Examining Cases of Child Physical Abuse Evaluations to Identify Opportunities to Improve Intimate Partner Violence Screening in Pediatric Emergency Departments

The association between child maltreatment and intimate partner violence (IPV) is well supported. Universal IPV screening has been recommended by the American Academy of Pediatrics and the United States Preventative Task Force, and many children's hospitals have established screening protocols. However, the yield and best screening method in families undergoing a child physical abuse (PA) evaluation have not been fully explored. To determine if there is a discrepancy in IPV disclosures between universal IPV screening completed during pediatric emergency department (PED) triage ("triage screening") and IPV screening by a social worker ("social work screening") in families of children who were evaluated for PA. Caregivers of children who presented to an urban tertiary PED and underwent an evaluation for PA via a child abuse pediatrics consult. A retrospective chart review was completed. Data collection included: caregiver responses to both triage screening and social work screening, interview setting details and participants, the child's injuries, and details of the family's reported IPV experiences. Our study (N = 329) revealed that social work screening produced significantly more positive IPV disclosures than triage screening (14.0% vs. 4.3%, p < .001). Additionally, non-IPV violence concerns were identified in 35.7% (n = 5) of the positive triage screens, whereas social work screens had none. These results highlight the benefits of IPV screening by social work in high-risk scenarios, such as child PA evaluations, regardless of universal IPV screening results. Exploring differences between the two screening methods can inform decisions about screening protocols to improve IPV identification in high-risk populations.

Prevalence and correlates of neurocognitive impairment and psychiatric disorders among schoolchildren in Wakiso District, Uganda: a cross-sectional study

Background: There is limited data on the burden of mental disorders among children in the general population in Africa. We examined the prevalence and correlates of neurocognitive and psychiatric disorders among schoolchildren in Uganda. Methods: This cross-sectional study enrolled 322 schoolchildren aged 5-17years in Wakiso, Uganda. We assessed for neurocognitive impairment using the Kaufmann-Assessment-Battery, and psychiatric disorders (major-depressive-disorder (MDD), attention-deficit-hyperactivity-disorder (ADHD), generalised-anxiety-disorder (GAD), and substance-use-disorder (SUD)) using the parent version of the Child and Adolescent Symptom Inventory-5, and Youth Inventory-4R Self Report. Prevalence and risk factors were determined using respectively descriptive statistics, and univariable and multivariable logistic regression. Results: Twenty-five participants (8%) had neurocognitive impairment. Nineteen (5.9%) participants had MDD, nine (2.8%) had ADHD, seven (2.2%) had GAD, 14 (8.6%) had SUD; and 30 (9.3%) had any psychiatric disorder. Among the exposure variables examined in this study, including asthma, age, sex, grade of schooling, type of school and maternal and father's education and family socio-economic status, only asthma was associated with the disorders (MDD). Conclusions: The relatively high burden of mental disorders in this general population of children warrants targeted screening of those at risk, and treatment of those affected. Further, future studies should extensively investigate the factors that underlie the identified psychiatric disorders in this and similar general populations.

Prevalence and correlates of neurocognitive impairment and psychiatric disorders among schoolchildren in Wakiso District, Uganda: a cross-sectional study

Background: There is limited data on the burden of mental disorders among children in the general population in Africa. We examined the prevalence and correlates of neurocognitive and psychiatric disorders among schoolchildren in Uganda. Methods: This cross-sectional study enrolled 322 schoolchildren aged 5-17years in Wakiso, Uganda. We assessed for neurocognitive impairment using the Kaufmann-Assessment-Battery, and psychiatric disorders (major-depressive-disorder (MDD), attention-deficit-hyperactivity-disorder (ADHD), generalised-anxiety-disorder (GAD), and substance-use-disorder (SUD)) using the parent version of the Child and Adolescent Symptom Inventory-5, and Youth Inventory-4R Self Report. Prevalence and risk factors were determined using respectively descriptive statistics, and univariable and  multivariable logistic regression. Results: Twenty-five participants (8%) had neurocognitive impairment. Nineteen (5.9%) participants had MDD, nine (2.8%) had ADHD, seven (2.2%) had GAD, 14 (8.6%) had SUD; and 30 (9.3%) had any psychiatric disorder. Among the exposure variables examined in this study, including asthma, age, sex, grade of schooling, type of school and maternal and father's education and family socio-economic status, only asthma was associated with the disorders (MDD). Conclusions: The relatively high burden of mental disorders in this general population of children warrants targeted screening of those at risk, and treatment of those affected. Further, future studies should extensively investigate the factors that underlie the identified psychiatric disorders in this and similar general populations.

Prevalence and correlates of neurocognitive impairment and psychiatric disorders among schoolchildren in Wakiso District, Uganda: a cross-sectional study

Background: There is limited data on the burden of mental disorders among 'healthy' children in Africa. We examined the prevalence and correlates of neurocognitive and psychiatric disorders among schoolchildren in Uganda. Methods: This cross-sectional study enrolled 322 schoolchildren aged 5-17years in Wakiso, Uganda. We assessed for neurocognitive impairment using the Kaufmann-Assessment-Battery, and psychiatric disorders (major-depressive-disorder (MDD), attention-deficit-hyperactivity-disorder (ADHD), generalised-anxiety-disorder (GAD), and substance-use-disorder (SUD)) using the parent version of the Child and Adolescent Symptom Inventory-5, and Youth Inventory-4R Self Report. Prevalence and risk factors were determined using percentages and logistic regression. Results: Twenty-five participants (8%) had neurocognitive impairment. Nineteen (5.9%) participants had MDD, nine (2.8%) had ADHD, seven (2.2%) had GAD, 14 (8.6%) had SUD; and 30 (9.3%) had any psychiatric disorder. None of the factors examined were associated with the disorders. Conclusions: The unexpectedly high burden of mental disorders in this general population of children warrants targeted screening of those at risk, and treatment of those affected. Further, future studies should extensively investigate the factors that underlie the identified psychiatric disorders in this and similar general populations.

Domestic Violence and Its Effects on Women, Children, and Families

Men and women experience severe domestic violence (DV) and intimate partner violence (IPV); however, women and children remain especially vulnerable. Violence along the DV/IPV continuum has been recognized as a type of child maltreatment and a child's awareness that a caregiver is being harmed or at risk of harm is sufficient to induce harmful sequelae. Consequences of these abusive behaviors are associated with mental and physical health consequences. Health care professionals can screen, identify, and manage this pathology in affected families while educating communities to these pernicious effects.

Children Witnessing Domestic Violence in the Voice of Health and Social Professionals Dealing with Contrasting Gender Violence

Witnessing domestic violence (WDV) is recognized by the Istanbul Convention as psychological abuse that has dramatic consequences on the psychophysical health of children. Therefore, professionals who form the support network for WDV victims play a very fundamental role. In order to draw up useful guidelines for services dealing with WDV, and to give children more awareness of supportive settings, this study analyzes WDV in the perception of health and welfare professionals to enhance their skills and strategies for contrasting gender violence. Sixteen Neapolitan specialists dealing with WDV children were interviewed. A theoretical intentional sampling was used. Narrative focused interviews were carried out, transcribed verbatim and analyzed through the grounded theory methodology, using the ATLAS.ti 8 software (Scientific Software Development GmbH, Berlin, Germany). We assigned 319 codes and grouped these into 10 categories and 4 macro-categories. The analysis of the texts led to the definition of the core category as "The Crystal Fortress". It summarizes the image of the WDV children as described by the professionals working in contrasting domestic violence. In this structure the parental roles of protection and care (fortress) are suspended and everything is extremely rigid, fragile and always at risk of a catastrophe. It also symbolizes the difficult role of health professionals in dealing with such children and their families. For WDV children, protective factors guarantee solid development and supportive settings help them to learn proper emotional responsiveness and expressiveness and to develop their skills in talking with adults while avoiding negative consequences.

Toward a stress process model of children's exposure to physical family and community violence

Theoretically informed models are required to further the comprehensive understanding of children's ETV. We draw on the stress process paradigm to forward an overall conceptual model of ETV (ETV) in childhood and adolescence. Around this conceptual model, we synthesize research in four dominant areas of the literature which are detailed but often disconnected including: (1) exposure to three forms of physical violence (e.g., child physical maltreatment, interparental violence, and community ETV); (2) the multilevel correlates and causes of ETV (e.g., neighborhood characteristics including concentrated disadvantage; family characteristics including socio-economic status and family stressors); (3) a range of consequences of ETV (e.g., internalizing and externalizing mental health problems, role transitions, and academic outcomes); and (4) multilevel and cross domain mediators and moderators of ETV influences (e.g., school and community factors, family social support, and individual coping resources). We highlight the range of interconnected processes through which violence exposures may influence children and suggest opportunities for prevention and intervention. We further identify needed future research on children's ETV including coping resources as well as research on cumulative contributions of violence exposure, violence exposure modifications, curvilinearity, and timing of exposure.

Monoamine oxidase A and childhood adversity as risk factors for conduct disorder in females

BACKGROUND

Recent studies among males have reported a genotype-environment interaction (GxE) in which low-activity alleles at the monoamine oxidase A (MAOA) locus conferred greater sensitivity to the effects of childhood adversity on risk for conduct disorder (CD). So far, few studies of females have controlled for gene-environment correlation or used females heterozygous for this X-linked gene.

METHOD

Logistic regression analysis of a sample of 721 females ages 8-17 years from the longitudinal Virginia Twin Study of Adolescent Behavioral Development (VTSABD) assessed the additive effects of MAOA genotypes on risk for CD, together with the main effect of childhood adversity and parental antisocial personality disorder (ASP), as well as the interaction of MAOA with childhood adversity on risk for CD.

RESULTS

A significant main effect of genotype on risk for CD was detected, where low-activity MAOA imparted the greatest risk to CD in girls while controlling for the significant effects of maternal ASP and childhood adversity. Significant GxE with weak effect was detected when environmental exposure was untransformed, indicating a higher sensitivity to childhood adversity in the presence of the high-activity MAOA allele. The interaction was no longer statistically significant after applying a ridit transformation to reflect the sample sizes exposed at each level of childhood adversity.

CONCLUSIONS

The main effect of MAOA on risk for CD in females, its absence in males and directional difference of interaction is suggestive of genotype-sex interaction. As the effect of GxE on risk for CD was weak, its inclusion is not justified.

Youth exposed to violence: stability, co-occurrence, and context

With considerable literature establishing how separate types of violence disrupt the lives of children, there is emerging interest in examining violence across multiple interpersonal domains. This article examines four commonly occurring and frequently researched domains of violence exposure: marital physical aggression, mother-to-youth aggression, father-to-youth aggression, and community violence. A community-based sample of 103 parents and youth provided three waves of data at annual intervals beginning when the youth were aged 9-10. We explored stability of exposure, co-occurrence across different types of violence exposure, and associations with co-occurring risk factors. Approximately 30-45% of youth reported intermittent exposure over the 3 years. In addition to overlap among types of violence exposure within the family, we found overlap between parent-to-youth aggression and community violence, an association that was exacerbated in families where fathers reported high levels of global distress symptoms. Mother-to-youth, father-to-youth, and community violence related to youth behavior problems beyond the contextual risk factors of low income, stressful life events, and parents' global distress symptoms. These results highlight the importance of examining violence longitudinally, across multiple types, and with attention to contextual factors.

Building resilience in children of mothers who have Co-occurring Disorders and histories of Violence

Historically, children of parents with co-occurring substance abuse and mental health disorders and histories of violence/trauma have been overlooked in behavioral health treatment systems. The Women, Co-occurring Disorders and Violence Study (WCDVS) was a 5-year initiative funded by the United States Substance Abuse and Mental Health Services Administration (SAMHSA) that included a Children's Study that explored the treatment needs of children of women with these multiple disorders. This article describes the development of the Children's Study intervention that included clinical assessment, group intervention, and resource coordination/advocacy for children aged 5-10 to build resilience through increasing coping skills, improving interpersonal relationships, and helping coalesce positive identity and self-esteem. Innovative procedures, including the participation of consumer/survivor/recovering women and mothers, in the planning, implementation, and administrative applications of this intervention and study are also highlighted. It is recommended that programs begin to implement family-focused integrated treatment approaches that can potentially increase protective factors for children affected by parental mental illness, substance abuse, and violence.

La relation entre la violence conjugale et les troubles de comportement à l’adolescence

Cet article présente les résultats d’une recherche sur les liens entre la violence conjugale et les troubles de comportement à l’adolescence. Les données ont été recueillies auprès de 490 adolescents et adolescentes âgés de 16 à 19 ans fréquentant une école secondaire. Les résultats des analyses indiquent que la fréquence de la violence conjugale est un prédicteur significatif de la présence de troubles de comportement chez les adolescents et les adolescentes et de problèmes sur le plan des relations avec les parents. Par ailleurs, la relation entre la violence conjugale et les troubles de comportement peut s’expliquer, du moins en partie, par la qualité des relations avec les parents.

Child witnesses to domestic violence: a meta-analytic review

This meta-analysis examined 118 studies of the psychosocial outcomes of children exposed to interparental violence. Correlational studies showed a significant association between exposure and child problems (d = -0.29). Group comparison studies showed that witnesses had significantly worse outcomes relative to nonwitnesses (d = -0.40) and children from verbally aggressive homes (d = -0.28). but witnesses' outcomes were not significantly different from those of physically abused children (d = 0.15) or physically abused witnesses (d = 0.13). Several methodological variables moderated these results. Similar effects were found across a range of outcomes, with slight evidence for greater risk among preschoolers. Recommendations for future research are made, taking into account practical and theoretical issues in this area.

Children exposed to domestic violence: psychological considerations for health care practitioners

This article reviews the psychological impact of exposure to domestic violence on child development. The purpose is to give insight to the following questions: How does the experience of family violence affect a child's perception of the world and relationships with others? What type of coping style might this same child be likely to develop? What factors help protect a child who has been exposed to violence in the home? In addition, the article discusses assessment considerations for health care practitioners and recommends areas for future research and public policy development.

The impact of children witnessing violence

Over the past decade, Americans have recognized that violence has deeply permeated the lives of the most vulnerable among us--children. There is great concern over the effect these terrible experiences will have on present and future generations. It has also awakened the collective consciousness of our society that the impact of violence extends well beyond the child who is physically victimized to other larger groups of children such as those who witness these events. This article reviews the impact violence has on children.