Childhood Maltreatment (eBook)
99 Seiten
Hogrefe Publishing (Verlag)
978-1-61676-314-5 (ISBN)
The serious consequences of child abuse or maltreatment are among the most challenging things therapists encounter. In recent years there has been a surge of interest, and of both basic and clinical research, concerning early traumatization. This volume in the series Advances in Psychotherapy integrates results from the latest research showing the importance of early traumatization into a compact and practical guide for practitioners. Advances in biological knowledge have highlighted the potential chronicity of effects of childhood maltreatment, demonstrating particular life challenges in managing emotions, forming and maintaining healthy relationships, healthy coping, and holding a positive outlook of oneself.
Despite the resiliency of many maltreated children, adolescent and young adult well-being is often compromised. This text first overviews our current knowledge of the effects of childhood maltreatment on psychiatric and psychological health, then provides diagnostic guidance, and subsequently goes on to profile promising and effective evidence-based interventions. Consistent with the discussions of treatment, prevention programming that is multi-targeted at issues for maltreated individuals is highlighted. This text helps the practitioner or student to know what to look for, what questions need to be asked, how to handle the sensitive ethical implications, and what are promising avenues for effective coping.
The Authors
Christine Wekerle, PhD, is Associate Professor of Education, Psychology, and Psychiatry at the University of Western Ontario (UWO). She is also a Research Associate of the Centre for Research on Violence Against Women and Children at UWO. Dr. Wekerle has conducted research over the past decade in the areas of child welfare, childhood maltreatment, the overlap between substance abuse and relationship violence, and violence prevention. She recently received a mid-career award to further research on adolescent healthy functioning and violence prevention among child protective services clients (Ontario Women’s Health Council/CIHR Institute of Gender and Health).
Alec L. Miller, PsyD, is a Fellow of the American Psychological Association and is currently Associate Professor of Psychiatry and Behavioral Sciences; Chief of Child and Adolescent Psychology; Director of Adolescent Depression and Suicide Program; Director of Clinical Services at PS 8 School-Based Mental Health Program at Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Dr. Miller has spent the last decade heading a clinical-research team and training therapists internationally in the adaptation of dialectical behavior therapy for suicidal, selfinjurious, and maltreated adolescents.
David A. Wolfe, PhD, is the first recipient of the RBC Investments Chair in Developmental Psychopathology and Children’s Mental Health at the Centre for Addiction and Mental Health, University of Toronto. He is a fellow of the American Psychological Association and past President of Division 37 (Child, Youth, and Family Services). Dr. Wolfe has broad research and clinical interests in abnormal child and adolescent psychology, with a special focus on child abuse, domestic violence, and developmental psychopathology. He has authored numerous articles on these topics, especially in relation to the impact of early childhood trauma on later development in childhood, adolescence, and early adulthood. He recently received the Outstanding Career Award from the American Professional Society on the Abuse of Children, and the John Dewan Prize for Outstanding Contribution to Psychology from the Ontario Mental Health Foundation.
Carrie B. Spindel, PsyD, received her BSc from Cornell Universty and her doctorate in clinical psychology from Ferkauf School of Psychology, Yeshiva University. Dr. Spindel has expertise in the cognitive and behavioral treatment of maltreated children and adolescents. In 2004, she was granted the Distinguished Student Practice Award for Division 12 of the American Psychological Association. She is currently a post doctoral fellow at the Cognitive and Behavioral Consultants of Westchester in White Plains, NY.
From the Reviews
"This book provides outstanding suggestions and specific guidelines for mental health practitioners, from students to experienced therapists, in integrating empirically-based approaches into their clinical practice. The book clearly advances the field of intervention and treatment for children who have experienced abuse and neglect."
Barbara L. Bonner, PhD, Professor of Pediatrics, Child Study Center, Oklahoma City, OK
"This brief and concise book is replete with information and astute observations about the nature, context and effects of child maltreatment, which is wisely considered along dimensional, as well as the more usual categorical, lines. The authors succeed in portraying accurately those sequelae which require therapeutic intervention. Using the now necessary evidence-based approach, various forms of treatment are described and their applicability to specific post-abuse difficulties indicated. Case illustrations shed further light on the issues discussed. The book is thus a welcome addition to the child maltreatment literature, and will prove particularly useful to busy practitioners as well as to their managers, who will gain an understanding of the complexity and labor-intensive nature of work in this field."
Danya Glaser, MB BS, FRCPsych, Department of Psychological Medicine, Great Ormond Street Hospital for Children, London, UK
Table of Contents 10
1 Description 12
1.1 Terminology 17
1.2 Definition 21
1.3 Epidemiology 23
1.4 Course and Prognosis 26
2 Theories and Models of the Effects of Childhood Maltreatment 28
2.1 PTSD Symptomatology Model 28
2.2 Social Cognitive Information Processing Models 29
3 Diagnosis and Treatment Indications 31
3.1 Psychiatric Impairment and Specific Disorders Associated with Childhood Maltreatment 32
3.1.1 Mood Disorders 32
3.1.2 Suicidal/Self-Harm Behaviors 32
3.1.3 Anxiety Disorders 33
3.1.4 Posttraumatic Stress Disorder (PTSD) 34
3.1.5 Dissociation 36
3.1.6 Behavioral Problems and Disorders 37
3.1.7 Substance Use Disorders 39
3.1.8 Eating Disorders 40
3.1.9 Personality Disorders 42
3.1.10 Asymptomatic Victims 42
4 Treatment: Intervening with Childhood Maltreatment Victims 43
4.1 Methods of Treatment 44
4.1.1 Trauma-Focused Cognitive Behavior Therapy 44
4.2 Mechanisms of Action: Components of Trauma- Focused Cognitive Behavioral Treatment 45
4.2.1 Child- Treatment: Coping Skills Training 46
4.2.2 Child- Treatment: Cognitive Processing 46
4.2.3 Child- Treatment: Gradual Exposure 47
4.2.4 Child- Treatment: Psychoeducation 48
4.2.5 Parent- Treatment 48
4.2.6 Parent- Treatment: Orientation 48
4.2.7 Parent- Treatment: Coping Skills Training 49
4.2.8 Parent- Treatment: Gradual Exposure 50
4.2.9 Parent- Treatment: Psychoeducation 51
4.3 Efficacy and Prognosis 51
4.3.1 Empirical Support of TF-CBT for Childhood Sexual Abuse 51
4.3.2 Empirical Support for TF-CBT for Childhood Physical Abuse 52
4.4 Variations and Combinations of Methods 52
4.4.1 Dialectical Behavior Therapy 52
4.5 Problems and Issues in Carrying Out the Treatments 60
4.5.1 Individual Problems 61
4.5.2 Family Problems 61
5 Case Vignette 63
6 Further Reading 67
7 References 68
8 Appendix: Tools and Resources 71
Childhood Maltreatment Assessment Tools 71
The Children’s Impact of Traumatic Events Scale – II 72
Vicky Veitch Wolfe (2002) 72
The Children’s Impact of Traumatic Events Scale – II: Scoring Form 81
Vicky Veitch Wolfe (2004) 81
The Childhood Experiences of Violence Questionnaire 90
Childhood Experiences of Violence Questionnaire 91
Things that may have happened to me 91
The End 99
3 Diagnosis and Treatment Indications (p. 20-21)
Research links childhood maltreatment with a wide range of psychological and behavioral difficulties. Maltreatment can disrupt the normal course of development and can have short- and long-term implications requiring assessment and intervention. The most common diagnoses are in the areas of mood, anxiety, substance use, and antisociality (MacMillan & Munn, 2001).
A maltreated child is prone to revictimization and psychiatric symptomatology across the course of his or her life. It is important to note that while not all children and adolescents suffer psychological consequences related to earlier maltreatment, many children do in fact experience significant psychological impairment. Maltreated children and youth carry a long-term high personal burden of suffering and cost to service systems that has important consequences for the next generation. While maltreated youth are at higher risk for single disorders, they also are more likely to experience co-occurring or overlapping problems in adulthood.
There are few consistent linkages between maltreatment and problem behavior profiles, with two exceptions: (1) sexual abuse and sexual acting out, and (2) physical abuse and aggression. Children who are sexually abused engage in sexualized behaviors beyond what is developmentally appropriate. Such behaviors include sexualized play with dolls, inserting objects into genitalia, excessive masturbation, seductive behavior, age-inappropriate sexual knowledge, and seeking sexual stimulation from others. A sexually inappropriate behavior is one key factor that distinguishes sexually abused children from a clinic population without a history of abuse. This suggests that sexualized behavior may be a unique consequence of sexual abuse compared to other types of abuse.
Due to the pernicious impact of violence on females, with higher rates of sexual abuse and incest, childhood maltreatment is a critical risk factor for many of the problems women face: partner violence, ill health (e.g., gynecological health, chronic pain, arthritis, irritable bowel syndrome), depression, self-harming (cutting) and suicidal behaviors, anxiety, substance abuse, disordered eating, and posttraumatic stress disorder. In terms of risky sexual practices, childhood maltreatment is associated with adolescent females’ greater number of partners, earlier onset of "wanted" sex, and larger age differentials between partners. While adolescent girls are less likely to be risk takers than boys, those who do get involved in substance use and risky sexual behavior tend to suffer poor health outcomes and problems throughout life. A subset of at-risk girls will emerge street-involved, homeless, and/or working in the sex trade, elevating their chances of further victimization and disease exposure. Perhaps because females rely more on relationships for personal development and self-definition, maltreatment may be experienced as more disruptive to role functioning due to the impact of social betrayal.
3.1 Psychiatric Impairment and Specific Disorders Associated with Childhood Maltreatment
3.1.1 Mood Disorders
Depressive symptoms have commonly been associated with childhood maltreatment. Individuals with a history of child abuse and neglect report two- to three-fold increased likelihood of dysthymia and major depressive disorder during adolescence and young adulthood, as compared to nonabused individuals. Child sexual abuse victims exhibit significantly greater social withdrawal and internalizing symptoms such as depressed mood, anhedonia (i.e., lack of pleasure in previously reinforcing activities, like leisure, sex etc.), and feelings of worthlessness and guilt. Common emotional effects include guilt (i.e., feeling responsible for the abuse), helplessness and hopelessness, sleep disturbance, appetite disturbance, and low self-esteem.
Erscheint lt. Verlag | 1.1.2006 |
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Sprache | englisch |
Themenwelt | Geisteswissenschaften |
Medizin / Pharmazie ► Medizinische Fachgebiete ► Psychiatrie / Psychotherapie | |
Schlagworte | Child Abuse • childhood maltreatment • psychotherapy |
ISBN-10 | 1-61676-314-0 / 1616763140 |
ISBN-13 | 978-1-61676-314-5 / 9781616763145 |
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