exam 1 Flashcards
1
Q
child maltreatment includes:
A
child abuse and child neglect
2
Q
child abuse
A
an act of commission
3
Q
child neglect
A
an act of omission
4
Q
Research on Maltreatment (8)
A
- only IDed children are studied
- problems with retrospective designs
- effects may not be immediately obvious-need longitudinal research
- difficult not separating effects of poverty
- inability to make causal statements
- lack of clear definitions
- secrecy surrounding maltreatment
- problems separating different forms of maltreatment
5
Q
child risk factors for maltreatment (4)
A
- sex of child
- age of child- younger more vulnerable
- difficult temperament, disabilities, intellectual impairment
- disability/delay
6
Q
t/f Females more likely to be sexually abused while males more likely to be physically abused
A
TRUE
7
Q
Parental factors (11)
A
- substance abuse
- mental illness/problematic personality traits
- lack of preparation
- younger parents
- lack of/lower education
- intergenerational transmission
- poor attachment/empathy skills
- single parents- presence of father surrogates
- domestic violence
- large family (4+) or only child
- poor family functioning
8
Q
Family problems and dysfunction (4)
A
- Failure to complete basic family tasks
- failure in dealing with changes associated with developmental tasks
- failure to deal with crises
- failure to deal with societal pressures
9
Q
extra-familial factors (3)
A
- lack of support
- socially isolated
- poverty-unemployment
10
Q
parental rights
A
Disproportionate emphasis on parents’ rights compared to rights’ of children. Allowing parents complete rights over how to raise their children is based on the assumption of adequate parenting instead of recognition of painful statistics of child maltreatment & parental failure.
11
Q
t/f some say children have negative rights?
A
true
12
Q
some say children are not protected until…
A
damage is done
13
Q
t/f Clear links between abuse & neglect and later psychological, emotional, behavioral, & interpersonal difficulties and disorders.
A
true
14
Q
abuse and neglect affects brain development in a _____ manner
A
toxic
15
Q
chronic activation may result in permanent changes in brain (3)
A
chemistry, structure, & function.
16
Q
immediate emotional effects are (3)
A
isolation, fear, inability to trust
17
Q
long term effects show increased rate of (4)
A
- psychiatric disorders
- substance abuse
- severe relationship difficulties
- social development
18
Q
Factors Affecting the Effects of Child maltreatment (4)
A
- child’s age and development when abuse started
- type of abuse
- frequency, duration, severity
- relationship btwn child and abuser
19
Q
protective factors affecting effects of child maltreatment
A
- resiliency
- family/social environment
- caring, trustworthy, strong adult relationship
20
Q
t/f healthy functioning requires integration of left and right brain, connected by corpus collosum. Abused children have smaller corpus colosum.
A
true
21
Q
behavioral issues seen in children abused (4)
A
- emotional regulation
- response flexibility
- ability for affect attunement with significant others (empathy & emotional connectedness)
- conscience development
22
Q
what is essential for the foundation of a healthy personality?
A
attachment
23
Q
environmentally induced, complex developmental disorder
A
what some call the psychological effects of abuse
24
Q
Child Abuse Prevention and Treatment Act of 1974
A
provide funding for the prevention, identification, and treatment of child abuse and neglect
25
when were first chilb abuse reporting laws in CA introduced
1963
26
year law established immunity to reporters
1980
27
forms of child abuse (5)
1. Physical
2. Endangerment
3. Neglect (general or severe)
4. Emotional
5. Sexual
28
difference btwn abuse and discipline
```
Age of the child
Area Struck
Injuries
Weapon / Implement
Mood of Parent
Reason
```
29
when to report elder abuse (3)
1. witness an incident
2. receive information or evidence, whether visual or audible
3. an elder or dependent adult discloses or describes an incident that reasonably appears to constitute abuse
30
elder reporting exceptions
1. you are a rn, md, therapist and all following true
2. told by elder they experience abuse
3. no evidence
4. diagnosed with mi, dementia or conservatorship
31
types of elder abuse 6
Physical abuse (includes sexual abuse)
Neglect
Financial abuse
Abandonment
Isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering
Deprivation by a custodian of goods or services that are necessary to avoid physical harm or mental suffering
32
physical abuse
- A physical injury inflicted by other than accidental means on a child. This refers to intentionally injuring a child – PC 11165.6.
- Any physical force or action that results in or may result in a non-accidental injury of a child.
33
Abusive head injury
- more fatalities than any other form of PA
- children <12mos. highest rate inflicted
- early mortality
- survivors have learning disabilities, blindness, seizures
34
Shaken Baby Syndrome & Shaken Impact Syndrome
Symptoms include poor feeding, vomiting, lethargy, irritability, seizures, apnea or respiratory distress, unresponsiveness
Causes – crying, abusive parents cite inconsolable crying
35
abdominal injuries
- 2nd most common cause of fatal CPA
- punching/kicking is most common
- children <2yrs
- vague histories
- delayed medical care
- higher rate compared to accidental cause
36
throat injuries
rare but serious injuries -- from insertion.
37
thoracic injuries
- chest
- observed in 12% of abused children, mostly rib fractures but also lung contusions and collapsed lung, cardiac lacerations and rupture.
38
skeletal injuries
abuse accounts for 11% to 55% of all fractures in children. In children under age 1 it is 70%. Long bones are most common. Classic Metaphyseal Lesion (CML) fracture is particularly suspicious in a child under 2.
39
skin injuries
- most common
| - bites, burns, bruises (most common pa)
40
t/f bites by adult is considered a primitive behavior
true
41
bruising
1. bruises are the most common type of abuse injuries
2. Location, size, color, and frequency must be considered
3. Size - can tell us what object or body part the child was struck and/or harmed with
4. Color - can tell us how fresh the bruise is and the force with which the child was struck
5. Frequency – how often are bruising incidents occurring?
42
t/f fractures in children under 12 mos. abuse is to be suspected
true
43
Smothering and drowning
- no immediate effect, other than PA evidence
- bruising around face/chest depending on item/force
- w/ drowning may be hand or finger bruising back, neck, or shoulders
44
poisoning
- difficult to detect
- drugs, dish liquid, gas (ammonia and bleach) other noxious substances
- symptoms- nausea, vomiting, abdominal cramping, diarrhea, unconsciousness, etc.
- redness chemical burns, bleeding around mouth
45
hair pulling
- thinning hair, bald patches
| - headaches and neck pain
46
nonphysical consequences of PA 7
1. intellectual/academic problems
2. changes in cognitive processing (hostile attributions)
3. issues with interpersonal relationships
4. aggression
5. substance abuse
6. internalizing symptoms
7. post traumatic stress disorder
47
signs of PA 7
1. Injuries
2. depression/anxiety
3. negative peer relationships
4. violence towards others
5. continued victimization
6. behavior problems
7. shaken baby syndrome/shaken impact syndrome
48
behavioral indicators of PA 9
1. Children will mirror home environment
2. Passive watchfulness, hypervigilance
3. Negative view toward life
4. Lack of joy & ability to play
5. Withdrawal
6. Some act out anger, some turn it inward
7. Low verbal skills, low self-esteem, depression
8. Lack the ability to empathize
9. Poor peer relationships
49
characteristics of PA parents (6)
1. Hyper-vigilance to child non-compliance (with limited
awareness of positive behaviors)
2. Errors in accurately interpreting child’s emotional expressions/negative interpretations of those behaviors
3. Greater then normal physiological responsivity to stress
4. Preexisting negative schemata
5. Difficulty with emotional expression & regulation
6. Also, DV, mental health issues, or substance use/abuse
50
5 tasks parents need to master
1. Meet own needs in appropriate ways
2. Separate feelings from actions
3. Limits of responsibility
4. Making decisions – parents need to be comfortable making decisions & tolerating consequences
5. Delay gratification – many expect instant obedience & gratification
51
treatment for PA MUST ADDRESS
-Parenting skills
– Distorted cognitions/attributions of both parents and children
– Development of adaptive & nonviolent coping strategies
– Development of greater emotion regulation
52
Types of treatment for PA
– Parent-Child Interaction Therapy (PCIT)
– Alternatives for Families: A Cognitive- Behavioral Therapy (AF-CBT)
– Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT)
53
barriers to treatment PA 8
1. Insufficient time
2. Stigma associated with counseling
3. Lack of transportation
4. Low income
5. Inaccessible locations
6. Lack of information regarding services
7. Child not wanting to attend
8. Unresponsive service providers
54
fetal abuse definition
Fetal Abuse is an umbrella term that describes a wide variety of behaviors. These behaviors cause harm to a fetus.
– Ingesting chemicals including drugs or alcohol
– Direct physical assault (including assault by others)
55
predicting factors of fetal abuse 3
– Drinking before the pregnancy
– History of abuse
– Exposed to violence
56
issues with determining effects of prenatal development
1. Many women are polysubstance users
2. Drugs interacting with each other can cause effects that are different than either drug used alone
3. Dramatic differences in the effects of drugs on a fetus depending on when during the pregnancy the drug was taken
4. May also be exposed to a drug-using environment when they were born and as children
57
t/f The effects of substances remain active for much longer in the fetus than in the mother (increasing the period of exposure to the fetus)
true
58
the leading cause of preventative fetal death, fetal malformations, and neurodevelopmental problems, low birth weight, and neo-natal asphyxia is
drinking alcohol during pregnancy
59
drinking during pregnancy increases risk of
spontaneous abortion (miscarriage)
60
fetal alcohol syndrome
series of birth defects such MR, dysfunction of the CNS, low birth weight, heart problems, head and face abnormalities, and growth deficiencies
61
difficulties with effects of alcohol (4)
1. hard to determine how much alcohol was consumed because data is based on estimates and self-reports
2. Also, some children of alcoholics are born without FAS
3. Low levels of consumption are believed to cause no harm
4. Even those born without FAS show signs of Fetal Alcohol Effects, including higher infant mortality and lower than average IQ
62
Most commonly used drug by women of childbearing age
marijuana
63
use of marijuana linked to (4)
– premature birth
– small birth size
– increased startle response at birth
– high pitched cry
64
effects of nicotine linked to (4)
1. low birth weight,
2. premature delivery,
3. respiratory problems,
4. SIDS
65
neglect definition
- Failure to provide the minimum requirements
for care
• Failure to provide food, clothing, shelter, protection, emotional needs, and medical care.
66
t/f Harm to a child can be just a serious – even fatal – whether the parent acts intentionally or is simply careless, ignorant, depressed, or overwhelmed.
true
67
federal government defines neglect as:
* "Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, or
* an act or failure to act which presents an imminent risk of serious harm."
68
neglect as result of (4)
– The failure or inability of the parent or guardian to adequately supervise or protect the child
– The willful or negligent failure of the parent or guardian to adequately supervise or protect the child from the conduct of the custodian with whom the child has been left
– The willful or negligent failure of the parent or guardian to provide the child with adequate food, clothing, shelter, or medical treatment
– The inability of the parent or guardian to provide regular care for the child due to the parent's or guardian's mental illness, developmental disability, or substance abuse
69
types of neglect 5
```
physical
psychological
medical
mental health
educational
```
70
physical neglect
protection from harm (supervision, guns, smoking, household conditions) or providing basics including food, shelter (expulsion, shuttling, abandonment), & clothing
71
psychological/emotional neglect
parents who are emotionally unavailable to child’s needs for warmth, comfort, love, and affection
72
medical neglect
withholding medical care
73
mental health
refusal to comply with recommended therapeutic interventions for a child with emotional and/or behavioral problems
74
educational neglect
failing to comply with education laws that, at the very minimum, require children to attend school
75
what is the most common type of maltreatment?
neglect
76
developmental consequences of neglect (8)
Perform below average on standardized intelligence tests
• Exhibit social and/or emotional problems (including hostility, aggression, & withdrawal at school)
• Under stress they are passive and tend toward helplessness
• Significant developmental delays (including language delays)
• Serious delays in academic performance in middle school
• Subsequent delinquent behaviors, including violence toward a partner
• No sense of delayed gratification
• Can cause lifetime impairment
77
what is closely associated with MH problems, negative outcomes, & the greatest amount of distress?
poly-victimization
78
critical to consider in neglect
1. Poly-victimization – closely associated with MH problems, negative outcomes, & the greatest amount of distress
2. Severity of maltreatment
3. Age of onset and duration
4. Pattern of maltreatment across stages of a child’s development
5. Must distinguish between children who are physically & emotionally neglected
79
non-organic failure to thrive
• Involves failure to grow (or survive) despite adequate nourishment
– Below 5th Percentile in weight
– Baby was once of expected height & weight
– Delay in psychomotor development
– Little affect or interest in environment
– Lack of communication/emotionally distant
• Infants and toddlers displayed extreme attention-seeking behaviors when placed out of home
• School-aged children are reported to steal, be spiteful, & selfish
• Young adolescents can be defiant, hostile, & have academic and/or behavioral problems
80
age in which typically developing children develop attachment to caregiver
6-8mos.
81
__________ is largely dependent on consistent, sensitive responses to a child’s emotional needs: comforting when distressed, playing/singing with them when they seek interaction, and allowing quiet time
when given cues they need it.
secure attachment
82
insecure avoidant attachment
child experiences chronic unresponsiveness from their parents, become overly dependent on others, lack confidence and self-esteem, not trusting of others, difficulty
establishing close relationships
83
insecure resistant attachment
child experiences unpredictable care, overly dependent on teachers for help & attention, unpopular with others, lack confidence, self-esteem, and motivation, less able to form friendships, often victims of more aggressive peers
84
secure attachment
healthy development of the self, belief that others can be counted on, the self and others can be trusted to get needs met, belief that self is lovable, worthy, and capable
85
parental/caregiver factors for neglect 4
1. Basic needs – housing, food, clothing, transportation, health care
2. Emotional support system - crucial for parents
3. Understanding of child development – specifically of key child behaviors (separation anxiety, aggression, etc.)
4. Significant influence of how parent was cared for – how a parent thinks about his/her own history
A. facing painful experiences (often in denial)
B. acknowledging the ongoing influence of the past
C. choosing what to repeat & what not to repeat
86
consequences of neglect in childhood
• Language delays
• Intellectual and academic problems • Impaired socialization
– Neglected or rejected by peers
– Lower social behaviors scores
– Low self-esteem – keeps them from seeking others
– Aggressive – will do what it takes to get attention
– Often appear dirty and may have an unpleasant smell
• Trauma-related symptoms
87
consequences of neglect in adolescents (5)
1. Runaways
2. Social isolation
3. Intellectual/academic problems
4. Delinquency
5. Psychiatric disorders
– Somatization
– Obsessive-compulsions – intrusions with ritualistic actions
– Interpersonal sensitivity
– Depression
– Anxiety - including phobic anxiety (worry about irrational fears)
– Hostility -
– Paranoid ideation – abnormal suspicion that is not based on fact
– Psychoticism - impaired contact with reality
88
protective factors for neglect (7)
o Quality parenting - often seriously disrupted in neglected children o A caring adult or alternative caregiver - can help a child pull
themselves up
o Positive peer-relationships – difficult, as they gravitate toward deviant peers
o Average to above-average intelligence
o Internal locus of control – belief that one’s behavior influences what
happens in life
o High self-esteem
o Ability to self-regulate, solve problems
89
what makes intervention difficult in neglect cases (5)
1. difficult, as case workers are overloaded
2. neglect is difficult to document
3. case coordination is difficult to coordinate & follow up
4. change needed is alien to parents of neglected children
5. parents often have few skills and minimal ability to carry out plans
90
psychological/emotional neglect
Failing to meet the psychological/emotional needs of the child
91
psychological/emotional abuse
Behaviors that actively and directly harm the child’s mental health
92
definition of emotional/psychological maltreatment
o Acts of omission and commission, by those who are in a position of power that renders the child vulnerable.
o Such acts, immediately or ultimately, damage the behavioral, cognitive, affective, and/or physical functioning of the child.
Repeated pattern of caregiver behavior or extreme incidents that convey to the children that they are worthless, flawed, unloved, unwanted, endangered, or
only of value when meeting other people’s needs.
93
Research reveals that the ___________ dimension of PA, CSA, or neglect is the most damaging to children
psychological/emotional
94
t/f Psychological/emotional abuse occurring alone is associated with effects of a severity equal to and sometimes greater than others forms of maltreatment
true
95
spurning
Hostile/rejecting – includes verbal and non-verbal caregiver acts that reject or degrade a child.
o Belittling, degrading, & other non-physical forms of overtly hostile or rejecting treatment
o Shaming and/or ridiculing the child for showing normal emotions such as affection, grief, or sorrow
o Consistently singling out one child to criticize and punish, to perform most of the household chores, or to receive fewer rewards
o Public humiliation
96
terrorizing
Caregiver behavior that threatens or is likely to physically, kill, abandon, or place the child or the child’s loved ones/objects in recognizably dangerous situations.
o Placing the child in unpredictable or chaotic circumstances
o Placing the child in recognizably dangerous situations o Setting rigid, or unrealistic expectations with threats
of loss, harm, or danger of they are not met
o Threatening or perpetrating violence against the child
o Threatening or perpetrating violence against the child’s loved ones or objects
97
isolating
Caregiver acts that consistently deny the child opportunities to meet needs for interacting/communicating with peers or adults inside or outside the home.
o Confining the child or placing unreasonable limitations on the child’s freedom or movement within his/her environment and
o Placing unreasonable limitations or restrictions on social interactions with peers or adults in the community
98
exploiting/corruption
Caregiver acts that encourage the child to develop inappropriate behaviors (self-destructive, antisocial, criminal, deviant, or other maladaptive behaviors).
o Modeling, permitting, or encouraging antisocial behaviors (initiation of criminal activities, substance abuse, prostitution, performance in pornographic media, violence to or corruption of others).
o Modeling, permitting, or encouraging of developmentally inappropriate behavior (parentification, infantilization, living the parents’ unfulfilled dreams)
o Encouraging or coercing abandonment of developmentally appropriate autonomy through extreme over-involvement, intrusiveness, &/or dominance
99
denying emotional responsiveness
Caregiver acts that ignore the child's attempts and need to interact and showing no emotion in interactions with the child.
o Being detached or uninvolved through either incapacity or lack of motivation
o Interacting only when absolutely necessary
o Failing to express affection, caring, and love for the child
100
MENTAL HEALTH, MEDICAL & EDUCATIONAL NEGLECT
Caregiver acts that ignore, refuse to allow, or fail to provide the necessary treatment for the MH, medical, or educational needs problems or needs of the child.
o Serious behavioral/emotional problems or needs of the child
o Serious physical health problems or needs of the child o Serious educational problems or needs of the child
101
impact of psychological/emotional maltreatment (5)
1. problems of intrapersonal thoughts, feelings, and behaviors
2. emotional problems
3. social competency problems and antisocial functioning
4. learning problems
5. physical health problems
102
human needs theory- maslow
Basic needs –physiological (food, clothing shelter) and psychological (safety, love, belongingness, and esteem). If these needs are not met appropriately, the child may be forced to meet them in unhealthy ways that distort development
103
psychological stage theory
o Each stage has its own tasks and conflicts. Success or failure at each stage affects the likelihood of success or failure at subsequent stages.
104
attachment theory- bowlby
o Quality of attachment has profound implications for emotional
health and interpersonal functioning
o Secure attachment to caregiver provides a “secure base” for the child to explore the world. It also facilitates a sense of trust and helps the child achieve autonomy.
o Children who experience PM are disproportionately classified with anxious of disorganized attachment.
105
parental acceptance-rejection theory- rohner and rohner
o Acceptance – parental warmth and affection
| o Rejection – emotional abuse embodied in parental hostility, aggression, indifference, and neglect
106
interventions for emotional/psychological maltreatment
Very few programs directly address EA/PM
o Incredible Years series helps with parental behaviors
o Other treatments (PCIT) can be useful and need to focus on:
o Effective discipline
o Managing problematic behavior
o Talking & playing with children
o Building positive parent-child relationships
