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Questions on Child and Adolescent Issues 

Questions on Child and Adolescent Issues
Chapter:
Questions on Child and Adolescent Issues
Author(s):

Elizabeth Ford

and Merrill Rotter

DOI:
10.1093/med/9780199344659.003.0015
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Questions

1. The Education for All Handicapped Children Act (now known as the Individuals with Disabilities Education Act [IDEA]) was based on the expectation that all disabled children should have which of the following?

  1. A. Tuition waivers for more individualized private schools

  2. B. A free and appropriate public education

  3. C. Placement in a special education classroom

  4. D. Institutionalized education for the severely disabled

  5. E. Access to specialized nonpublic schools

2. The minimum standard of proof for the termination of parental rights is:

  1. A. Beyond a reasonable doubt

  2. B. Preponderance of the evidence

  3. C. Clear and convincing evidence

  4. D. More likely than not

3. In Graham v. Florida, the U.S. Supreme Court ruled that:

  1. A. The sentence of “life without parole” is prohibited for individuals who committed any offenses under the age of 18.

  2. B. The sentence of “life without parole” for individuals who commit nonhomicide crimes when under the age of 18 violates the Fourteenth Amendment’s requirement for equal protection.

  3. C. The sentence of “life without parole” for individuals who commit nonhomicide offenses when under the age of 18 violates the Eighth Amendment’s prohibition on cruel and unusual punishment.

  4. D. The sentence of “life without parole” for individuals who commit nonhomicide offenses when under the age of 18 violates both the Eighth and Fourteenth Amendments.

4. The importance of protecting psychotherapist–patient privilege is maintained by the following rationale:

  1. A. The protection of privacy in a psychotherapist–patient relationship is thought to be important in establishing therapeutic alliance and to facilitate engagement in treatment.

  2. B. Law enforcement needs supersede psychotherapist–patient privilege.

  3. C. Mandated reporting of sexual abuse has a higher priority than reporting neglect.

  4. D. Police can compel physicians and therapists to testify in cases of sexual abuse involving minors.

  5. E. Psychotherapists must weigh maintaining patient privilege when public safety concerns exist around sexual abuse.

5. In the United States, execution is allowed for:

  1. A. Juveniles under the age of 18

  2. B. Mentally retarded individuals

  3. C. Individuals with severe psychotic disorders

  4. D. Individuals who are so impaired that they do not understand why they are being executed

6. An 11-year-old student with chronic renal failure and end-stage kidney disease requires hemodialysis multiple times weekly. The patient’s parents would like the child to have this service provided at school so as to minimally disrupt the educational process. Which of the following best describes the school’s level of responsibility to perform the procedure based on the precedent set by Irving Independent School District v. Tatro?

  1. A. Transport the student to and from the procedure.

  2. B. Provide funding for the procedure.

  3. C. The school has no responsibility for the procedure.

  4. D. Send a private tutor with the student to the procedure.

  5. E. Perform the procedure at the school.

7. The principle utilized in Painter v. Bannister for the determination of child custody was:

  1. A. The tender years doctrine

  2. B. The best interests of the child

  3. C. Least detrimental alternative

  4. D. Primary caregiver standard

8. Juvenile courts:

  1. A. Have been a fixture in the United States since colonial times

  2. B. Are a relatively recent invention, with the first juvenile court appearing in 1899 in Illinois

  3. C. Like criminal courts operate under the parens patriae principle

  4. D. Have always functioned similarly with respect to the roles and educations of attorneys and judges

9. The holdings of the U.S. Supreme Court in Santosky v. Kramer as they pertain to the termination of parental rights include:

  1. A. The primary interest of the state in parental termination hearings is the best interests of the child.

  2. B. While parents have an interest in preserving the family, the state has no such interest.

  3. C. There are shared interests in an accurate and just decision at fact-finding proceedings, and the near-equal allocation of risk between parents and the state is unconstitutional.

  4. D. The natural parents were not negligent, and the Santosky children should not have been removed.

10. When federal and state laws differ about a disabled student’s entitlement to services, which of the following best summarizes the appropriate approach?

  1. A It is permissible to follow the state law if it has fewer mandates than the federal law.

  2. B. Both laws must be put before a legal professional who is an expert in case law to establish the best next step.

  3. C. The parents can list their preference with regard to which law is followed based on the subsequent services to be provided.

  4. D. The federal and the state laws both apply when the state requirements extend beyond the federal.

  5. E. The school district can choose the law that seems more applicable as long as it cites the reason for doing so.

11. Among the constitutional rights afforded juvenile defendants after In re Gault are:

  1. A. The right to an appeal

  2. B. The right to a jury trial

  3. C. The right to counsel

  4. D. The right to bail and a speedy trial

12. Implications of Santosky v. Kramer for children include:

  1. A. Child protective services will have a more difficult time investigating neglect and abuse allegations.

  2. B. Some children will not be removed from abusive or neglectful homes because it is more difficult to find clear and convincing evidence of abuse or neglect.

  3. C. More funding was made available for child protective service agencies around the country.

  4. D. Child protective services are able to remove children from abusive or neglectful homes more easily and efficiently than before.

13. Concepts underlying the philosophy of the juvenile court include:

  1. A. Closed proceedings and sealed records prevent discovery of procedural irregularities.

  2. B. The disposition should fit the offender rather than the offense in the interest of rehabilitation.

  3. C. Punishment as an extension of just desserts.

  4. D. Punishment is reserved for only the most severe and heinous of crimes, such as rape and murder.

14. A physician evaluates a child and is concerned about the potential for child abuse. The physician makes a report to child protective services, and the case is ultimately closed when no suspicious activity is found. The parents feel humiliated by the allegation and sue the physician for defamation and a violation of privacy. Which of the following most accurately represents the legal stance regarding this matter?

  1. A. Courts in most states tend to prioritize the rights of parents, and the physician is potentially liable.

  2. B. States vary greatly on this issue, and there is little national consensus on the matter.

  3. C. The outcomes of these cases are most dependent on the testimony of the child.

  4. D. Physicians who report in good faith are generally immune from liability for any damages.

  5. E. Parents are typically not allowed to bring suits against physicians for violations of privacy.

15. A clear and convincing standard for the termination of parental rights is justified because:

  1. A. Parental termination proceedings resemble criminal trials, and parents who face removal are often poor and uneducated and do not have the resources to oppose the state; therefore, it is more likely with a preponderance of the evidence standard that errors will be made.

  2. B. Parents have the right to reasonably discipline their children.

  3. C. DSS does not give parents assistance in reestablishing a weakened parent-child bond.

  4. D. A liberty issue is not at stake.

16. In DeShaney v. Winnebago, the main thrust of the ruling is based on the following principle:

  1. A. Due process protections are the foundation for mandated child abuse reporting statutes.

  2. B. The state has a duty to provide youth with adequate protection from all forms of abuse from parents.

  3. C. The state has a duty to provide youth with protection from harm from state agents.

  4. D. The Due Process Clause protects citizens against state actions and those of private citizens.

17. In Graham v. Florida, the Supreme Court cited which of the following in support of its opinion?

  1. A. Juveniles are immature and have an underdeveloped sense of responsibility.

  2. B. Most jurisdictions that technically allow juveniles to receive a life sentence without parole only rarely impose such a sentence.

  3. C. Juveniles are more capable of change than adults.

  4. D. All of the above.

18. Which of the following is correct with respect to the Iowa Supreme Court’s custody decision in Painter v. Bannister?

  1. A. Security and stability in the home are more important than intellectual stimulation in the development of a child.

  2. B. A parent’s or caretaker’s philosophy and way of life “within normal and proper limits” are irrelevant with respect to the determination of custody.

  3. C. The expert testimony of the child psychiatrist was afforded negligible weight.

  4. D. The child’s relationship with his grandfather, which was stronger than that with his father, received little attention in the decision.

19. Which of the following is correct about sentencing guidelines for a 15-year-old convicted of capital murder in adult court?

  1. A. The fact-finder is required to impose a minimum sentence of life without parole, although the death penalty can be considered.

  2. B. The fact-finder is required to impose a minimum sentence of life without parole but cannot consider the death penalty.

  3. C. The fact-finder cannot sentence the defendant to life without parole.

  4. D. The fact-finder must consider the impact of youth when imposing a sentence.

  5. E. A 15-year-old cannot be tried in adult court.

20. Which of the following best justifies a breach in physician–patient confidentiality in cases of suspected child abuse?

  1. A. Justice for the alleged perpetrator

  2. B. The safety of the patient at risk

  3. C. Prevention of professional liability

  4. D. The safety of the public at large

  5. E. Physician acting as an agent of the state

Answers

1. B

The EAHCA mandated that all handicapped children receive a “free appropriate public education.” This term has continued to be applied in educational settings and, although vague, is the basis for many of today’s educational standards. While some children spend time in special education classrooms and others go to specialized nonpublic schools, these do not apply to all disabled students and depend on individual and local district resources.

2. C

The minimum standard of proof for the termination of parental rights is clear and convincing evidence. In Santosky v. Kramer, the U.S. Supreme Court noted that parents faced with the irrevocable dissolution of their parental rights have a greater need for procedural protections than do parents resisting state involvement in ongoing family matters, such as temporarily removing children secondary to neglect.

3. C

In Roper v. Simmons (2005), the U.S. Supreme Court held that executing individuals under age 18 at the time of the offense was a violation of the Eighth Amendment’s prohibition against cruel and unusual punishment. In Graham v. Florida, the majority opinion of the Court reaffirmed their reasoning, holding that juveniles were immature and therefore less culpable and less deserving of the most severe punishments. Neither case prohibited imposing the sentence of life without parole on individuals who commit murder before the age of 18.

4. A

Law enforcement needs do not necessarily compel breeches in doctor–patient or psychotherapist–patient confidentiality. Regardless of the type, mandated reporters should report all child maltreatment to the appropriate authority if a reasonable suspicion exists. While a psychotherapist is indeed a mandated reporter of child abuse, the protection of privilege stems from the need to maintain treatment engagement and a therapeutic alliance, not public safety interests.

5. C

The Constitution does not prohibit the death penalty in severely mentally ill individuals, even if they are psychotic, as long as the individual understands the reason for his or her imminent execution (Panetti v. Quarterman, 551 U.S. 930 [2007]). The Supreme Court in Panetti declined to define what level of rational understanding a death row inmate needed, indicating that it hoped that psychiatric expert testimony would shed light on whether an inmate’s delusions were so severe as to render him or her incompetent to be executed.

6. C

Given that hemodialysis is a complicated medical procedure that employs the use of a dialysis machine and requires specialized training to administer, it would be considered a “medical service” rather than a “supportive service,” and the school would not have any additional responsibility beyond common courtesy (observing the patient, alerting parents and authorities if the patient does not appear to be doing well, etc.). Funding should come from the patient’s insurance or public aid. Of note, for nonmedical issues related to special education, the school may have to provide transportation services.

7. B

In Painter v. Bannister, the Iowa Supreme Court concluded that remaining in the secure and stable custody of grandparents, rather than the unstable, but potentially more intellectually stimulating, custody of the father served the best interests of the child. Most jurisdictions determine custody on the basis of the best interests of the child standard, although considerable judicial discretion is allowed.

8. B

The first juvenile court appeared in 1899 in Chicago, Illinois, and the concept grew in popularity. In juvenile court, the state as parens patriae would act as an advocate of youths, rather than as an adversary, and provide them with the help and treatment they required to overcome their youthful misdeeds. Due process was not considered to be necessary because the state was acting on behalf of the juvenile and therefore protection was unnecessary. Formal rules and procedures might hamper the court’s mission and prescriptive “treatments.” Prior to Gault, the key players in the juvenile court were social workers, mental health professionals, and probation officers. There was little law, therefore little need for attorneys, and many of the judges were not legally trained. The most important question revolved around amenability to treatment.

9. C

Justice Blackmun in the majority opinion wrote that the Court expressed no opinion regarding the merits of the Santoskys’ claims regarding their fitness for parenting the children who had been removed and noted that at “a hearing conducted under a constitutionally proper standard” (clear and convincing evidence, rather than preponderance of the evidence), “they may or may not prevail.” The Court vacated the judgment of the New York Appellate Division and remanded the case for further proceedings. The “best interests of the child” standard was more clearly articulated in Painter v. Bannister.

10. D

With regard to the education of handicapped students, federal law sets a bare minimally acceptable standard. Many states may extend regulations beyond this bare minimum, but state law may not undercut the minimal standard set by the U.S. Congress or Supreme Court.

11. C

In re Gault’s decision held that juveniles had the right to notice of charges, to counsel, to confrontation and cross-examination of witnesses, and to privilege against self-incrimination. Juveniles in juvenile court do not have the right to an appeal, a jury trial, a transcript of the proceedings, or the right to a speedy trial. Youths who are tried in adult court do have these rights.

12. B

Some child advocates have noted that by making termination of parental rights more difficult by raising the burden of proof, the Supreme Court decision in Santosky v. Kramer created a presumption against termination of parental rights, and that children have rights that do not necessary coincide with those of their parents or the state. The higher burden and proof may result in the already overstretched agencies charged with investigating abuse and neglect to have inadequate evidence to meet the increased burden; hence more children will remain in neglectful homes.

13. B

Proceedings are closed and records sealed in juvenile court to avoid stigma and are in keeping with the benevolent nature of the court. Because the focus of the juvenile court is on rehabilitation and treatment rather than punishment, the disposition is tailored to the offender rather than the offense.

14. D

While all of the answer choices in this question could technically be correct depending on the specific situation, the best answer is that doctors are generally protected when making decisions in the best interest of the child. Physicians may be held liable if the reporting is malicious, antagonistic, or otherwise unfounded. However, the law clearly favors reporting suspected abuse over withholding suspicions due to concerns about parental confidentiality. Potential penalties for not reporting suspected abuse are significantly greater than violations of confidentiality.

15. A

In its decision, the U.S. Supreme Court noted that there was a liberty issue at stake in Santosky v. Kramer, and more substantial than the loss of money or property, where the standard of proof is preponderance of the evidence. The Court noted that the parents’ interest in a termination proceeding is major (the loss of their children and family), and there is substantial risk of error involved if the standard used is preponderance of the evidence. Additionally, the government interest in favoring the preponderance of the evidence standard is slight. The Court’s opinion also reflected the difficulty that poor, uneducated parents may have in mounting a defense against “[t]he State’s ability to assemble its case” and referred to the state’s “unusual ability to structure evidence,” increasing the “risk of an erroneous fact finding,” noting that DSS sought court orders denying the Santoskys visitation with their children, which if successful would have put them out of compliance with the Family Court Act’s requirement for maintaining contact with their children.

16. C

In DeShaney v. Winnebago, the court ruled that the Due Process Clause protects citizens against state action but not against the actions of private citizens. The state has a duty to provide youths with protection from harm from state agents only. State child abuse reporting requirements preempt physician–patient privilege. Landeros v. Flood relates to establishing battered child syndrome and is a foundational case in establishing mandated reporting of child abuse and neglect.

17. D

In Graham v. Florida the Supreme Court utilized the same reasoning as in Roper v. Simmons. These include (1) juveniles’ lack of maturity and underdeveloped sense of responsibility; (2) their increased susceptibility to negative influences and outside pressures, including peer pressure; and (3) their more malleable personalities, which are “not as well formed.”

18. A

While some of the biases revealed by the Iowa Supreme Court in Painter v. Bannister are often quoted, including his “artsy” father’s “bohemian lifestyle,” the court’s opinion clearly indicates that the judges attempted to thoughtfully consider what was in the child’s best interests and had an appreciation of the fact that the “divergent life patterns” of the father “seem[ed] to represent alternative normal adaptations.” They attempted to contextualize the differences in lifestyle and the facts of the case as they applied to Mark Bannister. As is often the case in today’s child custody disputes, the opinion of the expert witness in this case was given considerable weight. However, it is interesting to note that the trial court, which awarded custody to the father, dismissed the testimony of the expert, in part because it was “dismissive” of the role of the natural father. One of the factors given weight by the Supreme Court was that the psychologist opined that it was “very evident” that Mark considered his grandfather to be his father figure.

19. D

According to Miller v. Alabama, trial courts must consider the contribution of youth (including developmental immaturity and diminished culpability) when sentencing juveniles who have been convicted of serious crimes (e.g., murder). Mandatory sentencing guidelines of life without parole for juveniles violate the Eighth Amendment, and therefore (A) and (B) are incorrect. However, there is still room for the fact-finder to sentence a juvenile to life without parole if the factors of youth have been considered; (C) is therefore incorrect. Answer (E) is incorrect because adolescents in many jurisdictions can be tried in adult court for certain crimes.

20. B

Answers B, C, and E are all potential justifications for physicians to beach confidentiality. For example, when quarantining an infectious patient, physicians are protecting the public at large and acting as an agent of the state. In these cases, the safety of individual patients may even take a back seat to that of the general public. However, in the case of child abuse, a breach of confidentiality is specifically intended to protect the patient. Preventing liability is secondary to patient safety issues.