Child maltreatment: a global issue

Perceived Acceptability of Child Maltreatment as a Moderator of the Association Between Experiences of Child Maltreatment and Post-Traumatic Symptoms: A Cross-Cultural Study

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator.

Comparing sentencing judgments of judges and laypeople: The role of justifications

There is a lack of understanding concerning the differences between laypeople's and professional judges' conceptions of justifications for sentencing. We conducted an online quasi-experimental study with 50 active judges and 200 laypeople. Participants were presented with a vignette describing severe child abuse leading to fatality and were asked to indicate a term of imprisonment for the father and the justification they would consider relevant when deciding on the sentence. A two-factor analysis of variance showed that laypeople disproportionately favored retribution compared to judges. This was reflected in the judges' higher scores for the other three justifications (incapacitation, general deterrence, rehabilitation). The Likert scales failed to detect any such differences. Furthermore, imprisonment terms given by judges were shorter than those given by laypeople. These results support the hypotheses that judges balance multiple justifications and find a shorter sentence that is appropriate; their lesser bias toward retribution supports the notion that judges should be balanced and fair-minded.

Perceptions of Speech-Language Pathologists' Service Provision in the Opioid Epidemic: A Focus Group Study

PURPOSE

This research intended to identify current practices being implemented with children who have a history or suspected history of opioid exposure, as well as challenges faced by speech-language pathologists in the schools.

METHOD

Focus group data from three groups totaling 20 speech-language pathologists (SLPs) working in schools in West Virginia, also used in a previous study, were analyzed using qualitative thematic analysis to better understand SLP service provision to children with a history or suspected history of opioid exposure.

RESULTS

Results revealed two primary themes, reported as (a) service delivery in action (current practice trends and challenges) and (b) affective/cognitive manifestations (uncertainty about their role and various emotions expressed) of the SLPs who participated in the focus groups.

CONCLUSIONS

This study revealed important clinical implications derived from the reports of participants. Particularly, the importance of communication and advocacy in the care of these children and the need to rethink what our scope of practice means when working with this vulnerable population are discussed.

Creative Interventions for Preparing and Disclosing Trauma Narratives in Group Therapy for Child Sexual Abuse

Group therapy is a widely utilized and empirically supported treatment for victims of child sexual abuse (CSA). An important aspect of trauma-focused groups for CSA is the composition and presentation of a trauma narrative as part of a gradual exposure process. One challenge in the creation of a trauma narrative in group is the contagious avoidance that may be present if group members are reluctant to engage in the development of a trauma narrative. Creative group therapeutic interventions can assist in mitigating avoidance, a hallmark of posttraumatic stress disorder (PTSD), by reducing resistance to constructing and processing the trauma narrative in CSA group treatment. Additionally, creative expressive arts interventions are a developmentally tailored approach to trauma narratives for young children with limited language as well as for traumatized youth who do not have words accessible to describe their CSA. This manuscript presents a wide array of creative therapeutic activities that can be utilized for creation and processing of the trauma narrative and facilitating cohesion and coping in group therapy for CSA. Using these expressive arts techniques can support youth in preparing for the trauma narrative and providing a space to process their CSA.

Service Organisations’ Cultural Competency When Working with Ethnic Minority Victims/Survivors of Child Sexual Abuse: Results from a Program Evaluation Study in Australia

Founded in the results of a systematic literature review, a professional development program was developed about the needs of ethnic minority victims/survivors of child sexual abuse, with one component on the role of organisations. The objective was to address the misperception that frontline workers are more responsible for cultural competency. The program was delivered across Australia in 2019 (T1 n = 112, T2 n = 44). Data collection for the program evaluation was conducted over six months using a mixed-methods design. The results show that: (a) a sizeable portion of organisations (16%) do not have any ethnic minority staff, and very few are in management positions (6–13%); (b) ethnic minority staff, and staff in organisations specialised for ethnic minority communities, offer choice to clients about ethnically-matched service providers more often; (c) there is evidence supporting the usefulness of ongoing training; (d) the use of a multicultural framework was rated higher ‘in principle’ than ‘in practice’, and ratings increased after the program; (e) the proportion of organisations collecting ethnicity-related data did not increase over time; (f) all organisations specialised for ethnic minority communities had visually inclusive websites but was only 54% for mainstream organisations; and (g) organisations specialised for ethnic minority communities have stronger links with other local ethnic minority community organisations. Overall, the program is seen as useful for promoting cultural competency at the organisational level; clearly identifying key mandatory and ideal elements, which support good practice with this highly vulnerable and marginalised client group.

A Pilot Study of a 6-Week Parenting Program for Mothers of Pre-school Children Attending Family Health Centers in Karachi, Pakistan

BACKGROUND

Recently, parenting programs to address behavioural and emotional problems associated with child maltreatment in developing countries have received much attention. There is a paucity of literature on effective parent education interventions in the local context of Pakistan. This study aimed to assess the feasibility of offering a 6-week parenting program for mothers of pre-school children attending family health centres (FHCs) in Karachi, the largest metropolitan city of Pakistan.

METHODS

A pilot quasi-experimental trial was conducted. Two FHCs were selected, one as the intervention and the second as the control. A total of 57 mothers of pre-school children (n = 30 intervention; n = 27 control) participated in this study. Mothers in the intervention group received SOS Help for parents module, while mothers in the control group received information about routine childcare. A parenting scale (PS) was administered before the program was implemented and repeated 2 weeks after the program was completed in both groups. Statistical analysis was performed to compare participants' attributes. Descriptive analysis was conducted to compare pre- and post-test mean scores along with standard deviation for parenting subscales in the intervention and control groups.

RESULTS

A total of 50 mothers (n = 25 intervention; n = 25 control) completed the 6-week program. Attrition was observed as 5/30 (17%) in the intervention arm and 2/27 (2%) in the control arm. Mothers commonly reported the burden of daily domestic and social responsibilities as the main reason for dropping out. Furthermore, the majority of participants in the control group recommended increasing the duration of weekly sessions from 1 to 1.5 hours, thereby decreasing the program period from 6 to 4 weeks. Mothers in intervention group reported substantial improvement in parenting skills as indicated by mean difference in their pre- and post-test scores for laxness and over-reactivity.

CONCLUSION

Parenting programs can be implemented for mothers attending FHCs in Pakistan. Mothers require positive reinforcement and constant encouragement at the participant level. Integrating such programs into primary healthcare at the population level has the potential to maximize child health benefits and to improve parenting skills at the country level.

Exploring child maltreatment and its relationship to alcohol and cannabis use in selected Latin American and Caribbean countries

OBJECTIVES

Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. A working group constituted by the Inter-American Drug Abuse Control Commission and the Center for Addiction and Mental Health in June, 2010 identified research on this relationship as a priority area for a multinational research partnership.

METHODS

This paper examines the association between self-reported child maltreatment and use in the past 12 months of alcohol and cannabis in 2294 university students in seven participating universities in six participating countries: Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay. The research also considers the possible impact of religiosity and minimal psychological distress as factors contributing to resiliency in these samples.

RESULTS

The results showed that experience of maltreatment was associated with increased use of alcohol and cannabis. However, the effects differed depending on the type of maltreatment experienced. Higher levels of religiosity were consistently associated with lower levels of alcohol and cannabis use, but we found no evidence of an impact of minimal psychological distress on these measures.

CONCLUSIONS

This preliminary study shows that the experience of maltreatment may increase the risk of alcohol and cannabis use among university students in Latin American and Caribbean countries, but that higher levels of religiosity may reduce that risk. More work to determine the nature and significance of these relationships is needed.

Oral Language Competence, Young Speakers, and the Law

Purpose

This paper highlights the forensic implications of language impairment in 2 key (and overlapping) groups of young people: identified victims of maltreatment (abuse and/or neglect) and young offenders.

Method

Two lines of research pertaining to oral language competence and young people’s interface with the law are considered: 1 regarding investigative interviewing with children as victims or witnesses in the context of serious allegations of sexual abuse, and the other pertaining to adolescent offenders as suspects, witnesses, or victims. The linguistic demands that forensic interviewing places on these young people are also considered. Literature concerning the impact of early maltreatment on early language acquisition is briefly reviewed, as is the role of theory of mind in relation to the requirements of investigative interviewing of children and adolescents.

Implications

High-risk young people (i.e., those who are subject to child protection orders because of suspected or confirmed maltreatment, and those who are engaged with the youth justice system) face an elevated risk for suboptimal language development but may need to draw on their language skills in high-stakes forensic interviews. Implications for early intervention policy and practice are identified, and the need for greater speech-language pathology advocacy and engagement in forensic interviewing research is emphasized.

Complex Trauma and Prenatal Alcohol Exposure: Clinical Implications

Complex trauma resulting from chronic maltreatment and prenatal alcohol exposure can significantly affect child development and academic outcomes. Children with histories of maltreatment and those with prenatal alcohol exposure exhibit remarkably similar central nervous system impairments. In this article, I will review the effects of each on the brain and discuss clinical implications for these populations of children.

Effects of placement type on the language developmental trajectories of maltreated children from infancy to early childhood

This study describes the developmental trajectories of language skills in infants with substantiated maltreatment histories over a 5-year period and evaluates the effect of three different custodial placements on their language trajectories over time: in-home (remaining in the care of the biological parent/parents), nonkin foster care, and nonparental kinship care. Participants included 963 infants reported to child protective services prior to their first birthday and whose maltreatment was substantiated. Results from covariate-controlled growth modeling revealed no significant placement effects. Across all groups, children's auditory and expressive communication scores decreased significantly from Wave 1 (intake) in the infants' first year to Wave 4, when children were about 3.5 years of age, then improved to baseline levels by Wave 5, when children were about 6 years old. Despite these fluctuations, children's average language scores in each placement group remained below the population mean at each wave of the study.

Parental violence and adolescent mental health

Being the target of parental violent acts decreases child adjustment and increases the likelihood of mental health problems in childhood and adolescence. Our study analyses how different types of parental violence ranging from verbal threats and swearing to hitting and kicking a child, are associated with child adjustment, indicated by strengths and difficulties scale (SDQ) total problem score, internalizing and externalizing problems as well as prosocial behaviour. We also study whether girls and boys and youths in two Nordic countries respond differently to parental violence. The data consists of a large-scale community sample of 15-16-year old Finnish (n = 5,762) and Danish (n = 3,943) adolescents. The representative data of continental Finland and its Finnish and Swedish speaking ninth graders as well as representative data of Danish ninth grade pupils were collected by the Police College of Finland and in Denmark by the National Institute of Public Health, University of Southern Denmark. The results show a clear dose-response effect between parental violent behaviour and the adolescent's problems. The more severe forms of parental violence were associated with higher levels of SDQ total difficulties and internalizing and externalizing symptoms. There was also a connection between parental violence and the deterioration of prosocial behaviour. The association was gender and nationality specific. The findings imply a high prevalence of parental violence and adverse mental health among the affected Finnish and Danish adolescents. Though the laws have been set in motion to prevent the use of parental physical violence the challenges remain in several domains of child protection, general health care, prevention and intervention.

Collaborative services: children experiencing neglect and the side effects of prenatal alcohol exposure

PURPOSE

The purpose of this article is to provide critical knowledge regarding children who are served by the child welfare system and how these children's specialized needs affect speech-language services. Specifically, the structure of social services system models is presented, with an emphasis on the cultural and systemic interactions between service providers and families. In addition, the role of special education for children who have experienced abuse, neglect, and prenatal drug or alcohol exposure is presented, with an emphasis on social service and special education legal issues.

METHOD

This article provides a critical analysis of the research literature to date regarding effective tools for providing collaborative intervention to children who are experiencing fetal alcohol syndrome disorder or abuse and/or neglect.

CLINICAL IMPLICATIONS

This article provides suggestions about the collaborative roles that speech-language pathologists should integrate into treatment milieu when delivering therapy to children with histories of abuse, neglect, and prenatal drug or alcohol exposure.

Prologue: Understanding Children Who Have Been Affected by Maltreatment and Prenatal Alcohol Exposure

This prologue introduces an important topic for multiple disciplines involved with children and their families. This introduction includes a review of some of the current literature on the effects of maltreatment and prenatal alcohol exposure on child development, an explanation of why this topic is essential learning for communication professionals, prevalence figures for the occurrence of these effects, and a summarization of the articles that have been contributed by a cross section of researchers from various disciplines.

Epilogue: Understanding Children Who Have Been Affected by Maltreatment and Prenatal Alcohol Exposure: Future Directions

This epilogue summarizes the six articles presented in the clinical forum focused on understanding children who have been affected by maltreatment and prenatal alcohol exposure. It presents common themes that emerged among the articles and future research directions.