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Publications (291)
Pediatricians have always seen the value of preventing health harms; this should be no less true for child maltreatment than for disease or unintentional injuries. Research continues to demonstrate that maltreatment can be prevented, underscoring the vital roles of both the family and society in healthy childhood development and the importance of s...
Primary care professionals (PCPs) can play a valuable role in the initial assessment of possible child sexual abuse (CSA), an all too prevalent problem. PCPs, however, are often reluctant to conduct these assessments. The goal of this paper is to help PCPs be more competent and comfortable playing a limited but key role. This is much needed as ther...
Background
Psychosocial risk factors in the home may impair children’s health and development and increase the risk of maltreatment. The Safe Environment for Every Kid (SEEK) model was developed to provide pediatric primary care professionals with a structured way to identify common psychosocial problems. The SEEK model includes use of the Parent S...
This Viewpoint discusses the strengths and shortcomings of child protective services, including mandatory reporting policies, with a goal of enhancing its role in ensuring children’s safety and strengthening families.
This Viewpoint describes why knowledge of a child’s environment is critical for optimal care and why it is important that this information be documented in a child’s electronic health record.
Objective:
Although use of interventions for screening for social determinants of health (SDOH) of families in pediatric primary care clinics has increased in the past decade, research on the barriers and facilitators of implementing such interventions has been limited. We explored barriers and facilitators and the mechanisms clarifying their role...
This commentary highlights several challenges concerning the conceptualization of child neglect and the approach to this prevalent problem, with the goal of stimulating further thought and hopefully action. Examples include consideration of potential harm, the role of culture, intentionality, and new forms of neglect related to new knowledge of chi...
This article draws attention to the overlapping literature on social determinants of health and adverse childhood experiences, and the growing clinical interest in addressing them to promote children’s and parents’ health and well-being. We address important considerations and suggest solutions for leaders and practitioners in primary care to addre...
Few studies have reported problem behaviors in adulthood related to the timing of child neglect. The objective was to examine the relationship between classes of child neglect and later behavior. The sample included 473 participants from the prospective Longitudinal Studies of Child Abuse and Neglect (LONGSCAN); their mean age was 23.8 years. They...
This study examined relationships between adolescent neglect and abuse and later health risk in a sample of 1050 youth (53% female, 56% Black, and 24% White) from the Longitudinal Studies of Child Abuse and Neglect. At age 16, the youth reported any adolescent exposure to neglect and physical, sexual, and emotional abuse. At age 18, they reported r...
Parent-child physical aggression, including both physical punishment and abuse, remains a prevalent problem in the United States. In this paper, we briefly review the prevalence and harms of parent-child aggression and discuss changes in social norms and policies over the past several decades. Then, we discuss broad social policies influencing risk...
The prevention of child maltreatment (CM) fits well within the pediatric scope of practice, as child primary care professionals (PCPs) have long focused on prevention and management of behavioral and social issues. This chapter will review the many ways that child PCPs can help prevent CM. Multiple evidence-based models have been developed to scree...
This review begins with a brief summary of the importance of child maltreatment as a major public health problem, given its prevalence and the substantial human and economic costs involved. The focus then shifts to consideration of personalized medicine and child maltreatment, including genetic and genomics factors, as well as the role of social de...
Background
Funding for prevention interventions is often quite limited. Cost-related assessments are important to best allocate prevention funds.
Objectives
To determine the (1) overall cost for implementing the Safe Environment for Every Kid (SEEK) model, (2) cost of implementation per child, and (3) cost per case of maltreatment averted.
Design...
Background:
Child maltreatment (CM) is a major public health problem, affecting many lives, in the short and long term, and costing individuals, families, and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary...
Neglect is the most common form of child maltreatment. Repeated calls have implored the scientific community to remedy the “neglect of neglect,” the paucity of research on neglect relative to abuse. Barriers to the advancement of scientific knowledge and to tackling this intractable public health problem include the difficulties defining neglect an...
The neglect of children is a widespread problem adversely affecting multiple domains of functioning throughout the lifespan. Repeated calls-to-action have noted the “neglect of neglect,” or lack of knowledge pertaining to neglect relative to abuse, particularly regarding prevention and intervention. Difficulties concerning neglect’s definition, ide...
The purpose of the current study was to examine the potential mediating effects of internalizing and externalizing problems at ages 14, 16 and 18 between types of childhood maltreatment and alcohol and marijuana use problems and disorders in young adulthood. Data were from 473 young adults who participated in the Longitudinal Studies of Child Abuse...
Background: Child maltreatment (CM) is a major public health problem, affecting many lives, in the short-and long-term, and costing individuals, families and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary ca...
Developmentally specific measures of neglect remain lacking, especially concerning neglect in adolescence. The current study examines the Mid-Adolescent Neglect Scale (MANS), a 45-item youth, self-reported measure of neglect. Sixteen-year-old participants (N = 802) in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) completed the MANS...
Background
The neglect of children is a serious global problem. The 1989 United Nations Convention on the Rights of the Child (CRC) was a major international achievement spurring national efforts to prevent and address neglect. However, the scope of neglect worldwide and progress in addressing it remain unclear.
Objective
This analysis assessed th...
Thoroughly revised and expanded, the 4th edition offers a practical, objective, evidence-based guide to the medical diagnosis and management of child abuse.
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This longitudinal prospective study examined the relationship between child maltreatment as per reports to child protective services (CPS) and adolescent self-reported marijuana use, and the association between relationships with mothers and fathers and use of marijuana. The association between relationships with parents early in childhood (ages 6...
Background:
Neglect is the most common form of child maltreatment with consequences that appear to be as serious as for abuse. Despite this, the problem has received less than its due attention.
Objective:
To examine the relationship between the timing and chronicity of neglect during childhood and substance use in early adulthood.
Participants...
Claims that new science is changing accepted medical opinion about abusive head injury have been made frequently in the media, legal publications, and in legal cases involving abusive head trauma (AHT). This review analyzes recently published scientific articles about AHT to determine whether this new information has led to significant changes in t...
Introduction:
The purpose of this prospective study is to examine the role of emotional abuse in predicting youth smoking.
Methods:
Data were drawn from the Longitudinal Studies of Child Abuse and Neglect. The sample was restricted to those who had an interview at age 12 years and at least one interview at ages 14, 16, or 18 years (n=775). Self-...
This indispensable resource provides a cohesive, sustainable, and ethical approach to medical education and research that addresses the health needs of children locally and globally.
https://shop.aap.org/principles-of-global-child-health-education-and-research-paperback/
Many children with unsubstantiated reports of child abuse and neglect repeatedly return to the child protection system, indicating that unsubstantiated reports may represent actual child maltreatment or risk for future maltreatment. Identifying patterns of re-reporting and predictors that may be associated with later substantiated re-reporting coul...
Introduction:
Youth with a history of child maltreatment use substances and develop substance use disorders at rates above national averages. Thus far, no research has examined pathways from maltreatment to age of substance use initiation for maltreated youth. We examined the longitudinal impact of maltreatment in early childhood on age of alcohol...
The view of what constitutes child abuse and neglect is dependent on the laws, cultural context, local thresholds and the availability. Since 1982, the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) has conducted surveillance of child maltreatment and child protection every two years, published in World Perspectives on...
Risky sexual behavior is a serious public health problem. Child sexual abuse is an established risk factor, but other forms of maltreatment appear to elevate risky behavior. The mechanisms by which child maltreatment influence risk are not well understood. This study used data from 859 high-risk youth, followed through age 18. Official reports of e...
The landmark guide to pediatric medicine - updated and streamlined for today's clinicians and students
Highlighting the numerous advances and developements in pediatrics, the new second edition provides a complete update of this premier clinical reference including signs and symptoms, behavioral health, care of healthy and high-risk infants, adoles...
Background and objectives:
Much of the research on children in high risk environments, particularly those who have been maltreated, has focused on negative outcomes. Yet, much can be learned from some of these children who fare relatively well. The objective was to examine resilience in high risk preschoolers, and to probe contributors to their ad...
There has been increasing acceptance of marijuana use in the United States in recent years, and rates among adolescents have risen. At the same time, marijuana use during adolescence has been linked to an array of health and social problems. Maltreated children are at risk for marijuana use, but the relationships among characteristics of maltreatme...
Child neglect is by far the most prevalent form of child maltreatment. There is a need to try to prevent this problem, and pediatric primary care offers an excellent opportunity. This article describes one such approach, the Safe Environment for Every Kid (SEEK) model. SEEK enables practitioners to identify and help address psychosocial problems fa...
Neglect is the most common form of child maltreatment, with many short- and long-term physical, psychological and social consequences. Child neglect poses challenges to researchers, policymakers and clinicians, due partly to the inherent difficulties in defining neglect. One challenge concerns how to address a heterogeneous, multiply-determined phe...
Despite growing evidence of links between adverse childhood experiences (ACEs) and long-term health outcomes, there has been limited longitudinal investigation of such links in youth. The purpose of these analyses was to describe the patterns of exposure to ACEs over time and their links to youth health.
The current analyses used data from LONGSCAN...
Child abuse and neglect are inherently challenging problems for pediatricians. It is hoped that this article makes this work easier, albeit not easy, and highlights the many ways that pediatricians can make a valuable difference in the lives of these vulnerable children and their families.
Background:
Food insecure children are at increased risk for medical and developmental problems. Effective screening and intervention are needed.
Methods:
Our purpose was to (1) evaluate the validity and stability of a single item food insecurity (FI) screen. (2) Assess whether use may lead to decreased FI. Part of a larger cluster randomized co...
Physicians play an important role in the forensic evaluation of suspected child abuse and neglect. There has been considerable progress in the medical field, helping distinguish findings related to maltreatment from other conditions or circumstances. Nevertheless, important questions remain. This article covers several of these questions and propos...
Evidence suggests that parenting attitudes are transmitted within families. However, limited research has examined this prospectively. The current prospective study examined direct effects of early maternal attitudes toward parenting (as measured at child age 4 by the Adult-Adolescent Parenting Inventory [AAPI]) on later youth parenting attitudes (...
The link between child maltreatment and juvenile delinquency has been well established, yet the underlying mechanisms through which the relationship may be explained are not very well understood. Although sexualized behaviors have been most studied in the context of sexual abuse, increasing evidence suggests that a broader conceptualization is warr...
The present study examined the impact of children's maltreatment experiences on the emergence of externalizing problem presentations among children during different developmental periods. The sample included 788 youth and their caregivers who participated in a multisite, prospective study of youth at-risk for maltreatment. Externalizing problems we...
Since the birth of modern pediatrics in the late nineteenth century, the role of medical professionals has evolved. Initially, the care of children as a medical specialty was primarily focused on combating infectious diseases and malnutrition. As these burdens lessened, attention turned to “new morbidities.” These included threats to children’s hea...
Child abuse and neglect are inherently challenging problems for pediatricians. It is hoped that this article makes this work easier, albeit not easy, and highlights the many ways that pediatricians can make a valuable difference in the lives of these vulnerable children and their families.
Studies have consistently demonstrated a lack of agreement between youth and parent reports regarding youth-witnessed violence (YWV). However, little empirical investigation has been conducted on the correlates of disagreement. Concordance between youth and parents about YWV was examined in 766 parent-youth dyads from the Longitudinal Studies of Ch...
Neglect is a pervasive form of child maltreatment. Health care practitioners often struggle with deciding when an action (or lack of action) by a caregiver constitutes inadequate care and is neglectful. The present article discusses the epidemiology, risk factors and outcomes of neglect. In addition, assessment using objective markers, such as harm...
Child maltreatment affects millions of children each year. health care providers are increasingly called upon to address such psychosocial problems facing many families. In this article, the authors describe a practical approach to further enhance pediatric primary care and make it more responsive to the needs of children and families. The Safe Env...
Importance
Child maltreatment and other adverse childhood experiences, especially when recent and ongoing, affect adolescent health. Efforts to intervene and prevent adverse childhood exposures should begin early in life but continue throughout childhood and adolescence. Objectives
To examine the relationship between previous adverse childhood ex...
CME Educational Objectives
1. Learn how to manage the complexities of defining neglect in children.
2. Examine the multiple contributors to neglect.
3. Understand principles for effectively intervening in a child neglect situation.
Child neglect is by far the most common form of child maltreatment. Approximately two-thirds of reports to child prot...
Neglect is a pervasive form of child maltreatment. Health care practitioners often struggle with deciding when an action (or lack of action) by a caregiver constitutes inadequate care and is neglectful. The present article discusses the epidemiology, risk factors and outcomes of neglect. In addition, assessment using objective markers, such as harm...
Since the birth of modern pediatrics in the late nineteenth century, the role of medical professionals has evolved. Initially, the care of children as a medical specialty was primarily focused on combating infectious diseases and malnutrition. As these burdens lessened, attention turned to “new morbidities.” These included threats to children’s hea...
Objective:
Studies have consistently demonstrated a lack of agreement between youth and parent reports regarding youth-witnessed violence. However, little is known about whether disagreement is associated with poorer outcomes and less utilization of mental health services. The purpose of the current study was to examine disagreement among youth an...
Objective:
The present study applied person-centered data analytic techniques to identify groups of youth with allegations for combinations of maltreatment types during preschool, early and late childhood.
Method:
Latent Class Analyses were conducted using officially reported child maltreatment data for five types of maltreatment (i.e., failure-...
A robust literature links childhood sexual abuse (CSA) to later substance use and sexual risk behavior; yet, relatively little empirical attention has been devoted to identifying the mechanisms linking CSA to risky behavior among youth, with even less work examining such processes in boys. With the aim of addressing this gap in the literature, the...
This study identified trajectories of maltreatment re-reports between ages 4 and 12 for children first referred to Child Protective Services (CPS) for maltreatment prior to age 4 and either removed from the home or assessed by a CPS intake worker as moderately or highly likely to be abused/neglected in the future, absent intervention. Participants...
To examine the effectiveness of the Safe Environment for Every Kid (SEEK) model of enhanced pediatric primary care to help reduce child maltreatment in a relatively low-risk population.
A total of 18 pediatric practices were assigned to intervention or control groups, and 1119 mothers of children ages 0 to 5 years were recruited to help evaluate SE...
(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)...
Objective:
Although widely studied in adults, the link between lifetime adversities and suicidal ideation in youth is poorly understood. The purpose of this study was to explore this link in adolescents.
Methods:
The analyses used a sample of 740 16-year-old youth in the LONGSCAN sample, and distinguished between childhood (before the age of 12)...
The current study is a longitudinal investigation of unobserved heterogeneity in the developmental trajectories of problem behaviors among children who have experienced maltreatment. The goal of this study is to inform effective intervention plans with respect to behavior problems of maltreated children by examining the different trajectories of be...
It is important for surgeons to be able to accurately assess and diagnose child abuse. While they are generally not the only medical professionals involved in the care of children with suspected abuse, they are highly regarded by hospital and social service staff, and their input regarding the cause of injury is unlikely to be ignored. Appropriate...
Background: SEEK (a Safe Environment for Every Kid) is a pediatric primary care-based maltreatment prevention program with demonstrated effectiveness. Cost-related assessments of prevention programs are important to determine optimal allocation of limited prevention dollars. Methods: SEEK program costs were calculated. Families in 8 pediatric pract...
Child maltreatment is a key risk factor for violent behavior in youth. Although neglect is the most prevalent form of childhood maltreatment, its contribution to development of violence is unclear, as is the potential mediating role of social bonds. This study assesses the relationship between childhood neglect before age 8 and the development of e...
The objectives of this study were to determine whether 1) residents trained in the SEEK (A Safe Environment for Every Kid) model would report improved attitudes, knowledge, comfort, competence, and practice regarding screening for psychosocial risk factors (parental depression, parental substance abuse, intimate partner violence, stress, corporal p...
This prospective investigation used multi-informant models to examine whether parental monitoring moderated associations between child maltreatment and either emotional distress or sexual intercourse. Data included 637 youth in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Child maltreatment was determined by lifetime Child Protec...
Abusive abdominal trauma (AAT) is the second leading cause of child abuse mortality. Previous outcome studies have been limited to data from trauma centers.
The goals of this study were (1) to examine mortality, length of hospitalization, and hospital charges among a national sample of children hospitalized for AAT; and (2) to compare these outcome...
This guidance details the needs of children, and the qualities of parenting that meet those needs. Parental mental disorders can damage the foetus during pregnancy through the action of drugs, prescribed or abused. Pregnancy and the puerperium can exacerbate or initiate mental illness in susceptible women. After their birth, the children may suffer...
This study aimed to empirically assess psychometric properties of a multi-dimensional youth self-report measure of neglectful behavior by parents.
Data were gathered from 593 12-year-old youth participating in the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) consortium; 272 also had data at age 14. Youth responded to a 25-item measure...
The current analyses examined the role of past traumatic experiences in predicting expectations about social, academic, and occupational outcomes. These analyses were conducted in a sample of 843 youth, each 14 years old, who were participants in the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN). The analyses took into account socioeco...
Although there is a well-known link between adverse experiences and suicidal ideation, there has been little study of the effects of recent adverse experiences on suicidal ideation in teenagers. This study examined the association between recent adverse experiences and suicidal ideation in a sample of 740 at-risk 16-year-old youth in the LONGSCAN s...
Little is known about the early childhood indicators of adolescent risk. The link between trajectories of externalizing behavioral problems and early adolescent risk behavior was examined in a longitudinal sample of 875 child participants in the LONGSCAN studies. Five trajectory groups of children defined by externalizing behavior problems were ide...