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Descriptors:
Psychopathology; Child Abuse; Cognitive Ability; Risk; Anxiety; Depression (Psychology); Posttraumatic Stress Disorder; Brain Hemisphere Functions; Diagnostic Tests; Mental Disorders; Ethnicity; Physiology; Reinforcement; Decision Making; Health Behavior; Correlation; Children

Abstract:
Background: Childhood maltreatment is strongly associated with increased risk of psychiatric disorder. Previous neuroimaging studies have reported atypical neural structure in the orbitofrontal cortex, temporal lobe, amygdala, hippocampus and cerebellum in maltreated samples. It has been hypothesised that these structural differences may relate to increased psychiatric vulnerability. However, previous studies have typically recruited clinical samples with concurrent psychiatric disorders, or have poorly characterised the range of maltreatment experiences and levels of concurrent anxiety or depression, limiting the interpretation of the observed structural differences. Methods: We used voxel-based morphometry to compare grey matter volume in a group of 18 children (mean age 12.01 years, SD = 1.4), referred to community social services, with documented and well-characterised experiences of maltreatment at home and a group of 20 nonmaltreated children (mean age 12.6 years, SD = 1.3). Both groups were comparable on age, gender, cognitive ability, ethnicity and levels of anxiety, depression and posttraumatic stress symptoms. We examined five a priori regions of interest: the prefrontal cortex, temporal lobes, amygdala, hippocampus and cerebellum. Results: Maltreated children, compared to nonmaltreated peers, presented with reduced grey matter in the medial orbitofrontal cortex and the left middle temporal gyrus. Conclusions: The medial orbitofrontal cortex and the middle temporal gyrus have been implicated in reinforcement-based decision-making, emotion regulation and autobiographical memory, processes that are impaired in a number of psychiatric disorders associated with maltreatment. We speculate that grey matter disturbance in these regions in a community sample of maltreated children may represent a latent neurobiological risk factor for later psychopathology and heightened risk taking. (Contains 1 table and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Child Abuse; Adults; Resilience (Psychology); Risk; Trauma; Child Development; Intervention; Adolescents; Children

Abstract:
Roughly one third of children subjected to abusive environments grow into healthy and capable adults, demonstrating remarkable resiliency, despite risks for developing maladaptive self-structures and destructive behaviors (Werner, "American Journal of Orthopsychiatry" 59:72-81 1989; Kendall-Tackett "et al.", "Psychological Bulletin" 113:164-180 1993). This paper suggests that, for adults with developmental arrests due to childhood traumas, it may be beneficial to approach enhancing resilience through interventions meant to foster resiliency factors in adolescents and children, tailored appropriately for an adult. Connections to current and effective interventions are reviewed as well as an invitation to the international community for additional perspectives. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Child Abuse; Child Care; Medical Services; Mothers; Mental Disorders; Clinical Diagnosis; Chronic Illness; Symptoms (Individual Disorders); At Risk Persons; Fathers; Parent Child Relationship; Health Services

Abstract:
Although child maltreatment due to abuse or neglect is pervasive within our society, less is known about fabricated or induced illness by carers (FII), which is considered to be a rare form of child abuse. FII occurs when a caregiver (in 93% of cases, the mother) misrepresents the child as ill either by fabricating, or much more rarely, producing symptoms and then presenting the child for medical care, disclaiming knowledge of the cause of the problem. The growing body of literature on FII reflects the lack of clarity amongst professionals as to what constitutes FII, the difficulties involved in diagnosis, and the lack of research into psychotherapeutic intervention with perpetrators. This lack of clarity further complicates the identification, management and treatment of children suffering from FII and may result in many cases going undetected, with potentially life-threatening consequences for children. It has been suggested that there is a national under-reporting of fabricated or induced illness. In practice these cases are encountered more frequently due to the chronic nature of the presentations, the large number of professionals who may be involved and the broad spectrum including milder cases that may not all require a formal child protection response. Diagnosis of fabricated disease can be especially difficult, because the reported signs and symptoms cannot be confirmed (when they are being exaggerated or imagined) or may be inconsistent (when they are induced or fabricated). This paper highlights and discusses the controversies and complexities of this condition, the risks to the child and how it affects children; the paucity of systematic research regarding what motivates mothers to harm their children by means of illness falsification; how the condition should be managed and treated for both mother and child; and implications for policy and practice. (Contains 1 table and 1 note.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Behavior Modification; Child Abuse; Mental Disorders; Emotional Disturbances; Child Health; Obesity; Diabetes; Psychological Studies; Outcomes of Treatment; Cost Effectiveness

Abstract:
Multisystemic therapy (MST) is effective for decreasing or preventing delinquency and other externalizing behaviors and increasing prosocial or adaptive behaviors. The purpose of this project was to review the literature examining the efficacy of MST for other child psychological and health problems reflecting non-externalizing behaviors, specifically difficulties related to child maltreatment, serious psychiatric illness [Serious psychiatric illness was defined throughout the current review paper as the "presence of symptoms of suicidal ideation, homicidal ideation, psychosis, or threat of harm to self or others due to mental illness severe enough to warrant psychiatric hospitalization based on the American Academy of Child and Adolescent Psychiatry (Level of care placement criteria for psychiatric illness. American Academy of Child and Adolescent Psychiatry, Washington, DC, 1996) level of care placement criteria for psychiatric illness" (Henggeler et al. in "J Am Acad Child Psy" 38:1331-1345, p. 1332, 1999b). Additionally, youth with "serious emotional disturbance (SED)" defined as internalizing and/or externalizing problems severe enough to qualify for mental health services in public school who were "currently in or at imminent risk of a costly out-of-home placement" (Rowland et al. in "J Emot Behav Disord" 13:13-23, pp. 13-14, 2005) were also included in the serious psychiatric illness category.], and health problems (i.e., obesity and treatment adherence for diabetes). PubMed, Web of Science, MEDLINE, and PsycINFO databases; Clinicaltrials.gov; DARE; Web of Knowledge; and Cochrane Central Register of Controlled Trials were searched; and MST developers were queried to ensure identification of all relevant articles. Of 242 studies identified, 18 met inclusion criteria for review. These were combined in a narrative synthesis and critiqued in the context of review questions. Study quality ratings were all above mean scores reported in prior reviews. Mixed support was found for the efficacy of MST versus other treatments. In many cases, treatment effects for MST or comparison groups were not sustained over time. MST was efficacious for youth with diverse backgrounds. No studies discussed efficacy of MST provided in different treatment settings. Four studies found MST more cost-effective than a comparison treatment, leading to fewer out-of-home placements for youth with serious psychiatric illness or lower treatment costs for youth with poorly controlled diabetes. Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Violence; Females; Race; Racial Relations; Intimacy; Risk; Conflict; National Surveys; Regression (Statistics); Interpersonal Relationship; Child Abuse; Sexual Abuse; Measures (Individuals)

Abstract:
The number of interracial relationships in the United States continues to increase. The fact is, though, that race remains a significant influence in the lives of individuals and in their relationships. Although there is evidence that relationships that cross racial/ethnic boundaries may be at greater risk for conflict and dissolution, there have been few investigations as to whether such relationships are at greater risk for violence. Using data from the National Violence Against Women Survey, I find that there are differences in risk of intimate violence depending on the racial/ethnic dyad of the couple. Ethnic monoracial relationships demonstrate the greatest risk for physical and nonphysical forms of violence, controlling for structural factors, whereas women in interracial relationships report higher rates of nonphysical violence, as compared with women in White monoracial relationships. Implications for theory and practice are discussed. (Contains 7 notes and 3 tables.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Child Abuse; Injuries; Posttraumatic Stress Disorder; Sexual Abuse; Self Destructive Behavior; Psychological Patterns; Neurology; Physiology; Correlation

Abstract:
Nonsuicidal self-injury (NSSI) is a significant problem in both clinical and nonclinical populations. Affect and state dysregulation are frequently observed in survivors of childhood sexual abuse and in those who engage in NSSI. Both have been found to predict NSSI, and affect regulation has also been modeled as a mediator of NSSI. This study extends present research by modeling both affect and state dysregulation as moderators of NSSI. The findings are discussed as an extension of the tension reduction theory and within a conceptualization of posttraumatic stress disorder (PTSD) as an asymmetry of the approach-avoidance neurophysiological system. (Contains 2 tables and 4 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Academic Achievement; Child Abuse; Grade Point Average; Behavior Problems; Crime; Path Analysis; Graduation; Young Adults; Educational Experience; Role; Attendance; Law Enforcement; Multivariate Analysis; Academic Aspiration; Gender Differences; Race; Ethnicity; Poverty; Antisocial Behavior; Urban Youth; Interviews; Resilience (Psychology)

Abstract:
This study investigates whether positive educational experiences in midadolescence mitigate the impact of exposure to substantiated maltreatment and reduces young adult antisocial behavior. While there is theoretical and empirical support for the mediating or moderating role of educational experiences on maltreatment and antisocial outcomes, few prospective studies exist. In this exploratory study, data are from the Rochester Youth Development Study (RYDS), a longitudinal panel study of 1,000 adolescents. The original sample included 73% males, and 85% African American or Hispanic youth of whom about 20% were maltreated. Measures in this study are from a combination of interview data and official records collected through age 23. Outcomes include self-reported crime and violence, arrest, and partner violence perpetration. Educational variables include midadolescent self-report of high school graduation, educational aspiration, college expectation, school commitment, teacher attachment, self-reported grades, school GPA, attendance, and an additive index of all school assets. Multivariate path analysis controlled for gender, race/ethnicity, poverty, and early antisocial behavior. Path analysis examined whether educational experiences mediated the impact of maltreatment on antisocial outcomes. Although maltreatment was significantly predictive of criminal and violent behaviors, it only was weakly associated with educational experiences. The impact of maltreatment on arrest was weakly mediated (reduced) by educational GPA and by high school graduation. The additive index also mediated the impact of maltreatment on crime and violence. Maltreatment's impact on partner violence was also weakly mediated by school GPA. Interaction terms were used to test for moderation: only one significant effect was found: school GPA protects maltreated youth from perpetration of partner violence as young adults. Although there are few significant effects in a number of models, the research is consistent with a focus on promoting school achievement and completion among urban youth in general, in conjunction with addressing earlier antisocial behavior problems. (Contains 2 tables, 4 figures, and 8 notes.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Child Abuse; Smoking; Adolescents; Child Welfare; Drinking; Depression (Psychology); Resilience (Psychology); Early Intervention; Caregivers; Sexual Abuse; Correlation; Symptoms (Individual Disorders); Young Adults; Welfare Services; Religion; Community Involvement; Prevention

Abstract:
Objective: It is well established that child maltreatment reflects a context of risk for multiple negative outcomes. Identifying factors that protect against negative outcomes is important for the development of strengths-based approaches that emphasize resilience, particularly for youth transitioning out of the child welfare system. The current study examined the relationship between an internal resilience measure, the Connor-Davidson Resilience Scale (CD-RISC; Connor & Davidson, 2003), and several external measures of resilience and behavioral outcomes (tobacco use and dependence, alcohol use and problems, and depression symptoms). In addition, two models of resilience were examined in the context of child maltreatment: a compensatory model and a risk-protection model. Methods: Ninety-three emerging adults (ages 18-25) who were making the transition out of child welfare completed self-report measures of child maltreatment, internal resilience (CD-RISC), external resilience (academic achievement, religious and community involvement, monitoring by caregivers, and presence of an adult mentor), alcohol and tobacco use, and depression symptoms. Results: Internal resilience was significantly associated with involvement in religion and community, and monitoring by caregivers. In addition, internal resilience was negatively associated with past year smoking and nicotine dependence, and with symptoms of depression. Hierarchical regression analyses were conducted to examine the direct and interaction effects of resilience on depression symptoms in the context of child maltreatment. When internal resilience was added to the model, it made a significant contribution to depression scores over and above child maltreatment (physical, sexual, and emotional abuse; emotional neglect). In addition, there was a significant Sexual Abuse x Resilience interaction, wherein high resilience was associated with a reduction in depression scores at higher levels of sexual abuse. Conclusions: These findings support internal resilience as both a compensatory and protective factor for depression symptoms in the context of sexual abuse among emerging adults transitioning out of child welfare. Prevention and early intervention within child welfare should include strengthening internal resilience, with continued monitoring of competencies through the transition from adolescence to emerging adulthood. (Contains 3 tables and 1 figure.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Child Abuse; Risk; Foster Care; African American Children; Race; Referral; Racial Differences; Mothers; Ethnicity; Victims; Child Welfare; Law Enforcement; Whites; Socioeconomic Status; Health; Hispanic Americans; Social Influences; Political Influences; Environmental Influences; Family (Sociological Unit)

Abstract:
Objective: Data from the United States indicate pronounced and persistent racial/ethnic differences in the rates at which children are referred and substantiated as victims of child abuse and neglect. In this study, we examined the extent to which aggregate racial differences are attributable to variations in the distribution of individual and family-level risk factors. Methods: This study was based on the full population of children born in California in 2002. Birth records were linked to child protective service (CPS) records to identify all children referred for maltreatment by age 5. Generalized linear models were used to compute crude and adjusted racial/ethnic differences in children's risk of referral, substantiation, and entry to foster care. Results: As expected, stark differences between Black and White children emerged in the rates of contact with CPS. Black children were more than twice as likely as White children to be referred for maltreatment, substantiated as victims, and enter foster care before age 5. Yet, there were also significant differences across racial/ethnic groups in the distribution of socioeconomic and health factors strongly correlated with child maltreatment and CPS involvement. After adjusting for these differences, low socioeconomic Black children had a lower risk of referral, substantiation, and entry to foster care than their socioeconomically similar White counterparts. Among Latinos, before adjusting for other factors, children of U.S.-born mothers were significantly more likely than White children to experience system contact, while children of foreign-born mothers were less likely to be involved with CPS. After adjusting for socioeconomic and health indicators, the relative risk of referral, substantiation, and foster care entry was significantly lower for Latino children (regardless of maternal nativity) compared to White children. Conclusions: Race and ethnicity is a marker for a complex interaction of economic, social, political, and environmental factors that influence the health of individuals and communities. This analysis indicates that adjusting for child and family-level risk factors is necessary to distinguish race-specific effects (which may reflect system, worker, or resource biases) from socioeconomic and health indicators associated with maltreatment risk. Identifying the independent effects of these factors is critical to developing effective strategies for reducing racial disparities. (Contains 4 tables and 3 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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Descriptors:
Child Abuse; Child Welfare; Foreign Countries; Incidence; Child Neglect; Placement; American Indians; Caseworkers; Public Agencies; Statistical Analysis; Computer Software; Decision Making; Eskimos; Surveys; Comparative Analysis

Abstract:
Objective: Fluke et al. (2010) analyzed Canadian Incidence Study on Reported Child Abuse and Neglect (CIS) data collected in 1998 to explore the influence of clinical and organizational characteristics on the decision to place Aboriginal children in an out-of-home placement at the conclusion of a child maltreatment investigation. This study explores this same question using CIS data collected in 2003 which included a larger sample of Aboriginal children and First Nations child and family service agencies. Methods: The decision to place a child in an out-of-home placement was examined using data from the "Canadian Incidence Study of Reported Child Abuse and Neglect-2003" and a reanalysis of CIS-1998 data (Fluke et al., 2010). The CIS-2003 dataset includes information on nearly 12,000 child maltreatment investigations from the time of report to case disposition. The CIS-2003 also captures information on the characteristics of investigating workers and the child welfare organizations for which they work. Multi-level statistical models were developed to analyze the influence of clinical and organizational variables using MPlus software. MPlus allows the use of dichotomous outcome variables, which are more reflective of decision-making in child welfare and facilitates the specific case of the logistic link function for binary outcome variables under maximum likelihood estimation. Results: Final models revealed the proportion of investigations conducted by the child welfare agency involving Aboriginal children was a key single agency level predictor of the placement decision. Specifically, the higher the proportion of investigations of Aboriginal children, the more likely placement was to occur. Contrary to the findings in the first paper (Fluke et al., 2010), individual Aboriginal status also remained significant in the final model at the first level. Conclusions: Further analysis needs to be conducted to further understand individual and organizational level variables that may influence decisions regarding placement of Aboriginal children. There is also a need for research that is sensitive to differences among, and between, Metis, First Nations and Inuit communities. Results are not generalizable to Quebec because data from this province were excluded. (Contains 7 tables and 3 figures.) Note:The following two links are not-applicable for text-based browsers or screen-reading software. Show Hide Full Abstract

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