Elias is a five twelvemonth old Mexican American male who has late been referred to the community reding centre due to the exposure of sexual maltreatment by his stepfather. Elias was a client of this community centre about 18 months before. Elias had been referred for hapless impulse control and hyperactivity. At that clip he was diagnosed as holding Attention Deficit Hyperactivity Disorder ( ADHD ) . He besides met with the bureau head-shrinker who had prescribed Elias Focalin. His cased was closed after merely a few Sessionss due to the family’s incompatibility and backdown from services.
At this point in clip Elias has been go toing his Sessionss with his female parent and babe brother. Stepfather’s whereabouts are unknown and he has non had any contact with the household since the maltreatment was exposed. Elias has returned to taking Focalin. since he failed to go on taking his medicine after retreating from services. However. there have been no alterations noted in his behaviour since he has begun to take the medicine. The head-shrinker believes that this may be due to the low dose he has prescribed Elias and because of such. the head-shrinker has opted to slowly increase the dose and closely supervise any alterations.
The clinician notes that Elias is highly overactive and exhibits minimum impulse control. Other than his high degrees of restlessness. Elias shows no discernible marks or symptoms of reaction to the sexual maltreatment. When clinician has attempted to treat with Elias about the maltreatment or his feelings about the maltreatment. Elias has changed the topic or ignored the clinician all together. Mother states that she has noticed no alterations in his behaviour since the maltreatment was discovered.
Practice Effectiveness Questions The particular population in treatment is kids. the societal jobs in focal point are sexual maltreatment and attending shortage hyperactivity upset ( ADHD ) . which leads the mark client group to be kids who have experienced sexual maltreatment and have been diagnosed with ADHD. Our client is Elias who is a kid. who has experienced sexual maltreatment and is diagnosed with ADHD. For the intents of this treatment our pattern effectivity inquiries are:
1 ) What are effectual intercessions for kids who have been sexually abused? and 2 ) What are effectual intercessions for kids who have been diagnosed with ADHD? Search Description Procedures The databases utilized for this hunt were: Google Scholar. Social Work Abstracts. Child Welfare Information Gateway. Academic Search Complete. Professional Development Collection. PsycARTICLES. PsycINFO. SocINDEX with Full Text Sociological Collection. Academic Search Premier. and JSTOR. It was besides helpful to reexamine the diary entitled Sexual Abuse: A Journal of Research and Treatment for relevant articles.
While seeking the aforesaid databases. the undermentioned keywords were utilised: ‘sexual maltreatment and ADHD’ . ‘sexual maltreatment and interventions’ . sexual maltreatment and co-morbidity’ . ‘ADHD and co-morbidity’ . ‘children and sexual abuse’ . ‘sexual maltreatment and intercessions. ’ All articles selected were peer reviewed. found in scholarly diaries. and published within the last 10 old ages. In seeking for relevant articles sing intervention of sexual maltreatment. most articles addressed intercessions designed to handle culprits of child sexual maltreatment ; a few articles were uncovered that discussed handling grownup subsisters of childhood sexual maltreatment.
Fewer still were articles that identified intercessions for kids who are recent or current victims of sexual maltreatment. In order to happen information relevant to our mark client group. we began drawing beginnings from mention pages of relevant articles which provided more focussed research relevant to intervention of kids who have experienced sexual maltreatment. Result The consequence of our thorough hunt of available literature led us to place eight articles to concentrate on.
Out of these articles. four dealt specifically with kids who have experienced sexual maltreatment. two focused on maltreatment of kids which included physical maltreatment along with sexual maltreatment. two were focused chiefly on ADHD. four focused on co-morbidity of either post-traumatic emphasis upset ( PTSD ) or ADHD and sexual maltreatment. and four specifically discussed interventions and intercessions. One-half of the selected articles were literature reappraisals while the staying four were describing from the point of view of a primary beginning on research surveies of interventions and intercessions.
The research surveies varied in their sampling and control or comparing groups ; merely two surveies were able to use a true experimental design with random assignment of survey participants to command and experimental groups. The literature reviews provided an extended overview of relevant surveies and intercessions from a secondary beginning point of view. The eight identified beginnings provided an mixture of research-based positions every bit good as a sampling of grounds based on authorization by those who reviewed the literature and discussed their findings in literature reappraisals. Research Findings
Description of Articles In the article Sexually Abused Children Suffering from PTSD: Appraisal and Treatment Strategies by David Heyne. Neville J. King. Paul Mullen. Nicole Myerson. Thomas H. Ollendick. Stephanie Rollings. and Bruce T. Tonge states that sexual maltreatment of kids is a major societal job because of its high prevalence and annihilating impact on the exploited kid. Children who have been sexually abused frequently demonstrate anxiousness. depressive tempers. improper sexual behaviours. incubuss. societal backdown. sleep troubles. choler. shame/guilt and school jobs.
The writers did diagnostic interviewing with their participants. The writers interviewed 30 six kids and 60 nine per centum were chiefly diagnosed with PTSD. Within the 30 six kids four of the kids with full PTSD had no other diagnosings. Nine had one carbon monoxide morbid diagnosings. ten had two carbon monoxides morbid diagnosings. and two had three carbon monoxides morbid diagnosings. PTSD is non ever prevailing and at times other emotional and behavioural jobs are prevailing. In fact. many surveies confirm that on clinical rating a big proportion of sexually abused kids run into diagnostic standards for PTSD ( Heyne. at EL. . 2003 ) .
This peculiar article showed that frequently there are other diagnosings that go along with PTSD but in an article by Peggy T. Ackerman. Roscoe A. Dykman. Jerry G. Jones. W. Brian McPherson. and Joseph E. O. Newton. did research on groups that have been affected sexual. physically abused. or both. The article Prevalence of PTSD and Other Psychiatric Diagnosis in Three Groups of Abused Children ( Sexual. Physical. and Both ) was a survey done with kids that are sexually and or physically abused. Fortunately. many kids who are victims of dismaying events do non develop PTSD or other psychiatric upsets ( Ackerman at EL. 1998 ) .
Very small is known as to why some exploited kids do and others do non develop psychiatric upsets. Even such basic variables as gender. ethnicity. socioeconomic position. intelligence. and age at clip of injury. have been inadequately studied. They were in a big children’s infirmary in which sexual and or physically abused kids were referred. The groups were divided into three. sexually and physically abused and both. Through the determination there were more male childs who were physically abused and misss who were sexually abused. Anxiety and behavior upsets were more frequent than temper upsets.
In harmony with clinical observation. abused male childs. regardless of type maltreatment. had higher rates of behavioural upsets and abused misss had higher rates of two internalising upsets: separation anxiousness ( caregiver studies ) and phobic upset ( child study ) ( Ackerman at EL. . 1998 ) . Studies show most clearly that kids who have been jointly physically and sexually abused are at greatest hazard for psychiatric perturbation. There are many different intervention intercessions one can travel through to minimise PTSD and attending deficient upsets.
Maryka Biaggio. Darlene Staffelbach. Dan Weinstein wrote the article ADHD and PTSD: Differential Diagnosis in Childhood Sexual Abuse which shows different intercessions used for exploited kids. Treatment intercessions for ADHD kids preponderantly consist of behavior direction. societal accomplishments developing. and stimulating or other medicine. Treatment intercessions for kids with PTSD by and large consist of direction and relief of emotional hurt utilizing drama. psychodynamic and cognitive behavioural therapy modes ( Biaggio at EL. 2000 ) . Relaxation techniques and hypnosis have besides been effectual in intervention of PTSD in kids.
Misdiagnosis may take clinicians to utilize inappropriate intercessions for PTSD. Side effects experienced by ADHD kids on stimulating medicine may include trouble falling asleep. deficiency of appetency. crossness. concerns. stomach aches. sickness. giddiness. tachycardia. musculus tics or vellications. slowed physical growing. and skin roseolas ( Biaggio at EL. . 2000 ) . Another unsought onsequence of ADHD misdiagnosis in SAC ( sexual abused kids ) is the failure to turn to and handle the injury symptoms of kids who really have PTSD. Given the hazard of wrongly ordering. untreated injury. and negative impact on self-pride for kids misdiagnosed with ADHD. it is unfortunate small attending has been given to this issue ( Biaggio at EL. . 2000 ) .
Increased attending to clinical decision-making in the differential diagnosing of ADHD and PTSD may take to more appropriate. good. and timely intercessions. Darcie ) Allison M. Briscoe-Smith and Stephen P. Henshaw’s article entitled: Linkages between kid maltreatment and attention-deficit/hyperactivity upset in misss: Behavioral and societal correlatives. was an first-class beginning to research the relationship of sexual maltreatment and ADHD and get down to discourse the co-morbidity of these events for kids. The article described a research survey carried out with a sample of 228 females at a summer cantonment for misss with ADHD over a three twelvemonth span.
Each twelvemonth cohort groups were created to place the prevalence of maltreatment among misss diagnosed with ADHD and those who had non received a diagnosing of ADHD. Out of the 24 identified instances of maltreatment histories. 20 of these misss were diagnosed with ADHD. and of those abuse histories ten were sexual in nature which is much higher than any other signifier of ill-treatment documented by the research workers. All misss who had maltreatment histories had a co-morbid diagnosing of Oppositional Defiance Disorder.
The survey found that misss with both ADHD and maltreatment histories were more likely to expose projecting behaviours and be negatively received by their equals. The survey besides analyzed the relationship between the prevalence of an maltreatment history and the rejection from equals and found aggression to partly intercede that relationship. The writers concluded that misss with ADHD were at increased hazard of holding maltreatment histories and questioned the accurate diagnosing of ADHD.
It was suggested that the misss who had histories of maltreatment may more accurately be diagnosed with PTSD and/or portion a co-morbid diagnosing with PTSD. Judith A. Cohen and Anthony P. Mannarino conducted a research survey comparing two intercessions to handle kids who have been sexually abused ; their findings were published in the article entitled: Interventions for Sexually Abused Children: Initial Treatment Outcome Findings. This article was one of few that specifically addressed intercessions for kids with the focal point being intervention of sexual maltreatment.
The sample consisted of 49 kids between the ages of 7 and 14 who were indiscriminately assigned to either sexual maltreatment specific cognitive behavioural therapy ( SAS-CBT ) or nondirective supportive therapy ( NST ) for a 12 hebdomad continuance. The survey found that kids in the SAS-CBT group improved significantly in societal competency and in the decrease of feelings of depression. Besides. well higher per centums of kids involved in SAS-CBT experienced what is considered clinically important betterments. In respects to impairment while in therapy. higher rates were found in kids who received NST.
For the safety of the other kids in the groups. kids who were systematically exposing insistent extreme sexually inappropriate behaviours were removed from intervention groups ; seven NST participants were removed from the survey as compared to two kids take parting in SAS-CBT. Parental satisfaction with intervention was high in both intervention groups which either intervention mode. The clinical feelings of the writers conclude that sexual maltreatment specific cognitive behavioural therapy is superior to nondirective supportive therapy in the decrease of depressive symptoms.
SAS-CBT was besides favored due to the benefit of including parents in intervention ( NST did non officially include parents ) . The writers besides concluded that there is value and importance in supplying a directing therapy technique in covering with the effects of injury caused by sexual maltreatment. Assessment of Evidence Implications of Evidence Interventions for sexual abused victim’s injury may include based cognitive behavioural therapy. drama therapy. parental involvement- parent preparation. behavioural therapy. get bying accomplishments developing. psycho-education. and bar consciousness.
PTSD intercessions may include injuries based cognitive behavioural therapy. and play therapy. Attention shortage upset can besides be treated with behavioural direction techniques. medicine. societal accomplishments developing. drama therapy. parent preparation. behavioural schoolroom intercessions and summer intervention plans. Many sexually abused kids have other diagnosing along with PTSD and several possible co-morbid diagnosing are more than likely behavioural. but frequently can be confused with PTSD. When looking at intercessions and interventions clinicians need to look at the client’s cultural background so that manner we do non irrupt on their lives.