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• Sexual force at sexual debut. Swedish adolescents with disabilities at higher risk than adolescents without disabilities.

  Authors: Elinor Brunnberg, Margareta Lindén Boström, Mats Berglund

  Child abuse & neglect.

  The aims of this study are first to compare the incidence of force on the first occasion of sexual intercourse reported by participants with disabilities to that of students without disabilities;The aims of this study are first to compare the incidence of force on the first occasion of sexual intercourse reported by participants with disabilities to that of students without disabilities; second to determine whether there are significant differences in mental health, substance abuse, and school performance as reported by participants forced into their sexual debut as opposed to those who were not forced, analysed by gender; and finally to identify the significant variables that predict girls reporting force at sexual debut as opposed to girls not reporting force, as well as to identify similar variables within the male group. There were no data on sexual abuse prior to the first occasion of full sexual intercourse. METHOD: This cross-sectional study is based on 2 surveys: Life and Health---Young People 2005 and 2007. All 17/18-year-old adolescents in upper-secondary schools in a county in Sweden were asked the same questions both years. A total of 2,254 students completed the survey in 2005 and 2,641 in 2007. RESULTS: The main finding is that force at sexual debut (intercourse) is more common among adolescents with a disability (4.0%) than those not reporting any disability (1.6%), and is most common among those reporting multiple disabilities (10.4%). This was found both for girls and boys, even if the rates for girls were several times higher. Other findings are that girls and boys reporting force at sexual debut (disability and non-disability groups taken together) reported different profiles. For girls, their country of origin and who they live with are significant. This background data is not significant for boys. Boys report a strong psychosomatic reaction. CONCLUSION: Culture-, functionality-, and gender-sensitive studies of adolescents' reactions to sexual abuse are needed to help determine relevant and effective interventions.

• The role of prothrombotic factors in the ocular manifestations of abusive and non-abusive head trauma: A feasibility study.

  Authors: Anna Yu, Derek Stephens, Brian M Feldman, Patricia C Parkin, Walter H A Kahr, Leonardo R Brandão, Michelle Shouldice, Alex V Levin

  Child abuse & neglect.

  OBJECTIVES: Retinal hemorrhage is a cardinal manifestation of abusive head injury. Thrombophilia is relatively common in the general population and in adults can be associated with retinalOBJECTIVES: Retinal hemorrhage is a cardinal manifestation of abusive head injury. Thrombophilia is relatively common in the general population and in adults can be associated with retinal hemorrhage. The specificity of retinal hemorrhage for abusive head trauma in the presence of prothrombotic factors, in particular following non-abusive head trauma, has not been investigated. Our objective was to determine whether the hypothesis that prothrombotic factors affect specificity of retinal hemorrhage to AHT can be tested. This may have important ramifications both for diagnosis and expert witness testimony. METHODS: To investigate the feasibility of studying this issue, we conducted a prospective cohort study of children with abusive and non-abusive head trauma. Thrombophilia screening and ophthalmic examinations were performed. RESULTS: Six of 30 admitted children were fully enrolled. Enrollment obstacles included caregiver stress, animosity towards allegations of abuse, child protection services involvement, and research phlebotomy coordination. Prevalence of thrombophilia was high in children with retinal hemorrhage and in 1 case the question of hemorrhage adjudicated as abuse was considered in light of a history of a fall. CONCLUSION: We estimate that to answer the critical question of retinal hemorrhage specificity for abuse in the presence of thrombophilia will require 53 centers for a 1 year study or 18 centers for a 3-year study. We identify potential obstacles and interventions.

• Psychopathy among pedophilic and nonpedophilic child molesters.

  Authors: Donald S Strassberg, Angela Eastvold, J Wilson Kenney, Yana Suchy

  Child abuse & neglect.

  OBJECTIVE: Among men who commit sexual offenses against children, at least 2 distinct groups can be identified on the basis of the age of the primary targets of their sexual interest; pedophiles andOBJECTIVE: Among men who commit sexual offenses against children, at least 2 distinct groups can be identified on the basis of the age of the primary targets of their sexual interest; pedophiles and nonpedophiles. METHOD: In the present report, across 2 independent samples of both types of child molesters as well as controls, a total of 104 men (53 pedophilic and 51 nonpedophilic) who had sexually offended against a child age 13 or younger were compared to each other (and to 49 non-sex offender controls) on psychopathy as assessed by the Psychopathic Personality Inventory (PPI). RESULTS: In both samples of child molesters, the nonpedophiles scored as significantly more psychopathic than the pedophiles. CONCLUSIONS: These results provide further evidence of the importance of distinguishing between these groups of offenders.

• Evaluation and referral for child maltreatment in pediatric poisoning victims.

  Authors: Joanne N Wood, Lydia H Pecker, Michael E Russo, Fred Henretig, Cindy W Christian

  Child abuse & neglect.

  OBJECTIVE: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrantOBJECTIVE: Although the majority of poisonings in young children are due to exploratory ingestions and might be prevented through improved caregiver supervision, the circumstances that warrant evaluation for suspected maltreatment and referral to Child Protective Services (CPS) are unclear. Therefore the objective of this study was to determine the percentage and characteristics of young poisoning victims who were evaluated for child maltreatment by the hospital team (social work and/or child protection team) and/or referred to CPS. METHODS: Retrospective study of poisoning victims<6 years old seen at an urban children's hospital from 2006 to 2008. Logistic regression was performed to evaluate the associations between the outcomes (evaluation for maltreatment by hospital team and/or referral to CPS) and predictor variables (demographics and circumstances, type and severity of poisoning). RESULTS: Among 928 poisonings, 41% were from household products, 20% from over-the-counter drugs, 7% from prescription narcotics/sedatives, 29% from other prescription drugs, and ≤1% each from ethanol, illicit drugs, or other substances. Most children were asymptomatic (69%) or stable (28%); 3% were critically ill. Only 13% were evaluated by the hospital team and 4% were referred to CPS. Demographic characteristics were not associated with referral to CPS. Higher clinical severity was associated with increased referral (p<0.001). Compared to poisonings with over-the-counter drugs, referrals were more likely for poisonings with ethanol and prescription narcotics/sedatives, but not other prescription drugs or household products (p<0.001). All illicit drug poisonings and 44% of ethanol poisonings were referred. The majority of referrals to CPS were for concerns for illicit drugs, poor supervision or multiple forms of maltreatment; 6% were secondary to concerns for intentional poisoning. CONCLUSIONS: Evaluations and referrals to CPS for maltreatment are uncommon in young poisoning victims. Referrals occurred consistently for illicit drugs but not ethanol. Although referrals were more likely for higher severity poisonings, it is unclear if the severity of poisoning is associated with the level of supervisory neglect or a marker of ongoing risk to the child. These findings suggest the need to identify risk factors for ongoing harm and the development of clinical guidelines used to determine which poisoning victims should be referred to Child Protective Services.

• Overweight and obesity among maltreated young adolescents.

  Authors: Janet U Schneiderman, Ferol E Mennen, Sonya Negriff, Penelope K Trickett

  Child abuse & neglect.

  PURPOSE: (1) To identify and compare rates of body mass index (BMI)≥85% (overweight/obesity) and BMI≥95% (obesity) in maltreated versus comparison young adolescents; (2) to determine whetherPURPOSE: (1) To identify and compare rates of body mass index (BMI)≥85% (overweight/obesity) and BMI≥95% (obesity) in maltreated versus comparison young adolescents; (2) to determine whether demographic/psychological characteristics are related to high BMI; (3) to determine whether type of maltreatment is related to high BMI in maltreated young adolescents. METHODS: We compared a sample of maltreated young adolescents to a comparison sample of adolescents from the same neighborhood. The maltreated sample (n=303) of young adolescents (ages 9-12) came from referrals from the county child welfare department in Los Angeles, CA from new cases of maltreatment opened in specified zip codes. A comparison sample (n=151) was recruited from the same zip codes. The total sample (both maltreated and comparison) was 77% Black or Hispanic and 23% White or biracial with 53% males and 47% females. A stepwise logistic regression was used to examine predictors of high BMI with demographic/psychological covariates and maltreatment group. The maltreated young adolescents were selected and the logistic model included all covariates as well as an interaction between gender and each maltreatment type (neglect, sexual, and physical abuse). RESULTS: Maltreated young adolescents were similar to comparison adolescents in obesity prevalence (27.1% and 34.4%, respectively), although comparison young adolescents were 1.7 times more likely to have overweight/obesity than the maltreated young adolescents (95% CI=1.13-2.76). No demographic variables predicted high BMI. For the comparison young adolescents, depression slightly increased the odds of overweight/obesity (OR=1.08, 95% CI=1.01-1.15). Being neglected reduced the odds of being in the overweight/obesity and obesity group when combining genders. For females, but not males, sexual and physical abuse slightly reduced the odds of obesity. CONCLUSIONS: Both the maltreated and comparison young adolescents had a high prevalence of overweight and obesity, which puts them at risk for health problems. Maltreatment reduced the odds of having a high BMI for adolescents in this study, which is opposite to research in adults. Further exploration of the mechanism of how maltreatment is related to weight as adolescents age, with specific emphasis on differences between genders, is needed.

• Number of childhood abuse perpetrators and the occurrence of depressive episodes in adulthood.

  Authors: Richard T Liu, Shari Jager-Hyman, Clara A Wagner, Lauren B Alloy, Brandon E Gibb

  Child abuse & neglect.

  OBJECTIVE: Although past research has documented a link between adverse childhood experiences - particularly childhood emotional (CEA), physical (CPA), and sexual abuse (CSA) - and depression,OBJECTIVE: Although past research has documented a link between adverse childhood experiences - particularly childhood emotional (CEA), physical (CPA), and sexual abuse (CSA) - and depression, relatively few studies have examined the unique impact of each of these highly co-occurring abuse types. Moreover, relatively little is known about the specific aspects of abuse experiences that increase risk for depression (e.g., number of perpetrators). The current study provides a conservative test of the association between the number of CEA, CPA, and CSA perpetrators, and depressive episodes in adulthood. METHOD: Two hundred and ninety-nine participants were followed longitudinally for 2.5 years. CEA, CPA, and CSA were measured using the Lifetime Experiences Questionnaire, and depressive episodes were assessed with diagnostic interviews administered every 6 weeks. RESULTS: After statistically controlling for the influence of cognitive risk for depression, baseline depressive symptoms, past history of clinical depression, and total number of different types of CEA, CSA, and CPA events, the number of CEA and CSA, but not CPA, perpetrators were uniquely associated with the number of depressive episodes experienced over the prospective follow-up. CONCLUSIONS: These results indicate that experiencing CEA and CSA from multiple perpetrators increased risk for clinical depression beyond what is accounted for by the total number of types of abuse experiences. This study highlights the need for future research to assess the specific qualities of childhood abuse experiences that uniquely confer risk for clinical depression, as well as possible mechanisms through which they exert their deleterious effect.

• Violence against pregnant women can increase the risk of child abuse: A longitudinal study.

  Authors: Ko Ling Chan, Douglas A Brownridge, Daniel Y T Fong, Agnes Tiwari, Wing Cheong Leung, Pak Chung Ho

  Child abuse & neglect.

  OBJECTIVE: To assess the impact of intimate partner violence (IPV) against pregnant women on subsequent perpetration of child abuse and neglect (CAN) by parents; and to test the mediation effect ofOBJECTIVE: To assess the impact of intimate partner violence (IPV) against pregnant women on subsequent perpetration of child abuse and neglect (CAN) by parents; and to test the mediation effect of recent IPV on the link between IPV during pregnancy and subsequent CAN. METHODS: This study was a longitudinal follow-up of a population-based study on pregnancy IPV conducted in antenatal clinics in 7 public hospitals in Hong Kong in 2005. Of all participants in the 2005 study, we recruited 487 women (with 184 having reported pregnancy IPV in the 2005 study) with newborn babies for a follow-up telephone interview in 2008. Participants responded to the Abuse Assessment Screen (AAS), the Parent-Child Conflict Tactics Scale, and some questions assessing demographic information. RESULTS: The most common form of physical violence was corporal punishment, with a prevalence rate of 75.1% in the preceding year and 75.4% over their lifetime. Physical maltreatment was less likely to be reported, accounting for 4.7% in the preceding year and 4.9% over their lifetime. The preceding-year and lifetime prevalence rates of neglect were 11.3% and 11.5%, respectively. Findings from logistic regression analyses showed that IPV experienced by participants during pregnancy was associated with greater odds of both lifetime (aOR=1.74) and preceding-year child physical maltreatment (aOR=1.78). Results of the regression analyses also provided supportive evidence for the mediation effect of recent IPV victimization on the relationship between IPV during pregnancy and recent CAN against children. CONCLUSION: IPV against women during pregnancy predicted subsequent CAN on newborns in Chinese populations. This underscores the importance of screening pregnant women for IPV in order to prevent CAN at an early stage. Home visitations are suggested to break the cycle of violence within a nuclear family.

• Parent emotional expressiveness and children's self-regulation: Associations with abused children's school functioning.

  Authors: Mary E Haskett, Rebecca Stelter, Katie Proffit, Rachel Nice

  Child abuse & neglect.

  OBJECTIVE: Identifying factors associated with school functioning of abused children is important in prevention of long-term negative outcomes associated with school failure. The purpose of thisOBJECTIVE: Identifying factors associated with school functioning of abused children is important in prevention of long-term negative outcomes associated with school failure. The purpose of this study was to examine the degree to which parent emotional expressiveness and children's self-regulation predicted early school behavior of abused children. METHODS: The sample included 92 physically abused children ages 4-7 and one of their parents (95.7% mothers). Parents completed a measure of their own emotional expressiveness, and parents and teachers provided reports of children's self-regulatory skills. Children's school functioning was measured by observations of playground aggression and teacher reports of aggression and classroom behavior. RESULTS: Parents' expression of positive and negative emotions was associated with various aspects of children's self-regulation and functioning in the school setting. Links between self-regulation and children's school adjustment were robust; poor self-regulation was associated with higher aggression and lower cooperation and self-directed behavior in the classroom. There was minimal support for a mediating role of children's self-regulation in links between parent expressiveness and children's behavior. PRACTICE IMPLICATIONS: Findings point to the relevance of parent emotional expressivity and children's self-regulatory processes in understanding physically abused children's functioning at the transition to school. Although further research is needed, findings indicate that increasing parental expression of positive emotion should be a focus in treatment along with reduction in negativity of abusive parents. Further, addressing children's self-regulation could be important in efforts to reduce aggression and enhance children's classroom competence.

• The impact of the Solution Based Casework (SBC) practice model on federal outcomes in public child welfare.

  Authors: Becky F Antle, Dana N Christensen, Michiel A van Zyl, Anita P Barbee

  Child abuse & neglect.

  OBJECTIVE: To test the effects of the Solution-Based Casework practice model on federal outcomes of safety, permanency and well-being. The Solution-Based Casework model combines family developmentOBJECTIVE: To test the effects of the Solution-Based Casework practice model on federal outcomes of safety, permanency and well-being. The Solution-Based Casework model combines family development theory, solution-focused skills and relapse prevention for the casework process in child protection. METHOD: 4,559 public child welfare cases were reviewed through a CQI case review process. RESULTS: This study found that cases with high levels of fidelity to the model demonstrated significantly better outcomes in the areas of child safety, permanency and well-being and exceeded federal standards, while cases with low fidelity to the model failed to meet federal standards. CONCLUSION: Components of the Solution-Based Casework were significant predictors of these federal outcomes and accounted for variance in these outcomes better than any other casework process factors.

• Let's prevent peer victimization, not just bullying.

  Authors: David Finkelhor, Heather A Turner, Sherry Hamby

  Child abuse & neglect.

• Transactional sex as a form of child sexual exploitation and abuse in Rwanda: Implications for child security and protection.

  Authors: Timothy P Williams, Agnes Binagwaho, Theresa S Betancourt

  Child abuse & neglect.

  OBJECTIVE: To illuminate the different manifestations of transactional sexual exploitation and abuse among Rwanda's children in order to inform effective responses by policies, programs, andOBJECTIVE: To illuminate the different manifestations of transactional sexual exploitation and abuse among Rwanda's children in order to inform effective responses by policies, programs, and communities. METHOD: Qualitative data was collected during April and May 2010. One-hundred and thirty-nine adults (56% female) and 52 children (60% female) participated in focus groups across three geographic locations in Rwanda. Eleven interviews were held with child protection stakeholders. RESULTS: Interview and focus group participants reported how children, primarily girls, engaged in transactional sex as a survival strategy in response to situations of adversity including economic deprivation, difficulty accessing school, and social pressure. CONCLUSIONS: Policy and programs should work to address the underlying social and economic determinants of transactional sexual exploitation through structural interventions that reduce gender inequalities to accessing school and securing basic needs. Further quantitative and qualitative research to better understand the complexities of this issue is warranted.

• Integrated programs for mothers with substance abuse issues and their children: A systematic review of studies reporting on child outcomes.

  Authors: Alison Niccols, Karen Milligan, Ainsley Smith, Wendy Sword, Lehana Thabane, Joanna Henderson

  Child abuse & neglect.

  BACKGROUND: Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle ofBACKGROUND: Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children. OBJECTIVES: To examine the impact and effects of integrated programs for women with substance abuse issues and their children, we performed a systematic review of studies published from 1990 to 2011. METHODS: Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline; the treatment program included at least 1 specific substance use treatment and at least 1 parenting or child treatment service; the study design was randomized, quasi-experimental, or cohort; and there were quantitative data on child outcomes. We summarized data on child development, growth, and emotional and behavioral outcomes. RESULTS: Thirteen studies (2 randomized trials, 3 quasi-experimental studies, 8 cohort studies; N=775 children) were included in the review. Most studies using pre-post design indicated improvements in child development (with small to large effects, ds=0.007-1.132) and emotional and behavioral functioning (with most available effect sizes being large, ds=0.652-1.132). Comparison group studies revealed higher scores for infants of women in integrated programs than those not in treatment, with regard to development and most growth parameters (length, weight, and head circumference; with all available effect sizes being large, ds=1.16-2.48). In studies comparing integrated to non-integrated programs, most improvements in emotional and behavioral functioning favored integrated programs and, where available, most effect sizes indicated that this advantage was small (ds=0.22-0.45). CONCLUSIONS: Available evidence supports integrated programs, as findings suggest that they are associated with improvements in child development, growth, and emotional and behavioral functioning. More research is required comparing integrated to non-integrated programs. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the needs of children of women with substance abuse issues.

• Assessment and treatment of adolescent sexual offenders: Implications of recent research on generalist versus specialist explanations.

  Authors: Lesleigh Pullman, Michael C Seto

  Child abuse & neglect. 36(3):203-9.

  Adolescent sex offenders (ASOs) are commonly considered a special kind of juvenile offender, with distinct risk and etiological factors from other adolescent offenders. However, a growing body ofAdolescent sex offenders (ASOs) are commonly considered a special kind of juvenile offender, with distinct risk and etiological factors from other adolescent offenders. However, a growing body of research suggests that ASOs are more similar to other adolescent non-sex offenders than they are different (e.g., Awad, Saunders, & Levine, 1984; Elliott, 1994; France & Hudson, 1993). The purpose of the present article is to review recent literature pertaining to the distinction between generalist and specialist adolescent sex offenders (ASOs). This article summarizes the findings from Seto and Lalumière's (2010) meta-analysis on theoretically derived risk and etiological factors for adolescent sexual offending. Based on these findings, recommendations for the assessment and treatment of this population are made. The results of Seto and Lalumière's (2010) meta-analysis suggests the majority of ASOs are generalist offenders who are similar to other adolescent non-sex offenders, while a minority of ASOs are specialist offenders, who have unique risk and etiological factors including childhood sexual abuse/maltreatment and atypical sexual interests. A clear distinction has been shown between generalist ASOs and specialist ASOs. Assessment measures and treatment targets geared toward one of these groups may be less effective with the other group, which means that this distinction is clinically important. It is expected that if treatment is matched to ASO type, sexual and nonsexual recidivism will be reduced and positive changes in other clinically important areas will be evident.

• The impact of childhood maltreatment history on parenting: A comparison of maltreatment types and assessment methods.

  Authors: Heidi N Bailey, Carey Anne Deoliveira, Vicky Veitch Wolfe, Elspeth M Evans, Cailey Hartwick

  Child abuse & neglect. 36(3):236-46.

  Childhood maltreatment is associated with subsequent parenting difficulties; however, most research has relied on self-reported parenting outcomes, and observational measures have revealed mixedChildhood maltreatment is associated with subsequent parenting difficulties; however, most research has relied on self-reported parenting outcomes, and observational measures have revealed mixed findings. Furthermore, research has focused predominantly on histories of sexual and/or physical abuse. This study explored associations between a wide range of childhood maltreatment experiences and both observed and self-reported parenting outcomes. Mothers of 4- to 6-year-old children at moderate social risk completed the History of Maltreatment and Trauma Form (HMTF), which assesses a range of maltreatment experiences and delineates specific characteristics such as chronicity and severity. Participants completed questionnaires assessing parenting stress and competence, and their emotional availability (sensitivity, intrusiveness, hostility) toward their children was coded from videorecorded interactions. Construct (factorial, convergent and discriminant) validity of the HMTF was demonstrated through factor analysis and a multi-trait, multi-method matrix comparing it to the Childhood Trauma Questionnaire. HMTF-assessed childhood maltreatment, specifically witnessing family violence, neglect and emotional maltreatment, were significantly associated with mothers' observed hostility toward their children, even after controlling for potentially traumatic adult experiences. In contrast, childhood sexual abuse history was associated with self-reported concerns regarding parenting competence, and this association held even after controlling for other forms of childhood maltreatment and potentially traumatic adult experiences. Self-reported parenting outcomes were unrelated to observed parenting behavior. Findings highlight the complexity of associations between child maltreatment and subsequent parenting outcomes. Although much previous research has focused on sexual and physical abuse, other more contextual forms of maltreatment may be similarly or more strongly associated with certain parenting outcomes. Furthermore, different forms of maltreatment may be associated with perceived versus observed parenting outcomes.

• Child welfare policy and practice on children's exposure to domestic violence.

  Authors: Theodore P Cross, Ben Mathews, Lil Tonmyr, Debbie Scott, Catherine Ouimet

  Child abuse & neglect. 36(3):210-6.

  This article reviews research, policy and programming in Australia, Canada and the US on the child welfare response to EDV. The review draws on searches of standard research databases, interviewsThis article reviews research, policy and programming in Australia, Canada and the US on the child welfare response to EDV. The review draws on searches of standard research databases, interviews with researchers and practitioners, and the authors' own research. Although EDV is underreported, across studies 7% to 23% of youths in general population surveys experienced EDV, 36-39% of youth in DV cases have witnessed the violence, and 45-46% of primary caregivers in child maltreatment investigations have experienced DV. Mandatory reporting can increase the number of cases that come to the attention of child welfare, but without resources for training and programming can lead to inappropriate reports, lack of referral for further assessment, and strains on the child welfare system. Improving the child welfare response to EDV can include collaboration between child welfare workers and DV advocates; increased training on screening for DV; new protocols on DV; and dedicated DV staffing within child welfare agencies. In recent years, policy and program attention to EDV has also been embedded within broader national efforts to protect children from violence and maltreatment. Differential response models that eschew investigation in favor of assessment and service delivery hold promise for families with DV. Empirical data are limited, but current research and practice experience suggest that child welfare agencies seeking to improve the response to EDV should collaborate with other disciplines involved with preventing and responding to DV, seek resources to support training and programming, consider methods that avoid stigmatizing parents, and build in a program evaluation component to increase knowledge about effective practice.

• Parental child abuse potential and subsequent coping competence in disadvantaged preschool children: Moderating effects of sex and ethnicity.

  Authors: Cristina M Lopez, Angela Moreland Begle, Jean E Dumas, Michael A de Arellano

  Child abuse & neglect. 36(3):226-35.

  This study evaluated the effects of abuse potential in parents on subsequent coping competence domains in their children, using a model empirically supported in a high-risk community sample byThis study evaluated the effects of abuse potential in parents on subsequent coping competence domains in their children, using a model empirically supported in a high-risk community sample by Moreland and Dumas (2007). Data from an ethnically diverse sample of 579 parents enrolled in the PACE (Parenting Our Children to Excellence) program was used to evaluate whether parental child abuse potential assessed at pre-intervention negatively contributed to child affective, achievement, and social coping competence in preschoolers one year later, and whether these associations were moderated by sex or ethnicity. Cross-sectional results indicated that parental child abuse potential was negatively related to child affective and achievement coping competence, after accounting for variance associated with child behavior problems. However, child abuse potential was not predictive of subsequent coping competence in any domain after controlling for previous levels of child coping competence. No moderating effects were found for sex and ethnicity, but results showed main effects of sex and ethnicity in cross-sectional analyses. Clinical implications and future directions are discussed.

• Sexual health in women reporting a history of child sexual abuse.

  Authors: Céline Lacelle, Martine Hébert, Francine Lavoie, Frank Vitaro, Richard E Tremblay

  Child abuse & neglect. 36(3):247-59.

  The present study examined the association between child sexual abuse (CSA) and sexual health outcomes in young adult women. Maladaptive coping strategies and optimism were investigated as possibleThe present study examined the association between child sexual abuse (CSA) and sexual health outcomes in young adult women. Maladaptive coping strategies and optimism were investigated as possible mediators and moderators of this relationship. Data regarding sexual abuse, coping, optimism and various sexual health outcomes were collected using self-report and computerized questionnaires with a sample of 889 young adult women from the province of Quebec aged 20-23 years old. A total of 31% of adult women reported a history of CSA. Women reporting a severe CSA were more likely to report more adverse sexual health outcomes including suffering from sexual problems and engaging in more high-risk sexual behaviors. CSA survivors involving touching only were at greater risk of reporting more negative sexual self-concept such as experiencing negative feelings during sex than were non-abused participants. Results indicated that emotion-oriented coping mediated outcomes related to negative sexual self-concept while optimism mediated outcomes related to both, negative sexual self-concept and high-risk sexual behaviors. No support was found for any of the proposed moderation models. Survivors of more severe CSA are more likely to engage in high-risk sexual behaviors that are potentially harmful to their health as well as to experience more sexual problems than women without a history of sexual victimization. Personal factors, namely emotion-oriented coping and optimism, mediated some sexual health outcomes in sexually abused women. The results suggest that maladaptive coping strategies and optimism regarding the future may be important targets for interventions optimizing sexual health and sexual well-being in CSA survivors.

• Incentive effect on inhibitory control in adolescents with early-life stress: An antisaccade study.

  Authors: Sven C Mueller, Michael G Hardin, Katherine Korelitz, Teresa Daniele, Jessica Bemis, Mary Dozier, Elizabeth Peloso, Francoise S Maheu, Daniel S Pine, Monique Ernst

  Child abuse & neglect. 36(3):217-25.

  Early-life stress (ES) such as adoption, change of caregiver, or experience of emotional neglect may influence the way in which affected individuals respond to emotional stimuli of positive orEarly-life stress (ES) such as adoption, change of caregiver, or experience of emotional neglect may influence the way in which affected individuals respond to emotional stimuli of positive or negative valence. These modified responses may stem from a direct alteration of how emotional stimuli are coded, and/or the cognitive function implicated in emotion modulation, such as self-regulation or inhibition. These ES effects have been probed on tasks either targeting reward and inhibitory function. Findings revealed deficits in both reward processing and inhibitory control in ES youths. However, no work has yet examined whether incentives can improve automatic response or inhibitory control in ES youths. To determine whether incentives would only improve self-regulated voluntary actions or generalize to automated motoric responses, participants were tested on a mixed eye movement task that included reflex-like prosaccades and voluntary controlled antisaccade eye movements. Seventeen adopted children (10 females, mean age 11.3years) with a documented history of neglect and 29 typical healthy youths (16 females, mean age 11.9years) performed the mixed prosaccade/antisaccade task during monetary incentive conditions or during no-incentive conditions. Across both saccade types, ES adolescents responded more slowly than controls. As expected, control participants committed fewer errors on antisaccades during the monetary incentive condition relative to the no-incentive condition. By contrast, ES youths failed to show this incentive-related improvement on inhibitory control. No significant incentive effects were found with prepotent prosaccades trials in either group. Finally, co-morbid psychopathology did not modulate the findings. These data suggest that youths with experience of early stress exhibit deficient modulation of inhibitory control by reward processes, in tandem with a reward-independent deficit in preparation for both automatic and controlled responses. These data may be relevant to interventions in ES youths.

• Characteristics of childhood sexual abuse in lesbians and heterosexual women.

  Authors: Sharon C Wilsnack, Arlinda F Kristjanson, Tonda L Hughes, Perry W Benson

  Child abuse & neglect. 36(3):260-5.

• Development of standardized clinical training cases for diagnosis of sexual abuse using a secure telehealth application.

  Authors: Lori D Frasier, Ioana Thraen, Rich Kaplan, Patricia Goede

  Child abuse & neglect. 36(2):149-55.

  The training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peerThe training of physicians, nurse examiners, social workers and other health professional on the evidentiary findings of sexual abuse in children is challenging. Our objective was to develop peer reviewed training cases for medical examiners of child sexual abuse, using a secure web based telehealth application (TeleCAM). Sixty de-identified cases developed by 2 child abuse pediatricians, were stratified by availability of information (minimal, moderate, comprehensive) for both positive and negative child sexual abuse findings. These cases were narrowed to a set of 30 cases through an expert peer review process using pediatricians with extensive expertise in the evaluation of child sexual abuse. A previously studied secure web-based telehealth application TeleCAM which contains a child abuse workflow, was used to develop, disseminate and review cases. A series of Free Margin agreement statistics are used to select those cases with the highest rates of agreement. A final set of 30 cases are stratified equally by availability of information and for both positive and negative findings. Mantel Haenszel Chi-square was used for trend analysis of the ordered categorical variables. The highest degrees of inter-rater reliability was found in cases with moderate to comprehensive information. Cases with minimal data had poor kappa agreement indicating that availability of differing levels and types of information contribute to variability in diagnostic findings. These final cases will be further studied with medical examiners in various settings utilizing TeleCAM as the application for dissemination.

• Incidence of hospitalization due to child maltreatment in Taiwan, 1996-2007: A nationwide population-based study.

  Authors: Wan-Lin Chiang, Yu-Tung Huang, Jui-Ying Feng, Tsung-Hsueh Lu

  Child abuse & neglect. 36(2):135-41.

  Little is known regarding the epidemiology of child maltreatment in Asian countries. This study aimed to examine the incidence of hospitalization coded as due to child maltreatment in Taiwan. We usedLittle is known regarding the epidemiology of child maltreatment in Asian countries. This study aimed to examine the incidence of hospitalization coded as due to child maltreatment in Taiwan. We used inpatient claims data of the National Health Insurance for the years 1996 through 2007 for estimation. Hospitalization of children aged 0-12 years with an ICD-9-CM code 995.5 "maltreatment syndrome" or E960-E969 "assault" in the main or secondary discharge diagnosis in claims data was defined as hospitalization due to child maltreatment. Poisson regression was used to examine the trends. A total of 1,726 children with 1,780 hospitalizations due to child maltreatment were identified during 1996-2007. The averaged annual incidence over 1996-2007 was 13.2/100,000 for infants, 3.5/100,000 for children aged 1-3 years, 2.1/100,000 for children aged 4-6 years and 3.3/100,000 for children aged 7-12 years. The incidence increased most among the infant group, from 4.8/100,000 in 1996-1997 to 25.4/100,000 in 2006-2007, a greater than 5-fold increase. The magnitude of the increase in incidence decreased with age, and no change in incidence was noted among children aged 7-12 years. The drastic increase in incidence in infants since 2003 corresponds with the introduction of use of ICD-9-CM code 995.55 "shaken infant syndrome" in Taiwan since 2003. Head injury was the main type of injury in all age groups. The incidence of hospitalization coded as due to child maltreatment in Taiwan differed by age group. Infants had the highest and the largest increase in incidence during the past decade. The increase might be due to improvement in awareness, competence and willingness to diagnose child maltreatment of medical staff in hospitals during the past decade after the revision of Child Welfare Law in 1993 and the new ICD-9-CM code for "shaken infant syndrome" being used since 2003. Physicians and nursing staff should be aware of and provide the detailed and specific information needed for proper discharge diagnosis coding, from which valid estimation of the incidence of hospitalization due to child maltreatment can be made. Administrative data should include both the N-code and E-code for each case of child maltreatment hospitalization to provide more complete information.

• Experiential avoidance and the relationship between child maltreatment and PTSD symptoms: Preliminary evidence.

  Authors: Chad E Shenk, Frank W Putnam, Jennie G Noll

  Child abuse & neglect. 36(2):118-26.

  Not every adolescent exposed to child maltreatment develops symptoms of post-traumatic stress disorder (PTSD), emphasizing the need to identify variables that explain how some maltreated childrenNot every adolescent exposed to child maltreatment develops symptoms of post-traumatic stress disorder (PTSD), emphasizing the need to identify variables that explain how some maltreated children come to develop these symptoms. This study tested whether a set of variables, respiratory sinus arrhythmia (RSA) and cortisol reactivity as well as experiential avoidance, explained the relationship between child maltreatment and PTSD symptoms. Adolescent females (N=110; n=51 maltreated) 14-19 years of age completed interviews, questionnaires, and a stressor paradigm. A multiple mediator model was used to assess the effect for the set of variables while identifying specific indirect effects for each variable. Results indicated that the set of variables mediated the relationship between child maltreatment and PTSD symptoms. However, only experiential avoidance contributed significantly to this effect when simultaneously estimating all other variables. The indirect effect for experiential avoidance was also significantly stronger than the effects of RSA and cortisol reactivity. Data support the examination of experiential avoidance in understanding how adolescents who have been maltreated develop PTSD symptoms with implications for prevention and intervention.

• Epidemiology of abusive abdominal trauma hospitalizations in United States children.

  Authors: Wendy Gwirtzman Lane, Howard Dubowitz, Patricia Langenberg, Patricia Dischinger

  Child abuse & neglect. 36(2):142-8.

  (1) To estimate the incidence of abusive abdominal trauma (AAT) hospitalizations among US children age 0-9 years. (2) To identify demographic characteristics of children at highest risk for(1) To estimate the incidence of abusive abdominal trauma (AAT) hospitalizations among US children age 0-9 years. (2) To identify demographic characteristics of children at highest risk for AAT. Secondary data analysis of a cross-sectional, national hospitalization database. Hospitalization data from the 2003 and 2006 Kids' Inpatient Database (KID). Frequency and rate of hospitalizations for abusive abdominal trauma as identified by ICD-9CM codes for abdominal trauma and child abuse and E-codes for inflicted injury. Hospitalization rates by age, insurance status, and frequency of specific organ injury. AAT rates were higher for infants than for any other age group, with 17.7 (95% CI 11.7-23.9) cases per million in 2006. More than 25% of all abdominal trauma in children <1 year of age was abusive. For all age groups, rates were higher for males than females, and for children insured by Medicaid compared to those with private insurance. Organs most commonly injured were the liver (64% of hospitalizations), kidney (19%), and stomach/intestines (12%). Although experts have considered toddlers to be at highest risk for AAT, infants have higher rates of AAT hospitalization. Similar to other abusive injuries, young age, male gender, and poverty are risk factors for AAT.

• A longitudinal examination of childhood maltreatment and adolescent obesity: Results from the National Longitudinal Study of Adolescent Health (AddHealth) Study.

  Authors: Sunny Hyucksun Shin, Daniel P Miller

  Child abuse & neglect. 36(2):84-94.

  We sought to explore the association between childhood maltreatment (e.g., neglect, physical and sexual abuse) and longitudinal growth trajectories of body mass index (BMI) from adolescence to youngWe sought to explore the association between childhood maltreatment (e.g., neglect, physical and sexual abuse) and longitudinal growth trajectories of body mass index (BMI) from adolescence to young adulthood. We used latent curve modeling to examine data from the National Longitudinal Study of Adolescent Health (N=8,471), pooling years 1995-2008. Relative weight was indicated by BMI. Children who experienced neglect had a faster average rate of BMI growth over time compared to children who experienced no childhood maltreatment. In addition, the co-occurrence of childhood neglect and physical abuse was related to increased levels of BMI at baseline, even after adjustment for 14 separate child and parental demographic and psychosocial characteristics. Parental obesity and education, child birth place, and family income were also associated with both baseline BMI and the rate of change in BMI over time. Childhood neglect plays a role in the development of adolescent obesity. Future research should examine potential mediators or moderators of the longitudinal relation between childhood neglect and adolescent and young adult obesity including impulsivity, depression, and compulsive eating behavior.

• Challenges in the evaluation for possible abuse: Presentations of congenital bleeding disorders in childhood.

  Authors: Jami Jackson, Shannon Carpenter, Jim Anderst

  Child abuse & neglect. 36(2):127-34.

  To describe children with congenital bleeding disorders that present in a manner that may be concerning for non-accidental trauma (NAT), and to evaluate associations with disease and demographicTo describe children with congenital bleeding disorders that present in a manner that may be concerning for non-accidental trauma (NAT), and to evaluate associations with disease and demographic characteristics. Ten year retrospective chart review of subjects at a Hemophilia Treatment Center. Demographic, historical, and disease characteristics were collected. Findings were compared to a priori criteria for bleeding/bruising that is concerning for abuse. Twenty-nine (15.3%) of the 189 children in the study had an initial presentation that was concerning for NAT. Of those 29, 75.9% were <5 years of age, 44.8% had von Willebrand disease (vWD), 51.8% had hemophilia, and 48.3% had a family history of a named bleeding disorder. Children from 9 months through 5 years of age were more likely than older children to present with findings concerning for abuse (OR 3.32, 1.21-9.10). No association was detected between presentation concerning for abuse and gender (OR 1.51, 0.6-3.77). Hemophilia was no more likely than vWD to present in a manner that was concerning for abuse (OR 0.7, 0.31-1.58). No children presented with patterned bruising. Children with bleeding disorders may present with bruising/bleeding that is clinically highly suggestive of NAT. Infants and young mobile children who have non-patterned bruising or bleeding as the only symptom concerning for abuse require an evaluation that includes testing for hemophilia and vWD. Children who have laboratory testing that indicates the presence of a bleeding disorder, but have clinical findings concerning for abuse, may benefit from a collaborative evaluation including a pediatric hematologist and a child abuse pediatrician.

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