Sandra J. Kaplan

Posttraumatic Stress Disorder in Mothers of Pediatric Cancer Survivors

Prevalence of posttraumatic stress disorder (PTSD) in 24 mothers of pediatric cancer survivors was compared with its prevalence among 23 mothers of healthy children. Significantly more mothers of pediatric cancer survivors were diagnosed with lifetime PTSD. Significant differences were also found in lifetime arousal, as well as current and lifetime reexperience and avoidance symptom clusters. Significant difference existed in the distribution of the number of prediagnosis high-magnitude events experienced by the mothers diagnosed with current PTSD as compared with the prediagnosis experience of the mothers who were not diagnosed with current PTSD. Illness severity, level of perceived family and extrafamilial social support, and Symptom Checklist-90-Revised global severity index scores did not significantly differ in the PTSD-positive and PTSD-negative groups.

Mothers' personal social networks and child maltreatment.

The social networks of 32 mothers in families being treated in a hospital-based program for indicated cases of child abuse and neglect were compared to the networks of a demographically comparable control group of 24 mothers whose children were not subject to maltreatment. The clinic mothers were found to be more isolated and more insulated from other people in their -networks. Their isolation reflected a deficiency primarily in their peer connections, and their insularity served to separate their immediate families from their peer connections and from the rest of their families. Child and adolescent maltreatment has become more noticeable to the public in recent years as our information-gathering systems have become more efficient and reports issued have revealed its deleterious effects on children (American Health Association, 1976; American Humane Association, 1978; Konopka, 1975; Straus, Gelles, & Steinmetz, 1980; Child Protective Services, Note 1). Severe maltreatment of children by members of their families is unsanctioned by all social communities. There are cultural differences in disciplinary child-rearing practices that share some of the attributes of violence, as described in Erlangers (1974) review, but nevertheless, there are limits and standards set by all social groups regulating such behavior and specifying the contexts in which and the extent to which it is permitted. The behavior we are concerned with, child maltreatment severe enough to be indicated by Child Protective Services, falls outside these limits and is considered a problem in every social group. Its persistence within the

Physically abused adolescents: behavior problems, functional impairment, and comparison of informants' reports.

Objective. This study, like earlier studies that focused on younger abused children, ascertained whether physically abused adolescents exhibited increased internalizing and externalizing behaviors. Relevance to pediatric practice is discussed. Design. A cross-sectional design was used to compare the behavior of physically abused adolescents and comparison adolescents using self-reports, parent reports, and teacher reports. The level of agreement among raters was also examined. Participants. The subjects were 99 physically abused adolescents between the ages of 12 and 18 years, who were recruited from Child Protective Services. Comparison subjects were 99 community-recruited nonabused adolescents who were matched for age, gender, and income with the abused adolescents. Measures. The behavior of the adolescents was assessed using the Child Behavior Checklist, and the comparable Youth Self-Report and Teacher Report Form, which are widely used measures of behavioral and emotional problems. The Child Global Assessment Scale was also used as a measure of functional impairment and of the need for mental health services. Results. Parents and teachers rated the problems of abused adolescents as significantly greater than the problems of nonabused adolescents on all checklist subscales. Abused adolescents reported significantly greater problems only on externalizing behavior subscales. In addition, based on interviewer ratings, physically abused adolescents exhibited significantly greater functional impairment. Conclusions. Similar to previous research on abused children, physically abused adolescents exhibit externalizing and internalizing behavior problems and experience greater functional impairment. Parent, teacher, and adolescent reports of externalizing behaviors were similar, but physically abused adolescents reported fewer internalizing behaviors than did the other informants.

Adolescent Abuse: Family Structure and Implications for Treatment

Twenty-two families in which 33 adolescents were abused were clinically evaluated. The families fell into three groups: childhood onset, where there was a history of violence in the families of origin; authoritarian families, where rigid parenting styles were characterized by a high degree of denial of family conflict; and overindulgent families, where a pattern of overly permissive parenting coupled with sporadic violent attempts at control seemed to be associated with an early loss of a parent. Implications for family-oriented treatment are discussed.

Psychiatrists and Child Abuse I. Case Assessment by Child Protective Services

A multiple choice self-report questionnaire was developed which contained questions about agency staffing patterns and patterns of referral of abused and neglected children and their parents to psychiatrists and psychologists. It was distributed to Child Protective Service offices in the New York City Metropolitan area. Responses indicated that the majority of abused children and their parents assessed by Child Protective Services are not being evaluated by psychiatrists or psychologists.

Psychiatric Disorders of Parents of Physically Abused Adolescents

Psychiatric disorders of 142 parents of adolescents who were documented as physically abused during adolescence and 168 parents of non-abused comparison adolescents were assessed. Fathers and mothers of physically abused adolescents exhibited higher rates of Axis I diagnoses and co-occurring disorders, and had more impaired GAS scores than comparison parents. Fathers of abused adolescents had greater lifetime incidence of Conduct Disorder and Substance Abuse/Dependence than comparison fathers. Mothers of abused adolescents had more unipolar depressive disorders than comparison mothers. This study highlights the importance of mental health assessments and interventions for parents of physically abused adolescents. Since onsets of parental psychiatric disorders antedated the abuse, early recognition and treatment of parental disorders may contribute to prevention of the onset and/or reoccurrence of adolescent physical abuse.

Psychiatrists and child abuse. II. Case assessment by hospitals.

A multiple choice self-report questionnaire about hospital staffing patterns for the assessment of child abuse cases, patterns of referral of abuaed and neglected children and their parents to psychiatrists and psychologists was distributed to hospitals in the New York City Metropolitan area listed in the 1974 American Hospital Association Directory as having pediatric beds. Responses indicated that psychiatric and psychological evaluations of abused children and their parents were infrequently done by hospitals. Sixty-six percent of hospitals reported having interdisciplinary committees for child abuse case review, but only 48% of these had psychiatrists as members.

A Controlled Study of the Life Events of the Mothers of Maltreated Children in Suburban Families

The life events of mothers in families of maltreated children were compared to the life events of a control sample, in terms of the number, the valence, and the type of events. It was found that the number of significant life events did not differ for the two samples, but more of the mothers in the control sample reported positive life experiences in a variety of areas. Many mothers in both samples were found to have experienced negative life events, but they differed with respect to the type of events they reported.