Traumatic Encephalopathy Syndrome and Tauopathy in a 19-Year-Old With Child Abuse

The majority of traumatic encephalopathy syndrome (TES) cases have been reported in former contact sport athletes. This is the first case with TES in a 19-year-old male patient with progressive cognitive decline after daily domestic physical violence through repeated hits to the head for 15 years. The patient presented with a moderate depressive episode and progressive cognitive decline. Tau positron emission tomography (PET) with 220 MBq of [18F]PI-2620 revealed increased focal signal at the frontal and parietal white/gray matter border. Brain magnetic resonance imaging (MRI) showed a cavum septum pellucidum, reduced left-sided hippocampal volume, and a left midbrain lesion. Cerebrospinal fluid results showed elevated total and p-tau. Neurocognitive testing at admission showed memory deficits clearly below average, and hampered dysfunctions according to the slow processing speed with a low mistake rate, indicating the acquired, thus secondary, attentional deficits. We diagnosed the patient with a TES suggestive of chronic traumatic encephalopathy and classified him as having subtle/mild functional limitation with a most likely transition to mild dementia within the TES criteria. This report underlines child abuse as a relevant criterion in diagnosing TES in cases with repetitive hits to the head. In addition to clinical markers, we show the relevance of fluid tau biomarkers and tau-PET to support the diagnosis of TES according to the recently published diagnosis criteria for TES.

Prolonged Infant Crying: Caregiving Quality and Child Physical Abuse Risk

Research suggests that prolonged infant crying may increase risk for child physical abuse (CPA). However, few studies have examined behavioral responses to infant crying among parents at risk for CPA. The present study sought to fill this gap by using a simulated infant to examine how mothers and fathers with varying degrees of CPA risk respond to prolonged infant crying. Specifically, a sample of 184 general population caregivers (107 mothers and 77 fathers) participated in a task that involved attempting to soothe a simulated infant that cried continuously for 30 min. The simulated infant sessions were video-recorded, and quality of caregiving behavior was coded in 5-min segments. Participants rated their negative affect (feelings of upset, distress, irritability) at the outset of the data collection session, before beginning the simulated infant task, and after the simulated infant task concluded. It was predicted that high-risk caregivers, compared to low-risk caregivers, would display lower quality caregiving, higher levels of negative affect, and that CPA risk group differences would increase over time. Gender differences were explored in relation to the aforementioned hypotheses. Over the course of the 30-min simulated infant task, the quality of caregiving behavior diminished among both high- and low-risk caregivers. As expected, high-risk caregivers, compared to low-risk caregivers, exhibited lower quality caregiving behaviors and were more likely to discontinue the simulated infant task early. In addition, high-risk, compared to low-risk, caregivers reported higher levels of negative affect throughout the data collection session, with the highest level of negative affect reported by high-risk caregivers after completing the simulated infant task. Overall, the quality of caregiving exhibited by men and women did not significantly differ. The present findings highlight the importance of early intervention designed to support caregivers' abilities to respond effectively to prolonged infant crying.

Psychoanalytic Interventions with Abusive Parents: An Opportunity for Children's Mental Health

Research has extensively shown that most people who experience maltreatment in their childhood develop mental disorders, psychosocial adjustment problems, and, in many cases, become maltreating adults themselves. Preventing child maltreatment and treating abused children and abusive parents are, therefore, pressing public health issues. As established by the UK Children Act in 1989, child development is enhanced by remaining in the family whenever the child's safety is assured. Thus, developing prevention and intervention programs for the purpose of repairing, whenever possible, the child-parent relationship should be a social priority. This narrative review focuses on the psychoanalytic studies related to intrapsychic dynamics and therapeutic intervention for physically abusive parents. The role of the transgenerational transmission of abuse and parents' narcissistic fragility is crucial. Psychoanalytic interventions focus on helping the parent work through their past painful experiences and narcissistic vulnerability. Parent-child psychotherapy and mentalization-based treatment have been found to be prevalent, while there is scarce literature regarding intensive individual psychoanalytic treatment. Within the framework of attachment theory, brief interventions were developed; however, they did not prove effective for those parents who suffered experiences of maltreatment or severe neglect in childhood and for whom long-term parent-child psychotherapy resulted, which proved to be the most effective.

School Nurses on the Front Lines of Healthcare: Red Flags and Red Herrings: Improving the Recognition of Bruises and Burns Associated With Physical Abuse in School-Age Children

Through a series of case scenarios, this article describes the assessment and management of suspected physical child abuse presenting as bruises and burns. Although it is not uncommon for school-age children to have accidental injuries, recognizing patterns associated with physical child abuse and understanding red flags for abuse is vital. Failure to recognize injury patterns suspicious for physical child abuse, and thus failure to intervene appropriately, may leave children at risk for more serious injury or death.

When Bigger Is Better: Household Size, Abuse Injuries, Neglect, and Family Response in Novosibirsk, Russia

Although previous research has demonstrated larger households to be at higher risk of physical abuse and neglect of children, we argue that unilateral conceptualization of larger households as a risk factor is inappropriate. Application of resource dilution theory must capture the possibility that larger families may have more members with both the agency and will to intervene against child maltreatment. We hypothesized a negative interaction between household size and protective informal social control by family members in predicting abuse injuries and neglect. A three-stage probability proportional to size cluster sample representative of Novosibirsk, Russia, was collected from 306 cohabiting couples. One parent in each household was interviewed. A focal child was selected using most recent birthday. When responses limited to families with minor children (below age 18) were selected, 172 families remained in the data. Physical abuse and neglect were measured using the Conflict Tactics Scales (CTS). Protective informal social control by family members was measured using the Informal Social Control of Child Maltreatment (ISC_CM) Scale. Models were tested using random effects regression and logistic regression. Nearly 7% of focal children were injured in the last year, 10% were neglected. Consistent with previous research, protective informal social control was associated with lower odds of injury and fewer instances of neglect. The significant negative interaction between household size and protective control is consistent with the idea that larger households may be protective when adult family members intervene against maltreatment to protect children. Replication and further investigation of protective ISC_CM in Western populations is much needed. Future research should not conceptualize or measure household size as a unilateral risk factor.

Exploring Positive Classical Conditioning Procedure Effects on Evaluations of Children, Thoughts About Children, and Behaviors Toward Children: Two Experiments

Exposing parents to a positive classical conditioning (+CC) procedure can (a) prompt positive evaluations of children, (b) alter judgments made about children from their behavior, and (c) reduce harsh behaviors enacted toward children. Two studies explored possible limits of these effects. Results from Study 1 showed that only some +CC effects evinced in prior research emerged when the positive trait words used as the unconditioned stimuli in prior research were replaced with positive emojis. Results from Study 2 showed with positive trait word stimuli that a backward +CC procedure produced many of the same effects produced by the forward +CC procedure. These results collectively support the idea that +CC procedures may simultaneously prompt several different kinds of learning. From a practical perspective, consideration of these various kinds of learning is important to an understanding of when the use of the +CC procedure might reduce child abuse risk.

Neurogenic Stunned Myocardium in Two Children with Neurological Injury

Neurogenic stunned myocardium is described as sudden and reversible cardiac dysfunction induced by an acute neurological event. This phenomenon has not been thoroughly investigated in infants, and is probably underdiagnosed. Here, we report the cases of two infants with neurogenic stunned myocardium in whom the clinical suspicion was relevant, with a brief discussion of this condition.

Recognition of child physical abuse by a group of Brazilian primary care health professionals

BACKGROUND

Child maltreatment is a complex social and public health problem.

AIM

To evaluate the frequency of the recognition by Brazilian health professionals in primary care of child physical abuse (CPA) and associated factors.

DESIGN

A representative cross-sectional study was conducted with dentists, nurses, family physicians, and pediatricians who participated in the network of the Family Health Strategy in the city of Belo Horizonte, Brazil. Data collection involved in the administration of a questionnaire validated for use in Brazil. Data were collected from 181 dentists, 235 nurses, 203 family physicians, and 96 pediatricians.

RESULTS

Among the 715 health professionals, 499 (69.8%) had some type of postgraduate degree and 414 (57.9%) recognized suspected or proved cases of CPA. The recognition was associated with occupation, as pediatricians recognized 14.11-fold [OR = 14.11 (95% CI: 3.73 to 53.43)] more cases of CPA compared with dentists. The recognition was also associated with a longer period of time working in the city [OR = 2.79 (95% CI: 1.24 to 6.29)].

CONCLUSION

The recognition of cases was positively associated with the longer working time in the municipal network and with pediatricians. The dentist was the category that was least associated with the recognition of CPA.

Fathers and maternal risk for physical child abuse

This study set out to examine father-related factors predicting maternal physical child abuse risk in a national birth cohort of 1,480 families. In-home and phone interviews were conducted with mothers when index children were 3 years old. Predictor variables included the mother-father relationship status; father demographic, economic, and psychosocial variables; and key background factors. Outcome variables included both observed and self-reported proxies of maternal physical child abuse risk. At the bivariate level, mothers married to fathers were at lower risk for most indicators of maternal physical child abuse. However, after accounting for specific fathering factors and controlling for background variables, multivariate analyses indicated that marriage washed out as a protective factor, and on two of three indicators was linked with greater maternal physical abuse risk. Regarding fathering factors linked with risk, fathers' higher educational attainment and their positive involvement with their children most discernibly predicted lower maternal physical child abuse risk. Fathers' economic factors played no observable role in mothers' risk for physical child maltreatment. Such multivariate findings suggest that marriage per se does not appear to be a protective factor for maternal physical child abuse and rather it may serve as a proxy for other father-related protective factors.