Victims Of Child Abuse Research Articles

When a Child's Life Depends on Us Recognizing Cutaneous Signs of Child Abuse

Abuse is the worst possible attack on a child’s dignity and wellbeing, and the law protects children against any type of physical or psychological assault. In 1959, just over a century after Charles Dickens had denounced the vulnerability of children in Oliver Twist, the United Nations General Assembly adopted the Declaration of the Rights of a Child, considered to be the first legal manifesto for the protection of minors. In 1962, an article published by Kempe et al. on battered child syndrome profoundly changed how the victims of child abuse were cared for and raised public awareness, prompting the adoption of legal measures that directly affected children. In Spain, in addition to the legislation in different autonomous communities, the Organic Law 1/1996 for the Legal Protection of Minors, dated January 15, requires physicians to protect the physical and psychological integrity of children and to report any suspected assault, past or present. Although it is beyond question that child abuse occurs, exact figures for its incidence in Spain are lacking. We do know that the number of reports is increasing, but it is difficult to count exactly how many cases there are because the physician involved may not know the procedure for filing the report, be worried about being wrong, or lack conclusive evidence of the cause of the lesions. In addition, some cases that are detected may go unreported because of the

Forensic aspects of water intoxication: Four case reports and review of relevant literature

Water intoxication (WI) is a rare condition that originates from over-consumption of water, with a potentially fatal outcome. Increased water intake (polydipsia) is followed by urination of high amount of diluted urine (polyuria) which are the main initial symptoms of WI. We present four case reports of WI. Two of them are unusual pediatric clinical cases using medical documentation and police case files, one of which is related to child abuse, and the other to a psychiatric disorder. The other two cases are fatal adult cases submitted to autopsy from a psychiatric hospital. Also, we present a diagnostic algorithm for polydipsia and polyuria before death. WI is usually seen in patients with psychiatric disorders, victims of child abuse or torture, drug abusers or it can be iatrogenically induced.

An examination of police officers' notes of interviews with alleged child abuse victims

An examination of police officers' notes of interviews with alleged child abuse victims

Childhood Bullying Correlates With Adult Domestic Violence

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessChildhood Bullying Correlates With Adult Domestic ViolenceJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:6 Jan 2012https://doi.org/10.1176/pn.47.1.psychnews_47_1_12-aAbstractAfter male bullies leave school, they may turn to bullying their girlfriends and spouses instead of fellow pupils, a new study has found.The study was headed by Kathryn Falb, a doctoral student in the Harvard School of Public Health, and the results were published in the October 2011 Archives of Pediatrics & Adolescent Medicine.Men who bullied their classmates as children are four times as likely to have engaged in violence against a female partner within the previous year.Credit: pjcross/Shutterstock.com“This is an important study—intuition would predict the findings, but it is very helpful to have confirmation of intuition,” Michael Miller, M.D., editor in chief of the Harvard Mental Health Letter and a psychiatrist unconnected with the study, told Psychiatric News. “It is useful to know that, in fact, childhood bullying is correlated with later perpetration of domestic violence.”The cohort included almost 1,500 men, aged 18 to 35, who were seeking services at urban community health centers. One reason why so many men were willing to participate in the study may have been because they were asked to fill out a computer survey form rather than be interviewed face to face, Falb told Psychiatric News.Survey responses indicated that many of the subjects came from troubled backgrounds—that is, had been exposed to parental interpersonal violence, physical abuse, or sexual abuse as children. Responses also showed that 25 percent had occasionally been a school bully, 16 percent had been frequent school bullies, and 16 percent had perpetrated physical or sexual violence on a female partner within the previous year.Falb and her colleagues then looked to see whether there was a link between having been a bully in school and perpetrating violence on a female partner within the year prior to the study, while controlling for possible confounders such as age, race, education, childhood sexual or physical abuse, or exposure to parental interpersonal violence.They found that such a link did exist. Men who had bullied schoolmates once in a while were twice as likely to have engaged in violence against a female partner within the previous year as were men who said they had never bullied their school peers. And men who had admitted bullying frequently in school were four times as likely to have done so as were men who had never bullied in school.Thus “identification of boys who bully others [in school] may offer an opportunity to intervene on future abusive behaviors, such as intimate partner violence perpetration as adults,” Falb suggested. But how to intervene? “Behaviors such as bullying and intimate partner violence perpetration often share many common causes, such as child-abuse victimization or witnessing parental violence,” she said. “Intervening on these determinants before children display bullying behaviors or intimate partner violence behaviors might be useful for preventing both behaviors,” she speculated. “[Also] interpersonal violence or dating violence prevention activities might be effective if targeted towards boys who bully."But what are the chances of such interventions really working? “Perhaps they would merely suppress behavior that might emerge later or when grownups aren’t around,” Miller conjectured. “But it is possible that an intervention could help a bully learn self-control or to cultivate empathy, reducing the later risk of aggressive behavior.”Also, “a helpful direction [for designing such interventions] would be to refine our understanding of the motivations for bullying behavior,” Miller said, although “it would be a difficult thing to study empirically,” he admitted. For example, bullying might be motivated by a desire for power and control over other individuals (as Falb and her colleagues proposed in their paper), or it could be motivated by sadism, rage, sociopathic manipulation, or other possible factors, he said.An abstract of “School Bullying Perpetration and Other Childhood Risk Factors as Predictors of Adult Intimate Partner Violence Perpetration” is posted at http://archpedi.ama-assn.org/cgi/content/short/165/10/890. ISSUES NewArchived

日本における法看護学発展の可能性と課題－臨床看護師の調査結果より－

Forensic nursing scientifically obtains and preserves the criminal damage from victims of domestic violence, child abuse, elder abuse, sexual violence and other related forms of violence. This was developed in North America in the 1980s, and has carried out appropriate nursing care while protecting the human rights of victims. Serious crime in Japan has been increasing, and it would seem that forensic nursing opportunities should expand as well. However, in Japan, there hasn't been much discussion about forensic nursing. Theorizing that support for clinical forensic nursing should be recognized and relevant, we carried out a survey of 581 clinical nurses to investigate the development of forensic nursing in Japan. 93 clinical nurses (16.0%) had a low level of familiarity with forensic nursing; however, 324 nurses (56.3%) had encountered patients who had suffered violence. 264 nurses (45.4%) had a feeling of wanting to be involved in forensic nursing, but were not confident with the knowledge and technology, while 144 nurses (24.8%) were concerned about the larger responsibility they would have. 400 nurses (68.8%) hoped to receive specialized knowledge and technical education. It is necessary to establish an education system for forensic nursing in accordance with the educational status-quo while considering the present state of forensic nursing education.

Non-verbal behavior of children who disclose or do not disclose child abuse in investigative interviews

ObjectiveThe study focused on children's nonverbal behavior in investigative interviews exploring suspicions of child abuse. The key aims were to determine whether non-verbal behavior in the pre-substantive phases of the interview predicted whether or not children would disclose the alleged abuse later in the interview and to identify differences in the nonverbal behaviors of disclosing and non-disclosing children. MethodWe studied DVD-recorded interviews of 40 alleged victims of child abuse. In all cases, there was external evidence strongly suggesting that abuse had occurred. However, half of the children disclosed abuse when interviewed using the NICHD Investigative Interview Protocol, whereas the other half did not. Two raters, unaware whether or not the children disclosed, independently coded the videotapes for nonverbal indices of positive and negative emotions, stress, and physical disengagement in each 15-second unit of the introductory, rapport building, and substantive interview phases. ResultsIndicators of stress and physical disengagement increased as the interviews progressed while indices of positive emotions decreased. Non-disclosers showed proportionately more physical disengagement than disclosers in both the introductory and substantive phases. ConclusionsAwareness of non-verbal behavior may help investigators identify reluctant children early in forensic interviews. Practice implicationsThere is substantial evidence that, when questioned by investigators, many children do not disclose that they have been abused. The early detection of reluctance to disclose may allow interviewers to alter their behavior, helping the children overcome their reluctance by providing non-suggestive support before the possibility of abuse is discussed. Of course, nonverbal behavior alone should not be used to assess children in investigative interviews. However, nonverbal cues may nonetheless provide additional information to interviewers and assist them in identifying reluctant children.

Percepcija zdravstvenih radnika koja se odnosi na broj i karakteristike dece žrtava zlostavljanja i zlostavljača

University Children's Clinic and Institute for Health Protection of Mother and Child 'Dr Vukan Čupić' in Belgrade have an incomplete database from which we could not get the social demographics of abused children who were patients of their institutions or the information about their abusers. That is why we decided to gather this data through perceptions of health professionals. Aim of the research was to investigate the perception of health professionals concerning the number and characteristics of child victims of abuse and abusers, as well as the phenomenology of child abuse. This phenomenological study used a quantitative method, and the technique used for data collection was a survey. The research instrument used was a questionnaire with mostly closed-ended questions. The sample included 135 doctors and nurses of both genders from the two largest and by type of organization most similar child care institutions in Serbia, the University Children's Clinic (UDC) and the Institute for Health Protection of Mother and Child 'Dr Vukan Čupić' (IMD). We tried to make a profile of the child victim of abuse based on perceptions of health workers on the form of abuse to which the child was exposed, and the age and gender of the child victims. Those children are aged between 1 and 5 years and are victims of physical abuse. Perception of health workers indicates that the most common abusers of children are members of their families.

Does Childhood Disability Increase Risk for Child Abuse and Neglect?

In this article we review the empirical evidence for the presumptions that children with disabilities are at increased risk for child maltreatment, and parents with disabilities are more likely to perpetrate child abuse and neglect. Challenges to the epidemiological examination of the prevalence of child maltreatment and disabilities are discussed. We conclude that the evidence for the relationship between child maltreatment victimization of children with disabilities and perpetration by caregivers with disabilities remains equivocal due to variability in research samples, key definitions, and study methodology. Future research examining the link between disability and child maltreatment would benefit from more rigorous methodology and inclusion of a theoretical framework, such as the ecological model of child maltreatment. One potential pathway from disability to child maltreatment is presented. Knowing and understanding the link between disability and child abuse and neglect is an important step toward planning targeted and appropriate prevention and intervention activities.

Secrecy, Betrayal and Crime

In the past few years numerous secret transgressions and crimes have been revealed in the media. Whistleblowers reveal clandestine agreements between managers and directors of large companies; criminals ( pentiti ) make deals with criminal justice officials; cyclists and athletes make public confessions about drug use; victims of sexual abuse come forward with their testimonies. In this paper, I try to analyze why attitudes about secrecy have changed in the last couple of decades and how and why so many secrets have been revealed, either by individuals who are complicit (whistleblowers or cyclists), by victims (of child abuse by the Catholic clergy) and by outsiders (WikiLeaks activists). In addition, some suggestions on the methods of criminological research in closed and isolated groups which consider such information leaks a form of betrayal are provided.

Retrospective review to determine the utility of follow-up skeletal surveys in child abuse evaluations when the initial skeletal survey is normal.

ObjectiveThe AAP recommends that a follow-up skeletal survey be obtained for all children < 24 months of age who are strongly suspected to be victims of abuse. The objective of the current study was to evaluate the utility of a follow-up skeletal survey in suspected child physical abuse evaluations when the initial skeletal survey is normal.MethodsA retrospective review of radiology records from September 1, 1998 - January 31, 2007 was conducted. Suspected victims of child abuse who were < 24 months of age and received initial and follow-up skeletal surveys within 56 days were enrolled in the study. Children with a negative initial skeletal survey were included for further analysis.ResultsForty-seven children had a negative initial skeletal survey and were included for analysis. The mean age was 6.9 months (SD 5.7); the mean number of days between skeletal surveys was 18.7 (SD 10.1)Four children (8.5%) had signs of healing bone trauma on a follow-up skeletal survey. Three of these children (75%) had healing rib fractures and one child had a healing proximal humerus fracture. The findings on the follow-up skeletal survey yielded forensically important information in all 4 cases and strengthened the diagnosis of non-accidental trauma.Conclusion8.5 percent of children with negative initial skeletal surveys had forensically important findings on follow-up skeletal survey that increased the certainty of the diagnosis of non-accidental trauma. A follow-up skeletal survey can be useful even when the initial skeletal survey is negative.

Educational paper

The emergency room (ER) represents the main system entry for crises-based health care visits. It is estimated that 2% to 10% of children visiting the ER are victims of child abuse and neglect (CAN). Therefore, ER personnel may be the first hospital contact and opportunity for CAN victims to be recognised. Early diagnosis of CAN is important, as without early identification and intervention, about one in three children will suffer subsequent abuse. This educational paper provides the reader with an up-to-date and in-depth overview of the current screening methods for CAN at the ER. Conclusion: We believe that a combined approach, using a checklist with risk factors for CAN, a structured clinical assessment and inspection of the undressed patient (called ‘top–toe’ inspection) and a system of standard referral of all children from parents who attend the ER because of alcohol or drugs intoxication, severe psychiatric disorders or with injuries due to intimate partner violence, is the most promising procedure for the early diagnosis of CAN in the ER setting.

Child sexual abuse

To evaluate the prevalence of sexual abuse in the pediatric population of the Federal District and discuss the difficulties in interpreting the examination of the genitalia in this age group, both by general practitioners as medical expert forensic officers. This is a retrospective, transversal, and epidemiological study on children younger than 12 years, who attended the Institute of Forensic Medicine of DF (IML-DF), Brasilia, Brazil, with suspicion of sexual abuse between 2008 and 2009. During this period, 3607 persons with suspected sexual abuse and 1762 (48.8%) children younger than 12 years were treated in IML-DF. Of this total, 238 (13.5%) were boys, and 1524 (86.5%) were girls. Among the boys, the average age was 6.5 years, and 9.6% were found to have injuries consistent with sexual abuse. In 43.4% of these cases, the perpetrator was known. The main lesions found were anal fissures and lacerations, bruises, and anal dilatation. In 20 cases (8.4%), the time interval between fact and examination precluded any conclusion. The girls (1524 cases) referred to the IML-DF were subjected to two types of tests: libidinous acts (773 to 50.7%) and rape (751 to 49.3%). In tests of libidinous acts, 5.3% had signs of sexual abuse perpetrated by acquaintances (68.2%), and 3.0% were inconclusive because of the long time lag between the examination and fact. In survey of rape cases, only 2.1% of subjects examined had lesions consistent with abuse. In 57 of 1524 cases, specimens were sampled for sperm test, and five cases (8.7%) showed positive results. The average age of girls being sexually abused (10.7 years) was higher than that for boys (6.5 years). Our findings confirm the discrepancy between the expectations of parents and the general practitioner, and the reality of the findings in specialized centers. Approximately 90% of child victims of abuse do not show evidence of physical damage. These were found in less than 10% of abused children. Physical signs of abuse often are difficult to recognize and should not be the only indicators.

Do Asian-American Women Who Were Maltreated as Children Have a Higher Likelihood for HIV Risk Behaviors and Adverse Mental Health Outcomes?

Objectives This study is the first to systematically investigate whether multiple child maltreatment is associated with HIV risk behaviors and adverse mental health outcomes among Asian-American women. Methods We conducted a cross-sectional study of unmarried Chinese, Korean, and Vietnamese women ( n = 400), aged 18 to 35, who are identified as children of immigrants, using computer-assisted survey interviews. Results Approximately 7 in 10 women reported having been maltreated as a child and 6.8% reported any type of sexual abuse. Only 15% of our sample reported having sex at age 16 or before, yet almost 60% had ever engaged with potentially risky sexual partners. Contrary to the findings from previous studies of White and Black women, sexual abuse plus other maltreatment was not associated with HIV risk behaviors among Asian-American women. However, it was associated with a marked increase in depression, lifetime suicidal ideation, and suicide attempts. A higher education level was associated with increased odds of HIV risk behaviors, including ever having had anal sex and ever having potentially risky sexual partners. Conclusion There was no evidence indicating that multiple child maltreatment was linked with HIV risk behaviors, but it exhibited a robust association with poor mental health outcomes. These empirical patterns of internalizing trauma, suffering alone, and staying silent are in accord with Asian-cultural norms of saving face and maintaining family harmony. The prevention of multiple child maltreatment may reduce high levels of depression and suicidal behaviors in this population. It is urgent to identify victims of multiple child maltreatment and provide culturally appropriate interventions.

Men as victims of intimate partner violence

Introduction Intimate partner violence is an important worldwide problem. In general, men are considered perpetrators of this type of violence, but they can also be victims. The experience of men as victims of intimate partner violence is not yet described and characterized in Portugal. The aim of this study is to contribute to characterize this phenomenon to better understand it, including the temporary and permanent physical harm to men’s health, in a medico-legal and forensic perspective. Material and methods This study is a retrospective analysis of 535 suspected cases of male victims of intimate partner violence, aged 18 years or older, observed in the Clinical Forensic Medicine Department of the North Branch of National Institute of Legal Medicine of Portugal, between 2007 and 2009. Results Over this period, 4646 suspected victims of intimate partner violence were examined; 11.5% ( n = 535) of them were men. Male victims’ age range was 18–89 years, with an average of 41 years; 61.5% were married; all of the documented cases had completed primary instruction; most of them were employed; 16.2% reported being victims of childhood abuse. The alleged perpetrators were all females; their age range was 19–81 years, with an average of 38 years; 9.3% had history of alcohol abuse and 12.1% had a psychiatric disorder; 11% claimed to have been abused in the childhood. Victims were married to the perpetrators in 63.9% of the cases; 81.6% had previous history of intimate partner violence, however, most of them did not report it to the authorities and only a minority sought medical care (8.1%) because of this previous abuses. Concerning the reported violent episode, the most common mechanisms of aggression were scratching (18.9%), punching (16.7%) and hit with a blunt object (16.6%). The most common injury was an abrasion; upper limbs were the most frequent injury’s location; 96.1% healed in less than 9 days; 4.9% had sequelae (scars); 36.9% sought medical care. Conclusions The reported cases of intimate partner violence against men represent 11.5% of the total of these cases observed in the medico-legal services of Porto. This number may be bigger because men tend to underreport and hide this kind of victimization, and also because injuries usually are mild (women perpetrate psychological abuse and minor acts of physical violence). Male victims may benefit from preventive and informative public policy campaigns.

Forensic nurses' experiences of receiving child abuse disclosures

A child's self-disclosure of abuse is a critical component in initiating intervention to stop abuse and decrease the likelihood of long-term negative outcomes. This study described the context in which child abuse victims disclosed to forensic nurses. Thirty interviews were conducted at the International Forensic Nurses Scientific Assembly 2007 and then analyzed using narrative inquiry methodology. Five themes emerged: child-friendly environment, building rapport, engaged listening, believing unconditionally, and the potential for false disclosures. Nurses can provide an environment that allows a child the perception of limitless time to share their unique stories.

The Cumulative Impact of Sexual Revictimization on Emotion Regulation Difficulties

The present study examined associations between child sexual abuse (CSA), adult sexual victimization, and emotion regulation difficulties in a sample of 168 incarcerated women. Approximately 50% of the participants reported CSA, 54% reported adult sexual victimization, and 38% reported sexual revictimization (i.e., CSA and adult victimization). Revictimized women reported significantly greater difficulties with several facets of emotion regulation when compared to singly victimized and nonvictimized women. Interestingly, singly victimized women did not demonstrate greater emotion regulation deficits when compared to nonvictims. Findings suggest that the negative impact of victimization experiences on adult emotion regulation abilities may be cumulative. Furthermore, they highlight the potential importance of assessing and targeting emotion regulation difficulties among child abuse and adult sexual victimization survivors.

Mortality and Child Abuse in Children Presenting With Apparent Life-Threatening Events

Children who present to the emergency department following an apparent life-threatening event (ALTE) often appear well, have a normal physical examination, and usually do well. The incidence of mortality following an event appears to occur infrequently, but has not been well described. However, it has been our experience that children who are victims of occult child abuse have a high mortality rate. Children younger than 24 months who presented to the emergency department following an ALTE were prospectively enrolled and followed up for a period of 12 months. Mortality rate was recorded. During the study period of 9 years, 563 patients were enrolled. The mean age of the patients was 2.6 months. Eleven patients (2%) were diagnosed with child abuse. Those diagnosed with child abuse were more likely to have focal findings on physical examination (54% vs 17%, P < 0.01). Three children died; the overall mortality rate was 0.5% (3/563). One of the 3 deaths was secondary to child abuse. The other 2 deaths were reported at autopsy to be secondary to sudden infant death syndrome. One of the 11 cases of child abuse ended in a death, which is a 9% mortality rate of child abuse victims who present with an ALTE. Although the subsequent mortality rate for children who present with an ALTE is low, child abuse was one of the identifiable causes of death and should be considered during evaluation of all children who present with an ALTE.

El papel del maestro y la escuela en la Protección Infantil : Detección de casos y notificación en los servicios de protección infantil en La Rioja

Currently one of the issues most frequently discussed in the professional field of child protection is the need to establish working systems that enable coordination between the different resources and institutions and between different disciplines who work around the family and children. The education system is an essential part of system resources that work with victims of child abuse. But there are many difficulties and reluctance that present the education professionals (teachers, professors, staff) to detect these situations and get involved in their resolution. This article aims to raise awareness among professionals with the triple objective of justifying its role in addressing the problem, to overcome some of the above difficulties and report on the notification procedure in the Comunidad Autónoma de La Rioja.

The Links Between Religiosity, Childhood Sexual Abuse, and Subsequent Marijuana Use

A number of studies indicate that childhood sexual abuse (CSA) has a negative impact on later psychological well-being. It is well documented that experiences of CSA are associated with depression, self-destructiveness, and subsequent substance abuse or alcohol consumption. Compared with women who experienced no such sexual abuse in childhood, women who were victims of sexual abuse in childhood were more likely to be depressed and use drugs or consume alcohol in later life. Analyzing data of 1,569 females derived from the "Longitudinal Study of Violence Against Women," this study examines whether the strain caused by sexual victimization leads to a higher level of subsequent marijuana use and whether religiosity moderates the negative effects of CSA. It was found that CSA was associated with an increased level of marijuana use in high school. However, more proximate sexual victimization (victimization in college) seemed to override the impact of CSA on subsequent marijuana use. Religiosity was found to moderate the effect of CSA on marijuana use in high school. Religiosity was negatively associated with marijuana use in high school as well as the second and fourth collegiate years. Policy implications and promising directions for future research are discussed.

Validación social de intervenciones conductuales con niños: evaluación de metas, procedimientos y resultados

This article presents the results of the application of a model to determine the social validity of a behavioral intervention program for children with behavior problems and that have been victims of child abuse. A discussion on the importance of determining the social validity of behavioral interventions as a means to evaluate the program effectiveness and in insuring that the needs of the consumers are met is presented. The assessment of the social validity of the program was conducted at three levels: 1) the degree of client's satisfaction with the treatment goals established, 2) the level of acceptability of the treatment procedures employed , 3) the overall satisfaction of the consumers with the treatment outcomes of the programo The social validity of treatment goal selection was assessed by having the parents respond to a questionnaire regarding treatment goal selection. The acceptability of treatment procedures was determined in 6 stages. In each stage, the parent rated the acceptability of a variety of behavioral procedures applied to the same behavioral problem. A written description of the use of each procedures as well a video-taped vignette illustrating its use was presented the parents. A modified version of the Treatment Evaluation Inventory (Kazdin, 1980a) was used to establish the acc~ptability scores for each procedures. Satisfaction with treatment outcomes was assessed through consumer satisfaction questionnaire that the applied to the parents after completion of each of the intervention procedures that constitute the treatment programo The results show the social validity of the program in that the high degree of satisfaction with treatment goals, a high level of acceptability with the procedures employed and overall satisfaction with treatment outcomes.