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Historical Timeline: 1875

Society for the Prevention of Cruelty to Children (SPCC) developed


Historical Timeline:

unexplained multiple fractures & subdural hematoma


Historical Timeline:

“The Battered-Child Syndrome” by Dr. C. Henry Kempe


Historical Timeline:

the National Center for the Prevention of Child Abuse and Neglect established


Historical Timeline:

(CAPTA) Child Abuse Prevention andTreatment Act is passed


CAPTA defines child abuse and neglect as:

"Any recent act or failure to act on the part of a parent which results in
serious physical or emotional harm,
sexual abuse or exploitation"


"An act or failure to act which presents an imminent risk of serious harm."


Historical Timeline:

First child abuse reporting law in California.
Only for physicians reporting evidence of physical abuse.


Historical Timeline:

The Child Abuse & Neglect Reporting Act (CANRA) is developed.

Expanded definition of abuse & who must report.


CARNA defines abuse and neglect as:

physical abuse,
sexual abuse (including both sexual assault and sexual exploitation),
willful cruelty or unjustified punishment,
unlawful corporal punishment or injury,
and neglect (including both acts and omissions).


Under current law, child abuse does NOT include

1) “A mutual affray between minors.”

2) “Reasonable and necessary force used by a peace officer acting within the course and scope of his or her employment as a peace officer.”

3) “An amount of force that is reasonable and necessary for a person employed by or engaged in a public school to quell a disturbance threatening physical injury to person or damage to property, for purposes of self-defense, or to obtain possession of weapons or other dangerous objects within the control of the pupil.”

4) “A child receiving treatment by spiritual means...or not receiving specified medical treatment for religious reasons, shall not for that reason alone be considered a neglected child. An informed and appropriate medical decision made by parent or guardian after consultation with a physician or physicians who have examined the minor does not constitute neglect.”


When do I report?

As a mandated reporter, all you need is a “reasonable suspicion” that abuse or neglect is occurring.


What is “reasonable suspicion?”

Reasonable suspicion means that it is “objectively reasonable for a person to entertain a suspicion, based upon facts that could cause a reasonable person in a like position, drawing, when appropriate, on his or her training and experience, to suspect child abuse or neglect”

Verbal disclosures of abuse should always be reported.


What happens if I am a mandated reporter & I have a reasonable suspicion of abuse or neglect and I don’t report?

A person who fails to make a required report is guilty of a misdemeanor punishable by up to six months in county jail and/or up to a $1000 fine


How trauma impacts a child’s brain:

100 billion ____?



How trauma impacts a child’s brain:

1,000 trillion ____?

synapses by 8 months


How trauma impacts a child’s brain:

% of core brain structures formed by age 3?



How trauma impacts a child’s brain:

What is used is ____ & what isn't is ____?

What is used is saved & what isn’t used is lost

• Experiences repeated over & over & over (i.e. - nurture)


How trauma impacts a child’s brain:

Our brain develops from the?

bottom up & inside out


How trauma impacts a child’s brain:

Changes in brain chemistry based on?


• Cortisol levels are increased when an overactive stress response occurs


3 parts of the brain:

Brain Stem
Limbic system


Parts of the brain:
Brain Stem

Basic functions that __?
Regulates __?

• keeps us alive

• temperature, heart rate, respiration, blood

• The “reptilian” part of our brain – shared with lizards

• Fight, flight, or freeze: The brain stem reacts & bypasses rational thinking for the sake of survival


Parts of the brain:

Limbic system

__ responses that __?
Amygdala stores __?

Emotional responses that guide our behaviors
• Fear, hatred, love, joy

Amygdala store emotional memories through our senses
• Memories can be triggered by certain smells, sounds,

Mammalian” brain – we share this with other mammals including cats, dogs, elephants, dolphins, etc.


Parts of the brain:


• Speech & language
• Abstract thinking
• Planning
-Cause & Effect
• Deliberate decision making
• Unique to primates


“What fires together wires together”

Which experiences have greater impact?

Early experiences have a far greater impact than later ones


What is attachment?


• Special enduring form of emotional relationship with a specific person

• Involves soothing, comfort, and pleasure

• Loss or threat of loss of the specific person evokes distress

• The child finds security and safety in the context of this relationship


Two main jobs of an attuned, securely attached caregiver

1) Increase pleasure
2) Decrease distress


4 kinds of attachment

1) Secure
2) Insecure: Ambivalent
3) Insecure: Avoidant
4) Insecure: Disorganized


1) Secure

Parent meeting most needs

Parent consistently and reliably provides adequate care

Child seeks comfort from caregiver, easily consolable


2) Insecure: Ambivalent

Parent meeting some needs

Parent goes between being attentive & preoccupied

Child has difficulty regulating – transitions are hard


3) Insecure: Avoidant

Parent meeting minimal to no needs

Parent is neglectful or dismissive of child’s needs

Child appears overly independent or autonomous


4) Insecure: Disorganized

Pathogenic care Traumatic Reactive

Parent is the source of comfort and fear

Child shows lack of consistent behavioral responses


Internal Working Model

Based on all of our interactions with others, we begin to develop a view and belief system about ourselves, others, and the world


4 Basic Needs Parents need to support

• Care
• Stimulation
• Continuity
• Reciprocity


• Care

– physical safety, food, clothing, shelter, to be clean & dry


• Stimulation

– emotional & physical interaction to learn about the world


• Continuity

– care provided consistently by the same caregivers


• Reciprocity

– interaction teaches a child s/he is valued


Erik Erikson Stages of Psychosocial Development

add here


Current society holds parents responsible for giving their children:

(7 things)

Medical care
Supervision & protection
Moral & social guidance



-Act of omission rather than an assault of act of commission
-Many types of behaviors/omissions that can be considered neglect:
1. Physical
2. Educational
3. Emotional


Physical Neglect

Failure to thrive
Inadequate supervision
Failure to meet a child’s basic physical needs:


Educational Neglect

Permitting truancy
Failure to send a child to school/enroll child in
Inattention to special education needs
& Language neglect


Language neglect

Part of educational neglect

-Parents may communicate only in commands
-Do not read to children
-Do not talk to children at length
30,000,000 word gap by 18 months to 3 years

3 T's


Emotional Neglect

-Inattention to child’s emotional needs
-Refusal to tend to serious emotional or behavioral
disorder (mental health neglect)
-Stimulation neglect (Cantwell) – inability to provide stimulation to offspring, endangers emotional/neurological development
i.e. – bottle propping (loss of touch/interaction & hand-eye coordination)


Assessing for Neglect

-Have the parents or caregivers failed to provide the child with needed care for a physical injury,
acute illness, physical disability, or chronic condition?
-Have the parents or caregivers failed to provide the child with regular and ample meals that meet basic nutritional requirements or have the parents or caregivers failed to provide the necessary, rehabilitative diet to a child with particular health problems?
-Have the parents or caregivers failed to attend to the cleanliness of the child’s hair, skin, teeth, and clothes?
-It is difficult to determine the difference between marginal hygiene & neglect. Caseworkers should consider the chronicity, extent, and nature of the condition as well as the impact on the child.
-Does the child have inappropriate clothing for the weather?
-Caseworkers should consider the nature and extent of the conditions and the potential consequences to
the child. They must also take into account diverse cultural values regarding clothing.
-Does the home have obviously hazardous physical conditions (exposed wiring or easily accessible toxic substances) or unsanitary conditions (feces- or trash-covered flooring or furniture)?
-Does the child experience unstable living conditions (frequent changes of residence of evictions due to the caretaker’s mental illness, substance abuse, or extreme poverty)?
-Do the parents or caregivers fail to arrange for a safe substitute caregiver for the child?


Child Neglect Index (CNI)
Nico Trocmé

1. Supervision

2. Physical Care
-Clothing & Hygiene

3. Provision of Health Care
-Physical Health Care
-Mental Health Care
-Developmental & Educational Care


Causes of Neglect

1. Economical
(neglect is a response to stress & poverty is an all-pervasive stress)

2. Ecological
(the individual as part of & interacting with the environment)
-Neighborhood, culture & society

3. Personalistic Individual
(development of the individual parent & how s/he has learned to process information)
-How we process information we receive from the world influences how we relate to the world & how we behave


Symptoms & Effects of Neglect

Infancy & Early Childhood

1. Nonorganic Failure to Thrive
- Below 5th percentile in weight
- Baby was once at expected weight
- Delays in psychomotor development
- Poor ability to suck
- Little interest in food
- “Unlovable”/unwilling to be held
2. Poor muscle tone
3. Hair rubbed off back of
head/back of head flattened
4. Unwilling to make eye contact 5. Do not smile, babble, or squeal


Symptoms & Effects of Neglect

Young Children

Poor motor skills
Language development delays
Flat affect
Extreme passivity
Short attention span
Impaired socialization
Inability to delay gratification

ADOLESCENTS: Early emancipation


Neglectful Parents


- Isolated

- Impossible to recognize/meet needs of child

- Indifferent

- Discipline out of need for quiet/convenience rather than concern for teaching child

- Poor capacity to problem solve or set goals for the future

- Less involved with others, less able to control impulses, less verbally accessible, less able to organize or plan, less equipped with pride in accomplishments or workmanship

- Lack of knowledge, lack of judgment, lack of motivation (Cantwell)


Personalities of Neglectful Mothers (Polansky & colleagues)

Apathetic-Futile – seem to have given up on living

Impulse Ridden – low frustration tolerance, inability to delay gratification, uses poor judgment in actions

Developmentally Disabled – supervision/education may be needed

Reactive-Depressive – inability to adjust to life changes & resultant depression

Psychotic – delusional thinking/hallucination à inconsistent caregiving


Issues in treatment

-Pervasive, generational histories
-Antisocial behavior
-Families are difficult to engage
-Families do not always follow through
-Families are not always eligible for treatment by appropriate agencies
-Resources to treat may be limited
-Treatment methods are not sufficiently refined to ensure success


What can help? (Treatments)

1. Offer something tangible the client wants

2. Attachment to case worker/therapeutic
relationship (difficulty trusting)

3. Model appropriate behavior

4. Visiting nurse/”lay” therapists/parent aides & partners/anyone who can coach the parent – give support, guidance & advocacy
- Shows the parent that someone cares!
- “Parent” the parent

5. You can only give what you’ve received


Two treatment models

Equilibrium Maintenance

Disequilibrium Techniques


Equilibrium Maintenance

- Remind of “normal”

- Challenge parenting


Disequilibrium Techniques

- Help assist in reestablishing
- Removal from home


Bruce on 4yo Laura & Mom Virginia

Children who don’t get

consistent, physical affection
or the chance to build loving bonds don’t receive

the patterned, repetitive stimulation

necessary to properly build the systems in the brain that connect reward, pleasure and human-to-human interactions


Bruce on Peter's brain

Adjust how you treat him based on the level he's at

Developmentally, he is a moving target


Bruce on Leon's brain

But because he’d been neglected when key social circuitry of the brain was developing

he couldn’t really appreciate the pleasure of pleasing someone else or receiving their praise,

nor did he suffer particularly from the rejection that followed if his behavior displeased teachers or peers having failed to develop an association between people and pleasure,

he saw no need to do as they wished, felt no joy in making them happy, and didn’t care whether or not they got hurt


“Theory of Mind”

-Other people are distinct from oneself

-Other people have different
knowledge about the world

-Other people have different desires and interests



- Inability to empathize

- Difficulty mirroring the feelings of others

-Lack of compassion for them

~ They don’t recognize what others feel & don’t care if they hurt them (may even desire to do so).


Cortisol - the stress hormone

Early trauma + genetic variability = dysregulated stress systems

(no longer responsive to anything except extreme stimulation)


The Golden Ticket

Patterned, repetitive experience in a safe and predictable environment

(plus Mama P’s physical affection & stimulation)


What is the Neurosequential Model of Therapeutics? (NMT)

Primary assumption of NMT: The human brain is the organ that mediates all emotional, behavioral, social, motor, and neuro-physiological functioning (All of these areas can be impacted)

Trauma/neglect cause abnormal organization & function of important parts of the brain & compromise the functional capacities of these systems throughout life


NMT: Impacts of early abuse:

- Extreme anxiety,
- Hyper-vigilance,
- Persistently activated threat response


The brain heals from...


- The brain stem up

The number of repetitions required to change the brainstem is far greater than the number required to change the cortex – it is easier to change beliefs than feelings

Any clinical effort to treat symptoms related to higher parts of the brain without first regulating the brains stem will be insufficient or unsuccessful


Neurosequential Model of Therapeutics (NMT)

Ultimate goal

= matching biological age and developmental age

- Match the developmental period at which the damage first started

- Use enrichment experiences and targeted therapies to help the brain areas which were affected by neglect and trauma

- After improved functioning, move on to next brain region & developmental stage