There is widespread concern that the COVID-19 pandemic has increased the incidence of child maltreatment. However, reports in the scientific literature documenting rates of child maltreatment during ...this period are scarce. This study was designed to explore whether the incidence of child maltreatment among patients presenting to a pediatric emergency department has increased during the COVID-19 pandemic.
We conducted a retrospective review of patients of all ages presenting to a pediatric Emergency Department trauma center, who also had a child abuse report filing or a sentinel injury diagnosis related to their index visit. All such patients who presented to this institution from March through July of 2017 through 2020 were included in the study.
Analysis demonstrated an increase in the incidence of child maltreatment in May and June of 2020 and that there was an overall shift in distribution of types of child maltreatment during the COVID-19 pandemic. There was a significant increase in the proportion of emotional/psychological abuse (2.52 % before the pandemic to 7.00 % during the pandemic, p ≤ 0.0001) and non-medical neglect (31.5%–40.0%, p ≤ 0.0001).
We observed an increase in specific types of child maltreatment during the COVID-19 pandemic. These findings highlight the need for increased attention to children at risk for child abuse and neglect.
Unilateral spatial neglect (USN) may lead to poor functional rehabilitation outcomes. However, studies investigating the rehabilitation outcomes of right-sided USN are lacking. We aimed to ...investigate (1) the clinical impacts of USN, including right-sided USN, for stroke patients in sub-acute rehabilitation, and (2) evaluate the differences in clinical characteristics and rehabilitation outcomes between right- and left-sided USN patients. We retrospectively screened the medical records of 297 inpatients at the Tokyo-Bay Rehabilitation Hospital who experienced a cerebrovascular accident with supratentorial lesions between January 1st, 2014 and December 31st, 2016. We performed independent multiple regression analysis in patients with left and right hemisphere damage. The Behavioral Inattention Test was a significant independent variable for predicting the motor, cognitive, and total functional independence measure (FIM), compared to the Stroke Impairment Assessment Set and Mini-Mental State Examination. USN affects motor FIM recovery more than cognitive FIM recovery regardless of the damaged hemisphere. Our study results confirm that both right- and left-sided USN influence the functional recovery of stroke patients. USN occurs, slightly less frequently, following a left hemisphere stroke. However, USN negatively affected rehabilitation outcomes, regardless of the neglected side. Therefore, USN treatment is necessary for patients with left and right hemisphere damage.
Abstract Objective Theoretically, exposure to experiences of emotional abuse (EA) and emotional neglect (EN) in childhood may threaten the security of attachment relationships and result in ...maladaptive models of self and self-in-relation to others. The purpose of this study was to explore the extent to which EA and EN treatment by parents contributed uniquely to young adult maladaptive long-term outcome with respect to symptoms of anxiety, depression, and dissociation. The extent to which the relationships between EA and EN and later symptoms were mediated by specific internalized maladaptive interpersonal schemas was also explored. Methods Questionnaires completed by 301 college men and women (52% female) assessed perceptions of experiences of childhood abuse and neglect, exposure to parental alcoholism, current symptoms of psychological distress, and endorsement of maladaptive interpersonal schemas. Results Hierarchical regression analyses revealed that perceptions of childhood EA and EN each continued to exert an influence on later symptoms after controlling for gender, income, parental alcoholism, and other child abuse experiences. Both EA and EN were associated with later symptoms of anxiety and depression and were mediated by schemas of vulnerability to harm, shame, and self-sacrifice. Only EN was related to later symptoms of dissociation; this relationship was mediated by the schemas of shame and vulnerability to harm. Conclusion The findings are discussed from an attachment perspective, focusing on how early interactions with parents contribute to the development of internal working models of self and self-in-relation to others that influence later cognitive schemas and psychological adjustment. Practice implications Although emotional abuse and emotional neglect are the least studied of all forms of child maltreatment, they may be the most prevalent. The current findings suggest that how college students have evaluated and internalized these experiences may be even more important than the events themselves in determining the extent to which these experiences exert a long-term impact. For this reason, early intervention might be particularly important in helping to modify internal working models of the self as worthless, others as abusive, or the world as threatening and dangerous as a result of past abuse experiences. This study underscores the need for counselors to actively elicit and explore experiences of emotional abuse and neglect in clients, in addition to inquiring about other abuse experiences and types of family dysfunction. The results of this study also support existing data suggesting that internalized representational models of self and others are a key mechanism underlying the relationship between emotional maltreatment and later psychopathology. Young's schema questionnaire proved to be quite sensitive in detecting specific maladaptive schemas that mediated later difficulties with depression, anxiety, and dissociation. Targeting these negative schemas in therapy may help to ameliorate such symptoms. The therapeutic relationship provides a particularly effective context for developing more positive models of self and others, as well as providing a context to explore core relationship themes across different relationship contexts (e.g., intimate partner, parent, friend, and work relationships). In particular, if the assessment of the client reveals that dissociative symptoms are present, counselors can acknowledge the adaptive function that this strategy once served, while also addressing potential limitations to over-reliance on this coping strategy.
Prior research typically focuses on a single child (“index” victim) when measuring child abuse and neglect (CAN) using Child Protective Services (CPS) records. However, excluding siblings has the ...potential to underestimate estimates of the prevalence, severity, and chronicity of CAN in the household, which includes all children in the family. CPS maltreatment records were searched in 2005 for 366 “index” victims who were surveyed for 5 consecutive years (from 1998 to 2002) for the Mobile Youth Survey (MYS) as well as other siblings in the household. The estimate of prevalence of CAN in the household increased by 10% when sibling(s) in the household were included in the CPS search. In addition, prevalence of sexual abuse in the household increased by 38% when siblings were included in the broader search of CPS records. More importantly, including sibling victims of CAN uncovered incidents of maltreatment that occurred before the birth of the targeted MYS “index” victim. In short, the inclusion of abuse and neglect of siblings is a straightforward and intuitive way to improve estimates of abuse and neglect in the household. More importantly, the age of onset of CAN of sibling victims provides a wider window of opportunity to identify at-risk families for targeted interventions and may represent a critical stepping stone toward the primary prevention of CAN in the household.
The present study established the norms of the 3 s Spreadsheet Test version 2 (3S-v2 Test) with 186 healthy adults, compared performance of 23 individuals with spatial neglect after right brain ...stroke to the norms, and examined the extent that allocentric neglect is independent from egocentric neglect. The task required in the 3S-v2 Test is to cross out the target digit "3" in a spreadsheet that contained 10 columns and 14 rows of digit strings, including 120 target digits and 720 non-target digits. Each target is categorized with respect to its location on the page (egocentric viewer-centered) and its position within the digit string (allocentric stimulus-centered). Patients completed the 3S-v2 Test, the Apples Test, and Scene Copying Test (a five-object figure copying test). Based on the neglect classification criteria of these three tests, 18 patients (78.3%) were identified with both forms of neglect, three patients (13.0%) had isolated egocentric neglect, and two (8.7%) had isolated allocentric neglect. Among patients who were determined as having allocentric neglect by a given test, we found no significant correlation between severity of allocentric neglect and stimulus location in the egocentric reference frame. Based on the present findings, we suggest that including the 3S-v2 Test, a functionally relevant task and different from the currently available tests, may increase the comprehensiveness of neglect assessment. In addition, allocentric neglect symptoms are independent of egocentric locations.
Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of ...the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature.
We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores.
192 unique samples consisting of 68,830 individuals.
We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis.
We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95–1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32–.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations.
These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.
Background
Childhood maltreatment is the most important preventable cause of psychopathology accounting for about 45% of the population attributable risk for childhood onset psychiatric disorders. A ...key breakthrough has been the discovery that maltreatment alters trajectories of brain development.
Methods
This review aims to synthesize neuroimaging findings in children who experienced caregiver neglect as well as from studies in children, adolescents and adults who experienced physical, sexual and emotional abuse. In doing so, we provide preliminary answers to questions regarding the importance of type and timing of exposure, gender differences, reversibility and the relationship between brain changes and psychopathology. We also discuss whether these changes represent adaptive modifications or stress‐induced damage.
Results
Parental verbal abuse, witnessing domestic violence and sexual abuse appear to specifically target brain regions (auditory, visual and somatosensory cortex) and pathways that process and convey the aversive experience. Maltreatment is associated with reliable morphological alterations in anterior cingulate, dorsal lateral prefrontal and orbitofrontal cortex, corpus callosum and adult hippocampus, and with enhanced amygdala response to emotional faces and diminished striatal response to anticipated rewards. Evidence is emerging that these regions and interconnecting pathways have sensitive exposure periods when they are most vulnerable.
Conclusions
Early deprivation and later abuse may have opposite effects on amygdala volume. Structural and functional abnormalities initially attributed to psychiatric illness may be a more direct consequence of abuse. Childhood maltreatment exerts a prepotent influence on brain development and has been an unrecognized confound in almost all psychiatric neuroimaging studies. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex as they are discernible in both susceptible and resilient individuals with maltreatment histories. Mechanisms fostering resilience will need to be a primary focus of future studies.
Childhood maltreatment is the most important preventable cause of psychopathology, accounting for about almost half of the risk for childhood onset psychiatric disorders. A key discovery is that maltreatment alters trajectories of brain development. This review synthesizes neuroimaging findings in children who experienced caregiver neglect, as well as from studies in young people and adults who experienced physical, sexual and emotional abuse. Key findings are that childhood maltreatment is associated with consistent alterations in key regions of the brain and maltreatment is consistently associated with enhanced amygdala response to threatening stimuli and diminished striatal response to anticipated reward. Brain regions and pathways affected are predominantly part of circuits regulating threat detection and reward anticipation, with exposure to single types of abuse associated with specific alterations that convey the aversive experience. These brain changes may be best understood as adaptive responses to facilitate survival and reproduction in the face of adversity. Their relationship to psychopathology is complex, however, as they are discernible in both susceptible and resilient individuals with maltreatment histories. Future studies will need to focus on mechanisms fostering resilience.
Read the Commentary on this article at doi: 10.1111/jcpp.12540
Dental neglect among children in Chennai Gurunathan, Deepa; Shanmugaavel, Arunachalam
Journal of the Indian Society of Pedodontics and Preventive Dentistry,
10/2016, Volume:
34, Issue:
4
Journal Article
Peer reviewed
Open access
Background: Child dental neglect is the failure of a parent or guardian to meet the child′s basic oral health needs such that the child enjoys adequate function and freedom from pain and infection, ...where reasonable resources are available to family or caregiver. Aim: The aim of the study is to evaluate the phenomenon of dental neglect among children in Chennai and to associate dental neglect with oral health status of children aged 3-12 years. Materials and Methods: This is a cross-sectional study involving 478 pairs of parents and children. Dental neglect scale and a questionnaire were used to assess the dental neglect score among parents of the children involved in the study. Oral health status of children was clinically assessed using oral hygiene index, decayed, extracted, filled teeth (def(t)), pulp, ulcers, fistula, abscess (pufa), decayed, missing, filled teeth (DMFT), PUFA as per the World Health Organization criteria and pufa/PUFA index. Student′s t-test and one-way ANOVA were used appropriately for statistical analysis using SPSS software version 20.0. Results: A significant higher dental neglect score was reported among the parents who reside in the suburban location (P < 0.001), whose educational qualification was secondary (P < 0.001) and who have not availed any dental service for >3 years (P = 0.001). A significant higher DMFT (P = 0.003), deft (P = 0 < 0.001), pufa (P = 0.011), and debris index (P = 0.002) scores were seen in the higher dental neglect group. Conclusion: Child dental neglect is seen among the parents whose educational qualification was secondary, who reside in the suburban location, and who have not utilized the dental services for more than 3 years in Chennai. This dental neglect results in poorer oral health of children.
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