CSET Practice Test On Human Development

Ignoring the Danger Signs of Child Abuse By Douglas J.
Besharov 

This article originally appeared in Newsday, April 21,
1996. 

SIX-YEAR-OLD Elisa Izquierdo might be alive today if her
case had not been so tragically mishandled by New York
City's Child Welfare Administration (CWA), now known as
the Administration for Children's Services. But focusing
on the faults of that agency obscures the failure of
schools, hospitals and other social service agencies to
report clear signs of Elisa's possible abuse.

As documented by the recently released report of the New
York City Child Fatality Review Panel, on which I serve,
Elisa "was known to the Brooklyn Family Court, the
Department of Probation, a legal services agency, at least
three CWA-contracted purchase-preventive service programs,
a noncontracted social services program, at least two
drug-rehabilitation programs, one alcohol-rehabilitation
program, a preschool, a public school, a school-based
child and family therapy program, at least two psychiatric
hospitals, several general hospitals, a private
pediatrician, several relatives, an influential private
individual and others."

In the 16 months before Elisa's death, there were at least
10 instances when a teacher, a doctor or a social worker
saw physical injuries or "bizarre" behaviors indicative of
maltreatment that were either not reported to the state
child-abuse hotline or rejected when a call was made. 

According to the Fatality Panel report and other published
accounts, these signs included: "burns on the leg and
foot"; "a bruise on the child's nose and marks around her
eyes"; "head lice and a small patch of hair loss"; a
"fever-like blister"; as well as repeated claims by her
mother that her father, his friends, her teachers and
various other adults had physically and sexually abused
Elisa and "the mother's repeated references to witchcraft
and voodoo, and her apparent belief that the child was
possessed by the devil." Agency records also indicate that
Elisa was known to be urinating and defecating throughout
her home, spreading her feces on the refrigerator and
drinking from the toilet.

Just as Elisa might have been saved by a more effectual
child welfare agency, so might she have survived if the
other agencies that saw her during her last two years of
life had reported these conditions to the authorities.
After all, since the early 1960s, child-serving
professionals' failure to report has been punishable by
law.

But what happened to Elisa is not unique to New York. A
nationwide study conducted about a decade ago for the
National Center on Child Abuse and Neglect provides
evidence of how often professionals fail to report signs
of child abuse and neglect. In 1986, about 56 percent of
the apparently abused or neglected children professionals
saw went unreported. That is about 500,000 children,
including about 2,000 with injuries severe enough to
require hospitalization.

What's going on? Although a few professionals may be
callously indifferent to the plight of children like
Elisa, most are not. One cannot read the records of the
agencies involved in her case without observing that
dozens of people were genuinely concerned. The reason we
know so much about her numerous physical injuries and
bizarre behaviors is that these professionals noticed
them, recorded them in their files and tried to help the
family. The problem is that too many professionals are not
adept at spotting signs of serious physical, sexual and
emotional abuse. They generally don't know what to report
- and how to report it.

Widespread drug addiction among disadvantaged parents,
like Elisa's, further complicates professionals'
recognition of possible child abuse. Such parents may
appear loving and concerned at one moment, only to turn
violent and depraved when under the influence of crack and
other dangerous drugs. The key to protecting their
children is recognizing the circumstantial evidence of
past maltreatment.

That didn't happen in Elisa's case. As the Fatality Panel
noted, "There were signs of possible physical abuse and
ample signs that both the child and her mother were in
extreme psychological distress, that the family could no
longer manage its problems and that intervention from an
outside source was absolutely necessary."

In the past, many efforts to train professionals to do a
better job of identifying and reporting child maltreatment
have been made. But they have often been superficial
(oneor two-hour training sessions are the norm) and short-
lived (efforts that start with great fanfare tend to peter
out as interest wanes).

Better education about reporting responsibilities would be
the single most effective method of encouraging more
complete and more accurate reporting. Education programs
should sensitize all child-serving professionals to the
occurrence of child abuse and neglect - especially within
the context of chronic parental drug addiction. The
programs should be comprehensive, rigorous and ongoing.
(There is, after all, substantial turnover in most of the
agencies that serve children.)

Moreover, the training should cover the emotional and
behavioral problems that are signs of possible
maltreatment - whose significance was either missed or
ignored by so many professionals who encountered Elisa. As
the panel noted, "In addition to recognizing physical
signs of maltreatment, mandated reporters must be trained
to recognize children's emotional reactions to abuse and
neglect, including behavior that is abnormal, extreme and
is not age-appropriate." Put simply, Elisa's behaviors
were red flags signaling the need for societal
intervention.

Such training will have to be planned with great care. It
will not do, for example, to tell people simply to report
their "gut feelings." That does not give investigators
enough to go on, as we saw in Elisa's case. The more
details a report contains about possible abuse, the more
likely a child-abuse investigator will be able to confirm
the situation.

Vague advice also increases the likelihood of
inappropriate reports, a problem that is now depleting
scarce agency resources. In 1993, more thanthree-quarters
of the reports made to the state child-abuse hotline were
closed after an initial investigation determined that they
were "unfounded."

At least one of the reports about Elisa was deemed
unfounded. An unfounded report does not necessarily mean
that the child was not actually abused or neglected.
Sometimes, the worker makes a mistake. More often,
evidence of child maltreatment is hard to obtain and may
not be uncovered when agencies lack the time and resources
to complete a thorough investigation or when inaccurate
information is given to the investigator.

But the current high rate of unfounded reporting goes far
beyond anything reasonably needed by the child welfare
agencies. Besides being unfair to parents, it endangers
children who are really abused. It imposes an unnecessary
burden on an agency already hard-pressed to investigate
all the cases reported appropriately, because each report
must be carefully investigated - homes must be visited;
parents questioned, friends, relatives and neighbors
interviewed, agency records checked and so forth. But all
this takes time. When workers feel the press of new cases
coming in every day, they inevitably cut corners and make
mistakes.

How serious a problem is inappropriate reporting? Between
1989 and 1993, as the number of reports received by the
city's child welfare agency increased by more than 30
percent (from 40,217 to 52,472), the percentage of
substantiated reports fell by about 47 percent (from 45
percent to 24 percent). In fact, the number of
substantiated cases - some families were reported more
than once - actually fell by about 41 percent, from 14,026
to 8,326. Thus, 12,255 additional families were
investigated during that time, although 5,700 fewer
families received child-protective help.

As a result, children in real danger - like Elisa - get
lost in the day-to-day pressures of large caseloads. For
example, as of June, 1995, CWA had 712 investigative
workers, but only 190 workers providing court-ordered
preventive or home-monitoring services. Reducing
inappropriate reporting by only 20 percent would have
allowed the agency to almost double the number of
caseworkers assigned to court cases.

Like nonreporting, inappropriate reporting is generally
neither deliberate nor malicious. Many unfounded reports
involve situations in which a well-intentioned person
overreacts to a vague and often misleading possibility
that the child may be maltreated. Others involve instances
of poor child care that, though of legitimate concern,
simply do not amount to child abuse or neglect.

The statewide child-abuse hotline could also do more to
help. Right now, the hotline staff itself decides whether
to reject reports from callers without reviewing the
family's history of child abuse and neglect. That is a
mistake.

For example, on Oct. 14, 1994, about a year before Elisa's
death, the school she was attending called the hotline in
Albany to report "conflicting information about an injured
hand." The call was rejected, presumably because the
school could not connect the injury to the mother's
conduct. But this decision was made by a worker who did
not have access to Elisa's record and the many previous,
confirmed reports of maltreatment over the preceding five
years.

If the hotline had known of this prior record, as the
panel noted, "it would have been more likely to accept"
the school's report. The computers at the Albany hotline
should be upgraded so that records of past reports can be
used - while the caller is on the line - to help decide
whether to accept or reject a report of child abuse.

One hospital was so concerned about burns on Elisa's leg
and foot that it asked its child-protection committee
whether a report should be made. The committee eventually
decided against calling the hotline, but again, if the
committee had known of Elisa's maltreatment, it almost
certainly would have done so. The panel called for the
implementation of a long-standing state law that
authorizes the hotline to provide such information to
physicians.

The glare of publicity surrounding little Elisa's death
may push agency officials to adopt these and other long-
overdue reforms. That's a high price for her to pay, but
wouldn't it be worse if she died in vain? 

Teachers Can Help Identify Child Abuse and Neglect From
the Texas Department of Education

Observer Teachers should be aware of the physical signs of
child abuse and neglect, as well as changes in behaviors
and relationships with peers. Sometimes it is hard to
determine what is differ-ent, but remember if it doesn't
seem right, it usually isn't.

Listener Teachers should listen to what children say. They
may speak directly to you or a friend, but they may also
speak through play, school work, or their reaction to
books they read.

Reporter On occasion, your observations of a child or
parent may lead you to suspect child abuse. As a
teacher/staff member, the law requires you to make a
report. The Child Abuse Hotline is 1-800-252-5400. Calls
are answered 24 hours a day, seven days a week.

Role Model Children need adult role models who provide
them with positive, nurturing reinforcement of their own
worth. Teachers and other staff in the schools are in a
unique position to be such models. Their behaviors and
actions are constantly seen by children and may provide a
basis for learning.

Advocate Services for abused children may be limited in
your area. The educational system may have or know of
valuable resources in the community that could be shared.
Remember, child abuse prevention is a community issue.
Connect yourself with others who share your con-cern.
Groups include: CASA; Advocacy Centers; Family PRIDE
Councils; Community Coalitions; child welfare boards;
Foster Parent Associations. As an advocate you can make a
difference in the child's life and demonstrate that there
are adults who care.

Indicators of Child Abuse No one sign speaks of abuse,
however, two or more should be considered as an indication
of possible abuse.

Physical Abuse Physical Indicators: Surface area injuries
Non-accidental bruising patterns Loop or wrap around
injuries Injuries in various stages of healing
Complications from old injuries Imprint of instrument on
skin Cigarette burns Signs of overall poor health

Behavioral Indicators: Unable to explain injury or
explanation inconsistent with injury Unusually fearful,
non-spontaneous Overly eager to please adults Discomfort
about undressing in front of peers

Sexual Abuse Physical Indicators: Headaches, stomach
aches, and overall not feeling well Pain in anal or
genital area Recurring vaginal or bladder infections
Sexually transmitted disease Oral, genital, or anal
bleeding Redness, swelling, itching, or trauma to the
genital or anal area Pregnancy Behavioral Indicators:
Sudden change in behavior Fears and phobias, retreat to
fantasy Disturbed sleeping patterns Changes in
relationships to adults (avoidance or clinging) Problems
in school Withdrawal from friends and family Running away
Inappropriate and obsessive sexual aware-ness, promiscuity
Depression, low self-esteem, self critical Appearance of
retardation Child states an adult is bothering him or her
Verbalization of sexual assault Discomfort or extreme
sensitivity to physical contact Discomfort about
undressing in front of peers Having friends who are
several years older Acquisition of unexplainable toys,
money, or clothes Regression to more childish behavior
Delinquent acts Suicidal gestures or attempts Plays
parental role

Cognitive development

Cognitive development is acquisition of conscious thought,
reasoning, symbol manipulation, and problem solving
abilities beginning in infancy and following an orderly
sequence.

Jean Piaget (1896-1980) was one of the most influential
researchers in the area of developmental psychology during
the 20th century. Piaget originally trained in the areas
of biology and philosophy and considered himself a
"genetic epistimologist." He was mainly interested in the
biological influences on "how we come to know." He
believed that what distinguishes human beings from other
animals is our ability to do "abstract symbolic
reasoning." Piaget's views are often compared with those
of Lev Vygotsky (1896-1934), who looked more to social
interaction as the primary source of cognition and
behavior. This is somewhat similar to the distinctions
made between Freud and Erikson in terms of the development
of personality. The writings of Piaget (e.g., 1972, 1990;
see Piaget, Gruber, & Voneche) and Vygotsky (e.g.
Vygotsky, 1986; Vygotsky & Vygotsky, 1980), along with the
work of John Dewey (e.g., Dewey, 1997a, 1997b), Jerome
Bruner (e.g., 1966, 1974) and Ulrick Neisser (1967) form
the basis of the constructivist theory of learning and
instruction. 

While working in Binet's IQ test lab in Paris, Piaget
became interested in how children think. He noticed that
young children's answers were qualitatively different than
older children which suggested to him that the younger
ones were not dumber (a quantitative position since as
they got older and had more experiences they would get
smarter) but, instead, answered the questions differently
than their older peers because they thought differently. 

There are two major aspects to his theory: the process of
coming to know and the stages we move through as we
gradually acquire this ability. 

Process of Cognitive Development. As a biologist, Piaget
was interested in how an organism adapts to its
environment (Piaget described as intelligence.) Behavior
(adaptation to the environment) is controlled through
mental organizations called schemes that the individual
uses to represent the world and designate action. This
adaptation is driven by a biological drive to obtain
balance between schemes and the environment
(equilibration). 

Piaget hypothesized that infants are born with schemes
operating at birth that he called "reflexes." In other
animals, these reflexes control behavior throughout life.
However, in human beings as the infant uses these reflexes
to adapt to the environment, these reflexes are quickly
replaced with constructed schemes. 

Piaget described two processes used by the individual in
its attempt to adapt: assimilation and accomodation. Both
of these processes are used thoughout life as the person
increasingly adapts to the environment in a more complex
manner. 

Assimilation is the process of using or transforming the
environment so that it can be placed in preexisting
cognitive structures. Accomodation is the process of
changing cognitive structures in order to accept something
from the environment. Both processes are used
simultaneously and alternately throughout life. An example
of assimilation would be when an infant uses a sucking
schema that was developed by sucking on a small bottle
when attempting to suck on a larger bottle. An example of
accomodation would be when the child needs to modify a
sucking schema developed by sucking on a pacifier to one
that would be successful for sucking on a bottle. 

As schemes become increasingly more complex (i.e.,
responsible for more complex behaviors) they are termed
structures. As one's structures become more complex, they
are organized in a hierarchical manner (i.e., from general
to specific). 

Stages of Cognitive Development. Piaget identified four
stages in cognitive development: 

1. Sensorimotor stage (Infancy). In this period (which has
6 stages), intelligence is demonstrated through motor
activity without the use of symbols. Knowledge of the
world is limited (but developing) because its based on
physical interactions / experiences. Children acquire
object permanence at about 7 months of age (memory).
Physical development (mobility) allows the child to begin
developing new intellectual abilities. Some symbollic
(language) abilities are developed at the end of this
stage.

2. Pre-operational stage (Toddler and Early
Childhood). In this period (which has two substages),
intelligence is demonstrated through the use of symbols,
language use matures, and memory and imagination are
developed, but thinking is done in a nonlogical,
nonreversable manner. Egocentric thinking predominates

3. Concrete operational stage (Elementary and early
adolescence). In this stage (characterized by 7 types of
conservation: number, length, liquid, mass, weight, area,
volume), intelligence is demonstarted through logical and
systematic manipulation of symbols related to concrete
objects. Operational thinking develops (mental actions
that are reversible). Egocentric thought diminishes. 

4. Formal operational stage (Adolescence and adulthood). In
this stage, intelligence is demonstrated through the
logical use of symbols related to abstract concepts. Early
in the period there is a return to egocentric thought.
Only 35% of high school graduates in industrialized
countries obtain formal operations; many people do not
think formally during adulthood. 

Many pre-school and primary programs are modeled on
Piaget's theory, which, as stated previously, provides
part of the foundation for constructivist learning.
Discovery learning and supporting the developing interests
of the child are two primary instructional techniques. It
is recommended that parents and teachers challenge the
child's abilities, but NOT present material or information
that is too far beyond the child's level. It is also
recommended that teachers use a wide variety of concrete
experiences to help the child learn (e.g., use of
manipulatives, working in groups to get experience seeing
from another's perspective, field trips, etc). 

Specific examples of how to use Piagetian theory in
teaching/learning process

Teaching the Preoperational Child (Toddler and Early
Childhood)

Use concrete props and visual aids to illustrate lessons
and help children understand what is being presented. Use
physical illustrations. Use drawings and illustrations.

Make instructions relatively short, using actions as well
as words, to lessen likelihood that the students will get
confused. After giving instructions, ask a student to
demonstrate them as a model for the rest of the class.
Explain a game by acting out the part of a participant. 

Do not expect the students to find it easy to see the
world from someone else's perspective since they are
likely to be very egocentric at this point. Avoid lessons
about worlds too far removed from the child's experience.
Discuss sharing from the child's own experience. 

Give children a great deal of physical practice with the
facts and skills that will serve as building blocks for
later development. Use cut-out letters to build words.
Avoid overuse of workbooks and other paper-and-pencil
tasks. 

Encourage the manipulation of physical objects that can
change in shape while retaining a constant mass, giving
the students a chance to move toward the understanding of
conservation and two-way logic needed in the next stage.
Provide opportunities to play with clay, water, or sand.
Engage students in conversations about the changes the
students are experiencing when manipulating objects. 

Provide many opportunities to experience the world in
order to build a foundation for concept learning and
language. Take field trips. Use and teach words to
describe what they are seeing, doing, touching, tasting,
etc. Discuss what they are seeing on TV.

Teaching the Concrete Operational Child (Middle Childhood)

Continue to use concrete props and visual aids, especially
when dealing with sophisticated material. Provide time-
lines for history lessons. Provide three-dimensional
models in science.

Continue to give students a chance to manipulate objects
and test out their ideas. Demonstrate simple scientific
experiments in which the students can participate. Show
craftwork to illustrate daily occupations of people of an
earlier period.

Make sure that lectures and readings are brief and well
organized. Use materials that present a progression of
ideas from step to step. Have students read short stories
or books with short, logical chapters, moving to longer
reading assignments only when the students are ready. 

Ask students to deal with no more than three or four
variables at a time. Require readings with a limited
number of characters. Demonstrate experiments with a
limited number of steps. 

Use familiar examples to help explain more complex ideas
so students will have a beginning point for assimilating
new information. Compare students' own lives with those of
the characters in a story. Use story problems in
mathematics. 

Give opportunities to classify and group objects and ideas
on increasingly complex levels. Give students separate
sentences on slips of paper to be grouped into paragraphs.
Use outlines, hierarchies, and analogies to show the
relationship of unknown new material to already acquired
knowledge. 

Present problems which require logical, analytical
thinking to solve. Provide materials such as Mind
Twisters, Brain Teasers, and riddles. Focus discussions on
open-ended questions which stimulate thinking (e.g., are
the mind and the brain the same thing?) 

Teaching Students Beginning to Use Formal Operations
(Adolescence)

Continue to use many of the teaching strategies and
materials appropriate for students at the concrete
operational stage. Use visual aids such as charts and
illustrations, as well a simple but somewhat more
sophisticated graphs and diagrams. Use well-organized
materials that offer step by step explanations. 

Give students an opportunity to explore many hypothetical
questions. Provide students opportunities to discuss
social issues. Provide consideration of hypothetical
"other worlds." 

Encourage students to explain how they solve problems. Ask
students to work in pairs with one student acting as the
problem solver, thinking aloud while tackling a problem,
with the other student acting as the listener, checking to
see that all steps are mentioned and that everything seems
logical. Make sure that at least some of the tests you
give ask for more than rote memory or one final answer;
essay questions, for example, might ask students to
justify two different positions on an issue. 

Whenever possible, teach broad concepts, not just facts,
using materials and ideas relevant to the students. While
discussing a topic such as the Civil War, consider what
other issues have divided the country since then. Use
lyrics from popular music to teach poetic devices, to
reflect on social problems, and so on. 

Source: Adapted from: Woolfolk & McCune-Nicolich. (1984).
Educational Psychology for Teachers. (2nd Ed.). Englewood
Cliffs, NJ: Prentice-Hall, Inc.