In the first major study of child abuse and neglect in 20 years, researchers with the National Academy of Sciences reported [on September 12] that the damaging consequences of abuse can not only reshape a child's brain but also last a lifetime. Untreated, the effects of child abuse and neglect, the researchers found, can profoundly influence victims' physical and mental health, their ability to control emotions and impulses, their achievement in school, and the relationships they form as children and as adults. The researchers recommended an immediate, coordinated" national strategy to better understand, treat and prevent child abuse and neglect, noting that each year, abuse and neglect costs an estimated $80 billion in the direct costs of hospitalization, law enforcement and child welfare and the indirect costs of special education, juvenile and adult criminal justice, adult homelessness, and lost work productivity. The report ... found that while rates of physical and sexual child abuse have declined in the past 20 years, rates of emotional and psychological abuse, the kind that can produce the most serious long-lasting effects, have increased. Every year, child-protection agencies receive 3 million referrals for child abuse and neglect involving about 6 million children, the report found, though with unreported instances, the actual number is probably much higher, the researchers said. Child victims are equally likely to be male or female, the report found. The majority are younger than 5. About 80 percent of the perpetrators are parents, the vast majority biological parents. More than half of the perpetrators are female.