Posttraumatic stress in children and adolescents exposed to family violence: I. Overview and issues.

Exposure to child physical abuse and parents' domestic violence can subject youth to pervasive traumatic stress and can lead to posttraumatic stress disorder (PTSD). This article presents evolving conceptualizations in the burgeoning field of trauma related to family violence exposure and describes how the often repeating and ongoing nature of family violence exposure can complicate a PTSD diagnosis. In addition, recent literature indicates that children exposed to family violence may experience problems in multiple domains of functioning and may meet criteria for multiple disorders in addition to PTSD. Considerations salient to the recognition of traumatic stress in this population and that inform assessment and treatment planning are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual and family therapy in the treatment of children.

Surveyed 144 clinicians (mean age 42.7 yrs) who evaluate and treat child referral cases to examine whether Ss who define themselves primarily as individually vs family oriented actually differ significantly in their therapeutic practices. 18 Ss were identified as advocating the individual child-oriented approach over the family-oriented approach, 74 Ss advocated the use of both approaches, and 52 Ss advocated a family-oriented approach. It was found that Ss who preferred the individual and combined approaches showed a preference to approach evaluation by first seeing the parents and then shifting to the identified child. Family-oriented Ss preferred an approach that focused on seeing all family members conjointly throughout treatment. Also, individual-oriented Ss showed a greater use of tools that are more closely associated with psychodynamic theory and allow for individual play: projective testing, doll or puppet play, and craft projects. The family-oriented group used more action-oriented, interpersonally focused tools, such as behavioral contracting and assigning tasks. The individual-oriented group rated psychodynamic models as significantly more useful, while the family-oriented group rated family systems models as significantly more useful. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress in children exposed to violence. Reenactment and rage

Violence is a major public health problem that increasingly involves children and adolescents as both victims and witnesses. Exposure to violence is now implicated in the development of stress conditions. This article uses Terr's typology to describe responses to various kinds of violence and suggests that the posttraumatic stress model adds a unique dimension to our understanding of the effects of violence on children and adolescents.     

Community-based intervention for children exposed to intimate partner violence: An efficacy trial.

A community-based intervention program was tested with 181 children ages 6-12 and their mothers exposed to intimate partner violence during the past year. A sequential assignment procedure allocated participants to 3 conditions: child-only intervention, child-plus-mother intervention (CM), and a wait-list comparison. A 2-level hierarchical linear model consisting of repeated observations within individuals and individuals assigned to conditions was used to evaluate the effects of time from baseline to postintervention comparing the 3 conditions and from postintervention to 8-month follow-up for both intervention conditions. Outcomes were individual children's externalizing and internalizing behavior problems and attitudes about violence. Of the 3 conditions, CM children showed the greatest improvement over time in externalizing problems and attitudes about violence. There were 79% fewer children with clinical range externalizing scores and 77% fewer children with clinical range internalizing scores from baseline to follow-up for CM children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapy with hospitalized children.

Provides a limited review of the literature pertaining to the use of play therapy in the hospital setting. Specific attention is given to situations involving the terminally ill child. V. Axline's (1969) original principles of play therapy are examined and applied to the play therapist's role in interactions with the hospitalized and/or terminally ill child. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapy for children with fetal alcohol syndrome.

Fetal alcohol syndrome (FAS) is the leading birth defect in the United States, yet few treatment options exist for children afflicted with this disorder. Although play therapy has demonstrated its efficacy with numerous special populations, as of today, no research has been conducted on its use with FAS. This article presents an overview of current data on FAS, an argument for the use of child-centered play therapy for children diagnosed FAS, and suggests areas of research needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play, aggression, the preschool child, and the family: A review of literature to guide empirically informed play therapy with aggressive preschool children.

Preschool-aged children displaying high levels of aggression repeatedly have been shown to be at significant risk for continued behavior problems and other social and emotional challenges throughout their lifetimes. The present literature review seeks to summarize and integrate findings across the fields of developmental psychology, family studies, child development, and play therapy to inform play therapists' practices with this population. Specifically, findings from research in these fields hold substantial implications for empirically informed ways in which play therapists can include parents within play therapy processes. Affective quality of parent- child interactions emerges as the common theme across all existing literature and is emphasized as a critical focus for play-based therapeutic intervention. Topics for future research by play therapists focusing on this population are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Trauma- and grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol.

This study assessed the prevalence of trauma exposure among middle school students and evaluated the effectiveness of a school-based, trauma- and grief-focused group psychotherapy protocol in treating a subset of students with severe exposure, posttraumatic stress disorder (PTSD), and functional impairment. Using a stratified screening procedure, 812 students completed a screening survey; 58 students (7.1% of those surveyed) met criteria for group treatment, and 26 students participated in the group. Group participation was associated with improvements in posttraumatic stress and complicated grief symptoms and in academic performance. Results suggest that students who are exposed to severe levels of community violence often may not be identified or treated. The findings also suggest that severe PTSD in adolescence may be associated with impaired school functioning, and that a reduction in PTSD symptoms may be related to academic remediation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender, power, and violence: Assessing the family stereotypes of the children of batterers.

Two hundred twenty one children, ages 6 to 12 years, in families with varying levels of domestic violence rated how much they agreed with 40 items concerning stereotyped beliefs about power and violence in the family. Varimax analyses yielded 4 factors; Male Power, Female Power, Violence Privilege, and Family Autonomy. Internal reliability and construct validity for the Family Stereotypes Card Sort were evaluated. Significant positive associations were found among physical violence and emotional abuse reported by the mother and family role stereotyping in the child. Family role stereotyping and beliefs in the acceptability of family violence differed by gender and ethnic minority status and varied by age and income but not by the level of adjustment problems in the child. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play, creativity, and adaptive functioning: implications for play interventions

This study focuses on the potential role for nitric oxide on the actions of the parasympathetic innervation to the heart. Earlier, we showed that the nitric oxide synthase (NOS) inhibitor N omega-nitro-L-arginine methyl ester (L-NAME) reduced the bradycardia induced by stimulation of vagal efferent motor fibres and that these effects are reversible through administration of the NOS substrate L-arginine. In the present study, we show that D-arginine does not reverse the effects of the inhibitors and confirm that they are reversed by L-arginine. Another NOS inhibitor, NG-nitro-L-arginine (L-NOARG), produced similar effects which were not reversed by L-arginine. In an examination of the effect of increasing NO availability with the NO donor sodium nitroprusside the vagally induced bradycardia was enhanced at all frequencies tested. In a separate series, the effects of NOS inhibitors and NO donors on the dromotropic actions of the vagus were examined. The NOS inhibitor L-NAME, reduced the increase in atrio-ventricular conduction delay normally induced by efferent vagal stimulation at all frequencies tested both in the 'paced' and 'unpaced' heart. Further, sodium nitroprusside enhanced this delay. Overall the study indicates that NO has an important facilitatory role on both the chronotropic and dromotropic actions of the vagus nerve on the heart and that NO may be a rate-limiting factor in the cardiac responses to vagal stimulation.     

Blame, shame, and community: Justice responses to violence against women.

Justice processing for crimes against women is reviewed. The data reveal conviction rates for partner violence and rape by known acquaintances are miniscule; mandatory arrest, protection orders, and diversion programs inadequately deter rebattering; few losses are compensated; and the adversarial justice process is retraumatizing, exacerbating survivor self-blame. To better address crimes against women, several nations and tribal communities use communitarian approaches, forms of restorative justice. The offense is framed to include the perpetrator, victim, and community. The process forgoes incarceration to have family, peers, and advocates design perpetrator rehabilitation, victim restoration, and social reintegration of both victim and perpetrator. Evaluations suggest communitarian justice may increase victim satisfaction, raise the social costs of offending, multiply social control and support resources, and open a new avenue to targeted prevention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapy behaviors of sexually abused children.

Examined the question of whether there are specific play therapy behaviors associated with children who have been sexually abused, and whether these behaviors differ by sex and age of the children. A survey instrument was developed which listed 140 play therapy behaviors. 21 play therapists participated in a field test to establish external validity. 249 play therapists were also surveyed to identify professionals who provide play therapy. Analysis identified highly interrelated play therapy behaviors of sexually abused girls and boys from ages 3–10 yrs. Suggested use of the play therapy behaviors include assessments to detect sexual abuse and recommendations for child placement and/or court testimony. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance-building interventions with adolescents in family therapy: A process study.

Identified, articulated, and measured therapist behaviors associated with improving initially poor therapist–adolescent alliances in multidimensional family therapy (MDFT). A list of preliminary alliance-building interventions was generated from MDFT theory and adolescent development research. This list was then refined through the observation of videotaped MDFT sessions. A sample of 5 improved and 5 unimproved alliance cases was then drawn from a larger treatment study. Ss (mean age 15 yrs) were primarily African American, male, adolescent substance abusers and their families. Coders rated the 1st 3 sessions of each case (30 sessions) to determine the extent to which each alliance-building intervention was employed. Measures of alliance features included the Vanderbilt Alliance Scale (D. E. Hartley and H. H. Strupp, 1983), the Alliance Building Behavior Scale (G. M. Diamond, et al, 1996), and the Self-Perception Profile for Adolescents (S. Harter, 1988). By session 3, therapists were attending to the adolescent's experience, formulating personally meaningful goals, and presenting as the adolescent's ally more extensively in the improved alliance cases than in the unimproved alliance cases. Using these data, proposed stages of alliance building with adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High school completion among Mexican-American children: Individual and family background variables.

Examined some of the potential differences between siblings of high school dropouts and persisters. Ss were 80 Mexican-American children in Grades 3–5; 40 siblings of drop outs and 40 siblings of persisters. Persisters were defined as students who had already graduated or who had reached the age of 16 and were making satisfactory progress in school. Variables examined included the younger S's expectation of completing high school, ratings of academic self-competence, school attitude, number of absences, and whether retention had occurred. Results indicate that Ss of dropouts reported a lower expectation of completing high school and had more absences than Ss of persisters. Elementary schools should integrate measures of absenteeism and expectancy in their identification of at-risk students. An examination of current school policies is recommended to assure that schools work to establish solid relationships with ethnic minority parents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating substance-abuse patients with histories of violence: Reactions, perspectives, and interventions.

One of the more troubling experiences that occurs in the psychotherapy of addicted persons is when they relate stories concerning their involvements with past acts of violence. Whether these events are regretted or not, they often arouse strong feelings in therapists and can present both patients and clinicians with questions about how to proceed. Attribution theory can be a useful tool for understanding the feelings and countertransference that arises, and a combination of insights from the field of posttraumatic stress disorder (PTSD) treatment and existential therapy, along with a focus on the question of character, are a potential foundation for the development of therapeutic interventions. The relationship between substance abuse and violence, the importance of treatment context, and the interdependence of identity and action are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing community violence: the children''s report of exposure to violence

Optical imaging methods are being explored as a potential means of screening for breast cancer. Previous investigations of time-resolved imaging techniques have suggested that due to the lack of photons with sufficiently small pathlengths, the spatial resolution achievable through a human breast would be unlikely to be better than a centimeter. Experimental results presented here indicate, however, that higher resolution may be achieved by extrapolating the measured temporal distribution of transmitted photons. This is performed using a least-squares fit between data and an analytic model of photon transport. The spatial resolution of a time-resolved imaging system was evaluated by measuring the edge response produced by an opaque mask embedded in the center of a 51-mm-thick, very highly scattering medium. The limiting spatial resolution was improved from about 13 mm to about 5 mm.     

Psychopathic traits in a large community sample: Links to violence, alcohol use, and intelligence.

Numerous studies conducted with offender or forensic psychiatric samples have revealed that individuals with psychopathic traits are at risk for violence and other externalizing psychopathology. These traits appear to be continuously distributed in these samples, leading investigators to speculate on the presence of such traits in the general population. Nonetheless, few studies of psychopathy have been conducted with large random samples of individuals from the community. The community sample from the MacArthur Violence Risk Assessment Study provides an opportunity to examine the prevalence and structural nature of psychopathic traits, as well as their association with external correlates in an urban community. The community data (N = 514) represent a stratified random sample of persons between the ages of 18 and 40 who were assessed on the Psychopathy Checklist: Screening Version (PCL: SV) and also for violent behavior, alcohol use, and intellectual functioning. Structural equation model analyses revealed that a 4-factor model found in offender and forensic psychiatric samples fit the community data well and was invariant across sex and ethnicity. Also, a superordinate factor comprehensively accounted for the 4 psychopathy first-order factors and significantly predicted the external correlates. The findings offer insight into the dimensional nature of the psychopathy construct. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Additional adverse events among women exposed to intimate partner violence: Frequency and impact.

Objective: To assess additional adverse life events that women exposed to intimate partner violence (IPV) may have endured and to ascertain whether, and in what ways, problems in adjustment are related more to IPV or to IPV plus other adverse life events. Method: Predictors of the effects of exposure to adversities were investigated in this study of 104 women exposed to severe IPV who reported conflict tactics, adverse life events, as well as symptoms of distress. Results: The majority of participants experienced additional adversities (86%). Significant differences were found between those exposed to IPV-only and those exposed to IPV plus other adverse events in terms of IPV frequency and current symptoms of distress. Women with IPV plus other adverse events had twice as many physical assaults and 4 times as many sexual assaults from an intimate partner compared to IPV-only women. The number of adverse events contributed significantly to variance in trauma symptoms over and above that of exposure to IPV alone. Women exposed to additional events had approximately twice as many avoidance and physiological arousal symptoms as IPV-only women. Conclusions: The results of this study suggest a variety of implications for IPV treatment and interventions. Specifically, the role that additional interpersonal violence, especially sexual violence, plays in the expression of distress may relate to the type of service offered to the survivor. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social learning family therapy with aggressive children: A commentary.

Comments on a study of social learning family therapy for aggressive children by T. V. Sayger et al (see record 1989-12762-001) within the broader context of research on the outcome of treatment for antisocial behaviors and discusses aspects of the study, including Ss' clinical impairments, family characteristics, and maintenance of therapy gains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)