Week 8 L14 C Maltreat Flashcards
Physical abuse includes
Punching, beating, kicking, burning, shaking, or otherwise physically harming a child
Often unintentional and resulting from severe physical punishment
Often by moms under distress and about of control
U.S. Child Abuse Prevention and Treatment Act:
Child maltreatment definition
Definition
Any recent act or failure to act on the part of a parent or caretaker, which results in death,
serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act, which presents an imminent risk of serious harm.
Neglect, pushy usual abuse, sexual abuse, educational neglect
Neglect
Includes?
Child’s basic needs are not being met
Physical neglect
Food, refusal of health care, inadequate supervision
Educational neglect
Not putting a child of manadatory age in school, not attending to special education needs
Emotional neglect
Failure to attend to child’s emotional needs, refusal or failure to provide needed psychological care
Sexual and emotional (harder to study) abuse
Sexual abuse
Touching genitals, intercourse, exhibitionism, production of
pornographic photos
Emotional abuse
Repeated acts by parents or caregivers that could or have caused serious behavioral, cogntive, emotional or mental disorders
Note that all abuse will cause emotional harm
Epidemiology of child abuse
Challenges of studying incidence and prevalence of
Reporting bias
People may not be willing to report this
Retrospective report
A lot of studies are completed by asking adults to report what they experienced as children, memories shaped hanged innacuracy? detail?
Use proxy, but poor estimates
One-year incidence rates for child abuse
Recall that incidence is new cases in a given time frame
In the U.S., 12.1/1000 children (more poverty, harder to get access to ehalthcRe)
In Canada, 9.7/1000 children
U.S. has higher rates of poverty, and it is much harder to get access to health care
Responding anonymously, 10% of parents report using forms of physical punishment that constitute child abuse (e.g., hitting the child with an object) not an infrequent experience
Most common type of maltreatment is
Neglect
Followed by:
Physical abuse
Sexual
Emo
Demographic characteristics of child dev.
Younger harder to manage, risk losing job late
Age
Younger children are more likely to be neglected
Older children (> 12 years) are more likely to be sexualy abused
, can be left lone for longe but not overnight
Gender
Girls are more likely to be sexually abused
Abused by male family members
Younger children are more likely to be
neglected
Sociological and financial aspects to child abuse?
Poverty
Crowded unsafe housing, restricted childcare opportunities
Single-parent families
Higher rates of physical abuse and neglect, due to stress and not being able to do it all. Mom is not supermom alone!
Parents have to make difficult choices, need money, leave baby alone overnight
Older children (> 12 years) are more likely to be
sexualy abused
Developmental Course of child abuse
Adaptation made, cause difficulties in other contexts.
Maltreated children must learn to cope with challenges in environment
These adaptations may cause problems in other contexts
1) Long term changes in physiological reactivity to stress, more or less reactive, not useful in older newer enviro
2) Understanding of emotion: anger association to being hit, less positive input,
Being abused or neglected by a parent exposes you to different emotional experiences
May change your understanding and experience of emotions
E.g., If you are constantly exposed to anger from a parent, and if recognizing that anger was adaptive, would that change your perception of emotion?
Study using emotion on faces
Reading Emotional Expressions and Child Maltreatment
Pollak et al. 2000
Participants
15 physically abused children
13 physically neglected children 11 children with no abuse history Between 3 and 5 years of age
Emotion recognition task
Children presented with 25 vignettes describing a protagonist experiencing one of 5 emotions: happiness, sadness, disgust, fear, anger
After each story, child shown three photographs of facial expressions (correct one and two distractors) and asked to point to the face appropriate for the stories protagonist
Emotion recognition task
(1) Sensitivity to differences between facial expressions
How accurate is the child?
Number of times a child says “angry” correctly
Remember that some of these will be lucky guesses
So subtract the number of times child days “angry” incorrectly
In general, neglected children were less sensitive to differences between facial expressions
In general, neglected children were less sensitive to differences between facial expressions than control.
Get less emo inout, and less able to identify faces!
Shows that emotional understanding has changed for abused hildren.
Bias towards labeling a particular stimulus as a particular emotion Ccording to the same study showing neglected children ls sensitive to faces recognition,
Extent to which a particular label may be more likely than others
Physically abused children show a bias for angry faces
Neglected children show a bias for sad faces
Specificity confident to expect abuse as not in neglect group! So good study
Two reasons for those findings: from study cannot distinguish faces regarding neglected children.
(1) Visually, children cannot discriminate between
the faces
(2) They have different understanding of the emotional displays
Follow up studies to tease apart why inability to discriminate?
Emotion discrimination task
Shown two photographs of models showing emotions and
asked “same or different”
No differences between three groups on this task
It is not that physically abused and neglected children cannot see the differences
Second task?
Emotion differentiation task
Children shown photographs of two models and asked to rate
the similarity of the facial expressions
Six shelfs lined up horizontally
One photograph placed on the far right
Child indicated similarity by placing the other photo
Neglected children perceived less distinction between angry, sad, fearful facial expressions
Physical abused children and control children perceived more distinction between anger and other negative emotions
See diference, but not as different.
Expeof abuse studies taken togethor
Change experience/understanding of emotion.
Something imp. For, interpersonal relations and acting on world!
Note also! not born who emotions! Expeerience in world shapes understanding!
Another study facial recognition
Pollak & Sinha, 2002
Participants
24 physically abused children 23 non-maltreated children
Presented children with photos displaying angry, sad, fearful, and happy facial images
Images are slowly filled in randomly, so that the expression gradually appears, (degraded photos)
Dependent variable is how early the child can identify the photo
At 3.3 second intervals, more of photo filled in
At each interval, children were prompted to identify
the emotion
Had to rate their confidence in their choice from (1) Guess to (5) Certainty
Only correct responses with a rating of 4 or 5 were used
Results:
Physical abused vs control
At no point are control children identifying happy faces more reliably than abused
But for anger
Physical abused children identify anger more reliably earlier, than control children, and then the control get to be just as good later.
Quicker and better at working with lees info.
Fear also had no difference like happiness.
Abused were worse at sad! Control were more reliable. Identify more accurately.
Conclusion for another study of faces, identification of degraded images
No systematic error.
Found that physically abused children needed less information to accurately identify angry faces than control children
Physically abused children needed more information than control children to identify sad faces
No difference for fearful and happy faces
Developmental Course
Summary of child abuse
Early experience of maltreatment fundamentally changes how children perceive emotions
Children who have been physically abused show a bias for identifying angry faces, and they need less information to identify angry faces
Implications for their behavior and emotional response
Diathesis-Stress Models
Why mLtreatment leads to psychopathology
Genetic predispositions interacting with maltreatment to lead to later psychopathology
Conduct disorder Caspi et al. 2002
MAOA activity interacting with maltreatment
Low MAOA activity and maltreatment predicting conduct disorder
Short allele and significant life stress, like child abuse lead to depression. Social support though plays a protective fold!
Less social support meant deprsion 2x higher!
5http, meta analysis controversy.
Caspi et al. found an interaction between maltreatment status and genotype
A second study replicated the Caspi et al. finding
Social support played a protective role
Maltreated children with a short allele and poor social support had rates of depression 2x higher than maltreated children with a short allele and social support
Diathesis-Stress Models
There is a main effect of maltreatment
Some individuals may be particular vulnerable
Multifinality
Classic interactions
Post-Traumatic Stress Disorder
Can occur with child abuse
Diagnostic protocol (no movies cannot do it)
Anxiety after an extremely traumatic experience Actual or threatened death, serious injury, sexual violation
Direct experience
Witness it in person
Learns that it happened to a close family member or friend
Experiences repeated exposure to details of event (not through media)
Core features in dsm v
Need to experi trauma! And 4 of
Four core features (change from DSM-IV)
Symptoms must persist for at least one month
Intrusion (1 required)
Recurrent, involuntary, memories (may see this in children as play episodes); flashbacks, nightmares, intense physical distress to reminders of the events, marked physiological reactivity to stressor
Avoidance (1 required)
Avoiding thoughts or feelings related to the trauma; avoiding stimuli related to the trauma
Extreme arousal (two required)
Difficulty falling or staying asleep, irritable/aggressive behavior, hypervigiliance, easily startled, difficulty concentrating, self-destructive behavior
Negative cognitions and mood (two required)
Inability to recall key features of the event, persistent negative beliefs about self or world; distorted blame of self or others; persistent negative trauma related emotions (e.g., horror, shame); diminished in activities; alienation from others; inability to experience positive emotions
Intrusion and avoidance ?in PTSD
Intrusion (1 required)
Recurrent, involuntary, memories (may see this in children as play episodes); flashbacks, nightmares, intense physical distress to reminders of the events, marked physiological reactivity to stressor
Avoidance (1 required)
Avoiding thoughts or feelings related to the trauma; avoiding stimuli related to the trauma
Negative cognitions and mood (two required)
Inability to recall key features of the event, persistent negative beliefs about self or world; distorted blame of self or others; persistent negative trauma related emotions (e.g., horror, shame); diminished in activities; alienation from others; inability to experience positive emotions
Extreme arousal (two required)
Difficulty falling or staying asleep, irritable/aggressive behavior, hypervigiliance, easily startled, difficulty concentrating, self-destructive behavior
PTSD in Children under 6 years of age, special diagnostic criteria
Complx cognitive things like for adults just not possible.
More behaviorally anchored
Young children may not show distressed affect
Only one symptom required for avoidance and negative cognitions/mood (compared to 3)
Feelings of detachment = social withdrawal
Loss of interest = restricted play
Irritable/aggressive behavior expanded to include temper tantrums
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) involves
Psychoeducation
Prevalence rates of trauma
Typical reactions to stress
Many children have transient symptoms
Cognitive techniques Relaxation skills
Safety skills Graded EXPOSURE
Create a “trauma narrative”
Very detailed and graphic
Gradually read and shared
May also need to do exposure around trauma cues
Video
TF-CBT for Child Sexual Abuse Cohen et al., 2004
Participants
– 2 sites
– 229 youths enrolled
– age 8 to 14
– 79% female
– PTSD symptoms (89% diagnosed)
– 90% experienced many traumas
Design
– Random assignment
Cbt or control
TF-CBT for Child Sexual Abuse Cohen et al., 2004
Treated for 12 weeks
Mean number of sessions completed was same for
each group (approximately 10)
Seven therapists were trained in both treatment modalities and administered both
Kept raters blind
Potential bias of having one particularly effective therapist mnimsized
TF-CBT
Child centered therapy
Focuses on establishing a trusting relationship with the therapist
Encourages parents and children to structure treatment
Both have strong theoretical basis and are widely used cct
Outcomes of TF-CBT
– Less PTSD sx
– Less depression
– Fewer total problems
Parent effects
– Less parent depression
– Less self-blame
– More support of child
– Better parenting in general
