A dilemma exists when a doctor is faced with a child or young person who refuses medically indica... more A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case had been interpreted by many to mean that a child ofsufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent ifhe or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases ofdoubt seek legal advice.
Book reviews 433 development of motor control, intestinal motor activity in the preterm infant, a... more Book reviews 433 development of motor control, intestinal motor activity in the preterm infant, and the development of the lower oesophageal sphincter in the preterm infant. The second section deals with disordered oesophageal function in two chapters. One deals with gastro-oesophageal reflux in infancy. The second deals with reflux and chronic bronchopulmonary disease. The third section covers small intestinal disorders and colonic function in five chapters. The first is on intestinal pseudo-obstruction in childhood. The second on the pathology of this condition. The third on motility disorders in cystic fibrosis. The fourth on the irritable bowel syndrome, and the last on constipation. The final section covers therapeutics and the use of prokinetic agents. Despite its multiauthorship Peter Milla has achieved a cohesiveness of style, clarity, and brevity. Each chapter has useful references. It is inevitable that there will be a slight degree of overlap between different authors but this is a minor fault in a book that should be useful in the understanding and management of this difficult area of paediatric gastroenterology. It should find a useful place in the libraries of general paediatricians as well as of those working entirely in paediatric gastroenterology.
This bibliography covers literature of multiple aspects of disclosure of child abuse. It is a sel... more This bibliography covers literature of multiple aspects of disclosure of child abuse. It is a selected bibliography, and is not comprehensive. Included are articles, reports, dissertations, books, and book chapters, written by researchers and practitioners from around the world, including Israel,
permissions Reprints/ [email protected] write to To obtain reprints or permission to repr... more permissions Reprints/ [email protected] write to To obtain reprints or permission to reproduce material from this paper, please to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/191/5/449 service Email alerting click here the top right corner of the article or Receive free email alerts when new articles cite this article sign up in the box at from Downloaded The Royal College of Psychiatrists Published by on December 12, 2010 bjp.rcpsych.org
His main areas of research and clinical interest include patients with persistent medically unexp... more His main areas of research and clinical interest include patients with persistent medically unexplained physical symptoms and patients with fabricated illnesses.
Henry Kempe considered sexual abuse to be just as common as physical abuse and neglect, yet felt ... more Henry Kempe considered sexual abuse to be just as common as physical abuse and neglect, yet felt that it was receiving insufficient professional and social attention while children and young people were suffering extensively and had been left without care from child-care professionals. Henry’s 1978 paper covered the protean presentations of sexual abuse vividly, with examples of physical complaints, diseases, mental health presentations, addictions, as well as the disruption of socialization and sexual development. Henry Kempe forced a reluctant professional community to acknowledge the problem of sexual abuse of children, and our inadequate response to it to date, forging the way for many of us who followed to make further contributions, and for that we owe a considerable debt to his efforts and his courage as expressed in this address and subsequent paper.
fabricated or induced illness (fii) is a rare form of child abuse that is usually, but not exclus... more fabricated or induced illness (fii) is a rare form of child abuse that is usually, but not exclusively, perpetrated by mothers of children under 5 years of age. detection and assessment require painstaking and detailed enquiry, and should not be attempted without full information from medical, social care, and other records. Suspected cases of fii often lead to family justice court orders to safeguard the child, appoint a guardian for him or her, and commission assessments. more than half of perpetrators have chronic somatoform and/or factitious disorders, often coexisting with a personality disorder. this article describes case characteristics suggesting that reunification with the child may be possible. these include: (a) acknowledgement of the fabrications; (b) an ability to work collaboratively with health and social services; (c) cessation of somatoform presentations to primary and tertiary care services; (d) reduction in frequency of any self-harming or substance misuse; (e) remaining in a stable relationship with social supports. treatment phases are described; better outcome has been demonstrated where changes in the family system and a therapeutic alliance with the fabricator's partner and extended family could be established. the time-frame for intervention must be sensitive to the developmental needs of the child. Successful outcome is dependent upon coordinated efforts by more than one mental health team, working closely with children's social care, primary health care, and central paediatric involvement, to ensure the child's safety and future well-being.
Previous research indicates that many adults (nearly 40%) fail to report their own documented chi... more Previous research indicates that many adults (nearly 40%) fail to report their own documented child sexual abuse (CSA) when asked about their childhood experiences. These controversial results could reflect lack of consciously accessible recollection, thus bolstering claims that traumatic memories may be repressed. In the present study, 175 individuals with documented CSA histories were interviewed regarding their childhood trauma. Unlike in previous studies, the majority of participants (81%) in our study reported the documented abuse. Older age when the abuse ended, maternal support following disclosure of the abuse, and more severe abuse were associated with an increased likelihood of disclosure. Ethnicity and dissociation also played a role. Failure to report CSA should not necessarily be interpreted as evidence that the abuse is inaccessible to memory, although inaccessibility or forgetting cannot be ruled out in a subset of cases.
The purpose of the present study was to identify predictors of two potential sequelae of child se... more The purpose of the present study was to identify predictors of two potential sequelae of child sexual abuse, self-blame attributions and internalizing behavior problems. In the study, detailed information was collected on 218 victims of sexual abuse aged 4 to 17, involved in criminal cases, about their background, the abuse, and their mother's reaction following discovery of the abuse. Increased attributions of self-blame were predicted by the child having a close relationship with the perpetrator, experiencing severe sexual abuse (e.g., long-lasting abuse that involved penetration), perceiving the abuse as disgusting, and coping with the abuse by pretending it was not happening. Similar factors did not emerge as predictors of internalizing behavior problems. Results suggest that different child and abuse characteristics predict the two sequelae often associated with childhood sexual abuse. Thus, although self-blame attributions and behavior problems are often considered similar consequences of sexual abuse, there appears a need to distinguish the two types of outcomes following sexual victimization in childhood.
A dilemma exists when a doctor is faced with a child or young person who refuses medically indica... more A dilemma exists when a doctor is faced with a child or young person who refuses medically indicated treatment. The Gillick case had been interpreted by many to mean that a child ofsufficient age and intelligence could validly consent or refuse consent to treatment. Recent decisions of the Court of Appeal on a child's refusal of medical treatment have clouded the issue and undermined the spirit of the Gillick decision and the Children Act 1989. It is now the case that a child patient whose competence is in doubt will be found rational if he or she accepts the proposal to treat but may be found incompetent ifhe or she disagrees. Practitioners are alerted to the anomalies now exhibited by the law on the issue of children's consent and refusal. The impact of the decisions from the perspectives of medicine, ethics, and the law are examined. Practitioners should review each case of child care carefully and in cases ofdoubt seek legal advice.
Book reviews 433 development of motor control, intestinal motor activity in the preterm infant, a... more Book reviews 433 development of motor control, intestinal motor activity in the preterm infant, and the development of the lower oesophageal sphincter in the preterm infant. The second section deals with disordered oesophageal function in two chapters. One deals with gastro-oesophageal reflux in infancy. The second deals with reflux and chronic bronchopulmonary disease. The third section covers small intestinal disorders and colonic function in five chapters. The first is on intestinal pseudo-obstruction in childhood. The second on the pathology of this condition. The third on motility disorders in cystic fibrosis. The fourth on the irritable bowel syndrome, and the last on constipation. The final section covers therapeutics and the use of prokinetic agents. Despite its multiauthorship Peter Milla has achieved a cohesiveness of style, clarity, and brevity. Each chapter has useful references. It is inevitable that there will be a slight degree of overlap between different authors but this is a minor fault in a book that should be useful in the understanding and management of this difficult area of paediatric gastroenterology. It should find a useful place in the libraries of general paediatricians as well as of those working entirely in paediatric gastroenterology.
This bibliography covers literature of multiple aspects of disclosure of child abuse. It is a sel... more This bibliography covers literature of multiple aspects of disclosure of child abuse. It is a selected bibliography, and is not comprehensive. Included are articles, reports, dissertations, books, and book chapters, written by researchers and practitioners from around the world, including Israel,
permissions Reprints/ [email protected] write to To obtain reprints or permission to repr... more permissions Reprints/ [email protected] write to To obtain reprints or permission to reproduce material from this paper, please to this article at You can respond http://bjp.rcpsych.org/cgi/eletter-submit/191/5/449 service Email alerting click here the top right corner of the article or Receive free email alerts when new articles cite this article sign up in the box at from Downloaded The Royal College of Psychiatrists Published by on December 12, 2010 bjp.rcpsych.org
His main areas of research and clinical interest include patients with persistent medically unexp... more His main areas of research and clinical interest include patients with persistent medically unexplained physical symptoms and patients with fabricated illnesses.
Henry Kempe considered sexual abuse to be just as common as physical abuse and neglect, yet felt ... more Henry Kempe considered sexual abuse to be just as common as physical abuse and neglect, yet felt that it was receiving insufficient professional and social attention while children and young people were suffering extensively and had been left without care from child-care professionals. Henry’s 1978 paper covered the protean presentations of sexual abuse vividly, with examples of physical complaints, diseases, mental health presentations, addictions, as well as the disruption of socialization and sexual development. Henry Kempe forced a reluctant professional community to acknowledge the problem of sexual abuse of children, and our inadequate response to it to date, forging the way for many of us who followed to make further contributions, and for that we owe a considerable debt to his efforts and his courage as expressed in this address and subsequent paper.
fabricated or induced illness (fii) is a rare form of child abuse that is usually, but not exclus... more fabricated or induced illness (fii) is a rare form of child abuse that is usually, but not exclusively, perpetrated by mothers of children under 5 years of age. detection and assessment require painstaking and detailed enquiry, and should not be attempted without full information from medical, social care, and other records. Suspected cases of fii often lead to family justice court orders to safeguard the child, appoint a guardian for him or her, and commission assessments. more than half of perpetrators have chronic somatoform and/or factitious disorders, often coexisting with a personality disorder. this article describes case characteristics suggesting that reunification with the child may be possible. these include: (a) acknowledgement of the fabrications; (b) an ability to work collaboratively with health and social services; (c) cessation of somatoform presentations to primary and tertiary care services; (d) reduction in frequency of any self-harming or substance misuse; (e) remaining in a stable relationship with social supports. treatment phases are described; better outcome has been demonstrated where changes in the family system and a therapeutic alliance with the fabricator's partner and extended family could be established. the time-frame for intervention must be sensitive to the developmental needs of the child. Successful outcome is dependent upon coordinated efforts by more than one mental health team, working closely with children's social care, primary health care, and central paediatric involvement, to ensure the child's safety and future well-being.
Previous research indicates that many adults (nearly 40%) fail to report their own documented chi... more Previous research indicates that many adults (nearly 40%) fail to report their own documented child sexual abuse (CSA) when asked about their childhood experiences. These controversial results could reflect lack of consciously accessible recollection, thus bolstering claims that traumatic memories may be repressed. In the present study, 175 individuals with documented CSA histories were interviewed regarding their childhood trauma. Unlike in previous studies, the majority of participants (81%) in our study reported the documented abuse. Older age when the abuse ended, maternal support following disclosure of the abuse, and more severe abuse were associated with an increased likelihood of disclosure. Ethnicity and dissociation also played a role. Failure to report CSA should not necessarily be interpreted as evidence that the abuse is inaccessible to memory, although inaccessibility or forgetting cannot be ruled out in a subset of cases.
The purpose of the present study was to identify predictors of two potential sequelae of child se... more The purpose of the present study was to identify predictors of two potential sequelae of child sexual abuse, self-blame attributions and internalizing behavior problems. In the study, detailed information was collected on 218 victims of sexual abuse aged 4 to 17, involved in criminal cases, about their background, the abuse, and their mother's reaction following discovery of the abuse. Increased attributions of self-blame were predicted by the child having a close relationship with the perpetrator, experiencing severe sexual abuse (e.g., long-lasting abuse that involved penetration), perceiving the abuse as disgusting, and coping with the abuse by pretending it was not happening. Similar factors did not emerge as predictors of internalizing behavior problems. Results suggest that different child and abuse characteristics predict the two sequelae often associated with childhood sexual abuse. Thus, although self-blame attributions and behavior problems are often considered similar consequences of sexual abuse, there appears a need to distinguish the two types of outcomes following sexual victimization in childhood.
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