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A developmentally delayed, 13-year old autistic boy required management of multifocal cerebral and pulmonary tumors, involving several anesthetics over a 4-month period. At each anesthetic he refused premedication, displayed increasing anxiety and became more combative. With parental guidance and involvement, a variety of anesthetists tried a range of techniques to achieve induction, each ultimately resorting to the use of physical restraint. Principles essential to the care of such a child include early recognition, parental support, multi-disciplinary planning of procedures requiring general anesthesia, continuity of anesthesia care, and clear guidelines about the perioperative management of uncooperative children, including the ethical use of restraint. [ABSTRACT FROM AUTHOR]

Objective: According to sociological and ecological models of abuse, typically nonabusive parents could behave abusively towards their children under certain circumstances. The purpose of this study was to examine factors that place parents at risk of abusing their children by predicting parents' use of discipline practices and attitudes that may bias parents towards abusive behaviors, which we refer to as abuse-proneness. Method: A telephone interview was administered by the Gallup Organization to a nationally representative sample of 1,000 parents. Using a set of theoretically relevant risk factors, multiple regression was used to predict variations in parental attitudes (i.e., attitudes towards physical discipline and attitudes that devalue children) and parental discipline practices (i.e., physical discipline, nonphysical discipline, and verbal abuse). Results: The findings confirmed the importance of examining elements of parental attitudes, history, personality characteristics, as well as religion and ideology in predicting abuse proneness. Child age also was an important predictor in all analyses except predicting parental attitudes that devalue children. The findings suggest also, however, that it may be unduly simplified to regard parents as somewhere on a continuum of nonpunitive to punitive disciplinarians. Social isolation was not a significant predictor in any of the analyses. Conclusions: Although many important theoretical predictors of abuse proneness were confirmed, many questions arise regarding the diversity of discipline practices that parents use, and the relevance of child's age and social isolation in predicting abuse proneness. Implications for practitioners and future research are discussed. [ABSTRACT FROM AUTHOR]