Lecture - Psych Med (Child abuse) Flashcards
What is the impact of child abuse?
(it’s imp for us to know bc stats show it’s common and has big impact)
- Possible physical consequences:
- failure of growth
- developmental delays (If child being abused, the things necessary for a child to develop normally won’t be there)
- death
- scarring, disfigurement, impairments - Possible psychological conseuqences
- low self-esteem
- relationship problems (trust, attachment)
- externalsing behaviours and disorders (aggression, violence, oppositional disorders etc)
- Internalising behaviours and dsiorders (suicide, anxiety, depression, self harm)
- may affect cognitive development (vocational problems)
- PTSD
What are the 4 types of child abuse?
- Neglect
- Emotional
- Physical
- Sexual
What is neglect abuse?
Passive unintentional ignoring of the child’s needs
A child has needs like physical (food, clothing and shelter), safety needs for protection (supervision), emotional and intellectual developmental needs (e.g. not playing or interacting with them) - like, need caring adult who responds and reciprocates emotional processes.
Neglect is when you won’t meet child’s needs (passive and unintentional). Adult won’t intentiionally do it e.g. the parent might have alcohol or drug issues, might be depressed - won’t respond to baby’s needs very well or people who have been themselves brought up in an abusive envionment so the parent is neglectful.
Emotional, physical and sexual are intentional
What’s emotional abuse?
Intentionally carrying out some of the following acts:
- frequent criticism, ridicule, humiliation and threats
- frequent rejection, deprivation of affection, exclusion from family life
- frequent punishment for minor misdemeanours or positive behaviours (e.g. smiling, playing)
- frequent blocking of peer relationships, isolation
- exposure to family violence/pet violence/criminality (so like, threatening to hurt the pet or actually hurting the pet or if 8 year old being used for stealing bc they can fit through the hole in the window)
So like it’s frequent, deliberate and outside of the norm. E.g. the kid can be nice but the parent is hella negative or if like one child gets less of everything (love, resources etc)
What’s pysical abuse?
Deliberately inflicting injury on a child
Like hurting, kicking, throwing, biting, stabbing, burning, scalding, strangling/suffocating, drowing or poisoning the kid
What’s sexual abuse?
The use of a child (male or female) for sexual gratification
- can be non-contact (like peeping or showing pee pee)
- child sexual abuse images (child porn isn’t a thing - it’s abuse)
- fondling w/ genitals, breasts or buttocks
- oral sex
- anal sex (w/ penis, fingers or other object)
- attempted/completed vaginal intercourse (w/ penis or other object)
Whether the child agrees or not
-child can’t agree to sexual activity with an adult
Must be a developmental age difference between the victim and perpetrator to be ‘sexual abuse’
-One person knows what they’re doing and they have power of the younger one (doesnt have to be adult and child - it can be adolescent and child too)
Three indicators for abuse: verbal, physical and behavioural
- What are some verabl indicators
- Do kids usually disclose?
- What’re some reasons for non disclosure?
- Three:
- VERBAL DISCLOSURE FROM THE CHILD: may be direct or tentative/incomplete (“I dont like that uncle”/”I’m not happy at home”)
- VERBAL DISCLOSURE FROM THE ADULT: may directly report what they’ve seen or may voice tentative concern about a situation
- INDIRECT VERBAL EVIDENCE: inconsistencies, discrepencies, doesn’t fit w/ injury, delayed treatment seeking - Nope, kids dont usually disclose even when there is evidence that it has occured
- Reasons for non disclosure:
- to protect familiar perpetraors (esp family members) (“What happens to that family if I tell on them? They’re the only ones who take care of me”)
- yeild to requests or threats about not telling (Might have rewards or “you need to keep this a secret between us else mum wont be happy”)
- avoidance (Like PTSD - not thinking about an event that is traumatic so they just avoid)
- feel ashamed, embarrased or to blame (And then they dont wanna tell this story)
- fear threatened or imagined consequences
- may not understand that they’ve been abused (They may not understand that it is a sexual behaviour and then when they realise what was done, they’ll disclose later on)
Three indicators of abuse: verbal, physical and behavioural
Just know that all signs may not be specific to abuse. Some signs may indicate conditions other than child abuse. You need to look for a pattern of evidence
Okay so what are the signs of physical abuse and what should you sorta notice about the injuries?
Signs of physical abuse
-
Bruises and welts
- multiple injuries, differing ages, differing sites
- site (soft tissue area like ear lobes, genitals, upper thighs, cheek) - bruises on lower legs and arms are often result of normal play
- shape (shape may reveal cause like oval with teeth marks, fingertip brusising) -
Cuts and abrasions
- May be deliberate cuts
- around the mouth of an infant - force feeding
- hair pulling (bald patches) -
Scalds and burns
- many of these are accidental (superficial as child pulls away)
- abuse burns are often full thickness (not superficial if hand held in boiling water for long time)
- cigarette burns: circular and multiple
- deliberate scalds differ from accidental (sock or glove pattern is where hand held or foot held long time in heat) -
Fractures
- esp in infants (they can’t move so how do they get fractures?)
- look for other signs (old fractures that weren’t treated…) -
Head injuries
- serious intracranial injury with multiple skull fractures requires major force
- intracranial injury with no skull fractures - shaking the baby
6. Abdominal Injuries
- Poisoning/apnoea (temportary cessation of breathing) attacks
Signs of sexual abuse:
-
Genital injures
- if pissible, refer to DSAC
- brusing or scratching of inner thigh, grip marks, lacerations or brusing to vulva/rectum
- burns to the private region
- bleeding, pain or restricted movement (I think with vaginal intercourse) -
Sexually transmitted diseases
- non-sexual transmission of STD are rare (so if you get it as a kid, you’re probably being abused)
- thrush common and very rarely linked to SA - Pregnancy
Three indicators of abuse: verbal, physical and behavioural
What are behavioural indicators?
They may not neccessarily indicate abuse!
- Agression
- Withdrawal
- Anxiety and regression (eg bed wetting)
- Fear
- Sadness
- Defiance
- Overly resonsible
- Attachments disturbed
- Obsessions
- Sexualised behaviour
What is common age appropriate sexualised behaviour? Like, at these ages, what do you expect the child to do sexually?
0-5
6-12
Adolescents
- 0-5: touch or rub their own genitals. Show and look at private parts, childish sexual language like ‘pee pee’, masturbation is possible
- 6-12 years: ask questions about menstruation, pregnancy and sexual behaviour, experiment with other kids eg touching, kissing, showing, may masturbate in private.
- Adolescents: ask questions about sex and relationships, use sexual language and talk about sex acts to other teens, masturbation in private, experiment sexually with similar aged adolescents
What is non-age appropriate sexual behaviour?
Expressing sexual knowledge not usual for their age in language, behaviour or play (e.g. exhibiting adult like sexual behaviour, talk or play)
- eg an 11 yo wanting to view an adult’s penis (they know it’s not appropriate)
- eg a 4 yo demonstrating with his teddy sex intercourse
May not neccessarily indicate sexual abuse!
When you suspect child abuse, who should you notify?
- Police where imminent threat to safety of the child/doc/other person
- Social worker at ministry for vulnerable children, oranga tamariki (mvcot)
__________________________________________________
Ministry for vulnerable children:
Anytime, you can ring them up about the child and give them why you are concerned etc and they’ll categorise it - wont just send police straight away. They arent bad guys taking the child away- they are good source of inofrmation about what to do (leave the child a little longer, talk to the kid etc)
Legal issues - what is the paramount principle in the children, young persons, and their families act 1989?
What’s section 15?
What about 16?
The welfare and interests of the child or young person shall be the first and paramount consideration
“Child comes first”
15: Any person who believes that any child or young person has been, or is likely to be harmed (whether physically, emotionally or sexually) or ill-treated, abused, neglected or deprived may report the matter to a social worker or a member of the police
16: Protection when disclosing: No civil, criminal or disciplinary proceedings shall lie against any person in respect of the disclosure…..pursuant (in accordance with) to section 15…..concerning a child or young person (whether or not that information also concerns any other person) unless the information was disclosed or supplied in bad faith (so if you are doing it to get back at someone then bad)
What are the strenghts and weaknesses to using the child as a witness?
STRENGTHS:
- Even very young kids can report their experiences
- If asked open questions, they can do it accurately
WEAKNESSES:
- Have limited memeory retrieval and verbal skills (so hard to get all/full info out)
- Suggesstive and coercive questioning can lead to inaccuracies (so shouldn’t obvi ask like “so your mum gave you that bruise, didn’t she?” - this might just lead to them saying yes bc yolo and they might not understand the double negaitves etc
What is forensic/evidential interviewing?
You need to be highly skilled and be able to talk at the developmentally appropriate age. Ask free recall or open-ended questions. Avoid leading, suggesstive or coercive practises. Develop rapport, child environment and obtain evidence
For assessing risk - you wanna talk to the child, not interview the child. How do you go about doing this?
Talking with the child requires careful documentation, how do you document thoroughly?
What are some things to avoid when interviewing child?
