Wekerle / Wolfe / Cohen Childhood Maltreatment

2. Auflage 2019
ISBN: 978-1-61334-418-7
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 100 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

The new edition of this popular, evidence-based guide compiles and reviews all the latest knowledge on assessment, diagnosis, and treatment of childhood maltreatment – including neglect and physical, sexual, psychological, or emotional abuse. Readers are led through this complex problem with clear descriptions of legal requirements for recognizing, reporting, and disclosing maltreatment as well as the best assessment and treatment methods. The focus is on the current gold standard approach – trauma-focused CBT. An appendix provides a sample workflow of a child protection case and a list of extensive resources, including webinars.

This book is thus invaluable for those training or working as expert witnesses in childhood maltreatment and is also essential reading for child psychologists, child psychiatrists, forensic psychologists, pediatricians, family practitioners, social workers, public health nurses, and students.

Zielgruppe

Child psychologists, child psychiatrists, forensic psychologists, pediatricians, family practitioners, social workers, public health nurses, and students.

Autoren/Hrsg.

Wekerle, Christine

Wolfe, David A.

Cohen, Judith A.

Bromberg, Daniel S.

Murray, Laura

Fachgebiete

• Sozialwissenschaften Soziologie | Soziale Arbeit Soziale Arbeit/Sozialpädagogik Soziale Arbeit/Sozialpädagogik: Familie, Kinder, Jugendliche
• Sozialwissenschaften Soziologie | Soziale Arbeit Soziale Gruppen/Soziale Themen Kindesmissbrauch, Sexueller Missbrauch, Häusliche Gewalt
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Kinder- & Jugendpsychiatrie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Kinder- und Jugendlichenpsychotherapie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Leseproben

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Theories and Models of Child Maltreatment
Child maltreatment can be likened to a “natural experiment” in which development accommodation and adaptation proceed based on the meaning the victims ascribe to their experiences. Current thinking about childhood maltreatment attempts to integrate biological, child, caregiver, familial, and community risk and protective factors in a transactional model in which environments, within and across time and key developmental junctures, may be sustained or altered substantially. More scientific effort has gone into understanding victimization than perpetration, with the exception of sexual offending. Detailed analyses of ethnic, cultural, and religious values and identification, as well as immigrant and refugee health service experiences, are yet to be fully explored. Despite the centrality of trauma in the theory of maltreatment-related impairment, the majority of affected children do not have PTSD. A compounding of traumatic events may be most relevant in understanding the harmful outcomes, as seen in polyvictimization, clinical and care subpopulations, and what is labeled complex trauma. Foster care youth populations are exposed to a wide array of traumatic events, and many will experience PTSD. Recent work has focused on resilience of maltreated and foster care youths, stressing self-maintaining and self-righting systems. A key theoretical concept is to view child maltreatment as an indicator of relationship dysfunction. The learning ground for the child is largely an interactional one. Thus, maltreatment can be expected to impair successful resolution of developmental goals across the lifespan (e.g., attachment, communication, autonomy, intimacy, generativity, altruism, and enlightenment). In keeping with “living what you learn,” maltreated children are vulnerable to reenacting learned schemas or scripts for victim–victimizer–rescuer roles and withdrawal and avoidance patterns in relationships, driven by fear reactions and love needs. Given the disruption to the typical caregiver role in social referencing, maltreatment can be expected to disrupt the way a child would typically learn from others and see their role in relation to others. This disruption has implications for prosocial development, self-care, and self-righting mechanisms, and the balance between basic survival and self-actualization. Thus, the complex range of outcomes associated with maltreatment may reflect several interconnected processes, including alterations in neurobiological processes, learning-based mechanisms, and biased information processing. Those with a trauma spectrum disorder frequently have an altered regulation of the hypothalamic-pituitary-adrenal (HPA) axis, our central stress response system. In brief, the hypothalamus releases corticotrophin-releasing factor, which stimulates the pituitary gland to release adrenocorticotrophic |20|hormone into the bloodstream. This leads to the adrenal gland releasing the stress hormones (cortisol). The value of stress is that it enables quick action to increase safety under threat, and it increases the availability of the body’s food supply (carbohydrate, fat, and glucose). Threat gets averted, and the person can return to their readiness state. But following maltreatment, the person could detect a threat, question if the threat is a false alarm or real, and their system would go from 0 to 100 in its attempt to avert threat. This process creates a special kind of conditioning to environmental sounds, relationship cues, bad news – minor and major stressors sometimes alike. This process primes a person to be on alert. Outside the maltreating home, it often results in overreactivity and oversensitivity. If cortisol levels remain too high for too long, there is muscle breakdown, decreased inflammatory response, and suppression of the immune (defense) system. For a review of how the brain deals with cumulative stress, see Frodl and O’Keane (2013). The theory of toxic stress and developmental traumatology has driven greater understanding in the brain-based vulnerabilities ensuing from chronically, relationally unhealthy environments. This eco-bio-developmental framework recognizes the impact of health disparities within populations, and represents a paradigm shift in understanding the convergence in findings from molecular biology, neuroscience, clinical and experimental psychology, epidemiology, social work practice, and public health interventions. Child maltreatment (5 of the 10 ACEs) affects personal economics and well-being, and is a high priority for prevention. Normatively, the flight or fight (threat response) system works in a coordinated fashion with the tend and befriend (relational) system – for example, attachment processes help the child begin to quantify threat levels and gain confidence in survival self-efficacy. In short, the child learns to recognize that not everything in this early environment is trying to cause their death, or is harmfully intrusive and aversive. The transient increase in stress hormones protects the child from harm by dangerous persons, places, and things. However, excessively high levels of stress hormones and prolonged exposure to stress dysregulate the body’s systems yielding wear-and-tear effects on organs, including the brain. This accumulated life-course science points back to the preventable problem of child maltreatment, and prenatal care as a starting point, for prevention of chronic stress and the ensuing disruptions in mental, physical, financial, and community health across the lifespan. Traumatic events sensitize the brain, particularly during periods of critical brain growth and development, leading to atypical growth and connections (e.g., the corpus callosum becomes smaller in maltreated children). The fundamental emotional backdrop to the high intensity, unpredictability, and threat of injury is fear, and posttraumatic stress symptomatology or disorder develops from dysregulated fear circuitry. For an individual, the interaction between genetics and the child’s environment sets neurodevelopmental changes in motion, such as neuronal growth, migration, myelination, and synaptic changes, and the general “use it or lose it” rule can lead to individual vulnerabilities or competencies. When certain pathways are heavily used, these brain connections become stronger and quicker to initiate, which may support overuse of processes such as hypervigilance and dissociation. When neuronal synaptic connections in the brain are less well used, they may be eliminated (i.e., selective pruning or neuronal death) and denote areas |21|of relative deficit (e.g., in accurate processing and labeling of certain emotions). The infant and toddler years are especially sensitive periods in which the breadth and quality of sensory experience – emotional warmth, soothing sounds, positive touch, adequate food, and physical hygiene – provide repetitive environmental cues to maximize the individual’s genetic potential. There is a need for the developing infant to experience challenge or positive stress to which the caregiver can provide anticipatory and supportive guidance, scaffolding the experience, orienting toward success. For example, a child may want to climb high play equipment. With parental presence and guidance on how to remain secure and offering options as to when and how to come down, the child meets a challenge they care about. The child may feel focused, elated, cautious – this is positive stress (i.e., brief, mild to moderate). The safe, secure, nurturing parent helps the child to modulate their stress with effective action and prudent decision making such that the stress response system returns back to baseline. Unfortunately, in the maltreating home, there is an underexposure to these core elements with consequent low levels of (1) practice for safe self-challenge, fact-based, and accurate self-monitoring (as so much attention is focused on others’ emotions and actions to reduce personal harm), (2) self-praise (and the lack of contingent learning of performance praise, which undermines motivational development), and (3) an integrated, coherent sense of self and interpersonal boundaries that are reflected back to the child (mirroring). Thus, maltreatment interferes with regulation and development in predictable ways: (1) depleting and distorting the body’s natural coping and protective systems; (2) disrupting normal physical functioning, including sleep; (3) challenging mood stability and normal reactivity to external events; (4) biasing the processing of information toward supporting survival; (5) making security in attachment bonds more difficult to achieve and maintain; and (6) challenging a healthy, positive sense of self and future. Factors such...