Autism and Anger

Families who live with a child with autism are aware of the core diagnostic symptoms of autism: social impairment, difficulties with communication, repetitive behavior and restricted interests. But what is most disruptive to a family’s ability to cope and function when a child has autism are the extreme emotional outbursts that they exhibit.

According to the Stanford Report, two Stanford psychologists have found identified that individuals with autism lack effective emotion regulation strategies, and in a collaborative effort with the Stanford Autism Center, the researchers are planning to help people with autism learn to cope better.

Stanford psychology Professor James Gross, Stanford psychology postdoctoral scholar Andrea Samson, and University of Fribourg psychology Professor Oswald Huber completed a survey of adults with autism, and found that individuals with autism consistently reported using less effective strategies for emotional regulation than individuals without autism. Samson’s research has also demonstrated that adults with autism spectrum disorders report greater levels of negative emotion in general.

Different ways of coping with upsetting life circumstances

When faced with stressful or upsetting situations, there are a number of ways that people try to cope with what is or has happened. Persons with autism seem to struggle more in being able to utilize more adaptive strategies.   Two common strategies that we all use to cope with upsetting experiences include reappraisal and suppression.

In reappraisal, one tries to re-frame the upsetting experience. Gross utilizes the example of a friend who doesn’t greet you when you pass. In re-appraisal, instead of feeling hurt or ignored, a person might reason that the friend was distracted and didn’t see you.  Reappraisal involves cognitive processing instead of reacting only to one’s initial feelings or emotions. This can be very helpful in reducing negative emotions.

Suppression is more simple;  a person hides their true feelings. So one would not show that they were upset by being ignored by a friend. Suppression is not as effective as reappraisal over time. Negative feelings are not negated, but just suppressed, and the effort to contain negative feelings can become overwhelming, and interfere with a person’s ability to think and problem solve.

Most people  use a combination of strategies for emotional regulation. In their research, Samson and Gross found that adults with autism spectrum disorders, when compared with  non-affected individuals, were significantly less likely to use reappraisal and more likely to use suppression. They also reported greater levels of negative emotion in general.

One proposed explanation about why a persons with autism might struggle with using reappraisal–a  more cognitive skill– to cope with negative emotions was because persons with autism struggle with alexithymia:an inability to identify or describe  one’s own feelings.  In their survey, Gross, Samson, and Huber controlled for alexithymia in their subjects, and still identified difference in emotional regulation between persons with autism and those without.

Treatment to improve emotional regulation

Samson and Gross are working with Stanford School of Medicine psychiatry Associate Professor Antonio Hardan, to examine emotional development among children and youths with autism – and how this knowledge might lead to new treatments for the condition.

The researchers intend to repeat their survey, but they also intend to  investigate  physiological responses such as brain activation, heart rate, breathing and skin conductivity.

It is hoped that  this combination of psychological and physical data will guide the development of a  training regimen to help individuals with autism  gain improved emotional regulation.  Samson has proposed that instead of teaching persons with autism to use skills that are effective for persons without autism, that treatment should utilize some of the strengths seen among persons with autism. She notes that people on the autism spectrum  tend to process and focus on details and that strategies that play to this strength may be best for persons with autism.

“OSR#1 is not a dietary supplement but a toxic, unapproved drug with serious potential side effects”  the FDA warns, says the June 23 Chicago Tribune article.

OSR#1 is an industrial chelator that  is now being marketed as a supplement to treat autism.

According to CTI Science’s website, “OSR#1® is a toxicity free, lipid soluble antioxidant dietary supplement that helps maintain a healthy glutathione level”.

The FDA wrote a letter of warning to Boyd Haley, the president of CTI Science indicating that they are making unapproved claims:

Your firm markets OSR#l as a dietary supplement; however, this product does not meet the definition of a dietary supplement in section 201(ff) of theFederal Food, Drug, and Cosmetic Act,

“The claims listed above make clear that OSR#1 is intended to affect the structure or any function of the body of man or other animals. Accordingly, OSR#l is a drug under section 201(g)(1) of the Act, 21 U.S.C. § 321(g)(1). Disclaimers on your website, such as “OSR#l® is not a drug and no claim is made by CTI Science that OSR#1® can diagnose, treat or cure any illness or disease,” do not alter the fact that the above claims cause your product to be a drug.”

They go on to indicate that this new drug may not be introduced or delivered for ….interstate commerce…because there is no FDA-approved application in effect for the product.

“Additionally, under section 502(a) of the Act, 21 U.S.C. § 352(a), a drug is misbranded if its labeling is false or misleading in any particular”…”Your website states that” [s]ome reports of temporary diarrhea, constipation, minor headaches have been reported but these are rare and the actual causes are unknown,” as well as “OSR#1 is without detectable toxicity” and “OSR#1® … has not exhibited any detectable toxic effects even at exceptionally high exposure levels.” However, animal studies that you conducted found various side effects to be associated with OSR#1 use, including, but not limited to, soiling of the anogenital area, alopecia on the lower trunk, back and legs, a dark substance on lower trunk and anogenital area, abnormalities of the pancreas, and lymphoid hyperplasia. Based on these animal studies and side effects known to be associated with chelating products that have a similar mechanism of action to OSR#1, we believe the use of your product has the potential to cause side effects, and the before-mentioned website statements falsely assert that the product does not have the potential to cause side effects. Therefore, these statements render your product’s labeling false or misleading. ”

In response to prior Chicago Tribune articles, Boyd Haley was on Twitter stating ”

“Contrary to the Chicago Tribune implication, OSR1 has undergone extensive safety testing. The truth is at www.OSR1.com. Please retweet!”

However, on the OSR1.com website, there is no mention of these test results.  There is a “safety and pharmacokinetics summary”, but it doesn’t discuss or cite the “extensive studies” .

The Tribune quotes Ellen Silbergeld, a John’s Hopkins researcher:

“It would be hard to imagine anything worse,” said Ellen Silbergeld, an expert in environmental healthwho is studying mercury and autism at Johns Hopkins University’s Bloomberg School of Public Health. “An industrial chemical known to be toxic — his own incomplete testing indicates it is toxic. It has no record of any therapeutic aspect of it, and it is being marketed for use in children.”

Kim Stagliano, Managing Editor of the “Age of Autism” blog has written in an email that was quoted in the Tribune Article : “I continue to trust his science,” . “I’m sure CTI Science will address the letter appropriately.” This physician-scientist is confused.  Boyd Haley has not provided science to support that this agent is effective and safe to the FDA, and I cannot find any citations on his website to scientific research.  Prof. Haley appears to have withheld safety information from the autism community. It is his own “science” that suggests this chemical is toxic.

Scientists at the University College London  have produced data suggesting,  that our brains contain a highly distorted model of our own bodies

The study,published in Proceedings of the National Academy of Sciences,  focused on the brain’s representation of the hand.

The brain’s model of the hand is one in which our fingers are perceived to be shorter and our hands fatter than they are.

Neuroscientists suspect the reason for these distortions may lie in the way the brain receives information from different regions of the skin.

Participants in the study were asked to put their left hands palm down under a board and judge the location of the covered hand’s knuckles and fingertips by pointing to where they perceived each of these landmarks to be. A camera situated above the experiment recorded where the participant pointed. By putting together the locations of all the landmarks, the researchers reconstructed the brain’s model of the hand, and revealed its striking distortions.

People estimated that their hands were about two-thirds wider and about one-third shorter than actual measurements.

Participants were also accurate in picking out a photo of their own hand from a set of photos with various distortions of hand shape, suggeting there is clearly a conscious visual image of the body as well.
The research is attempting to understand how proprioception works–in other words, “how does the  brain know where all parts of the body are in space even when your eyes are closed”?

Neuroscientists think that “position sense” requires two distinct kinds of information. Signals that the brain receives from muscles and joints play an important role in position sense, but the brain also needs a model of the shape and size of each body part; to know where the fingertip is in space, the brain needs to know the angles of joints in the arm and hand, but also the length of the arm, hand, and finger.

Neuroscientists suspect that the brain’s distorted model of body shape  is related to how the brain represents different parts of the skin. For example, the size of the brain representation of the five fingers gets progressively smaller for each finger between the thumb and the little finger, mirroring the relative size of fingers in the body model reported in this study.

These findings may be relevant to psychiatric conditions such as Anorexia nervosa and other eating disorders. It is possible that people tend to perceive the body as being wider than it is.  Though the participants had an accurate visual image of their own body, it is possible that the distorted perception related to proprioception could dominate in some people, so that body image is distorted.

A mirror neuron is a cell in the brain that fires when we observe another person perform an action. For example, if we watch another person pick up a cup, place it to their mouth and drink, mirror neurons fire, and give us an idea about how it feels to hold the cup, to lift the cup, to feel the cup touch our lips, to feel the liquid in our mouths.

Neuroscientists have hypothesized that mirror neurons are responsible for the human capacity to empathize with others, and to understand how another person might be thinking or feeling–how we can understand another person’s pain, how we understand how they are feeling when they smile. In the April edition of the journal Current Biology Dr. Itzhak Fried,  a UCLA professor of neurosurgery and of psychiatry and biobehavioral sciences, Roy Mukamel, a postdoctoral fellow in Fried’s lab, and their colleagues (Arne D. Ekstrom, Jonas Kaplan and Marco Iacoboni) have provided the first direct evidence that mirror neurons truly exist, by making a direct recording of their actions, in the motor regions of the brain, as well as in regions responsible for vision and memory.

When a research subject performed an activity, specific subsets of mirror cells in the research subject’s brain increased their activity. When a research subject only observed another person performing an action, these subsets of mirror cells decreased their activity. The researchers hypothesize that the decreased activity from these subsets of mirror cells occurs to prevent an observer from automatically performing the action that they are observing the action of another person, and to help us distinguish our own actions from those of others.

The researchers implanted electrodes into the brains of 21 patients with intractable epilepsy, so that seizure foci could be identified for potential surgical treatment. The researchers obtained consent from the patients to use the same electrodes for their clinical research.

The experiment included three parts: facial expressions, grasping and a control experiment.

Activity from a total of 1,177 neurons in the 21 patients was recorded as the patients were asked to observe various facial expressions and grasping actions performed by others in videos on a laptop computer. They were then shown visually presented words and asked to perform the action. Finally, for the control task, the words were presented, and patients were instructed not to perform the action.

The mirror neurons in the medial frontal cortex (responsible for movement) and medial temporal cortex (responsible for memory) showed their greatest activity both when the individual performed a task and when they observed a task. This finding demonstrates that mirror neurons are located in more areas of the human brain than was previously thought, and that the mirror neurons provide detailed and complex mirroring of the actions of other people–and it is very likely this mirroring of others that helps us understand the actions, intentions, and feelings of others automatically.

This study is important because:

1. it provides evidence that mirror neurons–neurons that link the activity of the self with that of others–really exist

2. it suggests that the distribution of mirror neurons is wider than was previously thought

3. it is suspected that dysfunction of mirror cells may be involved in disorders such as autism, since autism is a condition where verbal and nonverbal communication, imitation, and empathy for others is impaired. If we can better understand the mirror neuron system, we may be able to find ways to treat this disorder.

The project was supported by the National Center for Research Resources, a component of the National Institutes of Health (NIH).

To Boost Social Skills, Let Persons With Autism Choose Their Leisure Activity

Recent research suggests that giving persons with autism the power to choose their own leisure activities can boost their enjoyment, as well as improve communication and social skills, according to an international team of researchers.

“For many of us, we look at recreation as a time to spend on activities that are fun and that are designed for our enjoyment,” said John Dattilo, professor of recreation, park and tourism management, Penn State. “But for some people with disabilities, particularly those who have autism, these activities can be a source of frustration, simply because they didn’t have a chance to make their own leisure choices.”

Dattilo said that a group of 20 autistic adults who participated in a yearlong recreation program that offered them a chance to choose activities, scored higher on personality tests that measure social and communication skills than the control group of 20 autistic adults who were randomly assigned to the program’s waiting list. Participants met for two hours each weekday and could choose among several activities that promoted engagement and interactivity, including games, exercises, crafts and events.

The researchers, who released their findings in the current issue of Research in Autism Spectrum Disorders, said that after completing the program, participants showed significant improvement at recognizing and labeling emotions. The participants scored about 24 percent higher than the control group in the ability to recognize emotions in a person in a picture. The score of the participants’ ability to label those emotions correctly was 50 percent higher than the control group’s score.

Since people with autism are less willing to interact socially, caregivers are particularly interested in programs that help improve social and communication skills, according to Dattilo, who worked with Domingo Garcia-Villamisar, professor of psychopathology, Complutense University of Madrid, Spain.

“The big measure for us in this program was the improvements in social behavior and interaction,” said Dattilo. “The defining quality of people with autism is that they have difficulty in social situations.”

The participants also improved their ability to carry out executive functions, such as setting goals and maintaining attention.

Dattilo said recreation programs that encourage people with autism to make their own leisure choices create a cycle of increasing independence, rather than a pattern of reliance on caregivers to provide recreational activities.

“While people are learning, you can also give them choices,” said Dattilo. “And as they make those choices, they are also learning and are empowered to make even more choices.”

The works of University of Rochester psychologist Edward Deci and author and psychologist Mihaly Csikszentmihalyi inspired the researchers to pursue the experiment, Dattilo said. Deci and Csikszentmihalyi emphasize self-determination as a critical component of human fulfillment.

SOURCE: http://live.psu.edu/story/51689

A New Biological Test For Autism

A joint research project between Harvard University and University of Utah scientists has resulted in the development of a new biological test for autism.

The test  uses magnetic resonance imaging (MRI) to measure deviations in brain circuitry, and  is an objective way of identifying individuals with the disorder that could someday replace the subjective methods that are currently used.

Today, Autism is diagnosed  with clinical interviewing  and  observation of the child for another hour or so.  It is hoped that this MRI will provide a more definitive way of determining autism early on, by pointing to something in the brain that is biologically based

Dr. Lange, Nicholas Lange, ScD, associate professor of psychiatry at Harvard Medical School,  was the senior study author, and with  Janet E. Lainhart, MD, from the University of Utah, Salt Lake City, and other colleagues, they set out to explore the hypothesis that study of white matter microstructure in regions of the brain responsible for language, emotion, and social cognition would further the understanding of autism neuropathology.

Diffusion tensor imaging measures white matter microstructure by mapping directions of water diffusion in a local brain tissue frame of reference.

Other types of MRI scans, such as those that compare the sizes of various parts of the brain between healthy individuals and individuals with a particular brain disorder,have not shown much difference in autism.

The researchers took white matter microstructure measurements from the superior temporal gyrus and temporal stem in 30 males aged 7 to 28 years who were diagnosed as having autism by the standard subjective scoring system and in 30 matched controls.

In the subjects with autism, less information was being exchanged in the key areas of the brain responsible for language, social functioning, and emotional behavior.

The test was able to detect autism in this study with 94% accuracy, by identifying less organized wiring.

The findings correlate with the clinical impairments of autism, such as the inability to read body language, and the resulting lack of friendships.

“There appears to be a lack of ordered directional diffusion along the axons to help them make those connections, and we were able to pinpoint just where this is occurring through this brain circuitry imaging,” Dr. Lange noted.

Dr. Lange is hopeful that this test will someday be used clinically to make  accurate and prompt diagnoses in young children.

Early diagnosis may allow intensive, individualized, and early interventions to minimize the impact of the disorder.

This test is NOT YET ready for clinical use. At the present time, child and adolescent clinicians must continue to rely upon careful clinical assessments to diagnosis Autism.

The study was sponsor by the National Institutes of Mental Health. Dr. Lange and Dr. Lainhart have disclosed no relevant financial relationships.

Autism Res. Published online November 29, 2010.

ADHD and Marriage: How ADHD Affects Relationships

Does your husband or wife constantly forget chores and lose track of the calendar? Do you sometimes feel that instead of living with a spouse, you’re raising another child? Your marriage may be suffering from attention deficit hyperactivity disorder.

Is ADHD affecting your marriage?  Mental health experts note that attention problems can take a toll on adult relationships.

In a marriage, the common symptoms of the disorder — distraction, disorganization, forgetfulness — can easily be misinterpreted as laziness, selfishness, and a lack of love and concern.

It is estimated that at least 4 percent of adults have ADHD; about 10 million U.S. adults, with only about 1.2 million of affected adults in treatment, and with many adults having never received the diagnosis as children.

As many as half of all children with A.D.H.D. do not fully outgrow it and continue to struggle with symptoms as adults.

Symptoms can include trouble with maintaining employment or completing schooling, marital difficulties,  financial challenges, repeated driving violations/tickets,

Adults with attention disorders often learn coping skills to help them stay organized and focused at work, but experts say many of them struggle at home, where their tendency to become distracted is a constant source of conflict.

Some research suggests that adults with ADHD are  twice as likely to be divorced; another study found high levels of distress in 60 percent of marriages where one spouse had the disorder.

Spouses of adults with ADHD often feel they cannot count on their partner. They may feel that the spouse is not dependable such that the unaffected spouse must take responsibility for everything.

Sometimes the unaffected spouse can become chronically angry, frustrated that they dont help around the house, that they are inconsiderate, or that they cannot count on the spouse to complete simple tasks such as running to the bank, paying bills on time, or picking up the kids. They may feel they have no choice but to constantly nag to make sure things get done.

Spouses with attention deficit, meanwhile, are often unaware of their latest mistake, confused by their partner’s simmering anger. A lengthy to-do list or a messy house feels overwhelming to the A.D.H.D. brain, causing the person to experience paralysis, and they accomplish nothing, which further infuriates their spouse. This does not happen due to laziness or selfishness, it happens due to the difficulty with task planning and organization.

Although treatment often starts with medication, it typically doesn’t solve a couple’s problems. Talk therapy may be needed to unpack years of accumulated resentments.

Behavioral therapy and coping strategies — for both partners — are essential. Long, to-do lists given to the spouse with ADHD will not be productive. instead, asking that one task at a time be targeted is more helpful.

Emotional Abuse-Talk to Your Child Without Harming Them

What you say to your child is important.
Here are some tips to assure that what you say won’t damage your child

Sticks and stones will break my bones,
But names will never hurt me.

Many of us who are now parents understand that this children’s rhyme does not provide true comfort, and that the words of playmates DID hurt us.

Words can hurt children, and the damage inflicted on a child by the thoughtless remarks of a parent or other adult can torment a child–for their lifetime.

In fact, emotional abuse, though it is often ignored, can be far more devastating than the physical abuse that so often captures media headlines.

The emotional abuse of harsh words, spoken thoughtlessly, can lead a child feeling berated, belittled, demoralized. The impact this has on a child’s emotional development is insidious. A child’s spirit can be destroyed, and they may lose any positive sense of self. Emotional abuse destroy’s a child’s ability to feel loveable, to love himself or herself, and has a negative effect on a child’s ability to care for and get along with others. Emotional abuse increases self-destructive and antisocial behavior. Emotional abuse has been linked to eating disorders, promiscuity and suicide.

None of us is perfect, and many of us can recall a time when we’ve lost our self-control, and said something hurtful and demoralizing to our children, over something minor. We might say things like: “You clumsy idiot! You can’t do anything right!”

When words like these are repeated often enough, the child’s sense of self-esteem plummets and he or she begins to agree with his parents’ assessment of him: he or she really is dumb, a jerk, an idiot, a moron. The child begins to learn that love is not without conditions. And since it seems impossible to meet his or her parent’s expectations, the child becomes satisfied with settling for the “loser” role.

In too many homes today, the lights are on but no one is there. People are home but not home. Inattentive and verbally abusive parents are producing children who seem normal but are not what they should be, what they could have been.

There are studies that demonstrate that this abusive, humiliating and demeaning parenting behavior is transmitted from generation to generation, meaning that adults who had abusive parents tend to parent their own children the same way. This pattern will continue until a parent is willing to change their behaviors, change the dynamics, and find a way to interact differently with their own children. They must be willing to see and acknowledge that they are saying and doing to their children.

To change this pattern, treatment often requires treating the parent and the child, helping the parent feel respected and empowered, and allowing them to change the ways they respond to their child.
The problem of verbal abuse is REAL, and COMMON, but difficult to document, and, therefore, difficult to intervene to prevent. Certain stressors can increase the problem of verbal abuse, job loss, marital problems, financial concerns. Often, adults attempt to cope with these stressors using alcohol and other drugs, but this tends to make matters worse. Parents then lose their inhibitions, and may say terrible things to their children that they later regret.

How can you be sure your words build up rather than destroy your children?

† Guard your vocabulary. There are some words that people in a family should never say to each other. Words like stupid, dummy, jerk, idiot, worthless and freak have no place between parents and their children.

† Avoid absolute statements such as “You never . . . ” Or “You always . . . ” Have a sense of good manners with your family. This doesn’t mean that you must avoid all conflict or that you can’t set limits.

† Separate the child’s actions from the child. Instead of responding to a tantrum with a barrage of abusive language, let him know that you love him — but not his actions, which are unacceptable.

† When things happen that can set off an explosion, take time out. Wait. And then wait some more. When you hold your tongue until the heat of the moment has passed, it’s a lot easier to respond with love rather than anger.

† Be available. Be willing to stop and peek in on your child’s world. He or she will feel more valuable because of it. Don’t start interrogating the minute the child walks in the door.

Wait until you’re relaxed and instead of probing about his day, why not share your day? Instead of accusing, compliment. Instead of insisting, be silent.

† Active listening refers to a kind of listening and a response that does not judge, ridicule or order. And the more we listen without judging, the more we help our children to accept their feelings, we improve their problem-solving ability and increase their willingness to listen to us.

† Teach by example. Let your kids hear you acknowledge your mistakes. Risk being humble. Dare to say, “I’m sorry” to your children when appropriate. Apologizing reveals that the truth is larger than your ego and their feelings are more important than your pride.

If you can accept yourself in spite of your limitations, all the while working to be the best you can be, you’ve gone a long way to help your kids value themselves.

Based on the work of Jean Guarino, free-lance writer.

Child Protective Services: Important Job, Difficult to Effect Change

Child Protective Services investigated more than three million cases of suspected child abuse in 2007, but a new study suggests that the investigations did little or nothing to improve the lives of those children.

In 1973, Congress passed the Child Protective Services Act, designed to encourage more thorough and accurate reporting and record-keeping in child abuse cases. In New York, for example, there are now Child Protective Services offices in every county, paid for in part with federal funds.

Researchers examined the records of 595 children nationwide, all at similar high risk for maltreatment, tracking them from ages 4 to 8, 164 that were investigated for suspected abuse or neglect, and 431 families that had not been investigated. The scientists then interviewed all the families four years later.

The scientists looked at several factors: social support, family functioning, poverty, caregiver education and depressive symptoms, and child anxiety, depression and aggressive behavior — all known to increase the risk for abuse or neglect. They were unable to find any differences in the investigated families compared with the uninvestigated in any of these dimensions, except that maternal depressive symptoms were worse in households that had been visited.

One possible interpretation of this result would be that the investigated families were at greater risk to begin with, and that the investigation helped them to recover to the expected level of risk. But if this were so, the authors write, households with recent investigations would have greater risk than households with more distant investigations. Statistical analysis found no such association. They concluded that Child Protective Services investigations had little or no effect.

The researchers were in some ways unsurprised by their findings. Even when services are offered, they usually take aim at immediate risks — substance abuse, or domestic violence — not abiding problems like poverty or poor social support. Whatever interventions were offered apparently failed to reduce the risk for future child abuse.

Dr. Kristine A. Campbell, the lead author of the study, said that it may be too easy to blame Child Protective Services. “I believe that C.P.S. has a critical role,” she said. “As a pediatrician, when I’m there in the middle of the night with a child who has been beaten up, I need them. But we have to look at other systems that can really create a safety net for these children.”

Still, C.P.S. serves an important role in gathering information. This study supports the idea that it is time for further discussion of the role of protective services, beyond investigation.The difficulty is, that C.P.S. is charged with dealing with acute issues. We do not have a means for C.P.S. to deal with the chronic, underlying issues.

The study appears in the October issue of The Archives of Pediatrics & Adolescent Medicine, has certain weaknesses: some potentially modifiable risk factors — intimate partner violence and substance abuse, for example — were not included in the data they used. And not all of the five different geographical sites systematically collected information on all risk factors.

An editorialby Dr, Abraham B. Bergman was published with the study, titled “Child Protective Services Has Outlived Its Usefulness,” and suggests some essential changes: child abuse, is a crime and should be investigated by the police; public health nursing services should be the first to respond to concerns of child neglect; social workers should assess appropriate living situations and work with families to obtain services, and not be engaged in law enforcement.

Child Protective Services: Change Is Necessary

Child Protective Services investigated more than three million cases of suspected child abuse in 2007, but a new study suggests that the investigations did little or nothing to improve the lives of those children.

In 1973, Congress passed the Child Protective Services Act, designed to encourage more thorough and accurate reporting and record-keeping in child abuse cases. In New York, for example, there are now Child Protective Services offices in every county, paid for in part with federal funds.

Researchers examined the records of 595 children nationwide, all at similar high risk for maltreatment, tracking them from ages 4 to 8, 164 that were investigated for suspected abuse or neglect, and 431 families that had not been investigated. The scientists then interviewed all the families four years later.

The scientists looked at several factors: social support, family functioning, poverty, caregiver education and depressive symptoms, and child anxiety, depression and aggressive behavior — all known to increase the risk for abuse or neglect. They were unable to find any differences in the investigated families compared with the uninvestigated in any of these dimensions, except that maternal depressive symptoms were worse in households that had been visited.

One possible interpretation of this result would be that the investigated families were at greater risk to begin with, and that the investigation helped them to recover to the expected level of risk. But if this were so, the authors write, households with recent investigations would have greater risk than households with more distant investigations. Statistical analysis found no such association. They concluded that Child Protective Services investigations had little or no effect.

The researchers were in some ways unsurprised by their findings. Even when services are offered, they usually take aim at immediate risks — substance abuse, or domestic violence — not abiding problems like poverty or poor social support. Whatever interventions were offered apparently failed to reduce the risk for future child abuse.

Dr. Kristine A. Campbell, the lead author of the study, said that it may be too easy to blame Child Protective Services. “I believe that C.P.S. has a critical role,” she said. “As a pediatrician, when I’m there in the middle of the night with a child who has been beaten up, I need them. But we have to look at other systems that can really create a safety net for these children.”

Still, C.P.S. serves an important role in gathering information. This study supports the idea that it is time for further discussion of the role of protective services, beyond investigation.The difficulty is, that C.P.S. is charged with dealing with acute issues. We do not have a means for C.P.S. to deal with the chronic, underlying issues.

The study appears in the October issue of The Archives of Pediatrics & Adolescent Medicine, has certain weaknesses: some potentially modifiable risk factors — intimate partner violence and substance abuse, for example — were not included in the data they used. And not all of the five different geographical sites systematically collected information on all risk factors.

Dr. Abraham B. Bergman wrote an editorial that was published with the study: “Child Protective Services Has Outlived Its Usefulness,” and suggests some essential changes:

  • child abuse is a crime and should be investigated by the police
  • public health nursing services should be the first to respond to concerns of child neglect
  • social workers should assess appropriate living situations and work with families to obtain services
  • social workers should not be engaged in law enforcement