CINAPS
Cambridge Independent Neuroscience and Psychiatry Services
Abuse
WHAT TO DO WHEN ABUSE IS SUSPECTED?
IF YOU ARE A CHILD OR YOUNG PERSON BEING HARMED OR THREATENED
IF YOU ARE A CHILD OR YOUNG PERSON BEING HARMED OR THREATENED
Tell an adult that you can trust immediately, such as a family member, a teacher, your GP, a nurse, psychologist or psychiatrist. It is often very helpful and important to talk to professionals like your GP. If you do not feel you are getting the results you want and you or members in your family are still being harmed or threatened, you need to tell someone else immediately. Don't give up until you feel you have help and you feel safe. Everyone deserves to feel safe. You can also contact Childline without giving any details of who you are.
Helpful Links has telephone numbers and websites of organisations including Childline who offer support to children and young people.
It is the responsibility of every doctor, mental health worker, teacher, social worker, police officer and adult to work hard to make sure children's opinions and wishes are heard and that children are safe.
IF YOU ARE A PARENT OR ADULT AND YOU SUSPECT THAT A CHILD / YOUNG PERSON IS BEING HARMED OR NEGLECTED
IF YOU ARE A PARENT OR ADULT AND YOU SUSPECT THAT A CHILD / YOUNG PERSON IS BEING HARMED OR NEGLECTED
Please speak to your GP or Social Care immediately.
It is every person's responsibility to speak up when worried about a child's safety or well-being; to protect children. You don't have to have 'proof' or be a 100% sure, just suspecting maltreatment or harm or risk is enough reason to discuss your concerns with a professional. It is Social Care's role to look at 'proof', not yours.
It might be that the family you have concerns about require extra social or mental health support and Social Care and Mental Health can work towards meeting their and their children's needs. Professionals always work very hard to keep families together.
Please see Helpful Links for websites and telephone numbers of organisations that offer support.
Please speak to your GP, Social Care or the Police today if you have concerns about a child, and ideally, put your concerns in writing.
Please speak to your GP, Social Care or the Police today if you have concerns about a child, and ideally, put your concerns in writing.
If you need to remain anonymous, you can share your concerns anonymously, just as long as you share your concerns. You can save a life.
IF YOU WORK WITH CHILDREN AND YOU SUSPECT A CHILD / YOUNG PERSON IS BEING HARMED OR NEGLECTED
IF YOU WORK WITH CHILDREN AND YOU SUSPECT A CHILD / YOUNG PERSON IS BEING HARMED OR NEGLECTED
Share information relating to your concerns with the appropriate authorities today and in writing and follow up with a telephone call to ensure the information has been received today.
Document all actions and telephone conversations clearly and without delay.
Do not refer to or ask someone else to share information, it is your clinical and legal responsibility.
Do not decide to manage it 'in house' and do not decide to 'leave it', because you think you know what the outcome might be of your referral due to shortage of staff in Social Care or any other reason.
It is the role of Social Care to complete risk assessments relating to risk for children, make decisions and provide social support to families and children.
Lets work together to protect children and families.
For further information and support please see information provided by the NSPCC.
For further information and support please see information provided by the NSPCC.
DEFINITION OF CHILD ABUSE
"Somebody may abuse or neglect a child by inflicting harm, or by knowingly not preventing harm. Children may be abused in a family, a community, an institutional setting, or more rarely, by a stranger. Most young people who are abused know their abuser." Working Together To Safeguard Children (Department of Health 1999)
TYPES OF ABUSE
1. Neglect
2. Emotional Abuse
3. Physical Abuse
4. Sexual Abuse
CHILDREN NEED THE FOLLOWING TO GROW AND DEVELOP
1. Stability
2. Guidance and Boundaries
3. Opportunity and Environment to Learn
4. Emotional Warmth
5. Ensuring Safety
6. Basic Care such as cleanliness
PROGNOSIS / HOPE? Absolutely - involve professionals and support as soon as possible to improve the outcome. Most professionals work very hard to keep families together. Professionals want to work with parents and carers to ensure their goals for their children are met.
WHAT IS SOCIAL CARE INVOLVEMENT?
Involvement, input, assessment or support from Social Care does not necessarily mean a child is at risk or harmed.
Some examples: Social Care might offer support to children when parents have medical problems, for instance after an operation, or financial problems, or they might offer support with shopping or practical tasks if adults have learning disabilities. Social Care can make a very positive difference to families or children needing extra support or help or advice.
STATISTICS AND IMPORTANT FACTS
-Most children know their abuser.
-More or less 58 000 children in the UK currently require protection.
-1 in 10 children in the UK have been neglected and this is the most common reason for taking child protection action in the UK.
-1 in 14 children in the UK have experienced emotional abuse by a parent or carer and this is the second most common reason for taking child protection action in the UK.
-1 in 14 children in the UK have been physically abused. Disabled children is at 3x higher risk.
-1 in 20 children have been sexually abused;
-More or less 58 000 children in the UK currently require protection.
-1 in 10 children in the UK have been neglected and this is the most common reason for taking child protection action in the UK.
-1 in 14 children in the UK have experienced emotional abuse by a parent or carer and this is the second most common reason for taking child protection action in the UK.
-1 in 14 children in the UK have been physically abused. Disabled children is at 3x higher risk.
-1 in 20 children have been sexually abused;
1 in 3 by another child / young person, 1 in 3 children abused by an adult told no one and more than 90% of children knew their abuser.
Statistics vary, updated and more detailed information is available at the NSPCC.
DIFFERENTIAL DIAGNOSES
DIFFERENTIAL DIAGNOSES
Children who are abused can present with many different symptoms including hyperactivity, impulsive behaviour, poor concentration, poor social skills, repetitive behaviour and violent behaviour. Children who are abused can present very similar to children with ADHD or Autism Spectrum Disorder. False negative or positive diagnoses are not uncommon.
Many medical problems, neurodevelopmental problems or mental disorders or illnesses look very similar and can present similar to child abuse. Child Psychiatrists are trained as medical doctors and specialists in mental health of children, and so, are trained to provide clarity in children's presentations.
Many medical problems, neurodevelopmental problems or mental disorders or illnesses look very similar and can present similar to child abuse. Child Psychiatrists are trained as medical doctors and specialists in mental health of children, and so, are trained to provide clarity in children's presentations.
POSSIBLE CONSEQUENCES OF ABUSE
Developmental delays (physical, cognitive, language, social, emotional)
Inexplicable deterioration in school work or chronic poor performance
Sudden change in presentation, personality or behaviour
Constant or regular hunger, stealing or hoarding of food
Chronic tiredness, insomnia, hypersomnia weakness or pain
Regular lateness or non-attendance at school or regular late collection from school
Running away from school or refusal or reluctance to go home after school
Poor excuses at school or excuses that make no sense for problems
Behaviour that makes no sense in school or at home or secretive
Destructive behaviour (Green 78) or aggressive behaviour (Green 78) or chronic anger
Abusive behaviour towards peers and teachers
Acting out the abusive behaviour with peers or adults (sexual, physical or emotional abuse)
Cycle of Abuse (McCarty 86; Steel 83)
Stealing and hoarding items other than food (items may be bizarre such as urine in cups)
Offending behaviour or drug and alcohol use (Herman 81)
Poor concentration, hyperactivity, impulsive behaviour, risk taking behaviour or recklessness
Developmental delays (physical, cognitive, language, social, emotional)
Inexplicable deterioration in school work or chronic poor performance
Sudden change in presentation, personality or behaviour
Constant or regular hunger, stealing or hoarding of food
Chronic tiredness, insomnia, hypersomnia weakness or pain
Regular lateness or non-attendance at school or regular late collection from school
Running away from school or refusal or reluctance to go home after school
Poor excuses at school or excuses that make no sense for problems
Behaviour that makes no sense in school or at home or secretive
Destructive behaviour (Green 78) or aggressive behaviour (Green 78) or chronic anger
Abusive behaviour towards peers and teachers
Acting out the abusive behaviour with peers or adults (sexual, physical or emotional abuse)
Cycle of Abuse (McCarty 86; Steel 83)
Stealing and hoarding items other than food (items may be bizarre such as urine in cups)
Offending behaviour or drug and alcohol use (Herman 81)
Poor concentration, hyperactivity, impulsive behaviour, risk taking behaviour or recklessness
Problems with social interaction, relationships and/or empathy
No interest in social interaction or relationships or physical contact
No interest in social interaction or relationships or physical contact
Problems with verbal and non-verbal (such as eye contact) communication and language
Bizarre behaviour or interests, obsessive, compulsive and/or repetitive behaviour
Need for predictability and for sameness - unable to tolerate change
Neurotic behaviour such as rocking, hair-twisting and thumb-sucking
Bizarre behaviour or interests, obsessive, compulsive and/or repetitive behaviour
Need for predictability and for sameness - unable to tolerate change
Neurotic behaviour such as rocking, hair-twisting and thumb-sucking
Anxiety disorders such as PTSD (Goodwin 85; Green 85), general anxiety, paranoia or panic
Low self-esteem, low motivation, isolation, withdrawal, aimlessness or passivity
Symptoms of depression (Sgroi 82) such as feelings of shame, guilt, worthlessness
Psychosomatic complaints (for instance headaches, tiredness where no causes are found) and
Dissociation (Kluft 85)
Regressive behaviour such as thumb sucking, bed wetting, insecurity or clingy behaviour
Reliance on primitive defences (Green 78) such as denial, projection and splitting
Self mutilation / self harm or suicidality (feeling suicidal)
Other mental health difficulties for instance Eating disorders
Attachment difficulties, mistrust (Herman 81) in significant adults and peers, few friendships
Borderline personality traits (Herman et al. 89)
Withdrawal from physical contact or fear of physical contact
Acceptance of punishment which appears excessive
Unnaturally compliant to parents or others
Refusal to discuss injuries or fear of medical help
Refusal to wear short sleeves, shorts, swimming trunks, changing in front of others
Over reaction of mistakes or problems and/or continual self-depreciation or self-disgust
Inappropriate emotional responses to painful situations
Fear of parents being contacted or a general fear of people
If you do not know whether you should be concerned or not - please discuss your concerns with your GP or with Social Care.
Please know that it is not the role of the Child Psychiatrist or GP to assess for abuse.
It is the role of Social Care to assess for abuse if concerns regarding abuse is raised.
Low self-esteem, low motivation, isolation, withdrawal, aimlessness or passivity
Symptoms of depression (Sgroi 82) such as feelings of shame, guilt, worthlessness
Psychosomatic complaints (for instance headaches, tiredness where no causes are found) and
Dissociation (Kluft 85)
Regressive behaviour such as thumb sucking, bed wetting, insecurity or clingy behaviour
Reliance on primitive defences (Green 78) such as denial, projection and splitting
Self mutilation / self harm or suicidality (feeling suicidal)
Other mental health difficulties for instance Eating disorders
Attachment difficulties, mistrust (Herman 81) in significant adults and peers, few friendships
Borderline personality traits (Herman et al. 89)
Withdrawal from physical contact or fear of physical contact
Acceptance of punishment which appears excessive
Unnaturally compliant to parents or others
Refusal to discuss injuries or fear of medical help
Refusal to wear short sleeves, shorts, swimming trunks, changing in front of others
Over reaction of mistakes or problems and/or continual self-depreciation or self-disgust
Inappropriate emotional responses to painful situations
Fear of parents being contacted or a general fear of people
Sexual knowledge inappropriate for age, sexual behaviour (Yates 82) or promiscuity
Sexually provocative behaviour or hinting at sexual activity
Weakened gender identity (Aiosa-Karpas et al. 91)
Sexually provocative behaviour or hinting at sexual activity
Weakened gender identity (Aiosa-Karpas et al. 91)
Poor physical hygiene, poor state of clothing or poor skin or hair tone
Emaciation, pot belly, short stature
Cover up clothes to hide injuries and/or multiple accidents and accidental injuries
Bruises especially on trunk, upper arms, shoulders and neck
Finger tip bruises (made by fingers), burns such as cigarette burns or bite marks
Fractures such as spinal fractures
Untreated medical or psychiatric problems
Neurological impairment (Green et al. 81)
Medical problems such as urinary or faecal incontinence
Unexplained pregnancies, infections, medical problems or injuries
Please know that assessments to better understand children's presentations and difficulties should be completed by professionals with the appropriate role, training and experience. These assessments are often complex and significant experience is required. Many presentations in Child Mental Health can present (appear) very similar to abuse. Sometimes more than one diagnosis is also relevant for children.
Emaciation, pot belly, short stature
Cover up clothes to hide injuries and/or multiple accidents and accidental injuries
Bruises especially on trunk, upper arms, shoulders and neck
Finger tip bruises (made by fingers), burns such as cigarette burns or bite marks
Fractures such as spinal fractures
Untreated medical or psychiatric problems
Neurological impairment (Green et al. 81)
Medical problems such as urinary or faecal incontinence
Unexplained pregnancies, infections, medical problems or injuries
Please know that assessments to better understand children's presentations and difficulties should be completed by professionals with the appropriate role, training and experience. These assessments are often complex and significant experience is required. Many presentations in Child Mental Health can present (appear) very similar to abuse. Sometimes more than one diagnosis is also relevant for children.
If you do not know whether you should be concerned or not - please discuss your concerns with your GP or with Social Care.
Please know that it is not the role of the Child Psychiatrist or GP to assess for abuse.
It is the role of Social Care to assess for abuse if concerns regarding abuse is raised.
All adults and professionals working with children do however raise concerns with families and if appropriate, Social Care, if concerns are present. Most professionals will speak to families, before they raise concerns with Social Care if possible and appropriate. Families usually know what to expect, they usually share the concerns of the professionals and they usually agree that Social Care should be asked for advice and welcome their input and support. We always aim to work collaboratively with families.
