PSY 349: Children At Risk Risk Factors: Socioeconomic status Health, achievement, well-being outcomes Drugs, substance abuse

use Supportive or toxic environments (divorce) Violence and aggression Race and gender Neglect and abuse What outcomes determine a positive or negative adjustment? When children meet expectations in health (mental and physical), education (did they graduate, get good grades?), and relationships/social interactions positively adjusted How do we determined a child had been affected by adjustments? How do we know failing an exam is a sign something is wrong? We are trained to assume bad outcomes mean maladjustment o Problem: The standard were judging a child by is set by culture, but there can be other things affecting a child that are not signs of maladjustment o Cultural bias (example: US culture teens need to develop sense of identity and have rebellious stage; other culture acting out is maladjustment. Terms to know: At Risk/Risk Factors: Set of presumed cause and effect dynamics that place child in danger of negative future events (ex: exposure to prenatal toxins negative health outcome) o Problem: Thinking there are risk factors leads to some maladapted outcomes o Lisbeth Schorr: risk is a statistical concept there is probability that an outcome with occur, not certainty or a cause-effect relationship Risk Markers: Factors that are indirectly related to an increased probability of a negative outcome; associated with risk, but not reason for negative outcome. (ex: boys are more likely to be diagnosed with conduct disorder, but being a boy isnt the reason, only a risk marker for CD) Risk Traits: Individual predispositions toward developing a problem condition or negative outcome (ex: gender disorders, parent with schizophrenia give child risk trait) o Traits are more likely to lead to negative outcomes, but are not certainty. Environment plays a role/can trigger. Turning Point Effects: Acute or chronic experiences (that have an acute onset) that can change the life course or outcome of an individual (ex: arrest, pregnancy, diagnosis of illness)

Repeated Daily Hassles: Accumulated stress; typically, low leveled negative experiences that can accumulate to have an impact on individual (ex: bulling, neighborhood noise influencing a childs ability to focus, exposure to toxins, exposure to substance abuse) o Also called micro-aggressors (small things over time that accumulate and can damage a child) Cumulative Risk: Increased risk due to (a) the presence of multiple risk factors at one time, (b) reoccurrence of same risk factors (ex: childs father goes to prison, comes home, goes back), and (c) accumulation of ongoing risks over time o Samaroff study of 215 families: Higher number of risk factors youre exposed to lower level of competence in a four year old o Michael Rutter: Potential for negative outcome when multiple factors are present is greater than summing individual strength of risk factors Sensitivity to Risk: Degree of vulnerability to a risk factor or set of risk factors. Fall into 3 categories: o Maladaptive o Adaptive Children of the Great Depression have more resilience now 45-90% of trauma survivors benefit for adversity and gain enhanced self-efficacy, better health behaviors, fueling of support and trust, life meaning o Moderate stress/moderate coping

Continuity of Risk: 1) Minimal risk: few stressors/risk most people 2) Remote risk: potential for future risk emerges, but no impact yet 3) High risk: increasing exposure to risks negative outcome more likely 4) Imminent risk: engaging in getaway negative behaviors can lead to greater risk Exposure to risk factors are influenced by: o Onset/timing o Duration o Intensity o Frequency o Interruption Bronfenbrenners Ecological Systems Theory: Organism-environment relationship Microsystem: Immediate environment of child (child, family, school, peers, neighborhood), anything directly interacted with! Mesosystem: Not direct with child but indirect; two Microsystems interacting with one another (ex: parents and teachers)

Impoverished Mesosystem: Non-communicating Microsystems undermine a adaptive outcome; Microsystems that communicate, but dont agree Exosystem: Factors not in immediate contact but still influence child (ex: parents work environment, parents social networks, school board members) Macrosystem: Largest cultural context (ex: economy, cultural norms attitudes) Chronosystem: Psychological and developmental change over time; dynamic interactions between individual change and environmental change o

Theories of Child Development: Gene Environmental Interaction: When someone has a risk trait, the environment still matters because environmental stress can trigger trait Biopsychosocial Model: Interaction between biological, psychological and social development (ex: effects of puberty on emotions and romantic relationships) Person-context Model: Match between characteristics of child and social environment; outcomes depend on child and environment (ex: Maslows Hierarchy of needs) o Maladaptive outcomes: Mismatch between needs of child and demands of social environment o Stages of child development: What do we expect a child to be doing at each stage? Prenatal development (conception-birth) Infancy and toddlerhood (birth-2) Early childhood (2-6) Middle childhood (6-12) Adolescence (12-19) Psychoanalytic/Psychosexual Theory (Freud): Parents manage childs psychosexual drives well adaptive development for child o Stages (where child derives pleasure from): Oral (birth-1): sucking, biting Anal (1-3): voluntary bladder/bowel control Phallic (3-6): genitals (translates to focus on parents: girls desire fathers, boys desire mothers) Latency (6-11): school skills (focus attention on achievements) Genital (12+):genitals/sexual relations o Limitations: Exclusive focus on the individual and parent relationship only Little evidence that stages predict later personality o If parent is overly strict, children can have inhibited behaviors

If child doesnt achieve balance at each stage, it can affect personality and psyche Psychosocial Development (Erikson): Child learns to negotiate psychosocial conflicts at different stages adaptive development o Eriksons eight life stages: Trust vs. mistrust (birth-1): child has to understand that the parents/adults will respond to their needs; if an infant isnt getting social comfort, there can be neurological damage Autonomy vs. shame/doubt (1-3): child learning how to do things for themselves; if child doesnt develop sense of independence, child can feel ashamed Initiative vs. guilt (3-6): child decides to make up own mind; if adults dont let them, they feel guilt Industry vs. inferiority (6-11): child learns skills and compare how well they can accomplish tasks to how well their peers accomplish the same tasks Identity vs. identity confusion (adolescence) Intimacy vs. isolation (young adulthood) Generativity vs. stagnation (middle adulthood) Integrity vs. despair (the elderly) Social Learning Theory (Bandera): Child learns through social/cognitive processes of observations and reinforcement (ex: Banderas BoBo doll study) o Observational Learning: observing behaviors of others remembering and performing behaviors at a later time o Imitation: replicating behavior seen in others o Reinforcement: response that increases the likelihood that a behavior will occur in the future (rewarded for behavior) o Punishment: response that decreases the likelihood that a behavior will occur in the future o Children are more likely to act the same as the people that appear to be most like them! -Bandera Sociocultural Theory (Lev Vygotsky): Childs personal and cognitive development stems from social interaction with parents and others in their Sociocultural context; children learn through collaborative (guided) learning act of learning new skills under the guidance of others o Zone of proximal development: Difference between what a child can accomplish independently (not much for children) and what a child can accomplish with the guidance and encouragement from more skillful partner (parent/teacher) Scaffolding: Expert tailoring instructions to the skill level of child, gradually increasing childs level of understanding Other theories are Piagets Cognitive Development theory, the evolutionary theory and behavioral genetics theory o

Studying Development: Research Frameworks Used to Study Life Course: o Social Address Model: focuses on outcome with contrasting group-based factors (a) geographic and (b) social background (SES, race, ethnicity, gender, language) Limitations: Focus on outcome rather than process No focus on individual factors or process o Person-Context Model: Impact of environment and process (time) on outcomes; focus on process, not only outcome (ex: measure psychological well-being of child moved from orphanage to multiple foster care families to adoptive families) Limiation: No focus on individual o Person-Process Context Model: Individual characteristics, information on shifting dynamics over time, and experience of individual in different environment all considered (ex: measure psychological well-being of child with high-self esteem who is moved from orphanage to multiple foster care families to adoptive family) Study Design Formats: Cross-Sectional: Compares groups or risk factors at one time point o First approach for linking age to outcomes o Limitation: No longitudinal outcomes (ex: aggression criminality) o Cohort effect: Differences observed across groups may be due to the similarity of their experiences as a cohort, not to the influence of the risk factor being studied Retrospective Study: Compares current outcome (ex: health of child) to info obtained about their previous risk factors (e.g., reviewing medical records of child over past 10 years) o Limitations: Limited to whatever information is available from the past Distortions of information or memory Prospective Study: Explores current characteristics and follows forward to measure later outcomes Diary Studies: Complete same questionnaire multiple times (daily, once per week, etc.); provides an analysis of person-context and process o Limitations: Selective Attrition: non-random loss of participants (e.g., illness, loss of interest, study fatigue) nonrepresentative sample: remaining participants differ from those who left study for important reasons Micro genetic Design: Identify when a developmental change is likely to occur and study participation intensively over a short

period of time before and after the developmental marker (ex: Collect data on students before, during and after transition to new school) Experimental Manipulations: Change/manipulate one key factor, measure impact on outcome (ex: Peer rejection aggressive behavior) o Controlled test of the relationship between two or more variables o Provides information on the PROCESS by which two variables are related o Limitations: Impact of manipulation on the child Non-naturalistic study

Developmental Trajectories: good outcomes

bad outcomes

early adolescence

late adolescence

Stable adaptive: some exposure to minor risk factors, but generally in a low threat environment Stable maladaptive: high risk environment; string of negative experiences and outcomes Adolescent recovery: began in poor environment/risky behaviors, but then have increased outcomes (turning point effect) Adolescent decline: turning point effect shoots child down to maladaptive pathways Temporary deviation: start well, suffer a maladaptive experience, but then recover o Period of storm and stress that causes ups and downs o Bruce Compton (who designed this model) says stability is more common than shifts

Prenatal Health and Development: Intergenerational Transmissions of Risk: Characteristics, experiences and vulnerability of parents/caregiver increasing a childs exposure risk o 2006: 49% pregnancies unintended, 98% of teen pregnancies (15 and younger) o Health of mothers in relation to prenatal health means health of mother quite a time before pregnancy, not the health at

the time you find out your pregnant. Unintended pregnancies mean the woman has not been preparing her body for pregnancy o Development is usually already in full force by the time the mother finally realized shes pregnant Prenatal Development: 40 weeks (3 stages) o Germinal stage (weeks 1-2) Genetic material of sperm + egg = single cell zygote 3 days following fertilization cells enter uterus 6-10 days after fertilization implantation of now divided cell in uterus Health of eggs and sperm is already communicating information about that childs future development Risks: Ectopic Pregnancy: embryo implants outside of the uterus (fallopian tubes most common) life threatening/termination of pregnancy Miscarriage: 10-25% of pregnancies following implantation end in miscarriage (before 20 weeks) Prenatal death is common if mother inhales something toxic o Embryonic stage (week 2-8) Cell differentiation Beginning of organogenesis: formation of organs Development of the placenta: fetomaternal organ that connects the fetus to uterine wall Nutrient and organ uptake to fetus Waste elimination to mother Immunity uptake to fetus from mother Amnion: fluid pouch that envelopes and protects fetus 8 weeks: ultrasound and images Placenta is a conduit (some things can pass from mother to placenta while others cannot) Most critical period/most vulnerable o Fetal period (weeks 9-38) Continued growth and organ development Weight and length increase Critical periods at tail ends

Teratogen: A substance, organism or physical agent that the mother, sperm, or fetus is exposed to that can derail appropriate development (ex: Drugs, pollution, maternal infections, radiation) Consequences of exposure: o Vary by substance, how much time exposed, and timing o Spontaneous abortion o Growth retardation o Metabolic dysfunction

o Cognitive dysfunction or disability o Alienated social behavior o Decreased fertility o Death of embryo o Minor alterations Sperm Damaging Teratogens: More than 60 different compounds o Lead, arsenic, chloride o Pesticides o Marijuana, alcohol, tobacco o Ionizing radiation, anesthetic gas o Industrial solvents Thalidomide o Developed as a sedative, then used to treat morning sickness (which usually occurs during the critical development time for fetus) (used in 1957-1961). There was inadequate FDA testing o Taken 4.5-7 weeks post conception 20% greater risk of birth defect and limb deformity Nutritional Deficiency: Lack of folic acid: neural tubes defects spina bifida (exposed spinal cord) o Causes neural tube defects: first 28 days of pregnancy o Some women dont have access to foods with this o 70% reduction in spina bifida if women take prenatal vitamins Nicotine o 18% US women are current smokers 13% moms smoked during last 3 months of pregnancy Reduces oxygen flow to the placenta Nicotine passes through breast milk o Consequences: Increased risk for miscarriage Pre-term delivery Placenta abruption-separation from uterine wall Low birth weight (2% risk) Boys higher risk? Heightened impulsivity and risk taking and rebellion Respiratory diseases/asthma

In normal development, mother and fetal blood dont mix Exposed through lungs, GI tracts, skin Cocaine/Drugs o Decreased blood flow to brain Placenta abruption at higher risk Premature delivery: 15-27% of deliveries o Attentional blunting: Require additional stimulation in their environments to be able to respond like a normal, nonexposed infant would respond

Confounds: low prenatal care, poly drug use, poor postnatal care Hard to show that only cocaine is responsible for these behaviors in children because of confounds o Gender effects: Delaney-Black et al (2004) Pregnant women/cocaine use during pregnancy 6 year follow-up (473 children/204 cocaine exposed) Boys w. exposure: greater hyperactivity, motor skill problems (compared to nonexposed boys) Girls: no difference Chaplin et al (2010) Girls w. exposure: higher anxiety response to stress, higher anger response to stress (compared to non-exposed girls) Boys: no difference Most effects are indirect: no difference between fullterm exposed vs. non-exposed infants POVERTY confound stronger predictor Alcohol o 12.2% pregnant women age 18-44 consume alcohol Most report consuming alcohol at beginning of pregnancy before they realize theyre pregnant Study relies on self-report from women o Fetal Alcohol Spectrum Disorder (FASD): Umbrella term used to reflect the range of effects associated with prenatal exposure to alcohol Fetal Alcohol Syndrome (FASD): Negative effects are dose dependent (how much a woman drinks how extreme consequences are) Streissguth (2007): 500 children exposed to varying alcohol levels prenatally 22% exposed to heavy maternal drinking o 2 diagnosed with FAD o 12 diagnosed with ARND Confounding variables: maternal health, timing and intensity of exposure, genetic background of mother Required criteria for diagnosis: Prenatal alcohol exposure FAS Facial features o Smooth philtrum (between nose & upper lip) o Thin upper lip

o Widening of eye gap Growth retardation: height/weight (below 10%) Central Nervous system damage: o Structural: head circumference, brain structure o Neurologic: poor coordination, muscle control o Functional (3 or more areas) Cognitive, e.g., low IQ Executive, e.g., planning behavior Motor, e.g., climsiness, gross/find muscle control Attention problems/hyperactivity Social skills problems Other Undiagnosed: 1 out of 7 children found to have FAS have been previously diagnosed accurately No cure Consequences: Irreversibly neurological damage Cognitive: IQ 65-80 (avg. 100) Mental and motor delays Heart defects Vision impairments Alcohol-Related Neurodevelopmental Disorder (ARND): Intellectual disabilities Behavioral and cognitive problems Alcohol-Related Birth Defects (ARBD): Anatomical/functional problems (ex: Kidney, heart, bone, hearing problems)

Maternal

Age: 17-35: healthier outcomes Over 35: advanced maternal age 1 in 5 women in U.S.: 1st pregnancy after age 35 o Health issues related to age of mother: Ovulate less frequently Endometriosis: abnormal tissue growth outside of uterus (painful condition) damage the normal tissue of uterus Blocked fallopian tubes Fibroids Infertility: failure to conceive after 1 year (6 months if > 35 years old)

o o o o o

35% male issue: Low or no sperm count, irregular shaped sperm (varicocele: veins in testicles are too large- heats up testicles affects # and shape of sperm) 20% ovulation 20% tubal 10% endometriosis 5% cervical 10% unknown

Maternal and Paternal Age: Over 35: Chromosomal abnormalities (e.g., down syndrome) and birth complications; prevalence rate for down syndrome increases exponentially as maternal age at birth increases (esp. after 35) Diabetes: o Type 1: Juvenile Diabetes: body does not produce insulin (5% incidence rate) Inherit from both parents (higher incidence in European Americans) Environmental trigger o Type 2: Diabetes: body does not use insulin properly Maternal/paternal diabetes increased risk Other factors: diet, lifestyle (smoking, alcohol), BMI o Gestational Diabetes: during pregnancy, body does not regulate insulin properly >25 years, family history, high BMI Increased risk for: excessive birth weight, jaundice, Type 2 diabetes Schizophrenia and Autism risk o Paternal age schizophrenia (but no other psychiatric disorders) and autism diagnosis in offspring Schizophrenia risk increases every 5 year increment after 25 years of age De novo mutations in paternal sperm cells increase with age 20 year old father: avg. 25 random mutations traced to fathers genetic material 40 year old father: 65 mutations mother: avg. 15 random mutations regardless of age Additional Birth Outcomes: Pre-term births: Born between 37 weeks of gestation have physical development challenges o Organ immaturity: lung and kidney o Breathing difficulties o Small scrotum (boys), enlarged genitals (girls) o Inactive/physical weakness o Treatment:

Stop pre-mature labor Steroids: lung maturity Warm: control air temperature Respirator: breathing regularly Prenatal Healthcare o Exposure: 1st trimester: 1 visit 2nd trimester: visit every 4 weeks 3rd trimester: visit every 2 weeks 36-40 weeks: visit every week o Barriers to prenatal care Financial: Medicaid laws expanded to ensure maternal coverage Knowledge: dental care, vitamins, visits Fear of detection of drug use; fear of parental response to teenage pregnancy

Infant Caregiver Attachment: A lasting psychological connectiveness between human beings (Bowlby) Bowlby and Amsworth: Bowlby found theoretically what attachment is, what its phases and components are. Amsworth proposed experimental model to be able to quantify the type of attachment bonds infant has with caregiver Mentally healthy: the infant and young child should experience a warm, intimate and continuous relationship with his mother (or permanent mother sub) in which both find satisfaction and joy Need to be connected to someone that is connected to us; this is crucial for development Harry Harlow (1950s): studied quality of maternal attachments vs. deprivation o He studied attachment in monkeys. What happens when monkeys dont develop attachment bonds early in life? Did a series of studies that manipulated attachment bond monkeys had with surrogate mother (wire vs. cloth) Criticisms: Fact that monkeys cling and the behavior Harlow is seeing is nothing more than instinctual clinging behavior monkeys have (cloth is easier to cling to than wire) Infant/Caregiver Relationships: Instinctual, evolutionary o Sucking, clinging, following, smiling o Mimicry, responsiveness to facial expressions o Infant appearance: Attractive to adults (ex: imprinting) o All of these instinctual behaviors are used to draw adults in to take care of them and to get them attached to them o Lorenz: Tried to find why children follow their mother. Studied geese learned that 13 hours after hatching, goose

will find mother and imprint on that person/creating a connection to moving objects. Its built into brain structure so they can follow mother in life. Found that goose will imprint on any moving thing it finds in first hours Hormones: o Released by hypothalamus (deals with response to stress) Fight or Flight (cortisol): too much can cause damage to physiological health Tend and Befriend (oxytocin): hormone that makes you feel connected to someone Patocin is synthetic version of oxytocin. Doctors used to give this to women in labor to get labor moving along. Why? Found that during labor, breast feeding, different interactions with infants, womens oxytocin levels surge o Mothers: Boost during labor, breastfeeding, skin to skin, affectionate contact o Fathers: Boost during stimulative play

Why are these attachment bonds important for child development? Long term social and emotional development Connection to peers, social networks, romantic partners; Emotional stability; Fewer developmental delays; Lower aggression/withdrawal (extreme); Coping flexibility (low anxiety) 80% of abused and maltreated children evidenced a maladaptive attachment to caregivers Healthy attachments from within first year of life (critical period) These early healthy attachments set stage for how you expect relationships to be in the future Phases of Attachment Schaffer and Emerson (1964): Looked at infants over time and studied how attachment happens Asocial phase (0-6 weeks) Indiscriminate attachment phase (6 weeks to 6/7 months) o Social smile to convey positive emotion o Start to differentiate (ex: prefer to see human faces than cartoons/puppets etc.) o Not yet attached to any one person Specific attachment phase (7-9 months) o Primary caregiver, usually o When mom leaves room, start to cry o Separation anxiety at highest Multiple attachment phase (over 12 months) o Form attachments other than mom o Develop different attachments with different people Four Characteristics of Attachment:

Proximity maintenance: Wanting to be close to primary care giver, clinging Safe haven: Sense of protection from primary care giver in an attempt to reduce stress environment puts on them Secure base: If you feel safe, then you can explore environment (Harlow monkeys in new room with mom vs. without mom) Separation distress

How Stable Are Attachment Consequences? (Waters et al.) Measured attachments at 15 months Observed in pre-school setting at 3.5 years o Secure: Social leaders, self-directed, eager to learn, high self-regulation (shows itself in adaptive behaviors) o Insecure: Socially and emotionally withdrawn Can impact broader functioning in a child Observed in camp at 11-12 and 15-16 years old o Secure: Better social skills, close friends Whats Your Adult Attachment Style? Adult Attachment Interview (AAI) (Main & Goldwyn) Attachment styles (Hazan & Shaver) o Developed methodologies for studying attachments in later relationships. Hazan & Shaver would make participants think back to relationship with primary caregiver secure or insecure? Then, look at current romantic relationship same or different? Avoidant (20%) Secure (60%) Anxious-Resistant (20%) Theory: When were infants, the relationship we develop with primary caregivers is an internal working model for future relationships, meaning we hold that first relationship as an example for future relationships Infant/Caregiver Relationships Bowlby: Maternal deprivation (1960s) Protect phase: Child is distraught and upset when primary caregiver leaves; cant be consoled Phase of despair: Children lose interest in things they consistently had interest with in past (dont want to play with toys, interact with other people) Detachment phase: Even when primary caregiver would temporarily come back, child would not interact as they did before the separation Permanent withdrawal from human relationships (only if separation was chronic): Rare; not connecting with other staff members/people in their environment

Deprivation: lack of physical stimulation (touch) by caregiver, unresponsiveness to cries, solitary nursing, limited development opportunity Maternal deprivation hypothesis (e.g., Bowlby, 1969) Social stimulation hypothesis: Not having interaction with people, impacts cognitive, verbal, social, physical and motor development o Not only maternal, but also social stimulation (physical contact/stimulation crawl around, skin-to-skin contact) Learned helplessness Consequences of Deprivation: Reactive Attachment Disorder (RAD): Inability to bond or connect socially to others (deprivation before age 4) o Lower IQ o Social immaturity o Dependence on adults o Poorer language skills o Externalizing behavior: aggression, hyperactivity o Internalizing behavior: withdrawal, anxiety o Continuum of deprivation Nelson et al (2007), Science Looked at children institutionalized in Budapest o Random assign: 68: remain in institution 68: foster care Biological families o Measured: cognitive, motor, behavioral at baseline, 30 months, 42 months and 54 months Found that kids adopted in foster care started to have behaviors similar to those children with their biological families. Children adopted before or around age 1 showed greatest improvement. Increased age less recovery However, they were still behind biological kids in IQ by 10 points (children age 1 or younger) Factors That Impact Attachment: Characteristics of Child: o Temperament: Emotional and behavioral characteristics of an individual Moderately stable across situations and over time Biologically influenced Observable in infancy Jerome Kagan proposed temperament hypothesis quality of infant attachment is guided by the temperament of the infant Infant temperament Easy (40%): Positive emotion, flexible coping responses to stress, easily comforted and relaxed, physically active and engaged

Difficult (10%): Irritable and moody, hyperactive (cant sit still) Slow-to-Warm-up (15%): Cautious to strangers, Not physically active/exploring These temperaments model how the child enters the world/reacts to things in the world How the interaction between temperament and environment infant is in can predict different outcomes Stability of Temperament: Moderate stability Goodness of Fit: the degree to which an individuals temperament is compatible with demands and expectations of his or her social environment Crockenberg (1988) o Infant irritability (child factor): Low irritable vs. High irritable o Mother-infant observations (interaction): Low responsive vs. High responsive o Social support (parent factor): support stressors = available support Pin Prick test: Prick a childs foot and see how long it takes them to calm down from crying (easy temperament), opposite is difficult temperament

Goodness of Fit Print-Out Low irritable infant & Low maternal social support low resistant/low avoidant Low irritable infant & High maternal social support low resistant/low avoidant High irritable infant & Low irritable social support high resistant/high avoidant High irritable infant & High maternal social support low resistant/low avoidant Family Cohesion (review in textbook): 1. Enmeshment high cohesion 2. Connected 3. Separated 4. Disengaged low cohesion Conjoint Behavioral Consultation: structured, indirect form of [treatment] in which parents and teachers are joined to work together to address the academic, social, or behavioral needs of an individual for women bother parties bear some responsibility (pg. 172-173)

Mesosystem interactions: parents & teachers Four stages: o 1. Conjoint needs identification: Involves bringing parents/family members in & talking about needs of child at home, school, etc. and coming up with necessary goals to help child improve o 2. Needs analysis: Figuring out how to intervene o 3. Plan implementation: Begin working with the child, having them spend 15 minutes of one-on-one time with parents doing homework, peers at school o 4. Plan evaluation: Systematic approach to attempting to get child to respond to a therapeutic intervention

Child Maltreatment & Trauma Types of Maltreatment Print Out Abuse Type o Physical o Sexual Sins of Commision o Psychological o Neglect Sins of Omission Most common: Neglect May be higher than psychological because psychological abuse is hard to detect and determine Victim Profile o 2009: Child Protective Services Unknown: 0.3 Medical neglect: 2.4 Psychological: 7.6 Sexual abuse: 9.5 Other: 9.6 Physical abuse: 17.8 Neglect: 78.3 Frequency of Allegations 2011: Child Protective Services o Referrals for 6.2 million children 64% unsubstantiated (no evidence that can categorize the child into a category of abuse) 22.1% substantiated (evidence that can be found that suggests abuse may be occurring) 1.3% indicted (there is some potential suspicion, but no concrete evidence to identify abuse) Referrals come mostly from teachers (#1), then neighbors, medical professionals and other family members. Mandated reporters (people in a helping profession): if you see signs or indications that suggest a person is in danger, you are legally mandated to report it.

Frequency of Abuse National Survey of Childrens Exposure to Violence o 4549 children: 0-17 years old (younger children are often more likely to be categorized into abuse categories) 60.6% experienced or witnessed victimization in past year (in-person witness, not television or media exposure could be domestic, violence in neighborhood, physical attack on someone) 4,000 adolescents, 12-17 years (Kilpatrick et al., 2003) o Sexual assault: 13% girls, 3.4% boys o Physical assault: 13.4% girls, 21.3% boys o Witnessed violence: 35% girls, 43.6% boys Many of these studies rely on self reports problem because there could be underreporting by gender or characteristic (boys tend to underreport sexual assault) Consequences of Neglect Neglect (chap 12): prevalence is high and impact is high o Deprivation of physical stimulation Increase glucocorticoid receptors Atrophy of hippocampal cells Increase reactivity to stress (permanent) Consequences of Sex Abuse 90% abuse: familiar to others 1 in 10 sex abuse victims report abuse o Boys underreport Signs/consequences: o Negative body image o Non-normative sexual behavior (hyper sexual behavior, using terms inappropriate for age, knowledge about inappropriate things) o Need for control: anxiety eating disorders, depression o Revictimization o Regressive behavior (e.g., thumb sucking) Forms of Trauma (Lenore Terr, 1981) Based on Chowchilla kidnapping (1976) o Type I: Single Event Trauma E.g., death of a parent, natural disaster Specific, detailed memories of things that happen during event Omens: something happened just before trauma that was a signal that something bad was going to happen o Type II: Repeated Trauma Experiences E.g., repeated sexual abuse, physical abuse

No detailed memories Cope: Denial Emotional numbing General Childhood Trauma o PTSD in Children Mental health condition triggered by traumatic event National comorbidity survey replication: adolescents (10,000 adolescents ages 13-18) 5% meet criteria of PTSD in lifetime: 8% girls, 2.3% boys Increased physiological arousal (startle response) Increased somatic symptoms Dissociation: emotional numbing (repeated trauma) Avoidance of trauma related stimuli Regressive behavior