The Psychological Assessment of Abused and Traumatized Children

By Francis D. Kelly | Go to book overview

Introduction

Like many of my colleagues, over the course of the past 10 years, I have become increasingly sensitive to and aware of how noxious experiences of abusive and neglectful environments may dramatically alter the course of a child's developmental odyssey. For those assessing children, it has become commonplace to inquire about abuse, not traditionally a focus of interest for reasons that are, in retrospect, somewhat difficult to comprehend. If we briefly reflect on history, it is possible to understand why this may have been the case. Freud, in his initial considerations of hysterical patients (mostly women), thought that their symptomology was linked to sexual abuse. He later modified this position ( Herman, 1992) and subsequently viewed his patient's symptoms as being an outgrowth of intrapsychic conflict, sexualized wishes and fantasies, which led to a quite different interpretive perspective and subsequent therapeutic course--one that denied both the obvious fact that many of his patients had been sexually abused and that their symptoms were the sequelae of this rather than a reflection of drive-defense conflict.

I often find myself reflecting on why 10 or 20 years ago I, and the majority of my colleagues, did not consider or accord more relevance to abuse and trauma as salient etiological factors that should be paramount in the clinical formulation. In almost all instances, it did not enter our consciousness: In other cases, it was probably a factor that somehow did not figure into the final information that firmed up and ordered our diagnostic thoughts. I especially muse about those more disturbed children and adolescents often described as borderline and find myself thinking about their life situations: How many of them were abused, traumatized, chronically neglected? How many of the hospitalized children and those in residential care were manifesting the predictable sequelae of pre-oedipal and latency years marked by maltreatment and trauma, manifestations that should have figured prominently when diagnostic and disposition issues were considered. In seeing

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