The paradox of “wonderful children”: The case of child abuse

In our society young children are generally considered to be “wonderful”. This dominant concept pervades not only parental thinking, but professional thinking as well. In the case of child abuse, however, profound contradictions can arise as a result. Professionals are primarily focused on children's welfare, while parents’ views are much more ambiguous.

In our example of a Family Centre these contradictions are clearly illustrated, and we hope to draw conclusions as to what change in theory and practice could result from an analysis of contradictions.     

The efficacy of the parent-teacher “partnership” of the 1990s

The 1990s are times of rapid social and technological change. There are many unknowns that face both adults and children. We all have problems that need resolution. The time when adults “knew” the answers and children learned by “watching” echo faintly in the whirl of scientific change which is impacting on most aspects of our daily life. As early childhood teachers we have to learn to enquire, to listen, to think together with children, their families and society. The concept of negotiation is central to communication while the basic tenet of the process focusses not on the person but the issue. It is in these times of rapid change that we need to deepen our understanding of the family and further our professional insights by “tapping” the wealth of crucial kndowledge that parents have about their children. Hurst asserts that the partnership of parents in issues of their children's education:

“is probably the greatest single opportunity for educational advance open to teachers today”.

Hurst: 1987; 109     

Indexes and boundaries for “quantitative significance” in statistical decisions

Boundaries for S, representing a “quantitatively significant” or “substantively impressive” distinction, have not been established, analogous to the boundary of , usually set at 0.05, for the stochastic or probabilistic component of “statistical significance”. To determine what boundaries are being used for the “quantitative” decisions, we reviewed pertinent articles in three general medical journals. For each contrast of two means, contrast of two rates, or correlation coefficient, we noted the investigators' decisions about stochastic significance, stated in P values or confidence intervals, and about quantitative significance, indicated by interpretive comments.

The boundaries between impressive and unimpressive distinctions were best formed by a ratio of 1.2 for the smaller to the larger mean in 546 comparisons, by a standardized increment of 0.28 and odds ratio of 2.2 in 392 comparisons of two rates; and by an r value of 0.32 in 154 correlation coefficients. Additional boundaries were also identified for “substantially” and “highly” significant quantitative distinctions.

Although the proposed boundaries should be kept flexible, indexes and boundaries for decisions about “quantitative significance” are particularly useful when a value of δ must be chosen for calculating sample size before the research is done, and when the “statistical significance” of completed research is appraised for its quantitative as well as stochastic components.     

“Missing Milestones”

Missing milestones are known to be a normal variant of development. The purpose of our study is to find if missing milestones always lead to normal development?

METHODS

This is a prospective case study on seven patients referred for motor developmental problems from July 1997 to February 1998 and then followed over a 2-year period. On each attendance, the multi-disciplinary team assessed children

RESULTS

We present a case series of seven children with “missing motor milestones”. Six of the seven, had tactile defensiveness but absent parachute reflexes on presentation

At the end of the two year period, 3 infants had normal development (Group I). One was discharged after 7 months. The second one had speech problems most likely secondary to her bilateral serous otitis media, with no other developmental problems. The third child acquired age appropriate milestones before the care was transferred to another hospital. Of the four in Group II, three developed global developmental delay and the fourth was diagnosed to have multiple cavernous haemangiomata in the brain. The pre-school alert panel was alerted for two of them possibly needing future help in school

Five of the seven children in our study were still being followed up after two years

CONCLUSIONS

Missing milestones in a subject can be a benign variation of normal motor development. However, they may also be the first sign to appear in children with neuro-developmental disorders

Tactile defensiveness may be the most useful early sign to enable the early diagnosis of non-weight bearing children with 'missing milestones'     

Rethinking “Harmonious Parenting” Using a Three-factor Discipline Model

Diana Baumrind's typology of parenting is based on a two-factor model of “control” and “warmth”. Her recommended discipline style, labeled “authoritative parenting”, was constructed by taking high scores on these two factors. A problem with authoritative parenting is that it does not allow for flexible and differentiated responses to discipline situations. It is argued that a simpler, and more adequate, approach would be to switch to a model of discipline with a third factor, labeled “tolerance”. Parents of the most socially competent children are adept at knowing when they have a problem and when they do not. An example of the latter would be when a child expresses negative affect while complying fully with a request. Baumrind's notion of authoritative parenting was a useful “dialectic”, demonstrating that control and warmth are independent and equally necessary behaviors, but it did not go far enough. Baumrind's category of harmonious parenting (high warmth, moderate control, high tolerance), which she sees as an anomaly, should be substituted for authoritative parenting as the preferred discipline pattern.     

The “U” technique: A new method for Norplant implants removal

The standard technique for Norplant implants removal was compared with a new technique called the “U” technique, which employs the use of a modified no-scalpel vas deferens holding forceps to grasp and remove the capsules. Seventy-six women requesting Norplant implants removal were randomly assigned to Group 1 (standard removal technique) or Group 2 (“U” removal technique). Variables measured included: (a) time required for complete removal, (b) number of capsules not broken or damaged during removal, and (c) number of incisions required for removal of all six capsules. In clients with visible or palpable capsules, the standard removal technique required significantly more time to remove all six capsules, on average, than the “U” technique (19 versus 7 minutes, p < 0.001); also more capsules were damaged during removal (5.6 undamaged versus 6.0,p < 0.01). In addition, with the standard technique, five clients required two incisions for removal of all six capsules while none of the clients required more than one incision with the “U” technique. Our conclusion is that the “U” technique is a quicker and easier method of removing Norplant capsules than the standard technique.     

“Potentially” contaminating behavioural practices in the preparation, feeding and storage of “ogi” — an infant cereal in a rural Nigerian community

Thirty households with children aged 6-18 months from four villages in the Badagry Local Government Area of Lagos State, Nigeria were studied. Open-ended unstructured ethnographic interviews were used to collect information on “potentially” contaminating food handling behaviour with particular reference to the preparation, feeding and storage of “ogi” an infant cereal. Focus group studies were conducted for women aged 18-45 years in the four villages to obtain more information.

Improper handwashing, widespread acceptance and use of feeding bottles, long storage and safety of place of storage were some of the “potentially” contaminating behavioural patterns identified.

Intensive health education on the dangers of feeding bottles, improper hand-washing and long storage of cooked “ogi” to the health of infants and young children is strongly recommended.     

“pop-out” method of levonorgestrel implant removal

The “pop-out” technique is a method of levonorgestrel implant removal that uses digital pressure to direct implants through a small skin incision. This technique was developed, theoretically, to cause less bruising and patient discomfort by avoiding the use of instruments. The pop-out technique is the primary method used for levonorgestrel implant removal in the Magee-Womens Hospital resident clinic. We performed a retrospective analysis of levonorgestrel implant removals performed between July 1, 1995, and December 31, 1998. Of the 168 removals included in this analysis, 38 were performed by one of two attending physicians, and 130 were performed by the residents with attending supervision. The average time for removal was 12 ± 5 min (range 2.25–27 min) when the “pop-out” method could be used to remove all six implants, and 14 ± 7 min (range 2.25–59 min) for all removals. The removal time for residents was inversely proportional to the anticipated level of difficulty of the removal and to the number of previous removals performed. The removal time was significantly faster when residents were supervised by one of the attending physicians as compared with the other attending physician. Only 0.7% (7/1,008) of levonorgestrel implants were fragmented during removal. This review shows that the “pop-out” method is a reasonable alternative to other proposed methods of primary implant removal. The difference in the level of expertise of the attending physician may significantly influence removal time when training clinicians in levonorgestrel implant removal.     

The Age of Criminal Responsibility: “The Frontier between Care and Justice”

This is an extract from a speech given by Mr Justice Gillen to a conference in Belfast organised by Children Law UK in January 2006. It addresses the potential conflict between the concept of the welfare of children inherent in the family care system and that of responsibility inherent in the criminal justice system. It questions whether the abolition of doli incapax and the age of criminal responsibility at the age of 10 in the UK places too much emphasis on the prevention of offending and too little attention on a child centred focus. The article exhorts a more holistic “joined up” approach to family and criminal justice.     

Quality children's television: the case of “Lift Off”

“Lift off” is a new, innovative children's television series produced by the Australian Children's Television Foundation. It has been well received by critics, parents, educators and most significantly, by its three-to-eight year old target audience.

The program easily satisfies the five criteria for quality programming formulated by the Children's Program Committee of the Australian Broadcasting Tribunal. The typical half-hour program is dense, requiring close viewer attention but it is claimed that the viewer is rewarded for her viewing investment with an enriching and pleasurable experience. The doubt is raised that the socially disadvantaged segment of the child audience, who use television for diversion rather than enrichment, may not be prepared to make such an investment of viewing attention.

One final concern is voiced. The Foundation's official spokespeople publicly claim that “Lift Off” will enrich the lives of a whole age cohort. It is argued that such claims overemphasise the supposed direct consequences and impact of media messages on individuals.     

Hormonal consequences of “missing the pill”

The hormonal effects of the deliberate omission of a low-dose combined oral contraceptive pill (150 μg levonorgestrel + 30 μg ethinyl estradiol) were studied in 32 apparently healthy women of the fertile age. Four groups of eight subjects each were requested to omit pill-taking on two consecutive days of the study, namely days 9 and 10 (Group I), 11 and 12 (Group II), 14 and 15 (Group III) and 17 and 18 (Group IV), respectively, and the peripheral plasma levels of progesterone (P), levonorgestrel (NOG) and estradiol (E₂) were measured daily for 29 days.The analysis of NOG levels revealed that one subject did not take any pill during the last cycle preceding the study and did not start pill-taking before day 10 of the study cycle. In this subject, a biphasic P profile with significantly, but insufficiently (up to 8.0 nmol/l), elevated P levels was found.In the remaining 31 subjects, the P levels remained invariably below 1.5 nmol/l; however, the mean P levels of days 1–15 were significantly (P < 0.01) higher than those of days 16–29.The assay of NOG levels indicated measurable values in each of the 31 subjects even six days after the discontinuation of pill-taking. From the peripheral NOG levels, an average removal half-life of 29 hours was calculated.The E₂ levels were uniformly suppressed (below 400 pmol/l) in 26 of the 31 subjects (hereafter: “low” E₂-group), whereas five subjects (“high” Eg-group) exhibited a cyclic E₂ profile, with peak levels between 530 and 1200 pmol/l. A linear increase with time in E₂ levels (P < 0.001) was found during the pill-free week in both groups of subjects.     

Teaching thinking skills: The “what” and the “how” of young children's thinking

This review illustrates current perspectives on young children's thinking, from the viewpoint of developmental psychology. Relevant findings from both cognitive developmental and information processing literatures are discussed. Specific abilities of preschoolers are highlighted, and practical suggestions are offered from both perspectives.     

The “syndrome of the post-premature child”: a study of its significance -- Part I

Prematurity has the greatest influence upon frequency and degree of mechanical disturbances uncovered by the Test of Imitation of Gestures. The authors look for the significance of this syndrome at various levels:

1. Possible organic damage to the central nervous system structures, through the tonic and motor disturbances checked out by the neurological examination.
2. In the disturbances of the early development of posturomotor abilities.
3. Deviant and delayed development of the cognitive factors (spatial and temporal structuring).
4. Emotional and relationship development.

The investigations were carried out on a sample group of prematurely born children and a control group group of children born at term.

After observing certain behavior disorders which occur among normal children -- mild disorders which become less obvious with age -- the authors show that frequent and gross disturbances which appear in the first months of life and persist beyond the age of 6 years distinguish the premature child. In this same group, however, delays in mental development noted early in life often disappear entirely by the age of 4 years, even among children who were born very prematurely.

The authors then isolated the most typical disturbances found among the premature children, with stress on factors of pathology, maturation, adjustment, and environment.

The authors study the relationship between the disturbances described above and the various aspects of the neurological examinations which enable them to objectify the dynamic factors of the body adjustment to the external world and to other people. The hypothesis that a fundamental relationship exists between disturbances of adjustment and the genesis of the “post-premature child syndrome”, develops from the comparison between the psychological and neurological data in their longitudinal evolution.

Commenting on the relevance of these findings for the care of premature children, the authors stress the value of motor training and remedial education for overcoming the disturbances of spatial structuration and body schema.     

“Abstinence” and “nonabstinence” models for the treatment of bulimia

One of the most controversial dimensions along which developing therapeutic approaches for bulimia can be differentiated is their allegiance to an “abstinence” or “nonabstinence” model. Through analogy to traditional treatment programs for chemical dependency, many self-help and professional programs for bulimia hold that the complete elimination of binge-vomiting behavior is a prerequisite for therapeutic work, and require abstinence from the inception of treatment. In contrast, the nonabstinence model suggests that a more gradual reduction in the frequency of episodes may be preferable in that it provides more opportunities for relapse prevention training and avoids reinforcing dichotomous thinking styles. The present paper reviews the theoretical and clinical arguments that have been advanced by each side, including the case for classifying bulimia as a substance abuse disorder. A strategy for investigating the relative efficacy of the two approaches is proposed. It is suggested that particular attention be paid to such variables as differential attrition, the effect of each modality on the accuracy of self-report, the need for continuing or supplementary therapy, the occurrence of treatment “casualties,” interactions between client characteristics and mode of therapy, and long-term results. In the interim before such data are available, a reasonable clinical recommendation may be the implementation of a “compromise” approach designed to maximize the advantages claimed by each model while minimizing possible risks.     

“They (ARVs) are my life, without them I’m nothing”—experiences of patients attending a HIV/AIDS clinic in Johannesburg, South Africa

This paper is a part of a larger study that explores the “social complexity” of antiretroviral therapy (ART), in resource-limited environments. Drawing on in-depth interviews with a sample of 44 patients in an urban HIV/AIDS clinic in Johannesburg, South Africa, this paper examines how people with HIV/AIDS conceptualise their illness and its treatment in this context. The paper concludes that the fear of stigma plays a significant role in patients’ experiences throughout the disease trajectory. Yet, demonstrates that there are indications that ARVs are transforming the experience of living with HIV/AIDS and a process of normalisation is taking place. Despite the resource-limited context and, often, lack of family and community support, patients see the ARVs as ‘life saving’ and express their long-term commitment to adhere to the drug regimen as well as their trust in health professionals.     

Montanide ISA™ 201 adjuvanted FMD vaccine induces improved immune responses and protection in cattle

Despite significant advancements in modern vaccinology, inactivated whole virus vaccines for foot-and-mouth disease (FMD) remain the mainstay for prophylactic and emergency uses. Many efforts are currently devoted to improve the immune responses and protective efficacy of these vaccines. Adjuvants, which are often used to potentiate immune responses, provide an excellent mean to improve the efficacy of FMD vaccines. This study aimed to evaluate three oil adjuvants namely: Montanide ISA-201, ISA-206 (SEPPIC, France) and GAHOL (an in-house developed oil-adjuvant) for adjuvant potential in inactivated FMD vaccine. Groups of cattle (n = 6) were immunized once intramuscularly with monovalent FMDV ‘O’ vaccine formulated in these adjuvants, and humoral (serum neutralizing antibody, IgG₁ and IgG₂) and cellular (lymphoproliferation) responses were measured. Montanide ISA-201 adjuvanted vaccine induced earlier and higher neutralizing antibody responses as compared to the two other adjuvants. All the adjuvants induced mainly serum IgG₁ isotype antibody responses against FMDV. However, Montanide ISA-201 induced relatively higher IgG₂ responses than the other two adjuvants. Lymphoproliferative responses to recall FMDV antigen were relatively higher with Montanide ISA-201, although not always statistically significant. On homologous FMDV challenge at 30 days post-vaccination, 100% (6/6) of the cattle immunized with Montanide-201 adjuvanted vaccine were protected, which was superior to those immunized with ISA-206 (66.6%, 4/6) or GAHOL adjuvanted vaccine (50%, 3/6). Virus replication following challenge infection, as determined by presence of the viral genome in oropharynx and non-structural protein serology, was lowest with Montanide ISA-201 adjuvant. Collectively, these results indicate that the Montanide ISA-201 adjuvanted FMD vaccine induces enhanced immune responses and protective efficacy in cattle.     

Effects of a prenatal “Information and Insights about Infants” program on the knowledge base of first-time low-education fathers one month postnatally

Pregnant women, in two clinics, one serving “low-risk” and the other serving “high risk” pregnancies, helped to recruit their male partners into a prenatal program. The 67 men, first-time fathers, all of low socio-economic status, were randomly assigned either to a control group or to an experimental group. The intervention group received two intensive 1 1#sh2 hour sessions of information and insights about infants in a small group within a clinical setting.

Father interviews and measures provided data on family parenting background; father attitudes towards infants; father perception of infants; father knowledge of when certain infant behaviors could be expected, couple dyadic adjustment, father social support, and father self-image. Postnatally fathers were videotaped with their infants during a feeding interaction. During the training sessions, detailed information about the behavioral capacities of the unborn#shnewborn and of infants during the first months of life were provided. Post test knowledge of infant scores of the experimental group were significantly higher #opp = 0.0001#cp than those of the comparison group.     

Tuber quality and nutritional components of “early” potato subjected to chemical haulm desiccation

“Early” potato is a typical crop grown in most of the Mediterranean countries, and it is one of the most important horticultural crops exported towards the Northern European markets. In order to improve market value of early potatoes, growers are more and more involved in choosing new potato varieties and constantly looking for methods to improve the commercial quality of tubers. One of the most increasingly used agro-techniques is chemical haulm desiccation, which aims to simplify harvesting and can help to manipulate tuber size distribution and tuber skin-set. Its effect on yield and quality aspects of early potato remains to be better evaluated. This paper resumes results of trials and analysis conducted during 2007 concerning the effect of the application of a chemical desiccant (gluphosinate ammonium) on some relevant nutritional parameters of three early potato varieties (Spunta, Ditta, and Krone) grown in Southern Italy. Tubers from the trials were analyzed for tuber size distribution, flesh and skin colour, dry matter, nitrate, soluble carbohydrates, total and resistant starch, vitamin C, phenol content, and total antioxidant activity. Results indicate that chemical desiccation does not affect the levels of vitamin C and those of other molecules with antioxidant properties as well as those of total soluble carbohydrates. On the other hand, it induces a significant decrease in starch storage and an increase in the percentage of resistant starch (a component of dietary fibre).