Ammerman R T, Hersen M, van Hasselt V B, Lubetsky M J, Sieck W R
Western Pennsylvania School for Blind Children, Pittsburgh 15213-1499.
J Am Acad Child Adolesc Psychiatry. 1994 May;33(4):567-76. doi: 10.1097/00004583-199405000-00015.
The goals of this study were (1) to determine the prevalence of child maltreatment in hospitalized children and adolescents with developmental disabilities and concomitant psychiatric disorders, and (2) to identify the contribution of specific mother and child characteristics to the use of more severe disciplinary practices by mothers.
One hundred thirty-eight psychiatrically hospitalized children and adolescents with developmental disabilities and mothers were assessed using a semistructured interview (Child Abuse and Neglect Interview Schedule) examining factors associated with risk of child maltreatment, and questionnaires measuring maternal and child functioning. The Child Abuse and Neglect Interview Schedule and hospital charts were then used to derive ratings on the prevalence and severity of child maltreatment.
Findings revealed that 61% of children had experienced some form of severe maltreatment by a care provider in their lifetime. Regression analysis indicated that interactions between high levels of social functioning and disruptive/oppositional behaviors and younger age in children, and low levels of social support and increased anger reactivity in mothers, were most predictive of mothers' use of severe disciplinary practices.
Maltreatment in psychiatrically hospitalized children and adolescents with disabilities is very prevalent, and it warrants careful clinical assessment. In the psychiatric setting, families in which the child is younger, higher functioning, and behaviorally disruptive, and where mothers have little social support and exhibit increased anger reactivity, are at especially elevated risk.
本研究的目标是：（1）确定患有发育障碍并伴有精神疾病的住院儿童和青少年中虐待儿童行为的发生率；（2）确定特定的母亲和儿童特征对母亲采用更严厉管教方式的影响。
对138名患有发育障碍的精神科住院儿童、青少年及其母亲进行评估，采用半结构化访谈（《虐待与忽视儿童访谈量表》）检查与虐待儿童风险相关的因素，并使用问卷测量母亲和儿童的功能状况。然后，根据《虐待与忽视儿童访谈量表》和医院病历得出虐待儿童行为的发生率和严重程度评级。
研究结果显示，61%的儿童一生中曾遭受过照料者某种形式的严重虐待。回归分析表明，儿童较高的社会功能水平与破坏性行为/对立行为及较年幼年龄之间的相互作用，以及母亲较低的社会支持水平和较高的愤怒反应性，最能预测母亲采用严厉管教方式的情况。
患有精神疾病的住院残疾儿童和青少年中，虐待行为非常普遍，需要进行仔细的临床评估。在精神科环境中，孩子年龄较小、功能较高且行为具有破坏性，同时母亲社会支持较少且愤怒反应性较高的家庭，风险尤其高。
