Child Abuse Experts Research Articles

Talking out the rage: an ego‐supportive intervention for work with potentially abusive parents

ABSTRACTChild abuse experts agree that the single factor ultimately responsible for child maltreatment is the inability of parents to control their aggressive impulses. This paper describes a verbalizing, ego‐supportive intervention for work with potentially abusive parents. It is designed to give parents increased understanding of the experience of parenting and greater control over their angry impulses. The intervention is based on two well‐supported premises: anger towards one's children is natural and inevitable; and putting angry feelings and thoughts into words significantly diminishes the tendency to put them into action. The engagement, ego‐building and prevention benefits of the intervention are discussed.

Pediatric short-distance household falls: Biomechanics and associated injury severity

Objectives Short-distance household falls are a common occurrence in young children, but are also a common false history given by caretakers to conceal abusive trauma. The purpose of this study was to determine the severity of injuries that result from accidental short-distance household falls in children, and to investigate the association of fall environment and biomechanical measures with injury outcomes. Methods Children aged 0–4 years who presented to the Emergency Department with a history of a short furniture fall were included in the study. Detailed case-based biomechanical assessments were performed using data collected through medical records, interviews, and fall scene investigations. Injuries were rated using the Abbreviated Injury Scale (AIS). Each case was reviewed by a child abuse expert; cases with a vague or inconsistent history and cases being actively investigated for child abuse were excluded. Results 79 subjects were enrolled in the study; 15 had no injuries, 45 had minor (AIS 1) injuries, 17 had moderate (AIS 2) injuries, and 2 had serious (AIS 3) injuries. No subjects had injuries classified as AIS 4 or higher, and there were no fatalities. Children with moderate or serious injuries resulting from a short-distance household fall tended to have fallen from greater heights, have greater impact velocities, and have a lower body mass index than those with minor or no injuries. Conclusion Children aged 0–4 years involved in a short-distance household fall did not sustain severe or life-threatening injuries, and no children in this study had moderate or serious injuries to multiple body regions. Biomechanical measures were found to be associated with injury severity outcomes in short-distance household falls. Knowledge of relationships between biomechanical measures and injury outcomes can aid clinicians when assessing whether a child's injuries were the result of a short-distance fall or some other cause.

Myths, Mysteries, and Monsters: When Shaken Babies Make the News

As the predominant cause of infant head injury that often results in death or long-term disability, Shaken Baby Syndrome (SBS) is both a criminal act and a public health concern. This article reports the findings of a qualitative content analysis of SBS-related news coverage from 1996 to 2007, exploring how broadcast and print news media categorize, frame, and source stories about SBS. This study reveals that while the legitimacy of SBS is widely acknowledged by child abuse experts in the United States, news reports typically frame SBS as a questionable diagnosis, the perpetrators as monsters, and the act of abuse unpreventable. Further, thematic health coverage appeared least frequently of all story types, reflecting a criminal justice rather than public health approach to reporting about SBS. These findings have several implications for crafting the media campaign strategy for The Period of PURPLE Crying: Keeping Babies Safe in North Carolina.

Primary care pediatricians’ experience, comfort and competence in the evaluation and management of child maltreatment: Do we need child abuse experts?

Objective We assessed the self-reported experience, comfort and competence of primary care pediatricians in evaluating and managing child maltreatment (CM), in rendering opinions regarding the likelihood of CM, and in providing court testimony. We examined pediatricians’ need for expert consultation when evaluating possible maltreatment. Methods A questionnaire was mailed to 520 randomly selected AAP members. Pediatricians were asked how frequently they evaluated and reported children for suspected maltreatment, and whether child abuse pediatricians were available to and used by them. Pediatricians were asked to rate their knowledge, comfort and competence in the management of CM. Demographic information was also gathered. Pediatricians’ experience with CM, their comfort, self-reported competence, and need for expert assistance is described. Logistic regression was used to assess factors that predicted pediatricians’ sense of competence while controlling for covariates found to be significant in bivariate analyses. Results One hundred forty-seven questionnaires were eligible for analysis. The majority of respondents had little experience evaluating and reporting suspected CM, and was interested in having expert consultation. While pediatricians often felt competent in conducting medical exams for suspected maltreatment, they felt less competent in rendering a definitive opinion, and did not generally feel competent to testify in court. Sense of competence was particularly low for sexual abuse. Increased practice experience and more courses in CM led to increased sense of competence in some areas. Conclusions Pediatricians acknowledged many limitations to providing care to maltreated children, and expressed interest in subspecialist input. Practice implications These findings add additional support to the American Board of Pediatrics’ decision to create a Child Abuse Pediatrics subspecialty. The findings also indicate a need to ensure funding for fellowship training programs in this field.

Translating Child Abuse Research Into Action

The Child Abuse Recognition Experience Study revealed that primary care clinicians did not always follow the legal mandate to report suspected child abuse to child protective services. National child abuse experts representing different disciplines met in a 2-day conference in January 2007 to discuss and develop new strategies that would address the barriers to reporting suspected child abuse and improve the protection of children. This article describes the rationale, structure, and goals of the conference.

Strategies for Saving and Improving Children's Lives

At the Child Abuse Recognition, Research, and Education Translation (CARRET) Conference, national child abuse experts representing different disciplines discussed and developed new strategies that would address the barriers to reporting suspected child abuse and improve the protection of children. This article describes the experts' analysis of the barriers to and strategies for improving the outcome for abused children, in addition to the steps planned to facilitate continued action.

Coaching children about sexual abuse: A pilot study of professionals’ perceptions

High stakes are involved in believing or disbelieving children’s assertions that they have been abused by adults. Consequently, children’s statements about possible maltreatment have become an immensely contested issue (e.g., Ceci & Bruck, 1995; Mansell, 1990; Mildred, 2003; Ney, 1995; Oates et al., 2000; Olafson, 2002; Rabinowitz, 1990). Although other types of cases are contested, sexual abuse cases are particularly controversial because evidence is often limited to the child’s account. A hypothesis that might explain away a child’s account of abuse is that the child has been coached. This explanation has been strongly endorsed by those accused (e.g., Butler, Fukurai, Dimitrius, & Krooth, 2001; Freyd, 1993; Goldstein, 1992; Wakefield & Underwager, 1988) and taken at face value by many professionals (e.g., Ceci & Bruck, 1995; Ney, 1995; Poole & Lamb, 1998; White & Quinn, 1988). Despite declarations that coaching must be routinely considered when child abuse is alleged, there is scant research to support coaching as a viable explanation for children’s accounts of abuse. Although relevant studies do not always address directly the coaching of children, they support a conclusion that coached statements and other types of false abuse allegations by children are uncommon. For example, Jones and McGraw (1987) undertook a review of 579 sexual abuse reports made to child protective services in Denver County in 1983, using a team of child abuse experts. The researchers concluded that eight cases were “fictitious” allegations made by five children (three by the same child).

Flawed Statistics in Murder Trial May Cost Expert His Medical License

In 1999, renowned child abuse expert Roy Meadow overstated the low odds of two infants in the same family dying suddenly for unexplained reasons, helping convict a mother of murdering her two sons. On 15 July, a professional panel ruled that Meadow should be erased from the register of physicians in Britain for his statistical blunder.

Temporary brittle bone disease: a true entity?

Temporary brittle bone disease is a recently described phenotype of increased fracture susceptibility in the first year of life in which there are multiple unexplained fractures without evidence of other internal or external injury. Most child abuse experts do not accept the existence of temporary brittle bone disease and presume these cases are child abuse. The author reviewed 26 cases of infants with multiple unexplained fractures that fit the criteria of temporary brittle bone disease and studied nine of them with either computed tomography or radiographic bone density measurements. The results show a striking association between temporary brittle bone disease and decreased fetal movement, usually from intrauterine confinement, and low bone density measurements in eight of the nine infants. The association with decreased fetal movement and intrauterine confinement is in keeping with the mechanostat-mechanical load theory of bone formation. The author feels that temporary brittle bone disease is a real entity and that historical information related to decreased fetal movement or intrauterine confinement and the use of bone density measurements can be helpful in making this diagnosis.

Behind the playground walls: sexual abuse in preschools

Representing over 6 years of research with children reporting nonritualistic and ritualistic sexual abuse in preschool settings, BEHIND THE PLAYGROUND WALLS is a clear, comprehensive examination of the effects of reported molestation on young children and their families. Based on data gathered from the children, parents, and therapists in a comparison study, the book covers the effects on children's behavior, fears, PTSD symptoms, sexuality, achievement, school performance, and self-concept. Moreover, the ways in which the children and their families coped with reports of abuse and the factors associated with positive short- and long-term outcome are detailed. Part I of the book outlines the scope of the problem. Cases from two communities - alleged ritualistic abuse in several preschools in Manhattan Beach, California, and nonritualistic abuse in a preschool day care setting in Reno, Nevada - are described and compared with a control group of nonabused children from southern California. The background literature is reviewed, as are the methods, procedures, and limitations of the study. Chapters in Part II offer perspectives on what happened to the children and the patterns of disclosure in therapy. Part III concentrates on the aftermath of such cases, with separate chapters on the children's overall levels of distress and cognitive, emotional, interpersonal, sexual, and school-related effects. The impact of sexual abuse on the children's parents, families, and therapists is discussed in Part IV. Factors that were associated with positive outcome for the children, both in the short term and at follow-up 5 years after initial disclosure, are then covered in Part V. Rounding out thevolume, Part VI presents community and research perspectives on the findings by well-known child abuse experts, and concludes with the authors' recommendations for treatment. Offering important new insights on a timely and critical topic, BEHIND THE PLAYGROUND WALLS is valuable reading

Women's Violence Against Their Children

Feminist scholars have rarely ventured into the realm of child abuse research. The aim of this paper is to lay the foundation for a feminist understanding of women's violence against their children. It begins with an assessment of the fundamental nature of the oppression of women in society and within the family. It continues with a critical analysis of how conventional child abuse and family violence experts have attempted to explain the problem of violence against children in the family. Ultimately, this paper reveals that if one is genuinely interested in unlocking the secrets of maternal child abuse, then the key is a feminist perspective that provides insight into the lives of women in the patriarchy.

Countertransference and failure to report child abuse and neglect

Though every state has laws requiring the report of suspected child abuse and neglect, failure to report remains a significant problem. Review of previous research on failure to report suggests that the reporters' anxieties about disrupting their relationship with the child's family as well as the reporters' gender, experience, and training affect willingness to report. Countertransference fear, guilt, shame, and sympathy are discussed as a basis for understanding the reporter's anxieties. We suggest that Countertransference issues should be addressed in the training and ongoing practice of mandated reporters. The following mechanisms are offered to deal with this issue in training and practice: (1) teaching professionals about how Countertransference reactions may arise during the reporting process (this training may include the use of risk management groups for private practitioners); (2) identification of a community child abuse expert for consultation; and (3) educating child protection workers about psychodynamics aspects of case management.