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1.
OBJECTIVE: To collect and compare the results of medical, child protective, and law enforcement evaluation of a sample of Maine children who were victims of abusive head trauma (AHT) in order to describe the clinical and evaluative characteristics as they relate to victims, families and perpetrators of such trauma and to improve the professional response to AHT in Maine.METHOD: Retrospective chart review of medical, child protective, and law enforcement records of all AHT victims admitted to two tertiary care hospitals in Maine or seen by the state medical examiner from 1991 to 1994.RESULTS: Nineteen children (age range 2 weeks to 17 months) were identified as victims of AHT (out of a total of 94 head trauma admissions) accounting for 20 hospitalizations during the study period. There was a history of prior injury in 30%, history of prior medical evaluations for possibly abuse related problems in 65%, while, on presentation, 75% had evidence or history of prior injury. The hospitals notified child protective services (CPS) in all 20 cases and correctly identified abuse in 18 (90%). Parental risk factors for abuse identified in CPS records included substance abuse (53%), domestic violence (42%), criminal history (32%), unrealistic expectations (42%), and attachment problems (32%). However, risk factors were inadequately assessed in 53% of homes. Law enforcement identified a likely perpetrator in 79% of cases and in the majority the identified suspect was the father. In the 15 cases where a perpetrator was identified by law enforcement, that person was alone with the child at symptom onset in 14 (93%).CONCLUSIONS: The medical response, at least at the inpatient level, was generally well done with regard to suspicion and reporting. Cases are possibly being missed at the outpatient level. Child protective risk assessment was limited overall yet in a third of the homes where AHT occurred, few if any risk factors were present to aid in identification and prevention. Law enforcement results suggest that a primary suspect for AHT is the caretaker alone with the child at the time of symptom onset. 相似文献
2.
Factitious disorder by proxy (FDP), historically known as Munchausen syndrome by proxy, is a diagnosis applied to parents
and other caregivers who intentionally feign, exaggerate, and/or induce illness or injury in a child to get attention from
health professionals and others. A review of the recent literature and our experience as consultants indicate clearly that
FDP has emerged in educational settings as well. Variants of educational FDP include parents of children with real or fabricated
physical disabilities who request excessive or unneeded school health services and parents who request extensive education-related
evaluations for children who do not demonstrate any educational need. If such cases continue to emerge, school districts will
be asked to test more students who do not have disabilities under the Individuals with Disabilities Education Act. Also, special
educational directors will be weighing the cost of providing unneeded testing and educational services against the cost of
defending themselves in litigation to prove that the testing and services are unnecessary. A table of guidelines is provided
for school and other personnel confronted with repeated requests for unwarranted special education services. Suggestions for
future research are included. 相似文献
3.
J G Jones H L Butler B Hamilton J D Perdue H P Stern R C Woody 《Child abuse & neglect》1986,10(1):33-40
Munchausen syndrome by proxy is a form of child abuse in which a disorder of the child is fabricated by a parent. Although often considered rare, it may have been overlooked frequently in the past. The reported cases of children with Munchausen syndrome by proxy range in age from infancy to 8 years. Their "illnesses" consist of fabricated histories, inflicted physical findings, altered laboratory specimens, and induced disorders. The perpetrator usually is the child's mother, who may have Munchausen syndrome. Consequences of the syndrome may include painful tests, frequent hospitalizations, potentially harmful treatment, and death. The diagnosis can be made when medical and social histories are characteristic of the syndrome and clinical findings are absent, suggestive of induced illness, or resolve upon separation of the child and parent. Suspicion of the syndrome should be discussed with the family once the safety of the child is insured, and the case should be reported under the child abuse reporting law of the state. Social, family, and medical histories must be obtained and verified, and court intervention should be considered. Four patients who illustrate typical features of the syndrome are described. 相似文献
4.
Children in homes with intimate partner violence (IPV) are at increased risk for physical abuse. We determined the frequency and injury patterns in children who underwent child abuse consultation after IPV exposure by retrospectively analyzing the "Examination of Siblings To Recognize Abuse" cohort of children referred for physical abuse. Children were selected who presented after IPV exposure. Among 2890 children evaluated by child abuse pediatricians, 61 (2.1%) patients presented after IPV exposure. Of the 61, 11 (18.0%) were exposed to IPV, but had no direct involvement in the IPV event, 36 (59.0%) sustained inadvertent trauma during IPV, and 14 (23.0%) were directly assaulted during IPV. Thirty-six patients (59.0%) had an injury: 31 (51.0%) had cutaneous injuries and 15 (24.6%) had internal injuries including fracture(s), intracranial or intra-abdominal injury. Of the 15 patients with internal injuries, 14 (93.3%) were less than 12 months old. Among the 36 patients with injuries, 16 (44.4%) had no report of direct injury, a report of a mechanism that did not explain the identified injuries, or a report of trauma without a specific mechanism. Five (13.9%) did not have physical examination findings to suggest the extent of their internal injuries. Injuries are present in a significant proportion of children presenting to Emergency Departments after IPV exposure. History and physical examination alone are insufficient to detect internal injuries especially in infants. These preliminary results support the need for future, prospective studies of occult injury in children exposed to IPV. 相似文献
5.
OBJECTIVE: This study examined the power of child, perpetrator, and socio-economic characteristics to predict injury in cases of reported child physical abuse. The study was designed to assess the validity of the assumption that physically injurious incidents of child physical abuse are qualitatively different from those that do not result in injury, that their generative factors are distinctive, and that the quality of caregiving in these two types of incidents is different. METHOD: A weighted, nationally representative sample of 8,164 substantiated punishment abuse cases in Canada was used. Various models were constructed and evaluated through logistic regression. RESULTS: Of six potential predictors - child age, perpetrator sex, child functioning, parent functioning, economic stress, and social stress - none predicted injury to the child. CONCLUSIONS: The findings suggest that injurious and non-injurious physical abuse cannot be distinguished on the basis of the personal characteristics or circumstances of the child or perpetrator. PRACTICE IMPLICATIONS: A common criterion for child welfare intervention into cases of suspected physical abuse is injury or risk of injury. This criterion assumes that injurious and non-injurious assaults are qualitatively different phenomena, predicted by different risk factors. In the present study an attempt was made to differentiate between injurious and non-injurious cases of punitive physical abuse on the basis of characteristics of the child, perpetrator, family, and social context. None of these factors explained the likelihood of injury, suggesting that the prediction of injury as an intervention criterion may be questionable. 相似文献
6.
Attrition from child trauma-focused treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is common; yet, the factors of children who prematurely terminate are unknown. The aim of the current study was to identify risk factors for attrition from TF-CBT. One hundred and twenty-two children (ages 3–18; M = 9.97, SD = 3.56; 67.2% females; 50.8% Caucasian) who received TF-CBT were included in the study. Demographic and family variables, characteristics of the trauma, and caregiver- and child-reported pretreatment symptoms levels were assessed in relation to two operational definitions of attrition: 1) clinician-rated dropout, and 2) whether the child received an adequate dose of treatment (i.e., 12 or more sessions). Several demographic factors, number of traumatic events, and children’s caregiver-rated pretreatment symptoms were related to clinician-rated dropout. Fewer factors were associated with the adequate dose definition. Child Protective Services involvement, complex trauma exposure, and child-reported pretreatment trauma symptoms were unrelated to either attrition definition. Demographics, trauma characteristics, and level of caregiver-reported symptoms may help to identify clients at risk for premature termination from TF-CBT. Clinical and research implications for different operational definitions and suggestions for future work will be presented. 相似文献
7.
Using Total Communication With Young Children With Down Syndrome: A Literature Review and Case Study
《Early education and development》2013,24(4):306-320
This paper presents a literature review regarding language abilities of children with Down syndrome and presents a case study concerning the effectiveness of using Total Communication with a young child with Down syndrome. The prevalence of expressive language delays in children with Down syndrome highlights the need to develop early interventions to promote language development. The existing literature on the usefulness of Total Communication as an intervention method with children and adults with special needs is documented and a rationale for the use of Total Communication with children with Down syndrome is presented. In the case study, a single subject simultaneous treatment design was used which involved introducing 20 words during free play (10 oral and 10 Total Communication), which were matched on phonetic complexity and reinforcement value. Results indicated that comprehension was not differentially affected by the type of communication approach used. However, expressively the child was able to use manual signs many months before any understandable words were produced. The use of manual signs did not inhibit use of speech. The results of this case study suggest that the early use of Total Communication can be an effective transitional mode of communication for at least some children with Down syndrome. Further research is needed to explore individual differences between children with Down syndrome and to identify factors that predict those children who benefit most from the use of Total Communication. 相似文献
8.
Forjuoh SN 《Child abuse & neglect》2000,24(8):1019-1025
OBJECTIVE: This study was undertaken to determine the incidence, hospital charges, and correlates associated with inpatient treatment of child maltreatment related injuries. METHODS: The data were based on the 1995 Pennsylvania Hospital Discharge Data which included all Pennsylvania acute care hospitals that reported child maltreatment discharges. Per capita hospital discharge rates were computed for children discharged with child maltreatment related injuries according to selected variables. Odds ratios for child maltreatment related injury hospitalizations were also computed. RESULTS: A total of 348 maltreated injured children ages 0-19 years were discharged from Pennsylvania hospitals in 1995, representing an incidence rate of 10.8 per 100,000 persons. The total hospital charges for child maltreatment related injury discharges amounted to over $5.4 million, of which Medicaid alone paid for 45%. Compared to a random sample of non-maltreated injured children (n = 1052), maltreated injured children were found to be significantly younger, more likely to be females, and more likely to be Black. Child maltreatment related injury hospitalizations were more likely to be urgent and via physician referral or transfer from other health care facility. Maltreated injured children were three times as likely to die as other children. CONCLUSIONS: These findings indicate that injury from child maltreatment is a major cause of hospitalization of young children 5 years and younger and represents a significant cost to publicly financed health care. While hospital discharge data can be used for population-based surveillance of child maltreatment related trauma, there is need for improvement in the surveillance of these injuries. 相似文献
9.
Using Total Communication With Young Children With Down Syndrome: A Literature Review and Case Study
This paper presents a literature review regarding language abilities of children with Down syndrome and presents a case study concerning the effectiveness of using Total Communication with a young child with Down syndrome. The prevalence of expressive language delays in children with Down syndrome highlights the need to develop early interventions to promote language development. The existing literature on the usefulness of Total Communication as an intervention method with children and adults with special needs is documented and a rationale for the use of Total Communication with children with Down syndrome is presented. In the case study, a single subject simultaneous treatment design was used which involved introducing 20 words during free play (10 oral and 10 Total Communication), which were matched on phonetic complexity and reinforcement value. Results indicated that comprehension was not differentially affected by the type of communication approach used. However, expressively the child was able to use manual signs many months before any understandable words were produced. The use of manual signs did not inhibit use of speech. The results of this case study suggest that the early use of Total Communication can be an effective transitional mode of communication for at least some children with Down syndrome. Further research is needed to explore individual differences between children with Down syndrome and to identify factors that predict those children who benefit most from the use of Total Communication. 相似文献
10.
Decades of research have established that experience of abuse and/or neglect in childhood is related to negative outcomes, such as juvenile delinquency. Existing research has shown that involvement in child welfare services is also related to juvenile delinquency, particularly for children who are victims of neglect. Research has also identified educational factors such as chronic absenteeism as significant predictors of involvement in the juvenile justice system. However, little research has investigated the combined influence of educational factors, child abuse, and involvement in child protective services on justice system involvement. The current study examined the influence of educational factors and involvement in child protective services on justice system involvement. The study utilized records from an educational database of children who attended a school within a county of Mississippi in any year from 2003 through 2013. Cases were then matched with records from the county Youth Court, Law Enforcement agencies, and Child Protection Services. A multivariate logistic regression controlling for gender, race, current age, and time at risk was conducted to involvement in the justice system. In general, educational factors were stronger predictors of justice system involvement than allegations of maltreatment. 相似文献
11.
《Child abuse & neglect》2014,38(9):1487-1495
Pediatric abusive head trauma causes significant cognitive and behavioral morbidity, yet very few post-acute interventions exist to facilitate long-term recovery. To meet the needs of this vulnerable population, we piloted a web-based intervention with live coaching designed to improve positive parenting and child behavior. The efficacy of this parenting skills intervention was compared with access to Internet resources on brain injury. Participants included seven families (four randomized to the parenting intervention and three randomized to receive Internet resources). Parenting skills were observed and child behavior was rated at baseline and intervention completion. At completion, parents who received the parenting skills intervention showed significantly more positive parenting behaviors and fewer undesirable behaviors during play than parents who received access to Internet resources. Additionally, during play, children in the parenting skills intervention group were more compliant following parent commands than children in the Internet resources group. Lastly, parents who received the parenting intervention reported less intense oppositional and conduct behavior problems in their children post-intervention than did parents in the Internet resources group. These findings provide preliminary evidence for the use of this web-based positive parenting skills intervention to improve parenting skills and child behavior following abusive head trauma. 相似文献
12.
This study is concerned with decision making in child abuse investigations. The study used an experimental design to investigate the effects of four case factors that influence child protective service workers' and attorneys' dispositions choices in alleged cases of physical child abuse. The factors were: the physical injury, mild or serious; previous report of child abuse, yes or no; parental reaction, positive or negative; and parental admission of involvement with injury, admit or deny. The main findings were: Attorneys had a tendency to recommend court intervention, while protective workers had a tendency not to recommend court action; and all four case factors had a significant effect on the disposition choices for both professional groups, although injury and previous report accounted for a larger proportion of the variance. 相似文献
13.
Liliana Cortes Marla Jean Buchanan 《International journal for the advancement of counseling》2007,29(1):43-55
There are child soldiers fighting with government forces and opposition groups in more than 30 countries worldwide. Although
studies have been conducted on the impact of war-related trauma on children, very few have focused on those children who do
not exhibit trauma-related symptoms after experiencing armed combat. The purpose of this study was to identify and understand
some of the mechanisms and resources that resilient children draw upon to overcome the trauma of child soldiering. Six Colombian
child soldiers were recruited through purposive sampling techniques to participate in a narrative study focusing on their
lived experiences and their personal understanding of how they were able to overcome the effects of war trauma. Six narrative
themes were identified and discussed in terms of the literature on trauma and childhood resilience and also related to counselling
needs and services. 相似文献
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16.
L J Dykes 《Child abuse & neglect》1986,10(2):211-221
In 1974 John Caffey described a form of abuse in infants which he called "The Whiplash Shaken Infant Syndrome." This syndrome involves vigorous manual shaking of infants by the extremities or shoulders, with whiplash-induced intracranial and intraocular bleeding, but with no external signs of head trauma. This article reviews the literature on whiplash shaken infant syndrome since Caffey's original review. The bulk of this literature focuses on the use of cranial computed tomography in the diagnosis of head injury in infants. Many questions remain regarding the incidence of this syndrome, and the long term morbidity resulting from this type of injury in infants. Caffey's recommendations for routine, regular examinations of the ocular fundi in all babies, and for a massive public educational program on the hazards of shaking infants have yet to be carried out. 相似文献
17.
The purpose of this study was to describe behavioural and emotional symptoms and to examine the effect of abuse-related factors, family responses to disclosure, and child self-blame on these symptoms in children presenting for medical evaluations after disclosure of sexual abuse. A retrospective review was conducted of 501 children ages 8–17. Trauma symptoms were determined by two sets of qualitative measures. Abstracted data included gender, ethnicity, and age; severity of abuse and abuser relationship to child; child responses regarding difficulty with sleep, school, appetite/weight, sadness, or self-harm, parent belief in abuse disclosure, and abuse-specific self-blame; responses to the Trauma Symptom Checklist in Children-Alternate; and the parent's degree of belief in the child's sexual abuse disclosure. Overall, 83% of the children had at least one trauma symptom; 60% had difficulty sleeping and one-third had thoughts of self-harm. Child age and abuse severity were associated with 3 of 12 trauma symptoms, and abuse-specific self-blame was associated with 10 trauma symptoms, after controlling for other variables. The children of parents who did not completely believe the initial disclosure of abuse were twice as likely to endorse self-blame as children of parents who completely believed the initial disclosure. Screening for behavioural and emotional problems during the medical assessment of suspected sexual abuse should include assessment of self-blame and family responses to the child's disclosures. In addition, parents should be informed of the importance of believing their child during the initial disclosure of abuse and of the impact this has on the child's emotional response to the abuse. 相似文献
18.
Laurel J. Kiser Carla Smith Stover Carryl P. Navalta Joyce Dorado Juliet M. Vogel Jaleel K. Abdul-Adil Soeun Kim Robert C. Lee Rebecca Vivrette Ernestine C. Briggs 《Child abuse & neglect》2014
The present study was conducted to better understand the influence of the child–perpetrator relationship on responses to child sexual and physical trauma for a relatively large, ethnically diverse sample of children and youth presenting for clinical evaluation and treatment at child mental health centers across the United States. This referred sample includes 2,133 youth with sexual or physical trauma as their primary treatment focus. Analyses were conducted to ascertain whether outcomes were dependent on the perpetrator's status as a caregiver vs. non-caregiver. Outcome measures included psychiatric symptom and behavior problem rating scales. For sexual trauma, victimization by a non-caregiver was associated with higher posttraumatic stress, internalizing and externalizing behavior problems, depression, and dissociation compared to youth victimized by a caregiver. For physical trauma, victimization by a non-caregiver was also associated with higher posttraumatic symptoms and internalizing behavior problems. The total number of trauma types experienced and age of physical or sexual trauma onset also predicted several outcomes for both groups, although in disparate ways. These findings are consistent with other recent studies demonstrating that perpetration of abuse by caregivers results in fewer symptoms and problems than abuse perpetrated by a non-caregiving relative. Thus, clinicians should not make a priori assumptions that children and adolescents who are traumatized by a parent/caregiver would have more severe symptoms than youth who are traumatized by a non-caregiver. Further exploration of the role of the perpetrator and other trauma characteristics associated with the perpetrator role is needed to advance our understanding of these findings and their implications for clinical practice. 相似文献
19.
The child sexual abuse accommodation syndrome 总被引：2，自引：1，他引：2
R C Summit 《Child abuse & neglect》1983,7(2):177-193
Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment. 相似文献
20.
April Chiung-Tao Shen 《Child abuse & neglect》2009,33(3):148-160
ObjectivesThis study investigated the joint long-term impact of witnessing interparental violence and experiencing child physical maltreatment on young adults’ trauma symptoms and behavior problems. It also explored Chinese traditional beliefs as a possible contributor to young adults’ trauma and behavior.MethodsThis study used self-reporting measures to collect data from a national proportionate stratified sample of 1,924 college students in Taiwan. The sample was divided into four groups: no violence; interparental violence only; child physical maltreatment only and dual violence, to compare the combined effect of dual violence on long-term outcome with the no violence group and the one type of violence group.ResultsThe results indicated a significant association of interparental violence and child physical maltreatment, and 11.3% of participants reported witnessing partner violence between parents and experiencing physical maltreatment during childhood. Participants experiencing dual violence reported more trauma symptoms and behavior problems than did those experiencing only one form of violence or none at all. Exposure to both interparental violence and child physical maltreatment during childhood is a significant predictor of young adults’ trauma symptoms and behavior problems, after controlling for other potentially confounding risk factors. Cultural factors also play a significant role in predicting young adults’ trauma symptoms and internalizing behavior problems, after accounting for control variables and violence-related variables. Moreover, cultural factors interact significantly with dual violence experiences in predicting young adults’ externalizing behavior problems.ConclusionsThis study extended Western co-occurrence study findings with large Taiwanese community samples. The results demonstrated that dual violence experiences during childhood have long-term detrimental impact on young adults’ trauma symptoms and behavior problems. Cultural beliefs and their interaction with dual violence experiences play a significant role in young adults’ trauma symptoms and behavior problems as well.Practice implicationsThe present findings underscore the need for interventions for young adults exposed to childhood dual violence. Moreover, the findings highlight the need for culturally sensitive interventions to address the cultural factor impact on young adults’ trauma symptoms and behavior problems. 相似文献