The paediatrician’s role in safeguarding children and young people exposed to domestic violence

Domestic violence is a public health issue and there has been growing recognition that there are harmful consequences for children and young people living in violent homes. Tackling domestic violence is a priority in UK government crime control policies, in health and in policies on child protection and children’s welfare. This article considers the paediatrician’s role in the context of UK policy expectations for safeguarding children and young people, early intervention and providing universal, targeted and responsive services to address children’s needs. Based upon a review of the research literature on domestic violence and the role of the paediatrician, this article briefly considers the impact of domestic violence upon children’s health and wellbeing. It also makes practical recommendations for paediatricians on: presenting symptoms and diagnosis; supporting children and the non-abusive parent; referral; and working with others to safeguard vulnerable children.     

Youth,guns, and violent crime

Young people are overrepresented as both victims and perpetrators of violence. Indeed, some commentators have suggested that recent cohorts of youth have been composed of "superpredators" who have little regard for human life. The evidence, however, suggests that other factors are responsible for recent increases in youth gun violence. This article analyzes the extent and causes of youth violence in the United States, paying particular attention to the late 1980s and early 1990s, when rates of homicide and robbery committed by youth rose to extremely high levels. Examination of trends for these crimes shows that: The increase in violence in the United States during the late 1980s and early 1990s was due primarily to an increase in violent acts committed by people under age 20. Similarly, dramatic declines in homicide and robbery in recent years are attributable primarily to a decline in youth violence. The increase in youth homicide was predominantly due to a significant increase in the use of handguns, which converted ordinary teenage fights and other violent encounters into homicides. Several other interrelated factors also fueled the rise in youth violence, including the rise of illegal drug markets, particularly for crack cocaine, the recruitment of youth into those markets, and an increase in gun carrying among young people. The author points out that youth violence diminished as the crack markets shrank, law enforcement increased efforts to control youth access to guns, youth gun carrying declined, and the robust economy provided legitimate jobs for young people.     

Behavior-oriented approaches to reducing youth gun violence

Advocacy groups on both sides of the guns issue frequently point to changing personal behavior--of both parents and children--as a key element in reducing gun violence among youth. Efforts to bring about these changes range from community-based campaigns, to laws and programs that encourage parents to store their guns safely, to educational initiatives that focus on keeping young children away from guns and encouraging youth to resolve disputes without violence. Unfortunately, these behavior-oriented programs have not shown great success in reducing youth gun violence. This article reviews the research surrounding behavioral approaches to gun violence prevention and highlights obstacles that hamper the effectiveness of these programs. Supportive communities can play a key role in protecting youth from violence in general, but the few community-based violence prevention programs that focus on youth have not been shown to decrease youth access to or use of guns. By and large, behavioral programs and legal interventions aimed at parents have not been proven to reduce youth gun violence. This may be due in part to parental misperceptions about children's risk of injury and ability to protect themselves. Children and youth are particularly difficult targets for behavioral change programs. Cognitive immaturity among younger children and perceptions of invulnerability among adolescents may be part of the reason. Most programs that seek to persuade youth to stay away from guns have not been proven effective. The author concludes that, although behavioral programs could be improved, overall they hold only limited promise for reducing youth gun violence.     

Psychosocial Indicators of Wellbeing for Resettled Refugee Children and Youth: Conceptual and Developmental Directions

In this article we present a framework for the development of psychosocial indicators of wellbeing for refugee children and young people which can be used to assess outcomes of interventions in the settlement context. While some experiences of refugee children and young people overlap with the general population of children and young people, many of their experiences are distinctive because of their exposure to violence prior to arrival and a range of stressors upon resettlement. Drawing on research conducted into outcome indicators at the Victorian Foundation for Survivors of Torture, several indicator domains are presented that have sensitivity and specificity for resettled refugee children and young people. The domains presented are distinctive and multifaceted. They encompass the perspectives of young people, parents, and service providers. They incorporate individual and relational aspects, subjective emotional states and observable behaviours. They include signs and symptoms of disturbances to psychological wellbeing, family wellbeing, connections to social groups and community, and positive expressions of wellbeing. They have been developed with an ecological context in mind and thus take into account a range of key contextual mediating variables.     

Mitigating the effects of gun violence on children and youth

Countless children and youth are exposed to gun violence each year--at home, at school, in their communities, or through the media. Gun violence can leave lasting emotional scars on these children. This article reviews research regarding the psychological effects of gun violence on children and youth, and offers suggestions for how parents, school administrators, and mental health workers can mitigate these negative effects. Children exposed to gun violence may experience negative short- and long-term psychological effects, including anger, withdrawal, posttraumatic stress, and desensitization to violence. All of these outcomes can feed into a continuing cycle of violence. Certain children may be at higher risk for negative outcomes if they are exposed to gun violence. Groups at risk include children injured in gun violence, those who witness violent acts at close proximity, those exposed to high levels of violence in their communities or schools, and those exposed to violent media. Parents, school administrators, and mental health workers all can play key roles in protecting children from gun violence and helping them overcome the effects of gun-related trauma. The authors recommend a number of strategies that adults can adopt to help children cope with gun violence, such as increasing parental monitoring, targeting services to youth at risk of violent activity, and developing therapeutic interventions to help traumatized young people.     

Sex behavior in puberty

The increasing number of Aids cases raises questions as to the risks to which young people are exposed. The present study attempts to illustrate the psychological development of sexuality during puberty. Taking development-psychological and depth-psychological aspects into account, the author attempts to throw light on the development of the ego and the instinctual and defensive behavior of young people. These intrapsychic constellations and social norms have a major influence on young people's sexual behavior.     

Handguns as a pediatric problem

Handgun injury is a major cause of morbidity and mortality in American society, particularly among young people. Large numbers of children are affected by handgun violence through the loss of fathers, brothers, and other relatives. Young children are injured, and occasionally killed, in handgun "accidents." Some young children and many adolescents are murdered with handguns. Like infant mortality, handgun violence in the United States is a medical as well as a social problem. Because of the great lethality of handguns and their very limited ability to provide personal protection, handgun injury can best be reduced by making handguns less available. Handgun control cannot reduce rates of crime or interpersonal assault, but it can reduce the frequency and severity of injury arising from these situations toward the much lower levels found in other countries. The involvement of children in the United States handgun injury epidemic warrants effective pediatrician involvement in efforts toward handgun control.     

Epilepsy and associated psychopathology in young people with intellectual disability

OBJECTIVE: This study aimed to investigate the role of epilepsy in psychopathology among an epidemiological sample of young people with intellectual disability (ID). The study also compared behavioural and emotional problems in young people on medication to control their epilepsy with those not on medication, and young people with epilepsy who were having current seizure activity with those with no current seizure activity. METHODOLOGY: An epidemiological cohort of 392 participants, representative of the general Australian population of young people with ID, were used in the study. One hundred and fifteen individuals from this cohort were identified as suffering from epilepsy. The Developmental Behaviour Checklist was used to measure symptoms of behavioural and emotional disturbance. RESULTS: Results confirmed that young people with ID and epilepsy did not differ from controls without epilepsy on measures of psychopathology. Furthermore, those with epilepsy on medication had no difference in levels of problem behaviours than epileptics not on medication. CONCLUSIONS: The results suggest that epilepsy has little or no influence on problem behaviours for young people with ID. Our attempt to understand the pathogenesis of behaviour problems in persons with ID may be better directed towards understanding genetic mechanisms than epilepsy pathologies.     

Climat incestuel : proposition d’objectivation des critères de définition à partir de jeunes orientés en institut thérapeutique, éducatif et pédagogique (ITEP)

Introduction

The consequences of sexual violence have a negative impact on the child's subsequent development. Emotional incest is harmful to the child, even if there are no actual physical acts; its consequences are not as well known as those of incest, but are likely to be similar. Young people with severely disturbed behavior are referred to Therapeutic, Educational and Pedagogical Institutes (ITEP). We looked for a history of sexual abuse in these young people, including emotional incest. The aim of this study is to better define emotional incest (among other forms of sexual violence) and to propose criteria for its identification among the young people attending ITEPs.

Aspects psychopathologiques de la violence

Actually, violence is expressed as soon as the youngest age; from school to their house and in the street. From where is it coming? What are its origin and it’s becoming? Violence is inside all human being. At the beginning violence is pulsion. Furthermore, across the development meeting an object; pulsion is going to be fastened. Since many years family and society seems to be unable to contain these pulsions of violence. Violence claims for this lack of contain from the baby state to adolescence. The child need to keep on his real object violence because he is afraid to feel failure. In this paper we approach border line personalities. Actually, we observe an increased of this diagnosis in front of the decreased of intrapsychic conflicts linked to neurosis. This understanding of the beginning, the expressions, and the psychopathological of violence can be useful in the care of this children. We stressed the fact of the necessary to work in coordination with all the people who attended the young patients. It seems also very important to taking to account scholarship, justice, and that politics take new measures.     

The role of the pediatrician in preventing suicidal behavior

Suicidality is a serious cause of morbidity and mortality among young people. Important risk factors for suicidal behavior are mental illness, alcohol and other substance use disorders, previous suicide attempt, impulsive and/or aggressive behavior, history of abuse, and access to lethal means. Emotional well-being and connectedness to family and school act to buffer or protect young people from involvement in self-directed violence. Pediatricians can play a major role in suicide prevention by identifying emotional and behavioral problems and intervening appropriately, promoting positive parenting skills and family cohesion, and providing injury prevention education to reduce access to lethal means. As part of a comprehensive strategy to prevent youth suicidal behavior, child health professionals are uniquely positioned to promote resiliency among youth and families as well as identify and provide appropriate treatment and service coordination for risk factors before injuries occur. Adequate training is critical to ensure that pediatricians are prepared to provide effective assessment, prevention and intervention for suicidal behavior.     

Surveying adolescents: Focusing on positive development

Although risk behaviours can threaten healthy youth development, reducing risks alone is not sufficient to help youth successfully negotiate adolescence. Promoting protective factors that buffer risk, such as family and school connectedness, community engagement and positive peer support, are also important for helping youth to thrive. Since 1992, the Adolescent Health Surveys conducted by McCreary Centre Society (Vancouver, British Columbia) have monitored both risk behaviours and protective factors among high school students across British Columbia. They have shown that, contrary to media images and community perceptions, the majority of young people are not exposed to risk factors such as violence and abuse; most do not have unprotected sex, drink and drive, use illegal drugs or consider suicide. They have also documented key protective factors that are linked to lower rates of risk behaviours and more positive outcomes, even for youth who face unsafe environments, family problems and other stressors. The shift toward assessing and promoting protective factors is a major paradigm change in adolescent health care, and clinicians can be an important partner with families and schools to foster healthy youth development.     

Burn out – slow down?

The article focuses on multitasking and virtual mobility in young people’s everyday life. The author demonstrates how paradoxes of a digital high speed society massively influence both the educational sphere and young people’s leisure time and encourage thinking about strategies concerning the work-life balance and burnout prevention in young target groups.     

Medical violence toward young children

The author describes the many circumstances during which infants and young children are submitted to violence by doctors or medical assistants when given medical care. This violence starts at birth in the newborn ward. Later it is found in all forms of care dispensed to young children in ambulatory as well as hospital practice. The author shows that most of this violence can be avoided provided that doctors act in full consciousness of its consequences.     

Changes in Family Structure and the Well-Being of British Children: Evidence from a Fifteen-Year Panel Study

In this paper, I use the Youth Panel data in the British Household Panel Survey to examine how changes in family structure influence the well-being of young people in the sample. Using 15 years of panel data, I use pooled cross-sectional and fixed effects models to estimate how the changes in family structure influence the well-being of children. In the pooled cross-sectional analysis, statistically significant differences are found between young people in living with two biological parents and all other groups. Fixed effects models demonstrate that transitioning out of a two-parent biological family is associated with less happiness, self esteem and household income. Movement into stepfamilies also decreases the happiness of young people, although the transition is also met by an increase in household income.     

Depressive symptomatology as a predictor of exposure to intimate partner violence among US female adolescents and young adults

OBJECTIVE: To examine whether depressive symptomatology is predictive of subsequent intimate partner violence victimization among a national prospective sample of female adolescents and young adults. DESIGN: Home interview data from 2 waves of the school-based National Longitudinal Study of Adolescent Health were used to examine whether baseline depressive symptomatology was associated with increased risk of past-year exposure to physical abuse by a current partner at 5-year follow-up, controlling for age, race/ethnicity, parental education, retrospective childhood physical and sexual abuse, and baseline dating violence and forced sex. SETTING: A stratified random sample of 80 US high schools and 52 middle schools. PARTICIPANTS: All young women (n = 1659) were in a current opposite-sex relationship at follow-up. MAIN EXPOSURE: Baseline past-week depressive symptomatology, measured as both a dichotomous and continuous variable. MAIN OUTCOME MEASURES: Past-year exposure to mild and moderate to severe physical abuse by a current intimate partner. RESULTS: In adjusted models with dichotomous depressive symptoms, high baseline symptom levels were associated with 1.86 times the odds of subsequent exposure to moderate to severe partner violence (95% confidence interval, 1.05-3.29). In adjusted models with continuous depressive symptoms, an increase of 1 SD in baseline symptom levels was associated with a 24% increase in odds of exposure to mild partner violence and a 24% increase in the odds of exposure to moderate to severe partner violence. CONCLUSIONS: The findings of this study suggest that depressive symptomatology among girls during adolescence is associated with increased risk of subsequent exposure to physical partner violence. Prevention, identification, and treatment of depressive symptomatology among adolescent girls may help to reduce the likelihood of subsequent victimization.     

Prevalence and correlates of partner violence among South African adolescents

BACKGROUND: Little is known about the prevalence of partner violence among adolescents, nor of the factors with which it is associated. The objectives of this study were to document prevalence rates for partner violence among high school students in Cape Town, and to explore factors that are associated with such violence. METHOD: The sample consisted of 596 Grade 8 and 11 students attending public high schools in Cape Town, who were selected using a multistage cluster design. They completed an anonymous and confidential questionnaire. The dependent variable was whether they had ever perpetrated partner violence, or intended to do so. The independent variables, which were derived from a modified version of the Theory of Planned Behaviour (TPB), included attitudes, subjective norms (general and peer social influence and outcome expectancy) and self-efficacy. Separate multiple logistic regression models were developed of partner violence intentions or behaviours on the scales derived from the TPB and demographic variables. Regression coefficients from adjusted models were used to examine the potential mediating role of partner violence intentions in the association between each scale and partner violence behaviours using the Sobel test. RESULTS: Among participants who reported being in a relationship, 20.7% reported perpetrating partner violence, and 16.4% reported intending to do so. After adjusting for demographic characteristics and other predictor scales, perpetration of partner violence was significantly associated with attitudes and outcome expectancy, while intention to perpetrate partner violence was significantly associated with attitudes and general social influence. The influence of attitude and general social influence on violent behaviours were each partially mediated by partner violence intentions. CONCLUSIONS: There are high levels of partner violence among high school students in Cape Town. Interventions to address this problem should focus on violence-related attitudes and outcome expectancy.     

Injury in young people with intellectual disability: descriptive epidemiology.

OBJECTIVES: To assess the public health importance of injury in a representative sample of young people with intellectual disability relative to the general population. SETTING: This study forms part of the Australian Child and Adolescent Development (ACAD) program examining emotional and behavioural problems in a cohort of young people with intellectual disability (IQ<70). The program has collected extensive biopsychosocial data from carers of subjects at two time intervals, 1990 (n = 579) and 1996 (n = 465). METHOD: Carer report of medically attended injury to subjects was collected for the first time during 1996 (age 5-29 years) and supplemented with medical record injury data from hospitals and general practitioners for 147 of the ACAD sample and 110 supplementary subjects. These data were compared with general population injury data to assess relative epidemiological differences. RESULTS: Annual injury mortality and morbidity rates were 150/100,000 and 55.6/1000 persons, with age standardised mortality and morbidity ratios of 8 and 2 respectively. Males and females had similar injury rates. The rate for injury hospitalisations was twice that of the general population. Falls were more common and transport injury and intentional injury less common causes of injury morbidity compared with general population. The patterns of cause, circumstances, and severity of injury in young people with intellectual disability have more similarities with younger children than with their same age group in the general population. CONCLUSION: This study should alert clinicians and others to the increased risk for injury and possible further handicap in this population. It is essential that injury prevention programs be implemented and evaluated for their effectiveness in reducing the substantial additional burden of suffering, care and cost resulting from injury to young people with intellectual disability.     

Witnessing violence among inner-city children of substance-abusing and non-substance-abusing women

OBJECTIVES: To determine if children of substance-abusing mothers witness more violence than children of non-substance-abusing (control) mothers, and to determine if children who witness violence have more behavioral problems and higher stress scores than children who do not witness violence. DESIGN: Cross-sectional research design comparing exposure to violence among children of substance-abusing mothers and control mothers of low socioeconomic status. SETTING: An inner-city pediatric clinic. PARTICIPANTS: Forty substance-abusing mothers and their children, and 40 non-substance-abusing mothers and their children, examined when the children were 6 years old. MAIN OUTCOME MEASURES: Maternal report of children's exposure to violence was assessed using the Exposure to Violence Interview and the Conflict Tactics Scale. Maternal report of children's behavior was assessed using the Child Behavior Checklist and the Children's Response to Stress Inventory. RESULTS: Children of substance-abusing mothers did not witness more violence than the control children (P>.05). However, 6-year-old inner-city children in the present study witnessed a high rate of violence: 43% had seen someone beaten up, 13% had seen someone threatened with a knife, and 7% had seen someone stabbed or shot. Children witnessing violence had significantly higher aggressive, delinquent, anxious/depressed, withdrawn, attention, and social problems (P<.05) on the Child Behavior Checklist, and higher stress scores (P =.05) on the Children's Response to Stress Inventory. CONCLUSIONS: More than half of the 6-year-old inner-city children in the present study witnessed some form of violence. Witnessing violence was associated with more behavioral problems and higher stress scores as assessed through maternal report. Subsequent research should examine the long-term effects of this exposure to violence among young children.     

Incarcerated adolescents' experiences as perpetrators of sexual assault

OBJECTIVES: To identify self-reported characteristics of past sexual assaults perpetrated by incarcerated juveniles and to determine potential precursors of this behavior. PARTICIPANTS AND METHODS: Participants completed an anonymous written questionnaire regarding their experiences of sexual abuse and/or assault as both a victim and a perpetrator. The questionnaire was incorporated into an existing annual survey of gang-related behaviors. RESULTS: A total of 805 adolescents (707 boys, 91 girls, and 7 gender-not-designated) participated. Of these teens, 79 males (11% of the males), 9 females (10% of the females), and 5 (71%) gender-not-designated said they had forced sex on someone (165 did not answer the question). Twenty-eight males (30% of the male perpetrators) and 4 females (44% of the female perpetrators) were both victims and perpetrators. Drugs and/or alcohol were frequently used by both the assailant (58% of the males and 55% of the females) and the victim (56% for the males and 66% for the females). The attributes of adolescent boys at highest risk of becoming perpetrators were all related to violence, including exposure to parents who were violent in the home (adjusted odds ratio, 2.68), being a victim of physical or sexual assault (adjusted odds ratio, 2.83), having parents who encouraged gang membership (adjusted odds ratio, 3.58), and knowing a perpetrator of sexual violence (adjusted odds ratio, 3.83). CONCLUSIONS: Adolescent boys and girls were both victims and perpetrators of sexual assault. Programs that identify and target violence in young children's lives, particularly intrafamilial violence, may reduce the risk of teenagers becoming perpetrators of sexual violence. Anticipatory guidance during teen years, regarding risk and avoidance of sexual exploitation, may be helpful in reducing the chances of sexual assaults.