A profile of abuse

Prevalence of confirmed child abuse and the use of resources in child psychiatric out-patients

This paper explores the extent of known child sexual and physical abuse in child psychiatric out-patient services in Leeds. We surveyed a one-month period, looking at all out-patient contacts, and found that at least 17.9% of patients had been physically or sexually abused and these patients took up 25.8% of out-patient time. When the 70 abused children were compared to a group matched for age group, clinical team and diagnosis It was found that they were more likely to be followed-up for longer and they received more therapeutic time over a given period than non-abused children. The implications for resources are discussed.

Maternal stress affects postnatal growth and the pituitary expression of prolactin in mouse offspring

Maternal stress exerts long-lasting psychiatric and somatic on offspring, which persist into adulthood. However, the effect of maternal stress on the postnatal growth of pups has not been widely reported. In this study, we found that maternal immobilization stress (IS) during lactation resulted in low body weight of male mouse offspring, which persisted after weaning. Despite free access to chow, IS induced maternal malnutrition and decreased the serum insulin-like growth factor-1 (IGF-1) levels in the mothers and in the pups. mRNA expression analysis of anterior pituitary hormones in the pups revealed that growth hormone (GH) and prolactin (PRL), but no other hormones, were decreased by IS. Expression of the pituitary transcription factor PIT1 and isoforms of PITX2, which are essential for the development and function of GH-producing somatotropes and PRL-producing lactotropes, was decreased, whereas that of PROP1, which is critical for the earlier stages of pituitary development, was unchanged. Immunohistochemistry also showed a decrease in pituitary PRL protein expression. These results suggest that stress in a postpartum mother has persistent effects on the body weight of the offspring. Reduced PRL expression in the offspring's pituitary gland may play a role in these effects.

Growth patterns in child abuse

This study reports clinical details and statistical analysis of linear and body mass growth retardation in a cohort of 260 abused children. Seventy-one children (26%) showed impairment of growth for weight or height; 21 out of 92 children who spent time in foster homes showed catch-up growth whereas only 5 out of 168 never separated from their parents demonstrated improvement in height or weight centiles. Out of 11 children placed in foster care who were more than 2 SD below the mean for height, 10 demonstrated significant catch-up whereas only 4 out of 28 children who remained in their natural homes did so. Catch-up growth among children who remained at home was generally less than that which occurred in foster homes. In 17 cases diagnosis of growth impairment preceded nonaccidental injury. Growth of growth-retarded children in natural homes was poor. Because of the relationship between poor growth and other parameters of development, children who show catch-up growth in foster homes should probably not be 'rehabilitated' with their natural parents.

Object relations theory applied to early emotional deprivation, resulting in autistic spectrum disorder

Objective: The following case report describes a child with autistic symptoms who experienced early emotional deprivation and institutionalisation. The paper discusses her symptoms in relation to Melanie Klein's theories on object relationships.

Method: LM was a four year old Rumanian adoptee, when she was first assessed by a child service in Dublin. On presentation, she exhibited a spectrum of autistic symptoms including an impairment in social interaction, absence of separation anxiety, poor attachment formation with others and restricted, repetitive, stereotyped patterns of behaviour. While attending the pre-school, she was involved in an individualised programme which focused on her specific needs.

Result: After attending the pre-school programme, L exhibited a greater ability to express various emotions and her social interaction with others had improved, but she continued to have marked deficits in her personality. This child's symptoms are discussed with reference to the paranoid schizoid and depressive positions associated with ego development.

Conclusion: By applying Melanie Klein's theories on object relations, one can gain a further understanding of a child's pathological symptoms, ego development and the necessary treatments required to improve these symptoms.

Height and body proportions in child abuse

Abused children are said to retain 'infantile body proportions'. The presenting height, sitting height, and leg length standard deviation scores of 91 victims have been calculated from data derived from a study of local inner city schoolchildren. In the study population 31/91 (34%) were significantly short and all but two of these had relatively shorter legs than backs, this limb disproportion being significant in 17. In 25 patients of the original group followed up after various social interventions there was a significant recovery of leg length. Measurement of height and proportionality, especially when compared with appropriate modern or local standards, is an important means of detecting and following up victims of child abuse.