Pediatric Symptom Checklist

Do they give the youth questionaire to the child to fill out? If the child is allowed to fill it out in the office (away from a parent) then it seems like it could be helpful. As far as asking for information about abusive situations - I think an abusive parent would be outraged if their child were asked about abuse in the home. I know my father would have been. It was the reason he banned us from seeing the school counselors, even though the school kept sending me there, year after year. I was not to speak to them because he was angry that anyone would insinuate that anything was wrong at home, or that he might be held responsible.

I think the screening is a step in the right direction... it's just that there is such a long way to go before we get to the point where all children are safe in their own homes.

Hi Paul,

I wonder how the clinicians interpret these checklists?

I'd imagine it would raise flags if the child presented in a way inconsistent to the parent scored checklist. So, if the parent said "never" to everything, but the child was withdrawn, it would raise flags. If the scoring was inconsistent with a known medical history, it would raise flags. My mother is a nurse, and this is what they often do. They look for the inconsistencies, rather than take the parents word on face value.

Also, the clinician often do "innocent chatter" with the children as the check-up is occurring. So they are often informally asking things which are designed to check out things from the perspective of the child.

I know this isn't foolproof. I don't know a system that is. I've just been helping a student with their research into what a medical professional can do when they have a "gut feeling" that there is abuse, but no proof. It was quite disheartening, as there seems to be little they can do besides add veiled notes in the childs medical records.

But yes, I agree... the power the abusive parent has over a child is immense. I know there are several incidents during my childhood with the family doctor that should have raised flags, but they never did.

I'm also glad they're screening for psychological issues as well as the physical...

Take care,
CG

It's great the checklist is looking at the psychological as well as the physical. I agree with Castorgirl that there are probably some red flags in there - like inconsistent behaviour. Or a question or combination of questions that raise flags. Even if the physician seemed not to look at it I'm sure they checked for the "flags".

I'm not sure how you would ask about abuse. "Do you or anyone else abuse your child?" Yea, like that's going to work. Sorry to be cynical but I think checklists like this, assuming there are some red flags, are as good as it gets.

Thanks for posting this Paul, it's interesting... I was at the doctor's constantly as a child and so obviously being abused, and yet, because my mother was so narcissistic and "charming" (to outside people) everyone there (including the doctors) thought I was the problem, not her!!!

I wonder if that question "Acts as if driven by a motor." could be referring to ADHD behavior? Either way, it's good they are asking, although I agree with you that it's pretty much "window dressing" and meaningless in ferreting out abusive situations. Perhaps it is intended more for situations where the child actually is the problem--like ADHD or bipolar etc. and the parent is just not educated enough in these areas to be able to identify it?

I think the day that health professionals, teachers, police and others pick up signs and symptoms of abuse before it becomes seriously entrenched and delivers everlasting, life altering damage will be a great day indeed.

That sounds like I don't believe abuse to be problematic, which obviously isn't the case. But there is evidence that shows if you intervene early, and get help for kids quickly, you can repair a lot of the hurt. My back up therapist does that kind of work. Obviously these kids are scarred... but perhaps, I hope, the scars don't run so deep and dysfunctionalise your entire life, if you get help when little.

Hope that makes sense and doesn't make me sound like some pro-abuse freakozoid.

Kerro - yes - I think any validating experience at an early age can repair a lot of damage! Just being listened to,heard, respected... I can't even imagine what that would have been like for me.

I wonder if the solution is training for the health professionals, rather than any forms? It's the flags that the abused children exhibit, often through body language that is key.

This is where I think the situation has improved over the last 20-30 years... There is more awareness of the possibility of child abuse.

Take care,
CG

Castorgirl - I agree, training is the key. For me the forms and checklists are just a way for health professionals to capture information about kids when they may not spend a huge amount of time with each kid. The forms and checklists should capture the things in the training, and flag any things that need further follow up.

We are certainly a long way from where we were 20 or 30 years ago. Back then child abuse was almost completey hidden - especially in middle class families. And there weren't the support services that are there now. My mother said that's one of the reasons she never left my father. She just couldn't do it on her own and there wasn't anywhere for her to go. There probably was, but white middle class women didn't access "those" services back then.

Paul - I agree about the bottom of the class doctors, and more so for children who may not see any doctor. That's why I think we need to train other professionals, like teachers, police, anyone who might see a lot of children in their work. Train them. Make reporting mandatory (as it is here for some professionals). Make action necessary and don't let the reports get caught up in red tape in the understaffed and underresourced child protection authorities where only the most grievous cases get any *real* attention.

This is such an interesting discussion. Thanks for starting it!

shen said:

"Just being listened to,heard, respected... I can't even imagine what that would have been like for me."

I can't imagine what that would have been like either shen...it's taking all these years and years of deprogramming to even understand that what I thought was love was really abuse...if that makes any sense...

In Australia teachers now have a duty to report any time they think a child may be being abused.

It can lead to lots of problems - just random stuff that isn't serious and has to be checked out.

But it is a step forward.

Charming parents are a real problem. (You'd think that the workers of various kinds would figure this out but they don't seem to have.)

When there is education about this it should be phrased as a possibility or as dealing with something that has happened. Children have not reported abuse because it was phrased as, "If this ever happens to you."

@ Evan - I think the main problem with mandatory reporting by teachers (and other professionals) in Australia that the training they are given about what to report isn't specific enough and, the bigger problem, that child protection authorities are so severely under resourced that they often cannot investigate every single report (and do necessary follow up) with the seriousness this deserves.

So a systematic failure?

* The people interacting with the children are not skilled or trained in what to look out for.
* There is little or no information sharing about the child between relevant organisations - we have information sharing to stop benefit fraud and tax evasion, why not for incidents of concern about child abuse?
* If there is abuse identified, the agencies in charge of the investigation are understaffed, under resourced and lack skills.
* Has societal attitudes towards abuse changed enough?

In New Zealand, a lecturer in one of the top medical schools is married to a convicted child abuser, has published articles about childhood STD's being caught through non-sexual contact, is named on the FMS website and has been an expert witness for the defense in CSA cases.

It scares me that people like this training our future doctors. Will these new doctors be able to see past their training by this person, and have empathy for the children? Will they be trained on how to spot the signs of abuse? Or, will they also begin to explain away the symptoms?

Jahda and Shen talk about validation, there's no way that this person would encourage any of the trainee doctors to give any sort of validation to the children in their care. They would be more likely to be told to ignore the signs.

Castorgirl - yes, I think there is huge system failure. There have been changes here recently that mean agencies can share information about children. Of course it's a privacy minefield, but somehow they got around that. That's got to be a huge leap forward.

Obviously that is only part of the problem. I do think society's attitudes have changed a lot over the last 20 or 30 years, but clearly at a glacial pace. Things continue to change - our authorities recently changed the way they describe child porn crimes and paedophilia (sp?). We no longer just call it "child porn" or "paedophilia" which as terms do nothing to portray the heinousness of the offences. Instead now the authorities are blatant in labelling this "child sexual abuse". I think that's also a step forward.

As for that lunatic who is training Kiwi doctors, I am speechless. I can only hope they are presented as one of a range of views that the trainees will hear, and hopefully one they will dismiss as lunatic fringe. At the very least I hope it helps fine tune their BS detector.

Hi Paul, I hope we haven't opened up any nasties for you. Take care.

We recently switched doctors for the children and I was glad to see that, while not directly asking "Is your child being sexually abused?", there was the question: "Is the child living in an abusive household?". That was the first time I'd seen such a question and I was glad, but I wonder how many would be willing to admit that. Unfortunately, shortly after reading and answering that question (which was "no"), I became dizzy, incoherent, panicky, etc., and was sent to a hospital. I suppose it simply stirred up some younger parts and they broke through, although I haven't discussed this with my therapist yet.

Anyhoo, I was happy to know that such questions are being asked in my area.

Thank you. The hospital visit was a very short one, only one hour, and the doctor (a primary care physician) knew exactly what was happening. They were very kind.

It sucks being triggered.