Showing papers on "Neglect published in 1999"

Spatial attention and neglect: parietal, frontal and cingulate contributions to the mental representation and attentional targeting of salient extrapersonal events.

Abstract: The syndrome of contralesional neglect reflects a lateralized disruption of spatial attention. In the human, the left hemisphere shifts attention predominantly in the contralateral hemispace and in a contraversive direction whereas the right hemisphere distributes attention more evenly, in both hemispaces and both directions. As a consequence of this asymmetry, severe contralesional neglect occurs almost exclusively after right hemisphere lesions. Patients with left neglect experience a loss of salience in the mental representation and conscious perception of the left side and display a reluctance to direct orientating and exploratory behaviours to the left. Neglect is distributed according to egocentric, allocentric, world-centred, and object-centred frames of reference. Neglected events can continue to exert an implicit influence on behaviour, indicating that the attentional filtering occurs at the level of an internalized representation rather than at the level of peripheral sensory input. The unilateral neglect syndrome is caused by a dysfunction of a large-scale neurocognitive network, the cortical epicentres of which are located in posterior parietal cortex, the frontal eye fields, and the cingulate gyrus. This network coordinates all aspects of spatial attention, regardless of the modality of input or output. It helps to compile a mental representation of extrapersonal events in terms of their motivational salience, and to generate 'kinetic strategies' so that the attentional focus can shift from one target to another.

The Impact of Psychological Contract Violations on Exit, Voice, Loyalty, and Neglect

Abstract: This study examines the relationships between violations of employees' psychological contracts and their exit, voice, loyalty, and neglect behaviors. Using a sample of over 800 managers, this research found that psychological contract violations result in increased levels of exit, voice, and neglect behaviors and decreased levels of loyalty to the organization. In addition, this research examines the moderating effects that situational factors (such as the availability of attractive employment alternatives) have on the relationships between psychological contract violations and managers' behaviors. The results suggest that these situational factors moderate the relationship between psychological contract violations and exit, but not the relationships between psychological contract violations and voice, loyalty, or neglect. Finally, this research also examines differences in the nature of psychological contract violations experienced across three categories of workers: new managers entering the workforce, ...

Posttraumatic Stress Disorder in Abused and Neglected Children Grown Up

Abstract: OBJECTIVE: The purpose of this study was to describe the extent to which childhood abuse and neglect increase a person’s risk for subsequent posttraumatic stress disorder (PTSD) and to determine whether the relationship to PTSD persists despite controls for family, individual, and lifestyle characteristics associated with both childhood victimization and PTSD. METHOD: Victims of substantiated child abuse and neglect from 1967 to 1971 in a Midwestern metropolitan county area were matched on the basis of age, race, sex, and approximate family socioeconomic class with a group of nonabused and nonneglected children and followed prospectively into young adulthood. Subjects (N=1,196) were located and administered a 2-hour interview that included the National Institute of Mental Health Diagnostic Interview Schedule to assess PTSD. RESULTS: Childhood victimization was associated with increased risk for lifetime and current PTSD. Slightly more than a third of the childhood victims of sexual abuse (37.5%), 32.7% of...

Childhood maltreatment increases risk for personality disorders during early adulthood.

Abstract: Background: Data from a community-based longitudinal study were used to investigate whether childhood abuse and neglect increases risk for personality disorders (PDs) during early adulthood. Methods: Psychosocial and psychiatric interviews were administered to a representative community sample of 639 youths and their mothers from 2 counties in the state of New York in 1975, 1983, 1985 to 1986, and 1991 to 1993. Evidence of childhood physical abuse, sexual abuse, and neglect was obtained from New York State records and from offspring self-reports in 1991 to 1993 when they were young adults. Offspring PDs were assessed in 1991 to 1993. Results: Persons with documented childhood abuse or neglect were more than 4 times as likely as those who were not abused or neglected to be diagnosed with PDs during early adulthood after age, parental education, and parental psychiatric disorders were controlled statistically. Childhood physical abuse, sexual abuse, and neglect were each associated with elevated PD symptom levels during early adulthood after other types of childhood maltreatment were controlled statistically. Of the 12 categories of DSM-IV PD symptoms, 10 were associated with childhood abuse or neglect. Different types of childhood maltreatment were associated with symptoms of specific PDs during early adulthood. Conclusions: Persons in the community who have experienced childhood abuse or neglect are considerably more likely than those who were not abused or neglected to have PDs and elevated PD symptom levels during early adulthood. Childhood abuse and neglect may contribute to the onset of some PDs. Arch Gen Psychiatry. 1999;56:600-606

Childhood Abuse and Neglect: Specificity of Effects on Adolescent and Young Adult Depression and Suicidality

Abstract: Objective To investigate the magnitude and independence of the effects of childhood neglect, physical abuse, and sexual abuse on adolescent and adult depression and suicidal behavior. Method A cohort of 776 randomly selected children was studied from a mean age of 5 years to adulthood in 1975, 1983, 1986, and 1992 during a 17-year period. Assessments included a range of child, family, and environmental risks and psychiatric disorders. A history of abuse was determined by official abuse records and by retrospective self-report in early adulthood on 639 youths. Attrition rate since 1983 has been less than 5%. Results Adolescents and young adults with a history of childhood maltreatment were 3 times more likely to become depressed or suicidal compared with individuals without such a history ( p p p Conclusions Individuals with a history of sexual abuse are at greater risk of becoming depressed or suicidal during adolescence and young adulthood. Adolescence is the most vulnerable period for those youths who may attempt suicide repeatedly. Many of the apparent effects of neglect, in contrast, may be attributable to a range of contextual factors, suggesting broader focus for intervention in these cases.

Psychological abuse: a variable deserving critical attention in domestic violence.

Abstract: Policy makers and researchers give psychological abuse considerably less attention than physical abuse in the partner abuse area. One reason for the relative neglect of psychological abuse is that there are difficulties in arriving at a common definition of psychological abuse that might be useful to both the mental health and legal professions. Another reason for the relative neglect of psychological abuse has been an implicit assumption that physical abuse exacts a greater psychological toll on victims than does psychological abuse. At the extreme level of physical abuse, this assumption seems defensible, but at levels of physical aggression that are most common in marriage and long-term relationships, psychological abuse appears to have as great an impact as physical abuse. Even direct ratings of psychological and physical abuse by women in physically abusive relationships indicate that psychological abuse has a greater adverse effect on them than physical abuse. Retrospective reports, longitudinal research, and treatment dropout research all provide evidence that psychological abuse can exact a negative effect on relationships that is as great as that of physical abuse. Finally, psychological abuse almost always precedes physical abuse, so that prevention and treatment efforts clearly need to address psychological abuse. Eight measures of various forms of psychological abuse that have reasonable psychometric properties and considerable construct validity are reviewed and a definition of psychological abuse in intimate relations is provided.

Prenatal and infancy home visitation by nurses: recent findings.

Abstract: This article describes a 20-year program of research on the Nurse Home Visitation Program, a model in which nurses visit mothers beginning during pregnancy and continuing through their children's second birthdays to improve pregnancy outcomes, to promote children's health and development, and to strengthen families' economic self-sufficiency. The results of two randomized trials (one in Elmira, New York, and the second in Memphis, Tennessee) are summarized, and an ongoing trial in Denver, Colorado, is briefly described. Results of the Elmira and Memphis trials suggest the following: The program benefits the neediest families (low-income unmarried women) but provides little benefit for the broader population. Among low-income unmarried women, the program helps reduce rates of childhood injuries and ingestions that may be associated with child abuse and neglect, and helps mothers defer subsequent pregnancies and move into the workforce. Long-term follow-up of families in Elmira indicates that nurse-visited mothers were less likely to abuse or neglect their children or to have rapid successive pregnancies. Having fewer children enabled women to find work, become economically self-sufficient, and eventually avoid substance abuse and criminal behavior. Their children benefitted too. By the time the children were 15 years of age, they had had fewer arrests and convictions, smoked and drank less, and had had fewer sexual partners. The program produced few effects on children's development or on birth outcomes, except for children born to women who smoked cigarettes when they registered during pregnancy. The positive effects of the program on child abuse and injuries to children were most pronounced among mothers who, at registration, had the lowest psychological resources (defined as high levels of mental health symptoms, limited intellectual functioning, and little belief in their control of their lives). Generally, effects in Elmira were of greater magnitude and covered a broader range of outcomes than in Memphis, perhaps because of differences between the populations studied, community contexts, or a higher rate of turnover among home visitors in Memphis than in Elmira. The article concludes that the use of nurses as home visitors is key; that services should be targeted to the neediest populations, rather than being offered on a universal basis; that clinically tested methods of changing health and behavioral risks should be incorporated into program protocols; and that services must be implemented with fidelity to the model tested if program benefits found in scientifically controlled studies are to be reproduced as the program is replicated in new communities.

Costs of Health Care Use by Women HMO Members With a History of Childhood Abuse and Neglect

Abstract: Background Early childhood maltreatment has been associated with adverse adult health outcomes, but little is known about the magnitude of adult health care use and costs that accompany maltreatment. We examined differences in annual health care use and costs in women with and without histories of childhood sexual, emotional, or physical abuse or neglect. Methods A random sample of 1225 women members of a health maintenance organization completed a 22-page questionnaire inquiring into childhood maltreatment experiences as measured by the Childhood Trauma Questionnaire. Health care costs and use data were obtained from the automated cost-accounting system of the health maintenance organization, including total costs, outpatient and primary care costs, and emergency department visits. Results Women who reported any abuse or neglect had median annual health care costs that were $97 (95% confidence interval, $0.47-$188.26) greater than women who did not report maltreatment. Women who reported sexual abuse had median annual health care costs that were $245 (95% confidence interval, $132.32-$381.93) greater than costs among women who did not report abuse. Women with sexual abuse histories had significantly higher primary care and outpatient costs and more frequent emergency department visits than women without these histories. Conclusion Although the absolute cost differences per year per woman were relatively modest, the large number of women in the population with these experiences suggests that the total costs to society are substantial.

Child and Adolescent Abuse and Neglect Research: A Review of the Past 10 Years. Part I: Physical and Emotional Abuse and Neglect

Abstract: Objective To review the clinically relevant literature on the physical and emotional abuse and neglect of children and adolescents published during the past 10 years. Method Literature published between 1988 and 1998 was reviewed following a systematic search of Medline, Psychinfo , and the National Clearinghouse on Child Abuse and Neglect. Results During the last decade there has been substantial progress in understanding the symptomatology associated with maltreatment. However, prevention and intervention research studies are relatively rare and frequently have important methodological limitations. Conclusions Child maltreatment research in the next decade needs to focus on understanding factors leading to resilient outcomes and on assessing the effectiveness of psychotherapeutic and psychopharmacological treatment strategies. Increased resources are needed to support child maltreatment research studies and investigators.

The Handbook of Child and Adolescent Clinical Psychology : A Contextual Approach

Abstract: Frameworks for Practice. Normal Development. Influences on Problem Development. Classification, Epidemiology and Treatment Effectiveness. The Consultation Process and Intake Interviews. Report Writing. Problems of Infancy and Early Childhood. Sleep Problems. Toileting Problems. Learning and Communication Difficulties. Autism and Pervasive Developmental Disorders. Problems of Middle Childhood. Conduct Problems. Attention and Overactivity Problems. Fear and Anxiety Problems. Repetition Problems. Somatic Problems. Problems in Adolescence. Drug Abuse. Mood Problems. Anorexia and Bulimia Nervosa. Schizophrenia. Child Abuse. Physical Abuse. Emotional Abuse and Neglect. Sexual Abuse. Adjustment to Major Life Transitions. Foster Care. Separation and Divorce. Grief and Bereavement.

Transition from paediatric to adult care. Bridging the gaps or passing the buck

Abstract: The fate of older adolescent patients in paediatric clinics is either one of transfer to adult services, long term retention in the paediatric clinic, or discharge from medical supervision, either voluntarily or by neglect. Neither simple transfer to adult doctors nor allowing adolescents to “drop out” of medical care is now acceptable quality care for young people with chronic illness. Arranging efficient and caring transfer for adolescents from paediatric to adult care is one of the great challenges facing paediatrics—and indeed the health services—in the coming century.1 Many illnesses once considered to be confined to childhood, such as cystic fibrosis and metabolic conditions, must now be thought of as diseases that begin in childhood but continue into adult life. Paediatric and adult medicine differ greatly in their approach to issues of growth, development, patient agency, and involvement of the family—differences that may become more noticeable with the recent separation of paediatricians from the Royal College of Physicians in the UK. Adolescents sit poorly between the family centred, developmentally focused, paediatric paradigm (which frequently ignores their growing independence and increasingly adult behaviour) and the adult medical culture, which acknowledges patient autonomy, reproduction, and employment issues but neglects growth, development, and family concerns.2 The simple matter of transferring care to adult physicians has been challenged in the past decade by the notion of “transition”, emphasising the need for the change to adult care to be a guided educational and therapeutic process, rather than an administrative event.3 To achieve effective transition, it must be recognised that transition in health care is but one part of the wider transition from dependent child to independent adult and that, in moving from child centred to adult health services, young people undergo a change that is systemic and cultural, as well as clinical.2 …

Maternal Care, Gene Expression, and the Development of Individual Differences in Stress Reactivity

Abstract: The quality of family life influences the development of individual differences in vulnerability to illness throughout later life. As adults, victims of childhood physical or sexual abuse are at considerably greater risk for mental illness, as well as for diabetes and heart disease (e.g., Refs. 1–3). Children need not be beaten to be compromised. Persistent emotional neglect or conditions of harsh, inconsistent discipline serve to increase the risk of depression and anxiety disorders to a level comparable to that observed in cases of abuse. 4 Indeed, for certain outcomes, the consequences of persistent neglect exceed those of abuse. 5,6 More subtle relationships exist. Low scores on parental bonding scales, reflecting cold, distant parent–child relationships, significantly increase the risk of depression and anxiety in later life (e.g., Refs. 7,8). And the risk is not unique to mental health. Russak and Schwartz 9 found that by midlife those individuals who, as undergraduate students, rated their relationship with parents as cold and detached, had a fourfold greater risk of chronic illness, including depression and alcoholism as well as heart disease and diabetes. Parental factors also serve to mediate the effects of environmental adversity on development. For example, the effects of poverty on emotional and cognitive development are mediated by parental factors, to the extent that if such factors are controlled, there is no discernible effect of poverty on child development. 10,11 Moreover, treatment outcomes associated with early intervention programs are routinely correlated with changes in parental behavior: In cases where parental behavior proves resistant to change, treatment outcomes are seriously limited. These findings suggest that variations in parental care mediate, in part at least, the effects of environmental adversity on child development. One of the more common findings here is that maternal depression associated with environmental conditions not only compromises parent–child interactions, but also limits the efficacy of early intervention programs.

Childhood victimization and drug abuse: a comparison of prospective and retrospective findings.

Abstract: This study examined whether childhood victimization increases risk for drug abuse using prospective and retrospective victimization information. Substantiated cases of child abuse/neglect from 1967 to 1971 were matched on gender, age, race, and approximate social class with nonabused/nonneglected children and followed prospectively into young adulthood. Between 1989 and 1995, 1,196 participants (676 abused/neglected and 520 control) were administered a 2-hr interview, including measures of self-reported childhood victimization and drug use/abuse (the National Institute of Mental Health Diagnostic Interview Schedule--Version III--Revised). Prospectively, abused/neglected individuals were not at increased risk for drug abuse. In contrast, retrospective self-reports of childhood victimization were associated with robust and significant increases in risk for drug abuse. The relationship between childhood victimization and subsequent drug problems is more complex than originally anticipated.

Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients.

Abstract: OBJECTIVE: Research on the etiology of dissociation in adults has focused primarily on childhood sexual abuse. The role of co-occurring childhood stressors and of more chronic adverse conditions such as neglect is less clear. This study examined the level of dissociation in relation to childhood trauma (sexual/physical abuse, witnessing interparental violence), early separation from a parent, and perceived parental dysfunction. METHOD: One hundred sixty inpatients consecutively admitted to a general psychiatric hospital were administered the Dissociative Experiences Scale and the Structured Trauma Interview. RESULTS: The mean Dissociative Experiences Scale score was 17.4; 18.0% of the patients scored beyond 30. Early separation was reported by 26.4% of the patients; 30.1% had witnessed interparental violence; 23.6% reported physical abuse; 34.6% reported sexual abuse; 11.7% reported rape before age 16; and 42.1% reported sexual and/or physical abuse. The level of dissociation was primarily related to repo...

A greater role of emotional than physical or sexual abuse in predicting disordered eating attitudes: the role of mediating variables.

Abstract: Objective Previous research on the role of trauma in eating psychopathology has generally focused on reported childhood sexual abuse. There has been relatively little research addressing the full range of abusive experiences, and none considering their long-term impact on eating. This study investigated the relationships between four forms of reported childhood abuse (physical abuse, sexual abuse, emotional abuse, neglect) and unhealthy eating attitudes in adult life. Within this relationship, depression, anxiety, and dissociation were considered potential mediators, and age of onset of abuse was considered a potential moderator. Method A nonclinical sample of 236 women completed self-report measures of abuse, eating psychopathology, and psychological function. Multiple regression analyses were used to test for associations as well as for mediating and moderating influences. Results When the intercorrelations of the different forms of reported abuse were controlled for, emotional abuse was the only form of childhood trauma that predicted unhealthy adult eating attitudes. That relationship was perfectly mediated by the women's levels of anxiety and dissociation. Age at onset of emotional abuse did not moderate these relationships. Discussion Although these results require extension to a clinical sample, the findings underscore the need to consider a history of emotional trauma as a potentially central factor in any abusive history. Treatment may depend on addressing the psychological consequences of such trauma. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 25: 159–167, 1999.

The Neglect and Importance of Emotion at Work

Abstract: This article provides an overview of the multiple roles of emotion at work. First, traditional approaches to work and well-being and their limitations are considered. The advantages of understanding more specific feeling states rather than the nonspecific states of "stress" and "satisfaction" are outlined. Next, some recent developments in activity surrounding the study of emotion at work are briefly described. A distinction is made in the article between the expression and experience of felt emotion at work. The literature around the expression of emotion at work and, in particular, emotional labour is reviewed by addressing four key questions. Then, the very limited research on the experience of emotion at work is described: The importance of looking at emotion in terms of transactions and processes rather than simple cause and effect is emphasized. Some of the implications of the overview for both practitioners and researchers are considered. The article concludes with the observation that as emotion i...

Characteristics of Repeated Referrals to Child Protective Services in Washington State

Abstract: This study replicates and extends prior research on the characteristics and correlates of child maltreatment recurrences based on an ecological model of child maltreatment. The use of a very large sample with a large number of risk factors avoids methodological shortcomings based on small samples size and sample selection bias. The risk and other characteristics of 12,329 referrals were studied to determine which factors related to recidivism within an 18-month period. Rereferral rates increase with the increasing number of prior referrals and of placements in foster care (followed by reunification), but there is little difference in rates of rereferral by substantiation. Several of the risk factors associated with an increased likelihood of rereferral, history of domestic violence, history of caregiver child abuse/neglect (CA/N) as a child, and substance abuse, are the risk factors least often assessed by socialworkers. Rates of rereferral vary by ethnicity, type of abuse, and population type (rural, urban).

Child abuse, domestic violence, and animal abuse : linking the circles of compassion for prevention and intervention

Abstract: Evidence is mounting that animal abuse, frequently embedded in families scarred by domestic violence and child abuse and neglect, often predicts the potential for other violent acts. In this work, contributors examine research and programmatic issues, and encourage cross-disciplinary interactions.

Perceived abuse and neglect as risk factors for suicidal behavior in adolescent inpatients

Abstract: The aim of this study was to assess relative risk of histories of different types of abuse (sexual, physical, and emotional) and neglect (physical and emotional) for suicidal behavior (attempts, ideation, and self-mutilation) in psychiatrically hospitalized adolescents. Seventy-one adolescent inpatients (34 boys, 37 girls) completed self-report measures of abuse and neglect, current suicidal ideation, and lifetime suicide and self-mutilation attempts. The prevalence of sexual and physical abuse was 37.5% and 43.7%, respectively, with 31.3% and 61% of youngsters reporting emotional and physical neglect. Fifty-one percent of youngsters had made suicide attempts, and 39% had self-mutilated. Suicide attempters were significantly more likely to be female, Latino, to report sexual, physical, and emotional abuse, and to endorse emotional neglect. In multivariate analyses, female gender, sexual abuse, and emotional neglect remained significant predictors of self-mutilation and suicidal ideation. Female gender and sexual abuse remained significant predictors of suicide attempts. These findings suggest that emotional neglect is an important and deleterious component of maltreatment experiences and may be a more powerful predictor of suicidal behavior in hospitalized adolescents than physical abuse, emotional abuse, and physical neglect.

Experiences of hospital care and treatment seeking for pain from sickle cell disease: qualitative study

Abstract: Objective: To investigate how sociocultural factors influence management of pain from sickle cell disease by comparing the experiences of those who usually manage their pain at home with those who are more frequently admitted to hospital for management of their pain. Design: Qualitative analysis of semistructured individual interviews and focus group discussions. Participants: 57 participants with genotype SS or S/β-thal (44 subjects) or SC (9) (4 were unknown). 40 participants took part in focus groups, six took part in both focus groups and interviews, and nine were interviewed only. Participants were allocated to focus groups according to number of hospital admissions for painful crisis management during the previous year, ethnic origin, and sex. Results: The relation between patients with sickle cell disease and hospital services is one of several major non-clinical dimensions shaping experiences of pain management and behaviour for seeking health care. Experiences of hospital care show a range of interrelated themes, which are common to most participants across variables of sex, ethnicity, and hospital attended: mistrust of patients with sickle cell disease; stigmatisation; excessive control (including both over- and undertreatment of pain); and neglect. Individuals respond to the challenge of negotiating care with various strategies. Patients with sickle cell disease who are frequently admitted to hospital may try to develop long term relationships with their carers, may become passive or aggressive in their interactions with health professionals, or may regularly attend different hospitals. Those individuals who usually manage their pain at home express a strong sense of self responsibility for their management of pain and advocate self education, assertiveness, and resistance as strategies towards hospital services. Conclusions: The current organisation and delivery of management of pain for sickle cell crisis discourage self reliance and encourage hospital dependence. Models of care should recognise the chronic nature of sickle cell disorders and prioritise patients9 involvement in their care.

Neglected Children: Research, Practice, and Policy

Abstract: Child Neglect - James Garbarino and Cyleste C Collins The Family with a Hole in the Middle Child Neglect - Susan J Zuravin A Review of Definitions and Measurement Research Child Neglect - Patricia McKinsey Crittenden Causes and Contributors Cultural Competence and Child Neglect - Jill E Korbin and James C Spilsbury Child Neglect - James M Gaudin Jr Short-Term and Long-Term Outcomes Neglect of Children's Health Care - Howard Dubowitz Prenatal Alcohol and Drug Use and Risk for Child Maltreatment - Ira J Chasnoff and Lee Ann Lowder A Timely Approach to Intervention Fatal Child Neglect - Barbara L Bonner, Sheila M Crow and Mary Beth Logue The Prevention of Child Neglect - Wayne Holden and Laura Nabors Evaluation and Risk Assessment of Child Neglect in Public Child Protection Services - Diana J English Intervening with Families when Children are Neglected - Diana DePanfilis Are Battered Women Bad Mothers? Rethinking the Termination of Abused Women's Parental Rights for Failure to Protect - Thomas D Lyon Child Neglect - Maureen M Black and Howard Dubowitz Research Recommendations and Future Directions Policy Issues in Child Neglect - Richard J Gelles

Spatial Neglect: A Clinical Handbook for Diagnosis and Treatment

Abstract: Spatial neglect is a profound clinical problem as well as intriguing scientific problem. In the last ten years, there has been an explosion of interest in this disorder, which as a result is no longer viewed as a single entity, but rather as a number of different disorders. This book is an attempt to bring the reader up to date with the latest advances in understanding neglect, at least insofar as this contributes to better clinical assessment, management and treatment. This is not a book for the specialist researcher in the neuropsychology of neglect and attention. Rather, it is a book aimed at clinicians - student and trained - from all disciplines involved in the assessment, management and treatment of neglect. The book begins with the description of four cases manifesting different types of unilateral neglect. The reader is introduced to different aspects of neglect through these patients. These distinctions include those between personal and extrapersonal neglect, motor versus sensory neglect and many others. The reader is also introduced to other phenomena that are closely related to neglect, including ansognosia and impaired sustained attention. The latest methodes of assessment of neglect are also described, as are methods of treatment, again with reference to the four introductory specimen cases.

The treatment of the long-term sequelae of child abuse

Abstract: The literature on the long-term sequelae of sexual and physical abuse is reviewed. Abused children are at risk of long-term adverse psychological sequelae related to the abuse per se and not just as a consequence of other associated background factors. There is some specificity relating the type of psychological outcome to the type of abuse experienced. Physical abuse is just as traumagenic as sexual abuse in the long-term. Whatever the efficacy of specific psychological treatments, there are broad general service measures that will prevent both abuse and re-abuse and therefore impact on long-term sequelae. The studies on the effectiveness of intervention to prevent psychological sequelae of abuse are systematically appraised. There are few well-conducted and adequately controlled studies of the efficacy of treatment for abused children. Where a corpus of studies does exist, e.g. group therapy for sexually abused children, treatment for abused children appears to be as effective for children whose problems arise from other causes. Studies have also shown that abusive parenting can be changed by training.