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Chapter 14 + (Last 2 Lectures before exam, movie notes and All Important highlights, and practice exam questions)

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Psychology 2320A/B
Tom Haffie

Chapter 14 &“Trouble with Evan” Movie,“Sweet Side” by LucindaWilliams Child Maltreatment and Non-AccidentalTrauma “The Trouble with Evan” note: CAS=Children’s Aid Society Evan at 11yrs has a conduct disorder, started smoking, shoplifting very violent Protective: Movie Notes Evan has above average intelligence, both mom and step-dad employed Risk: step-dad working in adult job at 11 father died at 14 years increasing gap between step-dad and child trouble with matches and fire born to mother while she was a teenager father in jail in passed for abuse to mother Diagnoses with no other info known? Conduct disorder: theft, smoking, violence Enrolled in parenting class, Evan becomes highlight of talk “When I lose it, I lose it real bad” -Step-dad “For that hour or 1.5 hour when he is screaming [at Evan], I cry, baby cries, dog cries” -mom “so many negative things that are said that cannot be taken back” Clues to Evans behavior in dark corners of their own memories ➔ install cameras inside family homes Provided Evan with own camera to express his view point Day 1: camera catches family conflict -art class: puts paint and clay in teachers coffee mug and is suspended -step-dad already starts to yell and threaten and Evan shuts down Evan about self; “He tries hard but makes bad choices and doesn’t know why” Step-dad’s cheque found in son’s pocket -Evan refuses to say that he did it 㱺 Blame all family problems and future problems on Evan During conflict: -no problem solving, he is not allowed to talk back to parents -distorted perceptions (assuming the worst, assuming bad character) -blame Movie making connections with young offenders and show how these connect to Evan in future (skip for sake of time in class) Child abuse- not about psychotic, it’s about being completely overloaded prime example: Someone unplugged freezer- Evan prime suspect Father goes crazy in front of children (he had just tried to cash cheque from wash and was unsuccessful) Emotional abuse: “lock you up in a cage and have people look at you like an animal” Chose scenes that don’t have certainty that Evan actually did something wrong Important to take a good history: Family arguing over dishes Marriage with husband Mike was very dangerous physical abuse, verbal abuse, parent alcoholism pretending there were many things that were okay that were not Mike (step-dad) spent time in jail for abuse to wife Karen Court gave custody over kids to Mike while Karen took break (long while) in Mexico Karen fled from life and went back to Mexico Returned and had no family to connect to, tried to commit suicide Psychiatric hospital: wanted to be with kids, but could not be w/ Mike 㱺 Returned to relationship with Mike to be with kids- now at present day of movie Mike doesn’t show affection to son because as a child he was not given any physical affection at age of 8.(he will now not hug Evan) ➔ Mike suffered from emotional abuse as child Evan cooks for family and his very proud to impress them Next day,Evan doesn’t come from school.Evan stolen cigarettes from Mike and was caught smoking➔ police ask if Evan is afraid to come home Mike trying to use techniques learned in parenting class Mike does not let the son talk at all All Mike had to do was ask“What’s up?” and listen Parents listen to young offenders and are interested in their stories BUT… Mom accusing Evan of stealing key from parent’s bedroom Mother threatens to punch Evan ➔ producers must now call CAS 1.5 hour fight.Fight over 10cents missing from room 㱺 she had miscounted the money,and she had mis-accused him Cautious that child abuse is not just being proven by bruises or physical violence “I don’t want to see him hit you again.So don’t let him do it again” ➔ Putting blame on Evan for Mike’s abuse Mike make Evan smoke a pack later on in film Neither parent came from good, warm family ➔ so must be aware of Hx before diagnosing CLASS NOTES (SLIDES AND LECTURE) Watch“Children See Children Do” on youtube From past exam: What is the key treatment for OCD? ERP Exposure and Response Prevention Wolfe,D.A.(1985) Child abusive parents: An empirical review and analysis. Psychological Bulletin,97,462-482 David Wolfe:dismissed the myth that parents who hit kids are psychotic its people with a lot of risk factors,people who are overwhelmed, people who do not know other parenting methods, Risk factors add up and eventually end in aggression regular people beyond ability to cope Peter Jaffe:works at centre for violence for women and children ➔ looked at kids who witness violence in the home (but are not recieving it themselves) 㱺 witnessing violence causes same “girls act in, boys act out” ➔ Peter succeeded in: It used to be police answering the door and then interview the (usually female) and ask“would you like to press charges?” -No,it is not safe to do so.What if he only is in jail for one night? Peter looked at policy:in Minnesota,the officer decides if he wants to press charged ➔ Now we have the officers to act upon domestic violence suspicion here in London (huge change to keep women safe) 1/10 kids subject to sexual violence Overview Child abuse and neglect have been recognized as a significant problem since the early 1970s In NorthAmerica,it is estimated that one in ten children experience some form of sexual victimization by an adult or peer,and also receives harsh physical punishment by a parent or other caregiver that puts them at risk of injury Child maltreatment refers to four primary acts:physical abuse,neglect,sexual abuse,and emotional abuse Non-accidental trauma refers to the wide-ranging effects of maltreatment on the child’s physical and emotional development Victimization is abuse or mistreatment of someone whose ability to protect himself or herself is limited Overview (cont’d.) Maltreatment often occurs within ongoing relationships that are assumed to be protective,supportive,and nurturing Abused or neglected children face paradoxical dilemmas: The victim wants to stop the violence but also longs to belong to the family in which they are being abused Affection and attention may coexist with violence and abuse ➔ causes huge internal conflict for child Intensity of violence tends to increase over time,but in some cases,physical violence may decrease or stop Societies are struggling to balance parental rights with children’s right to be safe and free from harm Maltreatment harms children physically,in developing relationships with others, and in their fundamental sense of safety and self-esteem History and Family Context - Textbook to read history Child maltreatment and non-accidental forms of trauma have always existed,but were not seen as a problem because children were viewed as the property and responsibility of their fathers,who had full discretion as to how punishment could be administered until 100 years ago • 8th century Roman Law of Chastisement: “rule of thumb” • Church doctrine: “spare the rod and spoil the child” • 1989: Convention on the Rights of Children spurred efforts to value the rights and needs of children, to recognize their exploitation and abuse Timothy Leary: Circumplex Model LOVE POWER Healthy Families Children need a caregiving environment that balances their need for control and direction (“demandingness”) with their need for stimulation and sensitivity (“responsiveness”) Healthy parenting includes: Knowledge of child development and expectations Adequate coping skills and knowledge of ways to enhance development through stimulation and attention Normal parent-child attachment and communication Home management skills Shared parenting responsibilities Provision of social and health services Healthy Families (cont’d.) Healthy patterns depend on: Parental competence and developmental sensitivity Family circumstances Availability of community resources (education,child-rearing information,social networks,and support) Family situation (e.g.,parents’ marital relationship and child’s characteristics) provides basic context of child-rearing Fundamental,expectable environment: Infants:protective and nurturing adults,as well as opportunities for socialization within culture Older children:supportive family,peer contact,opportunities to explore and master their environment Gradual shift of control from parent to the child and the community Family Stress and Disharmony Stressful events in the family affect each child differently Child maltreatment is among the worst and most intrusive forms of stress It impinges directly on the child’s daily life,may be ongoing and unpredictable,and often involves people the child depends on and trusts Impact depends on child’s makeup and available supports Children’s ability to respond to stress depends on the degree of support and assistance they receive from their parents,who serve as role models Maltreated children may have the hardest time adapting appropriately to any form of stress Figure 14.1 Most positive to most negative Continuum of Care Child care can be described along a continuum ranging from healthy to abusive and neglectful Positive end:appropriate and healthy forms of child-rearing actions that promote child development Middle range:poor/dysfunctional actions represent irresponsible and harmful child care Negative end:parents who violate their children’s basic needs and dependency status in a physically,sexually,or emotionally intrusive or abusive manner,or through neglect Continuum of Care (cont’d.) Types of Maltreatment NorthAmerican states and provinces:civil laws obligate persons who come in contact with children as part of their job or volunteer work to report known or suspected cases of abuse to the police or child welfare authorities Criminal statutes specify the forms of maltreatment that are criminally punishable U.S.ChildAbuse Prevention andTreatmentAct (CAPTA): Acts that result in death,serious physical or emotional harm,sexual abuse or exploitation,or an act or failure to act that present imminent risk of serious harm DSM-IV-TR:incidents of maltreatment are not forms of abnormal child behavior or psychological disorders May be considered onAxis I (focus of clinical attention) andAxis IV (psychosocial and environmental problems) PhysicalAbuse Multiple acts of aggression,including punching,beating,kicking,biting,burning, shaking,or otherwise physically harming a child Injuries are often the result of over discipline or severe physical punishment Severity and nature of injuries vary considerably Physically abused children are often described as more disruptive and aggressive than their age-mates,with disturbances that reach across a broad spectrum of emotional and cognitive functioning Neglect Physical neglect:refusal or delay in seeking health care,expulsion from the home, or refusal to allow a runaway to return home,abandonment,and inadequate supervision Educational neglect:allowing chronic truancy,failing to enroll a child of mandatory school age in school,or failing to attend to a child’s special educational needs Emotional neglect (most difficult to define):marked inattention to a child’s needs for affection,refusal or failure to provide needed psychological care,spousal abuse in the child’s presence,permission of drug/alcohol use by the child Requires consideration of cultural values and poverty when determining neglect Neglected children show behavior patterns between undisciplined activity and extreme passivity Child Neglect:“the sins of the father” ➔ child neglect overlooked is lack of a father song:“Papa was a Rolling Stone” “Long time coming”“my dad was just a stranger… my one wish is that there mistakes will be there own,not burdened by parent” Neglect (cont’d.) SexualAbuse -primarily against girls and primarily in a family Fondling a child’s genitals,intercourse with the child,incest,rape,sodomy, exhibitionism,and commercial exploitation through prostitution or the production of pornographic materials May significantly affect behavior,development,and physical health of sexually abused children Reactions and recovery of sexually abused children vary,depending on the nature of the assault and responses of important others Many acute symptoms resemble children’s common reactions to stress Constitutes a breach of trust,deception,intrusion,and exploitation of a child’s innocence and status EmotionalAbuse and Exploitation Emotional abuse: Repeated acts or omissions that may cause serious behavioral,cognitive, emotional,or mental disorders Exists in all forms of maltreatment Can be as harmful as to a child’s development as physical abuse or neglect Exploitation: Commercial or sexual exploitation,such as child labor and child prostitution Significant form of trauma for children and adolescents worldwide As many as ten million children may be victims of child prostitution,the sex industry,sex tourism,and pornography Prevalence and Context When battered child syndrome was first described in early 1960s,this phenomenon was thought to apply to fewer than 300 children in the U.S. Today,state child protective services agencies investigate close to 3.5 million suspected cases of abuse and neglect are investigated in the U.S.each year One-third of these are confirmed LOOKATWHY NUMBERSARE ‑ INTEXT Incidence ofAbuse and Neglect in NorthAmerica Almost one million children in U.S.are substantiated victims of child maltreatment each year (10.1 per 1,000 children) Neglect (78.4%),physical abuse (11%),sexual abuse (7.6%),psychological maltreatment (7.6%),and other forms of maltreatment (9.6%) About one in four suffered more than one form of maltreatment Sexual and physical abuse cases have declined considerably since 1992 Lifetime prevalence estimates of childhood abuse: Sexual abuse:4.3% of males;12.8% of females Physical abuse:31.2% of males;21.1% of females In Ontario, 10,000 ppl that were 15 or over asked “Did you experience childhood abuse as a child?” Sexual abuse: 4.3% Males, 12.8% females ➔ Three times more females Physical abuse: 31.2% males, 21.1 females Incidence ofAbuse and Neglect in NorthAmerica (cont’d.) Characteristics ofVictimized Children Age: Younger children more at risk for abuse and neglect,while sexual abuse is more common among older age groups (over 12) Except for sexual abuse,victimization rate is inversely related to the child’s age Sex: 80% of sexual abuse victims are female,but with that exception,boys and girls are victims of maltreatment almost equally Boys are more likely to be sexually abused by male nonfamily members,whereas girls are more likely to be sexually abused by male family members Characteristics ofVictimized Children (cont’d.) Racial characteristics: The majority of substantiated maltreated victims are white (44%),African- American (22%),or Hispanic (21%) Compared to children of same race or ethnicity in the U.S.,highest rates of victimization are for children who areAfrican-American (15.1/1000),American Indian orAlaska Native (11.6/1000),and multiple race (12.4/1000) White and Hispanic (8/1000),andAsian (2/1000) Characteristics of Family and Perpetrator More common among the poor and disadvantaged Children from single-parent homes with a live-in partner and large families are at highest risk 80% of victims are abused by one or both parents,although nearly 50% of sexually abused children are abused by persons other than parents/parent figures Mother is perpetrator of neglect 90% of time ➔ (mothers are the primary caregivers) Males are offenders in majority of sexual abuse (90%),and about half of those are the child’s father or father figure Except for sexual abuse,the most common perpetrator for child maltreatment is a female parent acting alone,typically younger than 30 years of age Cross-Cultural Comparisons Physical and sexual abuse are at epidemic proportions in many societies worldwide Estimated that by age 14,40 million children are victims of neglect and abuse each year worldwide A comparison of rates in NorthAmerican and otherWestern societies shows comparable rates of child sexual abuse: 20% for females and between 8% for males Developmental Course and Psychopathology Affects their whole being,in growth and development,as well as brain development Abuse and neglect are more than physical pain and transitory fear To a child or adolescent,these events often represent threats to their emerging sense of self,their world,and their feelings of safety and well-being Resilience andAdaptation Maltreatment does not affect each child in a predictable or consistent way; outcomes depend on severity and chronicity of events and how the events interact with the child’s individual and family characteristics Protective factors: Positive relationship with at least one important and consistent person in the child’s life who provides support and protection (may be a maltreating parent) Personality characteristics,such as positive self-esteem and sense of self Removing children from families can become another source of stress and disruption,with undesired side effects ➔ it is most difficult for child to be removed from home or have parents removed ∴ work is done to heal,reintegrate and educate family and not take kids away instead of foster families ➔ kinship,find a relative to live with Developmental  Consequences Early  attachment  and  emotion  regulation:   Parent-­‐child  attachment  and  home  climate  play  a  critical  role  in  emotion     regulation  (ability  to  modulate  or  control  the  intensity  and  expression  of   ) s e s l u p m i   d n a   s g n i l e e  f Developmental  Trauma:  when  early  attachment  neglected,  attachment   disturbance  and  developmental  trauma:   ▵  social  skills,  emotion  regulation,  impulse  control,  violence 㱺  insecure-­‐disorganized  attachment  (miscue  in  a  social  setting)   -­‐not  sure  how  to  properly  get  someone  else’s  attention Maltreated  infants/toddlers  have  difficulty  establishing    reciprocal,  consistent   interaction  with  caregivers:   Exhibit  insecure-­‐disorganized  attachment   Have  difficulty  understanding,  labeling,  and  regulating  internal  emotional   s e t a t  s   Learn  to  inhibit  emotional  expression  and  regulation,    remaining  more     fearful  and  on  alert     Difficulty  modulating  emotions  can  result  in  depressive  reactions  or  angry     outbursts  and  may  lead  to  self-­‐harm  as  well  as  internalizing  and     externalizing  problems Developmental  Consequences  (cont’d.) Neurobiological  development: r e z i m i t c i v   a   d n a  m i t c i v   a   g n     They  are  easily  distracted  by  aggressive  stimuli  and  make  hostile       attributions  for  the  actions  of  others Physically  abused  and  neglected  children  show  little  skill  at  recognizing  distress   in  others,  and  they  respond  to  others’  distress  with  fear,  physical  attack,  or  anger   Maltreated  children  (especially  physically  abused)  are  more  physically  and   verbally  aggressive  with  peers,  and  are  more  likely  to  be  unpopular  and  rejected   Maltreated  children  (especially  neglected)  often  withdraw  from  and  avoid   peer  interaction Developmental  Consequences  (cont’d.) Emotional  and  behavioral  problems  (cont’d.): Neglected  children  have  the  most  severe  and  wide-­‐ranging  problems  in  school   and  interpersonal  adjustment Sexually  abused  girls  have: Significant  neurodevelopment  differences  in  their  responses  to  stress   Greater  cognitive  deficits More  mental  health  problems  (especially  depression  and  PTSD),  and  illnesses Higher  rates  of  dropping  out  of  high  school,  self-­‐mutilation,  physical  and  sexual   revictimization,  and  teen  motherhood Increased  rates  of  drug  use Table  14.2  gives  possible  outcomes  of  child  abuse Developmental  Consequences  (cont’d.) Psychopathology  and  Adult  Outcomes Abused  and  neglect  increase  the  likelihood  of  failure,  future  maladaptations,  and   significant  emotional  and  adjustment  problems   Cycle-­‐of-­‐violence  hypothesis:  victims  of  violence  have  greater  chance  of   becoming  perpetrators  of  violence Child  sexual  abuse  can  lead  to  chronic  impairments  in  self-­‐esteem,  physical   health  problems,  and  emotional  and  behavioral  self-­‐regulation ‐  Chronic  psychiatric  disorders:  anxiety  and  panic  disorders,  depression,  eating   disorders,  sexual  problems,  and  personality  disturbances   Many  impairments  stem  from  PTSD Psychopathology  and  Adult  Outcomes Mood  and  affect  disturbances:   Depression,  emotional  distress,  and  suicidal  ideation  are  common  among  abused   children   If  unrecognized,  symptoms  can  increase  during  late  adolescence  and  adulthood,   and  can  lead  to  life-­‐threatening  suicide  attempts  and  self-­‐mutilating  behavior Much  greater  risk  of  substance  abuse,  increasing  risk  for  other  adjustment   disorders Psychopathology  and  Adult  Outcomes  (cont’d.) Post-­‐traumatic  stress-­‐related  problems:   As  many  as  half  of  victims  of  maltreatment  involving  sexual  abuse,  or  combined   sexual  and  physical  abuse,  meet  criteria  for  PTSD  during  childhood  or   adolescence About  one-­‐third  of  childhood  victims  of  sexual  or  physical  abuse  or  neglect  meet   criteria  for  lifetime  PTSD PTSD  symptoms  are  more  likely  to  occur  if  the  abuse  was  chronic  and  the   perpetrator  relied  on  coercion  or  trickery   ➔  excessive  attention  from  adult They  may  also  dissociate,  and  the  fragmentation  of  experience  and  affect  can   progress  into  borderline  disorder,  dissociative  identity  disorder,  or  chronic  pain Personality  disorder:  Long  standing  maladaptive  coping Trauma: A psychological response to a highly traumatic negative life event -experience fear helpplessness, or horror -disorganized or agitated as result READ PTSD: Chapter 7 (p.157-159) ➔ geniunely felt you were in danger 1) Re-expeperiencing of trauma memories, flashbacks, nightmares 2) Avoidance of reminders avoiding triggers, numbing, no future, dissociation 3) Hyperarousal Jumpy, agitated, angry, fearful, hyper, sleep problems Dissociation damaging in the long run ➔ cannot cope from problems Early, Chronic, and Complex Trauma -multiple traumatic events -not sure when situation will occur Early Attachment and Disruptions and Loss eg. teen mom w/ Hx drug and alcohol abuse frq. left home with neglect for child 24 mnths- taken by family services Between 24mnths-7yr had 8 foster homes, couldn’t handle child ➔ all stemming from no early attachment Trauma and the Brain • Often problems in storage or memory • reduced attention • memory difficulties language difficulties • • abnormal stress hormones States of Arousalgo between hyperarousal and hypoarousal (freezing/numbing) Hyperarousal: hypervigilant alarm fight flight freeze *sleep difficulties* sleep is key anger Hypoarousal: disengaged feeling numb dissociate avoiding reminders day dreams “not there” Seeing Behaviours through Trauma Lens “Instead what is wrong with child, think what happened to this child”- maybe it was just a disordered brain Learning to Tolerate Emotions need to have some pain to learn strategies to cope • understand emotions • • develop tools to self soothe • Mindfulness skills ➔ hot topic in 2014 • Interpersonal skills • be able to express self using words Mindfullness:   must  use  everyone  of  5  senses  to  look  at  chip  for  2-­‐3  mins  in  Boy’s  Correctional   centre see feel smell taste sounds 㱺  focussed  completely  on  their  surroundings forgetting  the  rest  of  worries  or  stresses  in  mind =less  reactive  and  less  stressed  about  past  of  future  worries Psychopathology  and  Adult  Outcomes  (cont’d.) Sexual  adjustment: -­‐Traumatic  sexualizati: o nhild’s  sexual  knowledge  and  behavior  shaped     in   developmentally  inappropriate  ways     -­‐Sexual  abuse  may  lead  to  weight  problems,  eating  disorders,  poor     physical  health  care,  physically  destructive  behavior,  and  in  early     adulthood,  promiscuity,  prostitution,  sexual  aggression,  and  victimization     of  and  by  others   Criminal  and  antisocial  behavior:   -­‐Although  most  abused  children  do  not  go  on  to  commit  crimes,  a     significant  connection  exists  between  maltreatment  and  violence  (toward     their  parents  and  themselves),  as  well  as  criminal  and  antisocial  behavior   Causes  of  Child  Maltreatment Physical  abuse  and  neglect  are  relational  disorders  that  most  often  occur  during   periods  of  stressful  role  transitions  for  parents,  early  childhood  and  early   adolescent  oppositional  periods  of  testing  limits,  and  times  of  family  instability   and  disruption Stress  is  among  the  multiple  causes   Sexual  abuse  is  influenced  by  cultural  and  familial  practices,  as  well  as  dynamic   forces  of  stress Maltreatment  is  not  typically  caused  by  adult  psychopathology  (fewer  than  10%   of  maltreating  parents  have  a  primary  psychiatric  illness);  however,  they  are  likely   to  have  a  history  of  learning  and  intellectual  deficits  and  personality  disorders Physical  Abuse  and  Neglect Many  abusive  and  neglectful  parents  have  had  little  exposure  to  positive  parental   models  and  supports They  often  had  difficult  childhoods,  find  daily  living  stressful  and  irritating,  and   don’t  have  the  energy  to  seek  out  support They  often  complain  of  chronic  physical  ailments  and  a  pervasive  mood  of   discontent Physical  Abuse  and  Neglect  (cont’d.) Offender  characteristics:  -­‐WHY  HISTORY  IS  CRUCIAL Less  interaction  with  their  children  than  other  parents,  responding  primarily  to   punish  misbehavior Information-­‐processing  disturbances  may  cause  maltreating  parents  to   misperceive  or  mislabel  their  child’s  behavior,  leading  to  inappropriate  responses Although  there  is  much  overlap,  neglecting  parents  are  more  likely  than  abusing   parents  to  exhibit  striking  personality  disorders  and  inadequate  knowledge  of   child’s  needs;  they  also  disengage  under  stress  (escape  and  avoidance) Lack  child-­‐rearing  and  information-­‐processing  skills,  as  well  as  ways  to  cope  with   anger  and  arousal Physical  Abuse  and  Neglect  (cont’d.) Child  and  family  influences: No  child  characteristic  has  been  linked  to  the  risk  of  maltreatment,  once   environmental  and  adult  factors  are  controlled  for  (with  the  exception  of  gende
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