Child and Adolescent Psychiatry Consulting

Archive for the ‘Trauma/Abuse/Violence’ Category

What you say to your child is important.
Here are some tips to assure that what you say won’t damage your child

Sticks and stones will break my bones,
But names will never hurt me.

Many of us who are now parents understand that this children’s rhyme does not provide true comfort, and that the words of playmates DID hurt us.

Words can hurt children, and the damage inflicted on a child by the thoughtless remarks of a parent or other adult can torment a child–for their lifetime.

In fact, emotional abuse, though it is often ignored, can be far more devastating than the physical abuse that so often captures media headlines.

The emotional abuse of harsh words, spoken thoughtlessly, can lead a child feeling berated, belittled, demoralized. The impact this has on a child’s emotional development is insidious. A child’s spirit can be destroyed, and they may lose any positive sense of self. Emotional abuse destroy’s a child’s ability to feel loveable, to love himself or herself, and has a negative effect on a child’s ability to care for and get along with others. Emotional abuse increases self-destructive and antisocial behavior. Emotional abuse has been linked to eating disorders, promiscuity and suicide.

None of us is perfect, and many of us can recall a time when we’ve lost our self-control, and said something hurtful and demoralizing to our children, over something minor. We might say things like: “You clumsy idiot! You can’t do anything right!”

When words like these are repeated often enough, the child’s sense of self-esteem plummets and he or she begins to agree with his parents’ assessment of him: he or she really is dumb, a jerk, an idiot, a moron. The child begins to learn that love is not without conditions. And since it seems impossible to meet his or her parent’s expectations, the child becomes satisfied with settling for the “loser” role.

In too many homes today, the lights are on but no one is there. People are home but not home. Inattentive and verbally abusive parents are producing children who seem normal but are not what they should be, what they could have been.

There are studies that demonstrate that this abusive, humiliating and demeaning parenting behavior is transmitted from generation to generation, meaning that adults who had abusive parents tend to parent their own children the same way. This pattern will continue until a parent is willing to change their behaviors, change the dynamics, and find a way to interact differently with their own children. They must be willing to see and acknowledge that they are saying and doing to their children.

To change this pattern, treatment often requires treating the parent and the child, helping the parent feel respected and empowered, and allowing them to change the ways they respond to their child.
The problem of verbal abuse is REAL, and COMMON, but difficult to document, and, therefore, difficult to intervene to prevent. Certain stressors can increase the problem of verbal abuse, job loss, marital problems, financial concerns. Often, adults attempt to cope with these stressors using alcohol and other drugs, but this tends to make matters worse. Parents then lose their inhibitions, and may say terrible things to their children that they later regret.

How can you be sure your words build up rather than destroy your children?

† Guard your vocabulary. There are some words that people in a family should never say to each other. Words like stupid, dummy, jerk, idiot, worthless and freak have no place between parents and their children.

† Avoid absolute statements such as “You never . . . ” Or “You always . . . ” Have a sense of good manners with your family. This doesn’t mean that you must avoid all conflict or that you can’t set limits.

† Separate the child’s actions from the child. Instead of responding to a tantrum with a barrage of abusive language, let him know that you love him — but not his actions, which are unacceptable.

† When things happen that can set off an explosion, take time out. Wait. And then wait some more. When you hold your tongue until the heat of the moment has passed, it’s a lot easier to respond with love rather than anger.

† Be available. Be willing to stop and peek in on your child’s world. He or she will feel more valuable because of it. Don’t start interrogating the minute the child walks in the door.

Wait until you’re relaxed and instead of probing about his day, why not share your day? Instead of accusing, compliment. Instead of insisting, be silent.

† Active listening refers to a kind of listening and a response that does not judge, ridicule or order. And the more we listen without judging, the more we help our children to accept their feelings, we improve their problem-solving ability and increase their willingness to listen to us.

† Teach by example. Let your kids hear you acknowledge your mistakes. Risk being humble. Dare to say, “I’m sorry” to your children when appropriate. Apologizing reveals that the truth is larger than your ego and their feelings are more important than your pride.

If you can accept yourself in spite of your limitations, all the while working to be the best you can be, you’ve gone a long way to help your kids value themselves.

Based on the work of Jean Guarino, free-lance writer.

How can it be that young children can kill?

All states wrestle with how to protect society from children who kill while making sure they get the rehabilitation they need, and ensuring  justice for victims’ families.

The most effective rehabilitation comes from juvenile programs where young children receive therapy in a positive environment and behavioral interventions aimed at increasing empathy, self-management, and self-regulation.

In adult prison, the emphasis is on punishment. More vocational and academic programs have been added, but not every young adult prisoner takes advantage of them. Juveniles don’t do well in prison, and they certainly cannot be expected to benefit from being placed with adults with criminal thinking. Instead, in prison, they are placed in an environment where criminal thinking tends to be the social norm.

Nationally, 10 percent of all murders are committed by juveniles, according to the Office of Juvenile Justice and Delinquency Prevention. That’s about 1,043 murders a

year. More younger children are committing increasingly violent crimes. The irony is younger children have a better chance of being rehabilitated because they stay under juvenile control longer, so that therapeutic interventions and supervision continues.Most of the time violent juveniles are transferred to adult court and tried as adults. If convicted, they remain in a juvenile detention center until they are 19, and then they are transferred to the adult prison to serve the remainder of their sentence. If one happens to be tried as a juvenile and is convicted, he serves his entire sentence in a juvenile detention center and is freed by the time he turns 19.

Experts say violent crime among  juveniles is down nationally. And when it happens, we know what treatments can be effective. What works is one-on-one and group therapy and empowering a child through academic and vocational classes. What doesn’t work is Scared Straight programs and boot camps. In fact, they actually have been shown to have negative effects.

Still, for many of these kids, their time in youth facilities is not long enough to reverse a lifetime of letdowns from the adults in their lives. Nationally, 40 percent of first-time offenders return to juvenile court.

Violence toward others peaks in adolescent years, but a violent adolescent doesn’t necessarily become a violent adult. Some two-thirds to three-

quarters of violent youths grow out of it and become more self-controlled. This, coupled with the efforts to rehabilitate in the juvenile justice system, is why some

ay trying children as adults is no benefit to society.

Child Protective Services investigated more than three million cases of suspected child abuse in 2007, but a new study suggests that the investigations did little or nothing to improve the lives of those children.

In 1973, Congress passed the Child Protective Services Act, designed to encourage more thorough and accurate reporting and record-keeping in child abuse cases. In New York, for example, there are now Child Protective Services offices in every county, paid for in part with federal funds.

Researchers examined the records of 595 children nationwide, all at similar high risk for maltreatment, tracking them from ages 4 to 8, 164 that were investigated for suspected abuse or neglect, and 431 families that had not been investigated. The scientists then interviewed all the families four years later.

The scientists looked at several factors: social support, family functioning, poverty, caregiver education and depressive symptoms, and child anxiety, depression and aggressive behavior — all known to increase the risk for abuse or neglect. They were unable to find any differences in the investigated families compared with the uninvestigated in any of these dimensions, except that maternal depressive symptoms were worse in households that had been visited.

One possible interpretation of this result would be that the investigated families were at greater risk to begin with, and that the investigation helped them to recover to the expected level of risk. But if this were so, the authors write, households with recent investigations would have greater risk than households with more distant investigations. Statistical analysis found no such association. They concluded that Child Protective Services investigations had little or no effect.

The researchers were in some ways unsurprised by their findings. Even when services are offered, they usually take aim at immediate risks — substance abuse, or domestic violence — not abiding problems like poverty or poor social support. Whatever interventions were offered apparently failed to reduce the risk for future child abuse.

Dr. Kristine A. Campbell, the lead author of the study, said that it may be too easy to blame Child Protective Services. “I believe that C.P.S. has a critical role,” she said. “As a pediatrician, when I’m there in the middle of the night with a child who has been beaten up, I need them. But we have to look at other systems that can really create a safety net for these children.”

Still, C.P.S. serves an important role in gathering information. This study supports the idea that it is time for further discussion of the role of protective services, beyond investigation.The difficulty is, that C.P.S. is charged with dealing with acute issues. We do not have a means for C.P.S. to deal with the chronic, underlying issues.

The study appears in the October issue of The Archives of Pediatrics & Adolescent Medicine, has certain weaknesses: some potentially modifiable risk factors — intimate partner violence and substance abuse, for example — were not included in the data they used. And not all of the five different geographical sites systematically collected information on all risk factors.

An editorialby Dr, Abraham B. Bergman was published with the study, titled “Child Protective Services Has Outlived Its Usefulness,” and suggests some essential changes: child abuse,  is a crime and should be investigated by the police; public health nursing services should be the first to respond to concerns of child neglect; social workers should assess appropriate living situations and work with families to obtain services, and not be engaged in law enforcement.

On Jan. 27, Julie Powers, 50, a mother of two in Tampa, drove her 13-year-old son, Beau, home from soccer practice and allegedly shot him in the head “for talking back” to her. Then she went upstairs and shot Calyx, her 16-year-old daughter dead as she sat at her computer doing her homework, according to an arrest affidavit. At the time, her husband was serving in Qatar as an army colonel. Powers said her kids were “mouthy.”

This is an unusual situation, because typically, it is younger children who are more likely to be killed. And usually, if a child is killed for being “mouthy” it is the result of a parent losing their temper, being aggressive, and throwing a child against a wall.

Killing newborns is much more common than killing older children.

As far as death by homicide goes, you’re more likely to be killed on the day you are born than on any other day of your life.

Younger children are much more likely to be killed than teenagers. If a child is killed for being “mouthy,” the remark that came out here, that’s more likely to lead to fatal battering. [Usually, in such cases,] a 3-to-5-year-old is thrown against a wall in an overzealous attempt at discipline and dies — as opposed to [a parent] planning to kill and shooting them with a gun.

Typically, circumstances in which parents kill their children include:

“ALTRUISM”:  When a mother plans to take her own life and believes her children are better off in heaven with her.

PSYCHOSIS:  The parent is acutely psychotic.

FATAL BATTERING: [as described above].

UNWANTED:  such as when a mother has  an infant born out of wedlock.

SPOUSAL REVENGE: a parent kills the children to hurt the partner, typically after infidelity or a separation

The case in Florida doesn’t appear to fit into any of these categories, based on the information we currently have. It is likely that there is more to the case than that the children were merely being mouthy.

When parents kill their children, the methodology may depend on the child. Age is one factor: a  3-year-old can be easily strangled or overdosed. Teens are not going to cooperate in being killed so the use of a knife or gun is more necessary. In some cases of fathers who kill teenagers there has been a real standoff and hostility, but that’s not typical for mothers.

Fathers are more likely to murder the whole family. In 95% of those cases in which whole families are killed, the fathers are the killer.

Is there any way to prevent these types of crimes?

There is no easy answer to intervening here. Better access to mental health care may be helpful.

Awareness; a woman who is very depressed and has young children who makes a suicide attempt has a 1-in-20 chance that she will try to take the kid with her. Specific inquiries about thoughts of harm toward children should occur in any evaluation of a seriously depressed mother.

What happens to parents who kill their children?

Most parents who kill their children go to prison rather than mental institutions. According to the FBI, women who kill their children and are not found insane, serve a mean length 17 years in prison. In women who kill newborns, the mean length is 9 years. Of all homicide perpetrators, none have a higher incidence of being found insane than mothers who kill their children.

Mothers who commit infanticide

They are not a general danger to the community. There are infanticide laws in 22 countries, including England, Canada and Australia — instead of women being charged with murder, mothers who kill children that are less than 1 year old are charged with infanticide. In the U.K., the vast majority get probation rather than prison. The recidivism rate is very low. The risk of suicide is substantial, however.

In February, 2009, Jordan Anthony Brown, then 11 years old, was charged with first degree murder in the shotgun slaying of Kenzie Marie Houk, his father’s pregnant girlfriend while she was sleeping. He will be tried as an adult and could become the youngest American ever to be sentenced to life in prison without parole.

A western Pennsylvania judge has ruled that Jordan Brown will be tried as an adult, because the juvenile justice system is not likely to rehabilitate him by the time he turns 21. If convicted of his current charges of first degree murder, Jordan at 12 years old, would be the youngest American to serve a life sentence without any chance of parole.

Police say that in February 2009, when he was 11, Jordan used a .20-gauge shotgun to kill Kenzie Houk, 26, in the family’s farmhouse outside Pittsburgh. She was 9 months pregnant; the unborn baby also died.

“There is no indication of any provocation by the victim that led to her killing,” Lawrence County Judge Dominick Motto wrote in his ruling yesterday. “The offense was an execution-style killing of a defenseless pregnant young mother. A more horrific crime is difficult to imagine.”

The judge based his decision on Jordan’s refusal to take responsibility for the crime, which two court doctors for the prosecution and defense said was necessary for rehabilitation.

The trial could begin in May.

In August, he Pennsylvania state House Judiciary Committee heard from the relatives of both victims and convicts today on a proposal to abolish life sentences without parole for juveniles.

The United States is the only country that sentences juveniles to life in prison without parole, and Pennsylvania has about 450 juvenile lifers, more than any state, said Rep. Kenyatta Johnson, D-Philadelphia.

At Philadelphia’s City Hall, committee members listened to testimony for and against House Bill 1999, which also would grant every juvenile lifer in the state parole hearings after serving 15 years of a life sentence, and every three years thereafter.

Bobbi Jamriska, 38, of Shaler, spoke on behalf of the National Organization of Victims of Juvenile Lifers. In 1993, Maurice Bailey of Crafton Heights, then 16, killed Jamriska’s sister, Kristina Grill, 15. Grill, was stabbed in the neck and beaten severely; investigators said her body had bloody footprints on her belly.

“There are bad seeds, individuals who are not fit to be part of a lawful functioning society,” she said. “There has to be within the legal system a means to keep these individuals from doing more harm to the innocent.”

She said life sentences are only imposed on juveniles in extreme situations, and that granting convicted killers parole hearings would force victims’ families to relive their losses.

But supporters of the new legislation note that juveniles’ brains are not fully developed and they lack key decision-making abilities.  Many juvenile lifers did not actually commit murder but were accessories, and the sentence is disproportionately meted out to minorities.

One-third of the state’s juvenile lifers were convicted of second-degree murder, said Ashley Nellis, a research analyst with the Washington D.C.-based The Sentencing Project, which researches and advocates for sentencing reforms.

Nellis also noted that the state’s 450 juvenile lifers, 315 are black.

“Social and medical research on young people verifies that they are categorically less culpable than adults because of their relative lack of maturity and underdeveloped ability to understand the consequences of their actions,” Nellis said. “Pennsylvania should join the growing consensus that rejects this practice.”

Does your husband or wife constantly forget chores and lose track of the calendar? Do you sometimes feel that instead of living with a spouse, you’re raising another child? Your marriage may be suffering from attention deficit hyperactivity disorder.

Is ADHD affecting your marriage?  Mental health experts note that attention problems can take a toll on adult relationships.

In a marriage, the common symptoms of the disorder — distraction, disorganization, forgetfulness — can easily be misinterpreted as laziness, selfishness, and a lack of love and concern.

It is estimated that at least 4 percent of adults have ADHD; about 10 million U.S. adults, with only about 1.2 million of affected adults in treatment, and with many adults having never received the diagnosis as children.

As many as half of all children with A.D.H.D. do not fully outgrow it and continue to struggle with symptoms as adults.

Symptoms can include trouble with maintaining employment or completing schooling, marital difficulties,  financial challenges, repeated driving violations/tickets,

Adults with attention disorders often learn coping skills to help them stay organized and focused at work, but experts say many of them struggle at home, where their tendency to become distracted is a constant source of conflict.

Some research suggests that adults with ADHD are  twice as likely to be divorced; another study found high levels of distress in 60 percent of marriages where one spouse had the disorder.

Spouses of adults with ADHD often feel they cannot count on their partner. They may feel that the spouse is not dependable such that the unaffected spouse must take responsibility for everything.

Sometimes the unaffected spouse can become chronically angry, frustrated that they dont help around the house, that they are inconsiderate, or that they cannot count on the spouse to complete simple tasks such as running to the bank, paying bills on time, or picking up the kids. They may feel they have no choice but to constantly nag to make sure things get done.

Spouses with attention deficit, meanwhile, are often unaware of their latest mistake, confused by their partner’s simmering anger. A lengthy to-do list or a messy house feels overwhelming to the A.D.H.D. brain, causing the person to experience paralysis, and they accomplish nothing, which further infuriates their spouse. This does not happen due to laziness or selfishness, it happens due to the difficulty with task planning and organization.

Although treatment often starts with medication, it typically doesn’t solve a couple’s problems. Talk therapy may be needed to unpack years of accumulated resentments.

Behavioral therapy and coping strategies — for both partners — are essential. Long, to-do lists given to the spouse with ADHD will not be productive. instead, asking that one task at a time be targeted is more helpful.

Nearly as many American soldiers have died of suicide as have been killed in combat in Afghanistan.

• There were 197 Army suicides in 2008, according to the Army’s numbers. The total includes active- and non-active-duty soldiers.
• Last year, the number was 245.
• This year, through May, it’s already 163.

The Army has instituted many programs to counsel and train soldiers  with a goal of suicide prevention. Several of them have failed. Often, as soldiers transitioned from one assignment to another, the new station was unaware of past mental health issues.

Source: U.S. military branches (2001-09) and Centers for Disease Control and Prevention (latest figures through 2006)

Credit: Adrienne Wollman