Intervention in child abuse and neglect: an emerging subspecialty in child and adolescent psychiatry.
Year: 2005
Type: article
Abstract: Remschmidt and Belfer rightly point out the importance of developing rightsbased and evidence-based policies for dealing with child and adolescent mental health problems. Awareness, prevention and intervention are especially required, and achievable, in the area of child abuse and neglect (CAN).
All types of CAN can produce shortand long-term psychological sequelae. Abused children have learned that their world is an unpredictable, often hurtful place. The adults who care for them may be angry, impatient, depressed, and distant. Further, they can be transformed without warning into hostile, violent persons (1). The young child may feel incompetent, unlovable, helpless and powerless, and become suspicious of others. Older children often demonstrate emotional problems, such as depression and anxiety. Verbally and physically aggressive behavior as well as passive compliance and avoidant behavior have been reported. Physically abused children frequently have significant problems in their ability to develop and sustain peer relationships (2). A history of sexual abuse may contribute to becoming a sexual offender (3,4).
In contrast to physical and sexual abuse (where children experience visibility, albeit negative), the neglected child feels invisible. Neglected children have been shown to become helpless and passive, and to display less affect, either positive or negative, in their peer encounters (5).
A systematic review has shown that both male and female victims of abuse have significantly higher rates of psychiatric treatment than the general population (6). Accordingly, it is essential for psychiatrists to consider a history of childhood abuse in their patients, and be familiar with the definitions, dynamics, and effects of all forms of CAN. Child and adolescent psychiatrists must also be able to work with parents and families. The complexity of CAN cases make it a necessity that psychiatrists cooperate not only with nurses, pediatricians, psychologists, psychotherapists and clinical social workers, but also with child protection workers, criminal justice professionals and the judiciary.
The realization that CAN is relevant to a variety of child, adolescent, and adult mental health problems, and the dramatic increase in cases, have created a need for clinical specialization with child victims and adult survivors of CAN. The Physical Abuse Assessment Model, the Physical Abuse Process Therapy Worksheet (7) and the abusefocused therapy are examples of efforts aimed at meeting this need. Moreover, recent years have witnessed the emergence of national, regional and international professional associations based on a multidisciplinary membership of mental health, social work, medical and criminal justice professionals and the judiciary. A main international example is the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) and its regional partner networks such as the Network of Arab Professionals for the Prevention of Child Abuse and Neglect. Professional journals, e.g. the ISPCAN Journal, that specifically focus on CAN are another important development, because they keep the field updated on new research.
CAN intervention as a subspecialty in child and adolescent psychiatry is feasible, and could be encouraged if basic and advanced training were offered in undergraduate and graduate level courses, and if courses on CAN were required for those applying for license renewal.
Source: PubMed Central
Author: M Adib Essali
Language: English
Topic: Child Abuse and Trauma
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W2281812882