The youngest victims of child maltreatment: what happens to infants in a court sample?

Current data show that infants represent an increasing proportion of cases of child maltreatment. To learn more about how infants fare in the current system and to provide baseline data against which to compare outcomes following recent legislative reforms, this study examined a subsample of infants in a sample of 200 care and protection cases brought before the Boston Juvenile Court in 1994. Child, parent, and case characteristics of infants 0 to 3 months of age (n = 46) were compared with characteristics of older children in the sample. All cases were followed prospectively for 4 years, and data were abstracted from court records. Results revealed that the infants were primarily children of substance abusers who had extensive prior histories of child protective service system involvement. Although the majority of the infants were eventually permanently removed from parental custody and adopted, many experienced time delays and multiple placements before achieving permanent homes.

Maintaining and shifting attention within left or right hemifield.

Positron emission tomography (PET) was used to examine two questions: (i) which structures of the intact human brain change their activity with the direction of attention to left or right visual field; and (ii) how does activity in these structures, and in parietal cortex in particular, depend on the frequency of attentional shifts? Subjects were required to discriminate the orientation of peripheral gratings. The two main experimental variables were the attended hemifield (left or right) and the proportion of trials requiring a shift within that hemifield (20% or 80%). A detection control condition was also included. Behaviourally, subjects were less accurate and significantly slower when a trial required a shift than when it did not. Ventral and lateral occipital areas showed significantly higher blood flow levels contralateral to the direction of attention. Replicating previous work, there was also a significant main effect of the direction of attention in left lateral prefrontal cortex: blood flow levels were higher during leftward attention in comparison both to baseline and to rightward attention. This left frontal effect reached significance in single subjects in whom several activation sites could be distinguished within left middle and inferior frontal gyrus. Right and left parietal cortex were activated during both left- and right-field attention conditions, with a tendency for higher activity levels when attention was directed contralaterally. Contrary to the experimental hypothesis, however, parietal regions were not activated differentially by high versus low numbers of attentional shifts. The current experiment confirms that left frontal convexity is sensitive to manipulations of the direction of visuospatial attention. The results do not indicate a specific role of parietal cortex in attentional shifting.

What progress has been made in meeting the needs of seriously maltreated children? The course of 200 cases through the Boston Juvenile Court.

OBJECTIVES: The study examined child, parent, and case characteristics in a sample of 200 cases of serious child maltreatment brought before the Boston Juvenile Court (BJC) on Care and Protection petitions in 1994. Whether recent changes in Massachusetts law have been effective in reducing delays in adjudication and helping children achieve permanent placements more quickly was also examined. METHOD: Data were abstracted from court records by the research team. The 200 cases were followed prospectively for 4 years. Retrospective data on the families' previous involvement with the protective service system were also abstracted from the records. Data from the 1994 cases were compared to that obtained from a sample of cases brought before the BJC in 1985-1986. RESULTS: Children permanently removed from parental custody in the 1994 sample required less time post-disposition to achieve permanent placements. However, overall, time frames for the 1994 cases remained remarkably similar to those in 1985-1986: children were in the protective service system an average of 5 years; cases required an average of 1.6 years in court; and half of the children permanently removed from parental custody were still in "temporary" foster care at 4-year follow-up. CONCLUSIONS: Although some improvements have occurred since 1985-1986, the system still fails to meet the needs of seriously maltreated children to achieve permanent placements promptly. The implications of the findings for system reform are discussed.

Auditory temporal processing impairment: neither necessary nor sufficient for causing language impairment in children.

Fourteen twin pairs, aged 8 to 10 years, were tested 3 times over 12 months; they included 11 children with language impairment (LI), 11 control children matched on nonverbal ability and age, and 6 co-twins who did not meet criteria for LI or control status. Thresholds were estimated for detecting a brief backward-masked tone (BM), detection of frequency modulation (FM), and pitch discrimination using temporal cues (deltaf0). Both BM and FM thresholds improved with training, and by the 2nd test session, FM thresholds were in the adult range. There were marked individual differences on BM and deltaf0 and, for both tasks, performance correlated with Tallal's Auditory Repetition Task administered 2 years previously. However, no auditory measure gave significant differences between LI and control groups; performance was influenced more by nonverbal than language ability. Some children did have a stable pattern of poor performance on certain auditory tasks, but their good FM detection raised questions about whether processing of auditory temporal information is abnormal. We found no evidence that auditory deficits are a necessary or sufficient cause of language impairments.

Maternal social support patterns and child maltreatment: comparison of maltreating and nonmaltreating mothers.

Compared to demographically matched mothers, maltreating mothers listed fewer friends in their social support networks, reported less contact with friends, and gave lower ratings of quality of support received from friends. Maternal depressive symptoms, quality of current relationships, and social support from friends were each independently associated with maltreatment status in logistic regression analysis. Implications for intervention and research are offered.

Different origin of auditory and phonological processing problems in children with language impairment: evidence from a twin study.

This study investigated the heritability of auditory processing impairment, as assessed by Tallal's Auditory Repetition Test (ART). The sample consisted of 37 same-sex twin pairs who had previously been selected because one or both twins met criteria for language impairment (LI) and 104 same-sex twin pairs in the same age range (7 to 13 years) from the general population. These samples yielded 55 children who met criteria for LI, who were compared with 76 children whose language was normal for their age (LN group). We replicated earlier work showing that group LI is impaired relative to group LN on ART. However, there was no evidence of a heritable influence on ART scores: Correlations between twins and their co-twins were reasonably high for both MZ and DZ twins, suggesting that performance is more influenced by shared environment than genetic factors. Analyses of extreme scores gave a similar picture of nonsignificant group heritability. In contrast, a test of phonological short-term memory, the Children's Nonword Repetition Test (CNRep), gave high estimates of group heritability. In general, CNRep was a better predictor of low language test scores than ART, but ART did make a significant independent contribution in accounting for variance in a test of grammatical understanding.

"Twin language": a risk factor for language impairment?

Retrospective parental report of earlier "twin language" was obtained for two groups of twins. Sample G consisted of 94 twin pairs between the ages of 7 and 13 years recruited through the school system as a general population sample. Sample L consisted of 82 twin pairs between the ages of 7 and 13 years who had been recruited for a genetic study; of these twin pairs at least one of the twins had a speech-language impairment persisting to school age. Parental report of twin language was higher (around 50%) for children with speech-language impairment than for those with normal language (11%). Consistent with this, children with twin language obtained significantly lower mean language scores than other children, although their mean nonverbal IQ was equivalent. The exceptions were a handful of children whose parents described use of a "private language" that coexisted alongside normal use of English. These findings are consistent with the view that what is described as twin language is usually use of immature or deviant language by two children at the same developmental level.

Predictors of behavior problems in preschool children of inner-city Afro-American and Puerto Rican adolescent mothers.

Maternal reports on the Child Behavior Checklist/2-3 (CBCL/2-3) were used to evaluate child, maternal, and environmental predictors of behavior problems in 83 preschool children of disadvantaged adolescent mothers. CBCL/2-3 scores correlated modestly with independent ratings of child difficult behaviors observed in videotaped mother-child play interactions. 13% of children had scores in the clinical range. Significant correlations were consistently found between CBCL/2-3 ratings and maternal depressive symptoms, social supports, and life stress--assessed 3 times during the first year postpartum. In hierarchical regression analyses, maternal depressive symptoms, residence with the adolescent's mother, and perceived emotional support from friends contributed most to the explained variance. A significant ethnicity x child gender interaction term also suggested that African American mothers of male children reported more behavioral problems. Findings evidence the heterogeneity of outcomes for children of disadvantaged adolescent mothers but also demonstrate how correlates of poverty negatively affect their socioemotional development.

Screening for psychosocial dysfunction in pediatric practice. A naturalistic study of the Pediatric Symptom Checklist.

This study examined the routine implementation of the Pediatric Symptom Checklist (PSC), a brief questionnaire which screens for psychosocial dysfunction in school-aged children in an outpatient pediatric practice. Results indicated that the PSC was well-accepted by parents and adequately tolerated by busy clinic staff. When the PSC was included as part of the standard procedure for well-child visits, the referral rate for psychosocial problems due to positive PSC scores rose to 12% from the clinic baseline referral rate of 1.5%, a significant increase (P < .01). Half of the children who screened positive on the PSC had not been previously identified by their pediatricians as having psychosocial problems, and more than half had never received any psychological treatment. When implementation of the PSC was discontinued, the referral rate fell to 2%, a rate similar to baseline. The findings suggest that it is possible to incorporate the PSC into routine pediatric practice and that the PSC can help pediatricians identify and better serve children experiencing psychosocial difficulties. The study also suggests that further work is needed to understand the barriers to ongoing implementation.

Screening for psychosocial dysfunction in inner-city children: further validation of the Pediatric Symptom checklist.

A sample of 123 6- to 12-year-old outpatients at an inner-city pediatric clinic was screened for psychosocial dysfunction using the Pediatric Symptom Checklist (PSC), a brief parent-completed questionnaire. The prevalence of positive screening scores on the PSC was 22%, significantly higher than the rate found in lower middle to upper middle-class samples. Comparing PSC case classifications with comprehensive assessments made by clinicians, overall agreement was 92% (kappa = 0.82; sensitivity = 88%; specificity = 100%); a comparison with several other measures provided additional support for the validity of the PSC. The PSC's reliability over time was also acceptable. These findings provide preliminary evidence that the PSC is as valid and reliable for screening children from economically disadvantaged and minority backgrounds as it is for middle and upper middle-class populations.

Protecting seriously mistreated children: time delays in a court sample.

The study examined the progress through the child protective system of a sample of 206 severely abused and/or neglected children brought before the Boston Juvenile Court (BJC) on Care and Protection (C & P) petitions. Overall, children were in the system an average of 5 years from the filing of the first official report of mistreatment to the resolution of their cases. The families had been known to the state child protective service agency for an average of more than 2.5 years before the current court involvement. Once arraigned in juvenile court on the C & P, the average case took almost 1.5 years to reach a disposition. After disposition, children permanently removed from parental custody required, on average, an additional year and a half in Probate Court to reach a permanent placement. Of the more than twenty variables examined, including severity of mistreatment, protective service history, and parental mental illness, no meaningful pattern emerged which could predict delays. Our findings characterize the delays experienced by many abused and neglected children, and highlight the necessity of closer monitoring of the progress of cases through the protective and court systems.

What happens after the care and protection petition? Reabuse in a court sample.

Of 206 cases of serious child mistreatment brought before a metropolitan juvenile court on Care and Protection Petitions (C & P), 63 (31%) were dismissed (returning the child to the parent(s]. During a 2-year follow-up period, 18 (29%) of these dismissed cases had substantiated reports of further mistreatment, and 10 (16%) subsequently returned to court on another C & P. Families that had previously been to court for a C & P, and those in which the parent was diagnosed psychotic or character disordered, were significantly more likely to return to court. In addition, we were surprised to find that 8 (6%) of the 130 children ordered permanently removed from parental custody also returned to court. This study documents the continuing mistreatment of children, even after the state's most serious interventions. The study also highlights the necessity of incorporating clinical research in the form of ongoing follow-up of individual cases into the court process, and suggests that it may be possible to identify cases with a very high probability of reinjury and return to court.

Serious child mistreatment in Massachusetts: the course of 206 children through the courts.

Two hundred and six severely abused and/or neglected children brought before the Boston Juvenile Court on care and protection petitions were followed prospectively for 4 years. Two thirds of all parents were found to be poor, 84% had one or more psychiatric disorders, and 81% had been known to the Department of Social Services prior to their court appearance. The average age of children at the start of the court process was 4.2 years, and the average length of temporary foster care was 2.3 years. Judges' decisions to return children to parental custody or to order permanent removal were most strongly predicted by parental compliance with court-order services. Of the 63 cases dismissed from court and thus returned to biological parents, 18 (29%) had substantiated reports of new mistreatment over an approximately 3-year follow-up period. We concluded that children are often poorly served by the current delays in the social service/legal system, and that further clinical research would provide needed empirical data on how best to protect mistreated children.

Screening for psychosocial dysfunction in pediatric dermatology practice.

The Pediatric Symptom Checklist, a brief psychosocial screening questionnaire, was used in a multi-center study of pediatric dermatology clinics (n = 377). Overall rates of positive screening indicated that approximately 13% of patients screened positive, a rate similar to findings in primary care pediatric settings. Examining the sample in greater detail demonstrated that children whose dermatologic disorder is perceived to have a greater impact on their appearance are at higher risk for psychosocial dysfunction.

Screening for dysfunction in the children of outpatients at a psychopharmacology clinic.

OBJECTIVE: The goals of this study were 1) to determine whether the use of the Pediatric Symptom Checklist in an adult-oriented psychiatric practice was feasible, 2) to determine if scores indicative of dysfunction on the Pediatric Symptom Checklist were associated with parental or background factors, 3) to determine whether children flagged by their scores on the Pediatric Symptom Checklist were receiving psychiatric services, and 4) to compare the psychosocial dysfunction in this group of children with that found in children screened as part of routine pediatric visits. METHOD: Adult outpatients in a hospital's clinical psychopharmacology unit were asked to complete the Pediatric Symptom Checklist regarding their children. These patients were the parents of 100 school-aged children. Factors such as the parents' diagnoses and demographic variables were also examined. RESULTS: The Pediatric Symptom Checklist was readily accepted by parents and fit easily into the routine of general psychiatric practice. Significantly more of the children of these outpatients than of children in comparable pediatric offices had scores indicative of psychiatric dysfunction (scores above the cutoff). Children of parents who were single, of low socioeconomic status, or with a diagnosis of personality (especially borderline) or mood disorder were more likely to have scores above the cutoff. More than a third of the children who had scores above the cutoff on the Pediatric Symptom Checklist were not currently receiving psychiatric services. CONCLUSIONS: The Pediatric Symptom Checklist provided a rapid and simple method for general psychiatrists to identify psychosocial dysfunction in their patients' children.

Psychosocial screening in pediatric practice: a survey of interested physicians.

This study followed up on 201 pediatricians and family practitioners who had requested information about the Pediatric Symptom Checklist (PSC), a parent-completed questionnaire which screens for psychosocial dysfunction in school-aged children. The physicians were sent a postcard survey asking whether they had used the PSC in their practices. Of the 157 (78%) who responded to the postcard survey, 36 (23%) reported that they had used the PSC. On a follow-up questionnaire, all of these physicians rated the PSC as useful, and nearly 80% reported that it led to increased case-finding and/or referrals. Ninety-six percent stated that they will continue to use the PSC; more than half of them routinely or frequently. The findings indicate a widespread interest in psychosocial screening, and suggest that additional educational efforts may be necessary to support the acceptance of the PSC in pediatric practice.

Influence of new quinolones on normal immune capabilities.

Ciprofloxacin, pefloxacin, norfloxacin, and ofloxacin were investigated for immunomodulatory activity on humoral and cell-mediated immune responses. Ciprofloxacin and pefloxacin altered the humoral immune responses of mice to sheep red blood cells. This effect was not exhibited by norfloxacin or ofloxacin. All four quinolones did not alter cell-mediated responses. When these antimicrobial agents were tested for their interaction with human polymorphonuclear phagocytic activity, all agents suppressed this activity. In addition, all except norfloxacin showed anti-inflammatory activity.

Effects of artemisinin, dihydroartemisinin and arteether on immune responses of normal mice.

Artemisinin (Qinghaosu) is a potent antimalarial sesquiterpene lactone isolated from the Chinese herb Artemisia annua. Arteether, a potent semisynthetic analogue of dihydroartemisinin is being developed by the World Health Organization as the artemisinin derivative of choice for the treatment of malaria. All three agents in doses of 400 and 600 mg/kg body weight were found to exhibit marked suppression of humoral responses, as measured by the hemolytic plaque assay, with arteether being the most potent. These agents did not alter the delayed-type hypersensitivity response to sheep erythrocytes at the same dose levels. In addition, all three agents were found not to possess any anti-inflammatory activity when tested on carrageenan-induced oedema. These results indicated that these agents have a selective immunosuppressive activity. They did not exhibit immunostimulating activity in contrast to what has been reported for sodium artesunate.