Treatment of co-occurring child maltreatment and substance abuse

Despite high prevalence and severe negative consequences of child maltreatment (e.g., Brown, G. R., & Anderson, B., (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55–61; Jaudes, P. K., Ekwo, E., & Van Voorhis, J.V., (1995). Association of drug abuse and child abuse. Child Abuse and Neglect, 19, 1065–1075; Murphy, J. M., Jellinek, M., Quinn, D., Smith, G., & Goshkom, M., (1991). Substance abuse and serious child mistreatment: Prevalence, risk, and outcome in a court sample. Child Abuse and Neglect, 15, 197—211), the treatment of perpetrators and victims of child abuse and neglect remains grossly understudied (Behl, L. E., Conyngham, H. A., & May, P. F., (2003). Trends in child maltreatment literature. Child Abuse and Neglect, 27, 215–229). More than half of parentes founded for the abuse and neglect of their children have evidenced drug abuse, yet no treatments have been validated that concurrently address these problems. The reciprocal interaction between substance abuse and child maltreatment supports the need to concurrently treat these problems. This article illustrates the relationship between child maltreatment and parental substance abuse and proposes a behavioral model to explain the reciprocal influence of drug abuse and child maltreatment. A behavioral treatment plan that is designed to concurrently address drug abuse and child abuse is proposed and suggestions are made for future directions in this area.     

Correlates of child abuse potential

Coercion theory provided the theoretical rationale for the present study. The hypothesis was that mothers' reports of child behavior problems and mothers' reports of external locus of control would be related to abuse potential. A total of 95 mother-child pairs were screened for child abuse potential during visits to a hospital-based pediatrie clinic. Following brief interviews, mothers completed three measures: Milner's Child Abuse Potential Inventory, Levenson's Locus of Control Scales, and the Revised Behavior Problem Checklist. Perceptions of control by powerful others and by chance were related to abuse potential for mothers of both sexes. Mothers' reports of their sons' anxiety-withdrawal and conduct-disorder behavior problems were related to abuse potential. There was a significant association among lie scores, internality, and abuse potential for mothers of female children. Mothers with high abuse potential reported significantly more behavior problems in their children. The findings were discussed in relation to coercion theory.Portions of this paper were presented at the biennial meeting of the Society for Research in Child Development, Detroit, April 1983. This research was conducted by the first author in partial fulfillment of the requirements for the Ph.D. at the University of Miami under the direction of Drs. Keith G. Scott and Annette M. La Greca. The first author wishes to thank the members of the committee, Drs. Herbert C. Quay, Simon B. Miranda, Daryl Greenfield, and Julia Rosenkrans, for their many contributions. Also, special thanks to the University of Miami Child Protection Team for their continuous support and guidance, and special appreciation to the mothers and children who participated in the study.     

Every Child Still Matters: interdisciplinary approaches to the spirituality of the child

Abstract

Ten years ago, I was a researcher with the Evaluation of Children’s Trusts which examined a key aspect of U.K. government policy, Every Child Matters. Every Child Matters was partly a response to Lord Laming’s 2003 report into the murder of 8-year old Victoria Climbié, which concluded that children’s services needed to be better integrated to avoid such tragedies in the future. Children’s Trusts were regional hubs, set-up across England to facilitate integrated professional practice; but Every Child Matters was bigger than this because it set out a policy vision for rethinking the child as a whole person. At the time, I was struck by the absence of any reference to spirituality in this new holistic view of the child, and this led me to write an article which was published in 2006 entitled, ‘Every Child Matters and children’s spiritual rights: does the new holistic approach to children’s care address children’s spiritual well-being?’.

This article was originally a keynote talk at the 2016 International Conference on Children’s Spirituality with the theme Spirituality and the whole child: interdisciplinary approaches, and this provided the opportunity both to see where we are now with integrated working for children and young people more generally, and to focus our attention on interdisciplinary approaches to children’s spirituality and the whole child in particular. The article begins by summarising some of the current thinking spirituality, the whole child and interdisciplinary working. The article then goes on to consider a long-standing concern of mine, and one which was highlighted in my 2006 article, which is what we intend to mean – collectively, as academics and professional practitioners concerned with children’s (and adults’) spirituality – when we use the term ‘spirituality’ in the professional context. In my view, it is time to stop stating that spirituality is hard to define, and come to an agreement about what we mean when we use it. Interdisciplinary approaches to children’s (and adults’) spirituality, and holistic approaches to the child (and adult), will not be successful unless there is a clear, shared agreement about what we mean, and the article ends with suggestions for ways forward.     

Evaluation of the London (Ontario) Community Group Treatment Programme for Children Who Have Witnessed Woman Abuse

Summary

Group intervention for children exposed to woman abuse is increasingly used to respond to the psychological needs of children exposed to woman abuse. This article describes a community group model of intervention for children exposed to woman abuse, and an evaluation approach used to assess the impact of such groups. The collaborative development of questionnaire/interview evaluation instruments for this purpose is described, and the set of instruments is presented in its entirety. The main instrument, entitled Child/Teen Witness to Woman Abuse Questionnaire, was tailored to the content of the groups and covers topics such as definitions and understanding of abuse, safety skills, beliefs and attitudes about abuse, perceived responsibility for abuse, alternatives to violence, non-violent conflict resolution strategies, and help seeking skills. Both closed-ended and open-ended questions are employed. Separate questionnaires assess consumer (mother/caregiver and child) satisfaction and feedback. The results of a study evaluating the groups are described, which showed good changes from pre to post intervention, as well as a high degree of satisfaction among children and mothers with regard to the groups. Feedback from children and mothers as to suggested improvements in the group is also described.     

The influence of social instructions on the effectiveness of a cognitive interview used with very young child witnesses

IntroductionThe modified cognitive interview (MCI) is an investigative interview method used to help child eyewitnesses to enhance the quality of their testimonies (Memon et al., 2010). Composed of cognitive (mnemonics) and social instructions, it indeed supports young witnesses to retrieve and to accurately report all their memories. If the benefits of the mnemonics on the MCI efficiency have been now established (e.g., Holliday & Albon, 2004; Verkampt & Ginet, 2010), the contribution of its social components has however not been deeply explored to date. This is notably the case of two main social instructions presented at the right beginning of an interview: the “Child can say ‘I don’t know”’ and the “Interviewer knows nothing about the facts” instructions.ObjectiveThis study aimed at evaluating the influence of these two social instructions on the effectiveness of MCI mnemonics, designed to be used by police officers to gather very young children's testimonies.MethodTo this end, 59 children aged 4 to 5.9 participated in a painting session and were interviewed two days later with a full modified cognitive interview (MCI), a MCI minus the “Child can say I don’t know” instruction, a MCI minus the “Interviewer knows nothing about the event” instruction, or a structured (control) interview that was solely composed of social instructions.ResultsThe results indicated an increase of 42% more correct information recollected with a full MCI relative to a structured interview during the free recall phase. However, the withdrawal of the “Interviewer knows nothing about the event” instruction from the MCI led the children to report 21% less information. This drop reached 3% with the MCI minus the “Child can say I don’t know” instruction.ConclusionChildren testimonies are therefore more informative when the mnemonics of the MCI are presented to the children along with social instructions.     

Intervention in child neglect: an applied behavioral perspective

Child maltreatment in the forms of abuse and neglect is a serious social problem, affecting over 1.5 million children in the US annually. Abuse has generally received more public and professional attention than other forms of child maltreatment. Given that more than one type of child maltreatment frequently occurs in families, there are few behavioral studies that have specifically addressed techniques for the reduction of child neglect. Only recently have researchers begun to regard child neglect as a phenomenon that may be conceptually different from other forms of child maltreatment, thereby warranting specific attention. Described here are intervention strategies for parents at-risk for or referred for child neglect. We review these strategies, along with commentary on the difficulties of conducting applied research in this field. Suggestions are offered for improved intervention research in child neglect.     

The effect of time-out release contingencies on changes in child noncompliance

This project evaluated the effect of time-out release contingencies on changes in child noncompliance to maternal instructions. Twenty-four clinic-referred, noncompliant, preschool children served as subjects. Each child was assessed under baseline conditions and then under one of three experimental conditions: Parent Release, Child Release, or Control. Children in the Parent Release and Child Release conditions experienced time-out contingent upon noncompliance. Temporal and behavioral time-out release contingencies were present in the Parent Release condition but not in the Child Release condition. A spanking procedure was used to inhibit premature escape from time-out for children in the Parent Release group. The results indicated that both time-out groups demonstrated increased compliance ratios. However, improvement associated with the Child Release condition was considered to be clinically insignificant.The authors wish to express their appreciation to Dave DeLawyer, Larry Snapp, and Mike Samac for their assistance in conducting the study.     

Gender/ed identities: an overview of our current work as child psychotherapists in the Gender Identity Development Service

Abstract

This paper is adapted from a presentation first given at the 2017 Association of Child Psychotherapists (ACP) Conference. We hope to give a feel of our work as psychoanalytic child psychotherapists working in a Tier 4 national assessment service for gender variant children and connect with our colleagues working therapeutically with these families in Child and Adolescent Mental Health Services (CAMHS) and other settings. Gender variance does not have a single cause, or straightforward developmental pathway; rather it is a complex interplay of multiple factors, akin to sexuality in the diverse manifestations and ‘tributaries’ taken. This paper is given as a plea for complexity, to counter the current intense focus on gender identity and the consequent reductionism this can lead to. To this end, three case studies from the clinic, taken from Under Five, Latency and Adolescent phases of development, are explored. The complexity of the cases is then discussed, followed by parallel issues of development, divergence and difference. These three ‘average’ cases from the Gender Identity Development Services (GIDS) serve to demonstrate the need for child psychotherapy as part of multi-disciplinary thinking about gender variance and how attention must be maintained to each unique story and process of identity development; as well as our clinical task to establish and encourage depressive functioning and secondary processes where possible.     

A Model Psychosocial Support Training and Workshop during a Medical Mission for Syrian Refugee Children in Jordan: Techniques,Lessons Learned and Recommendations

ABSTRACT

This article describes a model training and workshop for volunteers that was implemented with child refugees in Jordan, to build empowerment, resilience, and connection with others. The importance of such services for this population is emphasized. The present model, with elements of arts activities and play similar to those used in the Child Friendly Spaces, is based on my extensive experience working with diverse populations under various conditions of crisis, natural disaster, and infectious diseases, mainly in low resource settings. I review activities from my toolbox, their purpose, methods, and processing. The clinical value of such psychosocial support is presented, as has been shown by pilot research in several settings, despite limitations of conducting empirical assessments, which are discussed. Lessons learned and recommended are given. The intervention for refugee children is presented in the context of international policy agreements that provide an important foundation for such projects that clinicians and researchers can use to support their work for this population and others, in efforts to heal children from the traumas of refugeeism and other similar extreme stresses.     

Taking parent personality and child temperament into account in child language development

Individual differences have become increasingly important in the study of child development and language. However, despite the important role parents play in children’s language, no work has examined how parent personality impacts language development. The current study examines the impact of parent personality as well as child temperament on language development in 460 16- to 30-month-old children and 328 31- to 42-month-old children. Findings from both groups suggest multiple aspects of children’s language abilities are correlated with their parent’s personality. Specifically, parent consciousness, openness, and agreeableness positively correlate with child vocabulary size and other language abilities. Results also replicate and expand research on child temperament and language – child effortful control and surgency were positively correlated, and negative affect negatively correlated with most language abilities even after controlling for parent personality. Critically, parent and child traits appear to impact a child’s language abilities above and beyond well-known predictors of language, such as age.     

Fighting for children

Child abuse is a problem of national importance. Nationwide, billions of dollars are spent on the child welfare system, but child abuse rates remain high. At the federal level, new laws, such as the Child Abuse Prevention and Enforcement Act, the Foster Care Independence Act, and the Adoption and Safe Families Act, represent steps toward addressing the problem. However, increased efforts are needed to raise awareness of the problem of child abuse and to prevent it. Furthermore, more attention is needed to address the need for reform of the child welfare system and to involve the private sector in helping abused children.     

The relations of child adiposity with parent-to-child and parent-to-parent hostility

Objective: Investigate (1) the association of child adiposity with parent-to-child and parent-to-parent hostility, (2) the mediation of these associations by dietary behaviours and (3) moderation by gender.

Design: One hundred thirty-five couples with 6- to 14-year-old children completed measures of emotional and physical aggression, overreactive discipline and child diet. Parent-to-parent hostility was also coded from laboratory observations.

Main Outcome Measure: Child adiposity was a combination of body mass index and waist-to-hip ratio.

Results: Mother-to-child hostility was associated with child adiposity. This association was concentrated in boys and was not significantly explained by child dietary factors. Mother-to-father hostility was not significantly associated with boys’ or girls’ adiposity. Girls’ adiposity was not significantly associated with family hostility. Fathers’ hostility was not linked to child adiposity.

Conclusion: This is the first study to take a family-level approach to understanding the relation of hostility to child adiposity by examining relations among adiposity and both mothers’ and fathers’ hostility directed toward one another and toward their children. Our findings highlight the potential role played by mothers’ emotional hostility in boys’ adiposity and suggest that, if this role is further substantiated, mother-son emotional hostility may be a promising target for the prevention of child obesity.     

Developmental and mental health characteristics of children exposed to psychosocial adversity and stressors at the age of 18-months: Findings from a population-based cohort study

BackgroundPrior research on adverse experiences in early childhood has mainly focused on at-risk populations while studies of unselected populations are scarce. This topic therefore remains to be elucidated in broader child populations. Accordingly, the aim of this study was to examine if and to what extent children from a general population sample are exposed to psychosocial adversity and stressors in early childhood and whether the development and mental health of children with and without such exposure differ at the age of 18-months.MethodsA random sample of the Copenhagen Child Cohort (CCC2000) comprising 210 children and their parents participated in the study when the children were approximately 18-months. Information on exposures was obtained from a semi-structured interview including the Mannheim Parent Interview (MPI) and classified in agreement with the Multiaxial Classification of Child and Adolescent Psychiatric Disorders (ICD-10), and the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-3). Child development was assessed with the Bayley Scales of Infant and Toddler Development – Second Edition (BSID-II), while mental health was measured using the Child Behavior Check List (CBCL 1½-5).ResultsAmong the 210 children, 91 (43%) had been exposed to psychosocial adversity and persistent stressors. The exposed children differed from the non-exposed children by poorer cognitive development and behavioral regulation, as well as more attention problems and anxious/depressed symptoms. The children exposed to adverse caregiving environments were specifically more likely to have delayed cognitive development than the rest of the sample.ConclusionsIn a general population sample of children aged 18-months, exposure to psychosocial adversity and stressors was associated with poorer development and mental health in cognitive and affective domains. These findings highlight an avenue for further research with potential implications for early preventative practices.     

From enjoyment to physical activity or from physical activity to enjoyment? Longitudinal associations in parent–child dyads

Abstract

Background: This longitudinal dyadic study used cross-lagged analyses to examine reciprocal patterns of associations between physical activity (PA) enjoyment and moderate-to-vigorous PA (MVPA) among children and their parents.

Methods: At Time 1 (T1) 879 parent–child dyads provided their data. The follow-up (Time 2, T2) took place 7–8-months later. MVPA and PA enjoyment scales were filled out separately by parents and children at T1 and T2.

Findings: Child PA enjoyment (T1) predicted a higher level of child MVPA (T2), parental PA enjoyment (T1) explained a higher level of parental MVPA (T2), and parental MVPA (T1) predicted a higher level of parental PA enjoyment (T2). Furthermore, child PA enjoyment (T1) predicted a higher level of parental PA enjoyment (T2).

Conclusions: Child PA enjoyment was the key variable predicting child and parental outcomes. In particular, it explained child MVPA, but also PA enjoyment among parents.     

Regulatory disorders in early childhood: Correlates in child behavior,parent–child relationship,and parental mental health

According to the guidelines published by the German Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (2007), regulatory disorders of early childhood are characterized by a symptom triad, including (a) behavioral symptoms such as excessive crying, sleeping, or feeding problems; (b) a disturbed parent–child relationship; and (c) parental psychopathology. On the basis of a clinic–referred sample of 162 children, we examined whether children with and without regulatory symptoms differed in the quality of parent–child relationship and parental mental health, and how often the criteria of the symptom triad were fulfilled in the group of children with regulatory symptoms. In addition, emotional and behavior problems were compared in children with and without regulatory symptoms. Children with regulatory symptoms and children with other psychiatric symptoms did not differ with respect to child–parent relationship quality. However, parents of children with regulatory symptoms scored higher on the Symptom Checklist 90 Items‐Revised (G.H. Franke, 2002 ) than did the other parents. On the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, 2000), children with regulatory symptoms tended to show more somatic problems, but they showed significantly less withdrawn behavior than did the other children. Of the 67 children with regulatory symptoms, only 11 (16.4%) fulfilled all three criteria of a regulatory disorder.     

The federal response to child abuse and neglect

Addressing the problem of child maltreatment is a high priority for the Clinton administration. Guided by the principles of safety, permanency, and the child's well-being, the Administration on Children and Families (ACF) has made great strides in improving the lives of maltreated children. Critical programs administered by ACF include the Adoption and Safe Families Act, Community-Based Family Resource and Support Program grants, Children's Justice Act programs, and Child Abuse Prevention and Treatment Act research and demonstration projects. Projects serve both to expand existing programs and to develop innovative approaches. ACF has also sponsored several multidisciplinary national conferences designed to generate a sense of shared responsibility and a renewed commitment to solving problems of child abuse and neglect.     

Cognitive development in children of adolescent mothers: The impact of socioeconomic risk and maternal sensitivity

BackgroundAdolescent motherhood is accompanied by a constellation of risk factors that translate into developmental risk for the off-spring. Socioeconomic risk that is associated with adolescent motherhood as well as maternal interactive behaviors may contribute to the impact of adolescent motherhood on children’s developmental outcome.ObjectiveTherefore, the aim of the current study was to investigate differences in children’s cognitive development between children of adolescent and adult mothers in their first two years of life and to examine whether socioeconomic risk (e.g. such as educational and financial problems) and/or maternal sensitivity mediate developmental differences between children of adolescent and adult mothers.MethodsAdolescent mothers (<21 years; N = 64) and adult mothers (>25 years; N = 34) and their infants were included in the current study. Child cognitive development and maternal sensitivity were assessed at three different time points (T1: mean child age 5.26 months; T2: mean child age 14.69 months; T3: mean child age 21.16 months).ResultsChildren of adult mothers showed better cognitive performance at T3 compared to children of adolescent mothers but not at T1 and T2. A multiple mediation model including socioeconomic risk and maternal sensitivity as serial mediators demonstrated that the effect of adolescent motherhood on cognitive development was mediated in a causal effect chain with socioeconomic risk negatively affecting maternal sensitivity and maternal sensitivity affecting children’s cognitive development.DiscussionThe present findings demonstrate that maternal interactive behaviors are not only a simple predictor of cognitive development but may also act as a mediator of the association between more distal variables such as socioeconomic risk and cognitive development in adolescent mothers. This supports the need to promote prevention and intervention programs for adolescent mothers during the early postpartum period to reduce socioeconomic problems and enhance maternal interactive behaviors.     

Self-control,parenting, and problem behavior in early childhood: A multi-method,multi-informant study

BackgroundEarly childhood self-control and parenting are suggested to play key roles in the development of child problem behavior. The current study aims to 1) replicate earlier work by examining the unique and combined effects of child self-control and parenting on child problem behavior and 2) extend earlier work by including both mother and father reports.MethodsData were used from 107 Dutch families: mothers, fathers, and their two-year old child. Child self-control was measured using both father’s and mother’s reports of effortful control and with an observed behavioral task (i.e., gift-in-bag task). Similarly, parenting (i.e., emotional availability and discipline) and child problem behavior (i.e., externalizing and internalizing problems) were measured by using both father’s and mother’s reports.ResultsChild self-control reported by fathers and mothers, but not observed self-control, was related to fewer externalizing and (mother-reported) internalizing problems. Paternal emotional availability showed a modest association with fewer child externalizing problems, maternal emotional availability was related to fewer internalizing problems. Finally, there was an interaction between father- (but not mother) reported self-control and paternal emotional availability in the prediction of child internalizing problems. No main or interaction effect was revealed for discipline.ConclusionFindings confirm prior work on self-control, parenting, and child problem behavior. Most importantly however, the current study adds to the literature by highlighting the need for additional research including maternal as well as paternal data. Specifically, insight in the unique role of fathers may shed light on aspects of child adjustment not covered by mother reports alone.     

Exploring predictors of change in behavioral problems over a 1-year period in preterm born preschoolers

ObjectiveAlthough predictors of the prevalence of behavioral problems in preterm-born children have been frequently studied, predictors of behavioral change in these children remain unknown. Therefore, in this study we explore predictors of short-term changes in problem behavior in preterm-born preschoolers, an age period characterized by rapid behavioral change.MethodTwo- to 5-year-old children born with a gestational age <32 weeks and/or birth weight <1500 g were eligible, because of their high risk for behavioral problems. Following screening, 59 children with a t-score ≥60 on either the internal, external or total problem scale of the Child Behavior Checklist were included in the study. Linear mixed modeling was used to investigate predictors of change in behavior over a 1-year period.ResultsHigher levels of parenting stress, parent perceived child vulnerability, and parental hostility towards the child and lower educational levels of the mother significantly predicted increases in externalizing behavior. The higher the age of the child, the more internalizing problems decreased.ConclusionsParenting stress, parent perceived child vulnerability and parental hostility towards the child were the only modifiable predictors of increases in externalizing behavior, whilst no modifiable predictors of internalizing behavior were found. There may be a reciprocal interaction between stress in parents and child externalizing problems. Furthermore, stress and worries may directly influence parents’ reports on behavioral measures, because it could cause them to be concerned by behavior otherwise perceived as normal. Therefore, future interventions for parents of preterm-born children should primarily address parental stress and concerns regarding their child.