Sunday, November 15, 2009

Child Abuse and Neglect

Child Abuse and Neglect
Child abuse and neglect is defined as physical injury, emotional disturbance, sexual abuse, negligence, or maltreatment of a child under the age of 18 by a person who is responsible for the child's welfare.

Abuse is the breakdown of impulse control in the parent, guardian, or other caregiver.
there are four factors involved:
  1. Personalities features-The caregiver experienced lack of affection and support as a child and thus does not know how to provide the same for his or her child, or the caregiver is out of control due to substance abuse or psychotic illness.
  2. The difficult or different child- Examples include hyperactive, handicapped, premature, or sickly children or stepchildren.
  3. Inadequate support- The caregiver feels isolated or abandoned by relatives or friends who could provide guidance and assistance.
  4. Crisis situation- Stress overcomes the caregiver's ability to function.
Neglect is observed in families with multiple problems and disorganized lifestyles. Depression, desertion, drug or alcohol abuse, and chronic medical conditions may be seen in one or more caregivers.


  • gross motor development and skills
  • fine motor skills, manipulation, dexterity, and bilateral coordination
  • muscle strength
  • reflex development and maturation
  • postural control (use of protective and equilibrium reactions)
  • muscle tone
  • joint stability and mobility
  • sensory registration/awareness
  • sensory sensitivity/processing
  • perceptual skills ( visual, auditory, tactile, and kinesthetic)
  • attending behavior and concentration
  • ability to follow directions/sequencing
  • motivation or self-initiated activity
  • mood or affect
  • self-control
  • coping skills
  • social conduct skills
  • daily living skills
  • academic readiness or academic skills
  • play skills

No comprehensive or specific scale for occupational therapist to use assessing child abuse was identified. The following assessments may be useful:
  • Bayley Scales of infant development
  • Brazelton Neonatal Assessment Scale
  • A play scale
  • Child abuse potential inventory


The problems associated with child abuse can be verified and many. The list of problems should be considered as examples and not as comprehensive list.

  • Developmental milestones may be delayed, especially gross and fine motor skills.
  • Muscle weakness may be present if nerve or brain damage has occurred.
  • Paralysis may be present if nerve or brain damage has occurred.
  • Contractures may be present if condition has existed for some time.
  • Reduction range of motion may be present, depending on the type of injury.
  • Reflex maturation may be incomplete, with primitive reflexes continuing to be present.

  • Sensory loss may have occurred in vision, hearing, touch proprioception, or kinesthesia and less commonly in taste or smell.
  • Body image may fail to develop or an impaired body image may develop.
  • Sensory integrative Dysfunction may be present, including developmental dyspraxia and vestibular- bilateral disorder.
  • Sensory responses may be hypo- or hyperactive.

  • Learning disabilities may be present, including dyslexia, short attention span and hyperkinetic behavior.
  • The child may have poor problem- solving skills.

  • The child may have poor self-image and lack of confidence.
  • The child may feel guilty for "causing so much trouble." (note: The child is not the cause but may be made to feel so by repeated statements from one or more adults.)
  • The child may have blunted or flat affect.
  • The child may lack self-control, such as being sensitive and aggressive or having low tolerance for frustration.
  • The child may act helpless or be overly complaint or withdrawn.
  • Role identity within family unit may be ill-defined or fluctuating.

  • Parent(s) and child may lack coping skills.
  • The child may have delayed development of social interaction and conduct skills.
  • the child may be delayed in acquiring speech or vocabulary.
  • Bonding between parent and child may be inadequate or lacking.
  • The child may lack group interaction skills.
  • The child may be delayed in developing activities of daily living, such as dressing, tying shoes, or eating with a fork.
  • The child may be unable to perform certain ADLs (activities of daily living) if motor skills are involved.

  • The child may have developmetal delays in acquiring play skills.
  • the child may use less imagination in play.
  • The child may be unable to organize play activities.
  • The child may show little exploratory behavior in play.

The child may have few leisure interests beyond watching television or video.

Models of treatment include sensory integration (Ayres), and neurodevelopmental therapy (Bobath).

  • Promote development of groos and fine motor skills according to developmental level.
  • Increase muscle strength through progressive resistive exercises.
  • Maintain or increase joint range of motion through passive exercises and active involvement in activities.
  • Facilitate integration of primitive reflexes.

  • If sensory loss has occurred, facilitate development of remaining senses.
  • Increase body awareness and position in space.
  • Is sensory dysfunction is noted, see section on the specific disorder for treatment suggestions.
  • Modulate hyper- or hyporesponsiveness to stimuli.

  • Improve self-image and sense of mastery through use of creative activities ,such as crafts, games, music, dance, or drama.
  • Increase self-control by assisting the child to think of alternative approaches to situations and tasks.
Provide an opportunity for the child to practice social conduct in a group situation.

  • promote self-feeding skills.
  • Decrease oral motor sensitivity.
  • Increase skills in daily living.

  • Teach parents or caregivers the child's level of play skills and how to participate in play activities with the child.
  • Promote development of play skills
  • Assist in promoting academic readiness skills.

Encourage exploration of interests and developments of leisure skills.

Observe a child for signs of any additional abuse or neglect.

Prognosis and Outcome
  • Parent or caregiver is able to interact with the child without violent or abusive behavior.
  • Parent or caregiver demonstrates knowledge of the child's level of development and adjusts expectations to the child's level of performance.
  • Parent or caregiver is able to manage his or her own life situation and stresses without taking anger or frustration out on the child.
  • Child demonstrates improved developmental profile in motor, sensory, language, and self-care skills
  • Child demonstrates improvement in play skills.

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