child abuse that often results in permanent neurological damage (80% of cases) or death (30% of cases). damage results from intracranial hypertension (increased pressure in the skull) after bleeding in the brain, damage to the spinal cord and neck, and rib or bone fractures. impaired brain development. child abuse and neglect have been shown, in some cases, to cause important regions of the brain to fail to form or grow properly, resulting in impaired development. structural brain changes as a result of child abuse or neglect include overall smaller brain volume, hippocampal atrophy, prefrontal cortex dysfunction, decreased corpus callosum density, and delays in the myelination of synapses. these alterations in brain maturation have long-term consequences for cognitive, language, and academic abilities. in addition, these neurological changes impact the amygdala and hypothalamic-pituitary-adrenal (hpa) axis which are involved in stress response and may cause ptsd symptoms. poor physical health. in addition to possible immediate adverse physical effects, household dysfunction and childhood maltreatment are strongly associated with many chronic physical and psychological effects, including subsequent ill-health in childhood, adolescence and adulthood, with higher rates of chronic conditions, high-risk health behaviors and shortened lifespan. adults who experienced abuse or