Caregiver Psychological Maltreatment Behaviors Toward Children on TikTok.

We examined TikTok user engagement when parents post videos engaging in psychological maltreatment (PM) behaviors towards their children, using the APSAC-endorsed definition of PM. A new TikTok account was created and seeded with PM behavior videos identified previously; similar videos then appeared on the new account's "For You Page" (an algorithmic feed curated by TikTok). Researchers identified 35 creators who had posted at least one PM behavior video, resulting in their full profile being coded (N = 2684 videos) for five engagement metrics, presence of children, and presence of PM behavior. Non-parametric paired comparisons (Mann-Whitney tests) were made within individual creators for: (1) engagement metrics before and after the first PM behavior video, (2) engagement metrics for PM behavior videos versus non-PM videos, (3) engagement metrics for child videos versus non-child videos, and (4) proportion of videos containing children before and after the first PM video. All but one analysis was significant (effect sizes from .28 to .59, average r = .46). We discuss directions for future research, as well as how child welfare and content moderation policy can be updated to change social norms around sharenting.

Successes, challenges, and opportunities in providing evidence-based teletherapy to children who have experienced trauma as a response to Covid-19: A national survey of clinicians.

While teletherapy is not a new phenomenon, most clinicians have not been trained and do not routinely practice it. The current study was designed to ascertain challenges and opportunities presented by the widescale usage of teletherapy especially for traumatized children, which was necessitated by the COVID-19 pandemic. Two hundred and fifty clinicians across the United States providing teletherapy to traumatized children completed an online survey. Results revealed that many logistical aspects of treatment were perceived to be easier when implemented remotely. Some clinical aspects of care were also perceived to be easier, notably engagement with caregivers. Developing rapport, assessing emotions, and keeping children's attention, however, were perceived as more challenging. Child characteristics such as age, attention span, and screen fatigue were viewed as creating challenges. Most clinicians had not received training in relevant topics for teletherapy and were eager to receive such training. These results suggest many avenues for refining and fine-tuning remote mental health services especially for children.

Losses experienced by children alienated from a parent.

Parental alienation occurs when a child aligns with one parent and unjustifiably rejects the other as a result of parental alienating behaviors. This article provides an overview of current research and theory regarding the losses alienated children endure. Parental alienating behaviors alter the child's beliefs, perceptions, and memories of the alienated parent, triggering a cascade of profound losses for the child. These losses include loss of individual self, childhood experiences, extended family, community, and activities and relationships essential for healthy development. Consequently, alienated children often experience ongoing and ambiguous losses and thereby suffer disenfranchised grief in isolation.

Definitions and terminology regarding child alignments, estrangement, and alienation: A survey of custody evaluators.

Parental alienation (PA) is a highly consequential family dynamic that causes harm to children and parents. While many mental health and legal professionals agree that PA is common and potentially very harmful to children, there is still the appearance that there is controversy and discord in the field. The purpose of this study was to test the extent of consensus in the field regarding the basic tenets of PA theory. Specifically, 11 key terms related to PA were identified through expert input and preliminary field-testing. An on-line survey was created specifically for the study to assess level of agreement with these key terms among custody evaluators. This profession was selected because of their high degree of training and experience with a variety of family conflict situations; 119 child custody evaluators selected as members of a professional custody evaluator listing (88% response rate) rated their endorsement of these 11 key definitions with response options including: strongly agree, agree, neither agree nor disagree, disagree, and strongly disagree. Results revealed that roughly 80% of respondents agreed or strongly agreed with each of the 11 definitions. These results demonstrate a high degree of consensus and should guide future trainings of legal and mental health professionals to ensure a common language and understanding of this phenomenon.

Psychological maltreatment: Definition and reporting barriers among American professionals in the field of child abuse.

BACKGROUND: Despite reliable definitions and evidence of harm to children, psychological maltreatment (PM) is significantly less reported to Child Protective Services than physical or sexual abuse in the United States (U.S. Department of Health and Human Services, 2016). OBJECTIVE: The goal of this study was to identify factors influencing identification and intent to report psychological maltreatment. PARTICIPANTS AND SETTING: The sample was comprised of membership of the American Professional Society on the Abuse of Children (APSAC), a multi-disciplinary group of professionals in the field of child maltreatment. METHODS: An anonymous online survey was administered with a 39 % (N = 538) response rate. RESULTS: Only 4 of the 18 items, preselected by experts as representing all PM subtypes in the APSAC- endorsed definition (Hart, Brassard, Baker, & Chiel, 2019), were identified by most respondents as definitely PM. Most respondents believed that PM was associated with harmful outcomes "sometimes" or "mostly." Respondents revealed an intent to report to CPS only 4 of the 18 PM behaviors. Identification of a behavior as PM and as harmful predicted intent to report, explaining between 8-11 percent of the variance. CONCLUSION: Professionals in the field of maltreatment need more training on identification and reporting of PM. A model definition of PM should be developed in order to increase reliability of identification of psychological maltreatment.

Training for mandated reporters of child abuse and neglect: Content analysis of state-sponsored curricula.

BACKGROUND: Child abuse and neglect is a public health concern around the world, with well-established impacts and costs to children, families, and society. While mandated reporters make the majority of reports, child abuse is still under-reported and many mandated reporters fail to report known and suspected cases. OBJECTIVE: This study was designed to evaluate the content of US state-sponsored online mandated reporter training in order to identify gaps and need for improvement in mandated reporter training. METHODS: A deductive qualitative content analysis of the publicly available curricula was conducted. Variables coded were identified through a literature review and consultation with experts. RESULTS: Numerous gaps were identified in the curricula including: few trainings identified reasons why reports should be made, only about one fourth included a definition, indicators, and examples of each type of maltreatment, the average number of suggestions for responding to a disclosure made by a child was 3, and few curricula addressed barriers to reporting or the impact of reporting on the reporter. CONCLUSIONS: The trainings as a whole are not providing mandated reporters with comprehensive information about definitions, examples, and indicators of the major types of childhood maltreatment. In addition, the trainings contain only limited information to motivate reporters to see their role as part of a collective endeavor to protect children, and they are failing to adequately address reluctance about reporting. However, improvements are readily achievable. A partnership approach to curriculum design and delivery is recommended to develop effective training that will promote sound reporting.

Predictors of variation in sate reported rates of psychological maltreatment: A survey of statutes and a call for change.

BACKGROUND: Psychological maltreatment (PM) is equivalent in harm to other forms of child maltreatment and yet it is not included in all US State child abuse statutes and past research using the National Child Abuse and Neglect Data System (NCANDS, 1998, 2007, 2008) identified 300-480-fold differences in substantiated cases across US States. This variation is inconsistent with the significance of the problem and the availability of reliable operational definitions. PARTICIPANTS AND SETTING: US State statutes were coded and compared with reported rates of four different forms of child maltreatment in the 2014 and 1998 NCANDS data sets. METHODS: Data were extracted from NCCANDS and State statutes were coded independently by the authors (kappa = .96). RESULTS: For 2014, the difference in reported rates of PM between the State with the lowest rate and the State with the highest rate was 523-fold which was much higher than for physical (30-fold) and sexual abuse (20-fold) but not neglect (524-fold). Statutes still use the term "mental injury" from the original Child Abuse Prevention and Treatment Act (Child Abuse Prevention & Treatment Act, 1974) and two thirds did not define it. Reported rates of PM in NCANDS were not correlated with whether PM was defined in the statute but when a harm standard was present, reported rates were statistically lower. Almost 70% of statutes mentioned a current trend (e.g., sexual/human trafficking) demonstrating a willingness by States to amend statutes. CONCLUSIONS: A common, reliable definition of PM (and other forms of maltreatment) in CAPTA, NCANDS, and US State statutes is necessary for the US to have a surveillance system that allows for the assessment of the effects of policies on reported rates of all forms of maltreatment.

Best Interest of the Child and Parental Alienation: A Survey of State Statutes.

State statutes regarding the best interests of the child (BIC) in deciding disputed custody were reviewed and independently coded with respect to three issues (i) the child's preference and any limits (ii) parental alienation and (iii) psychological maltreatment. Results revealed that many states allowed for the child's preferences to be considered and none qualified that preference when undue influence has occurred; parental alienation as a term was not found in any state statutes but 70% of the states included at least one BIC factor relevant to its core construct of the parent supporting the child's relationship to the other parent; and many states included a history of domestic violence or child abuse but only three states explicitly mentioned psychological maltreatment. These findings highlight yet another way in which the BICS factors lack specificity in ways that could negatively impact children caught in their parents' conflict.

Associations between Exposure to Alienating Behaviors, Anxiety, and Depression in an Italian Sample of Adults.

The aim of this study was to examine associations between exposure to alienating behaviors (ABs) and anxiety and depression as mediated through psychological maltreatment and parental bonding in a sample of Italian adults in the community. Five hundred and nine adults were given a measure of exposure to ABs, the Baker Strategy Questionnaire; the Psychological Maltreatment Measure; the Parental Bonding Instrument; the State-Trait Anxiety Inventory-Y; and the Beck Depression Inventory-II. Exposure to ABs was associated with psychological maltreatment, which was associated with parental bonding, which was associated with each of the three mental health outcomes: depression, state anxiety, and trait anxiety. The authors conclude that exposure to ABs in childhood represents a risk factor for subsequent poor mental health.

Symptom Checklist-90-Revised scores in adult children exposed to alienating behaviors: an Italian sample.

This study addresses a particular form of child psychological maltreatment, exposing a child to alienating behaviors in the context of a high degree of conflict between the parents. The objective of this research was to identify retrospectively the alienating behaviors that occurred in an Italian sample of children and the reported associated psychosocial symptoms. Seven hundred and thirty-nine adults in Chieti, Italy, completed an anonymous and confidential survey regarding their childhood exposure to parental alienating behaviors and measures of current symptomatology. About 75% of the sample reported some exposure to parental alienating behaviors; 15% of the sample endorsed the item, "tried to turn me against the other parent." The results revealed strong and statistically significant associations between reported exposure to parental alienating behaviors and reports of current symptomatology.

Parental alienation, DSM-5, and ICD-11: response to critics.

There has been considerable interest among forensic practitioners in the proposals that parental alienation be included in the next editions of the Diagnostic and Statistical Manual of Mental Diseases (DSM) and The International Classification of Diseases (ICD). However, there has also been a great deal of misunderstanding about the proposals, and misinformation has been expressed in professional meetings, on websites, and in journal articles. In this article we address four common misunderstandings regarding parental alienation: that there is a lack of research to support it as a diagnosis; that adopting parental alienation as a diagnosis will lead to serious adverse consequences; that the advocates of parental alienation are driven by self-serving or malevolent motives; and that Richard Gardner should be criticized for self-publishing his description of parental alienation syndrome.

How well do evidence-based universal parenting programs teach parents about psychological maltreatment?: a program review.

OBJECTIVE: Psychological maltreatment (PM) is a widespread form of child maltreatment both in high-risk and maltreating families as well as in the general population of parents, yet there are no intervention programs that target it directly. The current study was designed as the first step in a larger program of research concerning educating parents about PM. In this study we evaluated the content of universal parenting programs to assess whether they include content on PM. Three questions were addressed: (1) Which types, if any, of PM were included in the content of these programs? (2) Which programs, if any, have content about each of the types of PM? (3) What are the implications for the development of PM curricula for parents? METHOD: Ten evidence-based, manualized, universal parenting programs identified from SAMHSA or a comparable model program registry were rated on how well their content covered 18 types of psychological maltreatment (PM), as defined by the American Professional Society on the Abuse of Children, APSAC (Bingelli, Hart, & Brassard, 2001; Hart & Brassard, 1995). Each type of PM was coded along several dimensions which resulted in two summary scores: (1) Does the program contain content designed to teach parents what not to do in regards to the 18 psychologically maltreating behaviors and (2) Does the program contain content designed to teach parents what to do instead? RESULTS: Content related to most PM types were not included in the curricula, especially regarding "what not to do" and not one program was rated as having content related to teaching all 18 types of PM. CONCLUSIONS: Existing parenting programs do not currently cover content for teaching community parents about psychological maltreatment.

Children with problematic sexualized behaviors in the child welfare system.

This study assessed the utility of the Child Sexual Behavior Inventory (CSBI) in a child welfare sample. In this study, 97 children from ages 10 to 12 from either foster boarding homes or a residential treatment center participated. Researchers interviewed foster parents or primary therapists about children's sexual behavior, traumatic events, clinical symptoms, and their attitudes toward the child. Findings revealed that problematic sexualized behaviors were more prevalent in the residential treatment center (RTC) sample than they were in a normative sample. The pattern of associations between sexual behavior problems, traumatic events, and clinical syndromes in both the RTC and the foster boarding home (FBH) samples was similar to what has been found in samples in which biological custodial parents were the respondents. Analyses comparing youth who met the criterion for having problematic sexualized behaviors and youth who did not meet the criterion revealed that the two groups differed on clinical symptoms, prior traumatic events, and negative reports by caregivers. Results confirm the utility of the CSBI measure for this population and highlight several important clinical and programmatic concerns for addressing problematic sexual behavior in children in the child welfare system.

Mental health and behavioral problems of youth in the child welfare system: residential treatment centers compared to therapeutic foster care in the Odyssey Project population.

This is the first multisite, prospective study of behavioral and mental health disorders of youth in residential treatment centers (RTC) and therapeutic foster care (TFC), and the first study to compare the two. This study addressed two questions in a sample of 22 agencies in 13 states: (1) how prevalent were emotional and behavioral disorders in the youth admitted to RTCs and TFC?, and (2) were the youth in RTCs significantly more likely to be disturbed than youth served in TFCs? Data were drawn from the Time 1 phase of the longitudinal national "Odyssey Project" developed by the Child Welfare League of America (1995). Measures included an extensive child and family characteristics form (CFC) and the Child Behavior Checklist (CBCL). The results revealed extremely high levels of behavioral and mental health disorders in the sample as a whole, well above the norms for a non-child welfare population. The prevalence of disorder in the RTC population was substantially greater than in the TFC population.

Characteristics of children in residential treatment in New York State.

This study addresses three questions about the population of children and families served in the highest level of care in the child welfare system in New York State residential treatment centers (RTCs): (1) How prevalent are emotional and behavioral problems in the youth entering RTCs? (2) Has the proportion of youth with such problems increased compared to 10 years ago? (3) Are there identifiable subgroups of youth entering RTCs? One-fourth of RTC admissions in fiscal year 2001 were randomly selected from a representative sample of 16 RTCs. The study completed a standardized data collection instrument based on a review of agency records, and included information that was known at the time each child was admitted. The results show significant increases compared to t10 years earlier in the proportion of youth with mental health problems and juvenile justice backgrounds. The findings suggest that youth who traditionally have been served by other systems of care are now being served in the child welfare system. The increased treatment needs of these youth and the heterogeneity of the RTC population have important implications for policies, programs, and practice.

Youth characteristics associated with behavioral and mental health problems during the transition to residential treatment centers: the Odyssey Project population.

This study aimed to determine what youth characteristics were associated with emotional and behavioral problems exhibited within the first three months of placement in residential treatment centers (RTCs) in a sample of youth from 20 agencies in 13 states. Two primary research questions were addressed: 1) What characteristics were associated with behavior during the transition to care? 2) Were the characteristics associated with behavior during the transition the same for boys and girls? Data were drawn from the Time 1 phase of the longitudinal national Odyssey Project dataset developed by the Child Welfare League of America. Measures included an extensive child and family characteristics (CFC) form and the Achenbach Child Behavior Checklist (CBCL). The results revealed significant gender-specific patterns of associations between youth characteristics and behavior exhibited during the transition to RTC placement. Notably, a sexual abuse history was associated with Externalizing for girls and Internalizing for boys and entering on psychotropic medication was associated with Internalizing for girls and boys and Externalizing for boys only. Results suggest many avenues for refining practice.

Sexual abuse histories of youth in child welfare residential treatment centers: analysis of the Odyssey Project population.

This multi-site examination of sexual abuse histories of youth in residential treatment centers asked, for the sample as a whole and by youth's gender: (a) How many perpetrators did each youth have? (b) What was the gender of the perpetrator? (c) What proportion of youth was abused by family members? (d) What proportion of youth was abused in a child welfare setting? And, (e) what proportion of sexually abused youth were also victims of physical abuse and/or neglect? Results revealed that males were more likely to have one perpetrator, a female perpetrator, and to have been abused in a child welfare setting and less likely be abused by a family member. Implications for refining programs and practices are discussed.

Youth with problematic sexualized behaviors in the child welfare system: a one-year longitudinal study.

This study assessed continuity of problematic sexualized behaviors (PSB) over a 1-year period. Ninety-seven 10-12-year-olds in either foster boarding homes or a residential treatment center participated at Time 1. Twelve months later, 78 youth were available for a second data collection assessment. At both data collection phases, researchers interviewed foster parents or primary therapists about the youths' sexual behavior. Findings revealed significant continuity in PSB over time, with children who at Time 1 exhibited PSB significantly more likely to exhibit PSB at Time 2. The reverse was also true in that the absence of PSB at Time 1 was associated with the absence of PSB at Time 2. In addition, a subset of specific PSB behaviors was noted to be most stable, although this varied across the groups. Youth with PSB exhibited several patterns of persistence in specific behaviors over time, including continuity, a mix of continuity and change, and complete discontinuity. The persistence of PSB over time was most true for the children living in a residential treatment center, the more disturbed group studied. We conclude that the persistence of PSB is more likely when the child has other problematic behaviors.

Elevated prolactin levels in male youths treated with risperidone and quetiapine.

The aim of this study was to report on the serum prolactin levels in 70 male youths at a residential treatment center who were treated with either risperidone or quetiapine. This is a cross-sectional retrospective medical chart review of 50 males (mean age, 13.5+/-2.8 years) treated with risperidone (mean dose, 2.4+/-1.6 mg/day) and 20 males (mean age, 13.5+/-2.4 years) treated with quetiapine (mean dose, 317.5+/-238 mg/day). Serum prolactin levels were drawn according to a protocol, after at least 6 weeks of treatment. Prolactin was above the upper limit of normal for 68% of the patients on risperidone and 20% of the patients on quetiapine (chi2 analysis: R>Q; p<0.001). Both risperidone and quetiapine produced dose-related increases in serum prolactin levels (R, r=0.34, p=0.017; Q, r=0.45, p=0.05). No correlation was found between duration of treatment and prolactin levels. Given that hyperprolactinemia secondary to antipsychotic treatment may result in reproductive and growth irregularities, periodic long-term monitoring during treatment with these two atypical antipsychotics (and perhaps others as well) may be warranted.

Covariates of length of stay in residential treatment.

This study explores variables associated with length of stay in a child welfare residential treatment center. The study followed three entry cohorts (416 boys) from admission through discharge. The researchers conducted event history analyses to examine the rates of discharge over time and the covariates of length of stay. They conducted analyses by discharge destination (reunified, transferred, or ran away). The results demonstrated that mental health issues slowed down rates of discharge for youth who were reunified or transferred. For children who left by running away, age and prior substance history were associated with faster rates of exit. These results have important public policy implications for improving the application of length of stay variables in planning and treatment.