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This chapter explores the Member States’ use of EU private international family law in the protection of children with links abroad from abuse or neglect by their family. These measures include rules governing the assumption of jurisdiction over the parental responsibility of a child, including both private and public law measures. The chapter argues that the abused and neglected child was not a central focus when regulating the cross-border family and, as a consequence, legal borders between Member States’ family law systems retain considerable significance for these children. Whilst each Member State has provision in place for public law child protection measures, the methods and approach adopted vary significantly between legal systems, as do the potential substantive outcomes for children. The EU’s private international family law rules are designed to obscure these differences and this has presented difficulties in supporting cross-national cooperation over child protection. The political nature of these decisions has meant that focus on the welfare of the child may consequently be lost.
Most evidence on associations between child maltreatment and subsequent common mental disorders (CMDs) comes from retrospective studies. Such findings may be affected by recall bias. Prospective studies of reports to statutory agencies are less common and may be subject to attrition bias.
Aim
To examine the associations of child maltreatment with emergency department presentations and in-patient admissions for CMDs in individuals up to 40 years old.
Method
Queensland-wide administrative health data were linked to a prospective birth cohort, including agency-reported and substantiated notifications of child maltreatment. Outcomes were emergency department presentations and in-patient admissions for CMDs.
Results
There were 6087 participants, of which 10.1% had been the subject of a child maltreatment notification. Admissions for CMDs occurred in 198 participants (3.3%) and emergency department presentations in 291 (4.8%). In the adjusted analysis, substantiated child maltreatment was associated with both admissions (odds ratio 1.92; 95% CI = 1.19–3.00) and emergency department presentations (odds ratio 2.10; 95% CI = 1.45–3.03). All agency-reported and substantiated child maltreatment subtypes (neglect, physical, sexual and emotional abuse) were associated with emergency department presentations for CMDs and notifications for more than one child maltreatment subtype. In the subgroup analysis, child maltreatment was associated with emergency department presentations for both anxiety (odds ratio 2.73; 95% CI = 1.68–4.43) and depression (odds ratio 2.23; 95% CI = 1.62–3.26) but with admissions only for depression (odds ratio 2.10; 95% CI = 1.15–3.84).
Conclusions
Child maltreatment is associated with both emergency department presentations and hospital admissions for CMDs in individuals up to 40 years old. Screening for child maltreatment in people presenting to hospital with CMDs may be indicated, as well as a greater awareness that survivors of child maltreatment may be at higher risk of developing such symptoms.
New Religious Movements have arisen not only in the present but have also developed in the past. While they differ in ideology and practice, they generally seem to live in high tension with mainstream society, especially when it comes to child-rearing. This Element examines several aspects of children growing up in new religions. It relies upon literature from different groups concerning child upbringing, the function of children in the groups considering the religious ideologies, and parental perspectives and parental styles. It also utilizes accounts from young adults growing up in these groups, both those who chose to stay and who chose to leave their groups as adults. A range of topics, such as socialization, education, health care, and relations to surrounding society are explored. In addition, this Element considers issues of physical and emotional abuse, state interventions, and the impact of second- and third generations of children in new religions.
Exposure to multiple forms of victimisation in childhood (often referred to as poly-victimisation) has lifelong adverse effects, including an elevated risk of early-adulthood psychopathology. However, not all poly-victimised children develop mental health difficulties and identifying what protects them could inform preventive interventions. The present study investigated whether individual-, family- and/or community-level factors were associated with lower levels of general psychopathology at age 18, among children exposed to poly-victimisation. Additionally, it examined whether these factors were specific to poly-victimised children or also associated with fewer mental health difficulties in young adults regardless of whether they had been poly-victimised.
Methods
We used data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative cohort of 2,232 children born in 1994–1995 across England and Wales and followed to 18 years of age (with 93% retention, n = 2,066). Poly-victimisation (i.e., exposure to two or more of physical abuse, sexual abuse, emotional abuse and neglect, physical neglect, bullying by peers, and domestic violence) and nine putative protective factors (intelligence quotient, executive functioning, temperament, maternal and sibling warmth, atmosphere at home, maternal monitoring, neighbourhood social cohesion, and presence of a supportive adult) were measured prospectively between ages 5 and 12 years from interviews with mothers and children, surveys of neighbours, child-protection referrals, and researchers’ observations. Early-adulthood psychopathology was assessed in interviews with each twin at age 18 and used to construct a latent factor of general psychopathology.
Results
Approximately a third (n = 720) of participants were prospectively defined as exposed to poly-victimisation (53% male). Poly-victimised children had greater levels of general psychopathology at age 18 than non-poly-victimised children (adjusted [adj.] β = 4.80; 95% confidence interval [95% CI] 3.13, 6.47). Presence of a supportive adult was the only factor robustly associated with lower levels of general psychopathology among poly-victimised children (adj.β = −0.61; 95% CI −0.99, −0.23). However, this association was also evident in the whole sample regardless of poly-victimisation exposure (adj.β = −0.52; 95% CI −0.81, −0.24) and no significant interaction was observed between the presence of a supportive adult and poly-victimisation in relation to age-18 general psychopathology.
Conclusions
Having at least one adult to turn to for support was found to be associated with less psychopathology in early adulthood among both poly-victimised and non-poly-victimised children. This suggests that strategies to promote better availability and utilisation of supportive adults should be implemented universally. However, it may be beneficial to target these interventions at poly-victimised children, given their higher burden of psychopathology in early adulthood.
Childhood maltreatment and peer victimisation are common sources of early-life interpersonal stress. Childhood maltreatment is associated with atypical frontolimbic emotion processing and regulation, and increased vulnerability for self-harm/suicide. However, few studies have compared the neurofunctional correlates between caregiver- versus peer-inflicted mistreatment.
Aims
We compared the alterations of neurofunctional correlates of facial emotion processing in youths exposed to childhood maltreatment or peer victimisation, and explored their associations with self-harm.
Method
Functional magnetic resonance imaging data were collected from 114 age- and gender-matched youths (39 childhood maltreatment, 37 peer victimisation and 38 controls) during an emotion discrimination task. Region-of-interest (amygdala, insula) and whole-brain analyses were conducted.
Results
Groups differed significantly during disgust processing only. Both groups had lower activation in the right amygdala and bilateral posterior insula than controls; left insular underactivation was furthermore related to increased self-harm in maltreated youths. Compared with controls, at the whole-brain level, both groups also had underactivation in a cluster of bilateral limbic-thalamic-striatal, precuneus/posterior cingulate, temporal, fusiform/lingual and cerebellar regions, which was negatively associated with emotional problems in controls, as well as a cluster of somatosensory regions associated with increased self-harm in maltreated youths.
Conclusions
Early-life interpersonal stress from caregivers or peers is associated with common underactivation of limbic-thalamic-striatal, precuneus/posterior cingulate and somatosensory regions during disgust processing. The hypoactivation of key emotion and sensory processing and self-referential brain regions could be a potential suppressive mechanism to cope with the aversive emotion; however, it may also entail increased risk of affective psychopathology in seemingly healthy youths.
Humans have evolved as a species with unique capabilities to destroy this world that we inhabit. Some of this destructiveness is a function of a loss of embodied wisdom and a dissociative disconnection from the complex systems of life on the planet. Inaction about climate change is a failure to protect our children and can be considered institutional child abuse. Climate disasters, along with other social injustices, traumatize all life on the planet, and disproportionately impact those already struggling with loss of community support. Fostering posttraumatic wisdom in youth requires recognition that some are vulnerable to maladaptive psychic numbing, while others manifest a resilience born from imagination and creativity.
A recent meta-analytic review demonstrated that retrospective assessments of childhood abuse acquired during adulthood – typically via self-report – demonstrate weak agreement with assessments of maltreatment gathered prospectively. The current report builds on prior findings by investigating the agreement of prospectively documented abuse from birth to age 17.5 years in the Minnesota Longitudinal Study of Risk and Adaptation with retrospective, Adult Attachment Interview-based assessments of childhood abuse administered at ages 19 and 26 years. In this sample, an agreement between prospective and retrospective assessments of childhood abuse was considerably stronger (κ = .56) than was observed meta-analytically. Retrospective assessments identified prospectively documented sexual abuse somewhat better than physical abuse, and the retrospective approach taken here was more sensitive to identifying abuse perpetrated by primary caregivers compared to non-caregivers based on prospective records.
This study compared two versions of the NICHD Protocol for interviewing young suspected sexual offenders: the Revised Suspect Protocol (RSP) and the Standard Suspect Protocol (SSP). The RSP incorporated relevant evidence-based practices informed by research on the value of (a) effectively explaining the suspects’ rights, (b) rapport building and support, and (c) appropriate questioning strategies. Interviewers using the RSP communicated the children’s rights more effectively (reading them more often, checking, verifying, and correcting understanding) and provided more support. In the substantive phase, they remained supportive while recall prompts dominated the questioning. Compared to children in the SSP group, children in the RSP condition understood their rights better, were more responsive during rapport-building, and reacted to interviewer support in the substantive phase with increased responsiveness, which in turn, predicted reduced reluctance, increased emotional expression, and greater informativeness. They were also more likely to make full rather than partial confessions than children in the SSP group. Full confessions were positively predicted by the appropriate communication of legal rights, interviewer support, and reliance on open-ended prompts, thereby confirming the superiority of the RSP relative to the SSP.
One of the most important aspects of human rights law for children is the recognition that the state has positive obligations to protect them from harm, including harm suffered in the home. Child protection is one of the most important areas for protecting children’s rights, but also one of the most difficult. As well as the right to protection from harm, children and parents also have a right to protection of their family life together. This chapter considers the extent to which the law and process of child protection protect the rights of children at risk from harm. It considers the importance of supporting families and the difficulty of deciding when to intervene. It then considers child protection proceedings and the extent to which children’s rights are protected in the law concerning child protection orders. Finally, it considers children’s own perspectives and the extent to which they are heard in the process.
This chapter considers the rights of children who are looked after by local authorities. It is clear in both international law and domestic law that children are entitled to state care that protects their rights and promotes their welfare; yet too often the state has failed in its duties as corporate parent. This chapter starts by considering the obligations owed by the state to looked-after children, including the difficult tension between the need to respect their family relationships, but also to plan for a secure future for the child. It then considers children in residential settings. A long history of abuse in such settings demonstrates the failure to protect many children from further abuse and exploitation. The rights of children in care are further at risk from the acute shortage of suitable placements, particularly for children with complex needs who are deprived of their liberty. The shortage of proper provision for these children means that many are accommodated in circumstances that not only fail to meet their needs, but are also degrading and dangerous. The chapter concludes by considering the extent to which the state is accountable to children for failings in their care.
Children are a critical part of certain legal trials, such as cases involving child abuse and neglect, and especially in cases of child sexual abuse. It is common for the only evidence in these types of cases to be the statement of the child victims. Children’s decisions about if and when to disclose the abuse are affected by many factors, and delays in disclosure are common. Police, forensic interviewers, prosecutors, and other professionals make decisions about when and how to interview children, the accuracy/credibility of their statements, if a case will move forward, and if and how children will testify in court. In some courtrooms, children are given special accommodations (e.g., testifying through closed-circuit TV or being accompanied by a therapy dog). Decisions about evaluating children in these situations have implications for the safety of children and the protection of innocent adults. Future research and policy implications are discussed.
Childhood maltreatment is associated with wide-ranging psychopathology at all stages of life. In the current study, we investigated whether posttraumatic stress disorder (PTSD) severity mediated the association between childhood maltreatment and internalizing and externalizing disorders among 262 South African trauma-exposed adolescents (aged 12–18 years). Childhood maltreatment and PTSD symptom severity were assessed using the Childhood Trauma Questionnaire and the Child PTSD Checklist, respectively. Psychiatric disorders were assessed utilizing the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version and were grouped into internalizing or externalizing disorders. Hierarchal logistic regression was used to assess the association of childhood maltreatment subtype with internalizing and externalizing disorders, controlling for age and gender, with PTSD symptom severity added to the final model. We found that sexual abuse was significantly associated with internalizing disorders, although this effect was no longer significant when PTSD was added to the model demonstrating that PTSD mediated the association between sexual abuse and internalizing disorders. Physical abuse, but not PTSD, was associated with externalizing disorders. Physical abuse, emotional neglect, and PTSD were associated with comorbid internalizing and externalizing disorders. These findings have implications for intervention and prevention strategies targeted at trauma-exposed adolescents with a history of childhood maltreatment.
Childhood maltreatment (CM) is a strong risk factor for psychiatric disorders but serves in its current definitions as an umbrella for various fundamentally different childhood experiences. As first step toward a more refined analysis of the impact of CM, our objective is to revisit the relation of abuse and neglect, major subtypes of CM, with symptoms across disorders.
Methods
Three longitudinal studies of major depressive disorder (MDD, N = 1240), bipolar disorder (BD, N = 1339), and schizophrenia (SCZ, N = 577), each including controls (N = 881), were analyzed. Multivariate regression models were used to examine the relation between exposure to abuse, neglect, or their combination to the odds for MDD, BD, SCZ, and symptoms across disorders. Bidirectional Mendelian randomization (MR) was used to probe causality, using genetic instruments of abuse and neglect derived from UK Biobank data (N = 143 473).
Results
Abuse was the stronger risk factor for SCZ (OR 3.51, 95% CI 2.17–5.67) and neglect for BD (OR 2.69, 95% CI 2.09–3.46). Combined CM was related to increased risk exceeding additive effects of abuse and neglect for MDD (RERI = 1.4) and BD (RERI = 1.1). Across disorders, abuse was associated with hallucinations (OR 2.16, 95% CI 1.55–3.01) and suicide attempts (OR 2.16, 95% CI 1.55–3.01) whereas neglect was associated with agitation (OR 1.24, 95% CI 1.02–1.51) and reduced need for sleep (OR 1.64, 95% CI 1.08–2.48). MR analyses were consistent with a bidirectional causal effect of abuse with SCZ (IVWforward = 0.13, 95% CI 0.01–0.24).
Conclusions
Childhood abuse and neglect are associated with different risks to psychiatric symptoms and disorders. Unraveling the origin of these differences may advance understanding of disease etiology and ultimately facilitate development of improved personalized treatment strategies.
Childhood trauma (CT) has been cross-sectionally associated with metabolic syndrome (MetS), a group of biological risk factors for cardiometabolic disease. Longitudinal studies, while rare, would clarify the development of cardiometabolic dysregulations over time. Therefore, we longitudinally investigated the association of CT with the 9-year course of MetS components.
Methods
Participants (N = 2958) from the Netherlands Study of Depression and Anxiety were assessed four times across 9 years. The CT interview retrospectively assessed childhood emotional neglect and physical, emotional, and sexual abuse. Metabolic outcomes encompassed continuous MetS components (waist circumference, triglycerides, high-density lipoprotein [HDL] cholesterol, blood pressure [BP], and glucose) and count of clinically elevated MetS components. Mixed-effects models estimated sociodemographic- and lifestyle-adjusted longitudinal associations of CT with metabolic outcomes over time. Time interactions evaluated change in these associations.
Results
CT was reported by 49% of participants. CT was consistently associated with increased waist (b = 0.32, s.e. = 0.10, p = 0.001), glucose (b = 0.02, s.e. = 0.01, p < 0.001), and count of MetS components (b = 0.04, s.e. = 0.01, p < 0.001); and decreased HDL cholesterol (b = −0.01, s.e.<0.01, p = .020) and systolic BP (b = −0.33, s.e. = 0.13, p = 0.010). These associations were mainly driven by severe CT and unaffected by lifestyle. Only systolic BP showed a CT-by-time interaction, where CT was associated with lower systolic BP initially and with higher systolic BP at the last follow-up.
Conclusions
Over time, adults with CT have overall persistent poorer metabolic outcomes than their non-maltreated peers. Individuals with CT have an increased risk for cardiometabolic disease and may benefit from monitoring and early interventions targeting metabolism.
iLookOut, a web-based child abuse training for early childcare professionals (ECPs), has been shown to improve knowledge and attitudes related to correctly identifying and reporting suspected cases of child abuse. The overarching goal of the present study is to examine “what works for whom” for iLookOut in order to identify strategies for optimizing learner outcomes.
Methods:
This prospective study enrolled 12,705 ECPs who completed iLookOut (November 2014–December 2018). We used structural equation models to test whether learner demographic and professional characteristics were differentially associated with implementation outcomes (i.e., acceptability and appropriateness) and whether these mediated subsequent indicators of training effectiveness (i.e., gains in knowledge).
Results:
Consistent with previous research, individuals with lower baseline knowledge scores showed greater knowledge gains (β = −.57; p < .001). Greater knowledge gains were seen for learners who reported higher acceptability (β = .08; p < .001) or appropriateness (β = .14; p < .001). Implementation outcomes strongly associated with knowledge gains included acceptability for female learners and appropriateness for learners who had not completed high school or had >15 years of experience in childcare settings. Where mediation was found, for the majority of groups, appropriateness emerged as the driving mediator.
Conclusion:
Implementation outcomes emerged as important drivers of knowledge change for most groups. The iLookOut Core Training’s use of a multimedia learning environment, video-based storylines, and game-based techniques were endorsed by learners and correlated with increases in knowledge. Future work should explore why aspects of the iLookOut training are rated as less acceptable or appropriate by some groups and what changes would improve efficacy for low performing learners.
Chapter Three compares the representation of vulnerable transient youth in the work of Leon Ray Livingston, whose road name was ‘A-No.1’, and the author Jack London. The chapter argues that both writers engage with the frequent abuse and exploitation of young boys, known as ‘punks’ or ‘gay-cats’, on the road. A-No.1’s semi-autobiographical writings are more explicit, obsessively reproducing the same narrative in which the author (or his fictional stand-in) saves a punk from the clutches of an older hobo, or ‘jocker’. For London, who was at the very least what today would be called bi-curious, the questions of transient sexuality and abuse were more fraught. He acknowledges the existence of sexually-vulnerable youths in early stories, written before he became a successful author. However, in his well-known work The Road (1907) he goes to great lengths to persuade his audience that he was never a gay-cat. The text positions London as a young man well ahead of his time, a claim that many critics have taken at face value. Yet paradoxically the text’s narrator seeks out the approval and protection of older men, including one who seems to expect sexual favours in return.
While child maltreatment is a global problem, urban settings highlight the problem due to large concentrations of people, which increase the likelihood that the maltreatment will be noticed and reported; urban Emergency Departments (EDs) are particularly situated for the detection of child maltreatment. The ability of the emergency physician to recognize and respond to child maltreatment is crucial in preventing further harm to the child. Emergency physicians are also mandated reporters, and are required by law to inform child protective services of all suspected cases. There are certain risk factors for child abuse and subtle red flags in the history and physical exam that we must familiarize ourselves with in order to appropriately identify child abuse. These risk factors and rates of child abuse may be unique for the clinician practicing emergency medicine in an urban setting. The evaluation of a child with suspected abuse also requires an extensive workup and detailed documentation, and such cases are prone to medical and legal consequences.
Childhood maltreatment (CM) has been related to social functioning and social cognition impairment in people with psychotic disorders (PD); however, evidence across different CM subtypes and social domains remains less clear. We conducted a systematic review and meta-analysis to quantify associations between CM, overall and its different subtypes (physical/emotional/sexual abuse, physical/emotional neglect), and domains of social functioning and social cognition in adults with PD. We also examined moderators and mediators of these associations. A PRISMA-compliant systematic search was performed on 24 November 2022 (PROSPERO CRD42020175244). Fifty-three studies (N = 13 635 individuals with PD) were included in qualitative synthesis, of which 51 studies (N = 13 260) with 125 effects sizes were pooled in meta-analyses. We found that CM was negatively associated with global social functioning and interpersonal relations, and positively associated with aggressive behaviour, but unrelated to independent living or occupational functioning. There was no meta-analytic evidence of associations between CM and social cognition. Meta-regression analyses did not identify any consistent moderation pattern. Narrative synthesis identified sex and timing of CM as potential moderators, and depressive symptoms and maladaptive personality traits as possible mediators between CM and social outcomes. Associations were of small magnitude and limited number of studies assessing CM subtypes and social cognition are available. Nevertheless, adults with PD are at risk of social functioning problems after CM exposure, an effect observed across multiple CM subtypes, social domains, diagnoses and illness stages. Maltreated adults with PD may thus benefit from trauma-related and psychosocial interventions targeting social relationships and functioning.
The current study examined if early adversity was associated with accelerated biological aging, and if effects were mediated by the timing of puberty.
Methods
In early mid-life, 187 Black and 198 White (Mage = 39.4, s.d.age = 1.2) women reported on early abuse and age at first menstruation (menarche). Women provided saliva and blood to assess epigenetic aging, telomere length, and C-reactive protein. Using structural equation modeling, we created a latent variable of biological aging using epigenetic aging, telomere length, and C-reactive protein as indicators, and a latent variable of early abuse using indicators of abuse/threat events before age 13, physical abuse, and sexual abuse. We estimated the indirect effects of early abuse and of race on accelerated aging through age at menarche. Race was used as a proxy for adversity in the form of systemic racism.
Results
There was an indirect effect of early adversity on accelerated aging through age at menarche (b = 0.19, 95% CI 0.03–0.44), in that women who experienced more adversity were younger at menarche, which was associated with greater accelerated aging. There was also an indirect effect of race on accelerated aging through age at menarche (b = 0.25, 95% CI 0.04–0.52), in that Black women were younger at menarche, which led to greater accelerated aging.
Conclusions
Early abuse and being Black in the USA may both induce a phenotype of accelerated aging. Early adversity may begin to accelerate aging during childhood, in the form of early pubertal timing.
Edited by
Masum Khwaja, Imperial College of Science, Technology and Medicine, London,Peter Tyrer, Imperial College of Science, Technology and Medicine, London
Violence is a global problem. Although popular perception may regard people with mental disorders as perpetrators of violence, the reality is that people with mental disorders are far more likely to be victims of violence when compared to people without disabilities. Safeguarding and protecting adults and children from violence is a core clinical and professional responsibility. This chapter describes types of violence to which people with mental disorders may be subjected, including institutional abuse, disability hate crime, domestic violence and abuse, stalking, harassment, sexual violence, physical violence, gang-related violence, radicalisation and child abuse. Preventative approaches to reducing violence towards adults and children at risk are discussed, including approaches to reducing use of force against people with mental disorders. Barriers to disclosure and approaches to facilitate disclosure are described, along with risk factors and warning flags for violence among victims, perpetrators and institutions. Guidance is given on responding to disclosure and an example is given of multi-agency working via multi-agency risk assessment conference arrangements.