O Transtorno Traumático do Desenvolvimento (TTD) é um conceito teórico-clínico que ainda não consta dos guidelines psiquiátricos oficiais. O presente trabalho consiste na apresentação dos dados referentes às prevalências encontradas para os diferentes critérios diagnósticos do TTD, oriundos da aplicação de um instrumento elaborado em língua portuguesa originalmente para esse estudo. A amostra foi constituída por 102 crianças e adolescentes de 8 a 14 anos, provenientes de diferentes cenários de risco para maus-tratos, incluindo uma escola pública (n=51), um ambulatório de violência (n=30) e um albergue para vítimas de violência familiar (n=21). Os resultados preliminares sugerem ser possível corroborar a hipótese que sustenta o conceito do transtorno ao indicar que crianças que são expostas à violência, têm maiores probabilidades de apresentar os sintomas que caracterizam o TTD. / The Developmental Trauma Disorder (DTD) is a clinical-theoretical construct that is not yet included in the official psychiatric guidelines. This study consists of the presentation of data on the prevalence found for the different diagnostic criteria of DTD, derived from the application of an instrument originally prepared in Portuguese for this study. The sample consisted of 102 children and adolescents 8-14 years old, representing different risk scenarios for abuse, including a public school (51), an outpatient clinic for violence (30) and a shelter for victims of family violence (21). The preliminary results suggest that it is possible to corroborate the hypothesis that supports the concept relating to the disorder, which indicates that children who are exposed to violence are more likely to exhibit symptoms that characterize DTD.

Objective: Posttraumatic Stress Disorder (PTSD) is highly prevalent in clinical and forensic mental health populations. Understanding the link between childhood maltreatment and the underlying mechanisms that can increase the vulnerability to developing and maintaining PTSD is imperative in clinical conceptualisations and intervention targets. A significant proportion of research is conducted with non mental health populations and there is a paucity of research with forensic populations. The first objective was to review the literature, in clinically related and forensic samples, investigating the association of emotion regulation with childhood maltreatment and Posttraumatic Stress (PTS) symptoms/PTSD. Emotion dysregulation and social problem solving deficits are commonly reported in the forensic population and have been associated with a number of psychopathologies. The empirical study examined the role of emotion regulation and social problem solving skills in the relationship between childhood maltreatment and adulthood trauma symptomatology in a male forensic population. Method: A systematic search of literature investigating the role of emotion regulation in relation to childhood maltreatment and/or PTS symptoms/PTSD was conducted using electronic databases; Medline, PsycINFO, Cinahl, Behavioural and Sciences Collection, EMBASE and PILOTS. Studies that met predetermined inclusion criteria were systematically reviewed. The empirical study employed a cross sectional design to examine the role of emotion regulation and social problem skills in the relationship between childhood maltreatment and adulthood trauma symptomatology. Fifty two male forensic mental health patients completed four self-report questionnaires; Childhood Trauma Questionnaire, Difficulties in Emotion Regulation Scale, Social Problem Solving Inventory-Revised: Short Form and the Post Traumatic Stress Disorder Checklist – Civilian Version. Results: The systematic review indicated strong evidence to suggest links between childhood maltreatment and emotion dysregulation, and emotion dysregulation and PTS symptoms/PTSD within clinically related and forensic samples. Preliminary evidence suggests a mediating role of emotion regulation in the relationship between childhood maltreatment and PTSD. The empirical study found that overall childhood maltreatment, childhood emotional abuse, sexual abuse and emotional neglect were associated with greater emotion dysregulation. Childhood sexual abuse, emotional neglect and physical neglect were associated with poorer social problem solving skills. With the exception of childhood physical abuse, all forms of childhood maltreatment, emotion dysregulation and poor social problem solving were correlated with greater trauma symptomatology. Mediation analysis indicated that both emotion dysregulation and poor social problem solving mediated the relationship between childhood emotional neglect and PTS symptoms in adulthood. Conclusions: The systematic review identified that further research is required within clinical populations to better understand the underlying causal pathways between childhood maltreatment and the development and maintenance of PTS symptoms/PTSD. The empirical study gives further insight into the forensic psychopathology and highlights the relevance of emotion regulation and social problem solving in the treatment of PTS symptoms.

O objetivo deste trabalho foi fazer a tradução e a adaptação do conteúdo do software “Módulo de Apoyo a la Gestión del Riesgo Social en la Infancia y la Adolescencia (MSGR)” para o contexto brasileiro. Por sua vez, o software visa auxiliar profissionais de diversas áreas a identificar e a como proceder diante de casos de suspeitas de maus tratos contra crianças e adolescentes. Foram realizados dois estudos empíricos. O primeiro estudo refere-se à tradução e à adaptação dos itens presentes no software, divididos em duas fases: (1) tradução dos itens, através do método backtranslation; e (2) validação por juízes, a fim de avaliar o nível de adequação dos itens originais, e grupos de discussão, para discutir os itens que não tiveram concordância igual ou superior a 80% entre os juízes e propor uma ação recomendada para cada tipo de gravidade. Participaram como juízes cinco profissionais especialistas na temática de maus tratos. Nos grupos de discussão participaram quatro profissionais que têm experiência no atendimento a crianças e adolescentes vítimas de violência. Os resultados da avaliação dos juízes apontaram 40 itens do software como não tendo o índice de concordância mínimo de 80% esperado. O grupo de discussão, por sua vez, decidiu o formato final de tais itens. Além disso, sugeriu a troca de nomenclaturas, além de propor o acionamento de diversos serviços de proteção para cada gravidade detectada. Discutem-se as mudanças realizadas, os diferentes serviços da rede de proteção, assim como o Estatuto da Criança e do Adolescente. O segundo estudo foi a aplicação piloto do software, já traduzido e adaptado. Participaram desta etapa 16 adultos, selecionados por conveniência,com idades entre 22 e 55 anos. Estes foram instruídos a responder a três estudos de caso fictícios, apontando as dúvidas de compreensão dos itens, além de suas opiniões quanto ao manejo e a utilidade do software. Os resultados indicaram dificuldades de compreensão de algumas palavras, especialmente entre os participantes que tinham somente o Ensino Médio completo. Também houve dúvidas quanto à ambiguidade de itens, além de tentativas de indução de respostas, mesmo quando as observações correspondentes não estavam contempladas no estudo de caso. Discutem-se aspectos relativos a facilitar o entendimento das questões e ao uso do software, além da importância deste para o auxílio na notificação das suspeitas. Por fim, ressalta-se a relevância da divulgação dos conhecimentos científicos acerca da identificação de maus tratos para a população, assim como o desenvolvimento de novas ferramentas para a utilização na proteção dos direitos da infância e adolescência. / The aim of this work was to translate and adapt to the Brazilian context the content of the software “Módulo de Apoyo a la Gestión del Riesgo Social en la Infancia y la Adolescencia (MSGR)”. This software aims to help professionals of many fields to identify and proceed when facing cases that involve suspicion of child and adolescent abuse. Two empirical studies were performed: The first study concerns the translation and adaptation of the software’s items in two stages: (1) translation of the items through the backtranslation method; and (2) validation from the judges to evaluate the level of adequacy of the original items, and discussion groups to discuss the items which did not reach 80% or more of agreement among the judges and to propose recommended actions for each severity level. Five professionals who are experts in this subject participated as judges. Four professionals who have experience in care service for children and adolescents who have been victims of abuse were part of the discussion groups. The results of the judges’ evaluation point 40 software items which have not achieved the expected minimum of 80%. The discussion group, in turn, made decisions about the final arrangement of those items. Besides that, the group suggested terminology changes, and the activation of several protection services for each level of severity detected. It discussed the changes, the child protection network’s different services, and also the Child and Adolescent Statute. The second study was the pilot application of the software after it had been translated and adapted. Sixteen adults participated in this stage. The selection criterion was convenience, and their ages ranged from 22 to 55 years old. They were instructed to answer three fictitious case studies, pointing doubts regarding the items and voicing their opinions regarding the handling and the utility of the software. The results show the difficulties to understand certain words, especially among participants who had only finished secondary school. There were also doubts regarding the ambiguity of some items, and some attempts to induce answers even when the corresponding observations were not considered by the case study. Aspects related to helping understand the issues raised and to the use of the software were discussed, as well as the importance of the software for notifying suspicion. Finally, we highlight the relevance of disseminating scientific knowledge related to the identification of abuse, as well as the development of new tools for protecting the rights of children and adolescents.

O Transtorno Traumático do Desenvolvimento (TTD) é um conceito teórico-clínico que ainda não consta dos guidelines psiquiátricos oficiais. O presente trabalho consiste na apresentação dos dados referentes às prevalências encontradas para os diferentes critérios diagnósticos do TTD, oriundos da aplicação de um instrumento elaborado em língua portuguesa originalmente para esse estudo. A amostra foi constituída por 102 crianças e adolescentes de 8 a 14 anos, provenientes de diferentes cenários de risco para maus-tratos, incluindo uma escola pública (n=51), um ambulatório de violência (n=30) e um albergue para vítimas de violência familiar (n=21). Os resultados preliminares sugerem ser possível corroborar a hipótese que sustenta o conceito do transtorno ao indicar que crianças que são expostas à violência, têm maiores probabilidades de apresentar os sintomas que caracterizam o TTD. / The Developmental Trauma Disorder (DTD) is a clinical-theoretical construct that is not yet included in the official psychiatric guidelines. This study consists of the presentation of data on the prevalence found for the different diagnostic criteria of DTD, derived from the application of an instrument originally prepared in Portuguese for this study. The sample consisted of 102 children and adolescents 8-14 years old, representing different risk scenarios for abuse, including a public school (51), an outpatient clinic for violence (30) and a shelter for victims of family violence (21). The preliminary results suggest that it is possible to corroborate the hypothesis that supports the concept relating to the disorder, which indicates that children who are exposed to violence are more likely to exhibit symptoms that characterize DTD.

abstract: There are a number of factors known to influence the occurrence of child maltreatment, including parental history of child maltreatment. Youth aging out of the foster care system have been shown to experience a number of challenges associated with the transition to adulthood, including early unintended pregnancy and parenting. However, despite the presumed risks associated with being in foster care and having a history of child maltreatment, very little research has been conducted to examine the parenting attitudes among youth aging out. This study explored the parenting attitudes and parental risk of child maltreatment among youth aging out of foster care in Arizona and examined the relationship between relational support and parenting. Foster youths' parenting attitudes and parental risk of child maltreatment across five constructs: parental expectations, parental empathic awareness of children's needs, beliefs regarding the use of corporal punishment, parent-child roles, and children's power and independence were assessed. Linear regression analyses were conducted to assess the relationship between youths' perceived social support from friends, family, and significant others and their parenting attitudes and youths' current living arrangements and their parenting attitudes. Findings indicate that youth had lower than the median normed sample scores on two out of the five parenting constructs, parental empathic awareness of children's needs and parent-child roles. Overall, 17% of youth in the sample were considered high risk of child maltreatment as parents, while 79% were considered medium risk. Perceived social support from friends was significantly associated with higher scores regarding youths' attitudes about the use of corporal punishment and children's power and independence. Youth living with foster parents had significantly higher scores than youth living on their own across three out of the five parenting attitude constructs. Youth living with relatives had higher scores than youth living on their own on the empathic awareness of children's needs parenting construct. Findings suggest that youth may rely on friends for social support and may develop more nurturing parenting attitudes if residing with foster parents or relatives. Implications for policy, intervention, and practice are discussed.   / Dissertation/Thesis / Ph.D. Social Work 2014

O objetivo deste trabalho foi fazer a tradução e a adaptação do conteúdo do software “Módulo de Apoyo a la Gestión del Riesgo Social en la Infancia y la Adolescencia (MSGR)” para o contexto brasileiro. Por sua vez, o software visa auxiliar profissionais de diversas áreas a identificar e a como proceder diante de casos de suspeitas de maus tratos contra crianças e adolescentes. Foram realizados dois estudos empíricos. O primeiro estudo refere-se à tradução e à adaptação dos itens presentes no software, divididos em duas fases: (1) tradução dos itens, através do método backtranslation; e (2) validação por juízes, a fim de avaliar o nível de adequação dos itens originais, e grupos de discussão, para discutir os itens que não tiveram concordância igual ou superior a 80% entre os juízes e propor uma ação recomendada para cada tipo de gravidade. Participaram como juízes cinco profissionais especialistas na temática de maus tratos. Nos grupos de discussão participaram quatro profissionais que têm experiência no atendimento a crianças e adolescentes vítimas de violência. Os resultados da avaliação dos juízes apontaram 40 itens do software como não tendo o índice de concordância mínimo de 80% esperado. O grupo de discussão, por sua vez, decidiu o formato final de tais itens. Além disso, sugeriu a troca de nomenclaturas, além de propor o acionamento de diversos serviços de proteção para cada gravidade detectada. Discutem-se as mudanças realizadas, os diferentes serviços da rede de proteção, assim como o Estatuto da Criança e do Adolescente. O segundo estudo foi a aplicação piloto do software, já traduzido e adaptado. Participaram desta etapa 16 adultos, selecionados por conveniência,com idades entre 22 e 55 anos. Estes foram instruídos a responder a três estudos de caso fictícios, apontando as dúvidas de compreensão dos itens, além de suas opiniões quanto ao manejo e a utilidade do software. Os resultados indicaram dificuldades de compreensão de algumas palavras, especialmente entre os participantes que tinham somente o Ensino Médio completo. Também houve dúvidas quanto à ambiguidade de itens, além de tentativas de indução de respostas, mesmo quando as observações correspondentes não estavam contempladas no estudo de caso. Discutem-se aspectos relativos a facilitar o entendimento das questões e ao uso do software, além da importância deste para o auxílio na notificação das suspeitas. Por fim, ressalta-se a relevância da divulgação dos conhecimentos científicos acerca da identificação de maus tratos para a população, assim como o desenvolvimento de novas ferramentas para a utilização na proteção dos direitos da infância e adolescência. / The aim of this work was to translate and adapt to the Brazilian context the content of the software “Módulo de Apoyo a la Gestión del Riesgo Social en la Infancia y la Adolescencia (MSGR)”. This software aims to help professionals of many fields to identify and proceed when facing cases that involve suspicion of child and adolescent abuse. Two empirical studies were performed: The first study concerns the translation and adaptation of the software’s items in two stages: (1) translation of the items through the backtranslation method; and (2) validation from the judges to evaluate the level of adequacy of the original items, and discussion groups to discuss the items which did not reach 80% or more of agreement among the judges and to propose recommended actions for each severity level. Five professionals who are experts in this subject participated as judges. Four professionals who have experience in care service for children and adolescents who have been victims of abuse were part of the discussion groups. The results of the judges’ evaluation point 40 software items which have not achieved the expected minimum of 80%. The discussion group, in turn, made decisions about the final arrangement of those items. Besides that, the group suggested terminology changes, and the activation of several protection services for each level of severity detected. It discussed the changes, the child protection network’s different services, and also the Child and Adolescent Statute. The second study was the pilot application of the software after it had been translated and adapted. Sixteen adults participated in this stage. The selection criterion was convenience, and their ages ranged from 22 to 55 years old. They were instructed to answer three fictitious case studies, pointing doubts regarding the items and voicing their opinions regarding the handling and the utility of the software. The results show the difficulties to understand certain words, especially among participants who had only finished secondary school. There were also doubts regarding the ambiguity of some items, and some attempts to induce answers even when the corresponding observations were not considered by the case study. Aspects related to helping understand the issues raised and to the use of the software were discussed, as well as the importance of the software for notifying suspicion. Finally, we highlight the relevance of disseminating scientific knowledge related to the identification of abuse, as well as the development of new tools for protecting the rights of children and adolescents.

O Transtorno Traumático do Desenvolvimento (TTD) é um conceito teórico-clínico que ainda não consta dos guidelines psiquiátricos oficiais. O presente trabalho consiste na apresentação dos dados referentes às prevalências encontradas para os diferentes critérios diagnósticos do TTD, oriundos da aplicação de um instrumento elaborado em língua portuguesa originalmente para esse estudo. A amostra foi constituída por 102 crianças e adolescentes de 8 a 14 anos, provenientes de diferentes cenários de risco para maus-tratos, incluindo uma escola pública (n=51), um ambulatório de violência (n=30) e um albergue para vítimas de violência familiar (n=21). Os resultados preliminares sugerem ser possível corroborar a hipótese que sustenta o conceito do transtorno ao indicar que crianças que são expostas à violência, têm maiores probabilidades de apresentar os sintomas que caracterizam o TTD. / The Developmental Trauma Disorder (DTD) is a clinical-theoretical construct that is not yet included in the official psychiatric guidelines. This study consists of the presentation of data on the prevalence found for the different diagnostic criteria of DTD, derived from the application of an instrument originally prepared in Portuguese for this study. The sample consisted of 102 children and adolescents 8-14 years old, representing different risk scenarios for abuse, including a public school (51), an outpatient clinic for violence (30) and a shelter for victims of family violence (21). The preliminary results suggest that it is possible to corroborate the hypothesis that supports the concept relating to the disorder, which indicates that children who are exposed to violence are more likely to exhibit symptoms that characterize DTD.

Childhood sexual abuse among males has been associated with many negative psychological outcomes. Studies have attempted to identify which sexual abuse characteristics (e.g., duration, age of onset) are associated with mental health difficulties. While informative, this research has been mostly limited to variable-centered analyses, which do not capture the heterogeneity in males’ abuse experiences and psychological presentations. This two-part dissertation advances our understanding of how best to measure childhood sexual abuse and how to account for the diversity of sexual abuse experiences and outcomes among men using a person-centered approach. Given that there are few validated measures of childhood sexual abuse, the first study examined the psychometric properties of a commonly-used measure in the sexual abuse literature, the Sexual Victimization Survey (SVS; Finkelhor, 1979). Once the validity and reliability of the SVS were established, the SVS was used to generate profiles on the basis of abuse characteristics (Study 2). Data for both studies were drawn from a sample of 302 males (85% Caucasian) aged 18 to 65 years seeking support for childhood sexual abuse. Participants completed a modified version of the SVS as well as the sexual abuse subscale of the Childhood Experiences of Violence Questionnaire-Short Form (CEVQ-SF; Tanaka et al., 2012). Twenty-one males completed the SVS again one week later for test-retest purposes. The SVS showed high inter-rater reliability on sexual abuse status and sexual abuse characteristics. Most males (85%) who endorsed sexual abuse on the SVS did so on the CEVQ-SF, resulting in fair concurrent validity. The SVS showed perfect one-week test-retest reliability on abuse status, as well as good to excellent agreement on sexual abuse characteristics between the initial and one week time points. Given the strong psychometric properties of the modified SVS, it was then used to generate childhood sexual abuse profiles in Study 2. Once participants with significant missing data were deleted, 215 men remained and were included in the generation of profiles. Latent profile analyses revealed three distinct profiles which varied in the severity of abuse experiences. The Severe profile (n = 56, 26%) depicted sexual abuse which began in mid-childhood and consisted of a one or two time fondling by an unfamiliar extrafamilial perpetrator. Men in the More Severe profile (n = 71, 33%) also experienced abuse in mid-childhood by an extrafamilial perpetrator, but experienced more severe sexual acts that spanned several months to several years. Men in this profile were emotionally closer to their perpetrators prior to abuse onset than males in the Severe profile. The Most Severe profile (n = 88, 41%) depicted abuse which began in early childhood and consisted of very severe sexual acts by trusted individuals both within and outside of the family. Men in the Most Severe were significantly more likely to concurrently have experienced child emotional and physical abuse as well as a greater number of non-victimization adversities, compared with men in the other two profiles. Profiles varied with respect to psychological outcomes. Males in the More Severe and Most Severe profiles reported significantly more internalizing problems than men in the Severe profile, and men in the Most Severe profile reported significantly more trauma symptoms than men in the Severe profile. Certain contextual variables were also associated with greater psychological difficulties, namely greater present-day use of avoidant coping predicted more internalizing and externalizing problems, as well as greater trauma symptoms. Worse childhood family functioning was associated with more internalizing and externalizing problems, and disclosure of the abuse (compared to non-disclosure) was associated with more externalizing problems and trauma symptoms. These results have several research and clinical implications, including tailoring assessment and treatment to meet the individual needs of male survivors.

Background: The long-term detrimental impact of childhood emotional maltreatment is being increasingly recognised in the empirical literature. Adulthood trait-aggression is one proposed outcome of childhood emotional maltreatment. However, the pathways by which emotional maltreatment leads to trait-aggression are not well understood. Method: A systematic review was conducted to appraise the current empirical evidence base regarding the relationship between childhood emotional maltreatment and adulthood trait-aggression. Eighteen studies were reviewed and their quality analysed based on a number of pre-defined criteria. An empirical study was conducted using a cross-sectional, survey based design to evaluate hostile attribution bias and emotion regulation difficulties as mediators between childhood emotional maltreatment and adulthood trait-aggression. Participants were men (N = 42) recruited from NHS Forensic Mental Health Services. Results: Results from the systematic review provided support for a positive and significant association between childhood emotional abuse and adulthood traitaggression. There was evidence to indicate that childhood emotional neglect was also positively associated with adulthood trait-aggression, however, only a small number of studies have examined this relationship. The empirical study found significant indirect effects of childhood emotional abuse on self-reported aggression through emotion regulation difficulties. Emotion regulation difficulties did not have a significant effect on the relationship between childhood emotional neglect and aggression. Hostile attribution bias was not found to significantly mediate the relationship between either emotional abuse and aggression or emotional neglect and aggression. Conclusion: Those who experience emotional maltreatment during childhood may be at increased likelihood of engaging in aggressive behaviour in adulthood. Emotion regulation difficulties may play a key role in the relationship between childhood emotional abuse and aggression and this should be taken into consideration when assessing and treating adults who have difficulties with aggression. The routes by which emotional neglect and emotional abuse lead to aggression may differ. Further research is required to better understand the processes which lead from emotional maltreatment to aggression, particularly with regards to emotional neglect.

In 2014, the Child Protective Services received 3.6 million referrals alleging child abuse and neglect, of which, 702,000 children were victims of abuse and neglect and an estimated 1,580 children died due to maltreatment. In addition to this appalling toll, the welfare effects of child victimization are substantial. Evidence suggests that compared to demographically similar adults who were non-victims, adults with documented histories of maltreatment are more likely to engage in criminal behavior; have adverse mental and physical health problems such as depression, addiction and post-traumatic stress disorder; and have lower levels of education and earnings. These essays contribute toward the understanding of the consequences of two very distinctive policies – mandatory arrest and medical marijuana laws – and their impact on child maltreatment. An important and controversial question in criminal justice policy concerns whether aggressive sanctions, such as mandatory arrest policies, serve as effective deterrents to familial violence. Chapter 1 provides a theoretical framework that models child abuse in which I allow for a strategic interaction between the child and his or her abuser. The comparative statics yield clear predictions of the impact of sanctions on child maltreatment – as the cost and probability of external interventions rise, the probability of violence falls. I follow this theoretical analysis with an empirical investigation of the impact of mandatory arrest policies on child victimization. I find a statistically significant and positive relationship between states that have implemented mandatory arrest laws and reported child maltreatment rates. This may seem surprising; however there are two explanations for the results. The likely explanation is that reporting of maltreatment increased in states mandating arrest; alternatively, recidivism may have increased in these states. Evidence from the OLS estimates for the reporting of abuse and child fatality rates (a proxy for the true incidence of child abuse), demonstrates that the increase in maltreatment is not due to recidivism but, in fact, more people reporting abuse to the police and Child Protective Services. The most important result that emerges from the data, however, is that while reported abuse increases in states with mandatory arrest laws, the true incidence of maltreatment actually falls. The ultimate goal of this paper is to stimulate further theoretical and empirical research that focuses on child abuse and prevention, thus enhancing an understanding of how sanctions influence child victimization. The next chapter looks at one potential risk factor for child maltreatment –marijuana use and liberalization –using evidence from medical marijuana laws (MMLs). Chapter 2 begins by extending the current MML-crime literature by providing a comprehensive evaluation of the impact of MMLs implemented at the state level on reported child victimization rates. I show that specific modes of medical marijuana regulation differentially influence the magnitude of reported incidences of child abuse, a finding which sheds new light on the current literature. More specifically, using fixed effects analysis applied to data from the National Child Abuse and Neglect Database System (NCANDS) and the Uniform Crime Reports (UCR), I show that states that allow for home cultivation in addition to decriminalizing its use see a further increase in the magnitude of reported incidences of child maltreatment rates. Since completing my dissertation, I have continued to investigate into issues that have implications for both theory and practice in my field. To that extent, I plan to analyze the slowly developing public sphere –a platform where culture and social change rely on both media and conversation.