Showing papers on "Neglect published in 1996"

Third National Incidence Study of Child abuse and Neglect

Abstract: This document reports the findings from the Third National Incidence Study of Child Abuse and Neglect (NIS-3), which was conducted by Westat, Inc., and its subcontractor James Bell Associates, under contract number 105-91-1800 from the Department of Health and Human Services.

The Cycle of Violence: Revisited 6 Years Later

Abstract: Objective: To assess the long-term effects of child abuse and neglect on delinquency, adult criminality, and violent criminal behavior Design: Prospective cohorts design that matched cases of abuse and neglect with those of controls Follow-up data collection at 22 to 26 years following abuse or neglect Setting: A metropolitan area in the Midwest Participants: Substantiated cases of child abuse or neglect identified from court records that were obtained from 1967 through 1971 (n=908) Comparison group matched on the date of birth, race, sex, and approximate social class (n=667) The current mean age was 325 years Main Outcome Measures: Official arrest records for nontraffic and violent crimes collected from local, state, and federal law enforcement agencies through mid-1994 Results: Childhood victims of abuse or neglect were more likely than controls to have a juvenile or adult arrest for any nontraffic offense (49% vs 38%) and for a violent crime (18% vs 14%) Victims of physical abuse and neglected children were more likely to be arrested for violence (odds ratios: 19 and 16, respectively), after controlling for age, race, and sex Conclusions: Childhood abuse and neglect have a significant impact on the likelihood of arrest for delinquency, adult criminality, and violence By the age of 32 years, almost half of the victims of abuse and neglect were arrested for a nontraffic offense By responding to incidents of child abuse and neglect, health care professionals can play an important role in preventing future violence More attention must be paid to childhood victims of neglect and to differences in the consequences of abuse and neglect by gender and race or ethnicity (Arch Pediatr Adolesc Med 1996;150:390-395)

The disturbed caregiving system: Relations among childhood trauma, maternal caregiving, and infant affect and attachment

Abstract: The interrelations among maternal childhood experiences of physical or sexual abuse, adult trauma-related symptoms, adult caregiving behavior, and infant affect and attachment were investigated among 45 low-income mothers and their 18-month-old infants. A history of physical abuse was associated with increased hostile-intrusive behavior toward the infant, increased infant negative affect, and a decreased tendency to report trauma-related symptoms. A history of sexual abuse was associated with decreased involvement with the infant, more restricted maternal affect, and more active reporting of trauma-related symptoms. Infants of mothers who had experienced childhood violence or abuse were not more likely to display insecure attachment strategies than infants of mothers who had not experienced trauma. However, the form of insecure behavior was significantly different. Insecure infants of violence-exposed mothers displayed predominantly disorganized strategies, whereas insecure infants of mothers with benign childhoods or neglect only displayed predominantly avoidant strategies. Results are discussed in relation to Main and Hesse's (1990) concept of frightened or frightening behavior and to current literature on psychological sequelae of trauma.

Childhood victimization and subsequent risk for promiscuity, prostitution, and teenage pregnancy: a prospective study.

Abstract: OBJECTIVES: This study examined the extent to which being abused and/or neglected in childhood increases a person's risk for promiscuity, prostitution, and teenage pregnancy. METHODS: A prospective cohorts design was used to match, on the basis of age, race, sex, and social class, cases of abused and/or neglected children from 1967 to 1971 with nonabused and nonneglected children; subjects were followed into young adulthood. From 1989 to 1995 1196 subjects (676 abused and/or neglected and 520 control subjects were located and interviewed. RESULTS: Early childhood abuse and/or neglect was a significant predictor of prostitution for females (odds ratio [OR] = 2.96). For females, sexual abuse (OR = 2.54) and neglect (OR = 2.58) were associated with prostitution, whereas physical abuse was only marginally associated. Childhood abuse and neglect were not associated with increased risk for promiscuity or teenage pregnancy. CONCLUSIONS: These findings strongly support a relationship between childhood victimizati...

Motherhood and mental health

Abstract: 1. The desire for children 2. Pregnancy and mental health 3. A portfolio of postpartum disorders 4. Puerperal psychosis 5. Infant loss 6. The mother-infant relationship 7. Child abuse and neglect 8. Infanticide 9. Drugs, prescribed and abused 10. Postpartum mental illness and the family 11. Services

Race and Child Welfare Services: Past Research and Future Directions.

Abstract: As in social discourse regarding virtually every other facet of American life, the subject of race* looms large in discussions of child welfare services. Any thorough assessment of recent trends in child welfare populations (e.g., abused and neglected children, children in family foster care, children awaiting adoption) must take note of the disproportionately large number of children of color. For example, a recent analysis of prevalence rates in five states with large out-of-home care populations (California, Illinois, Michigan, New York, and Texas) found that the proportion of African American children ranged from three times as high to over ten times as high as the proportion of Caucasian children in care Goerge et al. 1994 . Similarly, in California and New York, the point-in-time estimate of African American children in out-of-home care in 1990 exceeded 4% of all African American children Goerge et al. 1994 . Government policy, such as the Indian Child Welfare Act of 1978 (P.L. 95-608), reflects the struggle over how best to provide culturally sensitive protective services to families and children. The variety of state and local policies concerning transracial family foster care placement and adoption and the ongoing debate over these policies are further evidence of deep conflict over how much, and in what ways, race should be allowed to influence the functioning of the child welfare system. In the interest of providing guidance for research and program development, the authors reviewed child welfare outcome research studies to gain a better understanding of the role that race plays in the provision of child welfare services and in outcomes. Most assessments of the relative "fairness" of the child welfare services system are ultimately based on the end result of the system for clients. Although even a cursory review of the child welfare literature leads to the conclusion that there is much more knowledge of outcomes than of the processes that lead to the outcomes, differences in service provision associated with race bear consideration. This review does not include all child welfare research in which race was included as a variable. Large, rigorous studies are emphasized, with occasional attention to smaller studies that offer unique findings or hold out particular promise for future research. In some areas, only a handful of studies have the requisite sample size to make comparisons by race with acceptable statistical power. Several large and influential studies have been omitted because of methodological limitations that rendered their findings regarding race and outcome inapplicable for use here. Research studies were identified through searches of relevant electronic databases, review of salient academic journals, and reference to final reports of well-known studies. In this article, the empirical literature on the relationships among race, services, and outcomes in selected domains of child welfare is first discussed, followed by a summary of what previous research suggests about the role of race in child welfare. Finally, conceptual and methodological considerations for future research on this subject, and on the development of culturally competent child welfare services, are presented. Child Maltreatment and Race For many children, a report of child abuse is their entry point into the child welfare services system. Many studies have noted a relationship between demographic and socioeconomic factors and child maltreatment reporting. The data from various studies indicate that children of color are more likely than Caucasians to be overrepresented in child maltreatment reports, based on the proportion of children of color in the child population. The correlation between race and income, however, often clouds interpretation of most studies. Indeed, the second National Study of Incidence and Severity of Child Abuse and Neglect (NIS-2) National Center on Child Abuse and Neglect 1988 found that families whose incomes fell below $15,000 annually were four and one-half times more likely to be reported for all forms of maltreatment than those with incomes above that level. …

Functional consequences and awareness of unilateral neglect : study of an evaluation scale

Abstract: Unilateral neglect is a major predictor of poor outcome after right hemisphere stroke. However, conventional tests of neglect do not predict precisely everyday difficulties. We propose a functional scale consisting of 10 items related to neglect in everyday life (such as dressing, washing, eating, communicating, exploratory activities, and moving around): the Catherine Bergego scale (CBS). Inter-rater reliability has previously been found acceptable. The severity of neglect was assessed in 50 patients by an experienced therapist in real-life situations and scored for each item on a four-point scale. The CBS score correlated well with clinical tests of neglect, and with the Barthel index. Awareness of deficits was evaluated by questioning the patient about his difficulties on the 10 items of the CBS. A score of anosognosia can be calculated (difference betw een the score on the scale and the patient's self-evaluation). This anosognosia score was well correlated with the severity of neglect. We conclude tha...

Maladaptive coping and affective disorders among cancer patients.

Abstract: Coping has attracted much attention in research as a possible mediator of the psychological impact of cancer. Yet, conceptual ambiguity and methodological limitations have resulted in weak and contradictory findings. A major shortcoming has been the use of designs which do not represent adequately the complexity or the diversity of demands which arise from the diagnosis and treatment of cancer. The neglect of appraisal in the assessment of the relationship between coping and mental health is of particular concern, given the role it has been found to play in the onset and maintenance of affective disorders. In a prospective study 673 newly diagnosed cancer patients were interviewed 4 to 8 weeks and 1 year later to assess the effects of their appraisals, coping responses and resolution of any concerns on subsequent mental health. Logistic regression analyses, adjusted for possible confounding variables, were used to investigate the relationships between coping variables and affective disorders. When examined separately the degree of threat appraised, the reporting of a helpless response and perceived success of primary responses in resolving concerns all predicted subsequent effective disorder. However, in a multivariate model only appraisal and success of the response in resolving the concern were significant. No response was found to prevent affective disorders, however certain types of responses were associated with the resolution of specific concerns. The results highlight the importance of assessing the whole coping process and the need to address the complex and multifaceted characteristics of cancer demands. On the basis of our findings we describe a maladaptive cycle of coping, which we believe contributes to the later onset of affective disorders in cancer patients.

Trends in a National Sample of Sexually Abusive Youths

Abstract: Objective To describe sociodemographic factors pertinent to sexually abusive youths, to define common characteristics of the offending behaviors and victims, and to identify issues relevant to treatment recommendations. Method The Uniform Data Collection system (UDCS), developed by the National Adolescent Perpetrator Network, provided data from 90 contributors in 30 states on more than 1,600 juveniles referred to them for specialized evaluation and/or treatment following a sexual offense. The UDCS comprises four separate structured questionnaires that collect both factual information and clinical impressions. Results Physical and sexual abuse, neglect, and loss of a parental figure were common in these youths' histories. Twenty-two percent of the youths, who had been victims of sexual abuse, reported that the perpetrator of their own sexual abuse was female. The youths committed a wide range of sexual offenses, with twice as many of the referring offenses involving female victims than male victims. Conclusion The discovery of sexually abusive youths across both urban and rural areas supports the need for comprehensive service delivery and a continuum of treatment services to be available in all communities.

Beyond unilateral neglect

Abstract: Summary When required to set the endpoints of an imaginary horizontal line of a given length on the basis of its midpoint printed on a sheet of paper, left neglect patients most frequently misplaced endpoints leftwards. Though giving rise to the very same disproportion usually found with these patients on canonical line bisection tasks, this behaviour cannot be accommodated by current explanations of unilateral neglect. When the task was executed during leftward optokinetic stimulation (OKS), a manoeuvre known temporarily to improve neglect symptoms, the disproportion increased instead of vanishing. We therefore suggest that unilateral neglect is a manifestation of a disorder primarily implying a horizontal anisometry of space representation and that manipulations such as OKS may remove neglect without normalizing the representational medium itself.

The baking tray task: a test of spatial neglect

Abstract: This paper describes a new neglect test, where patients are asked to spread out 16 cubes as evenly as possible over a 75 × 100 cm board "as if they were buns on a baking tray". A consecutive series of 52 brain-damaged patients and 30 control subjects were examined with the new test as well as with several commonly used neglect tests. The baking tray task proved to be a quick and yet sensitive test, suitable for screening purposes and longitudinal studies.

Anosognosia for hemiplegia, neglect dyslexia, and drawing neglect: clinical findings and theoretical considerations.

Abstract: In this paper different models of anosognosia are confronted and data concerning denial behaviors are presented that were collected on a selected population of right brain-damaged patients affected by motor and neglect disorders. Anosognosia for motor impairment and anosognosia for cognitive impairments were found to be dissociated, as well as anosognosia for the upper and lower limb motor impairments. These findings are then discussed in an attempt to choose the more suitable theoretical framework for interpreting the various disorders related to denial of illness.

The Intergenerational Cycle of Child Maltreatment Continuity Versus Discontinuity

Abstract: Few studies have focused on identifying characteristics that discriminate between parents who break versus those who perpetuate intergenerational cycles of child maltreatment Both the dose and the attachment hypotheses were examined in this study of 213 mothers maltreated as children in one of three ways (beatings, neglect, or sexual abuse) Maltreatment continuity versus discontinuity was assessed through substantiated reports to a Child Protective Services (CPS) agency over a 7-year period Findings were consistent with the attachment hypothesis Poorer quality attachment relationships in childhood increased the probability of transmission Findings were consistent with the dose hypothesis for only one conceptualization of dose Those mothers who had experienced severe forms of sexual abuse (experienced coitus vs did not) were more likely to have a maltreated child These findings are discussed in terms of current theory and research on intergenerational maltreatment

Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: a cross-over study.

Abstract: A study of the effect of specific training for visual neglect on the recovery of motor and functional impairment in stroke patients is reported. Two groups of right hemisphere stroke patients with hemispatial neglect and one group without neglect were assessed by means of three functional and neurological scales (Rivermead Mobility Index, Barthel Index, Canadian Neurological Scale). Three evaluations were made at 0, 2 and 4 months from the beginning of physical rehabilitation. During the first 2 months of physical rehabilitation one of the two groups of neglect patients was randomly assigned to specific training for neglect, and the second group to a general cognitive intervention; during the final 2 months of rehabilitation the types of training were switched in the two groups. The non-neglect patients improved steadily during physical rehabilitation. In contrast, the functional recovery of the two neglect groups was time-locked to the period of the specific training for neglect. At the time of admission, the two neglect groups performed at the same level; after 2 months of rehabilitation, the group with neglect training showed higher functional recovery than the group with only general cognitive intervention. When the latter group received neglect training, there was no longer any difference between the two neglect groups. This pattern was present for both of the functional scales used but not for the neurological scale. Motor and functional recovery of stroke patients with neglect seems to be significantly improved by the simultaneous presence of a treatment specifically focused on neglect.

Children as Victims of Violence

Abstract: Violence against children and youths has always occurred, but it has recently been subject to increased public attention. This heightened attention is spawned by high-profile cases of stranger abductions, sexual assault, child abuse, and homicide, and by statistics suggesting an increase in the number of cases of child victimization. For example, newspapers recently reported that almost twice as many individuals under age 20 (5,500) died from gunshots in 1993 as in 1984. 1 But deaths, while the most dramatic of victimizations, are only the tip of the iceberg. More frequently, children are abused and neglected by parents, assaulted by siblings, or intimidated by other children. When all of these types of victimization are considered as a whole, children suffer far more victimizations than do members of other age groups. Children are more prone to victimization than adults not only because they are smaller and weaker than adults but also because they are dependent on adults for their day-to-day care and can seldom choose where and with whom they will live and spend time. Problems such as neglect, family abduction, and psychological maltreatment are strongly related to dependency, and these are much more common for children than for most adults. As children age, they become more independent, so the types of victimizations that they are most at risk for change, and the risks arise more from associations with other youths than from dependency on adults. 2 The concept of children as victims brings together the disparate studies of child abuse, sexual abuse, kidnapping, and other forms of violence with studies of such victimizations as assaults by siblings and peer violence. This integration highlights the number of victimizations that children face and may make it easier to identify relationships among different kinds of victimization and to design appropriate interventions. 2 Ultimately, however, defining and measuring child victimization as an integrative category of experiences is useful only if doing so leads to a better understanding of the

Childhood Family Problems and Current Psychiatric Problems among Young Violent and Property Offenders

Abstract: Objective The main objective was to examine whether young property and violent offenders would differ from each other in the prevalence of childhood abuse and neglect experiences, prevalence of various early family problems, and prevalence of disruptive behavior disorders, depression, and substance use. Method Childhood abuse and neglect assessments and family problems were based on interview, questionnaire, and file data. Psychiatric diagnoses were made on the basis of a structured clinical interview. Results There were no statistically significant differences in the prevalence of childhood physical or psychological abuse, or neglect between the groups. According to the files, physical abuse was experienced by 57.5% of the violent offenders compared with 37% of the property offenders ( p = .10). The prevalence rates of family problems were not different in the groups. Seventy-one percent of the violent group abused street drugs compared with 51% of the property group ( p Conclusions The property and violent offenders were surprisingly similar to each other in childhood experiences, family problems, and psychiatric diagnoses. The prevalence of childhood family and psychiatric problems was high in both groups.

Substance Abuse-Affected Families in the Child Welfare System: New Challenges, New Alliances

Abstract: During the past decade an unprecedented number of single-parent families entered the child welfare system because the mother had an identified substance abuse problem. Affecting as many as 80 percent of all cases of substantiated abuse and neglect (Child Welfare League of America, 1990), substance abuse is now cited as one of the three most common reasons for children entering care, along with abuse and neglect and economic stress (Children's Defense Fund, 1992). Substance abuse is regarded as a key factor in the recent growth of out-of-home placements (Child Welfare League of America, 1990). These trends have forced the child welfare field and substance abuse treatment providers to take a new look at the needs of parents with problems of chemical dependence and their children. As Halfon so aptly noted, this has meant "treading into an area that has been an incredible morass of conflicting policies and inadequate services" (cited in Child Welfare League of America, 1990, p. 24). This article examines these conflicts and problems in service delivery, looking first at the mandate framing child welfare practice and at issues in substance abuse treatment that affect this population. The article discusses specific practice and policy issues that must be addressed if the problem of chemical dependency is to be dealt with effectively and recommends ways to strengthen the delivery of services to this client population. Child Welfare Mandate Current child welfare practice is driven to a large extent by the Adoption Assistance and Child Welfare Act of 1980 (P.L. 98-617), which mandated that families be strengthened through services to prevent placement and, when placement was necessary, reunified as quickly as possible. It required that child welfare agencies make reasonable efforts to support families and to keep them together. The law builds in timelines for decision making through six-month case reviews and 18-month dispositional reviews. At the same time, child welfare agencies are also required through federal and state law to protect children from harm and ensure their safety. Thus, child welfare professionals must constantly struggle to find ways to strengthen families while also protecting children. When chemical dependency enters the picture, these mandates become difficult to balance, for the cycle of recovery does not always mesh with the child's needs or the timelines for child welfare decision making. To complicate matters further, these mandates must be met within a service delivery system that is woefully underfunded and where families' needs often extend far beyond the scope of what service providers can offer. Substance Abuse Treatment When mothers are referred by the child welfare system for substance abuse treatment, they are referred to a system that has historically focused on treating individual problems and that has been dominated by treatment models favoring the needs of men. Although gains have been made in the availability of services, still less than 1 percent of federal antidrug money is targeted toward drug treatment for women and even less toward pregnant and parenting women (Child Welfare League of America, 1990). The Alcohol, Drug Abuse, and Mental Health Services Block Grant program currently sets aside only 10 percent of its funds for the treatment of women (Child Welfare League of America, 1992). Treatment slots for pregnant women are virtually nonexistent in many communities (Gustavsson, 1991). Residential treatment programs, which are a necessary component of any comprehensive service delivery system (Barth, 1993; Child Welfare League of America, 1992; DeLeon & Jainchill, 1991; Straussner, 1989), pose special challenges for women with primary child care responsibilities and are equally scarce. To effectively serve chemically dependent women, experts have called for nothing less than a paradigm shift that would refocus services on the needs of the family and on the broader social and economic needs of women in treatment (Child Welfare League of America, 1990, 1992; Daghestani, 1988; Finkelstein, 1994; Reed, 1987; Zimmerman, 1988). …

Social factors and comorbidity of depressive and anxiety disorders

Abstract: Differences in rates of depression across and between populations can be considerable and are largely determined by psychosocial factors. Such findings have important implications for comorbidity. On the basis of multiplying independent probabilities, the proportion of comorbid conditions increases as base rates of the disorders increase in a population. If such a chance combination has clinical implications, it would appear to be a "fact" of significance irrespective of biological underpinnings. In a recent survey of 404 women living with at least one child in an inner-city area, the rate of both anxiety and depression was highly related to the childhood experiences of neglect and abuse. However, adversity in adult life (e.g. widowhood or divorce), which might be expected to relate to current stressors, was only related to the rate of depression. The two risk factors had a considerable impact on comorbidity by increasing the rate of each disorder and thus the probability of their occurring together. They had a lesser impact as "common antecedents". If both influences are considered, such adversity explains around half of the comorbidity. This is a conservative estimate of the impact of psychosocial factors.

Age of Onset of Sexual Abuse: Relationship to Sexually Inappropriate Behaviors

Abstract: Objective To examine how the age of onset of sexual abuse predicted inappropriate sexual behaviors in a sample of seriously mentally ill youths. Method A retrospective chart review was completed for all youths treated from 1987 through 1992 at a tertiary care public sector psychiatric hospital ( n = 499). Subjects were grouped according to the age at which they were first sexually abused: no sexual abuse ( n = 226), 0 through 3 years ( n = 78), 4 through 6 years ( n = 105), 7 through 12 years ( n = 71), and 13 through 17 years ( n = 19). Results The rates of sexually inappropriate behaviors in subjects with sexual abuse histories were quite substantial, ranging from 79.5% of the 0− through 3-year group to 42.1% of the 13− through 17-year group. Subjects first abused during early childhood, especially during the ages 0 through 3 years, had significantly elevated rates of hypersexual, exposing, and victimizing sexual behaviors. They also were significantly younger at the time of admission, came from more disrupted family settings, and had significantly higher rates of physical abuse, neglect, chronic sexual abuse, sexual abuse by either parent/stepparent and a higher total number of victimizers. When logistic regression analyses were done to examine the predictive power of potential risk factors, early age of onset of sexual abuse was the most significant predictor of all three types of inappropriate sexual behaviors. Conclusions Onset of sexual abuse prior to 7 years of age was significantly associated with hypersexual, exposing, and victimizing sexual behaviors. Early sexual abuse is also associated with a number of other poor prognostic factors, and further research is needed to define how these variables interact.

Risk factors for borderline pathology in children.

Abstract: Objective To examine risk factors associated with borderline pathology in latency-age children. Method The subjects were 98 children assessed for day treatment. Borderline subjects were identified in a chart review using the Child Diagnostic Interview for Borderlines, which divided the sample into borderline (n=41) and non border line (n=57) groups. Functional levels were assessed by Children's Global Assessment Scale scores. The risk factors were also rated by chart review; all subjects were given a cumulative abuse score and a cumulative parental dysfunction score. Results Both groups demonstrated severe functional impairment. The risk factors that differentiated the borderline group were sexual abuse, physical abuse, severe neglect, and parental substance abuse or criminality. Sexual abuse and severe neglect were significant in multi variate analysis. Cumulative abuse and cumulative parental dysfunction scores were both higher in the borderline group. Conclusions The findings indicate that the risk factors in borderline children are similar to those found in adults.