Child and Adolescent Psychiatry

Maltreatment 217

Table 27.1Prediction of intervention success

Factor Better outcome Worse outcome

Parental Acceptance of problems Denial of problems
Compliance with treatment Refusal to cooperate
Normal personality Personality problems:

• antisocial


• sadistic


• aggressive


• abused in childhood
  Supportive partner Abusive partner
  No psychiatric disorder Alcohol abuse
  Substance abuse
  Psychosis
  Characteristics of
  abuse

Less severe injuries Severe injuries
Burns and scalds
Failure to thrive
Mixed abuse
Penetrative sexual abuse
Longstanding sexual abuse
Sadistic abuse
Munchausen by proxy
Interaction with child Normal attachment Disordered attachment
Able to show empathy Unable to show empathy
Responsive caregiving Insensitive caregiving
Puts child’s needs first Puts own needs first
Child Healthy child Special needs – physical or
learning problems
Resilient response to abuse Extensive psychopathology
One nurturing relationship No positive influence
Circumstances Good local childcare No facilities
Informal networks Social isolation
Professional
intervention

Well trained and resourced

Therapeutic relationship

Few resources or skills Lack of

engagement

Source: Adapted from a scheme devised by Dr David Jones, to whom we are grateful for
permission to use it.

Effects of maltreatment

To date, few specific outcomes have been linked with specific patterns
of maltreatment. This is partly due to the wide overlap of types of
maltreatment, so it is hard to study ‘pure’ abuse of one type. Even when
‘pure’ forms of abuse are studied, impairments are seen in a wide range
of functions. It is plausible that many of these associated impairments
are attributable to the maltreatment. This is a causal inference that is
supported if the impairments improve or resolve once maltreatment
ceases, for example, because the individual is taken into care. Without
this improvement, it is important to consider additional explanations.