Increased nocturnal activity and impaired sleep maintenance in abused children.

OBJECTIVE: Previous studies have suggested that sleep disturbance may be the "hallmark of posttraumatic stress disorder," although several investigations have failed to find evidence for sleep disruption. The purpose of this study was to determine whether intense averse stimulation during early development, in the form of physical and/or sexual abuse, led to disruption of sleep and nocturnal activity. METHOD: Nineteen prepubertal children with documented abuse were compared with 15 nonabused normal controls and 10 depressed children. All subjects received a complete semistructured diagnostic interview. Ambulatory activity monitoring was used to evaluate sleep-related activity for three consecutive nights. Data were analyzed for nocturnal activity and algorithmic estimation of sleep initiation and continuity. RESULTS: Abused subjects were twice as active at night as normal and depressed children, and abused subjects emitted a greater percentage of their total daily activity during the night. Actigraph-derived sleep measures suggested that abused children had prolonged sleep latency and decreased sleep efficiency. Physically abused children had more impaired sleep efficiency than sexually abused children. CONCLUSION: Abused children have higher levels of nocturnal activity than normal controls or depressed children and appear to have more difficulty falling and staying asleep. Physical abuse appears to be the salient factor rather than posttraumatic stress disorder.

Parents' perceptions of their children's recovery 5 to 10 years following day-care abuse.

A follow-up study of 19 parents whose children had been physically, sexually and psychologically abused in day care 5 to 10 years previously, suggests that as perceived by the parent, over one third of the children remain clinically symptomatic, one third are in the normal symptomatic range, and one third are asymptomatic. Also, parents themselves were still distressed by the event and expressed concern as to their child's future interpersonal relationships. It is recommended that nurses provide brief counseling sessions to parents for management of their children's posttrauma symptoms.

Delayed reporting of the rape victim.

1. Delayed reporting of rape may be due to impaired cognitive processing, altered states of consciousness, or cognitive dissonance. 2. DNA may speak for the victim who does not remember a rape due to being unconscious. 3. Women with psychosis may incorporate a rape into their delusional system.

Infant abductors.

1. Admitted kidnappers identified four phases involved in stealing an infant as: setting the stage for a baby, planning the abduction, the act of abduction, and post-abduction discovery. 2. Abductors describe personal pressure and interpersonal pressures as motivations in stealing an infant. 3. The act of abducting an infant ranges from the use of no force to lethal force.

Memory presentations of childhood sexual abuse.

Questions are continually raised about the accuracy and validity of very young children's memories of traumatic events. Out of 19 children, where the median age was 2 1/2 at time of disclosure, 11 had full verbal memory, five had fragmented verbal memory traces, and three had no memory 5 to 10 years following day care sexual abuse. Data from this clinical study suggest the nature of children's memory is four-dimensional: somatic, behavioral, verbal, and visual. Efforts need to continue to document the nonverbal components for assessment and treatment purposes.

Biology of memory and childhood trauma.

Examples have been presented of children's behaviors that demonstrate the trauma-learning pattern of re-enactment, repetition, and displacement. They become persistent parts of the symptom complex of PTSD. The encapsulation phase occurs when the trauma event occurs and symptoms present themselves, but the events as yet are undisclosed. The trauma-specific behavior patterns, the general hyper-arousal symptoms, and the avoidant, numbing symptoms persist; the emerging disruptive behaviors are not linked to the traumatic event and reactions to the trauma. The response of the child's social and interpersonal context to the internalizing or externalizing behaviors post-trauma, continue shaping the internal cognitive schema of the child. When the child is unable to link ongoing, self-defeating, disruptive behavior to trauma experience, the underlying fear persists. This interferes with the child's ability to modulate emotions either through altering the persistence of refractory, self-limiting cognitive schema or the inability to use new experience to develop and grow. The flexibility of children to discriminate new information may be lost; the children are either numb to new information or hyperalert and perceive danger. Issues for treatment include children's distress over memories of the trauma and the lack of capacity to learn and develop from new interpersonal experiences. It has been our experience that nurses first must help the child relearn flexibility through self-observation, the element of self-soothing and calming behaviors, processing of new information, and strengthening of social relationships. With new and strengthened personal resources, the child then is able to begin to process the traumatic memories.

The nurse-patient relationship and victims of violence.

Vicarious traumatization is a phenomenon that recognizes that the exposure of persons, other than the victim, to the specifics of trauma material or the reenactment of traumatic experiences transmits the emotionally laden aspects of the original violence and thus is a source of emotional arousal and distress for the nurse working with victims of violence. This source of emotional arousal shapes the underlying approach--avoidance dynamic of countertransference responses that strain the empathic connection necessary for a safe and constructive nurse-patient relationship. Case consultation and supervision are necessary to protect the integrity of the nurse-patient relationship. The current isolating changes in the work setting cut the nurse off from needed support and guidance in working with victims of violence. The emotional risks inherent in working with victims of violence require that the nurse seek professional support for the interpersonal aspects of practice.

Children's drawings.

Children's drawings have been used in clinical interviews to provide direction for recollection and memory of events. Drawings encourage the retrieval of experience in the motoric, visual, and auditory recall. The drawing itself gives an expression of motor sensory discharge; the objects in the drawing help with the perceptual cues that are remembered; the cognitive dimensions are represented in the organization, interpersonal patterns, and verbal discussion of the picture. The premise of this paper is that children's drawings are useful as an associative tool for assessing and accessing traumatic memories.

Information processing of trauma.

This article presents a neuropsychosocial model to explain a victimization experience. It surveys the relation of sensation, perception, and cognition as a systematic way to provide a framework for studying human behavior and to describe human response to traumatic events. This framework is an information processing approach. The goal of information processing investigations is to identify how incoming external stimuli or intentionally engendered stimuli enter the central nervous system and eventuate in some kind of final response.

Drawing a connection from victim to victimizer.

1. The biological basis of the altered alarm/dissociative process during and after sexual trauma impedes the development of information processing essential for discerning intention, personal responsibility, sense of control over events, and trust in others. 2. Once this imbalance occurs, the child is restricted in developing cognitive schema to deal with interpersonal intimacy. This in turn results in secondary patterns of aggressiveness or avoidance. 3. The implication of this biological understanding of trauma and information processing for treatment underscores the necessity of reducing arousal, thus lessening the dissociative process. Drawings of the criminal act and the victim experience elicit cues connecting the two events, facilitating an increase in personal control over repeated aggressive acts.

Assessing child abuse: the TRIADS checklist.

Although all types of abuse injure children, psychological abuse is most elusive and damaging on many levels, particularly levels of attachment, affective development, and the evolution of empathetic capacities that allow a child to receive and transmit, in an appropriate manner, emotional information between people. Some think that this type of psychological abuse coupled with neglect and perhaps early physical abuse impairs the child's total capacity to respond emotionally (Brothers, 1989). Essentially, empathy is a matter of a complex informational processing activity. Alexithymia, an inability to perceive the emotions of others, has been linked in primate studies to deprivation (Sackette, 1966). This awareness of the impact of environmental factors on the development of critical emotional and ultimately interpersonal regulating mechanisms underscores the need to attend to all aspects of child abuse.

A trial of dipyridamole and aspirin in the prevention of smoking-induced changes in platelets and endothelium in men with coronary artery disease.

A random-order, double-blind crossover study compared the effects of placebo, dipyridamole and dipyridamole plus aspirin on smoking-induced changes in endothelium and platelets. Each of 12 male habitual smokers with coronary artery disease was given dipyridamole (75 mg) and aspirin (324 mg), dipyridamole (75 mg) and placebo for aspirin, or a placebo for each drug 3 times daily for 1 week before each of three 20-minute periods (separated by 2 weeks) of smoking 2 cigarettes after a 12-hour period of abstinence. During each period of smoking there were increases in the mean values of the plasma concentrations of beta-thromboglobulin, platelet factor 4 and nicotine, the endothelial cell count and the blood level of carboxyhemoglobin. In addition, the mean platelet aggregate ratio decreased during each period. After administration of placebos for both dipyridamole and aspirin, the respective mean values +/- standard deviations before and after smoking were 28 +/- 8 and 30 +/- 7 ng/ml (beta-thromboglobulin), 7.4 +/- 1.0 and 8.2 +/- 1.4 ng/ml (platelet factor 4), 3.7 +/- 0.6 and 15.7 +/- 3.5 ng/ml (nicotine), 4.2 +/- 1.4 and 5.4 +/- 1.7/counting chamber (endothelial cell count), 5.0 +/- 2.2 and 6.6 +/- 2.2% (carboxyhemoglobin) and 0.80 +/- 0.07 and 0.68 +/- 0.10 (platelet aggregate ratio). Each of the differences between the means before and after smoking was statistically significant (p less than or equal to 0.02). Neither dipyridamole alone nor in combination with aspiring significantly affected the mean smoking-induced change in any of these variables.(ABSTRACT TRUNCATED AT 250 WORDS)

Serial rapists and their victims: reenactment and repetition.

The major finding in this study of 41 serial rapists is the large numbers of reported and unreported victims. For over 1200 attempted and completed rapes, there were 200 convictions. The hidden rapes or earliest nonreported victims of these men as boys and adolescents were identified from their families, their neighborhood, and their schools. Examining the possible link between childhood sexual abuse and criminal behavior in this sample of 41 serial rapists, 56.1% were judged to have at least one forced or exploitive abuse experience in boyhood, as compared to a study of 2,972 college males reporting 7.3% experiencing boyhood sexual abuse. Looking within the abused samples, 56.1% of the rapists reported forced sex, compared to the college sample's 30.4%. Also, the rapist sample revealed higher rates of family member as abuser (48.4%), compared to 22.2% for the college sample. Retrospective reconstruction of the sexual activities and assertive behaviors of these men as boys reveals that 51% of the boys reenact the abuse as a preadolescent with their earliest victims being known to them (48% as neighborhood girls), family (25% as sisters), or girlfriend (25%). The onset of rape fantasies in midadolescence (mean age 16.9) crystalizes the earlier sexually initiated behaviors into juvenile behaviors of spying, fetish burglaries, molestations, and rapes. Repetition of these juvenile behaviors set their criminal patters on strangers--their next group of victims. To reduce victimization, serial rapists need to be identified early and stopped. This means acknowledging and reporting boy sexual abuse. This includes being sensitive to the reenactment behaviors noted in the initiated activities of abused children, which in turn need to be differentiated from peer play. Closer attention needs to be paid to families with incest behavior to insure that younger children are protected. Adolescents showing early repetitive juvenile delinquent behaviors must be assessed for physical and sexual abuse, and intervention must be planned to deal with the victimization. In the investigation and apprehension of serial rapists, law enforcement might pay closer attention to fetish burglaries and the spying, secretive behaviors that serve as the prototype for rape behavior.

Abused to abuser: antecedents of socially deviant behaviors.

The authors interviewed 34 young people who had been sexually abused as children 6 or 8 years after the abuse had occurred and compared them with 34 control subjects who had not been abused. They also compared subjects who had been abused for less than 1 year with those who had been abused for more than 1 year. The findings suggest a link between childhood sexual abuse and later drug abuse, juvenile delinquency, and criminal behavior. The authors explore the effects of pretrauma factors of previous childhood physical abuse and parental modeling of aggression and the postdisclosure factors of social and family blaming.

Pathways and cycles of runaways: a model for understanding repetitive runaway behavior.

Based on information provided by 149 runaways staying in a Canadian shelter, the authors developed a model that explains repititious running away as the result of youths' cognitive confusion and unrealistic beliefs. The majority of the youths, who had run away an average of 8.9 times, felt that the events that led them to run away were unpredictable, yet 54 percent blamed only themselves for what happened. The paper describes the pathways, cycles, and outcomes of running away; analyzes the relationship between the youths' experiences with prostitution, delinquency, and sexual and physical abuse and the length of time they had been away from home; summarizes the youths' reasons for running away; compares the beliefs of runaways with and without a history of sexual abuse; and discusses interventions.