Ecological integrated model of children of war: individual and social psychology.

The psychological trauma associated with war is a topic that has occupied the attention of mental health researchers and practitioners for some time. Most of their attention, though, has focused on the traumatic stress of soldiers, and little attention has been paid to the problems and traumatization of civilians caught in war zones, especially the children. In this paper, the limited research on children of war is reviewed, and themes are extracted. Children suffer from both acute and chronic traumatic stress. The key to determining the amount of suffering has to do with the dynamic interaction among five processes within an ecological framework: the child's psychobiological makeup, the disruption of the family unit, the breakdown of community, and the ameliorating effects of culture. The intensity, suddenness and duration of the war-like experience itself constitute an additional component to this ecological model. In the final section, psychotherapeutic guidelines to help children cope with symptoms associated with war are presented for current and future caregivers. The prevention of war should be the primary task of all.

Fetal alcohol syndrome and fetal alcohol effects. The University of Minnesota experience.

Fetal alcohol syndrome (FAS) describes a set of physical and neurologic defects that occur in the newborn as a direct result of maternal alcohol consumption. We report on a review of a series of patients seen at the University of Minnesota Hospital and Clinic (UMHC) who were identified as having been exposed to alcohol in the prenatal period. Of 46 patients, 38 were found to have FAS, and seven were found to have a less severe set of abnormalities termed fetal alcohol effects (FAE). This series at UMHC demonstrated many shocking characteristics. The average IQ of the children with FAS was under 70. Every child with FAE had significant hyperactivity and attention deficit. And nearly every child in this study was in foster care or an adoptive home. This review reveals the devastating problems victims of FAS and FAE inherit.

Dental aspects of 1248 cases of child maltreatment on file at a major county hospital.

The frequency of head, face, mouth, and neck injuries due to child maltreatment was investigated in a review of 1248 cases on file in the pediatrics office at Hennepin County Medical Center in Minneapolis, Minnesota, from January, 1985, to December, 1989. There were 485 boys (38.8%) and 763 girls (61.2%) examined. Physical abuse cases (41.0%) outnumbered sexual abuse (35.4%) and neglect episodes (23.6%). The gender ratio was distributed equally except in sexual abuse, where there were 4.7 girls for each boy examined. More than half of the children (52.9%) were in the 0-to-4 year age group. Considering all cases together, 37.5% presented with injuries to the head, face, mouth, and neck. However, that percentage doubled (75.5%) when physical abuse episodes were reviewed alone. The intraoral injuries seen were five tooth fractures, three tongue and tongue frenulum lacerations, two lip frenulum lacerations, 11 injuries to the oral mucosa, eight palatal lesions, two fractures of the mandible or maxilla, loose and missing teeth, and dental neglect. Despite the high frequency of injuries, no dentists examined children at the time of the hospital intake or referred children for suspicion of maltreatment in the population studied. The findings suggest the importance of involving dental professionals in identifying, reporting, and preventing child abuse and neglect.

Growth hormone response patterns in sexually or physically abused boys.

The ratio of growth hormone response to clonidine and L-dopa challenge was compared in 74 boys: 15 with purported physical abuse, 7 with purported sexual abuse, 13 normal controls, and 39 psychiatric controls. Sexually abused boys demonstrate a statistically significant elevated ratio of growth hormone response to clonidine versus response to L-dopa. Physically abused boys demonstrate lower clonidine/L-dopa growth hormone response ratios compared with controls. These effects widen with increasing physical development.

Perinatal stress: a study of factors linked to the risk of parenting problems.

Infants who are born preterm are at high risk for subsequent maltreatment. This study examines the relationship between family functioning, infant morbidity, parents' experience following their infant's admission to a neonatal intensive care unit, and postdischarge risk of parenting problems. For the sample as a whole, family factors emerged as the best predictors of outcome.

Interdisciplinary education in child abuse and neglect.

The increased need for professionals working with children and their families to understand, identify, and in some cases treat and follow up situations of child abuse and neglect has led to the offering of a structured graduate interdisciplinary course to students in various types of professional training. This initial effort represents an attempt not only to aid students in gaining insight into the dynamics of child abuse but also to encourage interdisciplinary communication among students from law, medicine, social work, education, and other fields which will hopefully continue into their professional life. Based on the experience accumulated from two offerings, a description is presented of the objectives, content, methodology, problems, and short-term evaluation of this course.

The neglect and abuse of children and youth: the scope of the problem and the school's role.

We have attempted to define the spectrum of maltreatment of children seen in our current society. The potential for abuse in the child's caretaker, a child who is somewhat different, and a stressful situation are ingredients which often interact to produce maltreatment. The maltreatment rendered to the child includes many mechanisms ranging from direct blows from a variety of objects, to violently shaking the child, to neglect. The spectrum of the pathological findings is as varied as the means to inflict the trauma or neglect and involves every organ system. The predominate pathology of abuse is located in the central nervous system, bones and cutaneous tissues. The school's role primarily involves awareness of the problem of maltreatment, a method of approach to identify and report "suspected" cases, and the documentation of the injuries or neglect which have been observed. The school plays an important role in the follow-up of individual cases in providing a supporting environment for the child and coordinating with other agencies dealing with the family. The school personnel and all professionals must work together if adequate services are to be provided to protect children and rehabilitate families.

Neglect and abuse of children: historical aspects, identification, and management.

The dentist's role primarily involves awareness of the problem of maltreatment, a method of approach to identify and report suspected cases, the documentation of the injuries or neglect which have been observed, and follow-up of any orofacial injuries. Orofacial trauma is present in up to one half of the reported cases of child abuse and consists of bruises, burns, lacerations, and fractures of teeth and jaws. Further studies in the dental field are needed to delineate the types and incidences of orofacial injuries and their relationship to child abuse. Dentists and all professionals must work together, if adequate services are to be provided to protect children and rehabilitate families.

Sexual abuse of children. An epidemiologic study.

An epidemiologic study of sexual abuse of children was made by reviewing Minneapolis Police Department records. Children were involved in 33% of all cases reported. Eighty-five percent of cases involved exposure or indecent liberties. Half of the cases occurred in the summer; half of the cases occurred from 2 to 6 PM. The mean age of victims was 10.7 years, and 88% were girls. All reported offenders were men; their "mean estimated age" was 28 years. The method of study did not allow determination of social relationships between victims and the offenders. Little information regarding the magnitude of the problems of medical, psychological, and social sequelae of sexual abuse of children is available in the literature.