Childhood Maltreatment Flashcards
Four major types of maltreatment
Physical abuse
Sexual abuse
Emotional abuse
Neglect
Physical abuse, as defined by WHO
Acts resulting in ACTUAL or POTENTIAL physical harm from interaction w/person of responsibility
Physical abuse as defined by Vermont
Permanent or temporary disfigurement or impairment of any bodily organ or function by other than accidental means.
Sexual abuse, as defined by WHO
Involvement of a child in sexual activity that he/she doesn’t fully comprehend and cannot consent to.
Sexual abuse, as defined by Vermont
Incest, rape, sodomy, any lewd or lascivious conduct involving a child
Emotional abuse, as defined by WHO
Failure to provide a developmentally appropriate, supportive environment so that a child can establish a full range of emotional and social competencies
Emotional abuse, as defined by Vermont
Pattern of malicious behavior resulting in impaired psychological growth
Neglect, as defined by WHO
Failure to provide for a child in ALL domains
Neglect, as defined by Vermont
Failure to supply adequate food, clothing, shelter, or health care
Is maltreatment a DSM-5 disorder?
No. Part of “other conditions” that might be a focus of clinical attention.
Maltreatment prevalence
3 million suspected cases in US
1-1.5 million confirmed
VERY prevalent, tracks socio-economic status (especially in case of NEGLECT)
Prevalence of maltreatment, ranked
- Neglect (most common)
- Physical abuse
- Sexual abuse
- Emotional abuse - hard to prove
- Other (least common)
Issues in maltreatment reporting
- Victims may be scared to self-disclose
- Fallibility of human memory
- false-negative rates are ~1/3: denial
it happened
- false-negative rates are ~1/3: denial
- Limited resources directed @ more “serious” abuse
Factors leading to maltreatment
Destabilizing factors, stage 1: reduced tolerance for stress and disinhibition of aggression
Stage 2: poor management of acute crises and provocation
Stage 3: habitual patterns of arousal and aggression with family members
Interviewing children about maltreatment problem
Majority of sexual abuse victims do not disclose in childhood. Children also minimize. They’re also vulnerable to suggestion (may be overstated in the media)
Factors related to greater interview disclosure
Having told somebody else before formal interview
Experienced first abuse as adolescent instead of child
Gradual/incremental disclosure of abuse
Common
How to effectively interview a child about maltreatment
“Lay groundwork” before asking questions
- truth-lie discrimination
- it’s ok not to know
- use non-suggestive questions
Source monitoring
Children don’t always discriminate where they heard something, may play into potential issues with maltreatment interviews
Neurobiological effects of maltreatment
(little direct research on children)
HPA axis dysregulation
Elevated levels of norepinephrine and dopamine
Overall: sensitization of fight-or-flight brain systems to stress
Cognitive/perceptual effects of maltreatment
Faster reaction time to angry faces (selective attentional bias)
Increased attention to threat-relevant stimuli
Mixed evidence for IQ ability
Difficulty with moral reasoning, threat evaluation, social info processing
Social information processing model
Maltreated children have harder time following the steps.
- Encoding of cues
- Interpretation
- Clarification of goals
- Response access
- Response decision
- Behavioral enactment
Bolger et al., 1998
Bolger et al., 1998: sexual abuse -> low self-esteem
Emotional maltreatment -> poor peer relationships
Having a close friend made a huge difference.
Emotional/behavioral effects of maltreatment
- Issues with emotional regulation
- Physical aggression in boys, relational aggression in girls
- More severe/chronic abuse: later aggression, both physical and relational
- Severity of neglect related to later internalizing and withdrawn behaviors
Effect of maltreatment on social relationships
Bolger et al., 1998 again.
Maltreated youth -> less satisfactory relationships w/ peers
Kids suss out aggressive children and distance themselves. Unpopular.
Chronicity of abuse -> aggression
Psychological First Aid
Telling people about resources available for them. Don’t do alone, [air with something.
Psychological debriefing
BAD. DO NOT DO.
No evidence of utility w/children and forces them to talk about the traumatic event straight afterward.
Acute interventions
Child-development policing program
TF-CBT
Trauma-focused cognitive behavioral therapy
3-18 yr olds.
Establishes and maintains therapeutic relationship w/child and parent.
Psychoeducation about childhood trauma and PTSD.
Emotional regulation skills.
Individualized stress management skills.
Common trauma-related cognitive distortions
Self-blame
Guilt/survivor guilt
Shame/embarrassment
Hero fantasies
Overgeneralization of danger
Minimization of trauma
Foreshortened future
Magical thinking
Revenge fantasies
Examples of TF-CBT
Helping the child share a trauma narrative through various mediums.
Gradual exposure to trauma.
Cognitive processing of trauma.
Education about healthy relationships.
Parenting skills.
Personal safety training.
Coping w/future trauma reminders.
