Childhood Abuse Effects of Childhood

¶ … Childhood Abuse

Effects of Childhood Abuse

What are the effects of childhood abuse on early adulthood forming relationships?

Summer- Assignment three- Intervention

Intervention description

Theory of change

Analysis of empirical literature

Child abuse has significant implications on adolescents forming relationships. Child abuse takes place in three known forms i.e. physical abuse, sexual abuse, and emotional abuse of children. The juvenile maltreatment results in several lifelong implications for the abused child. This paper is part of an extended study that included sections I and II. Section I entailed literature search and review of pertinent literature on the said topic. Section II involved 'problem formulation' whereby literature was accessed to put the issue of child abuse in context. This section III will present an empirical intervention study as basis of addressing the formulated problem. Section III will contain four parts after this introduction i.e. intervention description, theory of change, analysis of empirical literature on intervention, and the conclusion.

Intervention description

Any intervention program for reducing and mitigating child abuse implications must be aimed at enhancing evidence-based practice (EBP). Any model aimed at intervention in child abuse cases must be backed up with empirical research suggesting qualification of that model. Lack of pre and post intervention comparison data in patient conditions also renders much intervention programs useless, at least empirically. Chaffin and Friedrich (2004) stated that "ultimately, obtaining confident evidence of intervention benefit involves well-designed and well-controlled true randomized trials" (p. 1103). The study that will be described as intervention program was conducted by Ahmad, Larsson and Sundelin-Wahlsten (2007) in which Eye Movement Desensitization and Reprocessing (EMDR) treatment for children from 6-16 years of age was designed. The participants of the program were experiencing 'Post Traumatic Stress Disorder' PTSD. The program included 'Posttraumatic symptom scale for children (PTSS-C scale) was used by the researchers to record data of symptoms of participants and the resultant outcomes achieved. Self rating was also used as measured data. A controlled group was also assessed and it was later revealed that participants group improved on many scales developed in Posttraumatic symptom scale for children (PTSS-C scale). PSTD related symptoms also decreased after conducting the experiment. It was also mentioned that empirical data suggests cognitive behavioral therapy (CBT) as best intervention strategy for traumatized and maltreated children when reaching in adolescent's ages or in childhood.

The study does provide empirical data as to the effect of intervention by recording pre-test and post-test results on children aged 6-16 years. Total of 179 participants were included in the study based on inclusion criteria. 33% of participants met PSTD criteria whereas 42.4% did not meet PSTD criteria while others were also excluded from the study due to other reasons. Only 33 children were evaluated. Diagnostic interviews were conducted and indicated that 26 out 33 (approximately 78.8% of sample) experienced PTSD as well as one of the DSM-IV symptom such as attention deficit and hyperactivity disorder (30.3%), 45.5% had depression symptoms, 21.2% had oppositional defiant disorder, 18.2% had separation disorder, 3% had overanxious disorder and autism spectrum whereas conduct disorder was recorded in 12.1% of 33 participants. The results generated from repeated measures Analysis of Variance (ANOVA) significantly identified differences in participant and control group post-test symptoms. It was also reported that re-experiencing in participant group was lower as compared to control group. The study conducted by Ahmad, et al. (2007) does provide empirical evidence regarding soundness of Eye Movement Desensitization and Reprocessing (EMDR) as effective program basis to treat children and adolescents with traumatic experiences from childhood abuse of any form.

Theory of change

As mentioned by Rovi (2006) that childhood trauma from abuse situations leads to increased probability of addictions, personality ailments, depression, and anxiety disorders. Kellogg (2005) mentioend the presenc of 'suicidal behavior, eating disorders and sexual disorders' due to child abuse incidents taking place in early childhood. The researchers of proposed intervention, Ahmad, et al. (2007) did select participants that actually displayed symptoms of 'Post Traumatic Stress Disorder' (PTSD). Thus, the study was correct in treating the same psychological and physiological disorders associated to childhood abuse that were the focus of our study, as established in section I and II of this paper.

Theoretical foundation of intervention program: The theoretical foundation of reviewed intervention study is cognitive behavioral therapy (CBT). The CBT is turn in based on theoretical principles and ideas derived from psychological models of behavior and human emotions (Roth & Fonagy, 2005). Theories of emotion and psychotherapy as well as theories of abnormal and normal human behavior are vital in forming the cognitive and psychological models of human behavior. The author has cited Donnelly and Jackson (2002) to substantiate the relevance of CBT in treating maltreated children and adolescents. Although Ahmad, et al. (2007) have not explicitly described in detail regarding the theoretical foundation of their intervention program, with only a brief reference to CBT as the main model on which their proposed program in based, it can be reasonably assessed that intervention program is effectively based on CBT and CBT is widely cited as a model of intervention based on cognitive-behavioral frameworks incorporating psycho-emotional theories as well. In section II titled Etiology, it was mentioned that Freud has developed most of his treatment intervention based on psychosexual development aspects of children. Sex therefore plays an important role in defining the behavior and emotions of a child later in adolescent years. MacMillan (2008) also verified that early child orientation towards opposite sex defined how the child may develop over the years. Freud also connected the adult psychosis or panic attacks to the events in childhood of a person.

Why CBT: CBT was an appropriate model to have the intervention program based upon it. It is widely researched and reported that child abuse actually alters the perception of a child regarding his/her own self and the relationships around. A person having an experience of child abuse has his self-worth diminished (Norman, 2009). Thus, the abuse distorts 'the way children (later adoelesents) think about themseleves and other relationshps including their parents. Thus, the victims of child abuse need intervention in altering their belief system. CBT exactly aims this by tling about how a person think about his/her ownself and what is the impact of actions on one's feelings and emotions and vice versa. CBT also helps acknowledge the presence of emotions. Since a person's thoughts (cognition) impacts his/her actions (behavior), it is essential to treat distortion of both. CBT aims at reducing the anxiety caused by cignitive functions that were initially caused by child abuse. Further, the relevance and appropriation of CBT as a means of treating depression, social withdrawal, PTSD, psychosis, and other cognitive-behavorial impairments has been wiedely reported by researchers (Foa & Rothbaum, 2001; Cohen, Deblinger, Mannarino & Steer, 2004; Taylor & Chemtob, 2004).

How it works: The CBT intervention programs help the problematic youth and adolescents by making them understand the complexities of emotional and cognitive functions of their situations. The therapy investigates overwhelming problems and breaks them into thoughts, emotions, and actions that result from such feelings. The CBT model actually aims to address the impairments in thought process (cognition) so as to set right the resulting emotions, feelings and actions. When individuals are intervened with CBT, the post-test results show that the same individual acts very differently under same situation. Thus, the treatment plan presented by Ahmed, et al. (2007) had a positive impact on identified problem since the program addressed the root cause of issue that is to alter the conditions that enable creation of problem. Self-perception and perceptions regarding others are one such starting point that defines our relationships and actions. The model essentially tries to alter the belief system of children and adolescents when applied. The very belief system has been distorted by mal-treatment of varying nature and degree. This has already being reported in section II of this paper that physical, emotional, and sexual abuse of children results in several impairments in their cognitive and emotional abilities.

Analysis of empirical literature

Literature that reports the empirical evidence of CBT based intervention programs was reviewed. Following studies presented empirical evidence as to the effectiveness of CBT based interventions in cases related to abuse of children. Stein, et al. (2003) conducted a randomized controlled study in which psychological intervention based on CBT was conducted. This was a school-based intervention in which children with PTSD were treated (these children were exposed to domestic violence in their childhood). The randomized control trial conducted in 2001-2002 academic year took place in two middle schools of Los Angeles. 61 students were assigned to intervention group whereas 65 students were kept in wait-list-delayed (WLD) group. The researchers concluded that "standardized 10-session cognitive-behavioral group intervention can significantly decrease symptoms of PTSD and depression in students who are exposed to violence" (Stein, et al., 2003; p. 608).