Social Intuition and Social Information in Physical Child Abuse Evaluation and Diagnosis

Keenan, Heather T.; Cook, Lawrence J.; Olson, Lenora M.; Bardsley, Tyler; Campbell, Kristine A.

doi:10.1542/peds.2017-1188

Cited by 28 publications

(25 citation statements)

References 19 publications

(21 reference statements)

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“…This strategy was designed to minimize potential biases in decision-making regarding the compatibility of history and physical exam characteristics based on psychosocial risk factors that are associated with but not necessarily causal for abuse. 10 …”

Section: Methodsmentioning

confidence: 99%

Are negative/unrealistic parent descriptors of infant attributes associated with physical abuse?

Young

Pierce

Kaczor

et al. 2018

Child Abuse & Neglect

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Parents' perceptions of child behavior influence their responses to the child and may be important predictors of physical abuse. We examined whether infants 12 months of age or younger who were described with negative or developmentally unrealistic words were more likely than other infants to have been physically abused. As part of a prospective observational multicenter study investigating bruising and familial psychosocial characteristics, parents were asked to (1) describe their child's personality, and (2) list three words to describe their child. Four independent raters coded parent responses using a qualitative content analysis, identifying descriptors of infants and classifying each as positive, neutral, or negative/unrealistic. A medical expert panel, blinded to the psychosocial data, separately categorized each case as abuse or accident. We then analyzed the potential association between negative/unrealistic descriptors and abusive injury. Of 185 children enrolled, 147 cases (79%) were categorized as accident and 38 (21%) as abuse. Parents used at least one negative/unrealistic descriptor in 35/185 cases (19%), while the remaining 150 cases (81%) included only positive or neutral descriptors. Of the infants described with negative/unrealistic words, 60% were abused, compared to 11% of those described with positive or neutral words (p < .0001; age group-adjusted OR = 9.95; 95% confidence interval [3.98, 24.90]). Though limited by sample-size, this pilot study informs future work to create a screening tool utilizing negative/unrealistic descriptors in combination with other predictive factors to identify infants at high risk for physical child abuse.

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Section: Methodsmentioning

confidence: 99%

Are negative/unrealistic parent descriptors of infant attributes associated with physical abuse?

Young

Pierce

Kaczor

et al. 2018

Child Abuse & Neglect

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“…There is also a possibility of selection bias related to doctors' inclination to interpret findings as being related to physical abuse among socially underprivileged carers. 43 Our finding of an increase over time in out-of-home care associated with SBS/AHT criteria is intriguing in view of the fact that information about the dangers of shaking was introduced to parents during the study period 6 and parental reports of shaking decreased from 18% in 2006 to 0% in 2011. 8 The risk factors for infants in out-of-home care in association with SDH, RH, rib fracture, or long bone fracture have similarities with previously reported risk factors for SBS/AHT, such as preterm, 8,33 male preponderance, 9 and multiple birth.…”

Section: Discussionmentioning

confidence: 75%

“…Thus, biological risk factors might, at least to some extent, account for the relative overrepresentation of low socioeconomic status in the SBS/AHT criteria sample, compared with the reference population. There is also a possibility of selection bias related to doctors' inclination to interpret findings as being related to physical abuse among socially underprivileged carers …”

Section: Discussionmentioning

confidence: 99%

Medical diagnoses among infants at entry in out‐of‐home care: A Swedish population‐register study

Högberg

Sennerstam

Wester

et al. 2019

Health Science Reports

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Background and aims Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out‐of‐home care. The objective of this study was to analyse infants placed in out‐of‐home care in Sweden by incidence, medical diagnoses, and perinatal factors. Methods This was a population‐based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out‐of‐home care categories: (a) “Problems Related to Social Environment/Upbringing”, (b) “Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture”, and (c) “SDH, RH, rib fracture, or long bone fracture.” As a reference population, we randomly selected infants without medical diagnoses born the same year. Results Overall incidence of out‐of‐home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out‐of‐home care, children in category (c), “SDH, RH, rib fracture, or long bone fracture”, had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08‐2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32‐0.75) and a smoker (aOR 0.60; 95% CI, 0.37‐0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small‐for‐gestational age (5.2% versus 2.1%). Conclusion SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out‐of‐home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.

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“…Recent studies have examined different models of child abuse consultations (Keenan & Campbell, 2015), consensus processes to define key consultation elements for the medical evaluation of child abuse (Burrell et al, 2016; Campbell et al, 2015) and the use of structured information in combination with a peer review process (Lorenz et al, 2018). Recent findings suggest that structured information in cases of suspected child abuse without the social history promotes high agreement in diagnosis (Lorenz et al, 2018) while the addition or modification of social history to a CAP consultation note is capable of changing diagnosis in cases with medical uncertainty (Keenan, Cook, Olson, Bardsley, & Campbell, 2017). It is increasingly clear that the social history included in a CAP consultation can influence medical diagnostic decisions regarding abuse.…”

Section: Discussionmentioning

confidence: 99%

Social history: A qualitative analysis of child abuse pediatricians’ consultation notes

Olson

Campbell

Cook

et al. 2018

Child Abuse & Neglect

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Background: Child abuse pediatricians (CAPs) are often consulted for injuries when child physical abuse is suspected or when the etiology of a serious injury is unclear. CAPs carefully evaluate the reported mechanism of the child’s injury and the medical findings in the context of the child’s family and social setting to identify possible risk and protective factors for child abuse and the need for social services. It is unknown what population risk indicators along with other social cues CAPs record in the social history of the consultation notes when assessing families who are being evaluated for child physical abuse. Participants and setting: Thirty-two CAPs representing 28 US child abuse programs. Methods: Participants submitted 730 completed cases of inpatient medical consultation notes for three injury types: traumatic brain injury, long bone fracture, and skull fracture in hospitalized children 4 years of age and younger. We defined a priori 12 social cues using known population risk indicators (e.g., single mother) and identified de novo 13 negative (e.g., legal engagement) and ten positive social cues (e.g., competent parenting). Using content analysis, we systematically coded the social history for the social cues. Results: We coded 3,543 cues resulting in a median of 7 coded cues per case. One quarter of the cues were population indicators while half of the cues were negative and one quarter positive. Conclusions: CAPs choose a wide variety of information, not always related to known population risk indicators, to include in their social histories.

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Social Intuition and Social Information in Physical Child Abuse Evaluation and Diagnosis

Abstract: Social intuition and information play a role in the physical child abuse decision-making process, which may contribute to differential diagnosis. Simple interventions including decision tools, check lists, and peer review may structure evaluations to ensure children's equal treatment.

Cited by 28 publications

References 19 publications

Are negative/unrealistic parent descriptors of infant attributes associated with physical abuse?

Are negative/unrealistic parent descriptors of infant attributes associated with physical abuse?

Medical diagnoses among infants at entry in out‐of‐home care: A Swedish population‐register study

Social history: A qualitative analysis of child abuse pediatricians’ consultation notes

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