Develop. Med, Child Neurol. 1911, 19, 265-267

International Congress on Child Abuse and Neglect

Reported bu Margaret Lunch

REPRESENTATIVES from 17 countries attend- ed this first international congress on child abuse and neglect, held in Geneva in September 1976, which indicates that the problem is now being recognised as an international one. Doctors and social workers formed the largest group of participants, but many psychologists, psy- chiatrists, lawyers, nurses, teachers and anthropologists also attended. There was a large contingent from the United States armed forces.

Throughout the conference it was clear that there are many varying attitudes towards the problem of child abuse and neglect. There are also many differcnt levels of understanding: some speakers had only begun to recognise the problem, while others had been developing forms of treatment for some years.

A number of interesting management ‘programmes’ were described which have several messages in common : (1) the necessity of a comprehensive plan of family diagnosis and treatment; (2) an inter-disciplinary team approach is required ; (3) a combination of different forms of treatment is often needed for each family; and (4) many different forms of treatment can work equally well.

Many papers presented an idealised view of the programme that had been developed for dealing with child abuse in the speaker’s area, some of which were very new and as yet unevaluated. In other descriptions there were tantalising references to exciting ideas, for example the medico-social day- care centres in The Netherlands which provide therapy as well as relief for disturbed, deprived and abused pre-school children. Another example from Perth, Australia, was Margaret Jeffery’s approach to problems of handling cMdren, which uses psychological skills in the home setting. It also became apparent that some of the most expensive programmes were the least rewarding, whereas some of the most successful methods of treatment were modest adaptations of already existing faci I i t ies .

Pat Beezley, a social worker from the National Center for Child Abuse and Neglect in Denver, gave an excellent paper on the special qualities the therapist needs in dealing with child abuse. She said that some therapists found it very difficult to work in this field and that not all should be expected to do so. She thought that therapists should be able to deal with their own aggressive impulses and that they should not seek satisfaction from the progress of their patients. They should be

Human Development Research Unit, Park Hospital for Children, Old Road, Headington, Oxford OX3 7LQ.

265

DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY. 1977, 19

able to tolerate and accept increasing dependency and yet help the patient to become more independent.

Several papers were concerned with prediction and prevention of child abuse. Dr. Manciaux, from the International Children’s Centre in Paris, described the development of their ‘risk grid’, based on the analysis of 50 cases, the biographies of the parents, structure and daily life of the couple, and early history of the child.

Our own paper described a system of early identification of child abuse develop- ed in an Oxford maternity hospital. The abusing families could be distinguished from the general maternity-hospital popu- lation by five measures: (1) mother more likely to have been under 20 years at birth of first child; (2) mother more likely to have a history of emotional disturbance; (3) parents more likely to have been referred to the maternity hospital social worker; (4) the baby more likely to have needed special care after birth; and ( 5 ) mother more likely to have evoked concern over her ‘mothering’ while in hospital.

Dr. Kempe, from the University of Colorado Medical Center in Denver, described a method of identifying high-risk mothers by means of a questionnaire, labour, delivery and post-partum observa- tions, and demonstrated how simple inter- vention with such families can significantly improve the infant’s chances of cscaping serious physical injury.

Sheila Monaghan, working in a mater- nity hospital in Dunedin, New Zealand, spoke of an interesting programme in which vulnerable parents were identified in the maternity hospital and offered help there and then. A similar method was described by D. R. Pfeifer and C. Ayoub, from the Department of Pediatrics, Tulsa, Oklahoma. Children at risk were identified in the maternity hospital and a programme was set up to “help the child have a normal childhood by offering family-centred medi-

cal care, extensive counselling and the teaching of proper parenting”.

All these papers demonstrated that identification of children at risk of abuse is possible around the time of delivery. This makes prevention a realistic aim. Prevention may be helped further by seeing “child abuse and neglect as a public health problem”, as was advocated by Dr. Peterson from the Department of Paediat- rics in Uppsala.

I found the results of the follow-up studies depressing. Dr. Strauss, of the Hdpital des Infants Malades, Paris, pre- sented results from three French follow-up studies, concentrating on the 70 children in the Paris study. Whether left at home or placed in foster care, the outcome was grim for both the abused child and the siblings. This was especially so with regard to psychological features.

The follow-up study by E. Elmer of the Parental Stress Center in Pittsburgh made observations of 17 abused children and 17 accidentally injured children. These child- ren were followed-up eight years later, at the approximate age of nine years. Multiple variables were looked at and few differences were found between the two groups. It was felt that one interpretation of these findings was that the underlying problems of severe poverty in all the families studied overpowered any specific effect of the abuse itself.

A report from Utah indicated somewhat different findings. D. F. Kline, of the Department of Special Education, Utah State University, reported that large numbers of their abused children had deficits when they were studied some eight years after the abuse. Seven per cent of their abused population were in institutions, compared with 0.05 per cent of the general population of school-children.

It was made clear from these and other papers that protection of a child from injuries, while necessary, is not sufficient

266

MARGARET LYNCH

in the management of child abuse. Carolyn Jones, of the National Society for Preven- tion of Cruelty to Children, gave an important paper on this topic. She described a project which, as she said, “operated in near ideal conditions” (for social work). Although the project was able to reduce the severity of battering, the question of the child’s emotional development in the home remained a matter of great concern in a number of cases. It was also found that only slight positive changes occurred in most aspects of the parent-child relationships. In spite of marked improvements in cognitive development of the children, some family relationships remained distorted.

R. K. Oakes, from the Royal Alexandra Hospital for Children, Camperdown, New South Wales, described a follow-up study of 25 children who had been admitted to hospital with non-organic failure to thrive. When reviewed at an average of 6 years 4 months after their initial presentation, two of the children had died as a result of head injuries inflicted by adult members of their families, another child had suffered a fractured skull and a fourth had had a broken arm. Personality disorders and poor educational achievement were com- mon. The families had a high incidence of marital instability and economic difficul- ties. The mothers tended to be depressed and to have abnormal personalities. This paper showed clearly that non-organic failure to thrive and child abuse are parts of the same syndrome.

Two interesting papers described re- search into mother-infant interaction in cases of children at high risk of abuse. In one of these, given by R. L. Burgess and R. Conger from the College of Human Development at Pennsylvania State Univer- sity, it had been found that “abusive parents as a unit tend not to interact on a

physical level, whether positively (e.g. affectionately), negatively (e.g. hitting), or neutrally (e.g. gaining one’s attention)”. They seem to be passing on similar styles of interaction to their children. Similar patterns emerged for neglecting families.

Jill Korbin of the Department of Psychiatry, UCLA School of Medicine, Los Angeles, made a fascinating anthro- pological contribution. She said that “in some cultures children are apt to lose part of an ear for misbehaviour, to be smoked over a fire or deprived of sleep and food as a normal part of their socialisation. In others, children are virtually never pun- ished and all their needs are met until they are able to provide for themselves”. She stressed that it is necessary to develop ‘‘a culturally relative theory of child abuse” and that “long-term and intimate participa- tion, crucial to anthropological studies” is necessary in order to view factors asso- ciated with child abuse from the perspec- tive of the cultural group. This has obvious implications for those working with immi- grant communities.

Abuse and neglect causing mental retardation was the subject of the paper by M. Eppler and G. Brown from the Child Study Centre in Anchorage, Alaska. In a retrospective study of 426 cases of mental retardation, 65 (15 per cent) had evidence of abuse prior to identification of their retardation.

The Geneva meeting confirmed that the problem of child abuse is a universal one, and it was valuable that workers from many parts of the world were able to meet and share ideas.

The t?ext International Congress on child abuse is planned to be held in London in 1978.

Acknowledgement: I thank the Spastics Society for their generous grant which made it possible for me to attend the conference.

267