Child Abuse: New Directions in Prevention and Treatment across the Lifespan

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Edited by: David A. Wolfe, Robert J. McMahon & Ray DeV. Peters

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  • Banff International Behavioral Science Series

    SERIES EDITORS

    Kenneth D. Craig, University of British Columbia

    Keith S. Dobson, University of Calgary

    Robert J. McMahon, University of Washington

    Ray DeV. Peters, Queen's University

    Volumes in the Banff International Behavioral Science Series take the behavioral science perspective on important basic and applied challenges that confront practitioners working in the fields of the social, psychological, and health services. The editors invite leading investigators and practitioners to contribute because of their expertise on emergent issues and topics. Contributions to the volumes integrate information on themes and key issues relating to current research and professional practice. The chapters reflect the authors' personal, critical analysis of the topics, the current scientific and professional literature, and discussions and deliberations with other experts and practitioners. It is our intention to have this continuing series of publications provide an “expressive” early indicator of the developing nature and composition of the behavioral sciences and scientific applications to human problems and issues. The volumes should appeal to practitioners, scientists, and students interested in the interface between professional practice and research advances.

    Volumes in This Series:

    • Anxiety and Depression in Adults and Children Edited by Kenneth D. Craig and Keith S. Dobson
    • Advances in Cognitive-Behavioral Therapy Edited by Keith S. Dobson and Kenneth D. Craig
    • Preventing Childhood Disorders, Substance Abuse, and Delinquency Edited by Ray DeV. Peters and Robert J. McMahon
    • Child Abuse: New Directions in Prevention and Treatment Across the Lifespan Edited by David A. Wolfe, Robert J. McMahon and Ray DeV. Peters

    Copyright

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    Preface

    This volume brings together experts in both physical abuse and sexual abuse, who discuss innovative approaches to treatment and prevention. Although these two areas of trauma and abuse are logically connected in many ways, this is one of the few volumes that has addressed both topics under one cover. The result is a compendium of information that has seldom been shared between these two fields.

    The emphasis throughout the volume is on prevention and treatment approaches for physical and sexual abuse. This emphasis is accompanied by current psychological perspectives concerning the causes and treatment of different forms of child maltreatment. Each chapter offers a critical review of current findings and discussion of emerging theories, applications, and future directions related to various aspects of child physical and sexual abuse. The information is intended for researchers, practitioners, and students in behavioural sciences and should be of special interest to persons involved in various levels of intervention, such as social workers, clinical psychologists, psychiatrists, and other mental health professionals.

    The book is divided into two sections for the purpose of highlighting both physical and sexual abuse. This division is relevant to the organization and presentation of the material, allowing for similar issues and themes to be presented in the same section and for greater emphasis on the dual nature of the book.

    Part I, “Prevention and Treatment of Child Physical Abuse,” begins with a chapter by E. Mark Cummings, who introduces the volume with an overview of the way marital conflict, child abuse, and other major family events can affect the ongoing development of children and youth. He considers themes pertinent to marital conflict as a familial process related to abuse and proposes new directions for the conceptualization and study of the impact on children. In Chapter 2, Joel Milner and Cynthia Dopke provide an overview of child physical abuse offender characteristics as described in controlled studies in the literature. These characteristics are discussed in relation to major theoretical models that aid in the formation of treatment planning and services for children and parents. In Chapter 3, Marlies Sudermann and Peter Jaffe review the progress that has been made in recognizing the effect of witnessing domestic violence on the life course of children and adolescents. They describe and confront myths about wife assault and dating violence and present an integrated community response to preventing violence in marital and dating relationships.

    Treatment and prevention approaches aimed at physical child abuse and relationship-based violence provide the focus for the remaining half of Part I. In Chapter 4, Sandra Azar uses a cognitive-behavioral framework to explain both the etiology of child physical abuse and the developmental disturbances observed among affected children. Parents' maladaptive role “schemata” regarding children and parent-child relationships, negative attributional biases, and poor problem-solving ability form the basis for a documented treatment program for this population. Chapters 5 and 6 each provide practical discussions of ways that child maltreatment interventions can be integrated into broader intervention and educational services involving children and youth. David Wolfe and colleagues describe their youth-centered educational program, based on the premise that adolescence offers a prime opportunity to educate about issues concerning healthy, nonviolent relationships. After describing their risk model of the development of violence in relationships, they present a competency-enhancement, proactive strategy to promote healthy, nonviolent relationships, along with initial evaluation findings. Turning to the early parent-child relationship, David Olds reviews the procedures and outcomes from two large-scale evaluations of their early intervention program for mothers and young children and reports on current efforts to expand the project for use in broader intervention efforts. This important project was designed to prevent a host of maternal and child health problems that create substantial risks for child abuse and neglect and later crime and delinquency. Current findings from Olds's ongoing randomized clinical trials support the significance of this approach.

    Part II, “Prevention and Treatment of Child Sexual Abuse,” presents recent findings related more specifically to child sexual abuse, extending and further integrating the previous section on the causes and treatments of physical abuse. Several insightful developments in the delivery of early intervention and prevention services are discussed, such as programs for violence prevention in schools and communities and preparation of children who must testify in court.

    In Chapter 7, Lucy Berliner reviews treatment outcome with children who have been sexually abused. Strategies to develop treatment goals for child victims are developed from cognitive behavioral therapy, including gradual exposure, stress inoculation training, corrective information, cognitive restructuring, and the teaching of positive coping and social skills. The nature of sexual abuse treatment for children poses particularly complex evaluation difficulties, which are also addressed in this chapter. In Chapter 8, John Briere describes a theory of abuse-related symptom development and outlines a specific psychotherapy for adults severely abused as children. The psychosocial difficulties of abuse survivors are examined in the context of post-traumatic stress, dissociation, long-term alterations in self-functions and capacities, and ways to cope. William Friedrich continues the discussion of treatment methods in Chapter 9, presenting an informative perspective on the nature and course of psychotherapy with sexually abused boys. Particular consideration is given to gender and social issues pertaining to the treatment of sexually abused boys and adolescents. The treatment model that Friedrich presents addresses areas of attachment, dysregulation, and self-development/perception, each of which has relevance to treatment.

    Edward Connors and Maurice Oates next describe the emergence of sexual abuse treatment models within First Nations communities, where the sexual abuse of children has become a serious concern. During the last 15 years, First Nations have evolved models of healing that combine therapeutic knowledge from nonnative society with healing approaches from traditional practices. This chapter reviews the historical development and effectiveness of these models of sexual abuse treatment within First Nations communities, which have important relevance to many communities. Finally, Louise Sas, in Chapter 11, looks at current developments in many communities concerning the interface between abuse victims and the court system. Recent legislative changes in North America's criminal courts are discussed in relation to the treatment and reception of child sexual abuse victims who appear in court as witnesses. Sas presents a detailed description of court preparation techniques, including ways to empower the child witness, reduce their stress and fears, and help them resist suggestions on the stand by being assertive and direct.

    The Banff Conferences on Behavioural Science

    This volume is one of a continuing series of publications sponsored by the Banff International Conferences on Behavioural Science. We are pleased to join Sage Publications in bringing this series to an audience of practitioners, investigators, and students. The publications arise from conferences held each spring since 1969 in Banff, Alberta, Canada, with papers representing the product of deliberations on themes and key issues. The conferences bring together outstanding behavioural scientists and professionals in a forum where they can present and discuss data related to emergent issues and topics. As a continuing event, the Banff International Conferences have served as an expressive “early indicator” of the developing nature and composition of the behavioural sciences and scientific applications to human problems and issues.

    Because distance, schedules, and restricted audience preclude wide attendance at the conferences, the resulting publications have equal status with the conferences proper. Each presenter at each Banff Conference is required to write a chapter specifically for the forthcoming book, separate from his or her presentation and discussion at the conference itself. Consequently, this volume is not a set of conference proceedings. Rather, it is an integrated volume of chapters contributed by leading researchers and practitioners who have had the unique opportunity of spending several days together presenting and discussing ideas prior to preparing their chapters.

    Our “conference of colleagues” format provides for formal and informal interactions among all participants through invited addresses, workshops, poster presentations, and conversation hours. When combined with sightseeing expeditions, cross-country and downhill skiing, and other recreations in the spectacular Canadian Rockies, the conferences have generated great enthusiasm and satisfaction among participants. The Banff Centre, our venue for the conferences for many years, has contributed immeasurably to the success of these meetings through its very comfortable accommodation, dining, and conference facilities. The following list documents conference themes over the past 28 years.

    1969 I

    • Ideal Mental Health Services

    1970 II

    • Services and Programs for Exceptional Children and Youth

    1971 III

    • Implementing Behavioural Programs for Schools and Clinics

    1972 IV

    • Behaviour Change: Methodology, Concepts, and Practice

    1973 V

    • Evaluation of Behavioural Programs in Community, Residential, and School Settings

    1974 VI

    • Behaviour Modification and Families and Behavioural Approaches to Parenting

    1975 VII

    • The Behavioural Management of Anxiety, Depression, and Pain

    1976 VIII

    • Behavioural Self-Management Strategies, Techniques, and Outcomes

    1977 IX

    • Behavioural Systems for the Developmentally Disabled
      • School and Family Environments
      • Institutional, Clinical, and Community Environments

    1978 X

    • Behavioural Medicine: Changing Health Lifestyles

    1979 XI

    • Violent Behaviour: Social Learning Approaches to Prediction, Management, and Treatment

    1980 XII

    • Adherence, Compliance, and Generalization in Behavioural Medicine

    1981 XIII

    • Essentials of Behavioural Treatments for Families

    1982 XIV

    • Advances in Clinical Behaviour Therapy

    1983 XV

    • Childhood Disorders: Behavioural-Developmental Approaches

    1984 XVI

    • Education in “1984”

    1985 XVII

    • Social Learning and Systems Approaches to Marriage and the Family

    1986 XVIII

    • Health Enhancement, Disease Prevention, and Early Intervention: Biobehavioural Perspectives

    1987 XIX

    • Early Intervention in the Coming Decade

    1988 XX

    • Behaviour Disorders of Adolescence: Research, Intervention, and Policy in Clinical and School Settings

    1989 XXI

    • Psychology, Sport, and Health Promotion

    1990 XXII

    • Aggression and Violence Throughout the Lifespan

    1991 XXIII

    • Addictive Behaviours Across the Lifespan: Prevention, Treatment, and Policy Issues

    1992 XXIV

    • State of the Art in Cognitive/Behaviour Therapy

    1993 XXV

    • Anxiety and Depression in Adults and Children

    1994 XXVI

    • Prevention and Early Intervention: Child Disorders, Substance Abuse, and Delinquency*

    1995 XXVII

    • Child Abuse: New Directions in Prevention and Treatment Across the Lifespan*

    1996 XXVIII

    • Best Practice: Developing and Promoting Empirically Validated Interventions

    1997 XXIX

    • Stress: Vulnerability and Resiliency

    We would especially like to thank Philomene Kocher for her diligence in preparing the manuscript for publication, and Valerie Angus for her secretarial services. Also, we would like to acknowledge the expert guidance and support that we received from C. Terry Hendrix, Jim Nageotte, Nancy Hale, and Vicki Baker at Sage Publications. It has been a pleasure working with them. While preparing this volume, David Wolfe was on the faculty of the University of Western Ontario, Bob McMahon was on the faculty of the University of Washington, and Ray Peters was on the faculty of Queen's University. The assistance and support of these institutions is gratefully acknowledged.

    *We are especially grateful to the Children's Mental Health Unit of Health Canada for their support and contributions to the 1994 and 1995 conferences.

    —David A.Wolfe, —Robert J.McMahon, —Ray DeV.Peters
  • About the Editors

    David A. Wolfe, Ph.D., FAClinP, is Professor of Psychology and Psychiatry at the University of Western Ontario in London, Canada, and a founding member of the Centre for Research on Violence Against Women and Children in London. His interests in empowering youth as a means to prevent personal violence derive from 20 years of research on child abuse and neglect and his view that these phenomena are preventable. His numerous articles and books on the broad topics of child abuse and domestic violence include Children of Battered Women (with P. Jaffe and S. Wilson, 1990); Working Together to End Domestic Violence (with N. Lemon, P. Jaffe, & J. Sandler, 1996), and Alternatives to Violence: Empowering Youth to Develop Healthy Relationships (with C. Wekerle & K. Scott, 1997).

    Robert J. McMahon, Ph.D., is Professor and Director of the Child Clinical Psychology Program in the Department of Psychology at the University of Washington, Seattle. His primary research and clinical interests concern the assessment, treatment, and prevention of conduct disorders in children. He is a principal investigator on the Fast Track Project, a large, multisite, collaborative study on the prevention of serious conduct problems in school-age children. His primary responsibilities on that project concern the development and implementation of the family-based intervention components. He is also a principal investigator on the Early Parenting Project, a longitudinal study examining the development of children of adolescent mothers from infancy into elementary school. He is the author (with R. Forehand) of Helping the Noncompliant Child: A Clinician'sGuide to Parent Training and of a number of scientific articles, chapters, and reviews. He has also coedited (with R. Peters and others) several volumes emanating from the Banff International Conferences on Behavioural Science.

    Ray DeV. Peters, Ph.D., is Professor of Psychology at Queen's University in Kingston, Ontario, Canada, and is Research Director of the Better Beginnings, Better Futures Project, a large, multisite, longitudinal study in Ontario on the prevention of mental health problems in young children from birth to 7 years of age. He was a Visiting Scientist with the Oregon Social Learning Center in 1979–1980 and with the Mental Health Division of the World Health Organization in Geneva, Switzerland, in 1986–1987. His primary research interests are in the areas of children's mental health and developmental psychology. Since 1982, he has served on the Executive Committee of the Banff International Conference on Behavioural Science.

    About the Contributors

    Sandra T. Azar, Ph.D., is Associate Professor at the Frances L. Hiatt School of Psychology at Clark University in Worcester, Massachusetts. She has published numerous papers and chapters dealing with theory, research on treatment and assessment work with abusive families, and legal issues. She is conducting a NIMH-funded research study testing the validity of a cognitive model of the etiology of child abuse.

    Lucy Berliner, MSW, is Clinical Associate Professor at the University of Washington School of Social Work and Director of Research for the Harborview Center for Sexual Assault and Traumatic Stress. She is Associate Editor for the Journal of Interpersonal Violence and Child Maltreatment and serves on the Editorial Board for Child Abuse & Neglect and Sexual Abuse: A Journal of Research and Treatment. She has published the results of a randomized clinical trial of treatments for sexually abused children and a review of the treatment outcome literature for sexually abused children. Research interests include aspects of clinical and social interventions with victims and offenders.

    John Briere, Ph.D., is Associate Professor in the Departments of Psychiatry and Psychology at the University of Southern California School of Medicine, and a clinical psychologist at the Department of Emergency Psychiatric Services of LAC-USC Medical Center. He is on the editorial boards of several journals, is a member of the Board of Directors of the International Society for Traumatic Stress Studies (ISTSS), and is on the Advisory Board of the American Professional Society on the Abuse of Children (APSAC). The author of numerous research papers, chapters, and books in the areas of child abuse, psychological trauma, and interpersonal violence, his books include Therapy for Adults Molested as Children: Beyond Survival: Child Abuse Trauma: Theory and Treatment of the Lasting Effects; and Psychological Assessment of Adult Posttraumatic States. He is also coeditor of APSAC Handbook on Child Maltreatment and author of two standardized psychological tests: the Trauma Symptom Inventory (TSI) and the Trauma Symptom Checklist for Children (TSCC). He provides consultation on clinical and forensic issues to various groups and agencies and is a frequent workshop presenter.

    Edward A. Connors, Ph.D., is a psychologist registered in the Provinces of Ontario, Manitoba, and Saskatchewan, Canada. Of Mohawk ancestry and a band member of Kahnawake First Nation, he has worked with First Nations committees across Canada during the past 10 years in both urban and rural centers. His work during the past 12 years includes positions as Clinical Director for an infant mental health center in the city of Regina and Director for the Sacred Circle, a suicide prevention program developed to serve First Nations communities in Northwestern Ontario. Currently, he is Vice President of the Canadian Association of Suicide Prevention. His practice incorporates traditional knowledge about healing, along with his training as a psychologist. He directs Onkwatenro'shom'a Health Planners, which is a health consulting firm for First Nations communities. He has published book chapters in the areas of suicide, family therapy, and healing in First Nations.

    E. Mark Cummings, Ph.D., is Professor of Psychology at the University of Notre Dame, Notre Dame, Indiana. He is the author of numerous research papers and chapters on family emotional functioning and children's adjustment and is the coauthor or coeditor of several books, including Children and Marital Conflict: The Impact of Family Dispute and Resolution; Attachment in the Preschool Years: Theory, Research, and Intervention; and Altruism and Aggression: Biological and Social Origins. In addition, he is an Editor with Child Development and is on the editorial boards of Developmental Psychology and Journal of Emotional Abuse.

    Cynthia Dopke., M.A., is a doctoral candidate in Clinical Psychology at Northern Illinois University, DeKalb. She is working on an intervention program for high-risk mothers, which is supported by a grant from the Illinois Department of Children and Family Services. The coauthor of several book chapters in the areas of child abuse and human sexuality, her research interests include the relationship among child physical abuse, social information processing, and stress.

    William Friedrich. is Professor and Consultant in the Department of Psychology and Psychiatry at the Mayo Clinic and Mayo Medical School, Rochester, Minnesota. His interests in sexually abused boys derive from 22 years of research and clinical practice in child abuse and neglect. He has written numerous articles and books, including Psychotherapy With Sexually Abused Children and Their Families (1990).

    Carolyn Grasley., M.A., is a doctoral candidate in Clinical Psychology at the University of Western Ontario, London. She has a special interest in the long-term repercussions of child sexual abuse for the development of adult intimate relationships.

    Peter Jaffe., Ph.D., C. Psych., is Director of the London Family Court Clinic in London, Ontario, Canada, and a member of the Clinical Adjunct Faculty for the Department of Psychology and Department of Psychiatry at the University of Western Ontario. His clinical work and research concern children and adolescents involved with police or the courts, either as delinquents or as victims of family violence or custody disputes.

    Andrea MacEachran., B.A., is the coauthor of a chapter on child abuse and neglect in Assessment of Childhood Disorders (1997). She is currently a research assistant for a study on depression.

    Joel S. Milner, Ph.D., is Professor of Psychology, Distinguished Research Professor, and Director of the Family Violence and Sexual Assault Research Program at Northern Illinois University, DeKalb. He has received funding for family violence and sexual assault research from federal agencies such as the National Institute of Mental Health, the National Center on Child Abuse and Neglect, and the Department of Defense. The author or coauthor of more than 130 book chapters and articles, most in the area of family violence, his current research interests include the description and prediction of intrafamilial child sexual abuse and the testing of a social information processing model of child physical abuse.

    Maurice L. B. Oates, Jr., M.A., is a psychologist who has created innovative native programs in British Columbia that have spread widely. Of mixed native/Scottish background and a member of the Eagle Clan of the Nisgha village of Kincolith, his background includes some 15 years involved in the legal system (Probation Officer, Parole Agent, Auxiliary RCMP) and another 17 years working as a psychologist with aboriginal peoples both on and off reserves. His other interests include the environment, backpacking, and the study of plants and their uses.

    David Olds., Ph.D., is Professor of Pediatrics, Psychiatry, and Preventive Medicine at the University of Colorado Health Sciences Center, Denver, where he directs the Prevention Research Center for Family and Child Health. He has devoted his career to investigating methods of preventing health and developmental problems in children and parents from low-income families. He has conducted a series of randomized clinical trials that examined the effects of prenatal and postpartum nurse home visitation on the outcomes of pregnancy, infant caregiving, and maternal life-course development and determined the impact of those services on government spending. His numerous awards include the Charles A. Dana Award for Pioneering Achievements in Health, the Lela Rowland Prevention Award from the National Mental Health Association, and a Research Scientist Award from the National Institute of Mental Health. His publications have appeared in numerous journals, including Pediatrics, Journal of Community Psychology, Medical Care, and the American Journal of Public Health.

    Anna-Lee Pittman., MLIS, is Project Manager for the Youth Relationships Project and coauthor of a chapter in Handbook on Research and Treatment in Child Abuse and Neglect (1997).

    Deborah Reitzel-Jaffe., Ph.D., has published several journal articles and chapters on the topic of woman abuse and teen violence and has worked as a youth counselor and facilitator of groups for youth that address violence in relationships.

    Louise Sas., Ph.D., is a clinical child psychologist and Director of the Child Witness Project at the London Family Court Clinic in London, Ontario, Canada. She is also Adjunct Clinical Professor at the University of Western Ontario in London, Ontario. The author of research papers, journal articles, and chapters in the areas of child sexual abuse, legislation pertaining to child witnesses, and the impact of criminal justice system involvement in the lives of young victims, her most recent publication is a coauthored article entitled “Children and the Courts in Canada,” which appeared in Criminal Justice & Behavior.

    Marlies Sudermann., Ph.D, C. Psych., is a clinical psychologist, researcher, and Director of Violence Prevention Services at the London Family Court Clinic in London, Ontario, Canada. In addition, she serves as Adjunct Clinical Professor with the University of Western Ontario, Department of Psychology. She has published numerous scholarly articles, chapters, and evaluation reports on the topic of violence in relationships.

    Christine Wekerle., Ph.D., is Assistant Professor of Psychology at York University in Toronto and Co-Investigator of the Youth Relationships Project. Her research interests range across areas related to children and families (e.g., parenting problems, child abuse, child maladjustment). She has published articles and chapters pertaining to the link between child maltreatment and adolescent outcomes and is coauthor of the book Alternatives to Violence: Empowering Youth to Develop Healthy Relationships (1997) and the accompanying text The Youth Relationships Manual.


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