Effects of chronic maltreatment and maltreatment timing on children’s behavior and cognitive abilities

Background: Chronic maltreatment has been associated with the poorest developmental outcomes, but its effects may depend on the age when the maltreatment began, or be confounded by co‐occurring psychosocial risk factors. Method: We used data from the National Survey of Child and Adolescent Well‐Being (NSCAW) to identify four groups of children who varied in the timing, extent, and continuity of their maltreatment from birth to 9 years. Internalizing and externalizing problems, prosocial behavior, and IQ were assessed 21 months, on average, following the most recent maltreatment report. Results: Children maltreated in multiple developmental periods had more externalizing and internalizing problems and lower IQ scores than children maltreated in only one developmental period. Chronically maltreated children had significantly more family risk factors than children maltreated in one developmental period and these accounted for maltreatment chronicity effects on externalizing and internalizing problems, but not IQ. The timing of maltreatment did not have a unique effect on cognitive or behavioral outcomes, although it did moderate the effect of maltreatment chronicity on prosocial behavior. Conclusion: There is a need for early intervention to prevent maltreatment from emerging and to provide more mental health and substance use services to caregivers involved with child welfare services.     

Sexuality of children and adolescents with developmental disabilities

Children and adolescents with developmental disabilities, like all children, are sexual persons. However, attention to their complex medical and functional issues often consumes time that might otherwise be invested in addressing the anatomic, physiologic, emotional, and social aspects of their developing sexuality. This report discusses issues of puberty, contraception, psychosexual development, sexual abuse, and sexuality education specific to children and adolescents with disabilities and their families. Pediatricians, in the context of the medical home, are encouraged to discuss issues of sexuality on a regular basis, ensure the privacy of each child and adolescent, promote self-care and social independence among persons with disabilities, advocate for appropriate sexuality education, and provide ongoing education for children and adolescents with developmental disabilities and their families.     

Oral bleeding: Child abuse alert

Physicians must be aware of histories, behaviours and physical findings of maltreated children. We report two cases of physical child abuse in which the initial symptom was oral bleeding. In both cases, the diagnosis was delayed and was made only after severe injuries were inflicted. Injuries to the oral cavity and oral bleeding of uncertain origin in infants should be considered seriously and should be carefully assessed in relation to adequacy of history to explain the mechanism of injury. When an infant has been injured and no adequate explanation is available to account for the mechanism, inflicted injury must be suspected and evaluated, so that in cases of child maltreatment, diagnosis and protection of the child from further injury can take place as early as possible.     

Accidents and child abuse in bathtub submersions.

Non-accidental bath drowning is an infrequently reported form of child abuse. Details of 44 children who suffered from drowning or near drowning in the bath were analysed from a two year (1988-9) UK study to investigate factors that might point to abuse. Cases of near drowning were notified through the British Paediatric Surveillance Unit inquiry system and drowning cases from the Office of Population Censuses and Surveys, the Scottish Government Record Office, and the Northern Ireland Office. In 28 cases the story was of accidental submersion with a baby of modal age 9 months being left unsupervised in a bath. Two other neonates briefly slipped from the parents arms while having a bath. Four bathtub drownings were related to epilepsy. In contrast 10 cases (six drowning and four near drowning) had stories very suggestive of abuse with inconsistent histories, previous history of abuse, and late presentation for medical care. A diagnosis of abuse should be considered in the differential diagnosis of atypical bathtub immersions in the absence of epilepsy and developmental delay.     

Accidents and child abuse in bathtub submersions

Non-accidental bath drowning is an infrequently reported form of child abuse. Details of 44 children who suffered from drowning or near drowning in the bath were analysed from a two year (1988-9) UK study to investigate factors that might point to abuse. Cases of near drowning were notified through the British Paediatric Surveillance Unit inquiry system and drowning cases from the Office of Population Censuses and Surveys, the Scottish Government Record Office, and the Northern Ireland Office. In 28 cases the story was of accidental submersion with a baby of modal age 9 months being left unsupervised in a bath. Two other neonates briefly slipped from the parents arms while having a bath. Four bathtub drownings were related to epilepsy. In contrast 10 cases (six drowning and four near drowning) had stories very suggestive of abuse with inconsistent histories, previous history of abuse, and late presentation for medical care. A diagnosis of abuse should be considered in the differential diagnosis of atypical bathtub immersions in the absence of epilepsy and developmental delay.     

Child Abuse and Performance Task Assessments of Executive Functions in Boys

We examined executive functions using performance tasks in 126 boys aged 6 to 16 years. who attended public schools and therapeutic schools for children with emotional and behavioral problems. Children were further grouped based on the presence or absence of substantiated abuse histories. Based on their abuse histories and schools of origin, children were classified as Therapeutic, Abused (TA, N = 25). Therapeutic, Nonabused (TN, N = 52), and Public School (PS, N = 48). Controlling IQ and medication status, we compared children in the three groups on teacher ratings of behavior, on experimenter observations of behavior during testing, and on performance tasks challenging the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences. We examined mean group differences in symptoms, behaviors, and task performance, as well as differential age-dependent changes in these dimensions. Independent of abuse history, therapeutic school children demonstrated comparable levels of internalizing and externalizing symptoms, and comparable levels of redirections to task during testing-sessions, that were significantly higher than those of the public school children. Both groups of therapeutic school children also showed comparable overall performance on the capacities to inhibit an act in progress, and to passively avoid responses associated with adverse consequences that were poorer than the performance of children from the public school. Children with histories of substantiated abuse showed diminished improvement with increasing age in the capacity to passively avoid responses associated with adverse consequences when compared not only to the public school children, but also to the children from the therapeutic schools without histories of abuse. Our findings complement reports of behavioral observations of abused children, and reports associating child abuse with altered cognitive development in other areas of competence. They suggest that child abuse may negatively influence the expected developmental progression of competence in certain executive functions. This in turn could have implications for the nature and the persistence of certain forms of psychopathology associated with abuse and poor self-control. Given the cross-sectional nature of our data, however, longitudinal developmental studies of the relations between child abuse and executive functions are needed to elucidate the influence of abuse on the growth and development of such organizing principles of behavioral self-regulation.     

Integration of the Nurse Practitioner Into Your Child Abuse Team

Child maltreatment is a leading cause of childhood morbidity in the United States, often leading to lifelong adverse health consequences. Currently, there is a nationwide shortage of child abuse pediatricians (CAPs), resulting in many unfilled child abuse positions throughout the United States. In addition, the number of future CAPs currently in fellowship training will meet neither the current need for CAPs nor provide replacements for the senior CAPs who will be retiring in the next 5 to 10 years. Although it is recognized that pediatric nurse practitioners (PNPs) play an important role in the care of maltreated children, there are few available data on the impact of the PNP as an integral member of the child abuse team. Using the outcomes logic model, we present a systematic process through which the PNP can be effectively integrated into a medical child abuse team. The outcomes from this process show that the addition of PNPs to the child abuse team not only provides immediate relief to the nationwide CAP shortage but also significantly augments the diverse clinical skills and expertise available to the child abuse team.     

Intergenerational continuity of child abuse among adolescent mothers: authoritarian parenting, community violence, and race

Among the negative sequelae of child maltreatment is increased risk for continuity of maltreatment into subsequent generations. Despite acknowledgment in the literature that the pathways toward breaking the cycle of maltreatment are likely the result of dynamic interactions of risk and protective factors across multiple ecological levels, few studies have followed high-risk samples of maltreated and nonmaltreated parents over time to evaluate such processes. In the current investigation, exposure to community violence and authoritarian parenting attitudes were evaluated as predictors of the intergenerational continuity of abuse, and the moderating effect of African American race was examined. The sample included 70 mothers and their 18-year-old children, who have been followed longitudinally since the third trimester of the adolescent mothers' pregnancy. Results revealed that among mothers with a child abuse history, higher exposure to community violence and lower authoritarian parenting attitudes were associated with increased risk for intergenerational continuity of abuse. The relation of authoritarian parenting attitudes to intergenerational continuity was moderated by race; the protective effects of authoritarian parenting were limited to the African American families only. The salience of multiple ecological levels in interrupting the intergenerational continuity of child abuse is discussed, and implications for preventive programs are highlighted.     

Genitalia in human figure drawings: childrearing practices and child sexual abuse

To replicate and explore the associations of drawing genitalia on a human figure, child-rearing practices, and a history of alleged sexual abuse, we designed a cross-sectional study of 109 alleged child sexual abuse victims, ages 3 through 8 years, and a group of 109 comparison children matched for age, sex, race, and socioeconomic status but with no history of abuse. A standardized format was used to collect drawings, administer the Peabody Picture Vocabulary Test, and gather background data on medical, developmental, and child-rearing issues. Seven alleged sexual abuse victims and one comparison child spontaneously drew genitalia (p = 0.02, one-tailed Fisher Exact Test, estimated relative risk 7.96). No differences in drawing maturity (Draw-A-Man score) were identified, although Peabody Picture Vocabulary Test scores were higher in comparison children (82.1 vs. 91.0, p less than 0.01). Neither drawing genitalia nor history of alleged sexual abuse were significantly associated with histories of medical problems, enuresis, encopresis, urinary tract infection, or child-rearing practices related to sleeping, nudity, bathing, sexual abuse education, or exposure to sexually explicit materials. The similar patterns of child-rearing practices in both samples should make professionals cautious in attributing allegations of abuse to specific child-rearing practices. This study confirms our previous report that the presence of genitalia spontaneously drawn on a child's drawing of a human figure is associated with alleged sexual abuse.     

The Seventh Jack Tizard Memorial Lecture. Aspects of adoption

Adoption has a long history and there has been a change in traditional assumptions and practice. It is now seen as a form of child care, one of a spectrum of resources for children in need. Adopted children generally show a good outcome but are over-represented in clinical populations. This trend is likely to continue as older children with histories of severe deprivation, neglect, abuse and institutionalization are placed. New light has been thrown on "telling" in adoption by developmental studies. Adoption disruption increases with age and other factors at placement, requiring further research into its origins and management.     

Is There a Relationship Between Lacking a Primary Care Provider and Child Abuse?

OBJECTIVE: To examine the association between lacking a primary care provider and child abuse. METHODS: We conducted a secondary data analysis of 1462 children aged 相似文献   

A prospective analysis of the relationship between reported child maltreatment and special education eligibility among poor children

This study presents data from the first large-scale longitudinal study to track the involvement of children reported for maltreatment in both the special education and child welfare systems. A range of state and local administrative databases were combined and cross-sector service histories were established for 7,940 children who had received Aid to Families With Dependent Children between 1993 and 1994. The authors address the following questions: (a) Is maltreatment associated with entry into special education after controlling for other factors? (b) among maltreated children, does maltreatment type or child welfare service use predict special education eligibility? and (c) what is the relationship between maltreatment type and type of educational disability? Results indicate that child maltreatment system involvement generally predates special education entry and is predictive of entry even after controlling for other factors. A range of other associations between factors such as child and maternal characteristics, services received, maltreatment type, and special education classification are detailed.     

Factors that facilitate or impede physicians who perform evaluations for child maltreatment

Physicians are needed to evaluate children for the possibility of maltreatment. In many communities, physicians are reluctant to evaluate children who may have been maltreated. Because it is unclear which factors facilitate and impede physicians' involvement in evaluations for child maltreatment, physicians were surveyed to identify these factors. The biggest obstacles identified were the time involved in doing an evaluation, scheduling cases, and problems dealing with the legal, judicial, and social service systems. Medical information, training, and follow-up about the disposition of cases would help physicians who participate in evaluations. Interventions that enhance communication and training across disciplines could also be effective in increasing physician involvement in child abuse evaluations.     

Suicidal ideation among 8-year-olds who are maltreated and at risk: findings from the LONGSCAN studies

Suicidal ideation was examined among 1,051 8-year-old children identified as maltreated or at risk for maltreatment. Of these children, 9.9% reported suicidal ideation. Many variables, including maltreatment, had bivariate associations with suicidal ideation. Severity of physical abuse, chronicity of maltreatment, and the presence of multiple types of maltreatment strongly predicted suicidal ideation. In multivariate analyses of the domains of proximity, only ethnic background remained significant among demographic variables, only witnessed violence and maltreatment remained significant among family or contextual variables, and only child psychological distress, substance use, and poor social problem solving remained significant among child variables. The effects of ethnicity, maltreatment, and witnessed violence on suicidal ideation were mediated by child functioning. There were few interactions between maltreatment and other factors to predict suicidal ideation. Children who are maltreated and those exposed to community and domestic violence are at increased risk of suicidal ideation, even by age 8.     

Ecological influences on the sequelae of child maltreatment: a review of the literature

Numerous studies indicate that child maltreatment increases the risk for the development of internalizing and externalizing behavior problems. Great variations in outcome, however, have been noted among victims of maltreatment. From an ecological perspective, this review examines how the effects of maltreatment may be influenced by the contexts in which children develop, including their families, peer groups, schools, and communities. The literature reviewed suggests that contextual factors not only influence the incidence of maltreatment but also may moderate its developmental effects, thereby accounting for some of the heterogeneity in the outcomes associated with abuse and neglect. Closer examination of the influence contextual factors exert on the psychosocial sequelae of maltreatment will better inform the interventions, treatments, and public policies directed toward the maltreated population. Methodological considerations for conducting research in this area are also discussed.     

Strategies for addressing long-term issues after institutionalization

As a result of their preadoptive histories and experiences, internationally adopted children, especially those with a history of institutionalization, can present with a complex profile of developmental and behavioral issues. Although many children demonstrate significant recovery and resilience after joining their adoptive homes, others go on to have mild or sometimes more severe developmental and behavioral issues. This high-risk population requires comprehensive evaluation, monitoring, and interventions by professionals with expertise in child development and knowledge of the impact of institutionalized care to support optimal developmental and behavioral outcomes for children and their families. This article focuses on strategies for evaluation and management of long-term developmental and/or behavioral difficulties exhibited by postinstitutionalized children.     

Somatic Manifestations in Children Suspected of Having Been Maltreated

ABSTRACT. The present study revealed an incidence of maltreatment of 26.8 in 100 000 children under 15 years of age, higher than previously assumed. The sample comprises 41 children suspected of having been maltreated. A systematic examination included radiography and isotope scintigraphy of the skeletal system. In 9 cases the diagnosis was not confirmed, in 23 confirmed, and in 9 children it seemed likely. The most common form of maltreatment was physical violence with bruises. A total of 6 fractures were demonstrated. Three children had been exposed to sexual abuse. Intracranial haematoma, of long standing, was found in one child. Thirteen of the children (40%) were of short stature, their height and weight below the 25th percentile. Among 27 children examined by X-rays 16 (59%) had delayed skeletal maturation. Disturbances of growth, as well as behavioural abnormalities, were particularly striking in this group of patients. The findings suggest that even the slightest suspicion of maltreatment should lead to a general medical evaluation without delay.     

Somatic manifestations in children suspected of having been maltreated

The present study revealed an incidence of maltreatment of 26.8 in 100,000 children under 15 years of age, higher than previously assumed. The sample comprises 41 children suspected of having been maltreated. A systematic examination included radiography and isotope scintigraphy of the skeletal system. In 9 cases the diagnosis was not confirmed, in 23 confirmed, and in 9 children it seemed likely. The most common form of maltreatment was physical violence with bruises. A total of 6 fractures were demonstrated. Three children had been exposed to sexual abuse. Intracranial haematoma, of long standing, was found in one child. Thirteen of the children (40%) were of short statute, their height and weight below the 25th percentile. Among 27 children examined by X-rays 16 (59%) had delayed skeletal maturation. Disturbances of growth, as well as behavioural abnormalities, were particularly striking in this group of patients. The findings suggest that even the slightest suspicion of maltreatment should lead to a general medical evaluation without delay.     

How common is abuse in Greece? Studying cases with femoral fractures.

AIMS: To examine the extent of undiagnosed child abuse in Greece by studying young children with femoral fractures, which may be associated with abuse. METHODS: Fifty seven consecutive cases of children under 6 years of age with femoral fracture were identified from the Emergency Department Injury Surveillance System database. Controls were 4162 children with other orthopaedic injuries from the same database. RESULTS: Whereas in the literature about one third of femoral injuries among young children are attributed to child abuse, no child in the studied series had been diagnosed or even investigated in this context. Nevertheless, the pattern of occurrence of femoral injuries was compatible with that of child abuse, in that patients were frequently very young boys of low socioeconomic status, and the accident had frequently occurred under poorly identified or implausible conditions at time periods when most family members were crowded at home. CONCLUSIONS: Epidemiological risk factors for child abuse characterise femoral fractures in young children in Greece. It appears that child abuse is present in this country as in most other cultures. There is a clear need for refocusing medical personnel and hospital social services so that the problem is revealed, quantified, and appropriately dealt with.