Clinical expertise and the assessment of child sexual abuse.

OBJECTIVE: Mental health specialists (N = 48) were surveyed as to (1) their estimates of the likelihood that a 3-year-old child had been sexually molested (as alleged by her mother in the context of a child custody dispute) by her father, and (2) their recommendations, given their estimates, as to child visitation/custody. METHOD: Specialists heard a detailed presentation of the court-appointed clinician's findings in this case, which included parent interviews and videotaped child-parent interaction sequences. RESULTS: The array of estimated likelihoods was extreme despite that all the clinicians heard the same case. Recommendations to the court strongly tended toward restriction of child-father contact, even when estimates of the likelihood of abuse were low. CONCLUSIONS: Courts should be highly cautious in relying on clinical experts in child custody cases entailing allegations of child sexual abuse. Practitioners should be candid with courts concerning the absence of diagnostic precision in such cases.

Inferential statistical methods for strengthening the interpretation of laboratory test results.

Laboratory test results for the diagnosis of psychiatric illness usually are reported descriptively despite the ready availability of appropriate inferential statistics. A test's sensitivity, specificity, and diagnostic confidence are conditional probabilities. Confidence intervals may be calculated for these probabilities in any given study. Statistical tests for comparing the results of several studies use techniques for planned and posterior comparisons applied to contingency tables. These established statistical methods aid in the interpretation of laboratory test findings.

The effect of fluoride and strontium application on dentin: in vivo and in vitro studies.

The effectiveness of topical 2% sodium fluoride applied with and without 10% strontium chloride pretreatment was compared in patients complaining of tooth hypersensitivity. In addition the radiopacity of 2% sodium fluoride and 25% strontium chloride treated dentin was studied in vitro. Reduction of sensitivity to cold and mechanical stimuli was evaluated during a period of 3 months by pain scoring in the exposed cervical dentin of homologous teeth on the two sides of the jaws. There was a significant decrease in the sensitivity of the exposed cervical dentin after treatment with sodium fluoride solution with or without pretreatment with strontium chloride solution. At the end of the experimental period the combined strontium and fluoride treatment was found to be more effective than that of fluoride alone in reducing sensitivity to cold. The increase in radiodensity of dentin samples immersed in strontium chloride was statistically significant, while there was no significant increase in density for the samples immersed in sodium fluoride solutions. A mineralization process is possibly the effective means by which fluoride or strontium diminishes sensitivity of dentin.

Children's understanding of their emotionally disturbed peers. I. The concept of emotional disturbance.

Study of the interpersonal relations of emotionally disturbed children has focused largely on relationships within the family. Theories of childhood psychopathology focus almost exclusively on the parent-child triad as the etiological core of childhood emotional disturbance (Frank, 1965). Far less attention has been paid to the role of extra-familial attitudes and relationships in childhood psychopathology. In a general way, the increasing importance of the peer group during childhood has been recognized, but researchers have hardly begun to consider whether and how the manifold aspects of relationships between the emotionally disturbed and their normal peers might bear on the course of the disturbance or its refractoriness to treatment (e.g., Solomon and Wahler, 1973). Nor have they considered peer group influences on the development of the emotionally disturbed child's perception of the world and his place within it. Despite increasing recognition of the early importance of peer relations, virtually no systematic information exists on the ways in which normal children view their emotionally disturbed peers. Our purpose in this paper is to report the first of several analyses of data from an initial investigation of children's understanding of their emotionally disturbed peers. Specifically, we wish to examine whether there is evidence that normal children do, in fact, perceive as emotionally disturbed the symptomatic and distressing behavior of peers that mental health professionals would recognize as indicative of psychopathology. Further, we wish to study these issues with respect to grade and sex differences.

Children's understanding of their emotionally disturbed peers. II. Etiological factors.

In a previous study, we (Marsden and Kalter, 1976) found that fourth- and sixth-grade children not only made distinctions between normal and emotionally disturbed behavior, but also were able to discriminate degrees of childhood psychopathology in a manner strikingly congruent with clinician-judges. Having assessed children's perceptions of emotional disturbance, we turned our attention to how the children might account for the development of such childhood disorders. We are aware of no previous study which has examined children's views of the etiology of emotionally disturbed behavior of their peers. Such information could shed further light on children's understanding of childhood psychopathology and might implicitly indicate what children believe are the necessary ingredients for healthy emotional development. This knowledge would be useful to mental health professionals, teachers, and parents seeking both to understand the emotionally disturbed child's place in his peer group and to convey an understanding of emotional illness to normal children.

Perceptions of quality of life following divorce: a study of children's prognostic thinking.

The general quality of latency-aged children's prognostic thinking and the way in which they view the long-range impact of divorce upon peer adaptation are explored. When interviewed about responses to two fictional peers with marked behavior problems, 80 children in the third and fifth grades displayed an optimism in their prognostic thinking about the future of these peers. In general, peers from divorced homes were perceived as having a more positive future adjustment than peers from intact homes. However, male subjects from disrupted homes revealed a significantly pessimistic orientation regarding the impact of divorce upon the future; females from disrupted homes had a strikingly optimistic view. Implications for school-based interventions are discussed.

Divorced women: individual differences in stressors, mediating factors, and adjustment outcome.

Individual differences in exposure and response to stress in a sample of 56 divorced mothers were examined. Compared with normative data, the sample reported significantly more negative life events, more psychiatric symptoms, and poorer social adjustment. Social support and income emerged as the mediating factors most strongly associated with adjustment outcome.

Preventive intervention groups for parentally bereaved children.

A model of time-limited intervention groups for parentally bereaved children is described, and common emergent themes are discussed. These suggest that youngsters continue to struggle with death-related stress well beyond the time of the loss. The need to maintain an emotional attachment to internal representations of the deceased parent appears to be an important component of the bereavement process.

Children of divorce: predictors of change following preventive intervention.

Fifty-three fourth- and fifth grade children were tested on postdivorce adjustment immediately before and six months after participation in an eight-week preventive intervention program. At follow-up, most showed positive change, with those at special risk for adjustment problems showing substantial gains. Results did not vary with sociodemographic or divorce circumstances.

Anticipating parental death in families with young children.

Findings from a community study of parentally bereaved children demonstrate that forewarning of death is not associated with more favorable mental health outcomes than is sudden death of a parent. The applicability of the of the general anticipatory grief literature to the circumstances of children facing the loss of a parent is called into question, and the need to assess more carefully the effect on children of a parent's protracted terminal illness is emphasized.

Predictors of children's postdivorce adjustment.

Six hypotheses to explain how divorce may affect the trajectory of child development were tested using standardized measures and sociodemographic data. Correlational and multiple regression analyses revealed that the parent adjustment hypothesis received the strongest support. Boys appeared sensitive to events and behavior in their mothers' lives, while girls seemed attuned to mothers' internal states.

The multiproblem family presents in a children's outpatient psychiatric clinic.

This study focuses on children from multiproblem families when they appear at an outpatient psychiatric clinic for children. The sample consisted of the first 50 children and their families referred to a large children's outpatient psychiatric facility early in 1974. A multiproblem family was defined in terms of the number of helping agencies and/or professionals contacted by family members within the 3-year period prior to the current psychiatric evaluation and by the number of households in which the designated child patient had lived. Eighteen percent of the 50 cases met the criteria established for a multiproblem family. These indicators successfully differentiated multiproblem from nonmultiproblem families along a number of socioeconomic, demographic, family health, and family stability dimensions. Special difficulties encountered in psychiatrically evaluating children of such multiproblem families are presented, and ways of dealing with them are discussed.

Children's understanding of their emotionally disturbed peers: a replication.

Despite increasing recognition of the early importance of peer relations, virtually no systematic information exists on the way in which normal children view their emotionally disturbed peers. This paper reports a replication of recent findings on children's use of the concept of emotional disturbance. Ss were 40 fourth and sixth graders. Five vignettes that described one normal and four emotionally disturbed boys were read to individual Ss; who were interviewed about their understanding of the central figures (CFs). Interviews were coded to a 5-point scale of degree of perceived emotional disturbance. Earlier findings were replicated to a remarkable degree. Ss differentiated among the CFs in a manner congruent with clinician judges' ratings. Grade differences indicate the differential attention to and valuing of specific behaviors, rather than global differences in perception of emotional disturbance.

The biases of child sexual abuse experts: believing is seeing.

Experts in clinical evaluations of child sexual abuse were studied using a paradigm that requested them to estimate the likelihood of a 3-year-old child having been sexually molested by her father, as alleged by her mother, when she was two years old. All of the experts claimed special qualifications and experience in the field of diagnosing and treating child sexual abuse victims. Expert-respondents provided two estimates of the likelihood that the child had been molested, the first following a detailed presentation of the clinical case by the actual evaluator of the child (the presentation included opportunities to ask questions ad libitum beyond the presentation material), the second following an extensive discussion of the clinical material with other child experts present. The range of estimated likelihoods that the child had been molested was extreme among the expert respondents. The clinical conference format that was used seemed to provide the experts with no apparent means for eliminating or reducing differences in their clinical opinions. Recommendations concerning how the supervising court should regulate further child-father contacts were similarly varied. The implications of these findings for judicial acceptance of expert testimony in cases of alleged child sexual abuse are discussed.

Locus of control in children of divorce.

Scores on the Nowicki-Strickland Locus of Control Scale for Children (N-SLOCSC) were compared for third and fifth grade boys and girls from intact versus maritally disrupted family backgrounds. Significant main effects for each independent variable revealed that fifth graders more than third, boys more than girls, and the marital disruption more than the intact group, exhibited higher internality in their locus of control scores. These findings strongly suggest that experiencing a parental divorce in childhood has a significant influence on generalized perceptions of personal control and effectance, perceptions which may ultimately mediate both short- and long-term outcomes in children's post-divorce adjustment.