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Article Title

Child Abuse and Neglect: Effects on child development, brain development, and interpersonal relationships

Author

Arthur Becker-Weidman, Ph.D.

Posted Date

11/21/2005

 

Neglect, physical abuse, and sexual abuse have profound immediate and long-term effects on a child’s development. The long-term effects of abuse and neglect of a child can be seen in higher rates of psychiatric disorders, increased rates of substance abuse, and a variety of severe relationship difficulties. Child abuse and neglect is an inter-generational problem. Most frequently the perpetrators of abuse and neglect are profoundly damaged people who have been abused and neglected themselves. There are clear links between neglect and abuse and later psychological, emotional, behavioral, and interpersonal disorders. The basis for this linkage is the impact that abuse and neglect have on brain development. Daniel Siegel, medical director of the Infant and Preschool Service at the University of California, L.A., has found important links between interpersonal experiences and neurobiological development.

We know that a child uses the parent’s state of mind to regulate the child’s own mental processes. The child’s developing capacity to regulate emotions and develop a coherent sense of self requires sensitive and responsive parenting. The National Adoption Center found that 52% of adoptable children have attachment disorder symptoms. In another study, by Cicchetti, & Barnett , 80% of abused or maltreated infants exhibited attachment disorder symptoms. The best predictor of a child’s attachment classification is the state of mind with respect to attachment of the birth mother. A birth mother’s attachment classification before the birth of her child can predict with 80% accuracy her child’s attachment classification at six years of age. That is a remarkable finding. Finally, recent research by Mary Dozier, Ph.D. found that the attachment classification of a foster mother has a profound effect on the attachment classification of the child. She found that the child’s attachment classification becomes similar to that of the foster mother after three months in placement. These findings strongly argue for a non-genetic mechanism for the transmission of attachment patterns across generations.

Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average), and antisocial behavior (4.3 times average) . Generally the left hemisphere of the brain is the site of language, motor activity on the right side of the body, and logical thought based on language. The right hemisphere of the brain is responsible for motor activity on the left side of the body, context perceptions, and holistic perception. The orbito-frontal cortex (the part of the brain directly behind the eyes) is responsible for integrating emotional responses generated in the limbic system with higher cognitive functions, such as planning and language, in the cerebral cortex’s prefrontal lobes. The left orbito-frontal cortex is responsible for memory creation while the right orbito-frontal cortex is responsible for memory retrieval. Healthy functioning requires an integrated right and left hemisphere.

A substantial number of synaptic connections among brain cells develop during the first year of life. An integrated brain requires connections between the hemispheres by the corpus callosum. Abused and neglected children have smaller corpus callosum than non-abused children. Abused and neglected children have poorly integrated cerebral hemispheres. This poor integration of hemispheres and underdevelopment of the orbitofrontal cortex is the basis for such symptoms as difficulty regulating emotion, lack of cause-effect thinking, inability to accurately recognize emotions in others, inability of the child to articulate the child’s own emotions, an incoherent sense of self and autobiographical history, and a lack of conscience. The brains of abused and neglected children are not as well integrated as the brains of non-abused children. This helps explain why abused and neglected children have significant difficulties with emotional regulation, integrated functioning, and social development.

Conscience development and the capacity for empathy are largely functions of the orbito-frontal cortex. When development in this area of the brain is hindered, there are important social and emotional difficulties. It is very interesting that the orbito-frontal cortex is sensitive to face recognition and eye contact. Abused and neglected children frequently have disorders of attachment because of their birth-parents lack of sensitive responsive interactions with the child. Early interpersonal experiences have a profound impact on the brain because the brain circuits responsible for social perception are the same as those that integrate such functions as the creation of meaning, the regulation of body states, the regulation of emotion, the organization of memory, and the capacity for interpersonal communication and empathy. Stressful experiences that are overtly traumatizing or chronic cause chronic elevated levels of neuroendocrine hormones. High levels of these hormones can cause permanent damage to the hippocampus, which is critical for memory. Based on this we can assume that psychological trauma can impair a person’s ability to create and retain memory and impede trauma resolution.

Abused and neglected children exhibit a variety of behaviors that can lead to any number of diagnoses. However, the effect of early abuse and neglect on the child can be seen in just a few critical areas of development. These areas include emotional regulation, response flexibility, a coherent integrated sense of self across time, the ability to engage in affect attunement with significant others (empathy and emotional connectedness), and conscience development. The effects of early maltreatment on a child’s development are profound and long lasting. It is the impact of maltreatment on a child’s developing brain that causes effects seen in a wide variety of domains including social, psychological, and cognitive development. The ability to regulate emotions and become emotionally attuned with another depends on early experiences and the development of specific regions of the brain. Early maltreatment causes deficits in the development of these brain regions, primarily the orbito-frontal cortex and corpus callosum, because of the toxic effects of stress hormones on the developing brain.

These findings strongly suggest that effective treatment requires an affectively attuned relationship. Siegel stated, “As parents reflect with their securely attached children on the mental states that create their shared subjective experience, they are joining with them in an important co-constructive process of understanding how the mind functions. The inherent feature of secure attachment – contingent, collaborative communication – is also a fundamental component in how interpersonal relationships facilitate internal integration in a child.” This has implications for the effective treatment of maltreated children. For example, when in a therapeutic relationship the client is able to reflect upon aspects of traumatic memories and experience the affect associated with those memories without becoming dysregulated, the client develops an expanded capacity to tolerate increasing amounts of affect. The client learns to self-regulate. The attuned resonant relationship between client and therapist enables the client to make sense (a left-hemisphere function) out of memories, autobiographical representations, and affect (right hemisphere functions).

References

Creating Capacity for Attachment. Edited by Arthur Becker-Weidman, Ph.D., & Deborah Shell, MA, Wood 'N' Barnes, OK: 2005. The Developing Mind: Toward a Neurobiology of Interpersonal Experience. Daniel J. Siegel, The Guilford Press, 1999. Cicchetti & Barnett, 1991. “Attachment for Infants in Foster Care: The Role of Caregiver State of Mind,” Child Development, vol. 70, pp. 1467-1477, 2001. MacMillian, H.L., et. al., “Childhood Abuse and Lifetime Psychopathology in a Community Sample,” American Journal of Psychiatry, vol. 158 # 11, pp 1878-1883, November 2001. McEwen, B., “Development of the cerebral cortex XIII: Stress and brain development – II” Journal of the American Academy of Child and Adolescent Psychiatry, 38, 101-103, 1999.

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158956

Article Title

Peer Pressure and Teens

Author

Nivea David

Posted Date

12/16/2006

 

Peer pressure is one thing that all teens have in common. You can't escape it. It is everywhere. Whether it is pressure to conform to a group norm or pressure to act, peer pressure is something everybody has to deal with at some time in his or her life. Children, especially during adolescence, begin to spend a lot more time with their friends, and less time with their family. This makes them more susceptible to the influences of their peers. It is important to remember that teenage friends can have a positive influence on your children, you should therefore help them find friends that have similar interests and views as those you are trying to develop in your children, including doing well in school, having respect for others and avoiding drug use, smoking and drinking, etc.

How successfully you handle peer pressure depends a great deal on how you feel about yourself and your place in the world. There are certain "risk factors" for peer pressure, personality traits that make you more prone to give in to peer pressure. Parents of teens typically talk about peer pressure a lot. They sometimes blame peer pressure when teens make poor choices. But, peer pressure is often misunderstood in a number of ways. Peer Pressure is two types; such as positive and negative peer pressure.

Peer pressure isn't always negative. Peers may pressure others into negative behaviors or away from positive behaviors, but can push in positive directions as well. Not all teens react to peer pressure in the same way. Gender and age are factors. For example, boys are more susceptible than girls to peer pressure, particularly in risk situations. Younger teens are more easily influenced than older teens, with peer pressure peaking in about eighth or ninth grade. Individual characteristics such as confidence level, personality and degree of maturity make a difference. Peer pressure varies according to the situation: being with one close friend, in the small clique of friends, or seeing what the larger peer group is doing in school. Parents on longer-term issues, including college and vocational choices, political, moral and religious concerns, influence teens. That influence can lead to parents and teens having similar views, with variations based on peers and changing social opinion. The need for acceptance, approval, and belonging is vital during the teen years.

Teens who feel isolated or rejected by their peers —or in their family — are more likely to engage in risky behaviors in order to fit in with a group. In such situations, peer pressure can impair good judgment and fuel risk-taking behavior, drawing a teen away from the family and positive influences and luring into dangerous activities. To protect your teens from that go to the following web sites: http://www.troubled-teens.biz/ Troubled Teens Biz is a listing of articles specifically designed to support the parents of Troubled Teens. Provide them proper guidance about teen’s problems and in the process save the parent time, energy, and thousands of dollars.

References

About Author: Nivea David For listings please visit http://www.troubled-teens.biz/ for Help for Troubled Teens .

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Article Title

Can a child choose which parent to live with?

Author

Gary Direnfeld, MSW, RSW

Posted Date

5/18/2006

 

Eeny, meeny, miny, moe… Can a child choose which parent to live with? Sometimes parents involve their children in custody, residency and access matters hoping the opinion of the child sways the outcome. At other times, children may seek to initiate a change themselves.

The child’s desire may be due to conflict with a parent; seeking to be closer to a particular school or friends; or even seeking to avoid reasonable parental expectations looking instead to live with the parent with whom they have greater albeit inappropriate freedoms. Thus children sometimes wonder about their influence in such matters too. Generally, custody, residency and access decisions are matters for parents to decide. When they are unable to reach a decision between themselves, parents may turn to a counsellor for guidance. If that is unsuccessful, parents may then turn to a mediator and if that is unsuccessful, they may turn to the court.

With regard to the input of children, the older the child, they more weight their input can have in the decision making process. Often the age of twelve is considered a turning point when the opinion of a child may begin to truly give added weight to these decisions. However, there is nothing magical or automatic about that number. Maturity of the child, the situation and parental influence will also be important factors, not to mention the needs of the child and the respective parent’s ability to meet those needs appropriately and in a timely fashion. Therefore, being minors, the decision still remains in the hands of adults, be they the parents, professionals or Courts.

Parents are always cautioned against involving their children in custody, residency or access decisions. In the event a parent influences a child, the child may feel in a bind, unable to resist the influence of the parent and not wanting to undermine their relationship with the other parent. Hence influencing a child only adds to their psychological and emotional distress living between their separated parents. In these circumstances, parents must ask themselves if what they are doing is truly for the child or their own interest. From the child’s perspective there can be all sorts of legitimate reasons to alter their residency between separated parents. However the child may not be privy as to how the custody, residency or access decisions were arrived at in the first place. Hence their view of the situation may not be fully informed.

So while children may form a reasonable argument in view of their desire, it still remains between the parents to discuss and reach a decision. Whether child initiated or parent initiated, parents are encouraged to sit down with each other and the older child and if unable to resolve matters between themselves, consult a counsellor, mediator or lawyer to aid in their decision making process. Counsellors or mediators who work for an agency may have long waiting lists for service. Those who are in private practice, where the parents pay for service, are generally more readily available.

While parents may consult with the older child, hopefully in the end they will keep the actual decision making process to themselves.

References

Gary Direnfeld, MSW, RSW (905) 628-4847 gary@yoursocialworker.com www.yoursocialworker.com Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert on child development, parent-child relations, marital and family therapy, custody and access recommendations, social work and an expert for the purpose of giving a critique on a Section 112 (social work) report. Call him for your next conference and for expert opinion on family matters. Services include counselling, mediation, assessment, assessment critiques and workshops.

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56521

Article Title

Know Your Rights: Disability Manifestation Determination for Your Child

Author

Boris Gindis, Ph.D.

Posted Date

3/5/2006

 

It's well known that internationally adopted post-institutionalized children have more behavioral problems than children at large. It's not surprising: a wide range of typical for them disabilities is manifested in disruptive behaviors. Their problems are often difficult to understand and address, especially within school environment. For example, the symptoms of some neurologically-based impairments, such as Asperger's Syndrome, can be misinterpreted as purposeful misbehavior. Other children may have multiple disabilities or psychiatric conditions mixed with the learned institutional behavior, which makes the determination of the roots of their behavioral issues even more complex.

A disruptive and dangerous behavior at school typically results in serious consequences, ranging from the child's suspension from the class for several days to a full expulsion from the school. If the child with a disability had been determined to have committed an offense that violated school rules and could result in expulsion for longer than ten school days, the IEP team must meet to determine whether the misconduct resulted from the disability. This is referred to as manifestation of determination hearing. It must be done within the first ten days of child's suspension. If the behavior is a manifestation of the child's disability, the child must be returned to the current placement, unless the parent and IEP team agree otherwise. If a child has behavior problems that interfere with his or her learning or the learning of others, the IEP team must consider whether new strategies are needed to address the behavior.

If the IEP team determines that such services are needed, they have to be added to the IEP and provided. If the behavior is not a manifestation of disability, the child may be disciplined, suspended, or expelled to the same extent as a child without disability. As a result, no specific and necessary for a disabled child services will be offered. As you can see, it is very important for the parents of internationally adopted children with disabilities to understand what is at stake and how to approach this problem.

IDEA and the disability manifestation determination

The reauthorized Individuals with Disabilities Education Improvement Act known as IDEA 2004, was signed into law on Dec. 3, 2004; the provisions of the act became effective on July 1, 2005. This law is the basis of disciplinary proceedings and disability manifestation determination of students having educational handicapping condition. The provisions of the IDEA in regards to disability manifestation determination are described in the document that can be found at http://www.ed.gov/policy/speced/guid/idea/tb-discipline.pdf and clearly state several important things for the parents of internationally adopted children:

1. The determination of disability manifestation is done by the local education agency (LEA), the parent, and relevant members of the Individualized Education Program (IEP) team. If the child's parents disagree with the disability manifestation determination meeting decision, a due process hearing can be requested from a panel outside of the basic IEP team. At this meeting it is wise for parents to engage the services of an educational legal advocate, or a special education lawyer, who can help them make certain that the needed procedures are followed in the hearing.

2. The above members of the team must prove that the child's behavior was caused by, or had a direct and substantial relationship to the child's disability. The question is how to establish that the offending conduct was "caused by or had a direct and substantial relationship" to the child's disability. In the case of a child with a neurologically-based disability which involves impulsivity and uncontrollable acting-out behavior, finding a link between behavior and disability we need to focus on the neurological impediments to behavior control. The law directs schools to consider the use of Functional Behavioral Assessments and Positive Behavior Intervention Plans in the case of behavioral problems. However, relying on a commonly used reward and punishment model will not assist a child with a neurologically based disability. In fact, it frequently increases, rather than decreases, disruptive behaviors in students with neurologically-based disorders, such as Autism, Tourette Syndrome, or Bi-Polar disorder, because this behavior is stimulated and motivated by internal biological factors. Parents alone may not be equipped to prove the case; the help of a qualified professional, in some cases - a team of professionals consisting of a psychologist and educational law attorney - is needed.

3. If the child did not have an IEP and was not classified as disabled prier to the incident, he/she still may be considered a child with disability when:

  • The parent of the child expressed concern in writing to supervisory or administrative personnel of the appropriate educational agency, or a teacher of the child, that the child is in need of special education and related services.
  • The parent of the child has requested an evaluation of the child.
  • The teacher of the child, or other personnel of the LEA, has expressed specific concerns about a pattern of behavior demonstrated by the child, directly to the director of special education of such agency or to other supervisory personnel of the agency.

These provisions demonstrate that the parents can and should inform school in writing about their concerns and hire a relevant professional to participate in the IEP team to help monitor the procedures and/or help determine the real roots of their child's behavioral problem. Let us look at two case studies to better understand how important it is for the parent to have an experienced in international adoption issues professional to find the most appropriate solution for the child.

Case study: Jerome

Jerome is a 9-year-old child diagnosed with Asperger's Disorder, adopted at the age of 4 from Ukraine, currently placed in regular education class with supportive services. Here are Jerome's behavior patterns described by the parents; these behaviors are major concern for the parents and the school alike:

    Jerome's behavior continues to be the most challenging item to deal with. We have seen Jerome go into spitting, blowing his nose without using a Kleenex; he has become physically aggressive (i.e. throwing chairs and turning over tables); he has hit and kicked others, he has verbally threatened to hurt others and himself (i.e. using words like kill, break their necks, etc.) and has had to be restrained at times to protect himself and those around him. Although it has been difficult to determine what is triggering some of this behavior at school, we suspect he perceives a threat and his anxiety level is high, and on numerous occasions he has told us that he wasn't safe at school.

It is my professional opinion that these behaviors are the manifestation of Jerome's major mental health condition, Asperger's Disorder, and are to be treated as such. By no means should these behaviors be understood as "emotional disturbance." It is true that Jerome demonstrates at least two prominent features usually associated with educational classification of "emotional disturbance," such as: an inability to build or maintain satisfactory interpersonal relationships with peers and teachers and inappropriate types of behavior or feelings under normal circumstances. However, the same exact characteristics are the core features of the Asperger's Syndrome, related to severe impairment in social interactions and to heighten level of anxiety. Regardless to similarities in manifestation, the placement and remedial methodologies are different for children with Asperger's Disorder and Emotionally Disturbed children. In complex cases as Jerome's, the role of an externally hired professional who can help establish the true roots of disruptive behavior and recommend the adequate remedies for the child within the school system, the role of this specialist cannot be overestimated.

Case Study: Max

Max is an 8-year-old boy who was diagnosed with ADHD and is known to have learning difficulties and emotional instability; he has an educational classification Other Health Impaired; he was adopted from Russia two years ago. He is provided with special education services in the regular education classroom. Max's classroom behaviors often upset his new, first year teacher. He would often ask that directions be repeated and he needed extended time on most assignments. He would also become agitated and frustrated when he could not follow the teacher's instructions. One day when he was agitated a peer grabbed the work with which Max had been struggling. Max was trying to figure out how to cut out and paste a picture onto his class assignment. He was using blunt end plastic school scissors. When the classmate pulled his work away from him, Max picked up the scissors he was using in a threatening manner to the child and told him he had better watch out. The teacher sent the child to the principal's office. This was not a first visit but it was the first for violent behavior. Under mandates for "zero tolerance for violence" the principal immediately suspended the child for the rest of the school year (practically, for one month). In Max's case, both a disability determination manifestation IEP meeting and a due process hearing were held. It was determined that his actions were due to his disability: ADHD. His IEP team was asked to reconvene to provide more support for his behavior problems in the regular education classroom. The parents had to hire an attorney to help them work through the steps of this process.

The disability manifestation determination for an internationally adopted child is a very complicated issue. The rights of both teachers and other students must be protected. Violence and the use of drugs put others at risk as well. The case examples presented in this article show how expulsion can quickly happen in situations where it is not justified. In many cases the expulsion is justified. When this happens, work with the IEP team to determine if alternative education programs can be put into place so that your child can continue the education.

References

Dr. Boris Gindis is a child psychologist specializing in psycho-educational issues of older internationally adopted children. He is chief psychologist at the Center for Cognitive-Developmental Assessment and Remediation, the lead instructor at Bgcenter Online School, the author of many publications on international adoption issues and frequent presenter at conferences and workshops.

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45049

Article Title

Thalassemia

Author

George Rogu M.D.

Posted Date

2/21/2006

 

Hemoglobinopties are disorders of blood cell structure and they may occur in many different ethnic groups, such as African, Asian, Mediterranean or Middle Eastern decent. There are two major types of Hemoglobinopaties:

1) Thalassemias : which are caused by quantitative deficiencies in the in the production of globulin chains which are used to produce hemoglobin. These defects generally produce anemia of varying degrees depending on severity.

2) Structural abnormalities of globin chain production causing a defect in the shape of the blood cells. Examples of this type of anemia would be an illness called Sickle Cell disease. In this article we will talk about the Thalssemia syndromes and in particular about Hemoglobin H disease. In order for the human body to make normal hemoglobin, which is required to transport oxygen to all our vital organs, normal cells must have 4 alpha globin genes. In the Thalassemia disorders, there is a genetic defect or deletion in one to four of these alpha-globin genes on a chromosome #16.

The severity of the syndrome is related to the number of gene deletions.

  • Silent Carrier: has one gene deletion. They are asymptomatic and have normal blood findings.
  • Alpha-Thalsemia Trait: 2 gene deletions, they have normal or slightly decreased hemoglobin (blood levels) causing a mild anemia. 
  • Hemoglobin H disease: 3 gene deletions. They have mild to moderately severe anemia.
  • Hydrops fetalis: 4 gene deletions. They have severe intrauterine anemia, asphyxia, and usually expire shortly after birth. blood

In-patients with Hemoglobin H disease, or 3 gene deletions, these patents may be symptomatic and have secondary complications of hemolytic anemia. Patients with HbH disease can generally have moderate to severe anemia, with low hemoglobin levels of 7-10g/dl. Other common medical finding would be paleness, jaundice (or yellowness) large liver and spleen, increased susceptibility to infections, leg ulcers and pigment gallstones which occur after prolonged breakdown of red blood cells, can cause recurrent abdominal pain and may require surgery. Deficiency in Folic acid may also occur. Complications that can occur in children with HbH disease are generally the result of intermittent exacerbation of their anemia, which may require repeated blood transfusions. These episodes of hemolytic anemia generally are precipitated by certain drugs or by a parvovirus infection. Usually patients with HbH disease can lead fairly normal lives with relatively few blood transfusions. Transfusion therapy is usually reserved for patients with severe anemia (usually less than 7g/dl) and with symptomatic anemia.

Another complication of this disease is the enlargement of the spleen with worsening of the anemia. Many times this requires the removal of the spleen itself, and then you have all the complications other than just that of surgery, which is the susceptibility to bacterial infections. Usually removal of the spleen is reserved for patients with symptoms of large spleen, as reflected by leukopenia (decreased white blood cell levels) thrombocytopenia (decreased platelet count) and worsening anemia or, in-patients who were previously stable and develop blood transfusion requirement. What does the medical future of this child have in store for this adoptive family?

1) Usually patients with HbH disease can lead relatively normal lives.

2) They may require repeated blood transfusions, and after many years of therapy may result in a complication of iron overload.

3) Large spleen which may require its removal.

4) Susceptibility to bacterial infection after the removal of the spleen.

5) Many children are kept on prophylactic penicillin therapy to ward off infection.

6) Severe hemolytic anemia episodes which may easily be triggered in times of stress, infections with viral illness or may even by certain types of medications such as sulfur.

7) Gallstones and abdominal pain all secondary to pigment stone collection caused by prolonged destruction of red blood cells. Surgical removal of gallstones to alleviate the abdominal pain.

Now back to the original question that the parents say they are not carriers and are not ill. I believe that they are not ill but are more than likely both silent carriers of the disease or have the thalsemia trait or some combination of this. Because of the rules in genetics, it is possible to have three other children that are not ill with the severe form of the disease, but they may also be silent carriers or have the thalasemia trait. From the clinical description of this child's medical scenario, the diagnosis may be accurate. Good follow-up with a Pediatric Hematologist is essential to the management of this disease

Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made.

References

Adoptiondoctors.com is an innovative International Adoption Private Practice dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. We are the GO TO place for your Adoption related medical questions. All medical interactions are performed via, e-mail, express mail, telephone and fax. There is no need to make a live appointment or travel outside of you hometown. Blind referral and support services now available during your trip. Never feel like you are abandoned while you are overseas. Adoptiondoctors.com is just a computer click away.

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