Tulane University School of Medicine, New Orleans, LA.
Tulane University School of Medicine, New Orleans, LA; Vanderbilt University, Nashville, TN.
J Am Acad Child Adolesc Psychiatry. 2018 Sep;57(9):637-644. doi: 10.1016/j.jaac.2018.06.007.
Physical, sexual, and emotional abuse and various forms of neglect of children are associated with substantially increased risk for concurrent and subsequent psychopathology and are among the common problems encountered by clinicians in many clinical settings. Such cases pose additional challenges for clinicians because of the many complex family and system forces that engulf these children and their families. Assessing maltreated children generally requires more time than evaluations of children who have not experienced maltreatment. Young children, who experience the highest rates of maltreatment, present especially complex assessments because they are so dependent upon their caregiving environments. Treatment of psychopathology associated with maltreatment, which is often multimodal, requires addressing a variety of external factors that may perpetuate or exacerbate symptoms and impaired functioning. We suggest that the more clinicians understand the different cultures of the legal and child protective services systems will help them advocate more effectively for maltreated children's bests interests so that the complexity of their problems is matched by the comprehensiveness of our efforts to minimize their suffering, enhance their development, and promote their competence.
身体虐待、性虐待、情感虐待以及各种形式的忽视儿童的行为会极大地增加儿童同时出现和随后出现精神病理学的风险，这些也是许多临床环境中的临床医生经常遇到的共同问题。由于卷入这些儿童及其家庭的许多复杂的家庭和系统力量，此类病例给临床医生带来了额外的挑战。虐待儿童的评估通常比没有遭受虐待的儿童的评估需要更多的时间。受虐待率最高的幼儿呈现出特别复杂的评估，因为他们非常依赖于他们的照护环境。与虐待相关的精神病理学的治疗通常是多模式的，需要解决可能会持续或加剧症状和功能障碍的各种外部因素。我们建议，临床医生越了解法律和儿童保护服务系统的不同文化，就越能帮助他们更有效地为受虐待儿童的最佳利益辩护，从而使他们问题的复杂性与我们努力减轻他们的痛苦、促进他们的发展和提高他们的能力的全面性相匹配。
