Child – Emotional

The fear or anxiety caused or exacerbated by the incident or pattern of incidents: (Level of Functioning)

 

The fear or anxiety caused or exacerbated by the incident or pattern of incidents:

  1. extremely impacted the overall level of functioning
  2. highly impacted the overall level of functioning
  3. somewhat impacted the overall level of functioning
  4. did not impact the overall level of functioning

Overview

Example

Video Transcript:

Overview:

Here’s one of the typical current functioning items that you will see in the severity scales. But in this case it relates directly back to the fear and anxiety caused or exacerbated by the incidents. So when you’re thinking about the child, bear in mind those symptoms that are are either reported or simply observed. So was the child verbalizing saying they are in fact feeling fearful or anxious, and how is that impacting the functioning. Or are they not saying it but perhaps acting in a way that implies they are in fact fearful or anxious after the incident that is impacting those five major areas of functioning.

Example:

For this item, you need to focus on two things: fear/anxiety caused or exacerbated by the maltreatment AND the impact on overall level of functioning.

Sometimes, clinicians focus on the fear/anxiety – like the child was really scared in the moment, say while watching parents have physical fight in Exposure to Physical Hazards – but do not think about overall level of functioning.

Overall level of functioning requires you to think about the child’s behavior in relevant domains – like social interaction at school, home, with family, friends, etc

Here’s an example:
Teacher called CPS after 9-year-old wasn’t engaging in class work, fell asleep once in class during independent reading, and wasn’t really playing with friends during recess. Child is typically engaged in school work and likes interacting with classmates. When teacher spoke with child about these behaviors, child said he wasn’t sleeping at night due to fear of father. He said that’s making it hard to do school work, and he doesn’t feel good enough to play with friends.

This would be highly impacted given the change in school performance and social life.

 

The psychological symptoms caused or exacerbated by the incident or pattern of incidents (for example, anxiety, depression, ADHD, behavioral problems): (Level of Functioning)

2. The psychological symptoms caused or exacerbated by the incident or pattern of incidents (for example, anxiety, depression, ADHD, behavioral problems):

  1. extremely impacted the overall level of functioning
  2. highly impacted the overall level of functioning
  3. somewhat impacted the overall level of functioning
  4. did not impact the overall level of functioning

Overview:

Example:

Video Transcript:

Overview:

This item has to do with the psychological symptoms caused or exacerbated by the incident or pattern of incidences. With this item and with similar items in child emotional and other types of child maltreatment, always anchor yourself back to the incident or alleged instances. You’re not just looking for psychological symptoms, you’re looking for psychological symptoms as they relate to the alleged maltreatment. So if the child is reporting anxiety, look further into that. Is it anxiety due to or exacerbated by the incidence being investigated? If the child already has symptoms at baseline before the alleged incident or incidences you have to do a little bit more work. You need to see if things were exacerbated or got worse after the maltreatment that is being investigated.

Example:

Say the child was reporting clinically significant symptoms of depression or anxiety – either close to meeting the number of symptoms needed for a diagnosis or enough to meet diagnosis – and those symptoms made it hard to function in normal roles across domains – like not focusing at school, getting in trouble with authority figures, unable to socialize with friends (either isolating or fighting), fighting with parents at home, etc. This would be extremely impacted.

Moving it down a level – say the child was in treatment – seeing a psychologist, on medication, and actively monitoring ADHD symptoms – earning passing grades, and occasionally getting detention for not always following directions, but getting by – this would be highly impacted.

Somewhat impacted would be minor symptoms, or symptoms that are so well-managed they are not having a big impact on overall level of functioning. Like a child with depression who occasionally doesn’t complete a homework assignment or go out with friends because they don’t have the energy, but generally keeps a B average and mostly socializes with friends.

The somatic symptoms caused or exacerbated by the incident or pattern of incidents: (Level of Functioning)

The somatic symptoms caused or exacerbated by the incident or pattern of incidents:

  1. extremely impacted the overall level of functioning
  2. highly impacted the overall level of functioning
  3. somewhat impacted the overall level of functioning
  4. did not impact the overall level of functioning

Overview

Example

Video Transcript:

Overview:

The somatic symptoms caused or exacerbated by the incident or pattern of incidences is a pretty straightforward item. The challenge that typically arises here is dealing with a poor self-report or lack of self-awareness about bodily complaints related to the maltreatment. This is especially challenging for children. Some suggestions: ask about visits to the school nurse, if you can get school records, visits to the pediatrician related to bodily complaints, looking for things that are the standard somatic complaints that come up in young folks (stomachaches, headaches, chest pain) that don’t seem to have any real organic cause but that do seem to be related back to the incident. Because again your not looking for somatic symptoms, you’re looking for somatic symptoms related to treatment.

Example:

11-year-old child reports that since emotional abuse started, he’s been having headaches, stomach aches, and trouble sleeping that caused him to miss a few school days. He’s also having trouble focusing at school. Teachers confirm that academic performance is impacted.

This is highly impacted functioning because the somatic symptoms are interfering with school attendance and academic performance.

Let’s say there were somatic symptoms, but they weren’t really impacting the overall level of functioning like, “I sometimes have knots in my stomach, but I take a few deep breaths like the counselor taught me and I’m able to get back to my school work,” that would be somewhat impacted.

Extremely impacted would be going to the emergency room with stomach pain and severe headaches followed by testing and observation, but with no physical cause.

Given the acts, the child's level of functioning, and the risk and resilience factors present, which probability fits best? (Psychiatric Disorders)

Given the acts, the child’s level of functioning, and the risk and resilience factors present, which probability fits best?

  1. The child will be incredibly lucky to not develop a psychiatric disorder
  2. The child will be very lucky to not develop a psychiatric disorder
  3. The child will be lucky to not develop a psychiatric disorder
  4. The child will not develop a psychiatric disorder

Overview

Example

Video Transcript:

Overview:

This is a very complex item, but a very important one to rating child emotional maltreatment. So let’s break it down into its 3 components. First, the acts. It’s almost a mini severity rating. You want to be thinking about how significant the emotional maltreatment is for the child. Second, you want to be thinking about the current functioning. The big caveat here when thinking about that snapshot of current functioning, is that a child could look okay right now but in the future will have problems. That brings us to part three of the item which is risk and resilience factors. Back in the training we had those two nice columns. That column of risk factors, and you had that column of resiliency factors. For shorthand, think the more resiliency factors the more likely the child has buffering effects and good protections in place to decrease the likelihood of a psychiatric disorder. And the more risk factors the more likely the child is going to be put on a negative trajectory and have an increased likelihood of psychiatric disorders in the future.

Example:

For this item, you need to evaluate three pieces: the maltreatment, the current functioning, and the child’s environment. Based on those three things – will the child likely have a psychiatric disorder in the future?

Some things to consider – how significant were the emotional acts? Would those acts likely cause a psychiatric disorder in the future?

Current functioning – how is the child doing today? Current psychiatric issues may be an indicator of future psychiatric problems if the trajectory is not buffered with protective factors. Is the child showing any psychiatric symptoms?

Contextual factors – are there things in the child’s environment that could increase the likelihood of developing a psychiatric disorder? Will the child be in an environment that promotes psychiatric health? Will any current psychiatric issues be addressed?

Given the acts, the child's level of functioning, and other contextual factors, which probability fits best? (Cognitive Impairments)

Given the acts, the child’s level of functioning, and other contextual factors, which probability fits best?

  1. The child will be incredibly lucky to not have significant cognitive impairments.
  2. The child will be very lucky to not have significant cognitive impairments.
  3. The child will be lucky to not have significant cognitive impairments.
  4. The child will not develop significant cognitive impairments.

Overview

Example

Video Transcript:

Overview:

This is another one of those projection questions dealing with development. In this case how will the child’s cognitive functioning book in the future? Remember, with these types of items you need to think back to your current functioning snapshot. How is the child doing right now present day? And then consider those risk and protective factors. More risk factors increases the likelihood of problematic development, protective factors (resiliency factors) increase the likelihood that they will be able to buffer those negative facts and have a better outcome.

So for cognitive development what are we looking at here, remember were thinking about things for younger children (preschool age) be able to show developmentally appropriate communication (both understanding receptive, and being able to share expressive language). And I think it older, will school-age children be able to reach developmentally appropriate levels of academic achievement. Tie back to maltreatment, look at your snapshot and look at those risk and protective factors.

Example:

For this item, you need to evaluate three pieces: the maltreatment, the current functioning, and the child’s environment. Based on these three will the child likely have cognitive impairments in the future?

Some things to consider – how significant were the emotional acts? Would those acts likely impact cognitive functioning in the future?

Current functioning – how is the child doing today? Current cognitive functioning issues may be an indicator of future cognitive problems if the trajectory is not buffered with protective factors. Is the child meeting current cognitive milestones? Any delays? Any changes from the prior level of functioning?

Contextual factors – are there things in the child’s environment that could increase the likelihood of cognitive impairments, like now being cared for by a relative who cannot read with the child or help with homework like his or her parent? Will the child be in an environment that promotes cognitive functioning? Will any current cognitive challenges be addressed?

The act(s) or pattern of acts impacted: (Child Functioning)

The act(s) or pattern of acts:

  1. extremely impacted the child’s functioning (psychological, cognitive, social)
  2. highly impacted the child’s functioning (psychological, cognitive, social)
  3. somewhat impacted the child’s functioning (psychological, cognitive, social)
  4. did not impact the child’s functioning (psychological, cognitive, social)

Overview

Example

Video Transcript:

Overview:

This item has to deal with current functioning. What’s happening front of you? For this item, you want to be considering the child’s current functioning in psychological domain, cognitive domain, and social domain. So this one on its face kind of looks like an easier item, because you are only dealing with the information in front of you. We need to make sure though, because it is the multifaceted item, is that you’re getting all of the relevant reports. So how is a child doing in school if school-aged, dealing with peers, dealing with people in authority (such as school administrators and teachers), how are they doing with their siblings, with their same age peers and friends. We need to be evaluating all of these different components when it comes to an overall snapshot of their current functioning.

Example:

For this item, you need to evaluate three domains – psychological, cognitive and social functioning. Now, it’s not a simple formula. You can’t say something like, “Only psychological functioning was impacted, so it’s somewhat.” You really need to do a full-picture evaluation. Maybe the child is experiencing some social functioning issues, but is doing okay in other areas. That sounds like somewhat impacted. If the child is feeling depressed and anxious, and is having trouble with friends, that sounds like highly impacted. If one area is significantly impacted enough – say a child is having lots of depressive symptoms – this will likely cut across other domains of functioning.

The act(s) or pattern of acts impacted: (Child Development)

The act(s) or pattern of acts:

  1. is extremely likely to impact the child’s development (psychological, cognitive, social)
  2. is highly likely to impact the child’s development (psychological, cognitive, social)
  3. is somewhat likely to impact the child’s development (psychological, cognitive, social)
  4. will not impact the child’s development (psychological, cognitive, social)

Overview

Example

Video Transcript:

Overview:

For this item, you’re being asked how the act or the pattern of acts will impact the child’s future functioning, in this case as it relates to psychological, social, and cognitive functioning. So you want to take a step back and ask yourself: “what is the child going to look like in 5,10,15,20 years from now as it relates back to that psychological cognitive and social functioning?”

Within the item itself, you’re being asked to make this rating based on the act or the pattern of acts, so you really want to focus on the nature of the maltreatment here. Is the maltreatment such that right now the child might look one way, but the child is likely to look different in the future? So maybe the impact isn’t being felt greatly now, maybe it is, but in the future it is likely to have an even greater impact than it is currently.

Example:

In the overview explanation, I said that you need to project into the future, 5, 10, 15 years from now, while keeping the nature of the maltreatment in mind. Things might look OK now, but could be worse in the future based on the act or pattern of acts.

Here’s an example to highlight what this might look like:
Say SM mother has primary custody of 9 year-old son, and father is not actively involved in child’s life. SM mother often berates her son and says things like, “You’re a loser just like your dad. You might like school now, but you’ll be a burn out and not even finish high school. When things get hard, you’ll get lazy and stop going and you’ll fail just like him.” Now, this child might not have many challenges right now in school, but if he in fact starts struggling when the coursework gets more difficult in a few years, those berating words might come back and start impacting his functioning.

Another example: A 11-year-old daughter reports that she sleeps in the same bed as her father when he has visitation every weekend and a month during the summer. She’s been doing this since SM mother and father divorced when she was 5 years old. Daughter is starting to become interested in makeup and getting a bra to wear to PE class. Her father has started making comments about her interest and changes during puberty like, “Be careful as your chest and bum round out. Your mother has that hourglass figure, and you see what a whore she turned out to be. Don’t give it all away for free like her. Ruined our marriage and your childhood. Good thing you’re in my bed when I see you. Need to make sure you’re not acting out by yourself at night.” During interview with FAP, daughter doesn’t really report a dramatic change in her functioning, but that her father’s comments make her feel uncomfortable and she doesn’t want to see him as often.

OK, this child is just starting puberty, and hasn’t starting romantic or sexual relationships. There is a substantial potential that when these behaviors start happening, let’s say in about 5 years when she’s 17, these acts might impact her in a greater way.