Attachment and Risk of Future Harm: A Case of Non‐Accidental Brain Injury

Decision making in cases of non‐accidental brain injury is complex. Courts often view ‘alternate care’ as a means of ensuring that children are protected from further physical abuse. It is important for treating and assessing clinicians to present the court with a broad systems perspective highlighting the multiple factors which combine to impact on the child's future safety, welfare and wellbeing. These include risk and protective factors in the family of origin, the family's openness to monitoring and treatment; the child's needs for long‐term attachment relationships, and the risks associated with alternate care. This article highlights the need to consider long‐term attachment needs as part of any risk‐of‐harm assessment for young children who have been maltreated. Attachment issues are considered in the case of Nellie, a 17‐month‐old toddler with a serious and unexplained non‐accidental brain injury.     

The neurodevelopmental outcome in infants who have sustained a subdural haemorrhage from non‐accidental head injury

Subdural haemorrhage (SDH) in infants arises most commonly from non‐accidental head injury (NAHI) from shaking. Patients present with a varied severity of illness and a variety of symptoms and signs. Data on long‐term outcome of the survivors are not widely reported. The aim of this paper is to describe the physical and educational outcomes of children <2 years diagnosed with non‐accidental head injury and formulate guidelines on follow‐up. Data on 65 children <2 years with non‐accidental head injury and subdural haemorrhage diagnosed on CT/MRI/postmortem were extracted from the hospital and community notes and education reports. The Kings Outcome Scale for Childhood Head Injury (KOSCHI) was used. Sixteen children died (24.6%), 13 within 6 weeks and three 5 years after the injury. Of the 45 children followed up (follow‐up time 21.7–103 months), 25 had a good outcome, six were moderately disabled and 11 were severely disabled, while three were in persistent vegetative state. Problems identi?ed included cerebral palsy—16, ongoing seizures—5, visual problems—11, speech and language problems—17 and behavioural problems—13. Of the 29 children of school age on whom data were available, 12 children had a statement of educational needs. In conclusion, young children who survive non‐accidental head injury can have signi?cant physical, cognitive and behavioural problems. Regular follow‐up by a multidisciplinary team, which includes a community paediatrician, therapists, school health personnel and ophthalmologic services, until the child is established in school may facilitate early identi?cation of emerging problems and optimize management. Care must be taken not to discharge children with good outcomes, as behavioural and cognitive problems can emerge with time. Only a prospective study will help outline the subtle problems that can emerge with time in children with a so‐called good outcome. Copyright © 2004 John Wiley & Sons, Ltd.     

The ritual abuse of children: Implications for clinical practice and research

The development of a 14‐year‐old female from defending herself from sexual crimes to committing such a crime is presented in case‐report form. Her individual history, family dynamics, and transgenerational patterns are explored. A review of the current literature is utilized to understand why some abused persons become abusers.     

Maternal understanding of the toxicity of substances used in non‐accidental poisoning

A questionnaire‐based study was undertaken to determine the level of understanding amongst the general population of the toxicity of paracetamol and salt. One hundred mothers were questioned. All mothers considered salt to be a potentially serious poison. All had a good understanding of the maximum safe dose of paracetamol. Nearly one‐third did not consider paracetamol to be a potentially lethal poison. The results have bearing on assessment of cases of possible non‐accidental poisoning. Copyright © 2000 John Wiley & Sons, Ltd.     

‘It's a macho thing,innit?’ Exploring the effects of masculinity on career choice and development

Through the analysis of qualitative data of the life stories of ten male returners to further education this article aims to support and develop some of the ideas presented in Gender, Work & Organization by both Simpson in 2005 and Lupton in 2006 on men in non‐traditional occupations. I employ the notion of multiple masculinities to understand my cohort's careers and demonstrate that over time early socialization can be overcome so that some men can make non‐stereotypical career decisions later in life. In offering an explanation as to why this might be the case, I argue that in late modernity some men can actively choose non‐traditional occupations, albeit within a gendered and classed labour market. I also offer insights into male identity in late modernity.     

The Career‐O‐Gram: A Postmodern Career Intervention

The authors examine the usefulness of postmodernism in career counseling. Specifically, a case is made for broadening career counseling theories and techniques to feature the contextual influences inherent in each individual's unique career history. A career intervention, titled the Career‐O‐Gram, is introduced as a tool for exploring contextual influences on career development. A case study is presented to demonstrate the application of the Career‐O‐Gram.     

Transnational regimes of labor and statelessness: Intersections of citizenship regimes and local norms in East and Southeast Asia

This article offers a review of the literature on transnational labor regimes and statelessness to pursue further theorization from East and Southeast Asian contexts. The main focus is on how local norms (local sense of belonging, local moral code, and local hierarchies) are entangled with national‐level citizenship regimes to legitimate the discrimination of certain people to be statelessness and secure low‐wage migrant workers for the new global labor regime. First, traditional literature on citizenship and statelessness was reviewed; binary theoretical frameworks (including citizens/excluding non‐citizens) based on political recognition were indicated as the main limitations. Second, recent theories arguing for an intersection between national citizenship regimes and a new global labor regime were reviewed. Third, recent theories that illuminate the importance of local contexts in determining citizens' rights were reviewed based on formal exclusion and informal inclusion as well as formal inclusion and informal exclusion. Finally, it was concluded that further theorization is needed on how citizenship regimes and local norms intersect to produce statelessness, securing low‐wage migrant workers for the global labor regime through the global assemblages approach. Through the paper, East and Southeast Asia were illuminated as potentially fruitful research sites for further theorization on the topic.     

Promise or Problem? A Review of the Literature on Men Working in Early Childhood Services

Few men care for, or teach, young children. The 1991 UK census found that less than 1% of nursery nurses were male, while 14% of nursery/primary teachers were male. A similarly gendered picture can be found across European, North American and Australian studies of early childhood services, such as childcare centres and early education. The practice and prospect of men early childhood workers are both encouraged and resisted. The aim of this article is to review the international literature relevant to men working in early childhood services with pre‐school‐aged children. The case for male early childhood workers is reviewed: two pertinent themes from the related field of men working in non‐traditional occupations are highlighted. The review considers how these are applied to the specific context of men and early childhood services. Four aspects of the debate about men and early childhood work are examined: gender stereotypes; senior positions; gendered motives; and risks, allegations and protection. The literature suggests that men's careers have much to gain from working in early childhood services, but that, certainly in the Anglo‐American literature, a recurring theme is the representation of men early childhood workers as a source of suspicion.     

Casino self‐exclusion programmes: A review of the issues 1

Abstract

Casino self‐exclusion is a procedure by which individuals can have themselves banned from entering a casino. One of the purposes of this paper is to present information about the availability and features of these programmes. A second purpose is to make recommendations about how to best operate them based on cross‐jurisdictional analysis and lessons from the addiction literature. The first section of the paper describes the typical casino self‐exclusion programme, outlining the features common to most policies. The second section provides a detailed overview of the programmes operating in Canada in order to give the reader an appreciation of the procedural variations that exist. The third section discusses the effectiveness of self‐exclusion programmes. Finally, the fourth section contains recommendations on ways to improve effectiveness. When properly implemented, self‐exclusion can be a valuable tool in helping to curb problem gambling.     

Serious and fatal injuries to infants with discrepant parental explanations: some assessment and case management issues

The objective of this study was to examine the challenges faced by child protection systems in assessment and case management where babies and infants have received serious and fatal physical injuries in the context of discrepant parent/carer explanations. Thirty‐eight case files or review records of children under the age of 2 with serious or fatal physical injuries were examined. Qualitative methods were employed to identify issues relating to types of parent/carer explanations, factors of concern in addition to the injuries and child protection system responses to the families. Findings indicate that the initial safety response by child protection systems to babies with serious injuries with discrepant explanations can be inadequate. Assessment of further risks could be inconsistent, especially in cases where there are few other factors of concern apart from the injury. There is a need for the development in the UK of more systematic decision‐making processes to achieve more consistent standards of assessment and case management of high‐risk infants and to minimize false‐negative and false‐positive predictions of further risk. Copyright © 2002 John Wiley & Sons, Ltd.     

‘Failure to thrive’ revisited

The term ‘non‐organic failure to thrive’ (FTT) has long been used in relation to young children with faltering growth for which no organic cause is found. In this paper, problems arising from dichotomised organic/non‐organic responses to FTT are explored and reasons for the assumption that non‐organic FTT was always due to emotional abuse or neglect are presented. The case is made that, except in a minority of cases, children fail to grow because they consume insufficient calories. Research studies on reasons for poor intake, from factors related to the child and their parents to the wider family and environment, are summarised. Following a brief reference to literature on outcomes, I argue that centile charts should be routinely completed for all young children. If faltering growth is identified, a multi‐factorial assessment should be undertaken. Such an assessment reduces the risk of interventions being based on outdated assumptions about non‐organic FTT and maximises the potential for successful resolution of poor growth. After briefly summarising the literature on interventions, I conclude with suggestions for improving practice in this field, including working in partnership with families and with health and social care professionals already known to them. Copyright © 2008 John Wiley & Sons, Ltd.     

The Importance of Identity in Policy: The Case For and Of Children

This article draws out one of the core reasons why children should be conceived as active agents in research, particularly policy‐related research. The main thesis is that policy inevitably projects and, to an extent, constitutes the subject identities of its intended objects — in this case, that of ‘children’. Drawing on several bodies of theory — the ‘new’ sociology of childhood, identity theory, ‘governmentality’ and theories of discourse — the article shows why not incorporating children’s voices is a problem for social policy, and suggests that the impact of their exclusion has the potential to render policy both inappropriate and non‐responsive.     

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.     

Attachment‐Based Family Therapy With a 13‐Year‐Old Girl Presenting With High Risk for Suicide

This article describes the application of Attachment‐Based Family Therapy (ABFT) to the treatment of a 13‐year‐old female adolescent presenting with high risk of suicide, complicated by a history of depression and sexual trauma. The article begins with an overview of ABFT, including (a) how attachment theory guides treatment; (b) the structure of the clinical model; and (c) the data that provide empirical support. A case example is then presented that exemplifies the primary clinical procedures used to reach therapeutic goals in ABFT, including attachment repair and autonomy/competence promotion. Weekly changes in suicide ideation and depression scores are presented. The article concludes with a discussion about implications for family‐based treatment of suicidal youth.     

Sociological Approaches to Self‐injury

This paper reviews the burgeoning sociological literature on non‐suicidal self‐injury, in which individuals intentionally harm themselves by cutting, burning, scratching, or smashing their body parts. We identify challenges to studying self‐injury, such as conflicting definitions and categorizations. Comparing self‐injury to other behaviors such as suicide, body modification, and self‐mutilation, we assert that non‐suicidal self‐injury deserves its own conceptual category. We explain how a critical sociological approach provides a valuable counterweight to medical and psychological studies of self‐injury. In particular, this paper advances the deviance perspective. Finally, we highlight how technology has allowed self‐injurers to build supportive communities in cyberspace, blurring the line between hidden and public acts. We conclude with suggestions for future directions in the study of self‐injury.     

“Oh,language of exile – woven of sorrow and mockery”: the Kalevala centennial jubilee as a bone of contention between Hebraists and Yiddishists

The article explores contacts between eminent Jewish Zionists and the Finnish cultural and political elite using the Kalevala centennial jubilee as a case study. The article shows how Finnish nationalists sympathised with the cause of Zionists propagating the use of modern Hebrew: members of the Kalevala Society warm‐heartedly invited the Hebrew poet Saul Tchernichowsky from Palestine to the centennial jubilee in 1935. The article also deals with the exclusion of the Yiddish representative, Hersh Rosenfeld, recommended by the YIVO Institute for Jewish Research in Vilna, and discusses the possibility of anti‐communism and anti‐cosmopolitanism behind his omission from the centennial jubilee. The Jewish community of Helsinki, which was experiencing a rapid Finnification process, was involved in inviting the Hebrew representative to Finland. The article ends by analysing a Yiddishist poem that can be interpreted as an individual’s protest about the exclusion of the Yiddish language from the Kalevala centenary.     

‘Sit in the corner and don’t eat the crayons’: postgraduates with dyslexia and the dominant ‘lexic’ discourse

The lack of cultural diversity in higher education is recognised by policy objectives and a current focus on the development of widening participation for a range of students, including those with disabilities. Amongst this group are those with dyslexia who might previously have been disenfranchised from formal education and under‐represented within it. This paper explores the personal narratives and learner histories of six postgraduates and academics with dyslexia from their earliest memories of learning to their present experiences. It examines how literacy, as a dominant form of discourse, has defined concepts of academic ability resulting in the early exclusion of these learners from formal education. It is argued that this dominant discourse can be challenged by non‐authorised, informal learning resulting in stories of resistance.     

Non-attendance for health care: When rational beliefs collide

Some patients choose not to attend for health care despite health concerns or an opportunity for improved health. Social norms that privilege professional expertise, and good health, deem this choice irrational. However, this paper explores how a particular version of rational choice theory suggests ‘positive choices’ for such non‐attendance. These are cognitive and subjectively rational decisions, which are made freely with potentially positive consequences and are not social problems if respect for personal autonomy trumps obligations to others. Specifically, Boudon's ‘cognitivist theory of action’ is used to conceptualise non‐attendance as both a rational and irrational choice, from different perspectives. Because the perspective of non‐attendees has been marginalised, the paper also suggests a typology of instrumental and non‐instrumental ‘strong reasons’ for rational non‐attendance. This may help groups such as professionals to understand and accept that non‐attendance can be subjectively rational, without relinquishing their own perspective that it is irrational. Acceptance of the defensibility, if not the rightness, of the perspective of non‐attendees is needed to show respect for non‐attendees' moral agency and to begin to repair relationships with these individuals, who may seek help from health professionals in the future.     

The Citizenship Gap in European Societies: Conceptualizing,Measuring and Comparing ‘Migration Neutrality’ across the EU

Equality in life‐chances of nationals and immigrants is a sensitive issue on which there is more debate than systematic evidence. To evaluate this condition across European societies, the concept of integration as “migration neutrality” is introduced. “Migration neutrality” is defined as the irrelevance of national citizenship as a predictor of key social attainments. Odds ratios are used to measure the relative risk of non‐national as compared with national citizens in the attainment of relevant resources. While this indicator cannot control for compositional differences in the populations at stake, it represents a straightforward benchmark that can be used in different domains to describe and compare foreign citizens’ position relative to nationals. In this article, we calculate it across EU member states through Eurostat data. In particular, the focus is on migration neutrality in the risk of social exclusion. Country variations are found to be hardly amenable to established classifications of integration types. Moreover, the relationship between “migration neutrality” levels and pro‐immigrant policies (as measured by the Mipex index) is found to be weak, suggesting that these policies do not consistently target the reduction of the gap between nationals and non nationals.     

Attachment Perspective on Marital Dissolution and Relational Family Therapy

Divorce or dissolution of a long-term intimate relationship is an event on the continuum of an individual’s experience of attachment injury that is reawakened and played out again in this process. An attachment injury means the experience of rejection and betrayal of trust at a critical time of distress when one is in need of support. By means of the case study method, the article presents a case of a female client dealing with divorce. The history of traumatic relations through a lens of attachment theory is presented, along with divorce as the reawakening of an attachment injury and its processing in a relational family therapy model.