David L. Chadwick

Mental Health Problems of Children in Foster Care

We compared the rates of mental health problems in children in foster care across three counties in California. A total of 267 children, ages 0 to 17, were assessed two to four months after entry into foster care using a behavioral screening checklist, a measure of self-concept and, in one county, an adaptive behavior survey. Results confirmed previous research and indicated consistently high rates of mental health problems across the three counties. Behavior problems in the clinical or borderline range of the CBCL were observed at two and a half times the rate expected in a community population. Fewer children fell within the clinical range on the self-concept measure. No significant differences in rates between the three county foster care cohorts were observed, despite the different demographic characteristics of the counties. On the adaptive behavior scale, the mean scores for children in foster care were more than one standard deviation below the norm. Our findings suggest that the most important mental health screening issue with children in foster care is to identify what specific mental health problems need to be addressed so that the most effective treatment services can be provided.

Medical diagnosis of the sexually abused child

This article reviews what has been learned in the last two decades about the medical diagnosis of child sexual abuse. Studies indicate that a normal physical exam is common in sexual abuse victims, that healing of injuries due to abuse is rapid and sometimes complete, that a minority of victims seen for abuse are boys, that nonsexual transmission of sexually transmitted diseases is rare, and that congenital and acquired conditions may mimic physical findings caused by sexual abuse. The article summarizes clinical research on physical findings in nonabused children, abused children, and abused children with independent confirmation of abuse. A classification of physical findings is proposed along a continuum of certainty that sexual abuse has occurred. The childs history is essential in the accurate diagnosis of most cases of sexual abuse.

Annual Risk of Death Resulting From Short Falls Among Young Children: Less Than 1 in 1 Million

OBJECTIVE. The objective of the work was to develop an estimate of the risk of death resulting from short falls of <1.5 m in vertical height, affecting infants and young children between birth and the fifth birthday. METHODS. A review of published materials, including 5 book chapters, 2 medical society statements, 7 major literature reviews, 3 public injury databases, and 177 peer-reviewed, published articles indexed in the National Library of Medicine, was performed. RESULTS. The California Epidemiology and Prevention for Injury Control Branch injury database yielded 6 possible fall-related fatalities of young children in a population of 2.5 million young children over a 5-year period. The other databases and the literature review produced no data that would indicate a higher short-fall mortality rate. Most publications that discuss the risk of death resulting from short falls say that such deaths are rare. No deaths resulting from falls have been reliably reported from day care centers. CONCLUSIONS. The best current estimate of the mortality rate for short falls affecting infants and young children is <0.48 deaths per 1 million young children per year. Additional research is suggested.

The Touch Discrimination Component of Sexual Abuse Prevention Training Unanticipated Positive Consequences

The potential negative impact of sexual abuse prevention programs on children remains a central concern in the field of sexual abuse prevention. The purpose of this study was to examine the effectiveness of two prevention programs in improving childrens abilities to discriminate between appropriate and inappropriate types of touching. Two hundred sixty-four kindergarten through third-grade children from three public schools in San Diego were randomly assigned by classroom to one of three treatments: (1) a role-play-based sexual abuse prevention program, (2) a multimedia child abuse prevention program, or (3) a control group receiving fire prevention training. The results indicated greater pre- to posttest improvement for the role-play group than for the control group on total correct touch discriminations. Although there is concern that sexual abuse prevention programs may make children suspicious of appropriate touch, the present study found children in the role-play group better able to discriminate appropriate touch after training than before. The results are discussed in light of current findings in the child sexual abuse prevention literature.

Partial trisomy 20p derived from a t(18;20) translocation

SummaryTwo sibs show a strikingly concordant syndrome of congenital anomalies and G-banding reveals that each has partial trisomy 20p resulting from a t(18;20) translocation. They resemble other cases of partial trisomy 20p in some respects but also differ in some ways. Their normal sib, mother, and half-aunt are balanced heterozygotes for the t(18;20) translocation. The segregation of the balanced translocation in this family is associated with an extremely poor reproductive record. The segregation pattern closely parallels that of a t(13;20) translocation in a family described by Carrel et al. (1971) and Francke (1972). The similarity of segregation patterns is predictable on the basis of probable pachytene configurations, but the dissimilarity of phenotypes between families is not readily explained.

Syphilis as a sole indicator of sexual abuse: two cases with no intervention

THE DIAGNOSIS OF SEXUAL ABUSE is being made with increasing frequency. This is due mostly to increased disclosure, combined with the recognition that children do not usually lie about such matters. However, in the absence of a history, there may be other indicators of sexual abuse such as certain traumatic physical findings, or the presence of a disease known to be almost always sexually transmitted. In these cases, it is often more difficult to offer adequate protection to the victims. The Center for Child Protection (CCP) of the Children’s Hospital and Health Center in San Diego has seen two cases of secondary syphilis since 1979, during which time over 6,000 children have been evaluated for sexual abuse. In both of these cases, the medical practitioners and social agencies developed significant differences of opinion. The workers from the social agencies felt that, in the absence of a history, the medical evidence was insufficient and closed the cases. The medical team involved in these cases felt that secondary syphilis is a certain indicator of sexual abuse and were uncomfortable with this outcome. These cases are presented in the hope of stimulating discussion about the problem encountered when social agencies and courts are charged with decisions based only on medical evidence.

The serologic test for syphilis in sexually abused children and adolescents

Abstract Of 60,000 children evaluated for sexual abuse by 82 survey respondents, 24 were serologically positive for syphilis. Despite published recommendations for routine testing, only a third of respondents routinely tested all sexually abused children for syphilis. Criteria for selective testing and the consequences of selective testing are discussed.

Patterns of Unintentional and Intentional Injury at a Regional Pediatric Trauma Center: 1993-1997

Patterns of Unintentional and Intentional Injury at a Regional Pediatric Trauma Center: 1993-1997