The prevalence of child sexual abuse (CSA) has remained consistently high for years. While children most often disclose experiences of CSA to trusted teachers than to other non-relative adults in their lives, many teachers report feeling unprepared to handle suspected CSA cases. Schools, too, note their uncertainty about whether to intervene and - when they do - which other professionals to involve at what stages of the process. Against this background, this paper aims to identify key CSA intervention training areas that can enable teachers to handle cases of suspected CSA professionally and competently. In contrast to existing research, which tends to focus exclusively on teachers, this Germany-based study draws on interviews with professionals from a wide range of institutions, including schools (n = 17), child protection services (n = 15), and law enforcement (n = 13). Significantly, all of the interviewees highlighted the need for improved teacher education on CSA intervention, with inter-institutional collaboration and knowledge of how to conduct an intervention being the most frequent topics of recollection among those interviewed.
Partner economic abuse is an understudied form of intimate partner violence (IPV) that is increasingly considered to coincide with physical and/or sexual IPV (i.e., contact IPV), and can hinder help-seeking. This overlap is not well-understood, and measurement for economic IPV remains limited across global settings. This mixed methods study examines 1) measurement performance of an economic IPV scale; 2) prevalence of current economic IPV and contact IPV; 3) demographic and economic agency associations with groupings of IPV experience (mutually exclusive experience, co-experience, and none); and 4) underlying norms that perpetuate economic IPV via qualitative data. Cross-sectional analysis among young, partnered women in Nairobi (n = 591) drew from the 2023 data collection wave of an ongoing youth cohort. Exploratory factor analysis examined measurement performance of the economic IPV scale. Overlap between economic and contact IPV was explored. Multivariable multinomial regression examined associations of sociodemographic and economic agency measures with the groupings of IPV experience. Thematic analysis explored in-depth interview data (n = 15). The economic IPV scale had strong performance. Approximately 35% reported economic IPV, 28% reported contact IPV, and 19% reported both. Economic dependency was associated with increased risk of experiencing economic IPV by itself (RRR: 2.49 95%, CI: 1.15,5.40), and was not similarly associated with contact IPV. Being the primary earner was protective for economic IPV only as compared to no IPV; however, it was a risk factor for combined IPV as compared to economic IPV on its own (RRR: 6.01, 95% CI: 2.01,18.00). Qualitative findings describe a gendered context inclusive of partner financial control. Substantial co-occurrence of economic and contact IPV has implications for survivor financial barriers to help-seeking that cannot be ignored in service provision. Given identified differences in risk between IPV types, economic empowerment programming must apply nuanced attention to unique needs by IPV type.
Abstract Background Autism and schizophrenia spectrum disorders both represent severely disabling neurodevelopmental disorders with marked impairments in social functioning. Despite an increased incidence of psychosis in autism, and substantial overlap in symptoms and cognitive markers, it is unclear whether such phenotypes are specifically related to risk for psychosis or perhaps reflect more general, idiosyncratic autism traits. Attenuated positive symptoms (APS) currently constitute the best and most-replicated clinical predictors of schizophrenic psychosis, and are common in clinical youth with and without autism. The aims of this study were to test the hypothesis that facial affect processing is impaired in adolescents with APS and to explore whether such deficits are more indicative of psychotic or autistic phenotypes on a categorical and dimensional level. Methods Fifty-three adolescents with APS and 81 typically developing controls (aged 12–18) were included. The APS group consisted of adolescents with (n = 21) and without (n = 32) a diagnosis of autism spectrum disorder. Facial affect recognition and ‘lower-level’ cognitive skills, namely pattern and face recognition, were assessed with the Amsterdam Neuropsychological Tasks. For associations with schizotypal and autistic-like traits the Schizotypal Personality Questionnaire and Social Communication questionnaire were used and one-dimensional factor scores were generated with confirmatory factor analysis. Results Our preliminary findings suggest that APS in adolescents is not associated with impairments in pattern, face, or emotion recognition. However, the APS group with autism spectrum disorder generally showed slower reaction times for face/emotional stimuli and they were significantly worse in recognizing fearful expressions than APS participants without autism spectrum disorder and controls. There were no dimensional correlations with schizotypal traits and marginal correlations between autistic-like traits and speed of recognizing faces. Discussion Contrary to our expectations, APS demonstrated limited use in identifying cognitive deficits typical to schizophrenic psychosis. A more autistic-like profile may be characterized by slower reaction times to facial stimuli, suggesting that more complicated and dynamic social cognitive stimuli have a better chance of discerning between autistic and psychotic-like phenotypes.
The adultification of Black adolescent girls, viewing them as less innocent and more adult-like, has implications for their sexual and psychological well-being. Adultification creates bias, which hyper-sexualizes Black girls, increasing vulnerability to early sexual activity, sexual abuse, and lack of support, while hindering their ability to seek protection. However, protection from parents, peers, and communities may play a critical role in mitigating this risk for Black girls. The current study examined the role of maternal, paternal, peer friendships, and communal protective factors in mediating the association between adultification and sexual risk among Black girls. Girls' responses (N = 575), 9-18 years old, were analyzed. Multiple linear regression analyses were conducted to estimate the mediating effects of protective factors (mother, father, friendship, and communal) on adultification and sexual risk. In separate mediation models, paternal relationships and friendship partially mediated the association between adultification and sexual risk. However, in a parallel mediation model that simultaneously examined maternal and paternal relationships, friendship, and community protection, friendship emerged as the only significant indirect pathway. Greater adultification was associated with stronger peer friendship, which in turn was associated with greater sexual risk. Programs, policies, and interventions addressing the sexual health of Black girls should consider how peer relationships shape responses to adultification and promote peer environments that support healthy sexual development.
Abstract Background A recent narrative review of the research literature (Ben-David & Kealy, 2019) found that identity-related concerns were an important aspect of young people’s experiences in the early stages of psychosis. Themes across articles suggested that the emergence of psychosis leads to identity disruption, which in turn may contribute to additional mental health risks. Moreover, studies indicated the salience to young people of addressing personal identity during the recovery process. Understanding clinicians’ perspectives on issues related to identity in early psychosis is an important next step, particularly to determine needs for knowledge development, clinician support, and intervention practices. The current literature on clinician’s perspective on early psychosis and identity is limited, with more attention placed on clinician’s perspectives on the use of medication, and psychosocial interventions (e.g. cognitive behavioral therapy (CBT)). The purpose of the present study was to understand the perspectives of early psychosis intervention (EPI) clinicians on identity related concerns among young people in the early stages of psychosis. Methods An online questionnaire was distributed to 331 EPI clinicians in the province of British Columbia, Canada. Participants were asked about their opinions on identity in the early stages of psychosis using fixed and open response questions. The open-ended response question “what kinds of interventions do you think would strengthen clients’ personal identity in the early stages of psychosis?” was coded by two investigators, using content analysis methodology. Results The response rate was 30%. Of the participants, 98% agreed that personal identity is an important issue for clinical attention among young people in the early stages of psychosis, and 99% agreed that schizophrenia spectrum disorders can have a negative impact on a young person’s identity. Despite near-unanimous acknowledgement of identity as a critical issue in early psychosis, only 53% of clinicians endorsed a high level of confidence in their ability to address issues related to identity in treatment, and only 28% agreed that current intervention practices adequately address personal identity. Seventy-four percent of the participants provided qualitative responses regarding intervention approaches that they believed would strengthen clients’ personal identity in the early stages of psychosis. Common themes included social connection and peer support, therapeutic interventions (e.g. CBT, mindfulness, narrative therapy, psychoeducation), focusing on the youths strengths, involving family in the work, connecting youth to personal identity (e.g. exploring culture, values, interests and sources of meaning, storytelling), and enhancing relationships between service providers and youth. Discussion EPI clinicians in British Columbia agree that personal identity in the early stages of psychosis is an important issue. However, they indicated feeling markedly less confident in their ability to address issues related to identity in treatment. Findings suggest that EPI programs should invest in identity- related training for clinicians. Future research can focus on the impact of identity-related interventions with regard to treatment engagement and client recovery outcomes.
Objective recent years have seen considerable attention to concerns regarding youth access to screens. Many professional bodies and clinicians have advised parents to limit youth access to smartphones and tablets, particularly at young ages. However, little clear evidence has emerged to support this advice. Method a dataset of 80,878 young adults (mean age: 23.3) was provided by Sapienlabs. Data included childhood age of first access to smartphones and tablets, as well as exposure to adverse childhood events. Relationships with current mental health were tested using OLS regression. Results results indicated that exposure to adverse childhood events was predictive of mental health difficulties in early adulthood. Age of access to smartphones and tablets was not. Conclusions advice to parents to avoid earlier access to smartphones and tablets appears to be unwarranted. Moral panic concerns about technology may distract society from more pressing causes of mental health difficulties such as abuse, neglect, and parental mental health.
Abstract Pediatric cancer survivors have increased unemployment and lower educational attainment rates. This is most significant in brain tumor survivors who show five-fold relative odds increase in unemployment over other pediatric cancer survivors. The long-term effects of brain tumor treatment potentiate the difficulty with work and school reintegration seen in the broader Adolescent and Young Adult (AYA) population. To address this, our team designed an annual job fair for AYA Neuro-Oncology survivors. Vendors were invited representing disability advocacy groups, legal services, scholarship organizations, and employers with strong disability services, several who offered on-site interviews. Additionally, brain tumor survivors served as inspirational speakers for the event. Between thirty to forty survivors have attended each event. Pre- and post-surveys, as well as 3- and 6- month follow up was obtained. Universally, the day was engaging and motivating, both for survivors and staff, and stimulated conversation for pursuing career or academic success within families and the care team. While all the patients took applications, none of the patients completed the on-site interviews, finding them overwhelming. Even at the 3- and 6-month follow-ups following the first event, the survivors continued to be at varying levels of application completion; no one who was previously unemployed attained new employment. This improved after pre-event meetings were held with survivors to participate in resume building and interview preparation. Currently, two survivors obtained employment and are still employed at 1 year and five survivors were able to advocate for their disabilities services in college with help of a non-profit legal assistant.
OBJECTIVES: Low-income, Latina mothers are at high risk for experiencing maternal depression, which can impact their young children. This study sought to identify socioeconomic, psychosocial, health, and cultural correlates of depressive symptoms among Latina mothers of Head Start children. METHODS: A cross-sectional study was conducted with baseline data from 163 Latina mothers enrolled in a larger intervention trial (Mage = 32.7, SD=6.3). Mothers were screened for depressive symptoms using the Center for Epidemiology Studies Depression Scale (CES-D). Hierarchical regression models examined whether socioeconomic factors (education, employment, insurance status, income, economic pressure, and number of children in household), psychosocial and health factors (age, lifetime trauma exposure, intimate partner violence (IPV) exposure, living situation, health problems, social support, and prior mental health history), and cultural factors (maternal nativity, preferred language) explained a statistically significant amount of variance in maternal depressive symptoms. RESULTS: 38% of Latina Head Start mothers reported clinically significant levels of depressive symptomatology. Reporting income from earnings and social support were negatively associated with depressive symptoms, whereas lifetime trauma exposure, exposure to current physical and verbal IPV, and endorsing a history of depression were positively associated with depressive symptoms. Cultural factors were not significant. CONCLUSIONS FOR PRACTICE: Findings indicate a high rate of elevated depressive symptomatology in this sample. Cross-system interventions are needed that address both structural and psychosocial contributors to maternal depression for low-income, Latina mothers of young children. Future research should continue to explore the role of cultural factors for Latina mothers.
Abstract Case report - Introduction 15 year old girl with the diagnosis of granulomatosis polyangiitis (GPA) managed with induction regimen of intravenous cyclophosphamide and whilst on maintenance mycophenolate mofetil (MMF) developed multiple cavitating lung lesions with the large cavity abutting pulmonary vein and bilateral segmental pulmonary embolism (PE) posing complex management dilemmas. Case report - Case description 15-year-old girl presented with being unwell for 3 months with malaise, lethargy, joint pains, significant weight loss (10 kg), mouth ulcer and significant hearing loss. Investigations showed anaemia, raised inflammatory markers, and impaired kidney function (estimated glomerular filtration rate eGFR 40). Her ANCA was positive, hearing test showed significant mixed hearing loss and CXR was normal. The renal biopsy confirmed pauci-immune ANCA associated glomerulonephritis with 70% crescents. She was initially managed with intravenous pulse of steroids followed by oral weaning regime, double filtration plasmapheresis and commenced on induction regimen of intravenous cyclophosphamide. She received 6 doses of cyclophosphamide 500 mg/m2 and following good recovery with normalising kidney function; was commenced on maintenance MMF. At this point she developed new onset earache, sore throat, and hoarseness of voice with raised inflammatory markers and worsening symptoms despite antibiotics. This was presumed to a flare of vasculitis and hence was given further pulse of steroids and increased the dose of MMF. The ENT assessment did not reveal any subglottic stenosis. After few weeks, symptoms recurred with cough/hoarseness of voice and associated tiredness. Bloods showed raised inflammatory markers; CXR revealed cavitating lung lesions and a CT chest was arranged. CT chest showed apical sub pleural lung nodule and a large thick-walled cavity measuring 6.6x 4.4 cm abutting the pulmonary vein on the right side and bilateral segmental pulmonary emboli. The child was systemically stable with no respiratory distress and oxygen saturations were 100% in air. Case report - Discussion The management of GPA was further complicated by the pulmonary embolism and cavitating lung lesions abutting pulmonary vein. The management included escalation of immunosuppression with pulse of steroids, further dose of cyclophosphamide and commence Rituximab .The key challenges with the immediate management were risk of bleeding associated with the anticoagulation, treating the pulmonary embolism, risk of diffuse alveolar haemorrhage and managing the patient in a safe setting equipped with all the expertise required. The child was screened for cardiolipin antibodies on multiple occasions and these were negative. An ECHO was done to look for evidence of clot at the end of central line tip, but this was normal. Deep venous thrombosis of legs was ruled out by Doppler scanning. There was no clear source of emboli identified. Although there is emerging evidence for increased incidence of vascular events in GPA adult patients, the data on vascular events in children with GPA is scarce. Merkel and co-workers reported a high occurrence of pulmonary embolism (PE) and deep venous thrombosis (DVT) among GPA patients included in a randomized therapeutic trial (WeCLOT study) 1 .FAURSCHOU et al. reported that GPA was associated with a much lower relative risk of stroke than of pulmonary embolism and deep venous thrombosis; the risk of venous thromboembolic events among GPA patients was increased during early as well as late follow up periods. Currently there are no significant data on the use of antiplatelet and/or anticoagulant therapy in AAV. Following extensive multidisciplinary discussion with respiratory, haematology, cardiology, cardiothoracic surgical and paediatric intensive care teams, and the child was anticoagulated with close monitoring in paediatric high dependency unit and immunosuppression escalated alongside. Case report - Key learning points This case highlights the risk of thromboembolic events in children with GPA Proposed mechanisms in the literature for thrombosis in vasculitis at molecular level would probably explain the episode in the absence of source identified Multidisciplinary team approach is crucial for management of complex patients There were few challenges due to geographical location of the patient and the regional variation of subspecialty cover provided for their local District General Hospital For discussion- Role of Rituximab early in GPA?
Background Transgenerational trauma (TT)/Intergenerational trauma (IT) is the transmission of the effects of traumatic experiences of parents to their children, who have not themselves experienced traumatic events. This transmission occurs through neurobiological and metabolic changes and the environment in which they were raised. Methods A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed and Google Scholar databases were searched from 2005 to 2025. Studies focusing on adult offspring, exposure to ancestral trauma, biological markers (DNA methylation, cortisol), and psychological outcomes were included. Results The main study results are as follows: identification of sex-specific DNA methylation patterns in the NR3C1 gene and accelerated biological aging (GrimAge) in offspring; role of parental reflective functioning (PRF) and impaired mentalization as major psychological channels of trauma transmission; and evidence confirming the impact on three generations, manifested by treatment-resistant depressive disorders, anxiety, and neuroendocrine dysregulation (low cortisol levels). Conclusions This article highlights the intergenerational impact of trauma and highlights its epigenetic significance. The primary goal was to explore universal epigenetic mechanisms. Early understanding of ancestral history is crucial for personalized psychiatric care.
