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See no evil, hear no evil, speak no evil: why do relatively few male victims of childhood sexual abuse receive help for abuse-related issues in adulthood?

This literature review explores the reasons why comparatively few adult males with a history of childhood sexual abuse are seen by professionals for help with difficulties relating to that abuse. Two potential explanations are discounted as myths-that relatively few males are sexually abused, and that abuse has little effect on males. However, it is suggested that society (including professionals and the victims themselves) has given credence to these myths. Male victims are relatively unlikely to disclose their experience of childhood abuse, and (as a coping strategy) they deny the impact of sexual abuse on their lives. Professionals fail to hypothesise that their male clients may have been abused, and do not create the conditions that would enable males to talk about the abuse. Blumer's (1971) model of the social construction of problems is applied to account for these beliefs and behaviours on the part of victims and clinicians. It is argued that the childhood sexual abuse of males has not yet acquired legitimacy as a problem recognised by society, thus lagging behind the abuse of females. In short, the "evil' of childhood sexual abuse in the male population is not being seen or heard by clinicians, and is not being recognised or talked about by victims. Clinical implications are considered.

Adult↗

The assessment of social breakdown in newly-admitted psychiatric patients.

This paper presents a study of patients' social and domestic functioning preceding admission to a psychiatric hospital. A method is described for the quantitative assessment of 'social breakdown' in the areas of work, domestic performance and social group activity, based on reports from the patient and from another household member. Complementary changes in the domestic tasks carried out by other family members are also investigated. The sample consisted of 28 women and 17 men. Their usual level of functioning and their degree of breakdown are related to psychiatric diagnosis on admission, to the patient's position within the family and to the social class of the household. Discrepancies between reports are also investigated in relation to these variables.

Activities of Daily Living↗

[Neuropathological principles of behavioral disorders in dementia].

Psychotic symptoms, apathy, agitation and aggressiveness are behavioral disorders that occur frequently in patients with Alzheimer's dementia. They cause serious problems for patients, relatives and care-givers. These behavioral disorders are associated with neuropathologic changes and alterations of brain metabolism in specific brain areas. Disturbances in mesotemporal and frontal brain areas seem to be related to psychotic symptoms. Apathy is associated with dysfunction of frontal cortical areas. Agitation and impulsivity appear to result from a hypofunction of the serotonin system in association with a relative hyperfunction of dopaminergic and noradrenergic systems. These dysfunctions are the result of direct neuropathologic changes, but also due to cholinergic deficits that seem to both contribute synergistically to and independently cause behavioral disturbances.

Aged↗

Parent-assisted transfer of children's social skills training: effects on children with and without attention-deficit hyperactivity disorder.

OBJECTIVE: Previous research has demonstrated that peer rejection is a significant part of the clinical presentation of many children with attention-deficit hyperactivity disorder (ADHD). Outcome studies of treatment interventions have typically failed to show generalization of treatment gains to the home and classroom. This has been especially true for children who have comorbid oppositional defiant disorder (ODD). The present study was intended to demonstrate generalization of an outpatient social skills training program when parents were trained in skills relevant to their child's social adjustment. METHOD: Thirty-five children with ADHD and 14 children without ADHD were given 12 sessions of treatment (treatment group). Outcome was compared with 12 children with ADHD and 12 children without ADHD who were on a waitlist for treatment (waitlist group). Nineteen children with ODD were in the treatment group and five in the waitlist. Stimulant medication was prescribed for all children with ADHD. RESULTS: Subjects with ADHD showed improvement comparable with that of subjects without ADHD on all teacher- and parent-reported measures of peer adjustment and social skills, except teacher-reported withdrawal. Children with ODD had outcome comparable with that of children without ODD. Effect sized ranged from 0.93 to 1.34 indicating that the average treatment group subject was better off than 83.4% of waitlist subjects on outcome measures. CONCLUSIONS: The present results suggest that children with ADHD are best heiped by a combination of social skills training for themselves, collateral training for their parents and stimulant medication.

Analysis of Variance↗

"Theory of mind" in Asperger's syndrome.

Two studies are reported in which the ability of people with Asperger's syndrome to understand problems of the type "Peter thinks that Jane thinks that ..." tested. The results showed that in contrast to younger or more handicapped autistic individuals, Asperger subjects were able to solve problems of the type just outlined, i.e. that they possessed a second-order theory of mind. When asked to explain their solutions however, they typically did not use mental state terms but did not differ in this respect either from non-handicapped or socially impaired, chronic schizophrenic controls. The implications of the results for current cognitive theories of autistic impairment are discussed.

Adolescent↗

Psychiatric referrals from the police.

This is a study of one mode of inception into psychiatric care in Birmingham. Mentally disturbed people coming to the attention of the police are referred to a mental welfare officer and assessed by him, usually in a police station. The mental welfare officer may then refer for a psychiatric decision with regard to further management, and the patient is examined by the doctor in the police station. The annual frequency of use of this referral system was studied from 1962-73 inclusive. It is shown that there was an increase in referral over the years and that such referral from the police became an increasing proportion of new referrals to the Mental Health Department (Social Services Department). The sample of referrals from the police for 12 months is studied in greater detail (252 cases), surveying social characteristics of individual patients, the relationships between such police intervention and areas of the city, the nature of situation requiring intervention and the management and treatment which these patients received. The referrals were traced from contact with the mental welfare officer to hospital where the case notes of those admitted were studied for details of legal status and mental state on admission, diagnosis, duration of stay and disposal. The effectiveness of this method of entering treatment is discussed and some recommendations are made.

Adult↗

Subtypes of social withdrawal in early childhood: sociometric status and social-cognitive differences across four years.

From a sample of 567 kindergartners observed during free play, 150 children were classified as socially withdrawn and followed over 4 years. A cluster analysis involving teacher ratings was used to identify subtypes of withdrawn children. Four clusters were identified, 3 fitting profiles found in the literature and labeled unsociable (n = 96), passive-anxious (n = 23), and active-isolate (n = 19), and 1 typically not discussed, labeled sad/depressed (n = 12). Sociometric ratings indicated that unsociable children had elevated rates of sociometric neglect, active-isolates had higher than expected levels of rejection, and sad/depressed children had elevated rates of both neglect and rejection. Subtypes also differed in social information-processing patterns, with active-isolate children displaying the least component skills. The findings that some experience more difficulty than others might account for the ambiguity in extant studies regarding whether or not social withdrawal is a risk factor in psychosocial development, because withdrawal has most often been treated as a unitary construct in the past.

Anxiety↗

Parent, teacher and self-reports as predictors of signs of disturbance in adolescents: whose information carries the most weight?

We evaluated the ability of parents, teachers and self-reports to predict signs of maladjustment in 353 11- to 14-year-olds from the general population, over a 4-year time interval. Odds ratios were computed in order to test the ability of problem scales to predict later mental health referral and measures of parents' and children's own perceptions of the existence of major problems. Each informant made its own unique and indispensable contribution to the prediction of signs of maladjustment. Although teachers are often perceived as less able to assess internalizing problems than mothers and the children themselves, the present study showed that teachers' evaluations of internalizing problems are highly relevant if we take their ability to predict the subject's own perceptions of having problems as the criterion.

Adolescent↗

Behavioural treatment for sleep problems in children with severe learning disabilities and challenging daytime behaviour: effect on daytime behaviour.

The study aimed to investigate a group of children with severe learning disabilities, challenging daytime behaviour, and severe sleep problems to see if successful behavioural treatment of the children's sleep problems resulted in reduced daytime challenging behaviour as reported by mothers and teachers. A randomised controlled trial of behavioural interventions for the children's sleep problems was conducted (N = 30). The intervention group received an individually tailored behavioural programme and were supported by telephone calls from the therapist. Baseline assessments of the children's behaviour were made using the Aberrant Behavior Checklist and were repeated 1 month and 3 months after the start of intervention. There were no behavioural changes that were specific to children in the treatment group. However, improvements in some behaviours were seen in both the intervention and the control group at the 1-month and 3-month assessments and there was agreement between mothers' and teachers' reports for many of these changes. The results suggest that nonspecific effects of participating in the study (including an increased sleep duration, which was seen in both groups), rather than resolution of sleep problem per se, may have a beneficial effect on child behaviour and these factors need to be identified for therapeutic use.

Analysis of Variance↗

[Incidence of infantile cerebral lesions in children with behavioral disorders].

The delimitation of behavioural disturbances predominantly due to organic brain lesions from those caused by reactions due to environmental factors has practical importance for drug therapy and pedagogic guidance. Figures on the incidence of infantile brain lesions among children with behavioural disorders range from between 20 to 90%. However, comparison of the results is difficult, because different authors followed different aspects for the evaluation of their material. The authors have collected data from 497 children from the 3 to 15 year-old age group who suffer from behavioural disturbances: history, neurological and psychological findings, electroencephalogram, native x-ray picture of the skull, pneumo-encephalogram and echoencephalogram were reviewed for signs and findings suggesting infantile brain damage. Certain signs of intantile brain lesion were found in 28.6% of the children. Among the apparative diagnostic procedures without impairment to the patients, the electroencephalogram proved particularly suited for the support of the diagnosis. The most accurate data on the localization and extent of the lesion are provided by the pneumo-encephalogram. However, its performance is not possible or justified in each child.

Adolescent↗

[Structural and dynamic characteristics of patients with oligophrenia at a forensic-psychiatric clinic].

In a comparative structure-dynamic investigation of 250 oligophrenic patients at the debility stage the results of forensic-psychiatric evaluation of responsibility depended on the dynamic shifts. The complexes of symptoms of psychogenic decompensation and reactive states were singled out that were observable in debile patients. The criteria are given for the forensic evaluation of these states. A group of mentally retarded patients with considerable volitional-emotional disorders was studied which did not achieve the age-related compensation. In these, social dysadaptation was of a steady nature with persisting incapability of organizing and critically assessing their own behavior.

Adolescent↗

An evaluation of primary alcoholics with histories of violence.

Histories of violence were assessed in 275 consecutive male primary alcoholics who were interviewed and followed up 1 year later. After excluding individuals with primary antisocial personalities or primary drug abuse, 80 of these men were found to have histories of violence. Compared to the remaining subjects, this group was significantly younger and demonstrated significantly more social problems with school, home, and police both as adolescents and adults; these subjects were significantly more likely to have used drugs other than alcohol. The 12-month follow-up revealed a continued higher percentage of drinking among those with histories of violence as well as a greater risk for alcohol-related problems and some patterns of drug misuse. A history of prior violence may be a factor of prognostic importance in the treatment of primary alcoholism.

Adult↗

Sociology and the theory of responsibility: 'social background' as an excuse for crime.

The concept of social abnormality can be given a fairly precise meaning and is relevant to the theory of legal responsibility. Much work, however, would need to be done before it could take its place alongside mental abnormality as an excusing condition in the courts. The implications of such a plea would, moreover, be far reaching, two of the more obvious being the individualization of excuses and the relinquishing of the general preventive possibilities of punishment.

Antisocial Personality Disorder↗