Acceptability of the Predicting Abusive Head Trauma (PredAHT) clinical prediction tool: A qualitative study with child protection professionals

The validated Predicting Abusive Head Trauma (PredAHT) tool estimates the probability of abusive head trauma (AHT) based on combinations of six clinical features: head/neck bruising; apnea; seizures; rib/long-bone fractures; retinal hemorrhages. We aimed to determine the acceptability of PredAHT to child protection professionals. We conducted qualitative semi-structured interviews with 56 participants: clinicians (25), child protection social workers (10), legal practitioners (9, including 4 judges), police officers (8), and pathologists (4), purposively sampled across southwest United Kingdom. Interviews were recorded, transcribed and imported into NVivo for thematic analysis (38% double-coded). We explored participants’ evaluations of PredAHT, their opinions about the optimal way to present the calculated probabilities, and their interpretation of probabilities in the context of suspected AHT. Clinicians, child protection social workers and police thought PredAHT would be beneficial as an objective adjunct to their professional judgment, to give them greater confidence in their decisions. Lawyers and pathologists appreciated its value for prompting multidisciplinary investigations, but were uncertain of its usefulness in court. Perceived disadvantages included: possible over-reliance and false reassurance from a low score. Interpretations regarding which percentages equate to ‘low’, ‘medium’ or ‘high’ likelihood of AHT varied; participants preferred a precise % probability over these general terms. Participants would use PredAHT with provisos: if they received multi-agency training to define accepted risk thresholds for consistent interpretation; with knowledge of its development; if it was accepted by colleagues. PredAHT may therefore increase professionals’ confidence in their decision-making when investigating suspected AHT, but may be of less value in court.     

Child abuse and neglect in institutional settings,cumulative lifetime traumatization,and psychopathological long-term correlates in adult survivors: The Vienna Institutional Abuse Study

Child maltreatment (CM) in foster care settings (i.e., institutional abuse, IA) is known to have negative effects on adult survivor’s mental health. This study examines and compares the extent of CM (physical, emotional, and sexual abuse; physical and emotional neglect) and lifetime traumatization with regard to current adult mental health in a group of survivors of IA and a comparison group from the community. Participants in the foster care group (n = 220) were adult survivors of IA in Viennese foster care institutions, the comparison group (n = 234) consisted of persons from the Viennese population. The comparison group included persons who were exposed to CM within their families. Participants completed the Childhood Trauma Questionnaire, the Life Events Checklist for DSM-5, the PTSD Checklist for DSM-5, the International Trauma Questionnaire for ICD-11, and the Brief Symptom Inventory-18 and completed a structured clinical interview. Participants in the foster care group showed higher scores in all types of CM than the comparison group and 57.7% reported exposure to all types of CM. The foster care group had significantly higher prevalence rates in almost all mental disorders including personality disorders and suffered from higher symptom distress in all dimensional measures of psychopathology including depression, anxiety, somatization, dissociation, and the symptom dimensions of PTSD. In both groups, adult life events and some but not all forms of CM predicted PTSD and adult life events partly mediated the association of PTSD and CM. Explanations for the severe consequences of CM and IA are discussed.     

青少年急性膝关节创伤性骨髓异常与创伤机制及软组织损伤的关系

目的：初步探讨青少年急性膝关节创伤性骨髓异常与创伤机制及软组织损伤的关系。方法：回顾性分析69例青少年急性膝关节损伤患者的临床及影像学资料。通过膝关节磁共振成像（MRI）评估创伤性骨髓异常的部位及前交叉韧带、后交叉韧带、内侧副韧带、外侧副韧带及内、外侧支持带等软组织的损伤,根据临床资料汇总创伤机制。结果：69例患者包括19例轴移损伤,17例髌骨外侧脱位,12例过伸伤,11例外翻损伤和10例仪表盘损伤。轴移损伤引起创伤性骨髓异常部位多位于股骨外侧髁后区（94.7%）、股骨外侧髁前区（84.2%）和胫骨外侧平台后区（78.9%）,常伴有前交叉韧带撕裂（94.7%）。髌骨外侧脱位多位于髌骨（100%）、股骨外侧髁后区（100%）和股骨外侧髁前区（94.1%）,常伴有内侧支持带撕裂（88.2%）。过伸伤主要累及胫骨内侧平台前区（83.3%）、胫骨外侧平台前区（75%）和股骨内侧髁前区（66.7%）,常伴有前交叉韧带（91.7%）和后交叉韧带损伤（58.3%）。外翻损伤主要累及股骨,包括股骨外侧髁后区（72.7%）,股骨外侧髁前区（54.5%）和股骨内侧髁前区（45.5%）,常伴有内侧副韧带损伤（90.9%）。仪表盘损伤主要累及胫骨,包括胫骨外侧平台前区（100%）、胫骨内侧平台前区（90%）,常伴有后交叉韧带损伤（70%）。结论：青少年急性膝关节创伤性骨髓异常在MRI上的分布代表了特定的创伤机制的足迹,并能够精准地预测特定的软组织损伤。     

Prior opportunities to identify abuse in children with abusive head trauma

Infants with minor abusive injuries are at risk for more serious abusive injury, including abusive head trauma (AHT). Our study objective was to determine if children with AHT had prior opportunities to detect abuse and to describe the opportunities. All AHT cases from 7/1/2009 to 12/31/2011 at four tertiary care children's hospitals were included. A prior opportunity was defined as prior evaluation by either a medical or child protective services (CPS) professional when the symptoms and/or referral could be consistent with abuse but the diagnosis was not made and/or an alternate explanation was given and accepted. Two-hundred-thirty-two children with AHT were identified; median age (IQR) was 5.40 (3.30, 14.60) months. Ten percent (22/232) died. Of the 232 patients diagnosed with AHT, 31% (n = 73) had a total of 120 prior opportunities. Fifty-nine children (25%) had at least one prior opportunity to identify abuse in a medical setting, representing 98 prior opportunities. An additional 14 (6%) children had 22 prior opportunities through previous CPS involvement. There were no differences between those with and without a prior opportunity based on age, gender, race, insurance, mortality, or institution. Children with prior opportunities in a medical setting were more likely to have chronic subdural hemorrhage (48 vs. 17%, p < 0.01) and healing fractures (31 vs. 19%, p = 0.05). The most common prior opportunities included vomiting 31.6% (38/120), prior CPS contact 20% (24/120), and bruising 11.7% (14/120). Improvements in earlier recognition of AHT and subsequent intervention might prevent additional injuries and reduce mortality.     

Organic vs. functional neurological disorders: The role of childhood psychological trauma

Although the relationship between psychological trauma and medically unexplained symptoms (MUS) is well established, this relationship is less well understood in people with medically unexplained neurological symptoms. In the present study, we set out to compare people with functional neurological disorders, and organic neurological disorders, in terms of childhood and adulthood traumatic events, traumatic stress, emotional dysregulation and symptoms of depression and anxiety. We have hypothesised that those with functional neurological disorders would be more likely to report childhood and adulthood traumatic life events, traumatic symptomatology, emotional dysregulation and symptoms of anxiety and depression, compared to those with organic neurological disorders. Sample consisted of a consecutive series of people with functional neurological disorders and with organic neurological disorders (n = 82) recruited from a hospital in Scotland. Participants completed measures of life events, traumatic stress, emotional regulation, anxiety and depression. The two groups were found to significantly differ in relation to all measures, with the MUS group being more likely to report childhood and adulthood life events, more severe emotional dysregulation, traumatic stress and symptoms of anxiety and stress. Logistic regression analysis revealed that exposure to childhood traumatic life events, specifically childhood sexual abuse, and childhood physical neglect, were the only factors which were significantly associated with membership of the medically unexplained neurological symptoms group. Although further research is required to confirm our findings, our results suggest that identifying and addressing the impact of childhood trauma, may alleviate distress and aid recovery from functional neurological disorders.     

心理学专业学习者创伤共情的ERP探析

为了探索心理学专业学习者创伤共情的特征,采用事件相关电位技术(ERP),以创伤和非创伤图片作为实验材料,让心理学专业被试和普通被试做图片性质判断任务。结果发现:心理学专业被试在观看创伤和非创伤图片时ERP波形差异显著,在观看创伤图片时,N110的潜伏期更短、P2的潜伏期更长,P2的波幅更高、P300的波幅更低,与普通被试相比,心理学专业被试受创伤事件的影响更小;在观看非创伤图片时,二者没有显著差异。实验说明心理学专业学习者不容易受消极图片的影响,有更好的应对创伤事件的能力。     

Extended follow-up of neurological,cognitive, behavioral and academic outcomes after severe abusive head trauma

Studies about long-term outcome following abusive head trauma (AHT) are scarce. The aims of this study were to report long-term neurological, cognitive, behavioral and academic outcomes, ongoing treatments and/or rehabilitation, several years after AHT diagnosis, and factors associated with outcome. In this retrospective study, all patients admitted to a single rehabilitation unit following AHT between 1996 and 2005, with subsequent follow-up exceeding 3 years, were included. Medical files were reviewed and a medical interview was performed with parents on the phone when possible. The primary outcome measure was the Glasgow Outcome Scale (GOS). Forty-seven children (out of 66) met the inclusion criteria (mean age at injury 5.7 months; SD = 3.2). After a median length of follow-up of 8 years (range 3.7–12), only seven children (15%) had “good outcome” (normal life – GOS I) and 19 children (40%) presented with severe neurological impairment (GOS III and IV). Children sustained epilepsy (38%), motor deficits (45%), visual deficit (45%), sleep disorders (17%), language abnormalities (49%), attention deficits (79%) and behavioral disorders (53%). Most children (83%) had ongoing rehabilitation. Only 30% followed a normal curriculum, whereas 30% required special education services. Children with better overall outcome (GOS I and II) had significantly higher educated mothers than those with worse outcomes (GOS III and IV): graduation from high school 59% and 21% respectively (p = 0.006). This study highlights the high rate of severe sequelae and health care needs several years post-AHT, and emphasizes the need for extended follow-up of medical, cognitive and academic outcomes.     

South African Counsellors' Attitudes Towards Cognitive Behavioural Techniques to Ameliorate Trauma: Effects of a Training Workshop

Despite its successes in the United States and Europe, cognitive behavioural therapy (CBT) has a short history in South Africa. Local cultural realities and social conditions have been cited as obstacles to the implementation of CBT at community health centres. Yet, CBT's successes in ameliorating a variety of psychological conditions, including symptoms of PTSD, necessitate examination of its relevance and applicability in South African communities. The present study reports on counsellors' attitudes and opinions to CBT for the treatment of psychological trauma. We presented a two-day workshop on CBT and assessed counsellors' opinions and attitudes prior to and following the workshop. Results are discussed in the context of the high rate of traumatic events that occur in South African communities.