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Child Sexual Abuse: Evaluation and Outcomes

Evaluation, Diagnosis, and Outcomes of Child Sexual Abuse Jessica Smith  Penn State College of Medicine March 2002   Definition: “Sexual abuse of children refers to sexual behavior between a child and an adult or between two children when one of them is significantly older or uses coercion. The perpetrator and the victim may be of the same sex of the opposite sex.     The sexual behaviors include touching breasts, buttocks, and genitals whether the victim is dressed or undressed; exhibitionism; fellatio; cunnilingus; and penetration of the vagina or anus with sexual organs or with objects. Pornographic photography is usually included in the definition of sexual abuse. It is important to consider developmental factors in assessing whether sexual behaviors between two children is abusive or normative.”5 Epidemiology1: Women: 16.8% , Men: 7.9% Number of substantiated or indicated cases has decreased by 41% in the time period of 1992 to 2000. Risk Factors4: Age: incidence of child sexual abuse increases with age 0-3 y/o: 10% of victims 4-7 y/o: 28.4% of victims 8-11 y/o: 25% of victims 12 and older: 35.9% of victims Gender: 2.5-3:1 female predominance 25% of victims are male Disabilities: Risk increased for those with physical disabilities, especially those that impair the child’s perceived credibility: blindness, deafness, and mental retardation Gender effect: boys are over represented among sexually abused children when compared to sexually abused children without disabilities Family Constellation: Absence of one or both parents is a risk factor Presence of stepfather in home doubles the risk for girls Parental impairments are also associated with increased risk Socioeconomic status: More important for physical abuse and neglect...

Brain Injury and Misdiagnosis

Misdiagnosis of Psychiatric Disorders Secondary to Brain Injury: ODD, OCD, ADHD Robyn Smith Penn State College of Medicine 2002    I. Traumatic Brain Injury: General information  Prevalence: Traumatic Brain injury in children and adolescents is a major public health problem in the US. Each year, an estimated 2 million people sustain a head injury. About 500,000 to 750,000 head injuries each year are severe enough to require hospitalization, involving the annual hospitalization for about 100,000 children under the age of 15. Preschool- age children are the second highest risk group for brain injury. And 2/3 of children under 3 who are physically abused suffer traumatic brain injuries. (Savage, NHIF pediatric task force) Head injury is most common among males between the ages of 15-24, but can strike, unexpectedly, at any age. Many head injuries are mild, and symptoms usually disappear over time with proper attention. Others are more severe and may result in permanent disability. Sometimes the deficits are mild and go unnoticed and others may not exhibit their effects until years after the injury. Causes of TBI: Motor vehicle accidents account for an estimated 28% of traumatic brain injuries; sports/physical activity account for 20%; assaults are responsible for 9%; 43% are due to “other” reasons. However, when considering those brain injuries severe enough to require hospitalization, virtually half (49%) are caused by motor vehicle accidents.2 Consequences of Brain Injury: Cognitive Deficits-Shortened attention span, short-term memory problems, problem solving or judgment deficits, inability to understand abstract concepts. Loss of sense of time and space, identity of self and others. There may also be an inability to accept more than...

Teens Contemplate Suicide

3 million U.S. Teens Contemplate Suicide WASHINGTON (Reuters) –Three million American teens have thought seriously about or even attempted suicide, a government survey released Sunday showed. More than 13 percent of young Americans between 14 and 17 years of age considered suicide in 2000, the report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) found. Only 36 percent of them had received mental health treatment or counseling, SAMHSA said. Depression is the main cause of suicide, SAMHSA administrator Charles Curie said in a statement. “We need to help teens make the link between untreated depression and the risk for suicide, and help them identify serious depression or suicide risk in a friend,” Curie said. “We must encourage teens to tell a responsible adult when a friend is at risk for suicide.” More than a third of the three million teens aged 12 to 17 who said they thought about suicide in the past 12 months actually tried it, the survey, the first of its kind ever done by SAMHSA, found. Girls were twice as likely as boys to say they thought about suicide, but race did not seem to make a difference, the report found. Nor did whether the teens lived in the city, suburbs or country. The highest rate was in the western part of the country, where 13.5 percent of children aged 12 to 17 reported having had thoughts of suicide. Copyright 2002 Reuters. All rights reserved. More information: Depression in Children and Adolescents or National Suicide Prevention...

Mania or ADHD: Assessment with CBCL

Differentiating Mania from ADHD in Prepubertal Children Using the Child Behavior Checklist Augusta Czysz   Penn State College of Medicine 2002   Background: Child Behavior Checklists (CBCL) were first published in 1978 and 1979 by Achenbach and Edelbrock. They consist of lists of 118 problem behaviors that are organized into the Internalizing scale, including anxious obsessive behaviors, somatic complaints, schizoid behaviors and depressed withdrawal behaviors; the Mixed scale, comprised of immature-hyperactive behaviors; and the Externalizing scale, which includes delinquent, aggressive and cruel behaviors. A normalized T score was assigned to each behavior using a representative sample of age-appropriate children. These scores are tallied to give a child’s behavioral profile. These profiles were found to aid in differentiation of certain problem behaviors and syndromes. The original CBCL can be found as follows. Achenbach, TM. Edelbrock, CS. The Child Behavior Profile. J Consult Clin Psychol. 46, 478-488. 1978. 47, 223-233. 1979.   Identifying Bipolar Disorder for Early Intervention: Spencer, TJ. Biederman, J. Wozniak, J. Faraone, SV. Wilens, TE. Mick, E. Parsing pediatric bipolar disorder from its associated comorbidity with the disruptive behavior disorders. Biol Psych. 49(12): 1062-1070. 2001. According to a review article by Spencer et al, children with ADHD are 10x as likely to develop bipolar disorder (BD) than age-matched and gender-matched controls so it is important to be able to identify and begin treating BD early to help prevent unnecessary social and functional impairment for the child.   Diagnosing prepubertal Bipolar Disorder vs ADHD: Geller, B. Williams, M. Zimerman, B. Frazier, J. Beringer, L. Warner, KL. Prepubertal and early adolescent bipolarity differentiate from ADHD by manic symptoms, grandiose delusions,...
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