Tess Patterson

Exploratory assessments of child abuse: Children's responses to interviewer's questions across multiple interview sessions☆

OBJECTIVE The present study extends field research on interviews with young children suspected of having been abused by examining multiple assessment interviews designed to be inquisitory and exploratory, rather than formal evidential or forensic interviews. METHODS Sixty-six interviews with 24 children between the ages of 3 and 6 years who were undergoing an assessment for suspected child abuse were examined. Each child was interviewed 2, 3, or 4 times. The interviewers questions were categorized in terms of openness (open, closed or choice), in terms of the degree of interviewer input (free recall, direct, leading, suggestive), and for topic (whether the question was abuse-specific or nonabuse-related). Childrens on-task responses were coded for amount of information (number of clauses) reported in relation to each question type and topic, and off-task responses were categorized as either ignoring the question or a diverted response. RESULTS Children provided a response to most questions, independent of question type or topic and typically responded with one or two simple clauses. Some children disclosed abuse in response to open-ended questions; generally, however, failure to respond to a question was more likely for abuse-specific than for nonabuse-related questions. CONCLUSION The findings are discussed in terms of the growing literature on interviewing children about suspected abuse, particularly in interviews conducted over multiple sessions. PRACTICE IMPLICATIONS Assessment of suspected child abuse may involve more than a single investigative interview. Research examining childrens responses to questioning over multiple interviews (or single interviews conducted over multiple sessions) is necessary for the development of best practise guidelines for the assessment of abuse.

Drawing helps children to talk about their presenting problems during a mental health assessment

When children require mental health services, clinicians need to conduct assessments that are developmentally sensitive and that include the child’s point of view. Drawing is a popular tool that is commonly used in clinical settings. Research on drawing in experimental settings has confirmed that the opportunity to draw while talking increases the amount of verbal information that children report during an interview. The present research examined whether drawing also facilitates children’s self reports during a mental health assessment. A total of 33 5–12-year-old children were asked either to draw and tell about their presenting problem or to tell only. Children who drew and told provided twice as much verbal information as children who told only. Further, interviewers in the draw and tell condition used a greater number of minimal responses than did interviewers in the tell only condition. These data have important implications for clinical practice.

Interviews with children about their mental health problems: The congruence and validity of information that children report

To obtain a child’s perspective during a mental health assessment, he or she is usually interviewed. Although researchers and clinicians generally agree that it is beneficial to hear a child’s account of his or her presenting issues, there is debate about whether children provide reliable or valid clinical information during these interviews. Here, we examined whether children provide clinically and diagnostically relevant information in a clinical setting. In all, 31 children aged 5–12-years undergoing mental health assessments were asked open-ended questions about their presenting problems during a semi-structured interview. We coded the information that children reported to determine whether it was clinically relevant and could be used to diagnose their problems and to formulate and plan treatment. We also coded children’s information to determine whether it was congruent with the children’s presenting problems and their eventual clinical diagnoses. Most of the information that children reported was clinically relevant and included information about behaviour, affect, temporal details, thoughts, people, the environment, and the child’s physical experiences. The information that children reported was also clinically valid; it was congruent with the problems that were discussed (84%) and also with the eventual diagnosis that the child received after a complete assessment (74%). We conclude that children can contribute relevant, clinically useful, valid information during clinical psychological assessments.

Can drug treatments enhance learning in subjects with intellectual disability

Recent research has identified specific molecular mechanisms that might account for impaired learning in particular intellectual disability syndromes. These and other findings raise the possibility that targeted drug treatments might be developed to enhance learning in subjects with intellectual disability. This review considers strategies for developing treatments, and identifies critical issues that will need to be considered in such programmes.

Listening to the therapeutic needs of male survivors of childhood sexual abuse

Childhood sexual abuse of males is not uncommon with estimated prevalence rates across countries and different studies indicating that 8% of boys experience sexual abuse before age 18. A number of adverse outcomes are recognized in terms of mental health, behavioral, and relational difficulties. However, research also indicates that there is potential for healing. The present study explores the barriers, benefits, and processes involved in engagement in formal therapy for adult survivors of CSA from the male survivor’s point of view. Nine men spoke of their treatment experiences in response to semistructured interviews. Participants were all members of a group for male survivors of sexual abuse. Seven participants reported benefiting from treatment. Interpretative phenomenological analysis (IPA) of the interviews identified three superordinate themes: “motivation to engage in treatment,” “developing a connection with treatment providers,” and “changing thinking about the abuse.” These themes reveal a number of obstacles that are encountered in seeking treatment including stigma, process barriers, and engagement of a skilled and empathic therapist. For the men who were able to take part in therapy despite these barriers, improved quality of life were noted through the two primary mechanisms of relationship and changed thinking. Key changes in thinking included developing an awareness that they were not responsible for the abuse, understanding the effects of abuse, and developing an identity distinct from the experience of abuse. These changes in thinking occurred within the context of a robust therapeutic relationship.

Thoughts of suicide and stage of recovery in patients with schizophrenia in community mental health care

Objective: Suicidality among patients with schizophrenia remains a major concern. The consumer-oriented concept of recovery has been recognised as important in recent years. We aimed to assess whether there was any relationship between stages of recovery and suicidality among people with schizophrenia in community care. Method: In a community mental health service, 85 patients with schizophrenia consented to an interview during which their stages of recovery were assessed using the Stages of Recovery Instrument. They were asked about suicidality and screened for depression using the Revised Clinical Interview Schedule. Insight was assessed via the Insight and Treatment Attitudes Questionnaire. Data analysis involved logistic regression. Results: In the past year 14% of the patients reported having wanted to die and 13% had considered suicide. Scores indicating the highest stage of recovery were associated with lower odds of suicidal thoughts. In contrast, suicidality was not significantly associated with depression or stage of insight. Conclusion: The link found between suicidality and stages of recovery has practical implications for suicide prevention among those with schizophrenia in community care. Approaches that facilitate the recovery process may reduce suicidal thoughts in this population.

Childhood sexual abuse, poly-victimization and internalizing disorders across adulthood and older age: Findings from a 25-year longitudinal study

BACKGROUND We aimed to investigate associations between childhood sexual abuse and maltreatment and internalizing disorders (anxiety, depression, PTSD) across adulthood. METHODS Following a postal survey of 2220 women, a subsample was selected to participate in an interview. The subsample included 276 women reporting childhood sexual abuse and 221 women with no reported history of childhood sexual abuse. Interviews were repeated six and 25 years following the first interview. Internalizing disorders were assessed using ICD-8 and DSM-III criteria. RESULTS There was a lower probability of having an internalizing disorder at older ages than younger ages for all women, regardless of maltreatment history. Latent class analysis was used to define three classes (no/low maltreatment, sexual abuse, poly-victimisation). Compared with no/low maltreatment, a history of childhood sexual abuse was associated with almost double the risk of an internalizing disorder and a history of poly-victimisation was associated with over four times the risk of an internalizing disorder. Childhood sexual abuse and poly-victimisation remained associated with an elevated risk of a disorder in older age. LIMITATIONS Findings are limited by attrition (39% participated at Time 3), low prevalence of severe physical abuse, and changes in assessment practice of childhood maltreatment and mental disorder in the past 30 years. CONCLUSIONS Screening and treatment for internalizing disorders in women with histories of childhood maltreatment remains important in older aged populations.

Behavioral Management of Inappropriate Masturbation in an 8-Year-Old Girl

An 8-year-old girl, previously diagnosed with infantile masturbation, was referred and treated for inappropriate masturbation. Treatment involved age-appropriate sexual education, reinforcement contingencies, the use of distraction and redirection, and when necessary, timeout. The inappropriate masturbation behavior was substantially reduced during treatment phase from daily occurrence to occasional occurrence, and at 6-week post-treatment follow-up, inappropriate masturbation was absent.