Vivien Prior

Is the term child protection applicable to emotional abuse

Emotional abuse refers to a relationship rather than to a series of events. Based on a recent study of children registered under the category of emotional abuse, it has been possible to identify three tiers of concern, namely, parental attributes, categories of ill-treatment and impairments of the childs development. Registration came late in professional recognition of concerns about the children and their families. A majority of the children had moved away from home following registration. The paper discusses the carer–abuser relationship in emotional abuse and suggests that a strict application of the term ‘child protection’ is not appropriate in emotional abuse. While advocating an early response to concerns suggesting emotional abuse, the paper raises questions about the appropriateness of immediate use of formal child protection procedures in the investigation and assessment of suspected emotional abuse. Alternative approaches are suggested which may not need to include police and social services in the early stages. The response to recognition of emotional abuse is more appropriately considered as working towards protection.

Understanding attachment and attachment disorders

There is a pleasurable irony in reviewing this book for the Infant Observation Journal. The traditions and disciplines of both infant observation and attachment theory hail from the same corridors of the same institution, The Tavistock Clinic, both being born in approximately the same period, and both being preoccupied with the importance of rigorous and disciplined observation, albeit of different kinds. Each tradition has at its best shown a preparedness to be surprised at what study and observation teaches us. Although their founding parents (Esther Bick and John Bowlby) might not always have seen ‘eye-toeye’, in recent years any ‘stand-off ’ between a putative psychoanalysis concerned solely with internal worlds and an attachment theory preoccupied only with ‘behaviours’, has given way to a more accepting climate in which attachment theory has become ever more concerned with the subtleties of internal representations, and psychoanalysis has taken huge account of external factors. At a time when the popularity and acceptance of psychoanalytic ideas is being challenged and the language of attachment theory is apparently becoming common currency, a book that aims to evaluate carefully some of the ideas and claims made in the name of attachment theory is timely. This book is part of a series commissioned by Focus , a multi-disciplinary body based at the Institute of Psychiatry that is interested in Child and Adolescent Mental Health Services (CAMHS). The aim of the series is to develop resources for professionals and parents that examine the ‘evidence base’ for ideas and interventions. This book fits well into that category and can be read by those who know very little about attachment theory as well as by experienced practitioners and teachers who want to learn more about the details of attachment research. It sets out to examine the key concepts and studies in a way that sorts out ‘the wheat from the chaff ’, making clear what the authors feel can and cannot be said in the name of attachment theory. The book is divided into five sections, and looks in turn at basic concepts of attachment, at attachment and care-giving, and also at methods of assessing attachment and care-giving. It goes on to look in closer detail at the evidence for the pathways of the influence of attachment. The authors then move on to the meaty questions of what constitutes an ‘attachment disorder’, and the usefulness and limitations of such categorizations. Finally, it gives a solid run-down on interventions which relate to attachment theory, giving short shrift to those which might be considered highly dubious and for which there is no evidence of effectiveness. The book is well introduced and the first main section offers a very clear definition of attachment and an explanation of the attachment system, using Bowlby’s own formulations and later research and emphasizing the biological and evolutionary roots of attachment as

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 labour - Vast problem whose effects on children's health remain largely unstudied

Child labour today represents the largest single cause of child abuse across the globe. Most of it takes place in economically less developed countries, and much is hidden. In a minority of instances the effects of child labour may be neutral or even positive, such as helping out in a family run shop during school holidays. In recent years therefore the emphasis has shifted from the abolition of all forms of child labour to the elimination of intolerable and hazardous child labour. The International Labour Organisation estimates that worldwide 110 million children aged 5-14 years are engaged in labour that can be described as hazardous or intolerable.1 Most of this takes place in Asia and the Pacific, although the highest prevalence is in Africa, where children younger than 14 years make up a third of the total workforce.1 Slavery, bonded labour, prostitution, and the recruitment of child soldiers are all intolerable and illegal. Yet in central and west Africa alone an estimated 200 000 children are traded each year.2 Landlords can bond a child worker for as little as US

Decreasing rates of disorganised attachment in infants and young children, who are at risk of developing, or who already have disorganised attachment. A systematic review and meta-analysis of early parenting interventions

1.50 (£0.95, €1.50), and family debts are manipulated so that there is no hope of repayment. The commercial sexual exploitation of children is increasing, and organised networks can be found in Latin America, Asia, Africa, and, most recently, eastern Europe. An estimated 1 million children in Asia alone are victims of the sex trade, much of it focused around sex tourism.3 Paradoxically, …

Understanding Attachment and Attachment Disorders: Theory, Evidence and Practice

Background Disorganised attachment patterns in infants have been linked to later psychopathology. Services have variable practices for identifying and providing interventions for families of children with disorganised attachment patterns, which is the attachment pattern leading to most future psychopathology. Several recent government reports have highlighted the need for better parenting interventions in at risk groups. Objectives The objective of this review and meta-analysis was to evaluate the clinical effectiveness of available parenting interventions for families of children at high risk of developing, or already showing, a disorganised pattern of attachment. Methods Population: Studies were included if they involved parents or caregivers of young children with a mean age under 13 years who had a disorganised classification of attachment or were identified as at high risk of developing such problems. Included interventions were aimed at parents or caregivers (e.g. foster carers) seeking to improve attachment. Comparators included an alternative intervention, an attention control, treatment as usual or no intervention. The primary outcome was a disorganised pattern in childhood measured using a validated attachment instrument. Studies that did not use a true Randomised Controlled Trial (RCT) design were excluded from the review. Both published and unpublished papers were included, there were no restrictions on years since publication and foreign language papers were included where translation services could be accessed within necessary timescales. Results A comprehensive search of relevant databases yielded 15,298 papers. This paper reports a systematic review as part of an NIHR HTA study identifying studies pre-2012, updated to include all papers to October 2016. Two independent reviewers undertook two stage screening and data extraction of the included studies at all stages. A Cochrane quality assessment was carried out to assess the risk of bias. In total, fourteen studies were included in the review. In a meta-analysis of these fourteen studies the interventions saw less disorganised attachment at outcome compared to the control (OR = 0.50, (0.32, 0.77), p = 0.008). The majority of the interventions targeted maternal sensitivity. We carried out exploratory analyses to examine factors that may influence treatment outcome but these should be treated with caution given that we were limited by small numbers of studies. Conclusions Parenting interventions that target parental sensitivity show promise in reducing disorganised attachment. This is limited by few high quality studies and the fact that most studies are with mothers. More high quality randomised controlled trials are required to elucidate this further.