Providing medical evaluations for possible child maltreatment to children with special health care needs

OBJECTIVE: Children with special health care needs are known to be at increased risk of all forms of child maltreatment when compared to children without such needs. We describe a health care team's experience providing medical evaluations for suspected child maltreatment to children with special health care needs. METHOD: Consecutive cases seen as outpatients in the Abuse Referral Clinic for Children with Disabilities were abstracted and analyzed. Mail and telephone follow-up contact was attempted after the medical evaluation to determine adherence with treatment recommendations. A subsample of cases for which complete financial information was available was reviewed to determine a reimbursement rate. RESULTS: During the study, 49 children received complete outpatient evaluations. Ages ranged from 3 to 16 years old, and 54% were males. Special needs spanned a wide range of physical, developmental/cognitive and behavioral conditions. The largest number of referrals came from child protective services (42%) followed by referrals from physicians (27%). After the team's comprehensive evaluation, 18% of the children were found to have a history or physical examination that was diagnostic for child maltreatment, 13% were thought to be at high risk, 25% were thought to be at low risk and 44% were thought to have non-abusive etiologies. The collection rate was 14% for an average reimbursement of $38 per case. Only 29 caregivers could be found at follow-up and 22 remembered the recommendations made by the team. Of the 25 cases that were referred for outpatient mental health counseling, 12 (48%) complied. CONCLUSION: Children with a wide range of special health care needs were evaluated in an outpatient special health care needs clinic that offered comprehensive medical evaluations for possible child maltreatment. Medical evaluation services for this group of children were poorly reimbursed. Mental health services were frequently recommended but often not accessed. Child maltreatment teams seeking to serve children with special health care needs will need to plan for service delivery to a potentially diverse group of children and families who may experience difficulty in carrying through on the team's treatment recommendations.     

A Case Study of Giftedness and Specific Learning Disabilities: Bridging the Two Exceptionalities

Despite being unable to dress himself, sit still on a chair, or write a legible sentence, Scott was, from a very early age, able to build whole cities from construction blocks, able to complete complex puzzles, and verbally precocious. Even with his disabilities and their contrast with his academic talent, he completed K–12 school and went on to excel at university. This case study represents the challenges many parents experience with identifying their children’s disability and giftedness and ensuring that both exceptionalities are optimally developed. Through this case study, the roles an education system and the parents of such a child must assume if this development is going to happen are highlighted. Recommendations for identification, service provision, professional development for teachers, and collaboration among all parties connected with such students are made.     

Special Educational Placement Decisions for Handicapped Children: An Initial New Zealand Study

An examination was made of the case records and special educational placement decisions for a sample of 40 children, all of whom had been tested and/or reviewed by school psychologists during the year preceding the study and classified within one of the traditional special educational categories: intellectually handicapped, mentally backward, physically handicapped, hearing handicapped, visually handicapped, and emotionally maladjusted. It was found that very few children receiving special education were being returned to regular classes, and that factors other than the child's ability and/or learning/behavioural characteristics were strongly implicated in special educational decisions for mentally backward (mildly retarded) children, but to a lesser extent in decisions reached for children in other special educational categories. The study highlighted a difficulty likely to arise in a wide range of situations involving parents and children, where research access to case information must be balanced against parents’ rights to privacy and confidentiality of information disclosed in casework. Implications for the present results are considered, together with the need for alternative research strategies in this and related areas of enquiry.     

Ethical issues in research with abused children

This paper discusses sensitive ethical issues encountered in conducting research with abused children and the potential consequences of various methods of handling these dilemmas. Important ethical questions arise at three stages of the research: (1) obtaining consent for participation in the research; (2) conducting interviews with or administering tests to the subjects; and (3) providing information about test results to parents or others outside the research team. Concern with children's rights has been extended to the question of who can give consent for children to participate in research. In the case of abused children, the consent issue is complicated by the potential adversarial relationship between abusing parent and abused child. Procedures for interviewing or testing abused children must include provisions for three special situations: (1) when a child is distressed by the interviewing or testing; (2) when a child's answers or test results indicate emotional problems; and (3) when a child's answers or comments indicate that the child is being abused. Decisions concerning whether to inform parents or others about an individual child's answers must balance the parents' right to know against the child's right to privacy. All these circumstances require serious deliberation concerning the role and responsibility of the research investigator.     

Evaluating the teaching and learning experience for the child with dyslexia in special and mainstream settings in Ireland

This study examines and evaluates special provision for pupils with dyslexia in three different settings: reading schools, reading units and mainstream support. The research focused on the teaching and learning context for pupils with dyslexia, the support teacher, the mainstream teacher and the experience of the student. The main participants were teachers and tutors supporting pupils with dyslexia, and the parents of these children. Survey methods included questionnaires, focus group discussions, interviews and quantitative data on pupils' reading attainment. In addition, a total of six schools, two representing each model of support, were selected as case studies. This article reports part of a larger survey, which evaluated the effectiveness of three models of special provision for children with dyslexia in primary school. The study shows that there are academic and social benefits for the child with dyslexia who is enrolled in a special setting. However, placement in a reading school or reading unit per se does not guarantee that a child will ‘catch up’ with his or her peers. The findings reported a similarity in the methods and practices teachers use in both mainstream and special settings. The discussion suggests that if teachers are to ‘catch them before they fall’ there are serious questions that must be asked about how we are teaching basic literacy skills. The findings suggest an urgent need for a more balanced approach to teaching reading and writing.     

Texts as Artefacts Crossing Sites: Map Making at Home and School

This article compares a child’s drawings at home with a child’s drawings at school. The drawings were of maps, which had been a school topic. As part of a longitudinal study looking at children’s text making at home and at school three particular homes were focused on for eighteen months. This article looks at one home – that of a six year old Turkish boy who lives with his mother and brother. The case study illustrates how children can take something learned at school and transform it at home. The article starts with discussing the text created in the home, then compares this to texts created at school. The point is made that children can activate meaning in a different way at home than at school. While this is one case study, it suggests that transforming artefacts across sites may be something children do that often goes undocumented.     

Identifying the characteristics of child sexual abuse cases associated with the child or child's parents withdrawing the complaint

Most child sexual abuse cases do not result in a full trial or guilty plea; rather, case attrition occurs at earlier stages of the criminal justice system. One reason for the attrition of these cases is the withdrawal of complaints, by children or their caregivers. The aim of the current study was to determine the case characteristics associated with complaint withdrawal in child sexual abuse cases by the child or his or her parents once a report has been made to authorities. All child sexual abuse incidents reported to authorities in one jurisdiction of Australia in 2011 were analyzed (N = 659). A multinomial logistic regression was used to predict the following case outcomes: (1) withdrawn by the child or his or her parents, (2) exited for other reasons (e.g., the alleged offender was not identified, the child refused to be interviewed), and (3) resulted in a charge. Five predictors significantly added to the prediction of case outcome: child age, suspect gender, suspect age, child–suspect relationship, and abuse frequency. These results should contribute to the design of interventions in order to reduce complaint withdrawals if these withdrawals are not in the child's best interests.     

Chicken Club: schools and their relationship with families

Over time, schools have developed systems that include the families of children. Families often sign a home school agreement and attend parent forums or more formal meetings designed to plan provision for children with special educational needs. These endeavours, however, are arguably inadequate when the full influence of the family is properly acknowledged. Research makes clear that the main influencer on the child’s self-efficacy and therefore learning behaviours, is the family. This article reports findings from literature and a case study looking at making the most of the partnership between families and schools in order to meet the learning needs of individual children. It also addresses many barriers that families face in approaching schools and three ways schools in Cornwall, a rural county in South West England, are 'opening out’ their practice. The case study provides evidence of the progress children made in learning as a response to the new school and family partnership.     

The ADHD label,analogue methodology,and participants' geographic location on judgments of social and attentional skills

Two hundred fifty‐nine preservice teachers at a medium‐sized university in the Southwest participated in the current study. The participants were randomly assigned to a labeled condition, Attention Deficit Hyperactivity Disorder, or nonlabeled condition, and were presented a vignette in one of three forms: a written case study, a video clip, or a written case study with a video clip. The vignette described an elementary school aged child displaying disruptive behavior, while the video portrayed a similar aged child exhibiting disruptive behavior in the classroom. Following the presentation of the vignette, participants made judgments about the child's social skills and attentional skills by completing an examiner‐made rating scale. There was a significant main effect for the label condition on judgments of attention; participants in the labeled condition made significantly more negative judgment than did those in the nonlabeled condition. There were also significant main effects for the participants' high school location and vignette treatment. © 2004 Wiley Periodicals, Inc. Psychol Schs 41: 221–234, 2004.     

"It is Floating 'Cause there is a Hole'": A young child's experience of natural science

In this article, a video-recording of a young child's (3.3 years) dialogue with his teacher about experiments with elementary physics concepts forms a base for a discussion of early science education in preschool. Although, according to Piaget's theory, the child appears to be at the pre-operational stage, we argue for a pedagogical approach which focuses his awareness on the most basic aspect of science, i.e. that phenomena can be explained (this foundational principle must be understood before specific scientific explanations can be understood). The focus for the analysis is on the verbal interaction between the child and the teacher within the social practice of the preschool and on how this interaction enables the child to test and prove a hypothesis formulated by himself. The interaction in the case study will be used here as an illustration and a discussion of an approach to education in preschool.     

Child abuse: Thoughts on doctors, nurses and prevention

It is obviously better if child abuse can be prevented in the first place. There are many problems in society which doctors and nurses and other health care professionals can hardly be expected to fix up, but there are many weaknesses in what we do which can and should be repaired. As a group we are weak in our appreciation of the demoralizing strain that an awkward or crying baby can bring upon a household, particularly that of the nuclear family. The media paint a mythical picture of parenthood, possibly unreal, and leading to the isolation of the mother who wants to complain that her child is very trying. As a group, doctors and nurses are more concerned about reassurances that a child is not seriously ill or else will outgrow his particular symptom and are not very good at bending their energies towards providing relief of the symptom. The sanity of many families has been preserved by the judicious use of safe analgesics and sedatives. Many people obtain these in spite of the physician and not through him.To turn to an even earlier phase of infancy, where hospital personnel are intensely involved and could well mend their ways often — in Western countries more and more babies are being born in hospital. Frequently, insufficient efforts are made to ensure that the labour and delivery are pleasant emotional experiences for the mother. In the name of safety, sterility and administrative needs, many of the emotional needs of the parents are unmet. It is now being shown that actual physical attachment between mother and baby in the time — hours and days — after the baby is born can be extremely important in developing the mother/child bond which is the child's greatest protection. In many countries including mine there have to be associations of mothers who want to breast feed their own children, and these mothers often find that their greatest difficulties are with hospital personnel.The very necessary scientific measures required to ensure the safety of low birth weight and premature infants can separate mother from baby even more and this is reflected in the well-known increase in later child abuse among babies who have spent their early weeks in intensive care units. If the hospital personnel really try, they can make the mother and father feel at home in these ultrascientific units. The staff must not merely permit but must actively invite the parents into the special nursery, explain the surroundings and equipment, show how to gown and hand wash, how to open the Humidicrib, touch the baby and take part in the nursing management from the earliest possible time — the second or first day. Explanations appropriate to the parental level of understanding must be given and repeated.Anything which will strengthen the bonds within the family must be welcomed as something that will prevent child abuse.     

Between psychopathology and inclusion: the challenging collaboration between educational psychologists and child psychiatrists

This article reports on a Danish study on interprofessional collaboration between child psychiatrists and educational psychologists concerning children who are categorised as being at risk. Methodologically, the analysis is grounded in qualitative interviews with psychologists. A Foucauldian approach is applied to narratives and experiences that occur within these interviews concerning external collaboration with child psychiatrists. The article is informed by the research tradition that has problematised the significance of psychiatry and diagnoses in the field of special needs education and social pedagogy. We thus enquire into how the rise of diagnostics and medicalisation affects our understanding of children's difficulties. We discuss a paradox that is present in Denmark and other countries. As educational policies emphasise inclusion, the field of schooling experiences a huge rise in children with medical diagnoses. We argue that diagnostic knowledge is itself an insufficient basis for action and must be considered in relation to teachers’ overall training and teachers’ situated professionalism.     

The role of cranial MRI in identifying patients suffering from child abuse and presenting with unexplained neurological findings

OBJECTIVE: The aim of this study was to demonstrate the usefulness of cerebral MRI to detect possible child abuse in children with unexplained neurologic findings. METHOD: Between 1990 and 1997, 208 children were referred for suspected physical child abuse to the Child Protection Clinic of Ste-Justine Hospital, a tertiary care pediatric hospital. Among them, 39 children presented initially with neurological findings. For 27 of them, the CT Scan results prompted the diagnosis of child abuse. However, in 12 children, even if a CT-Scan was performed, the diagnosis and/or the mechanisms of the neurologic distress remained obscure. Investigation was completed with MRI study in those 12 cases. RESULTS: MRI findings were diagnostic for physical abuse in eight cases. A diagnosis of child abuse was made in two more cases by a combination of MRI and skeletal survey findings. In one case, MRI was suggestive but the diagnosis of child abuse could not be confirmed. One case was misinterpreted as normal. CONCLUSIONS: MRI is the test of choice to rule out child abuse when faced with a child presenting unexplained neurologic signs lasting for few days. The fact that MRI can better differentiate collections of different ages makes this imaging test particularly useful in identifying cases of child abuse. These results, however, always have to be integrated in a well conducted multidisciplinary clinical approach.     

Economic Recession,Teacher-Reported Cuts to School Resources,and Children's Economic and Psychiatric Problems in Young Adulthood

The study investigated whether cuts to school resources made during economic recession contribute to children's psychiatric and economic problems in early adulthood. The cohort consisted of 817 Finnish children. Data was gathered from teachers during a recession (child age 12) and from national registers on children's post-recession use of psychiatric and income benefit services (age 18–28). Children's need for remedial instruction, special education, or psychosocial services was associated with later use of income support and psychiatric services. Those receiving special education had an increased risk for adulthood use of psychiatric services as compared to those who needed, but did not receive, this service. A decrease in material resources and teachers' loss of motivation predicted children's later use of psychiatric services.     

A review of a reading class placement for children with dyslexia,focusing on literacy attainment and pupil perspectives

This research investigated a special reading class placement for children with dyslexia in the Republic of Ireland. The study compared the literacy attainments of children before and after their reading class placement, and determined in particular children’s views regarding the placement. Participants included 16 children with dyslexia who had completed at least two years or maximum three years in a reading class for children with dyslexia, as well as 14 reading class and mainstream teachers. A case study was utilised to examine the three reading classes using a variety of data collection procedures including standardised assessment results, focus group and group interviews over a sustained period of time. Results indicated that children and teachers were very positive about the placement for children with dyslexia, with both children and teachers reporting academic, social, emotional, behavioural and attitudinal gains for the children in these classes. Findings from quantitative data demonstrated that children made progress in the areas of reading accuracy, comprehension and spelling, during their placement. Interestingly, findings from this study confirm that children who spent three years in the reading class made greater progress in the areas of reading accuracy and reading comprehension than children who spent two years in the reading class. However, there was no significant difference in the spelling achievement gains for children who attended the reading class placement for either two or three years. The qualitative findings revealed children’s increased positive disposition towards their own learning experiences during the special reading class placement and this was reported by both children and teachers alike. However, issues regarding lack of collaborative opportunities between mainstream and reading class teachers, and differentiation of curriculum content in the mainstream classroom remained throughout the placement period.     

The emotional development of the highly able

The highly able can be expected to be expected to be at least as well balanced as any other children, but they do have special emotional problems arising both from other people’s reactions to their exceptionality and from inappropriate education. This was investigated in a British 14-year comparative study. Children labelled as gifted were found to be from different home backgrounds and to have different emotional profiles than others of the same measured ability who had not been seen as gifted. From this and other research it can be seen that expectations of highly able children can be confusing, for example that they either have poor social relationships or are natural social leaders. Teachers and parents may over-pressure pupils to excel at all times, or raise their all-round expectations for a child, even though s/he is only gifted in a specific area. Stress may also come from always having to learn at an unstimulating level, producing boredom, apathy and underachievement. Suggestions are made for helping the emotional development and improving educational provision for the highly able.