Wednesday, May 14, 2014

Child Abuse and Neglect: Current Concepts

Child Abuse and Neglect: Current Concepts.
American Board Article. Issue 332(21), 1995.
Author: Wissow, LS.
Resident: Margaret Maclin

Purpose: To review diagnostic and therapeutic issues posed by child abuse and neglect.

Definitions and Epidimiolic Features:
- Child maltreatment is intentional harm or a threat of harm to a child by someone acting in the role of caretaker, even if only for a short time.
- Maltreatment is divided into 4 groups: physical, sexual, emotional, and neglect.
- Negrlect is the most common of the 4 types.
- Physical abuse involves inflicting bodily injury through excessive force or forcing a child to engage in physically harmful activity.
- Emotional abuse is coercive, demeaning, or overly distant behavior by a parent or caretaker that interferes with a child's normal social or phycological development.
- Sexual abuse includes inappropriate exposure of a child to sexual acts or materials, the passive use of children as sexual stimuli for adults, and actual sexual contact between children and older people.
- Child maltreatment occurs across all SES groups.
- Incedence of sexual abuse is found in all SES groups evenly, Negrlect and physical abuse are found more often with increased level of poverty.
- Child abuse and neglect normally occur together with other forms of abuse in the home, such as spousal battery and violence between siblings.
- On average about 1.4 million US children under 18 (2.3%) ungero some form of child maltreatment every year.
- Though 80% of the deaths resulting from maltreatment occur in children under the age of 5, the incidence of physical and emotional abuse has been shown to increase with age.
- Social and emotional handicaps are the most serious long-term consequences of maltreatment.
- Physically abused children are generally more aggressive with their peers than those who have not been abused, have more troubled interpersonal relationships, and have more depress and aggressive symptoms and affective disorders.
- Sexuall abused kids also have increased frequency of anxiety disorders and problems with sex roles and sexual functioning.
- As adults, children that have been abused suffer two to three times as much from drug abuse and depression as members of the general population.
- This is reports to be due to changes, mediated by abuse, in the neuroendocrine systems influencing arousal, the pain threshold, learning and growth.

Detecting Abuse and Neglect:
- Child maltreatment is difficult to detect.
- Child care providers can detect maltreatment by creating an atmosphere that encourages disclosure and by learning to ask directly and empathetically whether maltreatment is taking place.
- A good history, psychological and medical from parent and child is key.

- One approach would be to view the presenting form of maltreatment as only a symptom of underlying disorders that must be uncovered before a long-term therapeutic plan can be divided.
- Treatment may involve working with the family as a init and working separately with individual members.
- Formal and informal tx teams usually include social workers, mental health professionals, attorneys and community aides, in addition to medical personnel.
- Tx appears not to work that well with adults who abuse their children. 30% were found to continue abusing their children even during tx.
- Positive results have been shown for some education programs for physically abusive and neglectful parents and preventive home visits to young mothers who otherwise appear to be at risk for abusing their children. (**How is this allowed? Stereotype women who look like child abusers?**)
- Tx results in children also appear to be mixed. Foster care, which would normally guarantee safety from the physical abuse might result in permanent separation of the child from the family, and this to a child may be more traumatic than being left with his abusive family.
- Family-preservation programs have thus become more popular, since they keep the child in the home while changing the home environment for the better.

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