Zusammenfassung
Zusammenhänge zwischen Misshandlung, Vernachlässigung oder sexuellem Missbrauch und späteren chronischen gesundheitlichen Belastungen bei betroffenen Kindern sind in den vergangenen Jahren deutlicher hervorgetreten. Dies gilt sowohl für Einschränkungen der psychischen Gesundheit als auch für einige chronische körperliche Erkrankungen, die zusammengenommen in der Pädiatrie als „neue Morbidität“ bezeichnet werden. Vermutlich liegen den beobachteten Zusammenhängen ursächliche Prozesse zugrunde, insofern mehrere der „Bradford-Hill-Kriterien“ (aus der Epidemiologie stammende Kriterien für die kausale Natur eines statistischen Zusammenhangs) als erfüllt angesehen werden können. Frühe Hilfen könnten ein Potenzial zur Veränderung solcher Zusammenhänge aufweisen. Allerdings fehlen Befunde hierzu bislang weitgehend. Zumindest für bindungsorientierte Interventionen mit Pflegeeltern nach Gefährdung lässt sich aber zeigen, dass sie physiologischen Fehlregulationen bei betroffenen Kindern entgegenwirken können.
Abstract
The effects of child maltreatment on children’s chronic health conditions have become more visible during recent years. This is true for mental health problems as well as some chronic physical conditions, both summarized as new morbidity within pediatrics. As several Bradford Hill criteria (criteria from epidemiology for the determination of the causal nature of a statistical association) are met, the likely causal nature of underlying associations is discussed. Early family support may have the potential to modify such associations, although empirical evidence is lacking. At least for attachment-based interventions with foster carerers after child maltreatment, positive effects on child HPA axis dysregulation have been demonstrated.
Literatur
Felitti V, Anda R, Nordenberg D et al (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med 14:245–258
Kendall-Tackett K (2004) Health consequences of abuse in the family. APA Press, Washington
Norman R, Byambaa M, De R et al (2012) The long-term health consequences of child physical abuse, emotional abuse, and neglect: a systematic review and meta-analysis. Plos Med 9:e1001349
Haggerty R, Roghmann K, Pless I (Hrsg) (1975) Child health and the community. Wiley, New York
Schlack H (2004) Die neuen Kinderkrankheiten. Einflüsse der Lebenswelten auf Gesundheit und Entwicklung. Frühe Kindh 6:18–21
Nationales Zentrum Frühe Hilfen (Hrsg) (2014) Leitbild Frühe Hilfen. Beitrag des NZFH-Beirats. Köln
Toczydlowska E, Chzhen Y, Bruckauf Z et al (2016) Income inequality among children in europe 2008–2013. Innocenti working paper no. 2016–15. UNICEF, Florence
Afifi TO, MacMillan HL, Boyle M et al (2016) Child abuse and physical health in adulthood. Health Rep 27(3):10–18
Afifi TO, MacMillan HL, Boyle M et al (2014) Child abuse and mental disorders in Canada. CMAJ 186:E324–E332
Stoltenborgh M, Bakermans-Kranenburg MJ, Alink L et al (2015) The prevalence of child maltreatment across the globe: review of a series of meta-analyses. Child Abus Rev 24:37–50
Afifi TO, Enns MW, Cox B et al (2008) Population attributable fractions of psychiatric disorders and suicide ideation and attempts associated with adverse childhood experiences. Am J Public Health 98:946–952
Li M, D’Arcy C, Meng X (2016) Maltreatment in childhood substantially increases the risk of adult depression and anxiety in prospective cohort studies: systematic review, meta-analysis, and proportional attributable fractions. Psychol Med 46:717–730
Russo F, Williamson J (2007) Interpreting causality in the health sciences. Int Stud Philos Sci 21:157–170
Institute of Medicine, National Research Council (Hrsg) (2014) New directions in child abuse and neglect research. National Academies Press, Washington
Ringeisen H, Casanueva C, Urato M et al (2008) Special health care needs among children in the child welfare system. Pediatrics 122:e232–e241
Stein RE, Hurlburt MS, Heneghan A et al (2013) Chronic conditions among children investigated by child welfare: a national sample. Pediatrics 131:455–462
Flaherty EG, Thompson R, Dubowitz H et al (2013) Adverse childhood experiences and child health in early adolescence. JAMA Pediatr 167:622–629
Lanier P, Jonson-Reid M, Stahlschmidt M et al (2010) Child maltreatment and pediatric health outcomes: A longitudinal study of low-income children. J Pediatr Psychol 35:511–522
Font SA, Berger LM (2015) Child maltreatment and children’s developmental trajectories in early to middle childhood. Child Dev 86:536–556
Van Horne BS, Moffitt KB, Canfield MA et al (2015) Maltreatment of children under age 2 with specific birth defects: A population-based study. Pediatrics 136:e1504–e1512
Jonson-Reid M, Kohl PL, Drake B (2012) Child and adult outcomes of chronic child maltreatment. Pediatrics 129:839–845
Thompson R, Flaherty E, English D et al (2015) Trajectories of adverse childhood experiences and self-reported health at age 18. Acad Pediatr 15:503–509
Lauterbach D, Armour C (2016) Symptom trajectories among child survivors of maltreatment: findings from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). J Abnorm Child Psychol 44:369–379
Ridout K, Parade S, Seifer R et al (2014) Interleukin 1B gene (IL1B) variation and internalizing symptoms in maltreated preschoolers. Dev Psychopathol 26:1277–1287
Byrd AL, Manuck SB (2014) MAOA, childhood maltreatment, and antisocial behavior: Meta-analysis of a gene-environment interaction. Biol Psychiatry 75:9–17
Bornovalova MA, Huibregtse BM, Hicks BM et al (2013) Tests of a direct effect of childhood abuse on adult borderline personality disorder traits: a longitudinal discordant twin design. J Abnorm Psychol 122:180–194
Jaffee SR, Caspi A, Moffitt TE, Taylor A (2004) Physical maltreatment victim to antisocial child: evidence of an environmentally mediated process. J Abnorm Psychol 113:44–55
Brown RC, Berenz EC, Aggen SH et al (2014) Trauma exposure and Axis I psychopathology: A cotwin control analysis in Norwegian young adults. Psychol Trauma 6:652–660
Danese A, Tan M (2014) Childhood maltreatment and obesity: systematic review and meta-analysis. Mol Psychiatry 19:544–554
Ouellet-Morin I, Odgers CL, Danese A et al (2011) Blunted cortisol responses to stress signal social and behavioral problems among maltreated/bullied 12-year-old children. Biol Psychiatry 70:1016–1023
Doom JR, Cicchetti D, Rogosch FA (2014) Longitudinal patterns of cortisol regulation differ in maltreated and nonmaltreated children. J Am Acad Child Adolesc Psychiatry 53:1206–1215
Laurent HK, Harold GT, Leve L et al (2016) Understanding the unfolding of stress regulation in infants. Dev Psychopathol. doi:10.1017/s0954579416000171
McLaughlin KA, Sheridan MA, Tibu F et al (2015) Causal effects of the early caregiving environment on development of stress response systems in children. Proc Natl Acad Sci USA 112:5637–5642
Rogosch FA, Dackis MN, Cicchetti D (2011) Child maltreatment and allostatic load: Consequences for physical and mental health in children from low-income families. Dev Psychopathol 23:1107–1124
Quas JA, Yim IS, Oberlander TF et al (2014) The symphonic structure of childhood stress reactivity: Patterns of sympathetic, parasympathetic, and adrenocortical responses to psychological challenge. Dev Psychopathol 26:963–982
Cicchetti D (2016) Socioemotional, personality, and biological development: illustrations from a multilevel developmental psychopathology perspective on child maltreatment. Annu Rev Psychol 67:187–211
Kim J, Cicchetti D (2010) Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. J Child Psychol Psychiatry 51:706–716
McGoron L, Gleason MM, Smyke AT et al (2012) Recovering from early deprivation: attachment mediates effects of caregiving on psychopathology. J Am Acad Child Adolesc Psychiatry 51:683–693
Puig J, Englund MM, Simpson JA et al (2013) Predicting adult physical illness from infant attachment: A prospective longitudinal study. Health Psychol 32:409–417
Habetha S, Bleich S, Sievers C et al (2012) Deutsche Traumafolgenstudie. IGSF, Kiel
Florence C, Brown DS, Fang X et al (2013) Health care costs associated with child maltreatment: impact on Medicaid. Pediatrics 132:312–318
Reynolds A, Mathieson L, Topitzes J (2009) Do early childhood interventions prevent child maltreatment. Child Maltreat 14:182–206
Morrison J, Pikhart H, Ruiz M et al (2014) Systematic review of parenting interventions in European countries aiming to reduce social inequalities in children’s health and development. BMC Public Health 14:e1040
Avellar S, Supplee H (2013) Effectiveness of Home Visiting in Improving Child Health and Reducing Child Maltreatment. Pediatrics 132(Supplement 2):S90–S99
Bernard K, Dozier M, Bick J et al (2015) Intervening to enhance cortisol regulation among children at risk for neglect: results of a randomized clinical trial. Dev Psychopathol 27:829–841
McAvoy H, Purdy J, Mac Evilly C et al (2013) Prevention and early intervention in children and young people’s services. Child Health and Development, Dublin
Herrmann P, Günay H (2016) Integration der zahnärztlichen Gesundheitsförderung in die Frühe Hilfe – Erfahrungen und Ergebnisse aus dem Modellprojekt Pro Kind. Gesundheitswesen 78:V32
Odgers C, Jaffee SR (2013) Routine versus Catastrophic Influences on the Developing Child. Annu Rev Public Health 34:29–48
Flannery JE, Beauchamp KG, Fisher PA (2016) The role of social buffering on chronic disruptions in quality of care: evidence from caregiver-based interventions in foster children. Soc Neurosci. doi:10.1080/17470919.2016.1170725
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Kindler, H. Kindesmisshandlung und neue Morbidität in der Pädiatrie. Bundesgesundheitsbl 59, 1332–1336 (2016). https://doi.org/10.1007/s00103-016-2428-2
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DOI: https://doi.org/10.1007/s00103-016-2428-2