Lecture 11: Child maltreatment and its impact on victims

Question 1

Definition of child abuse

Answer 1

• NSPCC 2019
• When a child is intentionally harmed = can be physical, emotion, sexual, online or in person. Can also by a lack of love and attention and practice care

Question 2

Types of abuse

Answer 2

• Physical abuse
• Sexual
• Psychological/emotional
• Neglect-emotional, failure to protect

Question 3

FGM (female genital mutilation)

Answer 3

• Around 200 million world-wide effects
• Culturally sensitive
• Illegal in UK since 1985
• FGM prevention orders to prevent girls being taken out of country

Question 4

Online abuse

Answer 4

• 44% children aged 5-15 have own smart phone

- 90% 11-16 year olds have social media account

Question 5

Tech facilitated grooming

Answer 5

• When someone builds a relationship of trust and emotional connection with child or young person so that they can manipulate and exploit them
• Young person can be trafficked, sexually assaulted or exploited

Question 6

Child sexual exploitation (CSE)

Answer 6

• Involves young person receiving something in return for sexual exchange
• Can involved coercion and threats
• Can give them phones to gain access
• Care home kids more vulnerable

Question 7

Rotherham CSE scandal

Answer 7

• 1990s and lasted over a decade
• Organised by gangs
• First convictions 2010
• Services failed to act on warning signs
• Minimisation of girls stories
• Most exploitation done by single perpetrator not gang

Question 8

UK statistics

Answer 8

• Taken from children services, police data on offences, criminal courts and local registers of death due to abuse
• Study looking at adults retrospective experience of child abuse
• Women = abuse more common, except physical abuse
• More men physically abused
• Psychological abuse most common
• Report tends to increase with age of respondents = questions validity

Question 9

Risk factors for abuse

Answer 9

• Parental factors e.g. poverty, drug abuse, mental health issues
• Environmental factors e.g. overcrowding and non-biological adult in house
• Child factors e.g. age (fatal cases in children under 4), lack of attachment

Question 10

Theories of abuse

Answer 10

Ecological model:
-Occurs within the wider system

Transitional model:
-Parental views about self and confidence

Transactional model:
-Emphasises interaction of causative factors in bringing about maltreatment and importance of high and low risk characteristics

Ecological transactional model:
-Provides integrated framework that aims to support intervention and social policy

Question 11

Serious case reviews

Answer 11

• Focussed on number of high profile child deaths
• Studied 95 serious case reviews between 2009-2016
• Found domestic abuse more common factor in 71% of cases
• 48% of cases alleged domestic abuser was not suspect in child death
• Therefore domestic abuse may mask other risks in family

Question 12

Neglect

Answer 12

• Most common form of abuse
• On going failure to meet Childs basic needs
• 1 out of 10 children suffer neglect
• Under researched = can see impact of neglect but cant see it occur
• Meta analysis of association between depression and childhood abuse/neglect = found psychological abuse and neglect strongly associated with depression and emotional abuse was most sig predictor, followed by neglect

Question 13

Effects of abuse on children

Answer 13

Impacts upon:

• Physical health
• Education
• Relationship
• Mental wellbeing
• Has potential to impact across generations

Question 14

Effects of abuse in childhood on adulthood

Answer 14

Meta analysis in literature review:
-Found effects were mental health issues, substance abuse, somatisation (physical complaint rather than psychological), suicidal ideation, risk of inter-generational cycle of abuse, increase risk of victimisation

Question 15

ACE (adverse childhood experiences) pyramid

Answer 15

• Scale developed to understand what is going on in child and adult abuse
• Abuse leads to increased emotional and cognitive impairment, adoption of health risk behaviours, increased risk of disability and disease, early death

Systematic review and meta-analysis:

• Having multiple ACE’s = more at risk of range of health problems
• Those factors strongly associated with potential for inter-generational transmission

Question 16

Toxic trio

Answer 16

If parent has these conditions:

• Domestic abuse
• Mental ill health
• Substance misuse
• If they have one of these child’s health is at risk

Question 17

Neurological impacts of child abuse

Answer 17

• In first year child must receive adequate stimulation to ensure nerve cells in brain develop fully
• Effects of abuse on child can begin before mother gives birth

Question 18

Corrosive cortisol

Answer 18

• Childhood trauma effect how brain organises itself and processes experiences
• Cortisol prepares for stress and is involved in pruning of neurones during brain development in foetal and infancy period = brain shaped by this
• However, toxic stress leads to brain circuits developing which either over or under react to stress
• Adaptive response has implications for HPA axis

Question 19

Romanian orphans

Answer 19

• Showed mild neurocognitive impairment, impulsivity and attention deficit
• Meta-analysis = 339 Romanian orphans = found 18% secure, 28% insecure, 54% disorganised = looked at moderating variables of how they formed disorganised styles
• Most likely to have disorganised attachment if they had Eastern European origin, age of institutionalisation matters (before 1st birthday), age of assessment (under 3 years) and type of assessment
• Conclusion = 1 year sensitive period

Question 20

Child maltreatment and attachment

Answer 20

• Looked at association between child maltreatment and insecure attachment
• Used strange situation = found maltreatment infants sig more likely to have insecure attachment
• Abuse associated with disorganised attachment

Question 21

Disorganised attachment

Answer 21

• Associated with fear
• Either parent is scary or parent is frightened = becomes dysregulated for infants
• Child has no effective way out of it = as a result there’s a release of emotions
• Traumatisation of attachment system
• Usually exert control over parent to get out of attachment

Question 22

Automatic reaction to trauma

Answer 22

• One response is fight or flight system
• Another response is the vagal parasympathetic control:
• ->Parasympathetic system, involving the freeze response
• ->Person makes dissociation and black out
• ->Common in prolonged abuse
• -> Related to vagus nerve = switching on when we are extremely frightened

Question 23

What helps traumatised individuals

Answer 23

• Safety
• Therapeutic parenting
• Children need high structure and nurture
• Parents should account for their developmental deficits
• Therapies e.g. play therapy

Question 24

Pyramid of needs

Answer 24

(Bottom to top)

• Feeling safe and developing relationships
• Empathy, thinking of self and others
• Resiliency and resolution

Question 25

Rutter et al (2011)

Answer 25

• 165 Romanian orphans
• Tested at 4, 6, 11, 15
• Control group = 52 British orphans
• When tested at 11 = correlation between rate of recovery and age of adoption
• Earlier adopted = higher IQ
• Same shown at 16

Question 26

Therapeutic interventions for children

Answer 26

• Dyadic developmental psychotherapy = popular therapy but scientific studies lacking
• Interventions aimed at foster carers to support environment
• Art and play therapies used to process non-verbal trauma before speaking age

Question 27

Therapeutic interventions for adults

Answer 27

• Safety most important factor
• CBT used to focus upon engagement safety and stabilisation
• Psychoeducation = use reducing hyperarousal with breathing and relaxation = teach self-soothing strategies