Childhood Maltreatment

Question 1

Four major types of maltreatment

Answer 1

Physical abuse
Sexual abuse
Emotional abuse
Neglect

Question 2

Physical abuse, as defined by WHO

Answer 2

Acts resulting in ACTUAL or POTENTIAL physical harm from interaction w/person of responsibility

Question 3

Physical abuse as defined by Vermont

Answer 3

Permanent or temporary disfigurement or impairment of any bodily organ or function by other than accidental means.

Question 4

Sexual abuse, as defined by WHO

Answer 4

Involvement of a child in sexual activity that he/she doesn’t fully comprehend and cannot consent to.

Question 5

Sexual abuse, as defined by Vermont

Answer 5

Incest, rape, sodomy, any lewd or lascivious conduct involving a child

Question 6

Emotional abuse, as defined by WHO

Answer 6

Failure to provide a developmentally appropriate, supportive environment so that a child can establish a full range of emotional and social competencies

Question 7

Emotional abuse, as defined by Vermont

Answer 7

Pattern of malicious behavior resulting in impaired psychological growth

Question 8

Neglect, as defined by WHO

Answer 8

Failure to provide for a child in ALL domains

Question 9

Neglect, as defined by Vermont

Answer 9

Failure to supply adequate food, clothing, shelter, or health care

Question 10

Is maltreatment a DSM-5 disorder?

Answer 10

No. Part of “other conditions” that might be a focus of clinical attention.

Question 11

Maltreatment prevalence

Answer 11

3 million suspected cases in US
1-1.5 million confirmed
VERY prevalent, tracks socio-economic status (especially in case of NEGLECT)

Question 12

Prevalence of maltreatment, ranked

Answer 12

1. Neglect (most common)
2. Physical abuse
3. Sexual abuse
4. Emotional abuse - hard to prove
5. Other (least common)

Question 13

Issues in maltreatment reporting

Answer 13

1. Victims may be scared to self-disclose
2. Fallibility of human memory
   
   • false-negative rates are ~1/3: denial
     it happened
3. Limited resources directed @ more “serious” abuse

Question 14

Factors leading to maltreatment

Answer 14

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

Question 15

Interviewing children about maltreatment problem

Answer 15

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)

Question 16

Factors related to greater interview disclosure

Answer 16

Having told somebody else before formal interview

Experienced first abuse as adolescent instead of child

Question 17

Gradual/incremental disclosure of abuse

Answer 17

Common

Question 18

How to effectively interview a child about maltreatment

Answer 18

“Lay groundwork” before asking questions
- truth-lie discrimination
- it’s ok not to know
- use non-suggestive questions

Question 19

Source monitoring

Answer 19

Children don’t always discriminate where they heard something, may play into potential issues with maltreatment interviews

Question 20

Neurobiological effects of maltreatment

Answer 20

(little direct research on children)

HPA axis dysregulation

Elevated levels of norepinephrine and dopamine

Overall: sensitization of fight-or-flight brain systems to stress

Question 21

Cognitive/perceptual effects of maltreatment

Answer 21

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

Question 22

Social information processing model

Answer 22

Maltreated children have harder time following the steps.

1. Encoding of cues
2. Interpretation
3. Clarification of goals
4. Response access
5. Response decision
6. Behavioral enactment

Question 23

Bolger et al., 1998

Answer 23

Bolger et al., 1998: sexual abuse -> low self-esteem

Emotional maltreatment -> poor peer relationships

Having a close friend made a huge difference.

Question 24

Emotional/behavioral effects of maltreatment

Answer 24

1. Issues with emotional regulation
2. Physical aggression in boys, relational aggression in girls
3. More severe/chronic abuse: later aggression, both physical and relational
4. Severity of neglect related to later internalizing and withdrawn behaviors

Question 25

Effect of maltreatment on social relationships

Answer 25

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

Question 26

Psychological First Aid

Answer 26

Telling people about resources available for them. Don’t do alone, [air with something.

Question 27

Psychological debriefing

Answer 27

BAD. DO NOT DO.
No evidence of utility w/children and forces them to talk about the traumatic event straight afterward.

Question 28

Acute interventions

Answer 28

Child-development policing program

Question 29

TF-CBT

Answer 29

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.

Question 30

Common trauma-related cognitive distortions

Answer 30

Self-blame
Guilt/survivor guilt
Shame/embarrassment
Hero fantasies
Overgeneralization of danger
Minimization of trauma
Foreshortened future
Magical thinking
Revenge fantasies

Question 31

Examples of TF-CBT

Answer 31

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.