Karen Salmon

Posttraumatic stress disorder in children: The influence of developmental factors

Despite the prevalence of childhood trauma, there are currently no developmentally oriented cognitive theories of posttraumatic stress disorder (PTSD). This paper outlines the definitional issues of PTSD in children, reviews the incidence of PTSD in children, and compares PTSD profiles in children and adults. We propose that a cognitive theory of childhood PTSD needs to accommodate developmental factors, including knowledge, language development, memory, emotion regulation, and social cognition, in addition to contextual factors such as family interactions. Implications of these developmental factors for assessment and treatment of traumatized children are discussed.

Punishment Insensitivity and Parenting: Temperament and Learning as Interacting Risks for Antisocial Behavior

We review ideas about individual differences in sensitivity or responsiveness to common disciplinary behaviors parents use to correct aggressive and antisocial behavior in children. At extremes, children may be seen as “punishment-insensitive,” an heuristic with some value relevant to models of the development of antisocial and aggressive behavior disorders. Literature from diverse fields, such as psychopathy, child temperament, socialization and the development of moral conscience, conditioning theory, and personality theory, have all utilized the idea that humans differ in their sensitivity to aversive stimuli and the cues that signal their occurrence, as well as their ability to inhibit reward-driven behavior, in the presence of punishment cues. Contemporary thinking places these dispositions squarely as basic biological aspects of temperament that moderate the effects of the environment (e.g., parenting) on outcomes (e.g., mental health). We review a largely forgotten literature that shows clearly that sensitivity to punishment is also reliably influenced by the environment itself. An attempt is then made to model the interactional processes by which parenting and punishment sensitivities in children magnify or diminish each others progress toward healthy or antisocial development. Implications for parenting of children with low responsiveness to punishment strategies are discussed.

Recalling an event one year later : The impact of props, drawing and a prior interview

One hundred and one 5-year-old children were interviewed about a routine health assessment carried out at school following delays of both 3 days and 1 year or 1 year only. Children were interviewed with prototypical medical items and a doll (props), with verbal prompts only (verbal), or with drawing (drawing). There was a decrease in both the amount and the accuracy of the information children reported over the 1-year delay, but no effect of the prior (3-day) interview. Children interviewed with props recalled more information than those asked to draw or interviewed with verbal prompts only, particularly at the long delay. Correct information was more likely to be repeated across interviews than were errors, and, whereas information repeated across interviews was highly reliable, information introduced for the first time after 1 year was not, particularly when children drew. These findings have important implications in applied contexts such as when children are called upon to provide testimony following very long delays. Copyright

Remembering and reporting by children: the influence of cues and props.

Until recently nonverbal props received little experimental attention in spite of the wide use of props such as toys and drawing in child clinical contexts. This article reviews research investigating the effectiveness of props as means of facilitating childrens recall and reporting of past events. In the first section, developmental and theoretical considerations influencing effectiveness of various kinds of props as aids to the retrieval and communication of information are outlined. Thereafter, findings of empirical research are reviewed for real props from the event, toys including dolls, drawing, context reinstatement, and photographs. Research findings suggest that a range of factors influence the extent to which props facilitate childrens reports of past events, including specificity of the information provided by the prop, the way the prop is presented during the interview, delay between the event and interview and, critical to these factors, the age of the child. Areas requiring future theoretical and research attention are identified.

The Effects of Mother Training in Emotion-Rich, Elaborative Reminiscing on Children's Shared Recall and Emotion Knowledge

The present study examined the impact of training mothers in high-elaborative, emotional reminiscing on childrens autobiographical memory and emotion knowledge. Eighty mothers were randomly allocated to one of two training conditions: in the reminiscing condition, mothers were encouraged to reminisce by asking their children (aged 3.5 to 5 years) elaborative Wh- questions, providing detailed descriptions, and discussing emotions, and in the control condition, mothers were encouraged to play by following their childrens lead. Forty-four mothers completed the study. Both immediately and 6 months after training, mothers in the reminiscing condition and their children each made more high-elaborative utterances and emotion references during shared recall than did mothers in the control condition and their children. Children of reminiscing mothers also showed better emotion cause knowledge after 6 months than did children of control mothers, but childrens independent recall to an experimenter did not differ according to condition. The findings suggest that an elaborative and emotion-rich reminiscing style can be taught to parents, with potential benefits for childrens shared (but not independent) memory contributions and for emotion knowledge development.

Factors associated with young children's long-term recall of an invasive medical procedure: a preliminary investigation.

ABSTRACT. This exploratory study investigated children’s recall of the voiding cysto-urethrogram (VCUG, x-ray of the kidneys) after a 6-month delay and the associations between children’s memory reports and specific behaviors coded during the procedure (distraction, crying, procedure-related talk). Thirty-two children, aged 2 to 7 years, were interviewed 6 months after undergoing the VCUG. Twenty-nine of the 32 children reported information about the VCUG after 6 months. Free recall was skeletal but highly accurate; more information was reported in prompted recall, but accuracy was reduced. Older children provided more complete and accurate reports than did younger children. Independently of age, specific child behaviors were associated with children’s memory reports: crying during the VCUG was negatively associated with the correct information reported and accuracy in prompted recall; procedure-related talk was positively associated with the correct information reported in free recall; and distraction was negatively associated with the accuracy of free recall. The implications for intervention in pediatric contexts are discussed.

The role of maladaptive appraisals in child acute stress reactions.

OBJECTIVE To test the prediction of cognitive models of trauma that negative, catastrophic appraisals central to the development of psychopathological stress reactions. DESIGN A cross-sectional, concurrent design was used. METHODS Sixty-six children (aged 7-13 years), who were hospitalized after traumatic injury were assessed within 4 weeks of their trauma for acute stress disorder, depression, and administered the Child Post-traumatic Cognitions Inventory (cPTCI). Parental acute stress was also assessed. RESULTS Childrens negative appraisals of their ongoing vulnerability accounted for 44% of the variance of acute stress reactions in children. Injury severity, depression, age, and parental acute stress levels did not account for significant additional variance. CONCLUSIONS The findings provide support for cognitive models of trauma adaptation and highlight the importance of assessing childrens appraisals of their traumatic experience in order to develop effective interventions.

Evaluation of a Brief Parent Intervention Teaching Coping-Promoting Behavior for the Infant Immunization Context A Randomized Controlled Trial

This study was designed to investigate whether a brief intervention encouraging parental coping-promoting talk within the treatment room would have beneficial effects on infant pain responses to an immunization injection. Infant-parent dyads were recruited from a 6-month immunization clinic and randomized to an intervention group (n = 25) or standard care control group (n = 25). Parents in the intervention group received an information sheet describing adult verbalizations associated with better pain outcomes for infants. The immunization procedure was videotaped. Parents in the intervention condition made significantly more coping-promoting statements than parents in the control condition. Infants in the control condition cried significantly longer than infants in the intervention condition. Coping-promoting and distress-promoting statements did not differ in terms of affective quality. Infants whose parents had rated them as more difficult in temperament cried longer following the injection. Teaching parents to engage in coping-promoting behaviors within the infant treatment room is an effective, low-cost intervention.

The Ethics of Care and Treatment of Sex Offenders

The ethics of care acknowledges the importance of establishing and maintaining practices that help people to meet their needs, develop and protect basic capabilities for problem solving, emotional functioning, and social interaction, and avoid pain and suffering. In this article, we explore the contribution an ethics of care perspective can make to work with sex offenders. First, we briefly describe five classes of ethical problems evident in work with sex offenders. Second, the concept of care is defined and a justification for a version of care theory provided. Third, we apply the care ethical theory to ethical issues with sex offenders and demonstrate its value in responding to the five classes of problems outlined earlier.

Toys in Clinical Interviews with Children: Review and Implications for Practice.

The use of toys in child clinical contexts is advocated by a number of researchers in the field as a means of overcoming developmental constraints on childrens reports of their psychological states and their experiences. This paper reviews the literature relating to the impact of toys on childrens ability to recall and communicate clinically relevant information. The conclusion is drawn that whether toys are a help or a hindrance depends on a number of factors, including the developmental stage of the child, the way the toys are presented, and the nature and cognitive demands of the task. The importance of developmentally sensitive and empirically supported strategies for eliciting information from children is highlighted.