Diagnosing physical abuse using Bayes' Theorem: a preliminary study

Objectives. To perform a preliminary study to compare the patterns of bruises in a physically abused group of children and a control group; to investigate whether these could be modelled statistically to enable probabilities of typical bruise patterns to be calculated; to apply Bayes' Theorem to find the probability that a child with a given bruise pattern has been the subject of physical abuse. Design. An observational study. Setting. Cardiff and Vale of Glamorgan. Subjects. Children who have suffered child physical abuse, 0–14 years. The diagnosis was confirmed at a case conference in all cases. A control group of 289 children who presented to the Accident and Emergency Department at the Cardiff Royal Infirmary after an accidental injury. Main outcome measures. The distribution bruise pattern in three regions of the body. The posterior probability of abuse for a given bruise pattern. Results. The bruise distribution in physically abused and control children was well described by a negative binomial distribution. There was a different distribution for the three different regions of the body in physically abused children. The bruising frequency and distribution for the physically abused group was very different from that of the controls. We were able to use parameters derived from these distributions to calculate posterior probabilities of physical abuse given a particular pattern of bruises using Bayes' Theorem. Conclusions. This preliminary study demonstrates that we can use Bayes' Theorem to combine prior probabilities of physical abuse with observed patterns of bruising in given children to obtain posterior probabilities of abuse. This principle has considerable potential for better diagnosis of the physically abused child. © 1998 John Wiley & Sons, Ltd.     

Profiles of adult survivors of severe sexual,physical and emotional institutional abuse in Ireland

Adult survivors of institutional abuse were interviewed with a comprehensive assessment protocol which included the Childhood Trauma Questionnaire, the Institutional Child Abuse Processes and Coping Inventory, the Structured Clinical Interviews for Disorders of the Diagnostic and Statistical Manual of Mental Disorders IV axis I disorders and personality disorders, the Trauma Symptoms Inventory, a Life Problems Checklist, the Experiences in Close Relationships Inventory and the Kansas Marital Satisfaction Scale. Profiles were identified for subgroups that described severe sexual (N = 60), physical (N = 102), or emotional (N = 85) abuse as their worst forms of maltreatment. Survivors of severe sexual abuse had the most abnormal profile, which was characterised by higher rates of all forms of child maltreatment and higher rates of post‐traumatic stress disorder, alcohol and substance abuse, antisocial personality disorder, trauma symptoms and life problems. Survivors of severe emotional abuse were better adjusted than the other two groups. The profile of survivors of severe physical abuse occupied an intermediate position between the other two groups. A thorough assessment of abuse history and current functioning should be conducted when providing services to adult survivors of institutional abuse, since this may have important implications for the intensity of services required. Survivors of severe sexual abuse may require more intensive services. Copyright © 2009 John Wiley & Sons, Ltd.     

Economic abuse,physical violence,and union formation

Intimate partner violence often includes economic abuse; unfortunately, economic abuse has not been examined sufficiently in the literature. Using longitudinal data from the Fragile Families and Child Wellbeing Study, this paper examined the occurrence of and changes in economic abuse and physical violence over time and how these factors influenced union formation. The results indicated that the prevalence of economic and physical abuse increased over time, particularly for economic abuse. The changes in union formation for cohabiting and visiting mothers were quite substantial over time. Regression analyses indicated that, over time, the occurrence and the increase of economic abuse and the increase of physical violence were significantly and negatively associated with the likelihood of stable union formations such as marriage and cohabitation. Policy and research implications are discussed.     

Defining organized sexual abuse

The label ‘organized abuse’ is widely used but without an agreed meaning. An agreed definition would improve communication among practitioners and make it easier to compare the results of different pieces of research. Items classified together must possess at least one feature in common: in the case of organized abuse this is that they all involve more than one perpetrator. Some types of case for which the label ‘organized’ has been used, like those that concern children's sexual abuse in an institution or that include allegations of a ritual context, do not fulfil even this initial criterion. Some cases of institutional or ritual abuse may also be cases of organized abuse but the terms are not synonymous with each other. Domestic cases, where all the perpetrators and the victims are members of a single household, are also sufficiently unlike the paradigmatic case of organized abuse for them to be excluded from the category. The recognition that exclusion is as necessary to rigorous definition as inclusion requires making explicit what definitions are and what they are for.     

Ritual,and child sexual abuse,but not ritual child sexual abuse

Central to the controversy over ritual (satanic) child sexual abuse have been claims concerning agency ‘diagnoses’ of cases. Specifically, it has been alleged that agency findings of ritual abuse have been erroneous and are the product of poor practice. There is, though, little systematic information regarding agency assessment of suspected ritual abuse cases. This paper presents two cases where there was evidence both of child sexual abuse and ‘ritual’ but where agencies adjudged that these aspects occurred independently of one another and were not indicative of ritual child sexual abuse. The existence of these cases underlines the need for a broader and more balanced debate in respect of ritual abuse in general and the agency handling of these cases in particular. Copyright © 2000 John Wiley & Sons, Ltd.     

Prevention of child abuse and neglect and improvements in child development

The aim of the study was to evaluate the implementation of a section in the Danish Social Assistance Act which encourages local authorities to offer families services in order to support children at risk of child maltreatment. The specific purpose of the present paper is to answer the question: Will the socio‐psychological development of children known to social services be improved when abuse and neglect are reduced? A sample of 1,138 children was drawn at random from new social services cases starting in 1998. Subsequently, about 80 per cent were evaluated by local caseworkers on the basis of a standardised questionnaire covering a period of four years. The most damaging family conditions seemed to be psychological maltreatment, physical/sexual abuse and neglect. Maltreated children were more often in a depressed state, unhappy, socially isolated, or they had an eating disorder, inadequate or under‐nutrition, suicidal tendencies, lack of concentration, or disturbed behaviour, compared to those children who were not exposed to abuse and neglect. If parental behaviour improved, effects on children's well‐being were also observed and positive changes in children's socio‐psychological development were identified. The questionnaire explored the impact of various interventions, including services geared to strengthen the child's network, but results indicated that the child displayed reduced risk of reactive symptoms only when parental behaviour improved and abuse and neglect were reduced. Copyright © 2009 John Wiley & Sons, Ltd.     

Prevalence estimates and correlates of elder abuse in the United States: The National Intimate Partner and Sexual Violence Survey

This study examines the prevalence and correlates of psychological abuse and physical abuse against women and men aged 70 or older. Self-report data from 2,185 respondents in the 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were used to create weighted estimates for past-year experiences of abuse. Correlates were then examined using survey logistic regression models. More than 1 in 10 adults who are 70 years of age or older (14.0%) have experienced some form of abuse in the past year, with 12.1% experiencing psychological abuse and 1.7% experiencing physical abuse. One in five victims (20.8%) were abused by both intimate and nonintimate partners. Health care insecurity was the strongest correlate of past-year abuse. The odds of experiencing abuse were 4.53 times greater for those who experienced health care insecurity than for those who did not. This presents a significant challenge for identifying and helping victims of abuse.     

Mothers' abusive childhood predicts child abuse

To examine the intergenerational transmission of abuse, the study compared 25 mothers whose child had been under the supervision of the child protection services (CPS) with 25 mothers who had had no contact with the CPS. The groups were compared with respect to their own self‐reported childhood abuse, their abuse of their own child and punitiveness. The data were gathered using interviews and files. There were no significant differences between the groups in self‐reported childhood physical abuse, but the CPS mothers had experienced more childhood psychological abuse, especially rejection, accusations, terrorizing and corrupting. The groups did not differ in the self‐reported physical or psychological abuse inflicted upon one's own child. In the total sample of 50 mothers, hierarchical regression analyses showed, however, that the mothers' childhood abuse experiences predicted their abuse of their own child. Punitiveness was best predicted by maternal childhood psychological abuse. The results thus provide evidence for the cycle of abuse model. Copyright © 1999 John Wiley & Sons, Ltd.     

Ritual abuse: Consequences for professionals

This paper details the results of a questionnaire survey completed by 71 members of a national support group of workers in the field of ritual abuse, investigating the extent and nature of personal, interpersonal and professional stress factors involved in such work. The results indicate that professional work in the field of ritual abuse frequently gives rise to negative changes in behaviour and in physical and emotional health among workers. Support and supervision requirements are also addressed, as is the possibility/probability of threat and intimidation. The discussion proposes, and considers, three hypotheses: that workers in the field of ritual abuse are currently professionally isolated; that ritual abuse work is qualitatively different from other work; and that ritual abuse work may involve threat and intimidation.     

The child abuse and divorce myth

When the authors of this article undertook a study into the way the Australian legal process managed child abuse allegations in custody and access disputes following partnership breakdown in de facto and legal marriages, they encountered what they came to think of as ‘the child abuse and divorce myth’. The myth centred around a belief that child abuse allegations made during or after partnership breakdown were weapons fashioned to gain advantage in the marital war. Therefore, they were not real; therefore, they should not be taken seriously. Despite little previous research, these views were strongly held by both families and professionals. The article examines the myth, believed to be an international phenomenon, and shows, in detail, how the study's findings do not support it. In fact, the findings from this unique study contradict the myth in its totality and in its specific aspects. Thus, it is argued that the myth should be abandoned and a new knowledge base for professional intervention that recognizes the reality of this problem be adopted instead. As a result of the study, a new specialized intervention program for children involved in residence and contact disputes where child abuse was alleged is being trialled in the Family Court of Australia. Hopefully, the introduction of further intervention programmes based on the reality of child abuse in these circumstances rather than on the myth will follow. Copyright © 2001 John Wiley & Sons, Ltd.     

A rapid systematic review on the association between childhood physical and sexual abuse and illicit drug use among males

This paper aims to review studies in relation to the association between childhood physical (CPA) and sexual abuse (CSA) and illicit drug use among the male clinical and general community populations using a systematic approach. Primary studies were identified using online databases which were searched comprehensively using a set of pre‐determined search criteria and terms. Other sources included expert contact and the reference list of a relevant review. Associations between exposure (CPA/CSA) and outcome (illicit drug use) were considered with regards to an array of factors. A total of 5012 references were initially identified out of which 18 studies met the necessary criteria for reviewing. The review demonstrates tentative support for factors such as earlier drug initiation, intravenous drug use and greater frequency of use among some of the samples. It also demonstrates the difficulties involved in drawing conclusions due to the complex and multifaceted nature of drug use and the variability in the quality of the research available in this area. Limitations of the current review are highlighted and recommendations offered for future research with consideration given to practical implications in clinical and forensic settings. Copyright © 2010 John Wiley & Sons, Ltd.     

Organized abuse: NSPCC experience

A survey of a national child protection agency's experience of organized abuse in 1990–1991 found awareness of incidents among 41% of the participants and direct involvement with children in 20%. The 19 cases where there was direct involvement with 61 children from 43 families were categorized by the workers as network (N = 10), ritual (N = 6) and child pornography (N = 3) and came from England, Wales and Northern Ireland. The children in the three types presented different profiles from each other and from that of the sexually abused children placed on child protection registers. The children in the network cases were more likely to be boys and abused by non-relatives, the majority of whom were charged and convicted. The children in the ritual cases were the youngest, more likely to be abused by extended family members and most often the subjects of legal protection. The inherent difficulties in fully describing an organized abuse ‘case’ are outlined.     

Does the mandate make a difference? reporting decisions in emotional abuse

Mandated (N = 57) and non‐mandated (N = 94) reporters were questioned as to their perceptions of the seriousness of 20 vignettes related to child emotional abuse, as well as their willingness to report the actions contained in the vignettes to child protective services. No difference was observed between mandated and non‐mandated reporters on the mean number of vignettes considered reportable. In addition, several psychosocial variables, including perceptions of teasing, political viewpoint, tendencies towards diffuse responsibility, perceptions of child protective services (CPS) and attitude towards helping others, were measured. Separate regression equations for mandated and non‐mandated reporters showed two different models in predicting reporting tendencies. Mandated reporters were most affected by the seriousness of the situation and their willingness to engage in prosocial behaviour, whereas non‐mandated reporters were most motivated by judgements of the seriousness of the abusive situation and their faith in child protective services. Being a male was also observed to be more predictive of reporting for non‐mandated reporters. Copyright © 2006 John Wiley & Sons, Ltd.     

Assessment and intervention in cases of suspected ritual child sexual abuse

Agency workers have been heavily criticized over their handling of alleged ritual child sexual abuse cases, particularly in respect of their assessments and interventions. However, a study of referrals to police and social service departments revealed that agency workers raised suspicions of ritual abuse in respect of both child ‘victims’ and adult ‘survivors’ very rarely. Furthermore, they did this only after an assessment which showed the cases to possess a number of ‘troubling’ features. While agency workers believed that all the child ‘victims’ had been subject to serious sexual abuse, virtually all of them were circumspect as to whether this had occurred in a ‘ritual’ context. Initially, agency workers were generally open-minded as to the experiences of adult ‘survivors’, but by the end of their assessments, they tended to be more concerned about their mental health and less concerned about issues of ritual abuse. Finally, agency workers appeared to act appropriately in terms of the types of intervention they used and the way in which they applied these. These results suggest that there should be more confidence in the ability of agency workers to respond to cases of alleged ritual abuse. Copyright © 2001 John Wiley & Sons, Ltd.     

The effect of experience of childhood abuse among university students on self-perception and submissive behavior

Objective

The aim of this study was to investigate the effect of experience of childhood abuse among university students on self-perception and submissive behavior.

Methods

The study group consisted of 646 students attending various departments of the Karadeniz Technical University Faculty of Education in Trabzon, Turkey. Participants were administered the Childhood Trauma Questionnaire, the Social Comparison Scale and the Submissive Acts Scale in a classroom setting.

Results

Analysis revealed a significant negative correlation between self-perception and all forms of abuse (physical abuse, sexual abuse, and emotional abuse and neglect), and a positive correlation between submissive behavior and all forms of abuse. The students' emotional abuse and neglect scores varied significantly according to gender, with males having higher emotional abuse and neglect scores than those of girls. Additionally, males had higher physical abuse scores than girls.

Conclusion

Childhood abuse emerged as a significant predictor of negative self-perception and submissive behavior. In addition, with the exception of sexual abuse, other forms of abuse vary according to gender. The experiences of childhood abuse may have a long-term impact on various features of character and behavior.     

Child sex abuse and the Irish criminal justice system

The aims of this study were to develop scales to assess experiences of sexually abused children in the Irish criminal justice system (CJS); identify aspects of the CJS which children experience as negative; compare the perceptions of children, parents and professionals of sexually abused children's experiences of the CJS; and determine correlations between perceptions of children's CJS experiences and current psychological adjustment. Forty‐three children, 101 parents, 32 mental health professionals, 27 police officers and 21 lawyers completed parallel versions of the Criminal Justice System Questionnaire (CJSQ) which assessed satisfaction with aspects of the CJS relevant to sexually abused children, specifically: Gardaí (police), medical examination, Director of Public Prosecutions, waiting for court, court professionals, court context and the CJS. Fifteen scales were developed by conducting principal component analyses. Children gave negative ratings on nine of these, and on seven children, parents and professionals differed in their perceptions of how children experienced the CJS with mental health professionals viewing the impact of the CJS as more problematic than parents and children. Scores of children and parents on CJSQ scales correlated with indices of current psychological adjustment. These results point to the importance of making the Irish CJS more child‐friendly and for evaluating these reforms with the CJSQ. Copyright © 2011 John Wiley & Sons, Ltd.     

Sexual abuse and juvenile delinquency

Case records were reviewed of 214 young women admitted to a Juvenile Classification Home in Japan for delinquent behaviour between 1983 and 1987. In 10 cases there were reports of a history of sexual abuse and these were 3 times more likely to be admitted to a Detention Home than other cases. All 10 women came from disrupted and economically disadvantaged family backgrounds. Most were depressed with low self-esteem. Five women were physically abused prior to sexual abuse, but behavioural problems were only concurrent and consequent to the sexual abuse. Most of the women were not believed by their mothers at the time of disclosure. Those women who were later believed by their mothers were more likely to return home (with the perpetrators no longer present) and less likely to continue to be victims of sexual abuse.     

Defining child abuse in Hong Kong

Definitions of child abuse are culturally driven. Hong Kong, with a predominantly Chinese population, has managed to eradicate much of the societal abuse that children suffer elsewhere in Asia. Professional and government attention has now shifted to child abuse and neglect within the family. The paper, based on interviews with key professionals. analysis of policy documents and practice records examines traditional Chinese parent-child relationships. the status of parental authority and corporal punishment and changes in contemporary Hong Kong family life. It goes on to outline the development of responses to child abuse in Hong Kong, some of the dilemmas that professionals face in defining abuse and areas for future research.