Parents with intellectual disabilities (ID) are disproportionately represented in child maltreatment (CM) statistics due to a confluence of factors. Prevention efforts should address this population by developing curricula that support various modes of learning. Technology offers a potentially effective tool because it is visual, free from extraneous factors, engaging, and self-instructional. SafeCare is an evidence-based parenting program with flexibility to adapt curricula while maintaining fidelity. The study aimed to determine the effectiveness of an adaptation to the SafeCare parent-infant (PII) module for parents with ID by using digital picture frames with pictures of their own PII to effect performance. A multiple-probe design across behaviors was used with one mother with ID and her infant. Results showed a significant increase in PII behaviors through two month follow-up. These data suggest the digital picture frame enhancement to the SafeCare PII module is a promising instructional tool for parents with ID.

Identifying high-risk areas for child maltreatment to ultimately aid public health agencies for interventions is necessary for protecting children at high risk. Rates of substantiated neglect and physical/emotional abuse in 2000-2002 are computed for the census tracts in the urban area of five counties in Metro Atlanta, Georgia, and analyzed using spatial regression to determine their relationships with twelve risk variables computed from the Vital Records births and the 2000 Census data. After accounting for multicollinearity among risk variables and spatial autocorrelation among observations for neighboring locations, it is found that high percentages of (1) births to non-married mothers, (2) births to mothers who smoked or drank alcohol during pregnancy, (3) unemployed males and females, and (4) single-parent families with children under age six best predict the rates of substantiated neglect, and that high percentage of births to mothers who smoked or drank alcohol during pregnancy best predicts the rates of substantiated physical/emotional abuse.

<p>In the largest known investigation to date of the prevalence of resilience following experiences of child maltreatment, a statewide, longitudinal sample of maltreated children was used to measure the prevalence of resilience, defined in this study as consistent competence over time and across multiple domains of functioning within the academic setting. In response to the relative paucity of resilience research using large samples, multiple domains of functioning, and longitudinal data, the current study measured resilience in a sample of over 150,000 children who were reported to child protective services agencies for suspected maltreatment. Functioning was measured within three distinct domains (academic performance, special education, and behavioral functioning) across a time period of up to 7 years. A sample of over 450,000 children with no known maltreatment history was used to compare relative rates of consistent competence over time and examine any differential effects on competence across groups. Approximately 18% of maltreated children exhibited consistently competent functioning in all domains across all available years of data, whereas approximately 35% of nonmaltreated children demonstrated consistent competence. County-level introduction of differential response policies investigating children's reported maltreatment was found to promote higher rates of competent functioning. In addition, relative levels of government expenditures in children's counties on two popular statewide early childhood programs (Smart Start and More At Four) were found to predict competent functioning for maltreated and nonmaltreated children alike. These findings suggest that child welfare policies aimed at identifying and assisting high-risk families in need of services and support and community programs targeted at improving children's early development and school readiness hold promise for improving adaptive functioning among maltreated children at high risk for experiencing difficulties in the school environment.</p> / Dissertation

Individuals who have experienced child maltreatment (CM) are at an increased risk for future interpersonal difficulties and violence in their romantic relationships. While positive connections with mentors have been shown to contribute to resilience among at-risk youth, the role of mentors in promoting positive romantic relationships among those with CM histories has not been previously examined. In this study, young adult women (N = 267; 18-25 years of age) who were in a romantic relationship at the time of the study completed a computerized questionnaire exploring CM, romantic relationship functioning, and mentoring relationships. Almost half of the women had a current or past mentoring relationship (n = 132). This study explored the associations between CM and romantic relationship qualities (i.e., levels of social support, negative interactions, relationship violence, and distribution of power), and examined whether having a mentor would be particularly helpful for women with a history of CM. Maltreatment experiences examined were child psychological maltreatment (CPM; 21%, n = 55), child physical abuse (CPA; 9%, n = 24), witnessing domestic violence (WDV; 16%, n = 43), and child sexual abuse (CSA; 11%, n = 29). Results showed that women who experienced higher levels of CPM and CPA, particularly by fathers, were more likely to report higher levels of psychological maltreatment and physical violence in their current romantic relationships compared to women with lower levels of CPM and CPA. Women who indicated a lack of emotional support (ES) from their parents reported higher levels of negative interactions in their romantic relationships. However, women with higher levels of ES from their fathers reported higher levels of social support in their romantic relationships. When these factors were accounted for in regression analyses, psychological and physical maltreatment experiences by fathers predicted levels of psychological and physical maltreatment in women’s romantic relationships. As well, higher personal levels of power in their romantic relationships were found among women with higher levels of WDV. Further, ethnicity, the participants’ age, relationship status (e.g., dating, common-law/married), and parental divorce emerged as important socio-demographic factors in relation to child maltreatment and relationship functioning. There was support for the role of mentors as a protective factor among women who had experienced physical abuse by their fathers. Mentoring characteristics such as duration of the mentoring relationship and attachment to the mentor were related to CM experiences and romantic relationship functioning. This study calls attention to the need for greater awareness of the link between CM and romantic relationship difficulties in young adulthood, as well as the role of positive mentoring relationships as a protective factor for those with a history of CM. Results from this study may benefit psychologists and others in similar professions who assist those who have experienced CM and who are at risk for interpersonal difficulties, and may help those already experiencing relationship difficulties. Additional implications include a need for better identification of youth who are at-risk for relationship violence and for the implementation of violence prevention programs in schools. Given the important role of mentors demonstrated by this study, there is also a need for further research regarding mentors and for greater support of mentoring programs.

This study investigated links between childhood maltreatment (CM), perceived stress, coping strategies, and physical health problems among adult women. There is mounting evidence to suggest that perceived stress and coping strategies help to explain the association between CM and physical health outcomes. However, research has yet to clarify the precise mechanisms through which stress and coping independently, and in combination, predict the health concerns of victimized women. Through the use of structural equation modeling (SEM), support was found for a model in which perceived stress partially mediated the association between CM and physical health problems. While emotion-focused coping was also found to partially mediate the CM-health relationship, problem-focused and avoidance coping did not. A moderated mediation model revealed that each coping strategy moderated the impact of maltreatment, but not of perceived stress, on physical health. Multi-mediation model testing indicated that emotion-focused coping and perceived stress better explain the relationship between CM and health than either variable on its own, and that this coping strategy fully accounted for the link between CM and subsequent stress. Finally, multivariate regression analyses revealed that child physical abuse was uniquely associated with greater physical symptoms, and child psychological maltreatment had a unique link with functional impairment; however, no form of abuse uniquely explained health care utilization. Findings suggest that child maltreatment is a risk factor for adverse health outcomes in later life and that stress and coping strategies are important mechanisms in this relationship. Implications for clinicians, medical professionals, and researchers are discussed. This study investigated links between childhood maltreatment (CM), perceived stress, coping strategies, and physical health problems among adult women. There is mounting evidence to suggest that perceived stress and coping strategies help to explain the association between CM and physical health outcomes. However, research has yet to clarify the precise mechanisms through which stress and coping independently, and in combination, predict the health concerns of victimized women. Through the use of structural equation modeling (SEM), support was found for a model in which perceived stress partially mediated the association between CM and physical health problems. While emotion-focused coping was also found to partially mediate the CM-health relationship, problem-focused and avoidance coping did not. A moderated mediation model revealed that each coping strategy moderated the impact of maltreatment, but not of perceived stress, on physical health. Multi-mediation model testing indicated that emotion-focused coping and perceived stress better explain the relationship between CM and health than either variable on its own, and that this coping strategy fully accounted for the link between CM and subsequent stress. Finally, multivariate regression analyses revealed that child physical abuse was uniquely associated with greater physical symptoms, and child psychological maltreatment had a unique link with functional impairment; however, no form of abuse uniquely explained health care utilization. Findings suggest that child maltreatment is a risk factor for adverse health outcomes in later life and that stress and coping strategies are important mechanisms in this relationship. Implications for clinicians, medical professionals, and researchers are discussed.

A Disforia de Gênero (DG) caracteriza-se pela marcada incongruência entre gênero e sexo atribuído ao nascer. Trata-se de uma condição rara, cuja prevalência varia muito de acordo com o local estudado: na Nova Zelândia, há 27,48 por 100 000 habitantes, enquanto que, no Irã, são 0,68 por 100 000 habitantes. Sua etiologia depende da interação entre fatores biológicos e psicossociais, sendo a herdabilidade estimada de 62%. Indivíduos diagnosticados com DG integram populações sujeitas a maior violência, desde bullying até violência sexual. História de maus-tratos na infância (HMI) associa-se a maior prevalência de psicopatologias e de envolvimento com trabalho sexual na vida adulta. O objetivo do nosso estudo é avaliar a HMI como indicador de consequências mal adaptativas na vida adulta de transexuais homem-para-mulher (HpM). Utilizamos dados transversais coletados de 289 transexuais HpM, que compareceram a atendimentos regulares, do ano de 1998 a 2014, em ambulatório do Sul do Brasil, chamado Programa de Identidade de Gênero (PROTIG). Elas foram diagnosticadas de acordo com os critérios do DSM-IV-TR para transtorno de identidade de gênero (TIG), avaliadas para comorbidades utilizando o Mini International Neuropsychiatric Interview (MINI) e para história psiquiátrica, demográfica, psicossexual e familiar por questionários específicos. A presença de HMI foi investigada por três perguntas qualitativas, envolvendo abuso sexual, violência sexual e negligência, semelhantes ao Traumatic Events Screening Inventory – Self Report Revised (TESI-SRR). A associação entre o HMI e variáveis tanto psicossociais quanto clínicas foi realizada por análises bivariadas seguidas por modelo de regressão logística. O modelo utilizado para a regressão logística incluiu a cirurgia de redesignação sexual (CRS), tentativas de suicídio, vírus da imunodeficiência humana (HIV), doenças sexualmente transmissíveis (DSTs), desordem depressiva maior, distimia, episódios maníacos e hipomaníacos, idade de início do cross-dressing definitivo, idade de início dos jogos trocados, atuação como profissional do sexo e apresentar, pelo menos, uma comorbidade psiquiátrica. O objetivo da regressão logística foi controlar potenciais confundidores nas associações bivariadas, não estabelecer relações de causa e efeito. Verificamos que a exposição à HMI associa-se com trabalho sexual (p < 0,001), com HIV (p = 0,006), com possuir pelo menos uma comorbidade psiquiátrica (p = 0,006), com transtorno de depressão maior (p = 0,025), com risco de suicídio (p = 0,014), com abuso de álcool (p = 0,027) e com maior idade de início do cross-dressing definitivo (p = 0,041) e dos jogos trocados (p = 0,009). Após a regressão logística, apenas a atuação como profissional do sexo (p < 0,001) e apresentar, pelo menos, uma comorbidade psiquiátrica (p = 0,005) permaneceram significativamente associadas com HMI. Nosso estudo sugere que as transexuais com HMI exibem maior frequência de envolvimento com trabalho sexual e psicopatologia em sua vida adulta. A partir disso, reforça-se a importância de ações preventivas direcionadas à coibir maus-tratos durante à infância, evitando-se, por exemplo, bullying homofóbico. Além disso, indivíduos diagnosticados com DG, que sofreram maus-tratos durante a infância, deverão receber especial atenção psicológica, a fim de impedir desfechos negativos, como doenças psiquiátricas e tentativas de suicídio. / Gender Dysphoria (DG) is characterized by marked incongruence between gender and sex assigned at birth. It’s a rare condition whose prevalence varies based on geographical location: in New Zealand, there are 27.48 per 100 000 inhabitants whereas, in Iran, there are 0.68 per 100 000 inhabitants. Its etiology depends on interaction between biological and psychosocial factors, presenting an estimated heritability of 62%. Individuals diagnosed with DG are victims of greater violence, from bullying to sexual violence. Childhood history of maltreatment (CHM) is associated with a higher prevalence of psychopathology and sex work in adulthood. The aim of our study is to further characterize the role of CHM as an indicator of maladaptive consequences in adult male-to-female transsexuals (MtF). Our study used cross-sectional data from a consecutive sample of 289 MTF transsexuals, which attended, from 1998 to 2014, an outpatient clinic in Southern Brazil, called Gender Identity Program (PROTIG). They were diagnosed according to the DSM-IV-TR criteria for gender identity disorder (GID), were evaluated for comorbities using Mini International Neuropsychiatric Interview and for demographic, psychosexual and family history with specific questionnaires. The lifetime presence or absence of childhood trauma was investigated by asking three separated questions, similar to specific questions related to sexual abuse and negligence included in the Traumatic Events Screening Inventory – Self Report Revised. The association between CHM and psychosocial and clinical variables was evaluated bivariate analyses followed by stepwise backwards logistic regression models. The logistic regression model included gender redesign surgery (GRS), suicide attempt, human immunodeficiency virus (HIV), sexually transmitted diseases (DST), major depression disorder, dysthymia, manic or hypomanic episode, age of cross-dressing definitive and age of exchanged games, sex work and psychiatric comorbidities. The purpose of the logistic regression was to control potential confounding factors in the bivariate associations, not to establish cause and effect relationships. We found that being exposed to CHM is associated with sex work (p < 0.001), HIV (p = 0.006), having at least one psychiatric comorbidity (p = 0.006), major depression disorder (p = 0.025), risk of suicide (p = 0.014), alcohol abuse (p = 0.027) and age of onset of definitive cross-dressing (p = 0.041) and of exchanged games (p = 0.009). After the logistic regression, only sex work (p < 0.001) and having at least one psychiatric comorbidity (p = 0.005) remained significantly associated with CHM. Our study suggests that transsexuals with CHM present a higher frequency of sex work and psychopathology in their adult life. These findings raise the important issue that prevention actions might be indicated to avoid children maltreatment especially in risk groups, for example, homophobic bullying in children with atypical gender behavior. In addition, individuals diagnosed with DG, who suffered abuse during childhood, should receive special psychological care, in order to prevent negative outcomes, such as psychiatric disorders and suicide attempts.

Dois estudos avaliaram o impacto e o processo de um modelo de grupoterapia cognitivo-comportamental para 49 meninas vítimas de abuso sexual com idade entre 9 e 16 anos. O Estudo I avaliou: o impacto do modelo na redução de sintomas de depressão, stress, ansiedade, transtorno do estresse pós-traumático (TEPT) e crenças distorcidas sobre o abuso e o efeito do tempo de espera por tratamento nestes sintomas; a manutenção do impacto da grupoterapia após 6 e 12 meses do término; e os fatores preditores para a resposta à grupoterapia. Os resultados, obtidos através do teste t para amostras pareadas apontaram que o modelo de grupoterapia apresentou impacto positivo, reduzindo significativamente os sintomas avaliados; o efeito da espera entre os grupos não revelou diferença significativa; os efeitos terapêuticos se mantiveram após um ano; e, os fatores preditores da resposta à grupoterapia foram: idade de início do abuso, presença de estupro e sintomas de revivência do TEPT antes da grupoterapia. O Estudo II avaliou o processo terapêutico a partir da análise clínica descritiva de dois casos, considerando as participantes que obtiveram escores extremos na análise da redução de sintomas. Os resultados apontaram que a idade de início do abuso, forma de abuso, experiência de abrigamento, resposta ao treino de inoculação do estresse e percepções de culpa foram aspectos que diferenciaram a resposta à grupoterapia. O modelo avaliado se mostrou efetivo para tratamento de meninas vítimas de abuso sexual. / Two studies assessed the effectiveness impact and process of a cognitive behavioral group therapy model applied to 49 female children and adolescents victims of sexual abuse (9-16 years). The Study I evaluated: the impact of the model in the reduction of symptoms of depression, anxiety, stress, post-traumatic stress disorder (PTSD) and the beliefs on the abusive experience and the effect of being in a waiting list for treatment in these symptoms; the permanence of the group therapy effects impact in a 6 and 12 months follow ups; the predictors factors for a group therapy response. The results, analyzed through the test t, revealed: the model showed positive impact, reducing the evaluated symptoms; the effect of being in the waiting list did not reveal significant difference in both groups; the therapeutic impact were maintained through the follow ups; the predictor factors for a response to group therapy were: age of the sexual abuse, rape presence and re-experiencing symptoms of the PTSD before the group therapy. The Study II assessed the therapeutic process using a two cases clinic analysis, considering the participants that obtained extremes scores in the analysis of symptoms reduction. The results pointed out to: the age of the sexual abuse, rape presence, sheltering, response the stress inoculation training and self perceptions of blame were aspects that explained the different response to the group therapy. The model was effective to the treatment of the girls victims of sexual abuse.

Made available in DSpace on 2016-08-03T16:34:27Z (GMT). No. of bitstreams: 1 MARIA TERESA BERTONCINI ZOGAIB.pdf: 466160 bytes, checksum: 624e42c58288056d900efadfbcef4c1f (MD5) Previous issue date: 2006-02-10 / This study examines the effectiveness of play intervention among institutionalized children with learning problems and depression symptoms, analyzing the influence of play in their well being and quality of life. The study was carried out using as methodology clinical intervention among eight children of both gender, aged eight, low income group, living in support homes for 2 years, first grade of elementary public school, with school complaint. After the characterization of the institution, individually assesses children s cognitive level using Raven s Progressive Colored Matrices, Piagetian tests of conservation, classification and series and verifies the school material. Following applies the Children s Depression Inventory CDI, standardized to Brazil. Based on this information, carry out eight weekly ninety-minute group play session using sensory-motor, symbolic and social strategies with room for spontaneous activity. After the play intervention, re-assesses the children using the same instruments from previous evaluation. The results show better school performance and decrease of depressive symptoms, with increase of self-steam and emotional confidence, reflecting in their life in general, including at school. The experiences lived during the play situations contributed for a better subjective self-evaluation from children, as well as a better school evaluation in their integrated cognitive and affective-emotional aspects. The results point out the importance of early recognition of depressive symptoms by technical team to start intervention programs, using the play to facilitate institutionalized children to overcome cognitive and affective difficulties / Este estudo verifica a eficácia de intervenções lúdicas junto a crianças abrigadas com problemas de aprendizagem e quadros de depressão, analisando a influência do brincar em seu bem-estar e qualidade de vida. Realiza-se através de metodologia clínica-interventiva, junto a oito crianças de ambos os sexos, de 8 anos, de classe de baixa renda, abrigadas há dois anos, cursando a 1ª. série de escola pública, com queixa escolar. Após caracterização da instituição, avalia-se individualmente o nível cognitivo das crianças através das Matrizes Progressivas Coloridas de Raven, das Provas Piagetianas de conservação, classificação e seriação e verifica o material escolar. Aplica a seguir o Inventário de Depressão Infantil CDI, normatizado para o Brasil. Com base nesses dados, realiza oito sessões lúdicas grupais, semanais, de noventa minutos cada, através de estratégias sensório-motoras, simbólicas e sociais, com espaço para atividades espontâneas. Após as intervenções lúdicas, reavalia as crianças com os mesmos instrumentos da avaliação anterior. Os resultados indicam melhora no desempenho escolar e diminuição dos sintomas depressivos, com aumento da auto-estima e da segurança emocional, com reflexos em sua vida em geral, inclusive na escolar. As experiências vivenciadas nas situações lúdicas contribuíram para uma auto-avaliação subjetiva mais positiva pelas crianças, assim como para uma avaliação escolar melhor, em seus aspectos cognitivos e afetivo-emocionais integrados. Os dados apontam a importância da equipe técnica ao reconhecer precocemente os sintomas depressivos para realização de programas interventivos, utilizando o lúdico como facilitador para superação das dificuldades cognitivas e afetivas das crianças abrigadas

Dois estudos avaliaram o impacto e o processo de um modelo de grupoterapia cognitivo-comportamental para 49 meninas vítimas de abuso sexual com idade entre 9 e 16 anos. O Estudo I avaliou: o impacto do modelo na redução de sintomas de depressão, stress, ansiedade, transtorno do estresse pós-traumático (TEPT) e crenças distorcidas sobre o abuso e o efeito do tempo de espera por tratamento nestes sintomas; a manutenção do impacto da grupoterapia após 6 e 12 meses do término; e os fatores preditores para a resposta à grupoterapia. Os resultados, obtidos através do teste t para amostras pareadas apontaram que o modelo de grupoterapia apresentou impacto positivo, reduzindo significativamente os sintomas avaliados; o efeito da espera entre os grupos não revelou diferença significativa; os efeitos terapêuticos se mantiveram após um ano; e, os fatores preditores da resposta à grupoterapia foram: idade de início do abuso, presença de estupro e sintomas de revivência do TEPT antes da grupoterapia. O Estudo II avaliou o processo terapêutico a partir da análise clínica descritiva de dois casos, considerando as participantes que obtiveram escores extremos na análise da redução de sintomas. Os resultados apontaram que a idade de início do abuso, forma de abuso, experiência de abrigamento, resposta ao treino de inoculação do estresse e percepções de culpa foram aspectos que diferenciaram a resposta à grupoterapia. O modelo avaliado se mostrou efetivo para tratamento de meninas vítimas de abuso sexual. / Two studies assessed the effectiveness impact and process of a cognitive behavioral group therapy model applied to 49 female children and adolescents victims of sexual abuse (9-16 years). The Study I evaluated: the impact of the model in the reduction of symptoms of depression, anxiety, stress, post-traumatic stress disorder (PTSD) and the beliefs on the abusive experience and the effect of being in a waiting list for treatment in these symptoms; the permanence of the group therapy effects impact in a 6 and 12 months follow ups; the predictors factors for a group therapy response. The results, analyzed through the test t, revealed: the model showed positive impact, reducing the evaluated symptoms; the effect of being in the waiting list did not reveal significant difference in both groups; the therapeutic impact were maintained through the follow ups; the predictor factors for a response to group therapy were: age of the sexual abuse, rape presence and re-experiencing symptoms of the PTSD before the group therapy. The Study II assessed the therapeutic process using a two cases clinic analysis, considering the participants that obtained extremes scores in the analysis of symptoms reduction. The results pointed out to: the age of the sexual abuse, rape presence, sheltering, response the stress inoculation training and self perceptions of blame were aspects that explained the different response to the group therapy. The model was effective to the treatment of the girls victims of sexual abuse.

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