Reported maltreatment in children with multiple disabilities

This study examined a population of children with multiple disabilities to investigate whether functional, developmental, or perinatal factors could differentiate children reported and substantiated as maltreated from those not so reported. Data were collected from medical records of a cohort of 500 children evaluated between 1973 and 1984 at the Kennedy Institute in Baltimore, Maryland. Maltreatment reporting was documented through the State of Maryland Abuse Registry and the counties of residence of all study children. Results indicated that the profiles of demographic and family characteristics associated with child maltreatment reporting in this population are consistent with the literature, but child functional and developmental characteristics were not confirmed as risk factors for substantiated maltreatment reports. Indeed, contrary to investigator expectations, the more severely disabled children, in terms of functioning, appeared at less risk of maltreatment than did disabled children functioning at more age-appropriate levels.     

The association between maltreatment and obesity among preschool children

OBJECTIVE: To determine whether child maltreatment is associated with obesity in preschool children. METHODS: Data were obtained from the Fragile Families and Child Wellbeing Study, a birth cohort study of 4898 children born between 1998 and 2000 in 20 large US cities. At 3 years of age, 2412 of these children had their height and weight measured, and mothers answered items on the Parent-Child Conflict Tactics Scales about three types of child maltreatment--neglect, corporal punishment, and psychological aggression. The frequency of each type of maltreatment behavior in the prior year was analyzed using categories--ever/never for neglect and quintiles for the other two types of maltreatment. Child obesity was defined as measured body mass index (kg/m(2)) > or =95th percentile. RESULTS: Eighteen percent of the children were obese, and the prevalence of any episode of neglect, corporal punishment, and psychological aggression was 11%, 84%, and 93%, respectively. The odds of obesity were increased in children who had experienced neglect (odds ratio 1.56, 95% confidence interval, 1.14-2.14), after controlling for the income and number of children in the household, the mothers' race/ethnicity, education, marital status, body mass index, prenatal smoking, and age, and the children's sex and birth weight. Neither the frequency of corporal punishment nor psychological aggression was associated with an increased risk of obesity. CONCLUSIONS: In a sample of preschool children from 20 large US cities, maternal self-report of neglectful behavior was associated with an increased risk of childhood obesity, after controlling for birth weight, maternal obesity, and multiple socioeconomic factors.     

The prevalence of depressive symptoms in children with learning disabilities.

Learning difficulties have been considered to be a symptom of childhood depression by some authors, whereas others have examined depression as a cause of cognitive difficulties, including learning disabilities (LD). This study examined the prevalence of depressive symptoms in a sample of public school elementary children aged 8 through 11, 37 boys and 16 girls, identified as LD by state standards. Of the sample of 53 children, 35.85% scored in the depressed range on the Children's Depression Inventory. Comparison of the children's self-reports and parents' reports of depressive symptoms in their children was not significant. Implications of the results are discussed relative to the role of school personnel and the assessment process in recognizing depressive symptoms in students with LD.     

Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth

OBJECTIVE: To examine family risk factors associated with dissociative symptoms among homeless and runaway youth. METHOD: Three hundred and twenty-eight homeless and runaway youth were interviewed using a systematic sampling strategy in metropolitan Seattle. Homeless young people were interviewed on the streets and in shelters by outreach workers in youth service agencies. RESULTS: The current study revealed widespread prevalence of dissociative symptoms among these young people. Multivariate analyses revealed that sexual abuse, physical abuse, and family mental health problems were all positively associated with dissociative symptoms. No gender differences were found for any of the models. CONCLUSIONS: Dissociative behavior is widespread among these youth and may pose a serious mental health concern. Some young people experience numerous stressors, and with few resources and little support available, many may invoke maladaptive strategies such as dissociative behavior to handle such situations, which may in turn be detrimental to their mental health. Unless youth are provided with programs and intervention, the cycle of abuse that they have experienced at home is likely to continue on the street.     

The prevalence of social maladjustment among school-age children

PL 94-142 mandates that students who are seriously emotionally disturbed be provided with a free and appropriate public education. Embedded in the federal definition of serious emotional disturbance is a clause that excludes socially maladjusted students from the diagnostic category. Although socially maladjusted children may therefore not receive special education services, their presence in the schools may have implications for society and particularly for the educational system. However, there is little data concerning the prevalence of socially maladjusted students in the schools. The purpose of this study was to investigate the prevalence of social maladjustment in two rural/suburban school systems in the southeastern United States. Results of the study indicate that the percentage of students reported as exhibiting characteristics of social maladjustment is sufficiently high to indicate that services beyond special education may be necessary to meet their educational and social needs.     

Obesity prevalence among youth investigated for maltreatment in the United States

The objective of this study is to determine the prevalence and correlates of obesity among youth investigated for maltreatment in the United States. Participants were drawn from the National Survey of Child and Adolescent Well-Being II, a national probability study of 5,873 children aged birth to 17 years under investigation for maltreatment in 2008. From child weight reported by caregivers, we estimated obesity (weight-for-age ≥95th percentile) prevalence among children aged 2 through 17 (n = 2,948). Sex-specific logistic regression models by developmental age were used to identify obesity risk factors, including child age, race/ethnicity, and maltreatment type. Obesity prevalence was 25.4% and was higher among boys than girls (30.0% vs. 20.8%). African American adolescent boys had a lower risk for obesity than white boys (OR = 0.28, 95% CI [0.08, 0.94]). Compared with girls aged 2–5 with a neglect allegation, girls with a sexual abuse allegation were at greater risk for obesity (OR = 3.54, 95% CI [1.01, 12.41]). Compared with adolescent boys with a neglect allegation, boys with a physical abuse allegation had a lower risk for obesity (OR = 0.24, 95% CI [0.06, 0.99]). Adolescent girls with a prior family history of investigation were at greater risk for obesity than those without a history of investigation (OR = 3.97, 95% CI [1.58, 10.02]). Youth investigated for maltreatment have high obesity rates compared with national peers. Opportunities to modify and evaluate related child welfare policies and health care practices should be pursued.     

The phenomenon of legislative advocacy among parents of children with disabilities

Although parents of children with disabilities have forged systemic changes for individuals with disabilities, little is known about the phenomenon of legislative advocacy (LA) including methods and barriers. In this United States‐based study, 49 parents of individuals with disabilities participated in focus groups about LA reporting both positive and negative experiences with LA. One focus group was held in Spanish; notably, none of the Spanish‐speaking parents reported experiences with LA. When discussing methods of LA, parents reported a variety of strategies including: building relationships, educating legislators, collective advocacy, and encouraging fathers and other parents to meet with legislators. Parents also reported barriers to LA: lack of knowledge, disempowerment and feeling overwhelmed. Implications for research to better understand LA and policy are discussed.     

Child maltreatment prevalence and mental disorders outcomes among American Indian women in primary care

OBJECTIVE: To examine (1) the prevalence, types, and severity of child abuse and neglect (CAN) and (2) the relationship between CAN and lifetime psychiatric disorders among American Indian women using primary care services. METHODS: A cross-sectional study was conducted among 234 American Indian women, age 18-45 who presented for outpatient ambulatory services at a community-based Indian Health Service Hospital in Albuquerque, New Mexico. Dependent measures included mood, substance abuse, and anxiety disorders as well as posttraumatic stress disorder (PTSD) as measured by the Composite International Diagnostic Interview. CAN was assessed using the Childhood Trauma Questionnaire. RESULTS: Approximately three-quarters of respondents (76.5%; 95% CI = 70.4, 81.7) reported some type of childhood abuse or neglect; over 40% reported exposure to severe maltreatment. Severity of child maltreatment was associated in a dose response manner with lifetime diagnosis of mental disorders. After adjusting for social and demographic correlates, severe child maltreatment was strongly associated with lifetime PTSD (prevalence ratio [PR] 3.9; 95% CI = 1.9, 8.0); and was moderately associated with lifetime substance use disorders (PR = 2.3; 95% CI = 1.6, 3.3); mood disorders (PR = 2.1; 95% CI 1.4, 3.2); and with two or more disorders (PR = 2.3; 95% CI = 1.6, 3.4). CONCLUSION: CAN was common in our sample of American Indian women in primary care and was positively associated with lifetime psychiatric disorders outcomes. Screening for CAN and psychiatric disorders would enhance the treatment of patients seeking primary care services. Primary prevention of child maltreatment might reduce the high prevalence of mental disorders among American Indian women.     

Physical and psychological maltreatment: relations among types of maltreatment

Maltreatment has serious consequences for the development of children. The reason for the negative outcomes is not, however, fully understood. This study investigated the hypotheses that psychological maltreatment would be present in almost all cases of physical maltreatment and that it would be more related to detrimental outcomes for children than would severity of injury. A sample of 175 maltreated children, 39 children in mental health treatment, and 176 normative children was assessed for type and severity of maltreatment. Both hypotheses were supported. In addition, evidence is provided that psychological maltreatment can occur alone, that assessments of parental psychologically maltreating behavior and negative child outcomes are highly correlated, and that child age and gender are unrelated to psychological maltreatment in young children whereas family income is related. Implications for investigation and treatment are considered.     

Predicting child maltreatment among Puerto Rican children from migrant and non-migrant families

ObjectivesThe objectives of the present study were to (1) describe the prevalence of child maltreatment among migrant and non-migrant Puerto Rican families and (2) identify socio-demographic and cultural (i.e., acculturation pattern, familismo) predictors of maltreatment within these two samples.MethodRepresentative community samples of Puerto Rican children (ages 5–13 at baseline) and their adult caretakers were interviewed at two sites: the South Bronx in New York City (n = 631 families) and the Standard Metropolitan Areas of San Juan and Caguas in Puerto Rico (n = 859 families). Participants were re-interviewed 1 and 2 years following the baseline assessment.ResultsWhile prevalence rates of maltreatment (physical abuse, 10%; sexual abuse 1%; neglect, 10%; and multi-type, 6%) did not differ between the two sites at baseline assessment, site differences emerged over time. Rates of physical abuse at follow-up were significantly higher in the Bronx compared to Puerto Rico. Further, for families living in the Bronx, living in poverty predicted chronic maltreatment, whereas living above the poverty line predicted new cases of maltreatment at follow-up. For families living in Puerto Rico, those who experienced physical abuse or multi-type maltreatment at baseline were more likely to report chronic maltreatment at follow-up regardless of poverty level. Cultural factors were not related to baseline or follow-up maltreatment at either site.ConclusionFindings suggest that while rates of child maltreatment may be similar in migrant and non-migrant Puerto Rican families and when compared to prevalence rates in the US, predictors of maltreatment may differ.Practice implicationsSince predictors of maltreatment may vary across population subgroups, studying homogenous samples will lead to more effective and targeted interventions.     

Child maltreatment and interpersonal relationship among Chinese children with oppositional defiant disorder

Child maltreatment negatively affects children's development and wellbeing. This study investigated the associations between child maltreatment (i.e., emotional neglect, emotional abuse, and physical abuse) and interpersonal functioning, including parent–child relationship, teacher–student relationship, and peer relationships among children with oppositional defiant disorder (ODD). A total of 256 children with ODD and their parents and class master teachers from Mainland China completed questionnaires. Results showed a negative correlation between emotional abuse (parent-reported) and children's interpersonal relationships with parents, teachers, and peers. Emotional neglect and physical abuse were related to poor parent–child relationships. Latent profile analysis revealed three profiles of child maltreatment among children with ODD. ODD children with more severe levels of one type of maltreatment were also more likely to have experienced severe levels of other types of maltreatment. Children with ODD who were in the group of high maltreatment had the poorest quality of interpersonal relationships. Our findings highlight the urgent need to prevent child maltreatment and promote more positive parenting in families with ODD children.     

Maltreatment among runaway and homeless youth

A sample of 223 adolescents who sought services from runaway and homeless youth programs in New York State during 1986-1987 was identified as having a history of maltreatment. A demographic profile is presented and the nature of their maltreatment described. The majority of these youth were female and between 15-16 years of age. Less than 25% came from intact families and one-third were born to single mothers. Of the sample, 60% had allegedly experienced physical abuse, 42% emotional abuse, 48% neglect, and 21% sexual abuse. Over one-third were "pushed out" of their homes by their families. Biological mothers were the most frequently cited perpetrators of maltreatment (63%), followed by biological fathers (45%). The sample of maltreated runaways is compared to both statewide and national samples of runaway and homeless youth with regard to their demographic characteristics and the problems they present to staff at intake (e.g., depression, substance abuse, etc.). Youth in the maltreated sample were more likely to be female and were more likely to have engaged in suicidal behavior. Otherwise, the maltreated runaways were not readily distinguished from the runaway and homeless youth population at large.     

Child maltreatment among school children in the Kurdistan Province, Iran

OBJECTIVE: This study examines the determinants of three types of child maltreatment: physical maltreatment, mental maltreatment, and child neglect among school children in the Kurdistan Province of Iran. The analysis examines the impact of socioeconomic, familial, demographic, and household dynamic factors on the three child maltreatment outcomes, and compares the differential impact of these factors across the three types of child maltreatment. A greater understanding of the factors associated with child maltreatment has the potential to inform public health interventions aimed at reducing specific forms of maltreatment and at identifying at risk populations. METHODS: Data were collected from 1,370 school students, age 11-18. Separate logistic models are fitted for six binary outcomes examining self-reported experiences of physical maltreatment in the home or school, mental maltreatment in the home or school, and child neglect in the home or school. RESULTS: Male children were more likely to report experiencing any kind of child maltreatment than girls. Residency in a rural area, poor parental relationships and the use of addictive substances by household members were associated with increased odds of reporting child maltreatment. Poor school performance was associated with the reporting of experiencing maltreatment at school. CONCLUSION: Each of the forms of child maltreatment is highly correlated with socioeconomic, demographic, and living condition factors. The results point to the strong influence that familial factors have in shaping a child's likelihood of reporting maltreatment. Characteristics of the mother were associated with maltreatment, but not characteristics of the father. The results highlight a number of mechanisms through which public health interventions may seek to reduce the prevalence of child maltreatment in Kurdistan; different approaches are needed to reduce child maltreatment in the home and school environments.     

Intimate partner violence among female caregivers of children reported for child maltreatment

OBJECTIVE: The purpose of this study was to determine the prevalence and correlates of intimate partner violence among female caregivers of children reported to child protective services. METHOD: Data were derived from the National Survey of Child and Adolescent Well-Being, a national probability study of children investigated for child abuse and neglect in the United States. Caregivers were interviewed about demographic characteristics, mental health, substance use, and physical violence by a partner. RESULTS: The lifetime and past year prevalence of intimate partner violence was 44.8 and 29.0%, respectively. Caregiver major depression and history of prior reports of child maltreatment were strongly associated with violence against women. CONCLUSIONS: The findings highlight the need for effective screening and identification of intimate partner violence in families in which child maltreatment has occurred.     

The impact of patterns of trauma exposure among low income children with and without histories of child maltreatment

Previous research has revealed a large prevalence of trauma experienced by children, creating high risk for the development of psychopathology. Research investigating the negative impacts of child maltreatment and other traumas has typically examined these experiences individually, controlling for co-occurring traumas, or has combined these experiences into a general variable of risk, thereby obscuring the complex relationships among environmental traumas and maltreatment. The current study expands on previous research by elucidating relationships between multiple contexts of overlapping traumas and maltreatment experienced by children, and by categorizing how these experiences join together to impact internalizing and externalizing symptomatology. Participants included 316 maltreated children and 269 nonmaltreated children (M age = 9.4, SD = 0.88) who attended a summer day camp research program for low-income children. Latent Class Analysis (LCA) identified three differential patterns of trauma exposure across children: 1) community violence and loss; 2) pervasive trauma; and 3) low trauma. Covariate analyses demonstrated that child maltreatment was significantly associated with class membership, suggesting that maltreated children were more likely to experience diverse traumas extending beyond their maltreatment experiences (pervasive trauma class). A two-way analysis of variance also demonstrated that trauma latent class membership and child maltreatment each represented unique predictors of internalizing and externalizing symptoms, with each having an independent effect on symptomatology. This investigation provides unique insight into the differential impact of patterns of trauma exposure and child maltreatment, providing support for further research and clinical practice addressing multiple levels of a child’s ecology.     

Effect of worker contacts on risk of child maltreatment recurrence among CPS-involved children and families

The mission and responsibility of child protective services (CPS) is to investigate maltreatment; intervene to protect children from harm; and promote safety, permanency, and well-being (DePanfilis & Salus, 2003; Goldman, Salus, Wolcott, & Kennedy, 2003). In 2015, approximately 7.2 million children in the United States were referred to CPS agencies, and 3.4 million children had an investigation or received an alternative response (US Department of Health & Human Services, 2017). Fluke, Shusterman, Hollinshead, and Yuan (2005) found that about one third of children with an allegation of maltreatment would have at least one re-report within a five-year period. Research indicates that the rates of child maltreatment or changes in indicators of child maltreatment have remained unchanged over time (Gilbert et al., 2012). Despite policies aimed at reducing or preventing maltreatment, the development of CPS systems across the United States, and a CPS workforce, the aggregate effects of the CPS system, services, and worker efforts are not well understood.     

The co-occurrence of adverse childhood experiences among children investigated for child maltreatment: A latent class analysis

Children investigated for maltreatment are particularly vulnerable to experiencing multiple adversities. Few studies have examined the extent to which experiences of adversity and different types of maltreatment co-occur in this most vulnerable population of children. Understanding the complex nature of childhood adversity may inform the enhanced tailoring of practices to better meet the needs of maltreated children. Using cross-sectional data from the National Survey of Child and Adolescent Well-Being II (N = 5870), this study employed latent class analysis to identify subgroups of children who had experienced multiple forms of maltreatment and associated adversities among four developmental stages: birth to 23 months (infants), 2–5 (preschool age), 6–10 (school age), and 11–18 years-old (adolescents). Three latent classes were identified for infants, preschool-aged children, and adolescents, and four latent classes were identified for school-aged children. Among infants, the groups were characterized by experiences of (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) caregiver divorce. For preschool-aged children, the groups included (1) physical neglect/emotional abuse/caregiver treated violently, (2) physical neglect/household dysfunction, and (3) emotional abuse. Children in the school-age group clustered based on experiencing (1) physical neglect/emotional neglect and abuse/caregiver treated violently, (2) physical neglect/household dysfunction, (3) emotional abuse, and (4) emotional abuse/caregiver divorce. Finally, adolescents were grouped based on (1) physical neglect/emotional abuse/household dysfunction, (2) physical abuse/emotional abuse/household dysfunction, and (3) emotional abuse/caregiver divorce. The results indicate distinct classes of adversity experienced among children investigated for child maltreatment, with both stability across developmental periods and unique age-related vulnerabilities. Implications for practice and future research are discussed.