Margaret A. Lynch

Sexual abuse of children in the United Kingdom

Questionnaires were circulated to 1,599 family doctors, police surgeons, paediatricians, and child psychiatrists to determine the frequency and nature of child sexual abuse in the United Kingdom. At least three per 1,000 children are currently being recognized as sexually abused sometime during their childhood. The majority of cases reported involved actual or attempted intercourse, and 74% of the perpetrators were known to the child. Family disturbance was noted in 56% of the cases. The most common outcome (43%) was criminal prosecution of the perpetrator. Area Review Committees had no clear policy for the management of sexual abuse. Before it is possible to protect children and to develop therapeutic services for the family, it will be necessary to acknowledge that sexual abuse is part of the child abuse spectrum.

A Description and Evaluation of a Community Child Mental Health Service

A community-based child mental health service was established for families of preschool children with emotional and behavioural problems in the children, psychosocial problems in the family or parenting difficulties. The intervention was home-based and conducted by health visitors and paediatric community medical officers trained in parent counselling, parenting issues and child behavioural management. The approach was based upon frameworks derived from counselling theory, with the intervention dependent upon the development of a trusting and respectful partnership with the parents. The aims were to promote and support the parents own exploration of the identified problems, and to help them establish clear aims and effective problem management strategies. Ongoing supervision was provided by a clinical psychologist. The evidence indicated that the training course was acceptable to non-mental health professionals and effective in preparing them to work with psychosocial problems. The service was a feasible option for work at the community level; it was acceptable to both referrers and parents and beneficial for families living in a very deprived inner-city community.

Child abuse before Kempe: an historical literature review.

This literature review traces the recognition of child abuse and ends where many texts begin with the publication of Henry Kempes paper in 1962, where the term, battered child syndrome, was used for the first time. Starting with the first known treatise in pediatrics, the review examines evidence produced throughout the centuries on the recognition of physical child abuse. Many of the references are medical and show how while the early physicians found it easy to accept that those caring for children might injure them, by the end of the 19th century, more obscure diagnoses were being sought to explain the lesions. However, even during the time some physicians were pursuing scientific etiologies, there are publications that demonstrate a continuing acknowledgment of the problem of child abuse. No review of this type can claim to be complete, and the author hopes others will be sufficiently interested to seek out further historical references.

Failure to thrive and the risk of child abuse: a prospective population survey

Objective — To identify the relative importance of failure to thrive during infancy as a risk factor for later abuse or neglect. Design — Whole population birth cohort (1 January to 31 December 1986) studied prospectively over a four year period. Setting — An inner city health district in London, England. Subjects — 2609 births, of whom 47 were identified as having non-organic failure to thrive by first birthday. Main outcome measures — Registration on Child Protection Register, or subject to investigation of suspected abuse or neglect without registration. Results — 2·5% (64) of birth cohort had been placed on the Child Protection Register during the period 1986–1990, and a further 1·2% (32) had been a cause for concern. The relative risk attributable to nonorganic failure to thrive was 4·3 (95% CI 1·65 to 11·94) and exceeded other measured risk factors, including birth weight <2500g, 1·96 (95% CI 1·01 to 3·82); gestation <35 weeks, 3·26 (95% CI 1·32 to 3·75); ordinal position >4, 1·53 (95% CI 0·72 to 3·23). A multiple logistic regression confirmed the independent contribution of non-organic failure to thrive to subsequent poor parenting warranting professional intervention. Conclusions — Early postnatal non-organic failure to thrive is a risk factor for later serious parenting deficiencies, but previous research has overstated its importance. Within the community studied the nature of subsequent risk was (non-nutritional) neglect, rather than non-accidental injury. More than eight out of 10 cases do not give further cause for concern.

Violence begins at home. Domestic strife has lifelong effects on children.

Physical violence in the family probably blights the lives of more people than all genetic disorders put together, yet research on the issue has struggled to achieve scientific legitimacy.1 Violence in the family includes “any act or omission committed within the framework of the family by one of its members that undermines the life, the bodily or psychological integrity, or liberty of another member of the same family or that seriously harms the development of his or her personality.”2 Separating the causes and effects of domestic violence from those of poor parenting, poverty, homelessness, substance abuse, and violent neighbours and schools is a tough research challenge.3nnEstimates of how many people experience violence in the family depend on definition, circumstances, and the method of inquiry,1 but even the lowest figures show that this is a common and serious problem. Several forms of violence and abuse may occur …

Responding to Child Sexual Abuse: The Criminal Justice System

Children who disclose sexual abuse, and the professionals working with them, continue to face a series of difficulties and dilemmas if the alleged abuser is to be brought before the criminal court. As part of a major study of 202 children who had been sexually abused, 35 were interviewed about their post-abuse experiences. The majority were positive about their contact with police. What the children wanted to happen to the abuser suggests that they did not always want imprisonment but that they required some form of redress, and above all that the abuser should be held accountable. However, accounts by the six children who were prosecution witnesses were all unequivocally negative about their experience of giving evidence and being cross-examined. The issues raised by the childrens qualitative evaluations provide increased support for the view that further reform is still needed if the interests of children, as well as justice, are to be truly protected within the criminal legal system.

Recognition of Child Sexual Abuse in the United Kingdom

Publisher Summary This chapter discusses the recognition of child sexual abuse in the United Kingdom. It presents the survey data as an example of the process of recognition of child sexual abuse. In the United States in 1978, sexual abuse of children was a growing national concern. The number of reported cases was increasing considerably, and many communities were developing treatment programs for victims and their families. In the United Kingdom, however, this was not happening. There was not as yet any widespread recognition of child sexual abuse as a major social problem. Even though there is no mandatory reporting of child abuse in Britain, identification and intervention are heavily influenced by government guidelines. Until 1980, circulars from the Department of Health and Social Security had not included sexual abuse within the definition of child abuse. The only figures available in the United Kingdom on the incidence of child sexual abuse were criminal statistics, particularly those on incest. There were no boys identified in this age group, but older boys were more vulnerable. It is possible that as boys and girls become more sexually developed as they approach adolescence, their chances of being sexually abused increase. Another possibility is that it is easier for professionals to identify sexual abuse in this age group because these children talk about their experiences.

Following Up Children Who Have Been Abused: Ethical Considerations for Research Design

Recruiting subjects for follow-up studies in child abuse raises ethical dilemmas. This paper examines the effects of the ethical stance taken in a study of a community sample of sexually abused children. The ethical code adopted required strict confidentiality and active consent to be interviewed from both child and carer, based on full information about the research objectives and method. The response rate was very low. A less rigid stance, which might have resulted in a larger sample, was considered inappropriate. Nevertheless, the quantitative and qualitative data yielded findings of interest to practitioners. Suggestions for future research practice are presented.

Child Abuse and Neglect inChina: What the Papers Say

In order to gain an insight into attitudes towards child abuse in China, a review of a number of newspapers for a period of 3 months was carried out. There was a dearth of relevant stories in national papers, but more in the local type of newspaper read by the majority of Chinese. Overall there were few reports relating to child abuse, especially in the intrafamilial setting. Of particular note is the number of reports of neglect of children following divorce. Violence towards students by teachers also features prominently. But by far the most reported issue is the damaging effect on children resulting from pressures for good academic performance in a highly competitive society.

A Follow-up Study of Abused Children and Their Families

The subjects of this follow-up study are 42 abused children and their 40 families who had received residential therapy at the Park Hospital for Children in Oxford (Lynch et al, 1975) between the years 1965–1974. All 42 children were considered to have suffered definite physical abuse and their main injuries are summarized in Table 1. At least 17 of the children had evidence of a previous, usually minor, injury which in retrospect could be seen to be examples of Ounsted’s “open warnings” (1975).