Child maltreatment and problem gambling: A systematic review

This study systematically reviews research on child maltreatment and risk of gambling problems in adulthood. It also reviews adult problem gamblers’ risk of abusing or neglecting their own children. Multiple database searches were conducted using pre-defined search terms related to gambling and child abuse and neglect. We identified 601 unique references and excluded studies if they did not report original research, or did not specifically measure child maltreatment or gambling. Twelve studies that included multivariable analysis of childhood maltreatment exposure and problem gambling were identified. Six of seven studies examining childhood sexual abuse and four of five examining physical abuse showed a significant positive association between abuse and later gambling problems (odds ratios for sexual abuse 2.01–3.65; physical abuse 2.3–2.8). Both studies examining psychological maltreatment and two of three examining neglect identified positive associations with problem gambling. In most studies, risks were reduced or eliminated when controlling for other mental health disorders. The three studies measuring risk of child abuse and neglect among current problem gamblers suggest an increased risk for child physical abuse and medical conditions indicative of neglect although there is a considerable amount of variation among studies. Child abuse is associated with increased risk of gambling problems – gambling treatment providers should ask about maltreatment history as part of their clinical assessment. Problem gamblers may be more likely to physically abuse or neglect their children, but data here are more limited. Child welfare professionals should consider asking questions about parental gambling when assessing family risk.     

Reporting rates of child sexual abuse in Indigenous communities in two Australian jurisdictions

Child sexual abuse is a significant problem in many Indigenous communities; there is also evidence of chronic under-reporting of this crime. This study aimed to compare reporting rates between Indigenous and non-Indigenous cases of child sexual abuse across two Australian jurisdictions. Datasets comprising child sexual abuse reports from the Police Information Management Systems of the two jurisdictions were used to calculate reporting rates, and to compare case characteristics and case progression. Results indicated that the reporting rate for child sexual abuse of Indigenous children was between two and four times that of non-Indigenous children. In the Indigenous cases, the second jurisdiction had lower reporting rates than the first jurisdiction. Further analysis of the Indigenous cases only found that cases in the second jurisdiction were more severe, more likely to have a forensic interview, and more likely for the suspect to be charged, than in the first jurisdiction. However, there were no significant differences in conviction rates between the two jurisdictions. Differences observed in severity and case progression suggest that the lower reporting rates observed in the second jurisdiction may be due to comparatively high levels of under-reporting, rather than lower actual levels of child sexual abuse. In conclusion, reporting rates of child sexual abuse can be better understood when further information, such as case characteristics and case progression rates, is available.     

Professionals' adherence to mandatory child abuse reporting laws: effects of responsibility attribution, confidence ratings, and situational factors

This study investigated the relationship between responsibility attribution and tendency to report child sexual abuse among practicing psychologists. Two hundred ninety-five licensed psychologists from two states completed vignettes in which the sex of the child and the father's admission or denial of alleged sexual abuse were systematically manipulated. Subjects assigned relative percentages of responsibility to the father, mother, child, and society for the abuse and indicated their tendency to report and their level of confidence that abuse was occurring. Results indicated a significant effect for responsibility to the mother which varied as a function of the father's response to the allegation of abuse. Mothers were blamed significantly more for the abuse when the father denied being abusive. Responsibility attribution did not predict reporting, while confidence in the occurrence of abuse did. Also, sex differences were found among participants where male subjects assigned significantly more responsibility to the abusive father than female participants, and the females blamed the mother more than the males. Results are discussed in the context of previous research on responsibility attribution in child abuse.     

Abuse of children in foster and residential care

OBJECTIVE: There have recently been many debates in the UK about how to provide good care for children placed away from home. Professionals have realized that the level of child abuse in foster care and children's homes is high. This research examines the characteristics of physical and sexual abuse of children in foster and residential care in a city in England. The number of cases of abuse reported by pediatricians in this group was compared to the number reported by the same pediatricians for the population of Leeds as a whole. METHOD: This is a retrospective study of 158 children, fostered or in residential care who were involved in 191 episodes of alleged physical and/or sexual abuse assessed and reported by pediatricians over a 6 year period from 1990 to 1995 in Leeds, England. Details of the child including the reason for placement in care, their physical and mental health, abuse characteristics, including perpetrator and case management were studied. RESULTS (see Table 1): 158 incidents of abuse in 133 children in foster/residential care are described. In foster care, 42 children were physically abused, 76 were sexually abused, and 15 experienced both forms of abuse. In residential care, 12 children were physically abused, 6 were sexually abused, and 6 experienced both forms of abuse. In foster care 60% of sexual abuse involved girls and 60% of physical abuse involved boys. In residential care almost twice as many boys as girls were reported to be abused. Foster carers perpetrated the abuse for 41%, natural parents on contact for 23%, and children 20% of incidents. A significant proportion of abuse was severe with 1 death, 8 children with burns, 18 with genital, and 34 with anal penetration. Long-standing emotional, behavioral and learning difficulties were common. Most children (80%) had been abused prior to entry into care. Foster children were 7-8 times and children in residential care 6 times more likely to be assessed by a pediatrician for abuse than a child in the general population. CONCLUSIONS: Children in foster or residential care form an at risk group for maltreatment. Their special needs include additional measures to protect them from abuse.     

Expert medical assessment in determining probability of alleged child sexual abuse

The purpose of this paper is to describe the role of the physician as part of the investigative team in child sexual abuse both in corroborating previously obtained disclosures and in determining the level of probability of sexual abuse where there has been no disclosure. At retrospective chart audit, history of physical and behavioral symptoms and physical and laboratory findings suggestive of child sexual abuse were correlated with allegations where known in order to classify 63 patients as to probability of sexual abuse. In this study 14.3% of cases were "unfounded" based on available evidence while 65% were "probable" or "determined." The remainder were "uncertain." Of 16 patients with physical signs, in 11 cases physical findings corroborated suspicion of child sexual abuse. The need for a systematic approach to the "directed medical interview" and examination, preferably videotaped, is discussed.     

Association between child sexual abuse and infectious disease diagnoses

BackgroundThough many studies have linked child sexual abuse (CSA) to psychological health problems, little is known regarding the relationship between CSA and children and adolescents’ physical health.ObjectiveThe objective of this study was to assess the relationship between CSA and infectious disease diagnoses.ParticipantsOf the 955 eligible children and adolescents who had a substantiated report of sexual abuse between 2001 and 2010, medical data was retrieved for 882 individuals, who formed the sexually abused group. These 882 participants were matched to 882 participants on age, gender, and administrative healthcare region to form the general population group.Setting and methodsThis matched-cohort study, conducted in a large Canadian city, compared the number of infectious disease diagnoses between the date of the substantiated sexual abuse report and August 1, 2013, between the two groups.ResultsResults indicate that sexually abused participants had 1.27 times more (95% CI – 1.13 to 1.42) infectious diseases diagnoses than those from the general population. They received 1.83 times more genitourinary infection diagnoses (95% CI – 1.43 to 2.33), 1.31 times more diagnoses for other types of infections (95% CI – 1.11 to 1.55) and 1.21 times more respiratory and ear infection diagnoses (95% CI – 1.05 to 1.40). There was no statistically significant difference regarding skin infection diagnoses. These results indicate an association between CSA and more frequent infectious diseases diagnoses.     

Helping children to the other side of silence: a study of the impact of the stay safe programme on Irish children's disclosures of sexual victimization

OBJECTIVE: This study aimed to evaluate the effectiveness of a school based safety skills program--The Stay Safe Programme--in facilitating the disclosure of sexual abuse among sexually victimized children and adolescents in Dublin. METHOD: A Cohort of 145 children who had participated in the Stay Safe Programme prior to their referral to a sexual abuse assessment unit were compared with a cohort of 443 children who had not participated in the prevention program on a range of disclosure related variables abstracted from case notes. RESULTS: More Stay Safe participants, particularly female adolescents, made disclosures of suspected sexual abuse than non-participants. A higher rate of initial disclosure to teachers was made by Stay Safe participants and more teachers in schools participating in the Stay Safe Programme initiated referrals for evaluation of suspected child sexual abuse. Following assessment a higher rate of confirmed abuse occurred among Stay Safe participants and for these confirmed cases more Stay Safe participants made purposeful disclosures and in significantly more cases referral was due to the child telling someone about the abuse. These differences in disclosure between program participants and non-participants were unrelated to demographic factors or characteristics of the abuse. CONCLUSIONS: The Stay Safe Programme was an effective secondary prevention intervention deserving widespread implementation.     

On the interpretation of pictures with and without a content of child sexual abuse.

OBJECTIVE: The purposes of the three experiments were to validate the possibility of a picture to evoke the recognition of child sexual abuse, to determine if the picture was anxiety evoking, and to investigate if the content of child sexual abuse would be transferred to a neutral picture. METHOD: In all three experiments, adult men and women were presented with a drawing intended to depict child sexual abuse, and were requested to interpret the picture. Experiment 1: Before and after the picture presentation, 226 participants were given a test of anxiety. Experiment 2: After the exposure of the child abuse picture, 200 new participants were asked to interpret an innocent child-adult picture. Experiment 3: To complete Experiment 2, 89 new participants were asked to interpret the pictures in the reverse order. RESULTS: Almost three-fourths of the participants saw child sexual abuse in the picture with a sexual threat. Those in Experiment 1 who saw the picture as child sexual abuse or as a problematic child-adult situation without sexual implications reported a significant increase of anxiety level. None in Experiment 2 or 3 saw child sexual abuse in the innocent picture. The sex of the abused child was significantly more often interpreted as opposite to one's own sex. CONCLUSIONS: The study indicates some people's deficient capacity to recognize the message of child sexual abuse in the picture. It seems that certain people can spare themselves anxiety by not registering the child's precarious situation or not seeing the child as being of their own sex. This has implications for the recognition of child sexual abuse in society. It was also shown that a sexual abuse theme was not transferred from one context to another context, which immediately followed it.     

Child maltreatment and attentional problems: A longitudinal birth cohort study

ObjectiveTo examine whether child maltreatment is associated with attentional problems in adolescence (14 years) and young adulthood (21 years), and whether outcomes depend on the type of maltreatment (sexual vs non-sexual).MethodsData from a population based cohort study involving 3778 mother-child pairs were linked with data from the state child protection agency to examine associations between child abuse and neglect and attention problems, measured using the Achenbach Child Behaviour Checklist (CBCL) and the Achenbach Young Adult Self Report (YASR).Results245 (6.5%) participants had been the subject of notification for non-sexual maltreatment (one or more of neglect, emotional or physical abuse) compared with only 54 (1.4%) who had been subject of notification for suspected sexual abuse. After adjusting for potential confounding variables including maternal, participant and sociodemographic factors, we found those exposed to non sexual maltreatment were likely to experience attentional problems at 14 years (p < .001) and 21 years of age (p = .044), compared with those participants who had not experienced non sexual maltreatment. By contrast, at age 14 years, sexual abuse was associated with attentional problems only as reported by the participant, not their carer. Results at 21 years of age for those exposed to sexual child maltreatment (p=.655) were again in contrast to the observed association between attentional problems and non sexual child maltreatment (p = .035).ConclusionIn this study, non-sexual maltreatment in childhood is associated with attentional problems at both 14 years and 21 years of age. These findings highlight the need for targeted research to better understand the longer term mental health outcomes for children exposed to non-sexual maltreatment. Potential implications for mental health services include the need for broader screening at presentation and importantly, greater collaboration with schools, general practitioners and paediatricians, given the greatest impact would arguably be within these settings.     

Role of emotion dysregulation in the relationship between childhood abuse and probable PTSD in a sample of substance abusers

This study examined associations among childhood abuse, emotion dysregulation, and probable posttraumatic stress disorder (PTSD) within a sample of 93 substance use disorder (SUD) patients in residential treatment. SUD patients with probable PTSD (vs. non-PTSD) reported (a) greater severity of childhood sexual, physical, and emotional abuse and (b) significantly higher levels of overall emotion dysregulation and the specific dimensions of difficulties engaging in goal-directed behavior when upset, difficulties controlling impulsive behaviors when distressed, limited access to effective emotion regulation strategies, and lack of emotional clarity. Additionally, significant positive associations were found between both childhood physical and emotional (but not sexual) abuse on the one hand and dimensions of emotion dysregulation on the other. Further analyses indicated that difficulties controlling impulsive behaviors when distressed accounted for the associations of both childhood physical and emotional abuse with probable PTSD status. Findings of the present study highlight a potential mechanism underlying the relationships between both childhood emotional and physical abuse and PTSD in SUD patients.     

“Alignment-Plus”: alignment with schooling requirements and cultural-bridging among indigenous middle-class parents

Abstract

Education research demonstrates that positive and trusting family/school relationships support academic achievement but for many Indigenous parents in Canada legacies of residential schooling have made it difficult to develop strong bonds with schools and teachers. Drawing on interviews with 69 Indigenous parents and eight non-Indigenous parents of children who identify as Indigenous from two Canadian provinces, this study explores the intersection between family/school relationships and social class, and highlights distinct ways that middle-class Indigenous parents are involved in schooling. Shifting from a “deficit” approach to a “strength based” approach highlights existing resources and capacities among those who are comfortable and familiar with navigating the education system while also creating prospects to build on that capacity to empower others who are less familiar/comfortable.     

Cultural adaptation,translation and validation of the ISPCAN Child Abuse Screening Tool – Retrospective Version (ICAST-R) for young adults in Sri Lanka

The aim of the present study was to adapt and validate the ISPCAN child abuse screening tool-retrospective version (ICAST-R) in Sri Lanka with a view to investigating the experiences of physical, sexual and emotional abuse during childhood.The adaptation was performed using qualitative research methods with young adults, parents, teachers, and a multidisciplinary group of experts. The translation to Sinhala (the local Sri Lankan dialect) was carried out by a nominal group technique. A multidisciplinary team of experts assessed the Sinhala ICAST-R (SICAST-R) for its content validity. Moreover, acceptability, reliability and construct validity were determined by conducting a validation study among 200 schooling young adults. The principal component analysis (PCA) technique was used to assess the construct validity. Response rates for each item were taken as evidence of acceptability. The internal consistency was assessed by Cronbach’s alpha, and test-retest reliability after two weeks was assessed using Cohen's kappa coefficient.The adaptation of ICAST-R included the introduction of an objective manner by which to measure severity of abuse and the inclusion of a set of questions regarding help-seeking behavior following physical and emotional abusive experiences.The SICAST-R showed adequate content validity and high acceptability, with response rates ranging from 90.3% to 99.5%. The minimum Cohen’s kappa coefficient was 0.76, indicating good test-retest reliability. The internal consistency (Cronbach’s alpha) for the total tool was 0.708, with the three constructs being 0.398, 0.844 and 0.637 for physical, sexual and emotional abuse, respectively. The PCA demonstrated good reproducibility for sexual and emotional abuse with the hypothesized structure.Overall, the SICAST-R showed adequate validity for the assessment of experiences of physical, sexual and emotional abuse during childhood among Sri Lankan young adults.     

Association of child maltreatment and depressive symptoms among Puerto Rican youth

This article compares multiple types of child maltreatment among Puerto Rican youth. We seek to expand the limited knowledge of the effects of multiple types of maltreatment on depressive symptoms in a specific Latino population as emerging studies indicate that children who are exposed to one type of maltreatment are often exposed to other types. This study examines the predictive strength of different and multiple types of lifetime child maltreatment (i.e., physical, sexual, and emotional abuse; and neglect), and the effect of youth support from parents, youth coping, youth self-esteem, and place of residence on depressive symptoms among Puerto Rican youth. Secondary data analyses were performed using three annual waves (2000–2004) of data from the Boricua Youth Study. The analytic sample consists of 1041 10–13 year old Puerto Rican youth living in New York and Puerto Rico. Results indicate that: (1) youth who experienced ‘sexual abuse only’, ‘multiple maltreatment’ (2 or more types of maltreatment), ‘physical abuse only’ have a significant increase in depressive symptoms (75.1%, 61.6%, and 40.5% respectively) compared to those without maltreatment; and (2) place of residence, exposure to violence, and mental disorders were significant risk factors. When developing psychosocial interventions, professionals should particularly focus on youth who report past lifetime experience with child maltreatment. Particular attention should be given to children living in the Bronx, New York and similar urban low-income areas who report past lifetime experience with multiple types of child maltreatment and who present symptoms or a diagnosis of co-occurring mental health problems.     

Examining the validity and reliability of childhood abuse scales: putting the courage to heal to the test

Objective: The main purpose of the current study was to examine the validity and reliability of The Courage To Heal Workbook checklist (Davis, 1990) in part, through examining the internal consistency and studying whether the CTHC distinguished between the participants reporting sexual abuse histories and those who did not.Method: Two hundred and seventy-nine college students were surveyed utilizing the symptom checklist from the Courage to Heal Workbook, Trauma Symptom Checklist-40 (TSC-40), Abusive Behavior Inventory (ABI), and questions related to participants’ beliefs that they had been abused as a child.Results: Results indicated that the Courage to Heal Checklist (CTHC) has robust reliability (alpha = .97) and can significantly discriminate between reported abuse survivors and nonsurvivors. Fifty-five percent of those participants reporting sexual abuse, 47% of those reporting physical abuse, and 34% of those reporting emotional abuse indicated a period of time during which they did not remember the abuse.Conclusion: Results indicate that the CTHC reliably differentiated between participants reporting past sexual abuse and those who did not. Mounting evidence continues to support that adult symptom profiles are able to indicate that some form of trauma is likely to have occurred in the past; however, differentiating between types of abuse based on symptom profiles may be impossible.Spanish abstract was not available at time of publication.     

Relationships between childhood abuse and neglect experience and HIV risk behaviors among methadone treatment drop-outs

OBJECTIVE: The purpose of this study was to examine the relationships between childhood abuse/neglect experiences (sexual abuse, physical abuse, emotional abuse, and child neglect) and adult life functioning among Methadone Maintenance Treatment Program (MMTP) drop-outs. METHOD: 432 subjects who dropped out of MMTP were recruited in New York City in 1997-1999. Adult life functioning was measured by HIV drug and sex risk behaviors, Addiction Severity Index (ASI) composite scores, and depression. The chi(2) tests, t tests, correlation, and multiple logistic regressions were performed to examine the relationships between abuse experiences and adult life functioning. RESULTS: The prevalence of child abuse/neglect history was high among MMTP drop-outs: sexual abuse-36%; physical abuse-60%; emotional abuse-57%; child physical neglect-66%; all four experiences-25%. As assessed via ASI composite scores, those who had been abused in childhood had significantly more medical, legal, relationship, and psychological problems than those who had not. Overall, several significant associations were found between the abuse experiences and HIV risk behaviors. Those who had experienced child neglect were more likely to be HIV positive. In multivariate analyses, childhood physical abuse was a significant predictor of having multiple sex partners while depression was significantly related to injection drug use in adulthood (p<.05). There were trends for the relationships between childhood sexual abuse and HIV sex risk behavior (p<.10) and between gender and injection drug use (p<.10). CONCLUSIONS: The findings support a need for drug treatment programs that include specialized therapies for those who suffered childhood abuse and neglect experiences.     

Violence among family members of children and adolescents evaluated for sexual abuse

OBJECTIVES: The two aims of this study were to: (1). describe the prevalence and characteristics of domestic adult and child physical violence in the homes of children and adolescents evaluated in a specialized sexual abuse clinic and (2). describe parent or caretaker responses to domestic adult and child violence and child sexual abuse, including tendencies to report or seek medical care. METHOD: A consecutive sample of 164 subjects (ages 7-19) were interviewed in a sexual abuse clinic regarding in-home violent or abusive experiences among family members that had occurred at any time during their childhood. RESULTS: Fifty-two percent of these children and teenagers reported spousal violence in their home. Fifty-eight percent of child sexual offenders who were in-home males also physically abused their adult female partner. Half of in-home males who were physically violent to children also sexually abused them. In 86% of homes with partner violence, the children were also physically assaulted. There was no difference in sexual abuse disclosure rates or patterns for children living with or without adult violence. CONCLUSIONS: Sexually abused children should be questioned about physical abuse and the presence of violence among adults in their home. Safety plans for sexually abused children should incorporate screening for family violence and safety plans for parents and siblings of child victims, when appropriate.     

Pregnancy and delivery for women with a history of child sexual abuse

OBJECTIVE: To study whether women with a history of child sexual abuse are at increased risk of delivering low birth weight infants. Secondary aims were to study smoking habits, obstetric complications, health care use, and health complaints during pregnancy among women with a history of child sexual abuse. METHOD: In a case control study, 82 women with birth of a low birth weight infant (< 2500 g) (cases) and 91 women with birth of a normal birth weight infant (controls) were interviewed about experiences of child sexual abuse. RESULTS: Fourteen percent of the women disclosed a history of child sexual abuse involving at least genital touch. Birth of a low birth weight infant was not associated with a history of child sexual abuse (OR 1.03, 95% CI .44-2.40). More women with a history of child sexual abuse were smokers during pregnancy (56% vs. 31%) compared with nonabused women. Abused women reported lower age at menarche and sexual debut. Nonscheduled contacts with the antenatal care clinic and discomfort during pregnancy were more frequent among abused women when controlled for low birth weight. CONCLUSIONS: Women who delivered low birth weight infants were not more likely to have experienced child sexual abuse than women who delivered nonlow birth weight infants. Abused women were unemployed and daily smokers more often than nonabused women. Some of the abused women reported more health complaints, and more use of health care services during pregnancy, but did not have more obstetric complications during pregnancy and delivery.     

Educational program on evaluation of alleged sexual abuse victims

Increased awareness of the problem of child sexual abuse has resulted in increasing numbers of children presenting to professionals for the evaluation of possible sexual victimization. A multidisciplinary project to develop professionals' knowledge and skills in the identification and evaluation of possible victims is described. The program focused on the child as a victim and emphasized developmental perspectives with regard to identification, interviewing children, the medical examination, and children in the legal system. Fifty-one medical and social work professionals from ten Indiana counties attended the program and responded to questionnaires about their experience and knowledge. Of 40 (78%) respondents, 63% had had no previous training in the medical evaluation for child sexual abuse. Child protective workers referred alleged victims primarily to the child's regular physician (37%) or emergency room (31%) for medical examination. Knowledge about child sexual abuse improved significantly at two weeks postsymposium (p = .001) and remained improved at six months postsymposium (p less than .02). These original participants have subsequently organized similar multidisciplinary programs in their local communities for medical, social, law enforcement, and legal professionals; thus, they have been "seeds" for further educational and cooperative efforts throughout the state.